Advances in pre-treatment evaluation of pancreatic ductal adenocarcinoma: a narrative review

Background and Objective: Despite advances in the multidisciplinary management of pancreatic cancer, overall prognosis remains poor, due to early progression of the disease. There is a need to also take action in staging, to make it increasingly accurate and complete, to define the setting of the therapeutic strategy. This review was planned to update the current status of pre-treatment evaluation for pancreatic cancer. Methods: We conducted an extensive review, including relevant articles dealing with traditional imaging, functional imaging and minimally invasive surgical procedures before treatment for pancreatic cancer. We searched articles written in English only. Data in the PubMed database, published in the period between January 2000 and January 2022, were retrieved. Prospective observational studies, retrospective analyses and meta-analyses were reviewed and analysed. Key Content and Findings: Each imaging modality (endoscopic ultrasonography, endoscopic retrograde staging laparoscopy) has its own diagnostic advantages and limitations. The sensitivity, specificity and accuracy for each image set are reported. Data that support the increasing role of neoadjuvant therapy (radiotherapy and chemotherapy) and the meaning of a patient-tailored treatment selection, based on tumour staging, are also discussed. Conclusions: A multimodal pre-treatment workup should be searched as it improves staging accuracy, orienting patients with resectable tumors towards surgery, optimizing patient selection with locally advanced tumors to neoadjuvant or definite therapy and avoiding surgical resection or curative radiotherapy in those with metastatic disease

Ejector characterization for refrigeration applications with natural refrigerants

Employing natural fluids in refrigerating plants at warm climate conditions sometimes impacts negatively on the system performance. Ejectors can play a key role in configurations aiming at improving the efficiency of such systems, however their geometry has to be optimized in order to gain the best benefit. Scope of this work is a numerical investigation on the geometry of the ejector in a cascade plant configuration with natural refrigerants, aiming at identifying the influence of various geometry aspects on the performance of the system. A one-dimensional model is employed for the ejector, while the performance of the refrigerating plant is evaluated in different operating conditions in order to seek the optimal configuration

Evidence of scavenging behaviour in crested porcupine

The vegetarian diet of many herbivorous mammals is supplemented with proteins of animal origin, especially in young individuals and in breeding females, to provide key proteins necessary for both growth and breeding. Among porcupine species, only the Cape porcupine (Hystrix africaeaustralis) has been observed to consume carrion flesh. From June to August 2019, a pigeon carcass was placed together with corn in 7 study settlements and near 2 monitored capture-traps, in order to assess the carrion flesh feeding habits of the crested porcupine (Hystrix cristata). Scavenging behaviour was recorded on four occasions. All the recorded individuals were adults and at least one was female. This demonstrates that the crested porcupine occasionally does eat flesh. Such evidence raises important questions concerning the relationship between feeding habits and the physiological needs of this herbivorous rodent

The Cepheids of NGC1866: A Precise Benchmark for the Extragalactic Distance Scale and Stellar Evolution from Modern UBVI Photometry

We present the analysis of multiband time-series data for a sample of 24 Cepheids in the field of the Large Magellanic Cloud cluster NGC1866. Very accurate BVI VLT photometry is combined with archival UBVI data, covering a large temporal window, to obtain precise mean magnitudes and periods with typical errors of 1-2% and of 1 ppm, respectively. These results represent the first accurate and homogeneous dataset for a substantial sample of Cepheid variables belonging to a cluster and hence sharing common distance, age and original chemical composition. Comparisons of the resulting multiband Period-Luminosity and Wesenheit relations to both empirical and theoretical results for the Large Magellanic Cloud are presented and discussed to derive the distance of the cluster and to constrain the mass-luminosity relation of the Cepheids. The adopted theoretical scenario is also tested by comparison with independent calibrations of the Cepheid Wesenheit zero point based on trigonometric parallaxes and Baade-Wesselink techniques. Our analysis suggests that a mild overshooting and/or a moderate mass loss can affect intermediate-mass stellar evolution in this cluster and gives a distance modulus of 18.50 +- 0.01 mag. The obtained V,I color-magnitude diagram is also analysed and compared with both synthetic models and theoretical isochrones for a range of ages and metallicities and for different efficiencies of core overshooting. As a result, we find that the age of NGC1866 is about 140 Myr, assuming Z = 0.008 and the mild efficiency of overshooting suggested by the comparison with the pulsation models.Comment: 13 pages, 10 figures, accepted in MNRAS (2016 January 14

Benign hereditary chorea and deletions outside NKX2-1 : what's the role of MBIP?

Heterozygous point mutations or deletions of the NKX2-1 gene cause benign hereditary chorea (BHC) or a various combinations of primary hypothyroidism, respiratory distress and neurological disorders. Deletions proximal to, but not encompassing, NKX2-1 have been described in few subjects with brain-lung-thyroid syndrome. We report on a three-generation Italian family, with 6 subjects presenting BHC and harboring a genomic deletion adjacent to NKX2-1 and including the gene MBIP, recently proposed to be relevant for the pathogenesis of brain-lung-thyroid syndrome. We observed a clear reduction of NKX2-1 transcript levels in fibroblasts from our patients compared to controls; this finding suggests that MBIP deletion affects NKX2-1 expression, mimicking haploinsufficiency caused by classical NKX2-1 related mutations

Vertical‑Surface Navigation in the Neotropical Whip Spider \u3ci\u3eParaphrynus laevifrons\u3c/i\u3e (Arachnida: Amblypygi)

Studies on whip spider navigation have focused on their ability to locate goal locations in the horizontal plane (e.g., when moving along the ground). However, many species of tropical whip spiders reside and move along surfaces in the vertical plane (e.g., trees). Under controlled laboratory conditions, the current study investigated the ability of the tropical whip spider, Paraphrynus laevifrons, to return to a home shelter on a vertical surface in the presence of numerous, similar, and competing refuge sites, as well as the distribution of navigational errors in the vertical, horizontal, and diagonal plane. We also assessed the relative importance of sensory cues originating from a previously occupied home shelter compared to the position of a previously occupied shelter in guiding shelter choice. It was found that P. laevifrons displays robust fidelity in relocating a home shelter on a vertical surface. When navigational errors did occur, they were not significantly different in all three directions. Additionally, cue-conflict test trials revealed that cues associated with an original home shelter, likely self-deposited chemical signals, were more important than sources of positional information in guiding the shelter choice of P. laevifrons

A Bio-Imaging Signature as a Predictor of Clinical Outcomes in Locally Advanced Pancreatic Cancer

Purpose: To evaluate the predictive value of 18F-FDG PET/CT semiquantitative parameters of the primary tumour and CA 19-9 levels assessed before treatment in patients with locally advanced pancreatic cancer (LAPC). Methods: Among one-hundred twenty patients with LAPC treated at our institution with initial chemotherapy followed by curative chemoradiotherapy (CRT) from July 2013 to January 2019, a secondary analysis with baseline 18F-FDG PET/CT was conducted in fifty-eight patients. Pre-treatment CA 19-9 level and the maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumour were measured. The receiving operating characteristics (ROC) analysis was performed to define the cut-off point of SUVmax, MTV, TLG and CA 19-9 values to use in prediction of early progression (EP), local progression (LP) and overall survival (OS). Areas under the curve (AUCs) were assessed for all variables. Post-test probability was calculated to evaluate the advantage for parameters combination. Results: For EP, CA 19-9 level > 698 U/mL resulted the best marker to identify patient at higher risk with OR of 5.96 (95% CI, 1.66–19.47; p = 0.005) and a Positive Predictive Value (PPV) of 61%. For LP, the most significant parameter was TLG (OR 9.75, 95% CI, 1.64–57.87, p = 0.012), with PPV of 83%. For OS, the most significant parameter was MTV (OR 3.12, 95% CI, 0.9–10.83, p = 0.07) with PPV of 88%. Adding consecutively each of the other parameters, PPV to identify patients at risk resulted further increased (>90%). Conclusions: Pre-treatment CA 19-9 level, as well as MTV and TLG values of primary tumour at baseline 18F-FDG PET/CT and their combination, may represent significant predictors of EP, LP and OS in LAPC patients

Psychological counseling in the Italian academic context: Expected needs, activities, and target population in a large sample of students

University psychological counseling (UPC) is receiving growing attention as a means to promote mental health and academic success among young adults and prevent irregular attendance and dropout. However, thus far, little effort has been directed towards the implementation of services attuned to students' expectations and needs. This work intends to contribute to the existing literature on this topic, by exploring the perceptions of UPC among a population of 39,277 students attending one of the largest universities in the South of Italy. Almost half of the total population correctly identified the UPC target population as university students, and about one third correctly expected personal distress to be the main need that UPC should target. However, a large percentage did not have a clear idea about UPC target needs, activities, and population. When two specific student subsamples were analyzed using a person-centered analysis, namely (i) those who expressed their intention to use the counseling service but had not yet done so and (ii) those who had already used it, the first subsample clustered into two groups, characterized by an "emotional" and a "psychopathological" focus, respectively, while the second subsample clustered into three groups with a "clinical", "socioemotional", and "learning" focus, respectively. This result shows a somewhat more "superficial" and "common" representation of UPC in the first subsample and a more "articulated" and "flexible" vision in the second subsample. Taken together, these findings suggest that UPC services could adopt "student-centered" strategies to both identify and reach wider audiences and specific student subgroups. Recommended strategies include robust communication campaigns to help students develop a differentiated perception of the available and diverse academic services, and the involvement of active students to remove the barriers of embarrassment and shame often linked to the stigma of using mental health services