• Rouse Hardison posted an update 6 months, 1 week ago

    ients undergoing open bowel resection. Addition of these medications to enhance recovery after surgery protocols should be considered.

    The utilization of cancer-directed treatment for patients with all stages of pancreatic cancer in the USA is unknown. This study sought to examine national practice patterns and identify patient, hospital, regional, and other factors associated with disparities in the use of guideline-concordant cancer-directed therapy.

    Patients diagnosed with PDAC between 2004 and 2015 were queried from the National Cancer Data Base. Standard of care cancer-directed treatment was defined as surgical resection plus chemotherapy or chemoradiation for patients with stage 1 and 2 disease, chemotherapy for patients with metastatic disease (stage 4), and chemotherapy with or without surgery or chemoradiation for patients with locally advanced stage 3 disease.

    A total of 336,629 patients with stage 1 (n = 38,443, 11.4%), stage 2 (n = 93,923, 27.9%), stage 3 (n = 37,492, 11.1%), or stage 4 metastatic (n = 166,771, 49.5%) disease were identified. Adherence with stage-specific standard of care treatment occurred in only 45.3% (nulti-disciplinary approachfor optimal outcomes. selleck Receipt of stage-specific standard of care treatment for PDAC is associated with improved long-term oncological outcomes, but is only achieved in less than half of patients. Further studies are needed to evaluate interventions to address these treatment disparities for patients with PDAC.

    Pancreatic adenocarcinoma is a complex disease requiring a multi-disciplinary approach for optimal outcomes. Receipt of stage-specific standard of care treatment for PDAC is associated with improved long-term oncological outcomes, but is only achieved in less than half of patients. Further studies are needed to evaluate interventions to address these treatment disparities for patients with PDAC.

    Postoperative pancreatic fistula (POPF) is the most common complication of pancreaticoduodenectomy (PD). Sometimes POPF is associated with biliary fistula (BF) or “mixed” fistula. The purpose of this study is to assess whether the severity of the fistulae, when present, is decreased with an external biliary stent in place.

    In this single-center study, we assessed patients who underwent elective PD from January 2014 to December 2017. Patients were divided into two groups standard PD (ST-PD) vs. PD with external biliary stent (PD-BS). Demographic, preoperative, intraoperative, and postoperative variables were analyzed, including complications according to the Clavien-Dindo classification, and those specific to pancreatic surgeries, and mortality rates within 90 days of operation.

    A total of 128 patients were included (65 in ST-PD group and 63 in PD-BS group). Postoperative complications occurred in 61.7% of patients (32.8%, Clavien-Dindo ≥ III) and were more common among patients in the PD-BS group (44.4% vs. 23.1%; p = 0.03). POPF was also more common among patients in the PD-BS group (39.7% vs. 18.5%; p = 0.008). No statistically significant differences were found for any other complications.

    Based on the results of our study, placement of a transanastomotic external biliary stent does not reduce the rate of pancreatic or biliary fistulae, or their severity; in fact, POPF is more likely when biliary exteriorization is present.

    NCT04654299.

    NCT04654299.

    The prognostic value of peritoneal lavage cytology (CY) for pancreatic ductal adenocarcinoma (PDAC) remains controversial. We assessed the prognostic impact of CY status stratified by resectability in PDAC patients treated with surgical resection.

    Clinical data from 440 patients with PDAC who underwent surgical resection were retrospectively analyzed to examine the association of CY status with clinicopathological factors and survival.

    Positive CY status (CY+) was found in 30 patients (7%). These patients had significantly worse overall survival in both the resectable (R) (P = 0.002) and borderline resectable (BR) (P < 0.001) groups. The median survival time of CY+ patients in the R and BR groups was 25.6 and 6.7 months, respectively. Multivariate analysis revealed that CY+ was an independent prognostic factor in the BR group (P < 0.001) but not in the R group (P = 0.08). In the R group, CY+ patients who received adjuvant chemotherapy had significantly longer overall survival than those without adjuvant chemotherapy (34.3 vs. 9.8 months, respectively; P < 0.001).

    The prognosis of CY+ patients in the BR group was extremely poor. In the R group, surgical resection combined with adjuvant chemotherapy may improve the prognosis of CY+ patients.

    The prognosis of CY+ patients in the BR group was extremely poor. In the R group, surgical resection combined with adjuvant chemotherapy may improve the prognosis of CY+ patients.Coal fly ash (CFA) is a useful recycled resource for uses such as cement raw material. To manage and evaluate safety for effective utilization of CFA, the leaching concentration and amounts of toxic elements in CFA need to be determined. In this study, 38 types of CFA and aged CFA generated in Japan were used to measure the occurrence and leaching concentration range of As and Se. In addition, the leaching characteristics over the long term were examined using statistical analysis. Leaching concentrations of As and Se from CFAs were in the range of 0.001-0.163 mg/L (average 0.025 mg/L, median 0.014 mg/L) and 0.001-0.189 mg/L (average 0.071 mg/L, median 0.055 mg/L), respectively. In general, the concentrations of aged CFAs were less than those of the CFAs with a few exceptions. Leaching concentrations of As and Se in the tank leaching test changed with time, and As and Se concentrations in the dispersions increased with stirring time. In contrast, pH of the dispersion decreased with time. The relation between As or Se and CFA factors showed that As or Se and pH or Ca were highly correlated. However, in aged CFAs for long-term use, the correlation coefficient for the relation between As and other factors was low while that for Se-S was high. Considering the effective utilization of CFA as a long-term recyclable resource, the leaching processes of As and Se in CFA would change with time depending on the environmental conditions.

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