Natural history of intra-abdominal fluid collections following pancreatic surgery

Background Little data are available for non-abscess abdominal fluid collections (AFCs) after pancreatic surgery and their clinical implications.We sought to analyze the natural history of such collections in a population of patients subject to routine postoperative imaging. Methods From 1995 to 2011, 709 patients underwent pancreatic resections and routine postoperative monitoring with abdominal ultrasound according to a unit protocol. AFCs were classified as asymptomatic (no interventional treatment), symptomatic (need for percutaneous drainage of sterile, amylase-poor fluid), and pancreatic fistula (drainage of amylase-rich fluid). Results Ninety-seven of 149 AFCs (65 %) were asymptomatic and resolved spontaneously after a median follow-up of 22 days (interquartile range, 9–52 days). Among 52 (35 %) AFCs requiring percutaneous drainage, there were 20 pancreatic fistulas and 32 symptomatic collections. A stepwise logistic regression model identified three factors associated with the need for interventional treatment, i.e., body mass index ≥25 (odds ratio, 3.23; 95 % confidence interval (CI), 1.32 to 7.91), pancreatic fistula (odds ratio, 2.93; 95 % CI, 1.20 to 7.17), and biliary fistula (odds ratio, 3.92; 95 % CI, 1.35 to 11.31). Conclusions One fourth of patients develop various types of non-abscess AFCs after pancreatic surgery. Around half of them are asymptomatic and resolve spontaneously

A change in management perspective on the implementation of the employee capital plans in Poland

PURPOSE: The purpose of this paper is to demonstrate how a change management perspective contributes new understandings about the Employee Capital Plans (PPK) implementation processes in Poland, especially their efficiency measured by participation of the employees.DESIGN/METHODOLOGY/APPROACH: For the research, methods of critical literature analysis, statistical methods, as well as description and explanation methods have been used.FINDINGS: In financial terms, the PPK program turned out to be very beneficial for its participants in the analyzed period. However, contrary to the assumptions of change leaders, it has not been universal so far and covered slightly more than 25% of those eligible to participate. The attitude of employers related to the introduction of the PPK in their workplace remains crucial.PRACTICAL IMPLICATIONS: Bad experience related to the reduction and expected liquidation of OFE (second, funded pillar of the public pension system) exacerbated the problem of the lack of trust in the Polish pension system. A cross-party agreement on retirement security should be built so that citizens regain faith in the state and its institutions.ORIGINALITY/VALUE: The implementation of a new company pension scheme can be explored from various aspects. Most often, analyzes are conducted from the perspective of pension economics (the impact of a new pension scheme on the level of financial security of elderly people and on the increase of savings in national economy). The added value of the article is the assessment of the Employee Pension Plans implementation as a change management process.peer-reviewe

CD44+ cytokeratin-positive tumor cells in blood and bone marrow are associated with poor prognosis of patients with gastric cancer

Background The phenotypic heterogeneity of circulating tumor cells (CTC) in peripheral blood and disseminated tumor cells (DTC) in bone marrow is an important constraint for clinical decision making. Here, we investigated the implications of two different subpopulations of these cells in gastric cancer (GC). Methods GC patients (n=228) who underwent elective gastric resections were prospectively examined for CTC/DTC. The cells obtained from peripheral blood and bone marrow aspirates were sorted by flow cytometry and CD45- cells expressing cytokeratins (8, 18, and 19) and CD44 were identified by immunofluorescent double staining. Results Ninety-three (41%) patients had cytokeratin-positive tumor cells in either blood or bone marrow, while cells expressing CD44 were found in 22 (10%) cases. CK+CD44+ cells were significantly more common among patients with distant metastases (50 vs 19%, P=0.001), while no such correlations were demonstrated for CK+CD44- cells. Detection of CK+CD44+ cells, but not CK+CD44-, was associated with significantly shortened survival. Moreover, the Cox proportional hazards model identified CK+CD44+ cells as a negative prognostic factor with an odds ratio of 2.38 (95% CI 1.28-4.41, P=0.006). Conclusion CD44+ phenotype of cytokeratin-positive cells in blood and bone marrow is an independent prognostic factor in patients with gastric cancer

The outcomes of three-dimensional conformal radiotherapy for early-stage non-small-cell lung cancer patients eligible and ineligible for stereotactic body radiotherapy

Wstęp: Radioterapia stereotaktyczna (SBRT) daje obiecujące, porównywalne z leczeniem chirurgicznym, wyniki u chorych na niedrobnokomórkowego raka płuca (NDRP) we wczesnych stopniach zaawansowania. Jednak nie wszyscy chorzy z tej grupy kwalifikują się do tej metody leczenia. Dokonano retrospektywnej oceny wyników radioterapii konformalnej (3D-CRT) u chorych na NDRP w I i II stopniu zaawansowania, ze szczególnym uwzględnieniem wyników chorych, którzy byliby kandydatami do SBRT, lecz u których z braku dostępu do tej techniki zastosowano 3D-CRT. Materiał i metody: Oceniono kolejnych 132 chorych na NDRP (I&#8211;II stopień) napromienianych radykalnie techniką 3D-CRT w latach 1998&#8211;2009. Stosowano różne schematy napromieniania. W związku z tym dokonano przeliczenia dawek na dawki biologicznie równoważne (BED). W grupie tej 68 chorych spełniało kryteria napromieniania techniką SBRT (obwodowy guz T1&#8211;3N0, średnica &#163; 5 cm). Przeżycie całkowite i wolne od progresji miejscowej oszacowano metodą Kaplana-Meiera dla całej grupy oraz grupy spełniającej kryteria i niespełniającej kryteriów SBRT. Dokonano oceny czynników rokowniczych w analizie jedno- i wielowariantowej. Wyniki: Mediana BED w całej grupie wyniosła 74 Gy (58&#8211;82 Gy). Chorzy spełniający kryteria SBRT mieli mniejszą objętość guza niż pozostali (p < 0,00001). Trzyletnie przeżycie całkowite i przeżycie wolne od progresji miejscowej wyniosły odpowiednio 37% i 50%. Porównując grupy potencjalnie kwalifikujące się i niekwalifikujące się do SBRT, uzyskano znamienną statystycznie różnicę jedynie w 3-letnim przeżyciu bez progresji miejscowej (odpowiednio 58% i 35%, p = 0,04). W analizie wielowariantowej tylko objętość guza, stan ogólny i stopień zaawansowania miały statystycznie znamienny związek z miejscową wyleczalnością. Wnioski: Wykazano poprawę wyleczalności miejscowej po zastosowaniu techniki 3D-CRT w przypadku guzów spełniających kryteria kwalifikacji do SBRT w stosunku do pozostałych. Jednak również w tych przypadkach miejscowa wyleczalność była gorsza od podawanych w piśmiennictwie wyników SBRT. Pneumonol. Alergol. Pol. 2011; 79, 5: 326&#8211;336Introduction: Stereotactic body radiotherapy (SBRT) in early-stage non-small-cell lung cancer (NSCLC) results in promising outcomes, comparable with the outcomes of surgery. However, not all such patients are good candidates for this treatment. We conducted a retrospective evaluation of the outcomes of three-dimensional conformal radiotherapy (3D-CRT) in patients with stage I/II NSCLC with a special focus on the outcomes of patients who were eligible for SBRT but received 3D-CRT due to the unavailability of the former. Material and methods: We evaluated 132 consecutive patients with stage I/II NSCLC who had received radical 3D-CRT between 1998 and 2009. As various radiotherapy schedules had been used, biologically equivalent doses (BEDs) were calculated for all the patients. A total of 68 patients were eligible for SBRT (peripheral T1-3 N0 tumours < 5 cm in diameter). Overall survival (OS) and local progression free survival (LPFS) were estimated using Kaplan-Meier methodology for the entire study population and for the groups eligible and ineligible for SBRT. Univariate and multivariate analyses were performed for the prognostic factors. Results: Median BED in the study population was 74 Gy (58&#8211;82 Gy). Patients eligible for SBRT had a significantly lower gross tumour volume (GTV) than the other patients (p < 0.00001). Three-year OS and LPFS were 37% and 50%, respectively. When we compared patients eligible for SBRT and those ineligible for SBRT the only significant difference was for three-year LPFS (58% v. 35%, p = 0.04). Multivariate analysis showed that only GTV, performance status and tumour stage were significantly correlated with local curability. Conclusions: We showed an improved local control following 3D-CRT in patients eligible for SBRT compared to the other patients. However, also in these cases, local control was inferior compared to the outcomes of SBRT reported in the literature. Pneumonol. Alergol. Pol. 2011; 79, 5: 326&#8211;33

Nanomechanical sensing of the endothelial cell response to anti-inflammatory action of 1-methylnicotinamide chloride

There is increasing evidence that cell elastic properties should change considerably in response to chemical agents affecting the physiological state of the endothelium. In this work, a novel assay for testing prospective endothelium-targeted agents in vitro is presented. The proposed methodology is based on nanoindentation spectroscopy using an atomic force microscope tip, which allows for quantitative evaluation of cell stiffness. As an example, we chose a pyridine derivative, 1-methylnicotinamide chloride (MNA), known to have antithrombotic and anti-inflammatory properties, as reported in recent in vivo experiments. First, we determined a concentration range of MNA in which physiological parameters of the endothelial cells in vitro are not affected. Then, cell dysfunction was induced by incubation with tumor necrosis factor-alpha (TNF-α) and the cellular response to MNA treatment after TNF-α incubation was studied. In parallel to the nanoindentation spectroscopy, the endothelium phenotype was characterized using a fluorescence spectroscopy with F-actin labeling, and biochemical methods, such as secretion measurements of both nitric oxide (NO), and prostacyclin (PGI2) regulatory agents. We found that MNA could reverse the dysfunction of the endothelium caused by inflammation, if applied in the proper time and to the concentration scheme established in our investigations. A surprisingly close correlation was found between effective Young's modulus of the cells and actin polymerization/depolymerization processes in the endothelium cortical cytoskeleton, as well as NO and PGI_{2] levels. These results allow us to construct the physiological model of sequential intracellular pathways activated in the endothelium by MNA

Feasibility and outcomes of early oral feeding after total gastrectomy for cancer

Background Little data are available supporting the feasibility and safety of early oral feeding in patients after total gastrectomy. The aim of this study was to analyze the potential applicability of early provision of oral diet in these settings. Methods Medical records of 353 patients who underwent total gastrectomy for gastric cancer between 2006 and 2012 were retrospectively analyzed. Early oral feeding was defined as clear liquid diet on postoperative day (POD) 1 followed by gradual introduction of solid diet on POD 2 to 3. Late oral feeding was defined as initiation of liquid diet from POD 4 to 6 and gradually advancing to solid diets. Results Early oral feeding was implemented in 185 of 353 (52 %) patients. Prompt provision of food did not increase the risk of anastomotic failure (odds ratio 0.924, 95 % confidence interval 0.609–1.402, P=0.709). The number of reoperations and inhospital mortality rates was unaffected by the timing of nutritional intervention. Early feeding tended to be associated with fewer surgical (15 vs 24 %, P=0.027) and general (8 vs 23 %, P<0.001) complications. However, subsequent multivariate regression models failed to confirm significant correlations between timing of oral meals and postoperative morbidity. Conclusion Our findings suggested that early oral feeding is feasible and safe after total gastrectomy for gastric cancer. However, benefits of such early nutritional interventions require further studies