Moreover, although DTI has been instrumental in increasing unders

Moreover, although DTI has been instrumental in increasing understanding of the brain’s structural connectivity, its limitations as an indicator of white matter integrity must be acknowledged. DTI metrics are influenced directly and indirectly by multiple properties of white matter and surrounding tissue, and research

into precise mechanisms of change in these metrics Inhibitors,research,lifescience,medical in humans is ongoing. In addition, methods such as higher order fitting to address possible effects of crossing fibers were not used in this study. Because correction for multiple comparisons was not highly conservative, interpretation of findings should be cautious pending replication of these results in an independent sample. Importantly, the cross-sectional design does not speak to whether individual variability in white matter profiles was a function of drinking history or a premorbid characteristic. A previous study found lower FA in several regions Inhibitors,research,lifescience,medical of interest shared with this study in alcohol-naïve adolescents with family history of alcohol dependence compared to healthy

control participants (Herting et al. 2010). Moreover, lower FA was significantly related to reduced frontocerebellar functional connectivity (Herting et al. 2011). Taken together with a report of reduced functional Inhibitors,research,lifescience,medical connectivity in frontoparietal networks in a study of a similar adolescent sample (Wetherill et al. 2012), it appears that genetic liability for AUDs may account for a substantial proportion of variance in neural

processing of alcohol cues. Inhibitors,research,lifescience,medical Regarding sampling methodology, the decision to include participants based on quantity and frequency of recent drinking rather than diagnosis Inhibitors,research,lifescience,medical of alcohol abuse or dependence can be seen as an asset or a shortcoming, depending on perspective. The objective was to link ABT-737 ic50 neurobiological outcomes to overt behavioral rather than syndromal markers in order to increase generalizability to the population of heavy drinkers, who may or may not endorse diagnostic criteria. Related to this issue is the fact that a large minority of participants reported using drugs other than alcohol. This characteristic limits interpretation of findings, as the possible neurobiological effects of these other drugs were not evaluated. At the same time, the rate of illicit drug use in our sample was unless similar to the rate of 31% reported by heavy drinkers in a recent epidemiological sample (Substance Abuse and Mental Health Services Administration 2012), lending ecological validity to our findings. In conclusion, our results expand on previous studies by establishing a relationship between lower white matter integrity and increased functional activation to an alcohol taste cue in a sample of heavy drinkers.

Mitralign Program

Update, TCT Meeting, Miami 2012) The C

Mitralign Program

Update, TCT Meeting, Miami 2012). The Cardioband System (Valtech Cardio Ltd, Or-Yehuda, Israel) is a transcatheter-implantable surgical-like ring (Figure 4). Differently from the previous devices, and similar to the MitraClip, it is delivered anterogradely via the right femoral vein and through a transseptal puncture. The Cardioband is a polyester prosthetic tube (band) sequentially fixed by helical anchors, from the antero-lateral to the postero-medial trigone; after implantation the band Inhibitors,research,lifescience,medical is shortened under echo-guidance on the beating heart, advancing a size-adjusting tool over a connecting cable. Results in 15 swine using a transatrial access have been promising,45 and an initial first-in-man experience has been safely and successfully started. Figure 4 The Direct Annuloplasty Cardioband System in a Patient Immediately Inhibitors,research,lifescience,medical after Implantation. Energy-mediated Annuloplasty These technologies can be considered a subgroup of direct annuloplasty

devices. However, rather than obtaining annular remodeling by implanting a device, they aim to reduce annular length by collagen shrinking through delivering of different energies. Safety remains a Inhibitors,research,lifescience,medical concern in terms of damage to surrounding structures (leaflets, myocardium, coronary sinus, circumflex artery, aortic valve) and thrombus formation. The QuantumCor (QuantumCor, San Clemente, CA, USA)is composed of a malleable radiofrequency probe with seven electrodes. Available preclinical data on sheep showed significant antero-posterior annular reduction together with some degree of MR Inhibitors,research,lifescience,medical decrease and no sign of damage of surrounding structures.46 The ReCor (ReCor Medical, Ronkonkoma, NY, USA) device is a balloon catheter with a cylindrical piezoelectric ceramic transducer located towards the distal

end, introduced in the left atrium through transseptal approach. The transducer converts electrical energy to acoustic energy, which is then delivered radially through a balloon inflated with Inhibitors,research,lifescience,medical a contrast-saline mixture at the mitral valve annulus site, without contact. In a series of 33 dogs, one death due to energy-induced ventricular fibrillation occurred and modest annular diameters reduction was observed, although no nearby structure was damaged.47 PARAVALVULAR LEAK CLOSURE Paravalvular leakage is a complication of prosthetic valve implantation occurring in 5%–15% of cases. Surgical re-operation is first associated with higher morbidity and mortality and does not always guarantee a trans-isomer mw definite solution since prostheses detachment recurrence is not infrequent. Although it remains more challenging than aortic leak closures, in recent years transcatheter mitral leak closure had emerged as a new valid option. Procedural success rate has improved over the years, ranging from 60% to 90% in the different series, with different kinds of Amplatzer occluders (vascular plugs, atrial septal defect, patent ductus arteriosus).

The disease of the candidates was not adequately described, relyi

The disease of the candidates was not adequately described, relying on low core (6–8) biopsy and color Doppler scans with no criteria regarding PSA, clinical stage, or Gleason score. Performing a hemiablation, the mean follow-up time was 70 months with a bDFS of 92.9% by ASTRO criteria. In addition to a strong bDFS, 88.9% retained potency preserved and 100% retained continence.

Lambert and associates released clinical trial data of unilateral cryoablation of unilateral lesions in 25 patients with a mean follow-up of 28 months.17 Inhibitors,research,lifescience,medical This study underlines the contralateral nature of PCa and the promising oncologic outcomes of retreatment with focal cryoablation. Inhibitors,research,lifescience,medical Lambert and colleagues conducted a retrospective study that monitored Gleason 6 or 7 (3 + 4) patients who had not previously received hormonal therapy or radiotherapy, with cancer confirmed to one lobe and tumor volume representing < 10% in a 12-core biopsy. Patients had a bDFS of 88%, with two patients demonstrating cancer on the contralateral side who

were retreated to focal cryoablation and Inhibitors,research,lifescience,medical considered disease free. Continence was preserved in 100% of patients and potency was preserved in 70.4%. In an effort to selleck chemical address the contralateral nature of PCa, Ellis and colleagues performed a trial series using a posterior hockey-stick cryoablation template.18 This study had the most vague candidate selection criteria and no biopsy mapping and as such demonstrated a high percentage of failure with contralateral lesions. Candidates were enrolled with a clinical stage between Inhibitors,research,lifescience,medical T1 to T3N0M0 and if (1) they were relatively young and unwilling to risk potency, or (2) they were older and uncomfortable with AS. The bDFS determined by PSA nadir was 88% in a study of 60 patients with a mean follow-up time of 15.2 months. Fourteen patients had positive biopsies for PCa after the procedure, 13 of which were present on the untreated side. Potency was maintained in 70.6% of patients after penile rehabilitation

and continence was maintained in 96.3%. In contrast to Inhibitors,research,lifescience,medical the Ellis and colleagues’ hockey-stick template, Onik and associates performed a 54-patient series with true focal cryoablation of a unifocal lesion.19 Although PDK4 Onik and associates had loose enrollment criteria, the effort of using an ultrasound-guided biopsy to confirm unilateral cancer and a longer follow-up showed the potential success of true unifocal therapy and raised questions about the amount of prostate tissue that actually needs to be removed to obtain cancer control. Candidates were selected when an ultrasound-guided biopsy showed unilateral cancer and maintenance of potency/continence was important to the patient. With a mean follow-up of 4.5 years, the study showed 95% bDFS by ASTRO criteria, potency preservation in 90% of patients, and continence preservation in 100% of patients.

Meehl suggested that individuals with schizotaxia would develop e

Meehl suggested that individuals with schizotaxia would develop either schizotypy or schizophrenia, depending on the protection or liability afforded by environmental circumstances, although he later proposed that schizotaxia need not progress into either of these more overt conditions.42 Given current data showing that, in addition to genes, environmental events (eg, obstetric complications, viruses) augment susceptibility to schizophrenia, Faraone ct al43 proposed that we use the term schizotaxia to indicate the

premorbid, neurobiological substrate of schizophrenia. Now, almost 40 years after the idea of schizotaxia was first advanced, a Histone Acetyltransferase inhibitor preponderance Inhibitors,research,lifescience,medical of evidence shows it to be a clinically meaningful condition. In fact, studies of nonschizotypal, nonpsychotic relatives of schizophrenic patients show that schizotaxia is not merely a theoretical construct, but has distinct psychiatric and neurobiological features. These include negative symptoms, neuropsychological impairment, impaired eye-tracking, and structural brain abnormalities.43 Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical Schizotaxia is a broader construct than schizophrenia. Our empirical studies suggest that the basic symptoms of schizotaxia occurs in 20% to 50% of first-degree relatives

of schizophrenic patients.40,44 In comparison, only about 10% of relatives will become psychotic, and less than 10% will develop schizotypal personality disorder.45,46 These figures suggest that schizotaxia does not

lead inevitably to schizotypal personality or schizophrenia, but in most cases is a long-term condition. This leads to the question of what type of etiological model accounts best for a long-term biological vulnerability (schizotaxia) that, under some circumstances, leads to more serious conditions (schizophrenia). Inhibitors,research,lifescience,medical Diagnostic criteria for schizophrenia ignore its etiology and pathophysiology DSM-III (and later versions) explicitly dissociated diagnostic criteria from speculation about Inhibitors,research,lifescience,medical etiology to avoid incorporating theories of etiology that were not subjected to empirical tests. At this point, however, DSM-III’s rejection of theoretical speculation about etiology should not lead us to reject empirical facts about most etiology as being relevant to diagnosis or conceptualization. Moreover, such a view risks a continuing disconnection of treatment from etiology. Since the introduction of antipsychotic medications, pharmacological treatments have focused on alleviating the most acute, florid symptoms of schizophrenia, ie, those related to psychosis. Although several newer antipsychotic medications also alleviate selected negative symptoms and cognitive deficits, treatment remains symptomatic. It is not aimed at correcting specific causes of the disorder, nor is it aimed at preventing its onset. We recognize how counterintuitive it is to think of psychosis as a somewhat nonspecific end state of schizophrenia.

Syndromes depending on mutation in ZMPSTE-24 belong to the so-cal

Syndromes depending on mutation in ZMPSTE-24 belong to the so-called secondary laminopathies. Figure 2 Prelamin A posttranslational processing. Progeria is not a unique model of aging. Another model of accelerated premature aging, in young adults, described by Werner, in 1904, is known as – Werner Akt signaling pathway syndrome (WS). A characteristic feature is scleroderma-like tight skin and bilateral cataracts. The clinical syndromes become apparent in the second decade of life. Clinical features Inhibitors,research,lifescience,medical include a short stature, bird-like facial appearance with skin wrinkling,

hair graying, thin skin on extremities with tendency to ulceration, hyperkeratosis and mottled pigmentation. Not unlike HGPS – atherosclerosis appears at a young age. In WS, atherosclerotic lesions are much more extensive in arterioles as compared to “normal” aging. Related abnormalities are bilateral cataract, osteoporosis, diabetes mellitus and hormonal insufficiency. Inhibitors,research,lifescience,medical Contrary to progeria, patients with Werner syndrome are at high risk of neoplasm, especially of mesenchymal origin, such as sarcoma and haematological malignancy. The ratio of mesenchymal to epithelial neoplasms is 1:10 in the “normal” population and 10:1. in Werner syndrome (20). Mean lifespan is 45 years

Inhibitors,research,lifescience,medical and the main causes of death – are complications of atherosclerosis and cancer. Underlying genetic defects include mutation in the RECQL2 gene on chromosome 8, which encodes DNA helicase WRN, an enzyme active in transcription and translation processes and in repair of damaged DNA. Inheritance

is autosomal recessive (21, 22). Inhibitors,research,lifescience,medical For the subgroup of Werner patients with more severe phenotype, due to the absence of mutations in WRN helicase gene, the name “atypical Werner syndrome” has been proposed. In some patients with the wild type of WRN gene, LMNA mutations have been disclosed, which allows these cases to be included in the group of laminopathies Inhibitors,research,lifescience,medical (mutation 169 G > C (A57P), 398 G > T (R133L), 419 T > G (L140R)) (23–25). Oxymatrine None of the diseases listed in Table ​Table11 represent a true model of aging. Both syndromes HGPS and WS are, however, of interest and may be important in the study of the difference between the cells in “normal” aging and senescence characteristic of these diseases (Table ​(Table11). Table 1 Comparison of Hutchinson-Gilford progeria (HGPS) and Werner (WRN) syndrome. Progeria is regarded as a model of a premature aging, therefore providing the possibility to follow-up the stages and mechanism of aging. It would be of interest to compare it with Werner syndrome, which is a model of slowly progressing aging in adults. Of special interest is the role of lamin A/C in system disorders i.e., in aging.

Electroencephalogram findings demonstrated that gacyclidine inhi

Electroencephalogram findings demonstrated that gacyclidine inhibited seizures that were induced by soman. It also markedly enhanced clinical recovery of soman-challenged primates. Gacyclidine inhibited the neuropathology that occurred three weeks following soman exposure in animals. In the presence of severe nerve agent poisoning, gacyclidine can be a useful adjuvant therapy along with the present

available polymedications of OP nerve agent poisonings.115 Sodium Bicarbonate It has been suggested that intravenous infusion of sodium bicarbonate produces moderate alkalinization (blood pH between 7.45 and 7.55) in OP pesticide poisoning. Sodium #selleck products keyword# bicarbonate was first used to correct the metabolic acidosis. Regarding its enhanced therapeutic effects, the infusion of higher doses of sodium bicarbonate (5 Inhibitors,research,lifescience,medical mEq/kg in 60 min followed by 5-6 mEq/kg/day) was shown to be useful.116 It may also be effective in nerve agents poisoning, and thus should be added to the treatment regimen.

The alkalinization products of nerve agents such as soman are shown to Inhibitors,research,lifescience,medical be less toxic and hence, the IV infusion of sodium bicarbonate may even be more beneficial in nerve agents poisoning. Magnesium Sulphate Intravenous magnesium sulfate (4 g) given in the first day after admission have been shown to decrease hospitalization period and improve outcomes in patients with OP poisoning.117 Magnesium

sulfate blocks calcium channels and thus reduce acetylcholine release. It also reduced CNS overstimulation resulting from NMDA receptor activation and reversed the neuroelectrophysiological defects.118 Adrenergic Agonists The alpha2-adrenergic receptor agonistssuch as clonidine can reduce acetylcholine Inhibitors,research,lifescience,medical synthesis and release in presynaptic junctions. Although clonidine has been used successfully in Inhibitors,research,lifescience,medical animal models, the therapeutic effects of alpha2-adrenergic receptor agonists on human are not fully known.119 Antioxidants Induction of reactive oxygen radicals and their contributors such as decreased total antioxidant capacity, and increased thiobarbituric reactive substances and lipid peroxidation occur in OP poisoning either as acute, subchronic or see more chronic exposure.120 Thus, antioxidants treatment may be beneficial in these patients. In a study on rats, vitamin E was reported to have therapeutic effects in dimethoate and malathion- induced oxidative stress in rat erythrocytes.121 New Treatments Removal of OPs from blood using haemodialysis, haemoperfusion or haemofiltration is not clear. In a recent report, it was claimed that haemofiltration after dichlorvos poisoning had revealed beneficial therapeutic effects.122 Bio-scavengers such as fresh frozen plasma (FFP) or albumin has been recently suggested as a useful therapy through clearing of free organophosphates.

However, the protein complex was mainly excreted after two hours

However, the protein complex was mainly excreted after two hours in contrast to IGF-1/NP which accumulation in liver was over 17%ID/g at the same time point. It has been shown that intravenously administered mesoporous silicon microparticles loaded with siRNA LGK-974 research buy encapsulated into nanoliposomes accumulate into the liver and spleen, but remain in the sinusoidal space, enabling sustained release of siRNA-loaded nanoliposomes [52]. Inhibitors,research,lifescience,medical In our other studies we have analyzed behavior of I-125 labeled thermally hydrocarbonized mesoporous

silicon nanoparticles in liver using combined data of autoradiography and electron microscopy [53]. Similar nanoparticles as used in this study were seen in hepatic veins and sinusoids but not internalized into macrophages or hepatocytes. In addition, Bimbo et al. reported that THCPSi nanoparticles are not phagocytes in extent by CaCo-2 or RAW 264.7 macrophages Inhibitors,research,lifescience,medical in vitro. Instead they showed a strong cellular association as majority of the nanoparticles remained attached to cell membranes [54]. We suggest that IGF-1/NP is intact in the liver and IGF-1 may be released during the 240min studied, whereas IGF-1/IGFBP-3 is cleared trough

hepatic system. This can be seen as steadier IGF-1 release in blood compared IGF-1/NP to IGF-1/IGFBP-3 and is also in accordance with our Inhibitors,research,lifescience,medical in vitro results. More stable release of IGF-1 conjugated to NPs can be achieved as compared to protein complexes. The doses used in our study have been the same as in experimental autoimmune encephalomyelitis Inhibitors,research,lifescience,medical mice where positive effects on inflammatory, demyelinating, and demyelinated lesions have been seen when using IGF-1 [55]. Relatively low levels of IGF-1 with or without IGFBP-3 or nanoparticles accumulated to the brains in all studied time points. The amount

crossing the BBB might, however, be sufficient to affect the physiological functions and modulate neuroendocrine and behavioural responses. The sustained release to blood and low tissue concentrations of IFG-1 delivered with nanoparticles may decrease the side effects like hypoglycemia without Inhibitors,research,lifescience,medical losing the therapeutic effect. Low blood and tissue concentrations together with constant and sustained release may be beneficial for the continuous Vasopressin Receptor IGF-1 therapy for INCL. In summary, we have studied the biodistribution and pharmacokinetics of human IGF-1 administrated free or complexed to its natural binding protein IGFBP-3 or nanoparticles in infantile neuronal ceroid lipofuscinosis (INCL) mouse model. IGF-1 conjugated to nanoparticles accumulated and also remained in liver probably in the hepatic veins and sinusoids at high concentration in contrast to IGF-1/IGFPB-3 complex which dissociated and was actively excreted via kidneys and liver during studied time points. Since IGF-1/NP level also in blood decreased moderately compared to IGF-1/IGFBP-3 this data demonstrates steadier release of IGF-1 in to the circulation and longer bioavailability of IGF-1.

1,2 Higher-order EF, such as problem solving and planning, typica

1,2 Higher-order EF, such as problem solving and planning, typically builds upon a combination of these three components. As a regulatory capacity, EF is central to a range of normal and

abnormal behavior particularly relevant for psychiatric illness, and has been suggested to impact psychiatric functioning Inhibitors,research,lifescience,medical through involvement in, and overlap with, emotional regulation (ER) processes. Indeed, both EF and ER deficits are pervasive throughout psychiatric disorders, to varying degrees of severity and specificity, and hence may be of significant transdiagnostic importance. There is evidence that the neural circuitry that supports EF and ER is largely overlapping. In this review we will focus specifically on the contribution of circuit abnormalities relevant to Inhibitors,research,lifescience,medical EF and ER to psychiatric disorders. We restrict our focus to patients aged 60 and below to insure that the relationship of cognitive deficits to psychiatric disorders is not primarily due to age-related changes in cognition. We will begin with

an overview of the neural systems underlying EF and ER, followed by a description of how deficits in these systems, or their behavioral output, subserve a range Inhibitors,research,lifescience,medical of psychiatric disorders. Finally, we will examine the relationship between EF and ER capacities and current treatments, as well as avenues for Inhibitors,research,lifescience,medical novel treatments through a neurobiological understanding of EF and ER. Neural systems supporting

EF and ER Cognitive regulation of behavior and emotions is supported by several circuits in the PFC. While the PFC is typically not necessary for the learning or performance of simple tasks, when task demands change, the PFC is required for proper adjustments Inhibitors,research,lifescience,medical in behavior to Ponatinib maintain accuracy and goal-directed behavior. This capacity of the PFC is conserved across mammalian species.3-5 Viewed this Carnitine dehydrogenase way, the PFC is responsible for maintaining an internal representation of current goals and modulating activity in brain regions responsible for perception or action in order to flexibly achieve these goals. In order to accomplish this, the PFC must be able to maintain a representation of goals in the face of distraction, update these representations as new information is received through multiple sensory modalities, and provide a feedback signal that can select the neural pathways appropriate for the current task context.6 Within this broad capacity for EF, several more specific subgroupings of functions are possible, commonly considered to be inhibition, working memory, and cognitive flexibility.

Data for this report were collected between November 1989 and Ju

Data for this report were collected between November 1989 and July, 2010. Participant recruitment procedures are described in detail elsewhere.45 Briefly, prospective subjects residing in San Diego, California were screened via telephone. Women were eligible to participate if they did not: i) smoke; ii) use hormonal contraceptives; or iii) use medications, Inhibitors,research,lifescience,medical herbs, or over-the-counter preparations

(eg, antihistamines, asthma medications, valerian root, black cohosh, melatonin, St John’s Wort, and/or decongestants with epinephrine [pseudoephedrine]) that would interfere with neuroendocrine measures. As per Benloucif et al, Tylenol was permitted (but not aspirin).46 Participants agreed to multiple overnight hospital stays in the General Clinical Research Center, where they were permitted to bring their child if necessary. Eligible women underwent the following laboratory tests: Inhibitors,research,lifescience,medical a chemistry panel, thyroid indices, complete blood count, urinalysis, and urine toxicology screening. Eligible women could not have significant medical illness, and women who were receiving drug treatment were required to see more discontinue any medication that would interfere with study measures.

We required DP women to discontinue antidepressant Inhibitors,research,lifescience,medical treatment >2 weeks (>4 weeks for fluoxetine treatment) before the start of the study. For participants who stopped antidepressant use prior to the study, their baseline mood ratings were obtained only after antidepressant withdrawal. In addition to ratings done during the evaluation phase, we also collected mood ratings on the evening before the PSG data collection. No participants were permitted to have had an alcohol abuse or Inhibitors,research,lifescience,medical dependency problem within the past year. Women with bipolar or primary anxiety disorders were Inhibitors,research,lifescience,medical excluded from the study, but women

with personal or family histories of unipolar depression were included in both the NC and DP groups. To establish DSM-IV entrance and baseline criteria, trained clinicians administered the following assessments to each participant: the Structured Clinical Interview for DSM-IV (SCID)47 and at least two baseline evaluation ratings, scheduled 1 week apart, using objective ratings with the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders (SIGH-SAD Thymidine kinase version),48 which includes the 21-item Hamilton Depression Rating Scale49 and an eight-item atypical depressive symptom inventory,50 plus subjective ratings with the Beck Depression Inventory (BDI).51 We also evaluated mood in pregnant and postpartum women with the Edinburgh Postnatal Depression Scale (EPDS),52 which has been validated for use during pregnancy.53 For study inclusion, DP women were required to have a mean SIGH-SAD score >14 and BDI and EPDS scores >10 for 2 weeks.

5% vs 40% p=0 005) Conclusion While resection of pancreatic ca

5% vs. 40% p=0.005). Conclusion While resection of pancreatic cancer can be performed with low perioperative mortality, the associated perioperative morbidity can be significant. Recent advances in surgical instrumentation have made wide spread adoption of laparoscopic distal

pancreatectomy possible. Similar to experience in other cancer types, the initial oncologic outcome with laparoscopic distal pancreatectomy appear comparable to open distal pancreatectomy. The advantage of minimally invasive surgery in terms of less blood loss and shorter hospital stay was also Inhibitors,research,lifescience,medical observed. The advances in surgical techniques also allow more aggressive surgical resection to be Inhibitors,research,lifescience,medical performed with acceptable perioperative mortality and morbidity. With the advances

in systemic treatment of pancreatic cancer, the ability to achieve negative resection margin will improve the outcome of patients with this aggressive disease. Footnotes No potential conflict of interest.
Adenocarcinoma of pancreas is the fourth Inhibitors,research,lifescience,medical most common cause of cancer-related death among U.S. men and women. Due to lack of specific symptoms and effective screening modality, about 80% of pancreatic cancer cases are diagnosed at advanced stage with locally advanced or metastatic disease. Surgical resection VRT752271 research buy remains the only curative therapy for pancreatic cancer patients, and 5-year survival for surgically resected patients is only 30%. Therefore, more research and novel strategies are urgently needed to understand biology better, detect the disease sooner, Inhibitors,research,lifescience,medical and develop better treatment to improve survival and quality of life. In this focused issue, we have covered important topics related to biology, detection and treatment of pancreatic cancer. Inhibitors,research,lifescience,medical Imaging modality is important to identify patients at risk for pancreatic cancer. With the advance of imaging modality and technique, there has been significant improvement in identifying smaller tumor in pancreas. At present time, only about 15-20%

of patients have resectable disease at the time of diagnosis. Preoperative staging to assess the extent of disease is critical to select patients for complete (R0) resection. Besides distant metastasis, lesions involving superior mesenteric artery and/or celiac axis are generally considered unresectable. Pre-operative evaluation with computed tomography and other modality crotamiton such as endoscopic ultrasound can better select patients for R0 resection. Tummala et al. have reviewed different imaging modalities and their utility in assessing patients with suspicious pancreatic lesion, and identifying unresectable disease in patients with pancreatic cancer (1). The improvement in perioperative care and surgical techniques has led to decrease in mortality and morbidity for patients receiving resection of pancreatic cancer.