Good morning and I welcome everyone to the National Galleries of Scotland Bill Committee's third meeting of 2015. Can I ask everyone to switch off mobile phones and any other electronic devices as they do interfere with the broadcasting system even when they are switched to silent? However, committee members may use tablets for committee business as the meeting papers are now provided in digital format. Welcome. The first item in our agenda is to decide whether to take item 3 in private. Do our members agree to take item 3 in private? Thank you. Then we can move on to agenda item number 2. The main item of our business today is to hear from the representatives of the city of Edinburgh Council following on from our session with the promoters at our last meeting. Graham Tully, sorry, estates services manager, and Karen Stevenson, who is the senior planner for the city of Edinburgh Council. Welcome to you both. I believe that Karen you may have a short statement to make before we begin. If that's okay, I'd like to just do an introduction. Okay, that would be great. Thank you. Thank you. The city of Edinburgh Council has a working relationship with the National Galleries of Scotland with regular collaboration on a management and maintenance and the operation of the mountain precinct and the western link entrance within East Brent Street Gardens. In 2011 the council through its planning function facilitated a piece of work with the galleries to review how further future investment in the area could best meet the needs of a variety of users and reinforce the special qualities of the gallery's complex and its relationship with Prince Street Gardens and of course the surrounding area. In particular the council highlighted the problem of legibility of some of the connections for people navigating around and through the area. Prince Street Gardens is a centerpiece of the heart of the World Heritage site and provides a linking landscape feature between the old and new towns of Edinburgh. The council has a management and conservation plan in place to guide changes to the gardens. The council has continued to dialogue with the gallery's design team during the development of their proposals and we agree that further work is required to take account of appropriate integration within the gardens. The council's legal and property teams have worked with the galleries in the promotion of the bill and secured a mandate from the Finance and Resources Committee at a meeting on 3 February to engage with the galleries on the sale of the land and the terms of which would require further committee approval. The council's planning authority has had pre-application discussions with the galleries and expect planning and listed building applications in due course. Thank you, Ms Stevenson, for that. I am aware now that there are a few of the questions that Muriel has been covered with your opening statement but can I just ask you to expand when the promoters were here? They explained during the oral evidence that the council agrees with the bill and that there has been that close discussions with the promoter in relation to the project. Can I ask you to expand on the issues and the nature of the co-operation between the various council departments and the promoter, please? I touched on an outline of how far back the discussions have gone. I think that the original introduction and working partnership with the galleries started quite a few years ago and we do have this constant relationship and working with them anyway about the management of the galleries. We have engaged principally through the planning department and the planning function of the council but planning have drawn together other departments within the council such as the parks department and finance and obviously my colleague here Graham in the property department as well as the arts teams and other management transport a whole range of departments actually interface on the gardens and the whole of the the man complex. So it is a complicated arrangement for us and involves a number of people. So we've certainly had a lot of discussions about how we progress changes and look at changes and the implications of what the galleries may or may not have wanted to do and we've obviously been there in partnership and by the side during their own personal process on appointing the design team and thinking about the way that they could change the building. So we have attended design team meetings as well but all on a sort of preliminary basis so there's been no formal position of such in planning terms taken yet that's still very much a pre-application. Thank you Mr Tully would you like to add anything? Just like to add that the council certainly is delighted to hear of the possibility of investment in the galleries and the council certainly at the committee on the third of February supported the galleries in commencing this process as the first stage to achieve the improvements. Could I ask just a further question to detail and then I'll open it up to the other committee members. Could I ask you to explain the likely impact on the gardens during the construction? I'm not sure who wants to answer that Mr Tully. Maybe in broad terms the actual building changes will obviously require to have sections of the gardens potentially may be closed off for sections which would happen in any development that takes place. I mean when we have festivals and events we have to restrict access in certain parts of the gardens so I think people are used to that and there are alternatives and alternatives would have to be put in place and there are alternative routes and accesses around because of where it's located in the city centre so I think that would be reasonable to expect. Okay thank you very much Mr Tully sorry. I could just add that you know with estate services we would have discussions with our colleagues in parks and between the council and galleries we would enter into a licence agreement to govern the operations on site method statements of working and hours of working just so we can control how that will impact on the gardens. Thank you very much thank you for that and could I now move over to my colleague Fiona McLeod who has a few questions. Thank you. As you know one of the primary purposes of the preliminary stage in looking at a private bill is on whether there is a need for a private bill and I was wanting to ask the council's views on why you have supported the national gallery in going down the route of this private bill especially when you look at in 2003 for the play fair project where the council first went to the court to dispose of the common good in the inalienable part of the process but this time the national galleries has decided to put both into the one bill and I wondered what the council's feeling on that was. I know that you support it if you'd just like to reiterate that support. Mr Tully. I have to say I'm not a lawyer having had discussions with the council's legal team they concurred with the gallery's legal team that the various legal hoops could be wrapped up in this single parliamentary process. So I'm probably again asking the wrong person the next question which is in the 1991 act that prevents the council from using the gardens for building on it except for specific purposes like for electricity generators and such like. Why there wasn't any consideration given to amending the 1991 act in this position was the council worried that to amend the 1991 act for this specific purpose would then have left the gardens open for a lot more development. I couldn't really comment on that final point. It might be something that we can write to the council and just pursue. You can write, we will be able to respond to that for you. I just really wanted to ask you if you could clarify the arrangements for the transfer of common good land and the council's evaluation of best value. I'm really asking that because as you know there could be a headline, council sells off parts of Princess Street Garden's shock horror. Obviously I think that this is absolutely a wonderful development for both the council and the gallery and more so the general public. How do you evaluate that best value in terms of public concern? I agree that there are sensitivities around the gardens and common good and clearly that the principle of the project will be governed by both this process and the planning process but in terms of the transfer arrangements the council would appoint external valuers to assess the best value issue and that would look at the very fact that what is being transferred is a quite a narrow strip about five meters wide which in itself doesn't have a lot of value on its own. It would also look at sort of the fact that the gardens will hopefully be the beneficiaries of some improvements or access so that will be a basket of benefits which will capture the issue of best value. When we did our site visit it seems to me that there's a very positive outcome in this instance but it's important that we record and acknowledge just what these are through this bill and that there will be disabled access to understand and the monument to the Spanish Civil War which has kind of never really been given much prominence will actually be in a better place and I think would you agree that these are benefits that we would want up a better word sell to the public in terms of better access and a more enjoyable space and improvement to the play first steps and so on? Absolutely and as Karen mentioned that once we've had a discussion following the values assessment we'll have discussions about other terms things like rights of access to maintain and clean the facade that's being created and all this will be documented and report back up to committee so that will be a public document so they will see all the benefits flowing from the project. Thank you, thank you for that. Thank you for that and okay, are we all okay? Sorry, yeah, any other further questions? Could I ask the last question you'll be glad to hear? The legal obstacle in 1991 act and I'm aware that my colleague but I just really wanted to get on record is the same one which led to the play fair project that needed to parliamentary approval in 2003. Although that doesn't relate to the bill itself, can you say whether it needs for a more general amendment to be made to the 1991 act so that there is an exception for public museums, galleries, i.e. so that the private bills are no longer needed for construction linked to such buildings in the garden what would be your advice or your opinion on that? I think I would have to have discussions with our colleagues in parks to see if there are any risks associated with that because obviously there are sensitivities surrounding the gardens and their use and it's quite difficult to at this stage identify whether this would be opening the door to intrusions into the gardens. It's maybe, sorry, Mrs Stevens. No, I was going to say in planning terms certain specific uses are obviously defined in the planning legislation but again that would have to be something that would be sensitivities there I think around those terms which the legal experts would have to look at very carefully. It's maybe something that, as committee members want to write to yourselves and hopefully get some clarification. Mr Todd? Mr Todd is associated with the sensitivities that in terms of the sale of the 5m strip and the development taking place on that, we would be imposing restrictions on the use of that to gallery space and ciliary uses again for the very reason that there are sensitivities around the use of the gardens. I think that that clarifies that and if we need any further clarification we will write to yourselves and hopefully get back to us to put that on record and I think that that's all of the questions that we were aiming to ask from the committee this morning so can I thank you once again for coming along this morning and I know it's been fairly brief however fairly wholesome and thank you again for coming along and I think we are now moving on to the next item on the agenda which now moves us into a private session so I close the meeting.


And we hear the ID Tech Act show and hi, so who are you? Hi, my name is Gustav, I'm the founder of the company Vulpes. And right here you're using the Vulpes gloves or your technologies in this glove? Exactly, so we have developed smart heated technology that can be controlled with a smartphone and this is completely sensor based technology, which means it can automatically regulate the temperature. So it's heating? So it's heating, yes, right. That's your technology, is it heating? It's heating, sensor based heating, yes. Sensor based heating, you also have it in the soles right here? Right, right, so the sensor's belly. You want to see how it works? Yeah, so on your phone you say I want hot feet, we click? Right, right, this is how it works. So we have built a platform and one of these, so there's a front end on the iOS where you can pick up any device like a jacket, for instance, or head or shoes, connect them, pair them with your smartphone and here you have your inventory of different products. So what I, for instance, would like to activate the heat, I click on the shoes or the insules and can control the insules based on the steering wheel or like plus and minus buttons. Is it connected now? Yes, it's connected now. So you see like the LEDs? I'm not sure if you can see that, but you see like LEDs is lighting up and you see depending on the different temperature levels, the LEDs changing, so this is kind of an indication of the heat. Nice, and it goes to the front of the foot or? Exactly, so you could like use a telemetry camera to have a look, I'm not sure if you can see that. So now we have 38 degrees, so it starts to heat up. Let me have a look, so 40 here. So actually the product can be heat up up to 60 degrees Celsius, so then we get pretty warm. And so the good part is that this insules is one of the most thinnest insules on the market with 1.2 centimeters in the thickness. We have a very powerful low temperature battery inside which can be operated up to minus 40 degrees Celsius. Is not lithium ion? Is lithium polymer? Lithium polymer, so that means it's better for this application, you have to step on it every day. It's not going to explode on your feet, right? No, it's completely protected, so it's completely encapsulated. So it's also certified according to all standards in the European Union and Japan. And is this for sale? Yeah, we're already selling those products, so this is kind of the product from 2017, so we're currently under development of a completely new system architecture which will improve the battery runtime, the communication system, and of course the comfort. All right. Is it connected to your poster? I'm checking. Yeah, it is. Because the poster just... It is actually. Oh, no. It just fell down. No problem. I will put it back. You said it was connected to the poster. How? Connected? No, I mean like... It was just demonstrations of it. So is this for sale also? Yeah, it's also for sale. And what's the price to have hot shoes or hot gloves? Yeah, 220 for hot gloves and 150 for a hot... And this goes inside any shoe? Mostly winter shoes. But you have to probably remove the insoles of their own shoe to have a better fit. And what are you showing here in the video? There's a hat also? Yeah, it's sort of like one of our first products we have developed. Nisha? So this is your special hat, small hat? Exactly. We have a different range of hats which use the same technology, same productivity technology. So for instance we have currently... On the mark we have two colors next season. So starting September 2019 we will get a completely new upgrade of the system with new production techniques on how to embed and improve the integration of heating yarns into the fabric. So how do you do that? The integration self? Yeah, what is the special part? You're doing in collaboration with the materials that are used for clothes? Textiles? Is it smart textiles? So what we do, our company is focusing on software and hardware integration. So this is the main part. And the integration itself is what we're doing. So we're applying a lot of different sensors and wearable parts to create one fully swathed through product. Alright, that's cool. And in September when you have the next generation, is it going to be a cheaper product? It has better performance actually, so we will increase the battery capacity by 15%. We will improve the communication standard to the most recent one and we will add more features inside. Bluetooth 5? Bluetooth 5, yeah. So lower power consumption? Exactly. A better PCB? A better PCB, exactly. I'm talking Nordic. Nordic semiconductor, yeah. We're considering taking them, so we have like two suppliers, Nordic and Texas Instruments. So we have to... Which one is better? I can tell you by the camera. Okay, no problem. And there's competitors doing this kind of stuff, right? So why are you special? So I think the special thing of what we're doing is we are connecting completely closing items from head to toe. So as you have seen on our mobile application, we can be completely... We have just one application for all of the products and I think it's kind of a handy because you have not like 1,000 different providers and having one technology applying for all of the items. But when people buy clothes, it's not only the heating, they also want nice clothes, right? So you're working with nice clothes designers? Yeah, we have our own designers in-house, so we have created next-generation gloves. So this is a sport glove, but we have created more urban gloves for everyday use, which has a much better appealing. They're smaller? Yeah, they're smaller, less bulky actually. So we're using different materials inside. And yeah, you have... Where's the battery? The battery is placed here underneath. So there is a waterproof pocket and there is the battery placed. You can take it out? Yeah, of course. You can take it out and charge it. So all our batteries are compatible with power banks. So you can charge it via micro USB. Nice. And they're cased in a shockproof and fire-resistant material, which means something has happened in the case of lithium-polymer battery. So this holds the energy inside the casing. How much MAH is here? 1.9 ampere hours. And how long time is it going to power the... So this glove is currently two to eight hours, depending on the temperature. So we're also doing an upgrade on the whole battery technology for the next-generation products. Okay. And wouldn't it be cool if this was smaller and maybe you could fit in a power bank? You just swap it and continue. Or in theory you could have more than one of these, right? Sorry? You could have more than one? Yeah, yeah. And then swap another one in? Yeah, of course you can. But the issue is, of course... I mean, it's always the issue of having like... We would like to have tiny batteries and tiny electronics, but then you compromise the performance. So you have to make some like... Nice. All right. And there you have it. Getting a hot in the winter.


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When I was 10 years old, I almost died. I fell two stories and I suffered severe brain trauma. The surgeon said that I only had 50% chance of survival and even if I made it, I would have brain damage and would never be able to live a normal life. But after many hours of surgery, by luck or by God's grace, or by my life design, I survived. After many examinations, they couldn't find anything that was wrong with my brain, but in a very particular way, my personality changed and I became more sensitive and intuitive. I started feeling something, something very subtle, but distinct. Like an energy force that wasn't there before. I thought that it was just my imagination, but it wasn't until decades later that I discovered it was a lot more than just my imagination. Which led me into the intensive scientific research into Qi and life force. With this newfound knowledge, I was able to self heal from an incurable disease without using any pills or surgery later on in life.


Good morning. It is Monday, April 13th. My announcements are growing up a little later than normal because I had an early morning power outage with some storms. I hope that all of you are safe and sound from the storms that swept through last night and this morning as well. In addition to our unit 4 content, and yes, we are in unit 4 now. There was a problem on Friday that about half of you didn't get done. There is a small one-page assignment for today as well. Please get that work done and send me any questions. It is also the first day for exam 3 to be available. We decided that even though Tuesday is the official exam day that we would have the test window open for both Monday and Tuesday.  You shouldn't have to take the full two hours, but you've got those two hours available. So it's kind of like in class where the exam is an hour and 20 minute window, but most of you finish up well before that. If you have any technical problems, take screenshots of what's going on and contact us immediately so that we can deal with those on a case-by-case basis. Hopefully most of you will not have any issues on that. I will be monitoring email and text messages from 8 a.m. to 8 p.m. on both Monday and Tuesday. So I recommend you try and take your test during one of those windows rather than late at night when I won't be able to get back to you if you have a quick question. Otherwise, if you've got questions or issues, contact me. I will be checking in with students as needed. And I wish you the best. Take your time. Do well.


This study investigates how to achieve the well below 2°C, preferably 1.5°C target set by the Paris Agreement. To do so, the Times Integrated Assessment Model, TIAM, was used, which is a global energy system model. Aggregate cost potential curves were implemented into TIAM, as well as demand technologies for the end-use sectors. Hydrogen and sinfuel trade routes were also established using liquid hydrogen transport, LH2. Four different scenarios were considered, each with different characteristics of climate and security of supply policies. The results showed that renewable energy sources would have to expand significantly in order to meet the 1.5°C target. Final energy consumption would shift toward direct electricity usage, while certain demand technologies, aviation and international shipping, would require hydrogen and sinfuels for full decarbonization. Different security of supply policies resulted in different regional allocations of hydrogen and sinfuel production and exports. In the case of climate policy, Middle East Asia was the preferred region for hydrogen export, while multiple regions were competitive for sinfuel production. In the case of security of supply policies. This article was authored by Felix Lipka, David Fransman, Thushara Adanke, and others. We're article.tv, links in the description below.


All right, we'll move on to another case. This is a 66-year-old male who presented with hemoptysis that he coughed up some blood while traveling. And past history, he has high blood pressure, on therapy control, high cholesterol. And he was evaluated because of the hemoptysis. And they did a CAT scan of the chest. They were concerned more about his lungs because of the scoffing up of blood. And the lungs were OK. There was nothing obvious in the chest by CAT scan. But incidentally, they discovered a mass in the left kidney and a benign-looking cyst in the right kidney. And again, on examination, similar to the patient we presented before, he had the left varicoseal. Again, to drive the point that a left varicoseal in a middle age and an elderly male should trigger a further evaluation. It should not be just left alone. The patient should be evaluated for something happening in the area where the left kidney is. And so this should be a bell for the patient, as well as for a primary physician and urologist. The labs were all normal. And he had this mass in the left kidney here, but no metastatic disease. Dr. Karam, how would you approach this patient? No metastasis. And he has this mass in the left kidney? So the chest is clear? Yes. No, we don't know why he was coughing blood. No metastasis. And that's all the films you're going to show me, right? Yes. So no hidden agenda. So for this patient, I would do a left radical nephrectomy and no dissection. You could see some probably enlarged lymph nodes there. Yep, that's what I would do. I would do it open myself just because of the nose being in a tricky location. Would you also take the left adrenal gland with the kidney? I don't know, because I can't see it on the film. So if it's not enlarged, do you take it out? If it's normal, I would not remove it, because the chance of metastasizing to the adrenal, it can happen to both sides. So direct extension of the tumor to the adrenal gland, you can usually see it on the CT scan or during surgery. And what we're worried about is metastasis from the kidney to the adrenal gland, which could happen both to the left or to the right side in, I think, almost equal frequency. So if it looks normal during surgery and on imaging, even on the left, I would personally keep it. OK, Dr. Mati, how would you approach this patient? I agree completely. I do the same thing. I would open radical lymph node dissection, preserve the adrenal. OK, Dr. Wood, different? I mean, I would probably remove the adrenal. It's just my sort of policy on locally advanced disease, particularly, again, on the left-hand side, where they share the same venous drainage. Certainly it could show up in the right adrenal as well. But I think in these more locally advanced tumors where the risk of metastasis is higher, that I would probably go ahead and remove the adrenal. I would do it open. I would do a lymph node dissection. It is interesting, though, in a sense. If you have a lot more cases, we don't have to spend a lot of time with this. But we spent a lot of time talking about neo-agipent therapy in the first part. And in a case like this, when there's so much disease in the lymph nodes, and those are truly positive, they're not reactionary. Where are you guys seeing lymph nodes? I'm assuming those are nodes, unless they're big veins on the other side. Is this the genital vein or what? The aorta on the other panel. That's bowel, isn't it? No, no, the other panel. Behind the aorta? Where? That's bowel. It's contrast. This is bowel here. Behind the aorta. Aorta, IVC. And bowel. Yeah, but between the spine and the aorta. It's not lymph nodes. This? Yeah. Well, it's not bowel. I'll show you guys how to read this later. It's not bowel. I'll have to. No, bowel doesn't live better. Those are not lymph nodes. These are opacified bowel looms. Behind the aorta? Behind the aorta? That could be a retroaortic renal vein. It's not a lymph node, for sure. That's why more films, yeah, but yeah. But I think the CT is calling your decision to do open because you want to remove the lymph nodes. But you could have lymph nodes. On the basis that we thought those were, because there should only be two circles above the spine, and there's four, five. So, all right. Well here, the patient underwent, and it's interesting you all decided to do open. And the patient did undergo, in fact, laparoscopic. Not open, laparoscopic nephrectomy. And sparing the left adrenal gland because it did not look enlarged by CAT scan or at the time of surgery by inspection. The lymph nodes were all negative. And here is the pathology, T3A, N0, no lymph node metasis, and no metasis. So we discussed this morning what would be the role of any therapy in the patient where you resect completely the disease. But he has local advanced disease. This is the T3A. So as we discussed, not to belabor the point too much, but off protocol, if there are no clinical trials available to the patient, or the patient declines participation in the clinical trial in this setting to prevent or reduce the probability of recurrence of the disease of the cancer after surgery, you observe them. And the frequency of scans, we discussed that this morning. If the patient is interested, very interested to participate in a clinical trial that offers adjuvant therapy, these adjuvant therapies are all with placebo control. I think this is important for the audience to really know that these trials have a placebo control. So the patient, it's double blind. The patient, as well as the team treating the patient, the physician and the nurse, do not know what the patient is actually taking. The patient could be taking a placebo or a drug. And it's given for a finite time, the majority of these adjuvant trials are one year. So would you, we all agree, if the patient is interested, enroll them on an adjuvant trial? Yes. Yes. So the patient was offered to enroll on a trial that's called the Ashur trial. It's a one year of adjuvant therapy with one of two drugs versus placebo, sunitinib, surafinib, or placebo for one year. And the patient didn't know what he was taking and that he had toxicity that led to interruption of therapy. And in fact, it took him because of the interruption 14 months instead of one year to finish the therapy. But he did finish it, he did receive the therapy, didn't know what he was getting. And 16 months later, after surgery, we have the scan here. Dr. Karam, would you like to comment on the scan? What do you see here? I mean, this is a benign right renal cyst for the audience. This is a benign. But is there anything that catches your attention? Are you worried about anything here? Like in that adreno you left behind? There's a one centimeter left adrenal mass that looks suspicious from a testotic disease that's presented two and a half years after surgery. Okay, would you have done anything at this stage of the game here? What's that? Would you have done anything at this stage of the 16 months after surgery? Would you do anything? I would have obtained imaging more frequently, maybe six months later rather than a year later. If it looks suspicious at that time. And if it is something that can be biopsy that would biopsy that too. But other than that, I think surgery would be what I would recommend if the patient has no metastatic disease. Okay, Dr. Ramatheed, any? Yeah, actually I have a fear. It's a sneaking suspicion. This is one of my patients looks very familiar. So yeah, I would do a laparoscopic nephrectomy. I can't recall if we did a biopsy or not. I think it's reasonable, but the suspicion is pretty high there. What did I say? Adrenalectomy. Adrenalectomy, what did I say? Nephrectomy. Oh yeah, forget it, yeah. Adrenalectomy. And I think the images we were seeing before, I think the patient probably had a vein coursing back there, which is what threw Dr. Karim and I off. We were thinking they were looking like lymph nodes in that one slide. But either way. Whatever. Yeah. Michael, Roberto, would anybody consider systemic therapy or left adrenalectomy? Surgery, surgery, yeah. All right. So he had a biopsy first and that confirmed that this is metastatic disease. There was no disease elsewhere and he underwent unblinding of his therapy and that he received before for one year on that trial and he was receiving synitinine and the side effects he experienced while receiving this drug were consistent with the toxicity of this agent. What would you offer now? They said it would be like this. Okay. He underwent a left adrenalectomy, negative margins, and the pathology is one centimeter metastatic RCC. Patient was observed after surgery. Three years after metastatectomy, surveillance films show a lesion in the left seven thrib. Reminder of metastatic evaluation is negative. And here, further evaluation of this. On the bone scan, he has a hot spot here. And on the CAT scan, there is this tumor here that corresponds to this. So he has metastatic disease to that left seven thrib. Dr. Pile, what would you do? I think I remember what I, you know, the case, but I read the case, but I think in this case, really three years, single metastasis means in the rib, I would make sure that that's the only site, but I would send it for surgery again, because, you know, it's been shown that probably that's, probably maybe it's the best option this patient has. I have a few cases when I was a Hopkins that, exactly the same. Even after therapy, that is the sanctuary in the bones and in the ribs, I just take the rib out and I ask the surgeon to take the rib out and the patient did find some. I would, if there is disease elsewhere, would then... Different story, but depends on where it is. But three years out, single met in the rib. Could the medical oncologist comment on the value of PET scanning in this circumstance? Michael, go ahead. Sure, yeah. You know, there's limited data and there is some data, but there's really not a good role for PET scan. Again, we talked in the earlier session that the most common PET scan uses FDG PET, and so really that's what I'm talking about. That's the labeled sugar. There are other types that, you know, might be more informative, but I would say at least if we're talking about the common type of PET FDG, it's probably not that useful. There's limited data that may be useful for following treatment response and advanced disease, but probably not for staging, so I wouldn't recommend that. I think you brought an important issue.  There is this notion that FDG PET does not work in clear cells, although there are some experience from Memorial. We had a couple of trials, Hopkins with PET and kidney cancer, every patient actually light up. So I would say probably if it's covered, in this case, maybe we're not a better idea to do a PET.  It might be negative. If the lesion is negative, of course it's not gonna help you. So what you're looking for though is other lesions, right? Yeah, just to be clear. But if the PET is negative, completely negative, it doesn't help, because you know that, like, yes, disease in the web. Okay, so he underwent a left rib resection and the pathology consisted with metastasis of the kidney cancer. Postoperatively, he had fluid buildup in the left chest, we call pleural effusion, and had a catheter to drain that effusion, the fluid. The fluid was sent for cytology, sent to the lab to test for malignant cells and there were no malignant cells. So it was a reactive postoperative complication and it's not malignant pleural effusion. So no cancer in the chest, other than the rib that was resected. He returns for repeat staging, and now the radiologist and your radiologist looking at the scans says, well, there looks like some spots in the pancreas, which in retrospect were there a year before on a prior CAT scan, but now are more visible, more obvious that they are consistent with metastasis to the pancreas. But there's no disease elsewhere. Now, what would you do, what would you offer him? Dr. Pili? Well, it is a challenging case because, you know, it is not the usual patient with kidney cancer we see in the clinic. But, and of course it would be compelling, intriguing to think about, you know, another surgery. Of course, the timing of this new legion is getting shorter and shorter, so you're wondering. And of course, when we do see disease in the pancreas, you're reluctant to send a patient for a WIPO procedure, for example, where is a pretty extensive disease, surgery. So I would, you know, I would discuss maybe with the surgical oncologist whether there is any role for removal of the, but depending how safe can be done the surgery and whether that truly is the only site. Dr. Harrison, would you go with total pancreatectomy? He has multiple lesions in the pancreas. It's not an option for a laparoscopic resection of the tail of the pancreas. This is the whole pancreas, multiple lesions. Would you do total pancreatectomy or systemic therapy? If the only option was total pancreatectomy, I would not do it, I would do systemic therapy. Systemic therapy, okay. What systemic therapy? So, would you go back, let me ask the question in a different way. Would you go back to Sunitinim, which he received years ago as adjuvant therapy? Would you go with a different tyrosine kinase inhibitor? Would you go with an amtore inhibitor? Would you go with high dose altitude? Or would you, obviously there is always the option of a clinical trial. What would you do? So, in this patient I'd probably think about oxytinib. I think a clinical trial would be a good option too. Certainly Sunitinib retreatment would be a good option. There's some limited data that if we treat patients and they progress on Sunitinib, which this is a little bit different of a scenario. But anyway, if they do progress we can retreat them. There's the dose escalation evidence. But I would have considered this patient to have had a good run at Sunitinib and then think about a more potent VEGF receptor TKI like oxytinib in this case. Dr. Wood, would you talk to your surgical oncologist colleagues for a total pancreatectomy? I mean, to be honest though, I think that this guy has definitely demonstrated that his disease is systemic. It's also very indolent, but it's systemic. And I think it starts to get ridiculous when you're just doing serial sectioning of the patient to try and take the cancer out. I think he's proved to me that he has systemic disease. And I think that the good news is that metastases to the pancreas usually behave very indolently. They're not very aggressive, they don't grow fast. So of all the patients that we've talked about today, this would be the guy that I actually would observe for a period of time for two reasons. Number one, because the pancreas mets usually don't grow at a very rapid rate. They're very indolent. But also, look to see if he crops up somewhere else to see if his disease shows up in another organ system. And then at that point, consider instituting therapy. You talk like a medical oncologist now. Actually, I was gonna make- I think I just got insulted, but no. Actually, I'm glad you brought that up because my thought, for some, and again, it's one of these things about kidney cancer we don't fully understand. There's clearly a seed and soil phenomenon. The cancers that go to the pancreas tend to behave generally much more favorably than, for example, those that go to the liver. So, and it's not clear to me why that happens and smart people like Dr. Karam maybe can figure this out over the next few years. But yeah, I would observe, I think, for those reasons that were mentioned. He may do very well for a while without any therapy.


This is stock number 21 J99. We are here at Summit Automotive in Fondlack, Wisconsin near new and used Jeep and Jeep Wrangler headquarters Today we are checking out this brand-new 2021 Jeep Wrangler Unlimited Rubicon package This vehicle has the award-winning 3.6 liter Pentastar V6 motor It's going to get you 24 miles per gallon on the highway 19 city for a combined total average of 21 miles per gallon Sarge green clear coat is the color paint coat is PGG if you were curious Quickly becoming one of my favorite colors on the Wranglers and judging by everybody online Pretty popular color amongst the Jeep crowd We shoot all of our videos in 1080p 60 frames per second So if you have HD capabilities on your computer tablet or smartphone device turn them on right now because it is definitely your best way to Check out the looks styling and color of the vehicle before seeing it in person as well as the options as well Go through it pretty in-depth here You get the painted and polished aluminum 17 inch rims with the little red Wrangler on there Falcon wild-peak MT tires. These are LT 285 70 R 17. It's definitely a mud terrain tread pattern to them Rubicon package is going to give you the granite crystal Jeep lettering with the red outlines the red and gray Trail-rated badge as well as the Rubicon lettering on the hood This one does come with the LED premium lighting group give the LED running lights and the fenders the LED halo lamps Around the lights there, and then these are actually LED headlamps as well, and then you get LED fog lamps, too You get the red-toe hooks with the Rubicon package You also get the granite crystal inserts and headlight bezels This one does have a front camera on it, which is pretty cool Get that sport hood Color match fenders color match top. Those are some pretty pricey options Speech speaking of options. We'll check out the original window sticker here So this is a 2021 Jeep unlimited Rubicon Sarge green black interior leather trim bucket seats 3.6 liter with the e-torque That's how you get that 24 miles per gallon on the highway and average of 21 eight speed automatic transmission Everything on the left there is your standard equipment And then your optional equipment starts Down here, and you get the Sarge green clear comb paint is 245 leather trim bucket seats are a 16 95 dollar option has the cold weather group Which gives you heated seats remote start and heated steering wheel LED lighting group, which is 1365 gives you all those Special lights in front and the tail lamps and then this one has the 8.4 radio and premium audio group Which is 1995 and that gives you the alpine premium sound that you connect 4c nav GPS navigation serious guardian for a year serious travel link and traffic plus for five years plus 4g lte Wi-Fi hotspot and emergency assistance call and That's all for 1995 safety group which gives you the park sense rear park assist system is 895 the advanced safety group Which is automatic high beam headlamp control Full speed forward collision worrying plus adaptive cruise control and advanced brake assist is 795 The eight speed and the three point six liter are combined total of three thousand bucks to get those Has the enter-and-go system with the remote proximity keyless entry 645 and then the color matched hard top is $2,495 and then the color match vendors are 695 so actually three thousand bucks Actually thirty one hundred bucks to get those color match options on the vehicle the LT 285 70 our 17 tires are 195 and then the special rims are 995 and then it has the integrated off-road camera, which is the camera on the front, which is 595 extra Total MSRP is sixty thousand four seventy five three year thirty six thousand bumper to bumper five year sixty thousand powertrain warranty They're your miles per gallon and then your safety radians They just do front crash of four stars and roll a row three And we'll get back to the interior in just a little bit We'll finish out the Outside walk around so when you get the color match vendors on these they come with kind of hard to see but there's actually a 3m clear tape on the front of those which protects it from rock chips and Road rash and stuff. So that's really nice four-wheel disc brakes on all the Wranglers get those LED tail lamps the backup parking sensors matching spare tire and rim Lots of room back here. You do get the color match bars. So when the top is off everything is Uniform and you get three bolts on each side two on the top. So a total of eight bolts To get this back hard top piece off remember you got to take the front hard top pieces off first Then those seats do fold down for extra storage and then you have two quick disconnects right there. I like that they put Storage back here again, and then they put the subwoofer on the side In 15 they switch the subwoofer to right here and then you didn't get that storage space anymore So it's nice that they put it on this side. You don't lose too much room back here You get the door hinge Hood or I'm sorry door hinge roof and windshield bolt holders here as well as the Jack tools are in there as well Get the JL badge on the back here Overall length wheel base for two door four door and then water forwarding there as well as where it's made Get the LED tail license plate lights as well and the red tow hook back here. You get the granite crystal fuel door cover Really like that color match hard top on these Wranglers Pretty much the only way to go in my opinion. You get the rock rails on the Rubicon, which is Nice for protecting the body of the vehicle if you're going off-road Blind spot monitoring heated mirrors inside the leather trim bucket seats in the Rubicon package are Heated you get the red stitching the Rubicon stitched into the backrest these now come with Side airbags Yet driver seat height adjuster lumbar factory floor mats auto headlamps tilt telescopic steering wheel power windows power locks and power mirrors as We hop inside the vehicle here See that this one has 12 miles on it and you get these seven inch LCD display You get the Rubicon animation and the Jeep driving over the land there, which is pretty cool And then you do get the digital speedometer on here compass display. You can put mileage time Miles per gallon Miles to empty all that good stuff comes with the heated leather wrap steering wheel Here's your adaptive cruise control normal cruise controls notice you get the red stitching Around the steering wheel there as well Bluetooth and information center controls on the left and audio controls on the back they really haven't changed the steering wheels on the Jeep lineup for about quite a while, so they're always Same layout, which is really nice if you're hopping from different Vehicle to vehicle in the Jeep and Dodge Chrysler lineup So you got the factory navigation on the 8.4 4c radio You also get a MFM and serious XM radio capabilities You can do your heated seats and heated steering wheel controls here and we're gonna turn this on so you can check out that Forward camera, so you do get the backup camera, which is now standard on the Wranglers And I really like them because they're high definition You get the dynamic dynamic grid lines the center line lines right up if you'd put a hitch on here It'd line right up with that so that's really cool And they made it high definition and now it's standard but now this front camera This is the first time I've ever seen it ever used it So that is really cool as well you get those dynamic grid lines on the front here to kind of see where you're going to be going Very very cool clean camera and rear glass so that must be able to put your windshield Washer or your rear glass washer fluid on but anyways, that's pretty cool in its high definition And it's a wide angle camera so you can see on both sides pretty far But a new feature that I've never seen so this is the first time demoing it pretty cool Then you get your youth connect apps here where you can do your off-road pages as well as your projection manager So the off-road pages they do take a second to load so while they're loading I'll let you know that you can do your climate controls down here Including your heated seats and heated steering wheel controls So I always do a little bit of animation there. You may be lost but never stuck in a Jeep You have your steering angle so once again as you turn that steering wheel It's going to tell you where you're at your sway bar disconnect front axle If it's locked or unlocked and then rear axle if it's locked or unlocked you can see where you're at at all times You have your accessory gauges here And then you have your pitch and roll So if you're doing a lot of off-road you kind of know where you're at Also, what I like is they got the latitude longitude and your altitude Since we're in CIDR photo studio here. We don't get Reception to the satellite so it's not really telling me the altitude properly But it's still a cool feature and then the other thing that you can do is the projection manager We can project yourself home to the screen. So if you got ways or Google Maps on your Android auto or Apple Carplay device you can project it to the screen and then it's like you have a different navigation system Wherever you go also you can play media and songs and stuff through the radio from your phone and control everything through the radio Pretty cool system. We did demo on it and Android auto if you want to check that out It's in the upper right hand part of the screen and Down here you get your window controls you get media center Augs USB and USB C and then you get the This is really what makes a Rubicon a Rubicon you get the front and rear locking axles or just the rear And then you have off-road mode and then you also have sway bar disconnect Down here you have your 4x4 shifter 8-speed automatic transmission keyless entry with the remote start It does have the flipper style key and it's a big bulky chunky key fob Really like it. You know, I know which keys you have in your pocket So notice you do get the red finish to the dash They always kind of do a different color based on which model you get So here is our like leather and then the like sports are gray and then the Rubicon's are red I have seen the Rubicon's in gray as well. You get the red stitching on the dash You know the quick disconnects on the rough pieces here SOS and assist buttons up there and then home link buttons for your garage door security systems and lighting systems Notice you do get these seven slots right there as well and then the auto dimming mirror We'll take a quick look at the back seats and then we'll do a walk around with all the LED lights on so you can see how those look Back seats lots of room back here compared to the JKs You get latch child safety system for any child car seats you may have and then factory floor mats back here These seats do fold down and they go almost completely flat Which is nice if you got a whole bunch of extra stuff plus they got this little flap here So nothing falls behind there And the other thing I like about the seats that they did is that you can have this headrest down When there's nobody sitting back here, and they actually made a little tab just for that, which is nice as well Do your child safety locks on the back doors? And we'll do one more final walk around here with all the LED lights on so you can check that out Sarge green definitely one of my new favorite colors on the Wranglers Check out these LED lights in the front here really bright Really good looking when it's driving down the road Plus you can see better Utilize that front camera to its max potential And I would personally like to thank you for checking out the video and to see more pictures of this Jeep or one of our other 450 new and used cars trucks scvs minivans Wranglers you name it We got it go to our website right there www.summitauto.com Full pictures and descriptions of every single vehicle from two locations all at summit auto.com And if you'd like to check out more HD videos you can go to youtube.com slash summit auto Remember to like subscribe and share on this video and all the videos that you see there In fact in a second You will see a link to subscribe to our YouTube channel on your left a link to more Jeep Wrangler videos like this one On your right if you have not been to our website on the bottom link to this vehicle on our website click those Check us out, and we're super excited to be offering this brand new 2021 Jeep Wrangler unlimited Rubicon in Sarge green clearcoat. Thanks again for checking out the video