scholarly journals Evaluation of Preoperative Diagnostic Methods for Resectable Pancreatic Cancer

2021 ◽  
Author(s):  
Akinori Maruta ◽  
Takuji Iwashita ◽  
Kensaku Yoshida ◽  
Shinya Uemura ◽  
Ichiro Yasuda ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Method ◽  
Peritoneal Dissemination ◽  
Diagnostic Methods ◽  
Adverse Event Rate ◽  
Safe Procedure ◽  
Diagnostic Ability ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Diagnostic

Abstract Background: In pancreatic cancer clinical practice guideline 2016, it is recommended to perform pathological diagnosis as much as possible, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, EUS-FNA has become mainstream as a method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified.Aims: To evaluate the diagnostic ability of EUS-FNA and preoperative diagnosis affects surgical outcome and prognosis of pancreatic cancer.Methods: Between January 2005 and June 2017, 293 patients who had surgical resection for pancreatic cancer were retrospectively evaluated. The interested outcomes were diagnostic ability of EUS-FNA and the influence for surgical result and prognosis.Results: The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than ERCP (45.5%) (p<0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p=0.001). Patients were divided into FNA group (N=160) and non-FNA group (N=133) for each preoperative diagnostic method. In the study of surgical curability R0 between two groups, there was no significant difference in FNA group: 65.0% (104/160) and non-FNA group: 64.7% (86/133), (p=1.000). In the prognostic study, the total of 256 patients with curability R0 or R1, the recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in non-FNA group. Moreover peritoneal dissemination occurred 34.3% (24/70) in the FNA group and 21.9% (16/73) in the non-FNA group, neither of which showed significant difference. The median survival time of FNA group and non-FNA group were 955 days and 799 days, respectively, and there was no significant difference between the two groups (Log rank p=0.735). In the Cox proportional hazards model examining factors influencing prognosis, staging, curability and adjuvant chemotherapy were dominant factors, but preoperative diagnostic method(EUS-FNA) itself was not.Conclusions: As a preoperative examination of pancreatic cancer, EUS-FNA was shown to be a safe procedure with high diagnostic ability. It was considered to be the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

scholarly journals Evaluation of preoperative diagnostic methods for resectable pancreatic cancer: a diagnostic capability and impact on the prognosis of endoscopic ultrasound-guided fine needle aspiration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Akinori Maruta ◽  
Takuji Iwashita ◽  
Kensaku Yoshida ◽  
Shinya Uemura ◽  
Ichiro Yasuda ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Diagnostic Method ◽  
Peritoneal Dissemination ◽  
Needle Aspiration ◽  
Diagnostic Methods ◽  
Ultrasound Guided ◽  
Diagnostic Ability ◽  
Fine Needle ◽  
Significant Difference ◽  
Preoperative Diagnostic

Abstract Background A pathological diagnosis of pancreatic cancer should be performed as much as possible to determine the appropriate treatment strategy, but priorities and algorithms for diagnostic methods have not yet been established. In recent years, the endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has become the primary method of collecting tissues from pancreatic disease, but the effect of EUS-FNA on surgical results and prognosis has not been clarified. Aims To evaluate the diagnostic ability of EUS-FNA and its effect on the preoperative diagnosis, surgical outcome, and prognosis of pancreatic cancer. Methods Between January 2005 and June 2017, 293 patients who underwent surgical resection for pancreatic cancer were retrospectively evaluated. The outcomes of interest were the diagnostic ability of EUS-FNA and its influence on the surgical results and prognosis. Results The diagnostic sensitivity of EUS-FNA was 94.4%, which was significantly higher than that of endoscopic retrograde cholangiopancreatography (ERCP) (45.5%) (p < 0.001). The adverse event rate in ERCP was 10.2%, which was significantly higher than EUS-FNA (1.3%) (p = 0.001). Patients were divided into FNA group (N = 160) and non-FNA group (N = 133) for each preoperative diagnostic method. In the study of surgical curability R0 between the two groups, there was no significant difference in FNA group (65.0% [104/160]) and non-FNA group (64.7% [86/133], p = 1.000). In the prognostic study, 256 patients with curative R0 or R1 had a recurrence rate was 54.3% (70/129) in the FNA group and 57.4% (73/127) in the non-FNA group. Moreover peritoneal dissemination occurred in 34.3% (24/70) in the FNA group and in 21.9% (16/73) in the non-FNA group, neither of which showed a significant difference. The median survival times of the FNA and non-FNA groups were 955 days and 799 days, respectively, and there was no significant difference between the two groups (log-rank p = 0.735). In the Cox proportional hazards model, factors influencing prognosis, staging, curability, and adjuvant chemotherapy were the dominant factors, but the preoperative diagnostic method (EUS-FNA) itself was not. Conclusions EUS-FNA is a safe procedure with a high diagnostic ability for the preoperative examination of pancreatic cancer. It was considered the first choice without the influence of surgical curability, postoperative recurrence, peritoneal dissemination and prognosis.

An Update on Airway Management

2020 ◽  
Keyword(s):  
Airway Management ◽  
Surgical Techniques ◽  
Daily Practice ◽  
Postoperative Management ◽  
Diagnostic Methods ◽  
Emergency Rooms ◽  
Specific Patient ◽  
Medical Practitioners ◽  
Preoperative Diagnostic ◽  
Airway Devices

In recent years, there have been many advances in the safe management of the patient's airway, a cornerstone of anesthetic practice. An Update on Airway Management brings forth information about new approaches in airway management in many clinical settings. This volume analyzes and explains new preoperative diagnostic methods, algorithms, intubation devices, extubation procedures, novelties in postoperative management in resuscitation and intensive care units, while providing a simple, accessible and applicable reading experience that helps medical practitioners in daily practice. The comprehensive updates presented in this volume make this a useful reference for anesthesiologists, surgeons and EMTs at all levels. Key topics reviewed in this reference include: New airway devices, clinical management techniques, pharmacology updates (ASA guidelines, DAS algorithms, Vortex approach, etc.), Induced and awake approaches in different settings Updates on diagnostic accuracy of perioperative radiology and ultrasonography Airway management in different settings (nonoperating room locations and emergency rooms) Airway management in specific patient groups (for example, patients suffering from morbid obesity, obstetric patients and critical patients) Algorithms and traditional surgical techniques that include emergency cricothyrotomy and tracheostomy in ‘Cannot Intubate, Cannot Ventilate’ scenarios. Learning techniques to manage airways correctly, focusing on the combination of knowledge, technical abilities, decision making, communication skills and leadership Special topics such as difficult airway management registry, organization, documentation, dissemination of critical information, big data and databases

scholarly journals Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrés Moreno Roca ◽  
Luciana Armijos Acurio ◽  
Ruth Jimbo Sotomayor ◽  
Carlos Céspedes Rivadeneira ◽  
Carlos Rosero Reyes ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Survival Time ◽  
Univariate Analysis ◽  
Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Icd 10 ◽  
The Difference ◽  
Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

scholarly journals Efficacy and Safety of Azelaic Acid Nanocrystal-Loaded In Situ Hydrogel in the Treatment of Acne Vulgaris

Pharmaceutics ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 567
Author(s):  
Ivona Tomić ◽  
Sandra Miočić ◽  
Ivan Pepić ◽  
Dubravka Šimić ◽  
Jelena Filipović-Grčić
Keyword(s):  
Azelaic Acid ◽  
Controlled Trial ◽  
Acne Vulgaris ◽  
Topical Therapy ◽  
Adverse Event Rate ◽  
Double Blind ◽  
Inflammatory Lesions ◽  
First Choice ◽  
In Situ Hydrogel

Acne vulgaris is a common, multifactorial, inflammatory skin disease affecting the pilosebaceous unit. Topical therapy is the first choice in the treatment of mild to moderate acne, and azelaic acid (AZA) is one of the most commonly used drugs. The aim of this study was to evaluate the safety and efficacy of a low-dose azelaic acid nanocrystal (AZA-NC) hydrogel in the treatment of mild to moderate facial acne. The study was designed as a double-blind, randomized controlled trial. Patients were randomized to treatment with AZA-NC hydrogel, 10%, or AZA cream, 20%, administered in quantities of approximately 1 g twice daily for 8 weeks. Efficacy of therapy was measured by the number of lesions and safety by the frequency and severity of adverse events. At week 8, the success rate of treatment with AZA-NC hydrogel, 10%, was 36.51% (p < 0.001) versus 30.37% (p < 0.001) with AZA cream. At week 8, treatment with AZA-NC hydrogel, 10%, resulted in a significant reduction in total inflammatory lesions from baseline of 39.15% (p < 0.001) versus 33.76% (p < 0.001) with AZA cream, and a reduction in non-inflammatory lesions from baseline of 34.58% (p < 0.001) versus 27.96% (p < 0.001) with AZA cream, respectively. The adverse event rate was low and mostly mild.

scholarly journals Determinants of Success and Early Complications in Common Femoral Artery Endarterectomy: A Retrospective Study

Surgeries ◽  
2021 ◽  
Vol 2 (2) ◽  
pp. 180-189
Author(s):  
Marcel Libertus Johannes Quax ◽  
Daniël Eefting ◽  
Herman Joseph Smeets
Keyword(s):  
Retrospective Study ◽  
Femoral Artery ◽  
Clinical Success ◽  
Ankle Brachial Index ◽  
Emergency Operation ◽  
Common Femoral Artery ◽  
Walking Distance ◽  
Safe Procedure ◽  
Hybrid Procedures ◽  
Significant Difference

Introduction: Common femoral artery endarterectomy (CFE) is considered a relatively simple, successful and safe procedure in the literature, but major complications can occur. This retrospective study was performed in order to define characteristics contributing to success or failure after common femoral artery endarterectomy, either performed as a single or hybrid procedure. Methods: A total of 298 patients who underwent CFE in our hospital between 1 January 2011 and 1 January 2017 were included. After exclusion, 227 patients were analyzed. Patient characteristics and outcomes were derived from the patient records. Follow-up was 30 days postoperatively. Outcomes were analyzed by the chi-square test and regression analysis. Clinical success was defined as a combination of technical success, improvement in the ankle-brachial index, increased walking distance and “no complications.” Results: The procedure was clinically successful in 74.4% of the patients, and in 25.6%, a complication occurred. The Rutherford class improved in 65.1% of the patients with 1.6 (SD 1.3) class points. The ankle-brachial index improved in 44.8% of the cases, with an average of 116.6%. The most contributing factors for complications such as death, unplanned amputation, surgical site infection, thrombosis and longer hospital admission were emergency operation and a higher ASA classification. Significantly more complications also occurred in patients with renal failure, congestive heart disease, a high Rutherford classification and previous groin incision. A higher Rutherford class was the only factor correlating with an increase in the ankle-brachial index. When single CFE (48.9% of cases) and hybrid procedures (51.1%) were compared, no significant difference in success or failure was found. Conclusion: Limb ischemia requiring emergency operation and preoperative comorbidity were identified as the most important factors predictive for complications following femoral artery endarterectomy. Combining femoral endarterectomy with an endovascular intervention does not seem to increase the risk of a postoperative complication.

scholarly journals P0828CKD STAGE DISTRIBUTION IN AN ITALIAN PROVINCE; SEVEN YEARS OF FOLLOW UP

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Alessandro Roggeri ◽  
Daniela Paola Roggeri ◽  
Carlotta Rossi ◽  
Marco Gambera ◽  
Rossana Piccinelli ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Administrative Database ◽  
Ca Channel ◽  
Dialysis Treatment ◽  
First Choice ◽  
Stage 4 ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background and Aims Chronic kidney disease (CKD) is a chronic illness with important implications for the health of the population and for the commitment of resources by public health services. CKD staging makes it possible to assess the severity of the disease and its distribution in the population. The distribution of the stages of CKD diagnosed through hospitalization were analyzed using administrative database of the Local Health Authority of a province with a population of about 1 million inhabitants in northern Italy. Method Patients with hospital discharge with a diagnosis of CKD (ICD9CM 5851, 5852, 5853, 5854) in 2011- 2012 years, without dialysis treatment, neither transplantation procedure nor acute renal failure were selected. Demographic characteristics, comorbidities, dialysis treatment, drugs prescription and nephrological follow-up were investigated. This cohort of patients was examined over a 7-year period (2011-2017). Stage five was not considered to avoid possible misunderstanding with five D stage. Results 1808 patients diagnosed with CKD were extracted from the 2011-2017 administrative database; of these, 1267 had a diagnosis with the CKD stage specification. The distribution of 1267 patients in the CKD stages at the first hospital discharge was as follows: 7.4% stage 1, 30.9% stage 2, 42.3% stage 3, 19.3% stage 4. The 832 patients described in the study were still alive as of Jan. 1, 2013 while 435 (34.3%) died by Dec. 31, 2012. Until Dec. 31, 2017, 503 of the 832 patients died representing the 52.8% of stage 1 patients, 62% of stage 2 patients, 58.2% of stage 3 patients, 66.4% of stage 4 patients. Males were the most prevalent gender (58.5%), without any significant difference into CKD stages. Our patients have a fairly high age as can be seen from the table 1. The presence of co-morbidities was assessed either directly for the main risk factors or by the modified Charlson index (MCI) for CKD patients. The average value of the MCI is 3.8 ± 3.1 for all patients and 3.4 ±3.0 for stage 1, 4.1 ± 3.3 for stage 2, 3.7 ± 3.1 for stage 3, 3.7 ± 2.9 for stage 4, with maximum values of 12.0, 17.0, 16.0 and 14.0 respectively. About 40% of patients had diabetes mellitus, with the highest prevalence in stage 4 (49.3%) and the lowest in stage 1 (25%). Cardiovascular disease was distributed almost equally among all patients with a value between 82% in stage 1 and 86.3% in stage 4. Cancer were present in 26.3% of patients with similar values in all stages. Just about 9% of patients underwent dialysis treatment for achieving ESRD, with a percentage of 5.6% among patients in stage 1 and 17.1% among those in stage 4. Hemodialysis represented first choice treatment (86%) compared with peritoneal one (14%). Time from the diagnosis of CKD to the first dialysis was variable with an average of 3.4 ±1.7 years; the longest interval for patients in stage 1 (5.1±1.8) and the shortest (3.0 ±1.6) for patients in stage 4. The number of nephrological visits at renal units was analyzed for an assessment of the extent of follow-up and prevention upon reaching the ESRD (table2). More than 90% of patients had prescribed drugs antagonists of the renin angiotensin system, in all stages of CKD; other antihypertensive drugs (Ca channel blockers and peripheral vasodilators) had a similar prescription level. Anemia control drugs (ESA and iron) had an incremental prescription with stages of the disease from 51.4% in stage 1 to 74% in stage 4, similarly to Ca-P metabolism control drugs ranging from 44.4% in stage 1 to 67.8% in stage 4. Conclusion Correct staging of CKD is very important to assess the prognosis of patients, but the major determinants of outcome are comorbidities and age of the patients. The cohort examined has a high mortality rate, far higher than reported in the literature for CKD. It should be noted that the sample was identified by hospitalization for cardiovascular diseases more than 50% complicated by diabetes and hypertension, so death represents the main outcome and not ESRD.

scholarly journals A Circulating Exosome RNA Signature Is a Potential Diagnostic Marker for Pancreatic Cancer, a Systematic Study

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2565
Author(s):  
Yixing Wu ◽  
Hongmei Zeng ◽  
Qing Yu ◽  
Huatian Huang ◽  
Beatrice Fervers ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Early Detection ◽  
Validation Dataset ◽  
Healthy Controls ◽  
Rna Seq ◽  
Healthy Individuals ◽  
Kras Mutations ◽  
Significant Difference ◽  
Rna Signature

Several exosome proteins, miRNAs and KRAS mutations have been investigated in the hope of carrying out the early detection of pancreatic cancer with high sensitivity and specificity, but they have proven to be insufficient. Exosome RNAs, however, have not been extensively evaluated in the diagnosis of pancreatic cancer. The purpose of this study was to investigate the potential of circulating exosome RNAs in pancreatic cancer detection. By retrieving RNA-seq data from publicly accessed databases, differential expression and random-effects meta-analyses were performed. The results showed that pancreatic cancer had a distinct circulating exosome RNA signature in healthy individuals, and that the top 10 candidate exosome RNAs could distinguish patients from healthy individuals with an area under the curve (AUC) of 1.0. Three (HIST2H2AA3, LUZP6 and HLA-DRA) of the 10 genes in exosomes had similar differential patterns to those in tumor tissues based on RNA-seq data. In the validation dataset, the levels of these three genes in exosomes displayed good performance in distinguishing cancer from both chronic pancreatitis (AUC = 0.815) and healthy controls (AUC = 0.8558), whereas a slight difference existed between chronic pancreatitis and healthy controls (AUC = 0.586). Of the three genes, the level of HIST2H2AA3 was positively associated with KRAS status. However, there was no significant difference in the levels of the three genes across the disease stages (stages I–IV). These findings indicate that circulating exosome RNAs have a potential early detection value in pancreatic cancer, and that a distinct exosome RNA signature exists in distinguishing pancreatic cancer from healthy individuals.

scholarly journals Influence of the Thermal Treatment to Address a Better Osseointegration of Ti6Al4V Dental Implants: Histological and Histomorphometrical Study in a Rabbit Model

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Antonio Scarano ◽  
Ezio Crocetta ◽  
Alessandro Quaranta ◽  
Felice Lorusso
Keyword(s):  
Thermal Treatment ◽  
Dental Implants ◽  
Bone Healing ◽  
Rabbit Model ◽  
Titanium Implants ◽  
Control Group ◽  
Left Femur ◽  
Bone Response ◽  
First Choice ◽  
Significant Difference

Background. Pure titanium continues to be the first choice for dental implants and represents the gold standard for their biocompatibility and physical and mechanical characteristics, while the titanium alloy (Ti6Al4V) has good mechanical properties. The surface structure of the titanium oxide layer formation on the surface influences and improves the bone response around dental implants. Purpose. The purpose of this study is to evaluate the influence of a thermal treatment of Ti6Al4V implant surfaces and the bone healing response in a rabbit model. Methods. Altogether sixteen implants with same design were inserted into the distal femoral metaphysis. A screw (13 mm long, 4 mm in diameter) was inserted in an implant bed. Each rabbit received two implants, one in the left femur and one in the right femur. The samples were histologically and histomorphometrically evaluated at 8 weeks. Results. A statistically significant difference (p = 0.000034) was present histologically in the percentages of bone-implant contact (BIC) between the test group (BIC = 69.25±4.49%.) and control group (BIC = 56.25 ± 4.8%) by one-way analysis of variance (ANOVA). Significance was set at p ≤ 0.05. Conclusions. The outcome of the present study indicates a novel approach to improving bone healing around titanium implants.

Differences of US-FNA BSRTC class, postoperative pathology, and mutation landscape of thyroid nodules between China and other countries.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 3055-3055
Author(s):  
Yuntao Song ◽  
Jie Liu ◽  
Weiran Wang ◽  
Tonghui Ma
Keyword(s):  
United States ◽  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Malignant Tumors ◽  
The United States ◽  
Braf V600e ◽  
Class V ◽  
Ras Mutation ◽  
First Choice ◽  
Significant Difference

3055 Background: Ultrasound and ultrasound-guided fine needle aspiration (US-FNA) are the first choice for judging benign and malignant thyroid nodules. This study will report on the differences of US-FNA BSRTC class, postoperative pathology and mutation landscape of thyroid nodules between China and other countries. Methods: We conducted a prospective study containing 383 FNA samples of thyroid nodules. For most of these FNA samples, genomic DNA and RNA were extracted and sequenced with FSZ-Thyroid NGS Panel V1, and postoperative pathology were followed up. Moreover, we also compared results of this study with those of West China Hospital in China, Yamashita Thyroid Hospital in Japan, and Cleveland Clinic in the United States. Results: Among the 383 FNA samples, the proportions of BSRTC class I to VI were 10.7%, 6.3%, 18.8%, 3.7%, 12.3%, and 48.3% respectively. Compared with study in other countries, the proportion of class II was significantly lower than that in Japan and the United States. Meanwhile, the proportion of class V and VI were significantly higher than the above two countries. Subsequently, 232 thyroid nodules were surgically removed. Postoperative pathology showed that the proportion of malignant tumors (85.3%) was also significantly higher than reported in Japan and the United States. But compared with other studies in China, there was no significant difference. Most of the malignant tumors were papillary thyroid cancer (PTC, 96%), accompanied with 2 follicular thyroid cancer (FTC), 3 medullary cancer (MTC) and 3 anaplastic thyroid cancer (ATC). Compared with study in the United States, the proportion of PTC and FTC were elevated (96% vs. 85.3%) and reduced (1% vs. 9.3%) respectively. At last, we also analysis the mutation landscape of 180 malignant tumors. Compared with TCGA study, the frequency of BRAF V600E in PTC in our study was significantly higher than that of TCGA (73.3% vs. 58%), and the frequency of RAS mutation was significantly lower (1.2% vs. 12.6%). And compared with an institutional experience of ThyroSeq v3 for Bethesda III and IV at the University of Pittsburgh Medical Center, the frequency of BRAF V600E and RAS mutation in Bethesda III-IV malignant tumors was also significantly higher (45.8% vs. 1.4%) and lower (8.3% vs. 47.1%). Conclusions: There were significant differences in BSRTC class and postoperative pathology between China and other countries, such as Japan and the United States. The possible reasons included that the indications for FNA in China were different. For example, most of patients who underwent FNA in this study had suspicious clinical/ultrasound features. So the proportion of BSRTC class V and VI as well as the malignant rate were elevated. On the other hand, more BRAF V600E and less RAS mutations were detected in malignant tumors in this study which might result from racial differentiation and discrepancy in proportion of PTC and FTC.

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