Outcomes and risk score for distal pancreatectomy with celiac axis resection (DP-CAR) : an international multicenter analysis

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000-2016) and three very-high-volume international centers in the United States and Japan (model validation 2004-2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2-11%) at 5 high-volume (1 DP-CAR/year) and 18% (95 CI, 9-30%) at 18 low-volume DP-CAR centers (P=0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P=0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19months (95 CI, 15-25months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor

Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study

BACKGROUND: Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). METHODS: Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). RESULTS: We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10-37). We observed no impact of PHAE on ischemic complications. CONCLUSIONS: DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes

Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis

Background: Distal pancreatectomy with celiac axis resection (DP-CAR) is a treatment option for selected patients with pancreatic cancer involving the celiac axis. A recent multicenter European study reported a 90-day mortality rate of 16%, highlighting the importance of patient selection. The authors constructed a risk score to predict 90-day mortality and assessed oncologic outcomes. Methods: This multicenter retrospective cohort study investigated patients undergoing DP-CAR at 20 European centers from 12 countries (model design 2000–2016) and three very-high-volume international centers in the United States and Japan (model validation 2004–2017). The area under receiver operator curve (AUC) and calibration plots were used for validation of the 90-day mortality risk model. Secondary outcomes included resection margin status, adjuvant therapy, and survival. Results: For 191 DP-CAR patients, the 90-day mortality rate was 5.5% (95 confidence interval [CI], 2.2–11%) at 5 high-volume (≥ 1 DP-CAR/year) and 18% (95 CI, 9–30%) at 18 low-volume DP-CAR centers (P = 0.015). A risk score with age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) score, multivisceral resection, open versus minimally invasive surgery, and low- versus high-volume center performed well in both the design and validation cohorts (AUC, 0.79 vs 0.74; P = 0.642). For 174 patients with pancreatic ductal adenocarcinoma, the R0 resection rate was 60%, neoadjuvant and adjuvant therapies were applied for respectively 69% and 67% of the patients, and the median overall survival period was 19 months (95 CI, 15–25 months). Conclusions: When performed for selected patients at high-volume centers, DP-CAR is associated with acceptable 90-day mortality and overall survival. The authors propose a 90-day mortality risk score to improve patient selection and outcomes, with DP-CAR volume as the dominant predictor

Prevalence of pulmonary hypertension in dogs naturally infected with Angiostrongylus vasorum in Belgium

info:eu-repo/semantics/nonPublishe

Evaluation of Bioactive Compounds on Different Extracts of Linum Usitatissimum and Its Antimicrobial Properties against Selected Oral Pathogens

Background: Antibacterial agents from natural sources have been suggested as alternatives for treating infectious diseases due to their low side effects. Flaxseed (Linum usitatissimum) exhibits some antibacterial properties, but its effects against oral pathogens are poorly understood. This study investigated flaxseed extracts' antibacterial effects against such pathogens. Methods: Non-polar and polar extracts of flaxseed, with n-hexane, dichloromethane (DCM) and methanol (MeOH), were prepared by sequential Soxhlet extraction. All extracts were qualitatively screened through gas chromatography-mass spectrometry to detect bioactive compounds. Antibacterial activities of flaxseed extracts with different volumes per disc (Oxoid, Badhoevedorp, Netherlands) (5, 7, 10, 12 and 15 µL/disc) were evaluated against four different oral pathogens: Streptococcus pyogenes, Streptococcus mutans, Lactobacillus casei and Enterococcus faecalis, using the disc diffusion method. Flaxseed extracts' inhibitory activities against the tested oral pathogens were examined by measuring the inhibition zone diameter. Results: Polar extract (methanolic extract) demonstrated significant antibacterial activity (p<0.01) against all tested oral pathogens, with inhibition zones comparable to those for penicillin. In contrast, n-hexane and DCM extracts demonstrated variable antibacterial activities. Conclusions: This study suggests that Linum usitatissimum methanolic extract exhibited the best inhibitory activity on all tested strains compared to the other extracts

Zooplankton in the Polar Night

Pelagic communities play a key role in Arctic ecosystems. Although zooplankton occupy several different trophic levels in the food chain, their primary niche is often considered that of a link between pelagic and ice-associated primary production on one side and higher trophic levels on the other. In fact, most of the biological energy (organic carbon) ending up in top predators such as seabirds, fish and marine mammals have been funnelled through one or more zooplankton species. As such, zooplankton ecology is often viewed and understood in relation to primary production regimes. However, recent research has showed that processes occurring in the zooplankton community during winter are crucial for our understanding of Polar Night ecology. As a group, they are active throughout the entire year, they conduct various forms of vertical migration in relation to both the moon and solar background illumination and some species utilize the Polar Night for reproduction. Evidence of reproduction among short-lived omnivorous zooplankton species during Polar Night suggests that production is sustained by feeding opportunistically throughout winter and Polar Night and that life history strategies are tuned to support fast turnover rates and not on building up large lipid reserves. This chapter provides an overview of the main zooplankton taxa inhabiting Arctic waters during the Polar Night and describes the main processes typical for zooplankton taxa during the Polar Night