Systematic evaluation of radiological findings in the assessment of resectability of peri-ampullary cancer by CT using different contrast phase protocols

Aims: To determine the relative significance of radiological signs in determining the resectability of peri-ampullary cancer (PC) and to assess the value of multi-phase imaging in detecting these findings. Materials and Methods: Blinded, double re-reporting of pre-operative imaging from five hospitals was undertaken of 411 patients undergoing surgery for PC over an eight year period, of whom 119 patients were found to be inoperable at the time of surgery. Results: The median tumour size was 26.7 mm and the proportion of patients reported to have regional lymphadenopathy (RL), venous (VI) and arterial involvement (AI) was 24.7%, 11.5% and 3.9% respectively and was similar regardless of the number of contrast phases undertaken. Significant associations were however noted between individual risk factors: VI was closely associated with tumour size (p=0.002) and AI (p< 0.0001). In multi-variable analysis AI, VI and RL were independently associated with resectability (relative risk of resection =0.05, 0.31 and 0.51 respectively). Tumour size however was not associated with resectability when VI was included in the multivariate model

The effect of the inclusion of trunk-strengthening exercises to a multimodal exercise program on physical activity levels and psychological functioning in older adults: Secondary data analysis of a randomized controlled trial

Background Engaging in multimodal exercise program helps mitigate age-related decrements by improving muscle size, muscle strength, balance, and physical function. The addition of trunk-strengthening within the exercise program has been shown to significantly improve physical functioning outcomes. Whether these improvements result in improved psychological outcomes associated with increased physical activity levels requires further investigation. We sought to explore whether the inclusion of trunk-strengthening exercises to a multimodal exercise program improves objectively measured physical activity levels and self-reported psychological functioning in older adults. Method We conducted a secondary analysis within a single-blinded parallel-group randomized controlled trial. Sixty-four healthy older (≥ 60 years) adults were randomly allocated to a 12-week walking and balance exercise program with (n = 32) or without (n = 32) inclusion of trunk strengthening exercises. Each program involved 12 weeks of exercise training, followed by a 6-week walking-only program (identified as detraining). Primary outcome measures for this secondary analysis were physical activity (accelerometry), perceived fear-of-falling, and symptoms of anxiety and depression. Results Following the 12-week exercise program, no significant between-group differences were observed for physical activity, sedentary behaviour, fear-of-falling, or symptoms of anxiety or depression. Significant within-group improvements (adjusted mean difference [95%CI]; percentage) were observed in moderate-intensity physical activity (6.29 [1.58, 11.00] min/day; + 26.3%) and total number of steps per min/day (0.81 [0.29 to 1.33] numbers or + 16.3%) in trunk-strengthening exercise group by week 12. With respect to within-group changes, participants in the walking-balance exercise group increased their moderate-to-vigorous physical activity (MVPA) (4.81 [0.06 to 9.56] min/day; + 23.5%) and reported reduction in symptoms of depression (-0.26 [-0.49 to -0.04] points or -49%) after 12 weeks of the exercise program. The exercise-induced increases in physical activity levels in the trunk-strengthening exercise group were abolished 6-weeks post-program completion. While improvements in physical activity levels were sustained in the walking-balance exercise group after detraining phase (walking only). Conclusions The inclusion of trunk strengthening to a walking-balance exercise program did not lead to statistically significant between-group improvements in physical activity levels or psychological outcomes in this cohort following completion of the 12-week exercise program

Assessment of the effect of interval from presentation to surgery on outcome in patients with peri-ampullary malignancy

Background: Delay between diagnosis of peri-ampullary cancer (PC) and surgery may allow tumour progression and affect outcome. This study aims to explore associations of interval to surgery (IS) with pathological outcomes and survival in patients with PC. Method: A database review of all patients undergoing surgery between 2006 and 2014 was undertaken. IS was measured from diagnosis by imaging. Potential association between IS and survival was measured using Cox regression analysis, and between IS and pathological outcome with multivariate logistic analysis. Results: 388 patients underwent surgery. The median IS was 49 days (1-551 days), and was not associated with any of the evaluated outcomes in patients with pancreatic (149) or distal bile duct (46) cancer. For patients with ampullary cancer (71) longer IS was associated with improved survival, with median survival of 1.3, 3.1 and 4.3 years for patients waiting 2 (25) months for surgery (p=0.036). A higher rate of margin positivity (31.4%) was also noted among patients who waited less than the median IS compared to those waiting longer than this interval (11.4%) (p=0.032). Conclusion: For patients with ampullary cancer there is a paradoxical improvement in outcome among those with a longer IS, which may be explained by progression to inoperability of more aggressive lesions

Bayesian estimation of incomplete data using conditionally specified priors

In this paper, a class of conjugate prior for estimating incomplete count data based on a broad class of conjugate prior distributions is presented. The new class of prior distributions arises from a conditional perspective, making use of the conditional specification methodology and can be considered as the generalisation of the form of prior distributions that have been used previously in the estimation of in- complete count data well. Finally, some examples of simulated and real data are given

Variation in survival after surgery for peri-ampullary cancer in a regional cancer network

Background: Centralisation of specialist surgical services requires that patients are referred to a regional centre for surgery. This process may disadvantage patients who live far from the regional centre or are referred from other hospitals by making referral less likely and by delaying treatment, thereby allowing tumour progression. The aim of this study is to explore the outcome of surgery for peri-ampullary cancer (PC) with respect to referring hospital and travel distance for treatment within a network served by five hospitals. Methods: Review of a unit database was undertaken of patients undergoing surgery for PC between January 2006 and May 2014. Results: 394 patients were studied. Although both the median travel distance for patients from the five hospitals (10.8, 86, 78.8, 54.7 and 89.2 km) (p < 0.05), and the annual operation rate for PC (2.99, 3.29, 2.13, 3.32 and 3.07 per 100,000) (p = 0.044) were significantly different, no correlation was noted between patient travel distance and population operation rate at each hospital. No difference was noted between patients from each hospital in terms of resection completion rate or pathological stage of the resected tumours. The median survival after diagnosis for patients referred from different hospitals ranged from 1.2 to 1.7 years and regression analysis revealed that increased travel distance to the regional centre was associated with a small survival advantage. Conclusion: Although variation in the provision and outcome of surgery for PC between regional hospitals is noted, this is not adversely affected by geographical isolation from the regional centre

Trunk exercise training improves muscle size, strength, and function in older adults: A randomized controlled trial

The aim of this study was to assess the effectiveness of a multimodal exercise program to increase trunk muscle morphology and strength in older individuals, and their associated changes in functional ability. Using a single-blinded parallel-group randomized controlled trial design, 64 older adults (≥60 years) were randomly allocated to a 12-week exercise program comprising walking and balance exercises with or without trunk strengthening/motor control exercises; followed by a 6-week walking-only program (detraining; 32 per group). Trunk muscle morphology (ultrasound imaging), strength (isokinetic dynamometer), and functional ability and balance (6-Minute Walk Test; 30 second Chair Stand Test; Sitting and Rising Test; Berg Balance Scale, Multi-Directional Reach Test; Timed Up and Go; Four Step Square Test) were the primary outcome measures. Sixty-four older adults (mean [SD]; age: 69.8 [7.5] years; 59.4% female) were randomized into two exercise groups. Trunk training relative to walking-balance training increased (mean difference [95% CI]) the size of the rectus abdominis (2.08 [1.29, 2.89] cm 2 ), lumbar multifidus (L4/L5:0.39 [0.16, 0.61] cm; L5/S1:0.31 [0.07, 0.55] cm), and the lateral abdominal musculature (0.63 [0.40, 0.85] cm); and increased trunk flexion (29.8 [4.40, 55.31] N), extension (37.71 [15.17, 60.25] N), and lateral flexion (52.30 [36.57, 68.02] N) strength. Trunk training relative to walking-balance training improved 30-second Chair Stand Test (5.90 [3.39, 8.42] repetitions), Sitting and Rising Test (1.23 [0.24, 2.23] points), Forward Reach Test (4.20 [1.89, 6.51] cm), Backward Reach Test (2.42 [0.33, 4.52] cm), and Timed Up and Go Test (−0.76 [−1.40, −0.13] seconds). Detraining led to some declines but all outcomes remained significantly improved when compared to pre-training. These findings support the inclusion of trunk strengthening/motor control exercises as part of a multimodal exercise program for older adults

The Effect of Exercise Training on Lower Trunk Muscle Morphology

Skeletal muscle plays an important role in maintaining the stability of the lumbar region. However, there is conflicting evidence regarding the effects of exercise on trunk muscle morphology

Assessing changes in static and dynamic postural stability in youth football players following the FIFA 11+ injury prevention program

Objective To examine the effect of FIFA 11+ warm-up program on static and dynamic postural stability in football players. Equipment and methods: Thirty young male football players (mean ± SD; age: 14.96 ± 0.76 years were recruited and divided into two groups (FIFA 11+ exercise group, n = 15 and control group, n = 15). The exercise group performed the FIFA 11+ injury prevention exercises as part of their warm-up and the control group continued their traditional warm up routines. The FIFA 11+ exercises were performed three times a week, for eight weeks. A single leg test with eyes closed, on a force platform, was used to measure static postural stability measurement, and time to stability after single leg drop-landing test was used for dynamic postural stability measurement. Results The repeated measures (Anova) showed that the experimental group performed significantly better (adjusted mean difference [95% CI] or percentage %) in static postural stability (center of pressure displacement in the anterior-posterior direction [0.03 (95% CI 0.003 to 0.06), 8.56%] and medial-lateral [0.05 (95% CI 0.02 to 0.08), 9.19%]), and in dynamic postural stability (time to stability in the anterior-posterior direction [0.64 (95% CI 0.09 to 1.2), 15.82%] and medial-lateral [0.6 (95% CI 0.01 to 1.2), 18.92%]), compared with the control group. In conclusion, The FIFA 11+ injury prevention program may improve static and dynamic postural stability