Pancreas cancer treatment: a surgeon's perspective today.

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Validations of new cut-offs for surgical drains management and use of computerized tomography scan after pancreatoduodenectomy: The DALCUT trial

BACKGROUND Postoperative pancreatic fistula (POPF) is the most fearful complication after pancreatic surgery and can lead to severe postoperative complications such as surgical site infections, sepsis and bleeding. A previous study which identified cut-offs of drains amylase levels (DALs) determined on postoperative day (POD) 1 and POD3, was able to significantly predict POPF, abdominal collections and biliary fistulas, when related to specific findings detected at the abdominal computerized tomography (CT) scan routinely performed on POD3. AIM To validate the cut-offs of DALs in POD1 and POD3, established during the previous study, to assess the risk of clinically relevant POPF and confirm the usefulness of abdominal CT scan on POD3 in patients at increased risk of abdominal collection. METHODS The DALCUT trial is an interventional prospective study. All patients who will undergo pancreatoduodenectomy (PD) for periampullary neoplasms will be considered eligible. All patients will receive clinical staging and, if eligible for surgery, will undergo routine preoperative evaluation. After the PD, daily DALs will be evaluated from POD1. Drains removal and possible requirement of abdominal CT scans in POD3 will be managed on the basis of the outcome of DALs in the first three postoperative days. RESULTS This prospective study could validate the role of DALs in the management of surgical drains and in assessing the risk or relevant complications after PD. Drains could be removed in POD3 in case of POD1 DALs < 666 U/L and POD3 DALs < 207 U/L. In case of POD3 DALs & GE; 252, abdominal CT scan will be performed in POD3 to identify abdominal collections & GE; 5 cm. In this latter category of patients, drains could be maintained beyond POD3. CONCLUSION The results of this trial will contribute to a better knowledge of POPF and management of surgical drains

How can the technology be integrated in Outdoor Movement Education for children and the youth with special needs?

The technological innovations of the last decade have caused countless changes to everyone's lifestyle, especially in the number of hours spent in front of a screen. These generational differences are even more marked if the new generations of students are taken into consideration, in fact, even at the school level, technological innovations have brought changes. Just as lifestyle and teaching have changed, what is considered as the "needs" of pupils and how they live and relate both in formal and informal environments have also changed. Considering the emergency period caused by the COVID-19 pandemic, greater attention has been paid to the importance of exercising and everyone has also re-evaluated the beauty and benefits of exercising outdoors. Outdoor Movement Education in this sense can be a key that allows the new generations to experience the emotions and sensations that can be felt during outdoor moving activities. This work is a reflection on how technology can be a tool to increase the benefits in Outdoor Movement Education considering children and youth with special needs. The results of this work have shown how the use of technology in Outdoor Movement Education brings numerous advantages both under the didactic profile (i.e., life skills) and with regard to the cognitive (i.e., attention and concentration), motor (i.e., motor skills, fundamental movement skills) and affective (i.e., enjoyment) domains of learning respectively

Effects of two different physical education teaching approaches on the levels of enjoyment in the Italian primary school students

Physical education allows children to develop motor skills, but it has an impact on affective domain too. The aim of this study was to analyse the effects of two different teaching approaches on the levels of enjoyment of 9-year-old pupils who attended the fourth grade of the primary school. A pre- post- repost design was used as a mean of a longitudinal study. The participants involved were divided into two groups: Teaching skill group (TS) and Teaching games group (TGM). The TS group followed a protocol using the traditional skill-based approach, while the TGM group followed the Tactical Game Model approach, highlighting tactical problems and awareness. The level of enjoyment was assessed by administering the PACES questionnaire. The results show no statistically significant difference, but it can be seen that the TGM group had a more positive trend in enjoyment levels than the TS group. Furthermore, carrying out an analysis by gender it was seen that the females of the TGM group had increases in the scores on the positive scale in the post intervention. In this respect, the physical education teacher has to account for affective learning outcomes when they identify the teaching methods for their courses

Tactical Games Model as curriculum approach at elementary school: Effects on in-game volleyball technical improvements

Objective: To assess the effects of a tactical games model (TGM) instructional plan on technical volleyball performances of elementary school students by taking into account for sex. Method: Thirty-nine fourth-grade students participated in a 15-week unit developed according to TGM. Their improvements in technical in-game skills were assessed by means of Team Sport Assessment Procedure indexes: volume of play, efficiency index, and performance score. A 2(sex) x 3(time) ANOVA with repeated measure was used to verify the students’ improvements. Effect size measures were used to interpret main effects and post-hoc analysis. Results: An overall large improvement resulted at the end of the instructional period, and this improvement seems to remain at least until the end of summer vacation. In pre-post training comparison, the improvements had similar moderate to large effect for both groups, while outcomes ‘differences were negative between post-training and the end of summer vacation. Girls seem to achieve greater and well-established improvements throughout the instructional plan. Implications: Teachers have to take into account sex when designed their lessons because these factors can enhance student’s learning processes. Furthermore, the results suggested the need to design developmentally adequate learning experiences during summer vacation for avoiding detrimental effect on students’ learning scores

Modelling of a chemical looping combustion system equipped with a two- stage fuel reactor

The proper selection of the oxygen carrier and the correct design of the fuel reactor represent the main criticalities for the success of the chemical looping combustion (CLC) process for solid fuels. In a previous work (1) a two-stage fuel reactor (t-FR), consisting of two bubbling beds in series (bottom bed and top bed) (Fig. 1), has been proposed in order to overcome the limitations of a single-stage fuel reactor (poor char conversion, slip of unburnt volatiles, extensive elutriation of char fines). A mathematical model has been developed with the aim of assessing the performances of the two-stage fuel reactor varying operating conditions in comparison with a benchmark case consisting of a single-stage fuel reactor equipped with and without carbon stripper. The t-FR showed the best performances in terms of combustion efficiency, volatile matter and char conversion, carbon-to-CO2 conversion efficiency and loss of elutriated carbon for all the operating conditions investigated. In the present work a further enhancement of the model has been developed in order to study the hydrodynamics of the proposed multiple interconnected fluidized beds (MIFB) system for the CLC of solid fuels. The modelled system consists of the two-stage fuel reactor, a riser (Air Reactor) and non-mechanical valves for the regulation of the solid circulation between the two reactors. The different parts are considered as separate blocks mutually interconnected (Fig. 1). The operation of the system has been simulated by considering chemical looping combustion of a bituminous coal with an oxygen carrier consisting of CuO supported on zirconia. The numerical simulation has been addressed to evaluate (at steady state) the solid circulation rate, the temperature and oxidation degree of solids and concentrations profiles of gaseous species at the exit of both air and fuel reactors, with the utilization of proper constitutive equations for each block. Specific attention has been paid to the fluid dynamic behaviour of the t-FR. Results of the CLC-MIFB system with the t-FR are presented and the effects on the feasibility of the process of a variation in operating conditions are commented. Please click Additional Files below to see the full abstract

Neoadjuvant Treatments for Pancreatic Ductal Adenocarcinoma: Where We Are and Where We Are Going

Background: Pancreatic ductal adenocarcinoma (PDAC) represents a challenging disease for the surgeon, oncologist, and radiation oncologist in both diagnostic and therapeutic settings. Surgery is currently the gold standard treatment, but the role of neoadjuvant treatment (NAD) is constantly evolving and gaining importance in resectable PDACs. The aim of this narrative review is to report the state of the art and future perspectives of neoadjuvant therapy in patients with PDAC. Methods: A PubMed database search of articles published up to September 2022 was carried out. Results: Many studies showed that FOLFIRINOX or Gemcitabine-nab- paclitaxel in a neoadjuvant setting had a relevant impact on overall survival (OS) for patients with locally advanced and borderline resectable PDAC without increasing post-operative complications. To date, there have not been many published multicentre randomised trials comparing upfront surgery with NAD in resectable PDAC patients, but the results obtained are promising. NAD in resectable PDAC showed long-term effective benefits in terms of median OS (5-year OS rate 20.5% in NAD group vs. 6.5% in upfront surgery). NAD could play a role in the treatment of micro- metastatic disease and lymph nodal involvement. In this scenario, given the low sensitivity and specificity for lymph-node metastases of radiological investigations, CA 19-9 could be an additional tool in the decision-making process. Conclusions: The future challenge could be to identify only selected patients who will really benefit from upfront surgery despite a combination of NAD and surgery

Motor learning for the developmental age in coded spaces and times

The traditional teaching methods linked to motor education and based on the canonical transmission of knowledge and learning are now outdated. In fact, we could say that we emphasize all forms of learning that have a dynamic and concrete development in which all children can have a role as a 'protagonist'. The school increasingly conditioned by continuous social changes, cannot be lived only as a place of duplication and transmission of knowledge, but can be lived and organized as a space of creativity, fun and emotion as well as imagination also motor. "This teaching practice is often hampered by the school organization of places and times and by the training of teachers' skills" (Lipoma, 2014, p.201). The environment, therefore, must be organized and structured according to the needs of children and their age groups, full of materials, large and small tools where it is possible, however, above all to make concrete experiences experiencing successes and failures in a safe environment. Another fundamental element that distinguishes the success of motor learning is the time dedicated to the movement that lately is reduced and of little quality. “The time devoted to recreational activities has decreased and this is found not only in the school but also in moments of extra-school leisure where you notice the increase of games "sedentary" to the detriment of those engines" (Casolo, 2019, p.495)

The Protective Role of Butyrate against Obesity and Obesity-Related Diseases

Worldwide obesity is a public health concern that has reached pandemic levels. Obesity is the major predisposing factor to comorbidities, including type 2 diabetes, cardiovascular diseases, dyslipidemia, and non-alcoholic fatty liver disease. The common forms of obesity are multifactorial and derive from a complex interplay of environmental changes and the individual genetic predisposition. Increasing evidence suggest a pivotal role played by alterations of gut microbiota (GM) that could represent the causative link between environmental factors and onset of obesity. The beneficial effects of GM are mainly mediated by the secretion of various metabolites. Short-chain fatty acids (SCFAs) acetate, propionate and butyrate are small organic metabolites produced by fermentation of dietary fibers and resistant starch with vast beneficial effects in energy metabolism, intestinal homeostasis and immune responses regulation. An aberrant production of SCFAs has emerged in obesity and metabolic diseases. Among SCFAs, butyrate emerged because it might have a potential in alleviating obesity and related comorbidities. Here we reviewed the preclinical and clinical data that contribute to explain the role of butyrate in this context, highlighting its crucial contribute in the diet-GM-host health axis

CA19.9 Serum Level Predicts Lymph-Nodes Status in Resectable Pancreatic Ductal Adenocarcinoma: A Retrospective Single-Center Analysis

BackgroundThe choice between upfront surgery or neoadjuvant treatments (NAT) for resectable pancreatic ductal adenocarcinoma (R-PDAC) is controversial. R-PDAC with potential nodal involvement could benefit from NT. Ca (Carbohydrate antigen) 19.9 and serum albumin levels, alone or in combination, have proven their efficacy in assessing PDAC prognosis. The objective of this study was to evaluate the role of Ca 19.9 serum levels in predicting nodal status in R-PDAC.MethodsPreoperative Ca 19.9, as well as serum albumin levels, of 165 patients selected for upfront surgery have been retrospectively collected and correlated to pathological nodal status (N), resection margins status (R) and vascular resections (VR). We further performed ROC curve analysis to identify optimal Ca 19.9 cut-off for pN+, R+ and vascular resection prediction.ResultsIncreased Ca 19.9 levels in 114 PDAC patients were significantly associated with pN+ (p <0.001). This ability, confirmed in all the series by ROC curve analysis (Ca 19.9 >= 32 U/ml), was lost in the presence of hypoalbuminemia. Furthermore, Ca 19.9 at the cut off >418 U/ml was significantly associated with R+ (87% specificity, 36% sensitivity, p 0.014). Ca 19.9, at the cut-off >78 U/ml, indicated a significant trend to predict the need for VR (sensitivity 67%, specificity 53%; p = 0.059).ConclusionsIn R-PDAC with normal serum albumin levels, Ca 19.9 predicts pN+ and R+, thus suggesting a crucial role in deciding on NAT