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Nature Communications Feb 2024Studying survivorship and causes of death in patients with advanced or metastatic cancer remains an important task. We characterize the causes of death among patients...
Studying survivorship and causes of death in patients with advanced or metastatic cancer remains an important task. We characterize the causes of death among patients with metastatic cancer, across 13 cancer types and 25 non-cancer causes and predict the risk of death after diagnosis from the diagnosed cancer versus other causes (e.g., stroke, heart disease, etc.). Among 1,030,937 US (1992-2019) metastatic cancer survivors, 82.6% of patients (n = 688,529) died due to the diagnosed cancer, while 17.4% (n = 145,006) died of competing causes. Patients with lung, pancreas, esophagus, and stomach tumors are the most likely to die of their metastatic cancer, while those with prostate and breast cancer have the lowest likelihood. The median survival time among patients living with metastases is 10 months; our Fine and Gray competing risk model predicts 1 year survival with area under the receiver operating characteristic curve of 0.754 (95% CI [0.754, 0.754]). Leading non-cancer deaths are heart disease (32.4%), chronic obstructive and pulmonary disease (7.9%), cerebrovascular disease (6.1%), and infection (4.1%).
Topics: Male; Humans; Cause of Death; Breast Neoplasms; Risk Factors; Causality; Heart Diseases
PubMed: 38374318
DOI: 10.1038/s41467-024-45307-x -
Nature Communications Feb 2024The development of vascular networks in microfluidic chips is crucial for the long-term culture of three-dimensional cell aggregates such as spheroids, organoids,...
The development of vascular networks in microfluidic chips is crucial for the long-term culture of three-dimensional cell aggregates such as spheroids, organoids, tumoroids, or tissue explants. Despite rapid advancement in microvascular network systems and organoid technologies, vascularizing organoids-on-chips remains a challenge in tissue engineering. Most existing microfluidic devices poorly reflect the complexity of in vivo flows and require complex technical set-ups. Considering these constraints, we develop a platform to establish and monitor the formation of endothelial networks around mesenchymal and pancreatic islet spheroids, as well as blood vessel organoids generated from pluripotent stem cells, cultured for up to 30 days on-chip. We show that these networks establish functional connections with the endothelium-rich spheroids and vascular organoids, as they successfully provide intravascular perfusion to these structures. We find that organoid growth, maturation, and function are enhanced when cultured on-chip using our vascularization method. This microphysiological system represents a viable organ-on-chip model to vascularize diverse biological 3D tissues and sets the stage to establish organoid perfusions using advanced microfluidics.
Topics: Microfluidics; Organoids; Tissue Engineering; Endothelium; Islets of Langerhans
PubMed: 38365780
DOI: 10.1038/s41467-024-45710-4 -
Cureus Jan 2024Introduction Diabetes mellitus (DM) is a chronic condition brought on by either insufficient insulin production by the pancreas or inefficient insulin utilization by the...
Introduction Diabetes mellitus (DM) is a chronic condition brought on by either insufficient insulin production by the pancreas or inefficient insulin utilization by the body. A hormone called insulin controls blood sugar. Patients with type 1 or type 2 diabetes frequently experience diabetes complications, which are also a major cause of morbidity and mortality. Microvascular and macrovascular problems of diabetes are the two main categories, with the former having a significantly higher prevalence than the latter. In contrast to macrovascular problems, which include cardiovascular disease, stroke, and peripheral artery disease (PAD), microvascular sequelae include neuropathy, nephropathy, and retinopathy. The occurrence of a foot ulcer coupled with neuropathy, PAD, and infection is known as diabetic foot (DF) syndrome, and it is a primary factor in lower limb amputation. Finally, there are additional diabetes problems that fall outside of the two categories listed before, including birth defects, dental disease, and decreased infection resistance. Aim This study aimed to evaluate the awareness of diabetic patients in the Qassim region about diabetic foot and its complications. Patient and methods This retrospective cohort study was conducted between January 2021 and January 2022 among diabetic patients. The patients were contacted through the contact numbers listed in their medical charts at the Diabetic Center in King Saud Hospital in Unaizah and the Diabetes Center in King Fahad Specialist Hospital. The data were collected by sending the link to the targeted patients using the Google Form questionnaire. Results Of the 384 diabetic patients, 51.6% were females, and 28.6% were aged between 18 and 30 years old. A previous history of foot ulcers has been reported by 10.4%. The overall mean score was 11.3 (SD 2.99) out of 20 points, with poor, moderate, and good awareness levels constituting 25.8%, 66.4%, and 7.8%, respectively. Factors associated with increased awareness include younger age, female gender, having no associated chronic disease, and not experiencing soreness on the foot or leg. Conclusion There was modest awareness among the diabetic population regarding diabetes foot care and its complications. Independent significant predictors of increased knowledge include younger age, female gender, having no associated chronic disease, and not experiencing soreness on the foot or leg. Increased diabetic education is vital to improving awareness levels of diabetic foot complications.
PubMed: 38357091
DOI: 10.7759/cureus.52306 -
International Wound Journal Feb 2024At present, it is regarded as a safe and efficient operation to treat terminal pancreatic disease. In this paper, we present a summary of the results of the clinical... (Meta-Analysis)
Meta-Analysis
At present, it is regarded as a safe and efficient operation to treat terminal pancreatic disease. In this paper, we present a summary of the results of the clinical trials that have been conducted to evaluate the efficacy of laparoscopic and open-access pancreatic resection for pancreatic carcinoma of the end of the pancreas. Systematic review of the comparison between laparoscopy and open-access pancreatic resection was conducted. Comparative studies published before October 2023 were included. The selection of the studies was done according to a particular classification and exclusion criterion. A few of our results, which were post-surgery, were associated with injury, were compared. Where appropriate, the reliability of the data has been corroborated by a sensitive analysis. Six trials of 2075 patients with pancreatic cancer who underwent distal pancreatic resection to be included in the definitive data analysis. Among them, 447 were treated with open-access surgery and 296 were treated with laparoscope. Six trials showed that there was no statistically significant difference in the risk of postoperative wound infection in patients with pancreas cancer who received a distal pancreatectomy between laparoscopy and open surgery(OR, 1.66; 95% CI, 0.76-3.61 p = 0.20). Four trials did not reveal any statistically significant differences in the risk of postoperative haemorrhage among patients with pancreas cancer who received a distal pancreatectomy between laparoscopy and open surgery (OR, 1.84; 95% CI, 0.54-6.26 p = 0.33). Both trials did not reveal any statistically significant difference in the duration of operation for patients with pancreas cancer who received a distal pancreatectomy between laparoscopy and open surgery (MD, 13.58; 95% CI, -7.31-34.46 p = 0.2). Based on these meta-analyses, the use of laparoscopy or open surgery was not associated with an increase in the risk of postoperative infection or haemorrhage. Furthermore, the duration of the two operations did not differ significantly. These two procedures appear to be a safe and viable choice in the treatment of pancreatic carcinoma. Nevertheless, a randomized, controlled study should be performed to verify the validity of this observation.
Topics: Humans; Pancreatectomy; Reproducibility of Results; Pancreatic Neoplasms; Pancreas; Laparoscopy; Postoperative Complications; Treatment Outcome
PubMed: 38351522
DOI: 10.1111/iwj.14708 -
Maedica Dec 2023Duodenopancreatectomy is a surgical procedure that involves the removal of part of the pancreas, duodenum, and bile ducts. This procedure is commonly performed in...
Duodenopancreatectomy is a surgical procedure that involves the removal of part of the pancreas, duodenum, and bile ducts. This procedure is commonly performed in patients with pancreatic cancer or other gastrointestinal disorders. However, the safety and efficacy of duodenopancreatectomy in older adults (octogenarians) remain unclear. The goal of this review is to assess the outcomes and complications of duodenopancreatectomy in octogenarian patients. A systematic search of relevant literature was conducted using PubMed, Embase and the Cochrane Library databases. Studies reporting the outcomes and complications of duodenopancreatectomy in octogenarian patients were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Egger's test was used to evaluate publication bias. A total of 14 studies were included in this review. The outcomes of duodenopancreatectomy in octogenarian patients were generally favorable, with a median 30-day mortality rate of 3.5% (range 0-16.7%). The most common complications were pancreatic fistula (12.2%), delayed gastric emptying (6.3%) and wound infection (5.5%). The overall long-term survival rate of octogenarian patients after duodenopancreatectomy was 21.2%. Duodenopancreatectomy can be safely performed in carefully selected octogenarian patients with good outcomes. However, this procedure is associated with a high risk of complications, particularly pancreatic fistula, in this age group.
PubMed: 38348067
DOI: 10.26574/maedica.2023.18.4.705 -
JFMS Open Reports 2024This report describes the case of a 7-year-old male neutered domestic mixed-breed cat that was initially referred to the Veterinary Hospital of the State University of...
CASE SUMMARY
This report describes the case of a 7-year-old male neutered domestic mixed-breed cat that was initially referred to the Veterinary Hospital of the State University of Londrina for evaluation of a 2-week history of abdominal distension and a 2-day history of anorexia, infected with feline immunodeficiency virus (FIV). Abdominal ultrasound revealed an expansive mass located around the pancreas and right hepatic lobe. In the transoperative macroscopic observation, multiple white nodules were visualized in the liver, pancreas, mesentery, intestine, stomach and peritoneal wall. Immunohistochemical examination revealed that neoplastic cells demonstrated a strong positivity for AE1/AE3 and CK20. A sparse immunoreactivity to chromogranin A was observed, which demonstrates neuroendocrine cell labeling. The histopathologic changes associated with the immunohistochemical profile confirmed the diagnosis of metastatic carcinoma with neuroendocrine differentiation, originating from the pancreas.
RELEVANCE AND NOVEL INFORMATION
Neuroendocrine tumors of the pancreas are rare and are associated with a poor prognosis in humans. In humans, approximately 7% of neuroendocrine tumors develop in the pancreas, and the 5-year survival rate for a pancreatic neuroendocrine tumor is 53%, according to the American Cancer Society. To our knowledge, only one case has been described in the feline species so far. Due to the rarity of this type of tumor in cats, there is little information about predisposition related to age, sex or breed, as well as the main clinical signs presented, survival time and treatment options.
PubMed: 38344074
DOI: 10.1177/20551169231213504 -
Journal of Cystic Fibrosis : Official... Feb 2024Relieving gastrointestinal symptoms is a research priority in cystic fibrosis. Emerging evidence highlights effects of cystic fibrosis transmembrane conductance...
BACKGROUND
Relieving gastrointestinal symptoms is a research priority in cystic fibrosis. Emerging evidence highlights effects of cystic fibrosis transmembrane conductance regulator (CFTR) modulators on gastrointestinal function, including pancreatic sufficiency. This study explores ivacaftor licensing and treatment on recorded pancreatic enzyme replacement therapy (PERT) prescription in the US and UK CF registries.
METHODS
Retrospective longitudinal registry study of recorded pancreatic PERT use between 2008 and 2017. Interrupted time series analysis in propensity-matched cohorts estimated annual change and step change according to ivacaftor eligibility before and after licensing year, 2012. Generalised estimating equations assessed adjusted risk of PERT use in individuals treated with ivacaftor after 2012 compared to untreated individuals.
RESULTS
In the US CF registry, the difference in annual change in prevalence of PERT use post-2012 between eligible cases and ineligible controls was -5.0 per 1000 people/year (95 %CI -7.6; -2.3, p = 0.001). The step change and annual change in prevalence of PERT use in eligible cases was not significantly different to controls in the UK CF registry. Relative to the relationship in 2013, ivacaftor treatment in the US CF registry was associated with a lower adjusted risk ratio of PERT use compared to untreated individuals by 2016 (0.97, 95 %CI 0.96; 0.99), which was not observed in the UK CF registry.
CONCLUSIONS
Licensing of ivacaftor was followed by a lower prevalence of PERT use in the eligible US population compared to pre-licensing period, as well as lower risk of PERT use in those who received treatment. Inconsistencies in US and UK CF registries were observed.
PubMed: 38342635
DOI: 10.1016/j.jcf.2024.01.011 -
Cureus Jan 2024A 54-year-old man was admitted for fever and dyspnea. He presented with severe COVID-19 pneumonia and elevated amylase and lipase levels. He received treatment for...
A 54-year-old man was admitted for fever and dyspnea. He presented with severe COVID-19 pneumonia and elevated amylase and lipase levels. He received treatment for COVID-19 and possible acute pancreatitis (AP). Although pneumonia and amylase levels improved, a high-grade fever persisted. On day 39, abdominal CT revealed heterogenous liquid and non-liquid components with a well-defined wall around the pancreas, and he was diagnosed with infected walled-off necrosis (WON) after AP. It was concluded to be associated with COVID-19 because there were no identifiable causes, such as alcohol consumption, gallstones, or other viral infections. The necrotic collection and fever improved after endoscopic transgastric drainage and necrosectomy. SARS-CoV-2 is becoming recognized as a new etiological infectious factor for AP, and COVID-19-associated AP shows higher severity and mortality. Clinicians should evaluate COVID-19 patients for concomitant AP, and if it is present, they should carefully monitor the development of local complications, including WON.
PubMed: 38327952
DOI: 10.7759/cureus.51889 -
Determining the Risk Factors of Complications Due to Endoscopic Retrograde Cholangiopancreatography.Cureus Jan 2024Background and objective The effective use of endoscopic retrograde cholangiopancreatography (ERCP) has been on the rise in diagnosing and treating benign and malignant...
Background and objective The effective use of endoscopic retrograde cholangiopancreatography (ERCP) has been on the rise in diagnosing and treating benign and malignant pathologies of the common bile duct and pancreas. ERCP, a complex procedure requiring high knowledge, skills, and practice, differs from other endoscopic applications as it involves the use of different techniques and equipment and the occurrence of more complications. The most commonly observed complications of ERCP are pancreatitis, bleeding, perforation, and infections. In this study, we aimed to assess the incidence of post-ERCP complications to identify the associated risk factors and indications. Methodology In this study, 181 ERCP procedures performed on 122 consecutive patients in the endoscopy unit of Istanbul Training Hospital were prospectively evaluated by using an observational method to determine the frequency of and risk factors for post-ERCP complications. The patients were followed up in the course of the ERCP procedure and for 30 days after the procedure; the complications and clinical developments were recorded. Results The mean age of the cohort was 59.7 ± 17.7 (19-97) years; 40.9% were female and 59.1% were male. The cannulation success was achieved in 77.3% of the ERCP procedure performed. Among the ERCP procedures applied, 89% were performed for therapeutic purposes, and choledocholithiasis (60.2%) was the most common indication for ERCP. Major complications were detected in 25.4% of the patients after ERCP. The most common major complication was cholangitis (9.9%), followed by pancreatitis (7.2%), cholecystitis (5.5%), bleeding (3.9%), and perforation (1.1%). It was observed that sphincterotomy was associated with an increase in all complications. The incidence of cholangitis decreased in the presence of dilated bile ducts unrelated to obstruction. The increased incidence of pancreatitis was associated with the female gender, the use of sphincterotomy and basket, inexperienced endoscopists, and inpatient admissions. The incidence of cholecystitis, on the other hand, was found to be linked with sphincterotomy and inexperienced endoscopists. Conclusions ERCP is a complex endoscopic procedure that requires high technical knowledge and skill and can cause serious complications. For endoscopists to perform clinically effective and accurate ERCP, it is important that they correctly determine the indications for the procedure, know its potential complications, and refrain from practices that will create complications and are unnecessary as much as possible.
PubMed: 38313949
DOI: 10.7759/cureus.51666