Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis

AbstractObjectivesCriteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour.MethodsA total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS).ResultsMedian OS was 23.0months. Median tumour size was 6.5cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6months vs. 32.7months (P= 0.020) and 10.7months vs. 32.7months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7months vs. 30.0months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1months vs. 10.7months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio4.07, 95% confidence interval 1.60–10.40; P= 0.003).ConclusionsLymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy

Awareness of health effects of cooking smoke among women in the Gondar Region of Ethiopia: a pilot survey

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Building blocks of change : The energy, health, and climate co-benefits of more efficient brickmaking in Bangladesh

The brick manufacturing industry in Bangladesh is characterized by informal inefficient coal-burning kilns that emit substantial greenhouse gases and air pollution. Despite decades of regulatory measures and the promotion of advanced kiln technologies, informal kilns persist. We employed a multiphase, interdisciplinary, mixed-methods approach to identify solutions. In this paper, we first summarize past approaches and discuss the key barriers we identified to improving the industry, then we present the design, and results of a randomized pilot energy efficiency intervention designed to overcome barriers to improved kiln operation. Our approach emphasized collaborating with informal zigzag kiln owners, who constitute the majority of brick producers, and carefully considering their incentives for changing a profitable business model. The intervention achieved high (60 %), including from non-study kilns, highlighting its appeal. Our findings provide insights into key elements for a successful intervention strategy that can be applied in larger-scale studies, not only for brick manufacturing but also for addressing broader environmental and health challenges

Emissions from South Asian Brick Production

Thirteen South Asian brick kilns were tested to quantify aerosol and gaseous pollutant emissions. Particulate matter (PM_2.5), carbon monoxide (CO), and optical scattering and absorption measurements in the exhaust of six kiln technologies demonstrate differences in overall emission profiles and relative climate warming resulting from kiln design and fuel choice. Emission factors differed between kiln types, in some cases by an order of magnitude. The kilns currently dominating the sector had the highest emission factors of PM_2.5 and light absorbing carbon, while improved Vertical Shaft and Tunnel kilns were lower emitters. An improved version of the most common technology in the region, the zig-zag kiln, was among the lowest emitting kilns in PM_2.5, CO, and light absorbing carbon. Emission factors measured here are lower than those currently used in emission inventories as inputs to global climate models; 85% lower (PM_2.5) and 35% lower for elemental carbon (EC) for the most common kiln in the region, yet the ratio of EC to total carbon was higher than previously estimated (0.96 compared to 0.47). Total annual estimated emissions from the brick industry are 120 Tg CO₂, 2.5 Tg CO, 0.19 Tg PM_2.5, and 0.12 Tg EC

Cyst location and presence of high grade dysplasia or invasive cancer in intraductal papillary mucinous neoplasms of the pancreas: a seven institution study from the central pancreas consortium

Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with "high risk stigmata" (HRS) or "worrisome features" (WF) are referred for resection. We aim to assess if IPMN location is predictive of harboring either high grade dysplasia (HGD) or invasive cancer (IC). Patients undergoing resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were analyzed. HRS and WF were defined by the 2012 Fukuoka international consensus guidelines. 168 (61%) patients had head/uncinate cysts, while 107 (39%) had neck/body/tail cysts. No differences were noted between groups with regard to age, duct type, cyst size, or presence of at least one WF. Patients with cysts in the head/uncinate were more often male (55% vs. 40%), had at least one HRS (24% vs. 11%), and more often harbored HGD or IC(49% vs. 27%)[all p < 0.05]. On multivariate analysis, only cyst location in the head/uncinate remained associated with presence of HGD or IC(odds ratio 4.76, p = 0.02). Cyst location is predictive of HGD or IC in patients with IPMNs. Head/uncinated cysts are more likely to harbor malignancy compared to those of the neck/body/tail. Additional studies are needed to confirm these findings, however, cyst location should be considered part of the decision making process for surveillance vs. resection for IPMNs