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

Modelling persistent organic pollutants (POPS) at the local, regional and global scales

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Climate change influence on POPs distribution and behaviour : a case study.

Climate change has the potential of affecting the behaviour and distribution of organic pollutants, including POPs. Direct effects of climate change, like temperature increase, modification of wind and precipitation patterns, sea level rise, snow and ice cover, may be very effective in altering the partitioning of POPs among the environmental compartments. Other consequences of future climate scenarios may imply the alteration of degradation rates, soil properties (and hence land use), air-particle partitioning of chemicals and so forth. A case study is here presented to illustrate the major implications of climate change on the long term at the local scale. A dynamic multimedia model was applied to selected PCB and PCDD/F congeners to simulate the effects of climate change on their distribution and fluxes over the next 50 y in the Venice Lagoon (Italy). Different climate change scenarios were tested, finding noticeable variations in POPs concentration even for minor environmental changes. PCBs and PCDFs environmental concentrations may differ by a factor two in a moderate climate change scenario, compared to a situation with stable climate over the next 50 y. However, model results also suggest that if global warming may have the potential of reducing the environmental levels of these chemicals, it would probably enhance their mobility and hence their potential for long range atmospheric transport

Introducing an integrated climate change perspective in POPs modelling, monitoring and regulation.

This paper presents a review on the implications of climate change on the monitoring, modelling and regulation of persistent organic pollutants (POPs). Current research gaps are also identified and discussed. Long-term data sets are essential to identify relationships between climate fluctuations and changes in chemical species distribution. Reconstructing the influence of climatic changes on POPs environmental behaviour is very challenging in some local studies, and some insights can be obtained by the few available dated sediment cores or by studying POPs response to inter-annual climate fluctuations. Knowledge gaps and future projections can be studied by developing and applying various modelling tools, identifying compounds susceptibility to climate change, local and global effects, orienting international policies. Long-term monitoring strategies and modelling exercises taking into account climate change should be considered when devising new regulatory plans in chemicals management. Climate change implications on POPs are addressed here with special attention to monitoring, modelling and regulation issues

Modified end-to-side double-layer open pancreaticogastrostomy after Whipple procedure: surgical tips for a safe anastomosis

Pancreatic fistula (PF) remains the Achilles' heel of pancreaticoduodenectomy (PD). Pancreaticogastrostomy (PG) appears to be associated with a lower risk of postoperative leak according to recent evidence. We started to fashion PG, especially in soft pancreas, modifying the original technique described by Bassi. At our institution, 105 PD procedures were carried out from January 2011 to December 2016; pancreatic-enteric continuity was restored by PG in 35 cases. Superior mesenteric/portal vein resection/reconstruction was necessary in three patients. A total of 34/35 patients underwent PG with an open anterior gastrostomy approach. Briefly, our double-layer PG anastomosis (illustrated by a video) starts with a posterior row of interrupted absorbable 4/0 monofilament sutures including the gastric serosa and the pancreatic capsule. It is essential to mobilize the left pancreas for 4-5 cm and to shape the posterior gastrostomy shorter than the pancreatic stump. After a wide anterior auxiliary gastrostomy the pancreas is invaginated into the stomach and an interrupted row of sutures between the posterior gastric wall (full-thickness) and the body of the pancreatic stump is fashioned. The anterior gastrostomy is closed with an absorbable running suture. Finally, a further layer of sutures is applied over the posterior suture line between the gastric serosa and the pancreatic capsule. The 90-day postoperative mortality was nihil. No biliary leakage was detected and the overall PF rate was 11.4% (4/35) according to the ISGPF study group. Only one patient suffered a grade B PF (in this case, PG was carried out only through a posterior gastrostomy), whereas three patients had a minor (grade A) PF. Our modified PG proved to be safe and easy to perform, while it carried excellent outcomes even in the setting of soft pancreas. Despite the limited number of cases, such modified PG appears promising, particularly for pancreatic remnants at higher risk of PF

Challenges in assessing release, exposure and fate of silver nanoparticles within the UK environment

There are significant challenges in assessing the fate and exposure of nanoparticles (NPs) in the environment owing to the lack of information on their use, potential pathways and sinks in the environment. In order to better understand the environmental exposure of silver nanoparticles (AgNPs), we reviewed the uses and potential exposure sources of both Ag and AgNPs. The approach taken was to identify the range of products that utilise its properties, identify potential environmental release pathways and subsequent fate once released into the environment. We then compared measured environmental concentrations with modelled concentrations from our work and others. We estimate that within the United Kingdom (UK) a total quantity of 8.8 tonnes per year of AgNPs is released from products containing AgNPs and enters UK waste water systems. Sewage sludge was identified as an important receiving compartment. Agricultural land with sludge applied was estimated to have a yearly increase in AgNP concentration of 36 [small mu ]g per kg per year. Available ecotoxicity data for soil and the predicted environmental concentrations are used to perform a risk characterisation. This work highlights the on-going challenges faced when undertaking a risk assessment of AgNPs in the environment

Coastal vulnerability assessment to climate change: from global to regional scale.

Recent concerns about potential climate-change effects on coastal systems require the application of vulnerability assessment tools in order to define suitable adaptation strategies and improve coastal zone management effectiveness. In fact, while various research efforts were devoted to evaluate coastal vulnerability to climate change on a national to global level, fewer applications were carried out so far to develop more comprehensive and site-specific vulnerability assessments suitable to plan possible adaptation measures at the regional scale. In this respect, specific indicators are needed to address climate-change-related issues for coastal zones and to identify vulnerable areas at the regional level. Two sets of coastal vulnerability indicators were selected, one for regional and one for global studies, respectively, concerning the same features of coastal systems, including topography and slope, geomorphological characteristics, presence and distribution of wetlands and vegetation cover, density of coastal population and number of coastal inhabitants. The proposed set of indicators for the regional scale was chosen taking into account the availability of environmental and territorial data for the whole coastal area of the Veneto region and was based on site-specific datasets characterized by a spatial resolution appropriate for a regional analysis. Moreover, a GIS-based segmentation procedure was applied to divide the coastline into linear segments, homogeneous in terms of vulnerability to climate change and sea-level rise at the regional scale. This approach allowed to divide the Veneto shoreline into 140 segments with an average length of about 1 km, while the global scale approach identified four coastal segments with an average length of about 66 km. The performed comparison indicated how the more detailed approach adopted at the regional scale is essential to understand and manage the complexities of the specific study area. In fact, the 25-m DEM employed at the regional scale provided a more accurate differentiation of the coastal area's elevation and thus of coastal susceptibility to the inundation risks, compared to the 1-km DEM used at the global level. Moreover, at the regional level the use of a 1:20,000 geomorphological map allowed to differentiate the unique landform class detected at the global level (e.g., fluvial plain) in a variety of more detailed coastal typologies (e.g., open coast eroding sandy shores backed by bedrock) characterized by a different sensitivity to climate change and sea-level rise. Accordingly, the information provided by regional indicators can support decision-makers in improving the management of coastal resources by considering the potential impacts of climate change and in the definition of appropriate actions to reduce inundation risks, to avoid the potential loss of valuable wetlands and vegetation and to plan the nourishment of sandy beaches subject to erosion processes

Temporal trends in the sources of PCDD/Fs to and around the Venice Lagoon.

Two salt marsh cores were collected from the Venice Lagoon, Italy, and analysed for PCDD/Fs. The samples were undisturbed and had an approximately constant accumulation rate. Radiochemical chronologies were established for the different core sections. The PCDD/F pattern in the surficial layers was very similar to that of atmospheric deposition measured in the same area. However, the pattern changed with increasing depth and was very different in the deeper sections, where the highest PCDD/F concentrations were measured. This layer was dated around the 1950s. Deeper layers have a profile similar to the surficial one. Undisturbed salt marsh cores appear to be a reliable tool for the reconstruction of temporal trends in the atmospheric deposition of persistent organic pollutants. It is proposed that the trends in the core reflect atmospheric deposition that probably results from the sum of two different contributions: emissions of the industrial district of Porto Marghera on the edge of the lagoon and the regional background

Reconstruction of historical trends of PCDD/Fs and PCBs in the Venice Lagoon, Italy.

Historical trends of PCDD/Fs and PCBs from the year 1900 have been reconstructed for the Venice Lagoon area by using a fugacity-based dynamic multimedia model. A novel approach to estimate the inputs to the system was applied. Emissions to the lagoon were estimated by studying dated sediment cores taken from salt marshes located in the lagoon area. These cores have recently proven to be a suitable tool to reconstruct the temporal trends of atmospheric deposition of POPs. According to the model, concentrations of PCBs and PCDD/Fs in air and water reflect the trends of their production and usage, peaking during the 1960s. The peaks in the sediment were delayed by 5–40 years depending on the congener. Predicted concentrations are in good agreement with experimental results. The most important input parameters, identified by a sensitivity analysis, are the degradation constants, Kow, the Henry's law constant, vapour pressure, active sediment depth, sediment resuspension, and deposition rates, and water residence time in the lagoon

Challenges in assessing the environmental fate and exposure of nano silver

There are significant challenges in assessing the fate and exposure of nano particles (NPs) owing to the lack of information on their use and potential pathways and sinks in the environment. This paper discusses these issues using nanosilver as a case study. The approach taken is to assess the production of nanosilver, the range of products that utilise its properties, potential environmental release pathways and subsequent fate. Estimates of UK nanosilver released into the environment have been made and sewage sludge identified as an important receiving compartment. This work aims to highlight the on-going challenges faced when assessing NPs in the environment. Using nanosilver as an example, difficulties in assessing production, use and release are discussed. The study also recommends a potential approach to assess the fate and behaviour assessment of nanosilver in the environment