Outcome of neoadjuvant treatment for pancreatic cancer in elderly patients: comparative, observational cohort study.

BACKGROUND: Use of neoadjuvant therapy for elderly patients with pancreatic cancer has been debatable. With FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan, oxaliplatin) or gemcitabine plus nab-paclitaxel (GnP) showing tremendous effects in improving the overall survival of patients with borderline resectable and locally advanced pancreatic cancer, there is no definitive consensus regarding the use of this regimen in the elderly. METHODS: This study evaluated the eligibility of elderly patients with borderline resectable or locally advanced pancreatic cancer for neoadjuvant therapy. Patients registered in the database of pancreatic cancer at the University of Colorado Cancer Center, who underwent neoadjuvant treatment between January 2011 and March 2019, were separated into three age groups (less than 70, 70-74, 75 or more years) and respective treatment outcomes were compared. RESULTS: The study included 246 patients with pancreatic cancer who underwent neoadjuvant treatment, of whom 154 and 71 received chemotherapy with FOLFIRINOX and GnP respectively. Among these 225 patients, 155 were younger than 70 years, 36 were aged 70-74 years, and 34 were aged 75 years or older. Patients under 70 years old received FOLFIRINOX most frequently (124 of 155 versus 18 of 36 aged 70-74 years, and 12 of 34 aged 75 years or more; P < 0.001). Resectability was similar among the three groups (60.0, 58.3, and 55.9 per cent respectively; P = 0.919). Trends towards shorter survival were observed in the elderly (median overall survival time 23.6, 18.0, and 17.6 months for patients aged less than 70, 70-74, and 75 or more years respectively; P = 0.090). After adjusting for co-variables, age was not a significant predictive factor. CONCLUSION: The safety and efficacy of multiagent chemotherapy in patients aged 75 years or over were similar to those in younger patients. Modern multiagent regimens could be a safe and viable treatment option for clinically fit patients aged at least 75 years.

Recurrent persistent hypophosphatemia in a male-to-female transgender patient with anorexia nervosa: Case report.

Refeeding hypophosphatemia remains a serious and common complication during the early phases of nutritional rehabilitation and weight restoration for patients with anorexia nervosa. Typically, the risk of refeeding hypophosphatemia diminishes after the first 1-2 weeks of the refeeding process and thus, frequent monitoring serum phosphorus levels becomes less important as refeeding proceeds. Herein, we describe a case of persistent recurrent hypophosphatemia in a male-to-female transgender patient with severe anorexia nervosa. As transgender patients become increasingly seen in the realm of eating disorders, it is worth noting this phenomenon to mitigate adverse events.

Season's appreciations.

To follow the tradition set by the late Franz Halberg, highlights of research performed over the last year from his Minnesota Center are summarized. They illustrate the broad international cooperation enjoyed by his center and the diversity of applications of the discipline he founded. The results briefly summarized herein in the form of an annotated bibliography are a testimony that his legacy continues to live on and constitutes a tribute to his memory.

Cugini's syndrome in statu nascendi. Oratio contra morem prevalentem et pro chronobiologica ratione ad pressione sanguinis curandam. A plea against the prevailing custom and in favor of a chronobiological approach to treating blood pressure.

An increase in the circadian amplitude (A) of blood pressure (BP) had been reported to precede a rise in the circadian BP average (MESOR, M), as pre-hypertension in the stroke-prone Okamoto rat. In humans, children with a positive family history of high BP and/or related cardiovascular disease had, on average, a larger BP-A than children with a negative family history, and an elevated BP-A was associated with intermediate values of the left ventricular mass index (LVMI), whereas an elevation in BP-M was only observed for larger LVMI values. Against this background, with 24-hour ambulatory monitoring (ABPM) interpreted chronobiologically, Pietro Cugini (University La Sapienza of Rome, Italy) has reported an elevation of both the circadian BP-M and BP-A as occurring with a minimal change (hypertensive) retinopathy. He determined by cosinor the extent of predictable BP change within a day as BP-2A, estimated by the least squares fit of a 24-hour cosine curve to the data. As compared to controls without retinopathy, he found a retinal end-organ involvement associated with average systolic (S) / diastolic (D) BP-Ms of 124/76 vs. 112/72 mmHg, with corresponding SBP/DBP-As of 12/10 vs. 8/7 mmHg. We refer to "Cugini's syndrome", suggesting the need for clarification, preferably in longitudinal studies, of any generalizable sequence in end-organ involvement, that may occur in the course of the development of some human Vascular Variability Disorders (VVDs) of unknown etiology, that include an elevation of the circadian BP-A and/or BP-M, concomitantly or separately in a sequence with the BP-A increase preceding that in BP-M, as in models of high BP in the rat or vice versa. Seven-day half-hourly or hourly around-the-clock monitoring of BP and HR variability interpreted chronobiologically, C-ABPM, as a minimum, is recommended for routine medical care to detect VVDs consisting of 1. MESOR-hypertension, MH; 2. Circadian Hyper-Amplitude-Tension, CHAT (BP overswing); 3. odd timing of the circadian rhythm of BP but not that of HR; 4. above-threshold pulse pressure; and/or 5. below-threshold HR variability. All conditions are best determined by 24-hour/7-day or, when abnormality is detected, longer C-ABPM. Eventually, all conditions will need to be assessed in the light of reference values from gender- and age-matched peers, as is now the case for the fi rst three VVDs listed above. When C-ABPM is not practicable, a 7-day series of 3-hourly manual self-measurements during waking (and one measurement about mid-sleep) (C-MBPM) is recommended. When continuous monitoring becomes possible, as it is within the state of the science, detecting Cugini's syndrome will also become possible with the clarification as to whether any change in BP-M and/or BP-A occurs concomitantly or sequentially, with changes in BP-A anticipated to precede changes in BP-M.

The relationship between athletic participation and high school students' leadership ability.

This study examined the relationship between adolescents' participation in athletics and their leadership skills. In a sample of 60 suburban high school students, athletes demonstrated significantly greater leadership ability than did nonathletes (according to their mean scores on the Leadership Ability Evaluation). Female athletes showed greater leadership ability than did male athletes, although the difference between their scores was not statistically significant. The implications of these findings for school athletic programs are discussed.

Identity development of homosexual youth and parental and familial influences on the coming out process.

This paper examines the literature on identity development of homosexual youth, and parental and familial influences on the coming out process. Research indicates that homosexual adolescents who have a close relationship with their parents and families tend to come out at a younger age and to experience more positive identities than do those who have a poor relationship.

Effects of paternal absence on male adolescents' peer relations and self-image.

This study explores the extent to which adolescent males experience different peer adjustment and masculine self-image as a function of father deprivation. A sample of 40 middle school boys (20 father-present and 20 father-absent) rated each other on peer adjustment and masculine self-image. Results indicate that father-absent boys evidence a poorer sense of masculinity as well as poorer interpersonal relationships than do father-present boys.

Adolescent self-perception as a function of vision loss.

The potential effect of vision loss on adolescents' self-perception has been the subject of limited research. Several previous studies have failed to shed much light on this relationship. This study, utilizing a sample of adolescents with visual problems and a comparison sample with normal vision, found significant differences in dimensions of perceived self-concept between these groups. Some possible interpretations of these results are offered. The need for new research in this field of inquiry is emphasized.

Shope papilloma virus. II. A comparison of several methods for purification of the virus.

Four methods for preparation of Shope papilloma virus have been compared. These comprise: (1) alternate centrifugation at low and high speed after grinding with alundum and saline, (2) purification with a fluorocarbon after similar extraction, (3) extraction with the aid of 2-mercaptoethanol and purification by alternate low- and high-speed centrifugation, and (4) extraction with 2-mercaptoethanol followed immediately by centrifugation to equilibrium in CsCI. It is necessary to remove CsCI before chemical analysis, and this has been accomplished by chromatography on Sephadex G-75. After banding, the virus from preparation (4) appears homogeneous in the electron microscope. The deoxyribonucleic acid (DNA) contents of the preparations were (1) 7.8, (2) 8.3, (3) 8.0, and (4) 11.9 percent of total nucleoprotein. At equal inputs of DNA, there was no significant difference in infectivity of any of the preparations. Method (4) is simpler than the others and results in a higher yield of a homogeneous preparation.