Adverse Tumor Biology Associated with Mesenterico-Portal Vein Resection Influences Survival in Patients with Pancreatic Ductal Adenocarcinoma

Background

Although pancreatoduodenectomy (PD) with mesenterico-portal vein resection (VR) can be performed safely in patients with resectable pancreatic ductal adenocarcinoma (PDAC), the impact of this approach on long-term survival is controversial.

Patients and Methods

Analyses of a prospectively collected database revealed 122 consecutive patients with PDAC who underwent PD with (PD+VR) or without (PD?VR) VR between January 2004 and May 2012. Clinical data, operative results, and survival outcomes were analysed.

Results

Sixty-four (53 %) patients underwent PD+VR. The majority (84 %) of the venous reconstructions were performed with a primary end-to-end anastomosis. Demographic and postoperative outcomes were similar between the two groups. American Society of Anesthesiologists (ASA) score, duration of operation, intraoperative blood loss, and blood transfusion requirement were significantly greater in the PD+VR group compared with the PD?VR group. Furthermore, the tumor size was larger, and the rates of periuncinate neural invasion and positive resection margin were higher in the PD+VR group compared with the PD?VR group. Histological venous involvement occurred in 47 of 62 (76 %) patients in the PD+VR group. At a median follow-up of 29 months, the median overall survival (OS) was 18 months for the PD+VR group, and 31 months for the PD?VR group (p = 0.016). ASA score, lymph node metastasis, neurovascular invasion, and tumor differentiation were predictive of survival. The need for VR in itself was not prognostic of survival.

Conclusions

PD with VR has similar morbidity but worse OS compared with a PD?VR. Although VR is not predictive of survival, tumors requiring a PD+VR have more adverse biological features.     

Presence of both odor identification and detection deficits in Alzheimer's disease

Recent studies of Alzheimer's disease patients have demonstrated (a) marked structural and biochemical alterations in brain regions associated with olfactory function (including the olfactory bulb and entorhinal cortex) and (b) decrements in the ability to identify odorants. In light of such findings, we administered the University of Pennsylvania Smell Identification Test (UPSIT) and a forced-choice phenyl ethyl alcohol odor detection threshold test to a relatively large number of patients diagnosed, on the basis of stringent criteria, as having mild to moderately severe Alzheimer's disease. Compared to age-, gender-, and race-matched normal controls, these individuals evidenced consistent and marked decrements on both types of olfactory tests (ps less than 0.001). Surprisingly few of the patients were aware of their disorder, despite its appearance early in the disease process. These findings indicate that both odor identification and odor detection problems are present in dementia of the Alzheimer's type, and raise the possibility that the odor identification problem may be secondary to the odor detection problem.     

Intermetallics Formation during Solidification of Al-Si-Cu-Mg Cast Alloys

The present study was undertaken to examine the effect of iron, manganese, copper and magnesium on the microstructural characteristics of Al-11%Si-2%Cu-Mg-based alloy referred to as 396 under different working conditions. The results show that strontium (Sr) has high affinity to react with magnesium (Mg), resulting in reduced effectiveness as eutectic silicon modifier or age hardening agent. In addition, Sr alters the sequence of the precipitation of the α-AlFeMnSi phase from post-eutectic to pro-eutectic which would harden the soft α-Aluminum matrix. The mechanism is still under investigation. The interactions between iron (Fe) and Mg and Sr-Mg result in the formation of serval dissolvable intermetallics during the solutionizing treatment such as β-AlFeSi, π-AlFeMgSi and Q-AlMgSiCu phases. The study also emphasizes the role of modification and grain refining as well as intermetallics in porosity formation and hardness of samples aged in the temperature range 155–240 °C.