Long term survivors with metastatic pancreatic adenocarcinoma treated with gemcitabine: a retrospective analysis

<p>Abstract</p> <p>Background</p> <p>Metastatic pancreatic adenocarcinoma has a short median overall survival (OS) of 5–6 months. However, a subgroup of patients survives more than 1 year. We analyzed the survival outcomes of this subgroup and evaluated clinical and pathological factors that might affect survival durations.</p> <p>Methods</p> <p>We identified 20 patients with metastatic or recurrent pancreatic adenocarcinoma who received single-agent gemcitabine and had an OS longer than 1 year. Baseline data available after the diagnosis of metastatic or recurrent disease was categorized as: 1) <it>clinical/demographic data </it>(age, gender, ECOG PS, number and location of metastatic sites); 2) <it>Laboratory data </it>(Hematocrit, hemoglobin, glucose, LDH, renal and liver function and CA19-9); 3) <it>Pathologic data </it>(margins, nodal status and grade); 4) <it>Outcomes data </it>(OS, Time to Treatment Failure (TTF), and 2 year-OS). The lowest CA19-9 levels during treatment with gemcitabine were also recorded. We performed a univariate analysis with OS as the outcome variable.</p> <p>Results</p> <p>Baseline logarithm of CA19-9 and total bilirubin had a significant impact on OS (HR = 1.32 and 1.31, respectively). Median OS and TTF on gemcitabine were 26.9 (95% CI = 18 to 32) and 11.5 (95% CI = 9.0 to 14.3) months, respectively. Two-year OS was 56.4%, with 7 patients alive at the time of analysis.</p> <p>Conclusion</p> <p>A subgroup of patients with metastatic pancreatic cancer has prolonged survival after treatment with gemcitabine. Only bilirubin and CA 19-9 levels were predictive of longer survival in this population. Further analysis of potential prognostic and predictive markers of response to treatment and survival are needed.</p

Geopolitics of the digital economy: Implications for states and firms

The lack of boundaries in cyberspace contributes to geopolitical disputes, as data and technology are weaponized across borders, and hacking of critical infrastructure becomes pervasive. But we lack a framework for understanding the tangible impact of geopolitical tensions and digital proxy conflict on states and firms. We argue that governments and companies can gain insights into these tensions by examining who controls the main structural power pillars of the international political economy: production, security, knowledge, and finance. Based on this approach, we consider how policymakers and practitioners can engage and navigate digital geopolitics in an age of uncertainty

Treatment and Outcomes of Non-Small-Cell Lung Cancer Patients with High Comorbidity

Background: The life expectancy of untreated non-small-cell lung cancer (NSCLC) is dismal, while treatment for NSCLC improves survival. The presence of comorbidities is thought to play a significant role in the decision to treat or not treat a given patient. We aim to evaluate the association of comorbidities with the survival of patients treated for NSCLC. Methods: We performed a retrospective study of patients aged ≥66 years with invasive NSCLC between the years 2007 and 2011 in the Surveillance, Epidemiology, and End Results Kentucky Cancer Registry. Comorbidity was measured using the Klabunde Comorbidity Index (KCI), and univariate and multivariate logistic regression models were used to measure association between receiving treatment and comorbidity. Kaplan-Meier plots were constructed to estimate time-to-event outcomes. Results: A total of 4014 patients were identified; of this, 94.9% were white and 55.7% were male. The proportion of patients who did not receive any treatment was 8.7%, 3.9%, 19.1%, and 23.5% for stages I, II, III, and IV, respectively (p \u3c 0.0001). In multivariate analysis, older age, higher stage, and higher comorbidity (KCI ≥ 3) were associated with a lower likelihood of receiving any treatment. The median overall survival (OS) for untreated and KCI=0 was 17.7 months for stages I and II, 2.3 months for stage III, and 1.3 months for stage IV. The median OS for treated and KCI=0 was 58.9 months for stages I and II, 16.8 months for stage III, and 5.8 months for stage IV (p \u3c 0.01). Treatment was an independent predictor of OS in multivariate analysis that included KCI scores. Conclusion: Our data suggest that lung cancer patients may derive a survival benefit from therapies, regardless of the presence of comorbidities, although the degree of benefit seems to decrease with higher KCI scores

ESTUDO DA FRAGMENTAÇÃO FLORESTAL E ECOLOGIA DA PAISAGEM NA SUB-BACIA HIDROGRÁFICA DO CÓRREGO HORIZONTE, ALEGRE, ES.

This work had as objective to analyze and evaluate the structure of the landscape in the Hydrographic Sub-Basin of Córrego Horizonte, located in the city of Alegre, ES. The assessments were made by of indices or metrics of landscape ecology that describe the size and shape of the landscape, the abundance of each type of stain and spatial distribution of similar or different spots. First we obtained the shape of the study area, and then the scan was made of the fragments by the software ArcGis 9.3, and calculations of these areas. It was later made the mapping of forest fragments of the whole area of the Hydrographic Sub-Basin Córrego Horizonte. The indices were calculated by free extension ArcGIS entitled Patch Analyst. Were found nine (9) fragments, these being the total area of 250.32 hectares representing 19.01% of the total area. The indices calculated in this study were: area index, density and size, edge, shape, or inside the central area and proximity. The results showed a high variation in the sizes of the patches, in this area for both small fragments of approximately 1 hectare, as large fragments. The sizes of the central areas also showed high value of standard deviation, showing the great variability among the fragments.Este trabalho teve como o objetivo analisar e avaliar à estrutura da paisagem na sub-bacia hidrográfica do córrego Horizonte, localizado no município de Alegre, ES. A quantificação foi feita por meio dos índices ou métricas de ecologia da paisagem que descrevem o tamanho e forma das paisagens, a abundância de cada tipo de mancha e a distribuição espacial de manchas similares ou dissimilares. Primeiramente foi obtido o shape da área de estudo, em seguida foi feita a digitalização dos fragmentos pelo software ArcGis 9.3, e os cálculos das áreas destes. Posteriormente, foi feito o mapeamento dos fragmentos florestais de toda a área da sub-bacia hidrográfica do córrego Horizonte. Foi calculado os índices por meio da extensão gratuita para o ArcGis intitulada Patch Analyst. Foram encontradas nove (9) manchas, sendo a área total destes de 250,32 hectares, representando 19,01% da área total. Os índices calculados neste trabalho foram: índice de área, de densidade e tamanho, de borda, forma, área central ou interior e proximidade. Os resultados mostraram que houve uma elevada variação nos tamanhos das manchas, ou seja, nesta área há tanto fragmentos pequenos com aproximadamente 1 hectare, como fragmentos grande. Os tamanhos das áreas centrais também apresentaram alto valor de desvio padrão, mostrando a grande variabilidade existente entre os fragmentos

Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study.

BACKGROUND: Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer. PURPOSE: We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations. METHODS: Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment. RESULTS: 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the 'patient interval', individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the 'primary care interval', doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the 'secondary care interval', obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments. CONCLUSIONS: Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection

Experiences along the diagnostic pathway for patients with advanced lung cancer in the USA: a qualitative study.

BACKGROUND: Most patients with lung cancer are diagnosed at advanced stages. However, the advent of oral targeted therapies has improved the prognosis of many patients with lung cancer. PURPOSE: We aimed to understand the diagnostic experiences of patients with advanced lung cancer with oncogenic mutations. METHODS: Qualitative interviews were conducted with patients with advanced or metastatic non-small cell lung cancer with oncogenic alterations. Patients were recruited from online support groups within the USA. Interviews were conducted remotely or in person. Analysis used an iterative inductive and deductive process. Themes were mapped to the Model for Pathways to Treatment. RESULTS: 40 patients (12 male and 28 female) with a median age of 48 were included. We identified nine distinct themes. During the 'patient interval', individuals became concerned about symptoms, but often attributed them to other causes. Prolonged or more severe symptoms prompted care-seeking. During the 'primary care interval', doctors initially treated for illnesses other than cancer. Discovery of an imaging abnormality was a turning point in diagnostic pathways. Occasionally, severity of symptoms prompted patients to seek emergency care. During the 'secondary care interval', obtaining tissue samples was pivotal in confirming diagnosis. Delays in accessing oncology care sometimes led to patient distress. Obtaining genetic testing was crucial in directing patients to receive targeted treatments. CONCLUSIONS: Patients experienced multiple different routes to their diagnosis. Some patients perceived delays, inefficiencies and lack of coordination, which could be distressing. Shifting the stage of diagnosis of lung cancer to optimise the impact of targeted therapies will require concerted efforts in early detection

Ilium and femur osteosynthesis in crab-eating fox (Cerdocyon thous)

Background: Fractures and dislocations are common orthopedic conditions arising from traumas from anthropic interaction on wild species, such as those caused by road trampling. Among the treatments, osteosynthesis is considered the method of choice in the treatment of fractures, such as ilium body fractures and femoral fractures. Based on this context, with regard to the incidence of auto accidents and few studies describing osteosynthesis techniques for crab-eating fox, the present study aimed to report the osteosynthesis performed on the body of the ileum and femur of a wild specimen of Cerdocyon thous. Case: A female, adult, crab-eating fox (Cerdocyon thous), coming from wild life was referred to hospital care with a history of run over. After specific examinations, it was diagnosed a complete transverse femoral shaft fracture, an oblique ilium body fracture, a pubic and ischial fracture, and pelvic canal narrowing. The treatment instituted was osteosynthesis of the femoral and ilium body fractures through the use of a 2.7 mm locking plate and screws. In the postoperative period, radiographic examination was performed, where bone callus formation was observed in the 5th week and bone remodeling and consolidation in the 11th week. After 140 days of rehabilitation, the animal was able to be released in the wild, with effective return of function of the pelvic limbs. The release was performed by environmental agencies in a national natural reserve, using radio necklace monitoring Discussion: Osteosynthesis techniques and preoperative and postoperative management proved to be effective for the return of adequate function of the pelvic limbs in Cerdocyon thous. For wild animals, the use of internal orthopedic implants (plate and screws, for example) become the most suitable for osteosynthesis. They decrease the risks of complications resulting from the management, since they require minimal postoperative manipulation. Thus, they maintain the wild behavior of the animal even in captivity. Among the complications observed in the clinical case, we can mention the use of long plate in the osteosynthesis of the ilium body and the narrowing of the pelvic canal as the most relevant. In relation to the pelvic canal narrowing and the reproductive cycle of the species, the crab-eating fox presents monogamous behavior, gestation of 3 to 6 pups per litter and breastfeeding for approximately 3 months. Because litters are relatively large (number of individuals per calving), the pups are relatively small - approximately 120 g at birth -, so it is expected that no complications occur during the gestational period. The treatment of fractures with the use of locking plates was efficient, obtaining bone consolidation at 10 weeks postoperatively, thus corroborating the scientific descriptions for bone consolidation in canids. Finally, the destination for release and monitoring by radiotelemetry was a joint decision between the environmental agencies of the State and the Union. The release decision was based on the maintenance of the wild behavior without evidence of meekness of the specimen, the absence of sanitary restrictions, as well as the population biology and the genetic flow since the release of the animal was carried out near the rescue site. It is concluded that the surgical treatment instituted by the femoral and ilium osteosynthesis was effective for the Cerdocyon thous specimen, cu