Platelets as a prognostic factor for patients with adenocarcinoma of the gastroesophageal junction.

OBJECTIVE: The aim of this study was to investigate the prognostic role of plasma platelet count (PLT), mean platelet volume (MPV), and the combined COP-MPV score in patients with resectable adenocarcinomas of the gastroesophageal junction. BACKGROUND: Platelet activation, quantified by PLT and elevated MPV, plays an essential part in the biological process of carcinogenesis and metastasis. An increased preoperative COP-MPV is associated with poor survival in various tumor entities. METHODS: Data of 265 patients undergoing surgical resection for adenocarcinoma of the gastroesophageal junction were abstracted. COP-MPV score was defined for each patient. Utilizing univariate and multivariate Cox proportional hazard analyses, survival was determined. RESULTS: In univariate analysis, elevated PLT (HR 3.58, 95% CI 2.61-4.80, p<0.001) and increased COP-MPV (HR 0.27, 95% CI 0.17-0.42, p<0.001 and HR 0.42, 95% CI 0.29-0.60, p<0.001) significantly correlated with shorter patients' overall and disease-free survival, for all 256 patients, as well as in the subgroups of neoadjuvantly treated (p<0.001) and primarily resected patients (p<0.001). COP-MPV remained a significant prognostic factor in multivariate analysis for OS. However, PLT alone showed significant diminished OS and DFS in all subgroups (p<0.001) in univariate and multivariate analysis. CONCLUSION: PLT is a potent independent prognostic biomarker for survival in a large prospective cohort of patients with resectable adenocarcinoma of the gastroesophageal junction. Additionally, we confirm that the COP-MPV score is significantly associated with worse outcome in these patients, but has no benefit in comparison to PLT.

Incorporating Biogeochemistry into Dryland Restoration.

Dryland degradation is a persistent and accelerating global problem. Although the mechanisms initiating and maintaining dryland degradation are largely understood, returning productivity and function through ecological restoration remains difficult. Water limitation commonly drives slow recovery rates within drylands; however, the altered biogeochemical cycles that accompany degradation also play key roles in limiting restoration outcomes. Addressing biogeochemical changes and resource limitations may help improve restoration efforts within this difficult-to-restore biome. In the present article, we present a synthesis of restoration literature that identifies multiple ways biogeochemical understandings might augment dryland restoration outcomes, including timing restoration around resource cycling and uptake, connecting heterogeneous landscapes, manipulating resource pools, and using organismal functional traits to a restoration advantage. We conclude by suggesting ways to incorporate biogeochemistry into existing restoration frameworks and discuss research directions that may help improve restoration outcomes in the world's highly altered dryland landscapes.

Muted responses to chronic experimental nitrogen deposition on the Colorado Plateau.

Anthropogenic nitrogen (N) deposition is significantly altering both community structure and ecosystem processes in terrestrial ecosystems across the globe. However, our understanding of the consequences of N deposition in dryland systems remains relatively poor, despite evidence that drylands may be particularly vulnerable to increasing N inputs. In this study, we investigated the influence of 7 years of multiple levels of simulated N deposition (0, 2, 5, and 8 kg N ha-1 year-1) on plant community structure and biological soil crust (biocrust) cover at three semi-arid grassland sites spanning a soil texture gradient. Biocrusts are a surface community of mosses, lichens, cyanobacteria, and/or algae, and have been shown to be sensitive to N inputs. We hypothesized that N additions would decrease plant diversity, increase abundance of the invasive annual grass Bromus tectorum, and decrease biocrust cover. Contrary to our expectations, we found that N additions did not affect plant diversity or B. tectorum abundance. In partial support of our hypotheses, N additions negatively affected biocrust cover in some years, perhaps driven in part by inter-annual differences in precipitation. Soil inorganic N concentrations showed rapid but ephemeral responses to N additions and plant foliar N concentrations showed no response, indicating that the magnitude of plant and biocrust responses to N fertilization may be buffered by endogenous N cycling. More work is needed to determine N critical load thresholds for plant community and biocrust dynamics in semi-arid systems and the factors that determine the fate of N inputs.

Seasonal and individual event-responsiveness are key determinants of carbon exchange across plant functional types.

Differentiation in physiological activity is a critical component of resource partitioning in resource-limited environments. For example, it is crucial to understand how plant physiological performance varies through time for different functional groups to forecast how terrestrial ecosystems will respond to change. Here, we tracked the seasonal progress of 13 plant species representing C3 shrub, perennial C3 and C4 grass, and annual forb functional groups of the Colorado Plateau, USA. We tested for differences in carbon assimilation strategies and how photosynthetic rates related to recent, seasonal, and annual precipitation and temperature variables. Despite seasonal shifts in species presence and activity, we found small differences in seasonally weighted annual photosynthetic rates among groups. However, differences in the timing of maximum assimilation (Anet) were strongly functional group-dependent. C3 shrubs employed a relatively consistent, low carbon capture strategy and maintained activity year-round but switched to a rapid growth strategy in response to recent climate conditions. In contrast, grasses maintained higher carbon capture during spring months when all perennials had maximum photosynthetic rates, but grasses were dormant during months when shrubs remained active. Perennial grass Anet rates were explained in part by precipitation accumulated during the preceding year and average maximum temperatures during the past 48 h, a result opposite to shrubs. These results lend insight into diverse physiological strategies and their connections to climate, and also point to the potential for shrubs to increase in abundance in response to increased climatic variability in drylands, given shrubs' ability to respond rapidly to changing conditions.

Shrub persistence and increased grass mortality in response to drought in dryland systems.

Droughts in the southwest United States have led to major forest and grassland die-off events in recent decades, suggesting plant community and ecosystem shifts are imminent as native perennial grass populations are replaced by shrub- and invasive plant-dominated systems. These patterns are similar to those observed in arid and semiarid systems around the globe, but our ability to predict which species will experience increased drought-induced mortality in response to climate change remains limited. We investigated meteorological drought-induced mortality of nine dominant plant species in the Colorado Plateau Desert by experimentally imposing a year-round 35% precipitation reduction for eight continuous years. We distributed experimental plots across numerous plant, soil, and parent material types, resulting in 40 distinct sites across a 4,500 km2 region of the Colorado Plateau Desert. For all 8 years, we tracked c. 400 individual plants and evaluated mortality responses to treatments within and across species, and through time. We also examined the influence of abiotic and biotic site factors in driving mortality responses. Overall, high mortality trends were driven by dominant grass species, including Achnatherum hymenoides, Pleuraphis jamesii, and Sporobolus cryptandrus. Responses varied widely from year to year and dominant shrub species were generally resistant to meteorological drought, likely due to their ability to access deeper soil water. Importantly, mortality increased in the presence of invasive species regardless of treatment, and native plant die-off occurred even under ambient conditions, suggesting that recent climate changes are already negatively impacting dominant species in these systems. Results from this long-term drought experiment suggest major shifts in community composition and, as a result, ecosystem function. Patterns also show that, across multiple soil and plant community types, native perennial grass species may be replaced by shrubs and invasive annuals in the Colorado Plateau Desert.

A complex urban ecological investigation in a mid-sized Hungarian city - SITE assessment and monitoring of a liveable urban area, PART 1: Water quality measurement.

Urbanization and related environmental pollution have strong effects on stream systems by inducing short duration high-peak floods, raised levels of nutrients and contaminants, altered channel geomorphology, sediment dynamics, and reduced biotic richness. The main purpose of this current study is to detect stream contamination levels in a mid-sized Hungarian city by comparing the results of two separate years (2011, 2018). Discharge, channel geomorphology, and water quality parameters were measured, and load-based contamination was calculated for the city's main watercourse (Gaja Brook). The pH, CaCO3, texture, and heavy metal contents - Cd, Co, Cu, Ni, Pb, and Zn - were reanalysed in the sediment for both investigated years. For comparison, enrichment factors were used to determine sediment accumulation. As a complex parameter, biological water quality was also determined using BMWP and MMCP protocols in 2018. The results show that conductivity and the nutrient concentrations were higher, but the discharge values were lower in 2011 than in 2018. The nitrate load doubled both times in the brook between the first and the last sampling sites. The enrichment factors decreased or stagnated when the values of the two years were compared, but severe enrichment of Cd was detected in the middle of the city and south of the city. The aquatic macroinvertebrate fauna structure defined clean, but slightly impacted watercourses north and south of the city as well, but the abundance and presence of sensitive taxa differed at the sampling sites. Székesfehérvár has better than expected water quality, which can be attributed to the good ecological states of the hydromorphology and the streamside zone.

The interaction of drought and habitat explain space-time patterns of establishment in saguaro (Carnegiea gigantea).

The long-lived columnar saguaro cactus (Carnegiea gigantea) is among the most studied plants in the world. Long-term studies have shown saguaro establishment to be generally episodic and strongly influenced by precipitation and temperature. Water limitation through lower-than-average seasonal rainfall and elevated temperatures increasing evaporative loss can reduce survivorship of recent germinates. Thus, multi-year, extended drought could cause populations to decline as older saguaros die without replacement. Previous studies have related establishment to temporal variation in rainfall, but most studies have been on non-randomized plots in ideal habitat and thus might not have captured the full variability within the local area. We studied how saguaro establishment varied in space and which habitat features may buffer responses to drought on 36 4-ha plots located randomly across an elevation gradient, including substantial replication in landscape position (bajada, foothills, and slopes) in the two disjunct districts of Saguaro National Park in southern Arizona, USA. Recent, severe drought coincided with drastic declines in saguaro establishment across this ~25,000-ha area. Establishment patterns derived from the park-wide data set was strongly correlated with drought, but the Park's two districts and diversity of plots demonstrated substantially different population outcomes. Saguaro establishment was best explained by the interaction of drought and habitat type; establishment in bajada and foothill plots dropped to near-zero under the most severe periods of water limitation but remained higher in slope plots during the same time span. Combined with saguaro density estimates, these data suggest that the most suitable habitat type for saguaro establishment shifted to higher elevations during the time span of the recent drought. These results place into context the extent to which historical patterns of demography provide insight into future population dynamics in a changing climate and reveal the importance of understanding dynamics across the distribution of possible local habitat types with response to variation in weather.

Rapid alignment of functional trait variation with locality across the invaded range of Sahara mustard (Brassica tournefortii).

PREMISE OF STUDY: Mechanisms by which invasive species succeed across multiple novel environmental contexts are poorly understood. Functional traits show promise for identifying such mechanisms, yet we lack knowledge of which functional traits are critical for success and how they vary across invaded ranges and with environmental features. We evaluated the widespread recent invasion of Sahara mustard (Brassica tournefortii) in the southwestern United States to understand the extent of functional trait variation across the invaded range and how such variation is related to spatial and climatic gradients. METHODS: We used a common garden approach, growing two generations of plants in controlled conditions sourced from 10 locations across the invaded range. We measured variation within and among populations in phenological, morphological, and physiological traits, as well as performance. KEY RESULTS: We found nine key traits that varied among populations. These traits were related to phenology and early growth strategies, such as the timing of germination and flowering, as well as relative allocation of biomass to reproduction and individual seed mass. Trait variation was related most strongly to variation in winter precipitation patterns across localities, though variations in temperature and latitude also had significant contributions. CONCLUSIONS: Our results identify key functional traits of this invasive species that showed significant variation among introduced populations across a broad geographic and climatic range. Further, trait variation among populations was strongly related to key climatic variables, which suggests that population divergence in these traits may explain the successful colonization of Sahara mustard across its invaded US range.

Virtual reality in urban water management: communicating urban flooding with particle-based CFD simulations.

For communicating urban flood risk to authorities and the public, a realistic three-dimensional visual display is frequently more suitable than detailed flood maps. Virtual reality could also serve to plan short-term flooding interventions. We introduce here an alternative approach for simulating three-dimensional flooding dynamics in large- and small-scale urban scenes by reaching out to computer graphics. This approach, denoted 'particle in cell', is a particle-based CFD method that is used to predict physically plausible results instead of accurate flow dynamics. We exemplify the approach for the real flooding event in July 2016 in Innsbruck.

On the sensitivity of geospatial low impact development locations to the centralized sewer network.

In the future, infrastructure systems will have to become smarter, more sustainable, and more resilient requiring new methods of urban infrastructure design. In the field of urban drainage, green infrastructure is a promising design concept with proven benefits to runoff reduction, stormwater retention, pollution removal, and/or the creation of attractive living spaces. Such 'near-nature' concepts are usually distributed over the catchment area in small scale units. In many cases, these above-ground structures interact with the existing underground pipe infrastructure, resulting in hybrid solutions. In this work, we investigate the effect of different placement strategies for low impact development (LID) structures on hydraulic network performance of existing drainage networks. Based on a sensitivity analysis, geo-referenced maps are created which identify the most effective LID positions within the city framework (e.g. to improve network resilience). The methodology is applied to a case study to test the effectiveness of the approach and compare different placement strategies. The results show that with a simple targeted LID placement strategy, the flood performance is improved by an additional 34% as compared to a random placement strategy. The developed map is easy to communicate and can be rapidly applied by decision makers when deciding on stormwater policies.

Soil moisture mediates alpine life form and community productivity responses to warming.

Climate change is expected to alter primary production and community composition in alpine ecosystems, but the direction and magnitude of change is debated. Warmer, wetter growing seasons may increase productivity; however, in the absence of additional precipitation, increased temperatures may decrease soil moisture, thereby diminishing any positive effect of warming. Since plant species show individual responses to environmental change, responses may depend on community composition and vary across life form or functional groups. We warmed an alpine plant community at Niwot Ridge, Colorado continuously for four years to test whether warming increases or decreases productivity of life form groups and the whole community. We provided supplemental water to a subset of plots to alleviate the drying effect of warming. We measured annual above-ground productivity and soil temperature and moisture, from which we calculated soil degree days and adequate soil moisture days. Using an information-theoretic approach, we observed that positive productivity responses to warming at the community level occur only when warming is combined with supplemental watering; otherwise we observed decreased productivity. Watering also increased community productivity in the absence of warming. Forbs accounted for the majority of the productivity at the site and drove the contingent community response to warming, while cushions drove the generally positive response to watering and graminoids muted the community response. Warming advanced snowmelt and increased soil degree days, while watering increased adequate soil moisture days. Heated and watered plots had more adequate soil moisture days than heated plots. Overall, measured changes in soil temperature and moisture in response to treatments were consistent with expected productivity responses. We found that available soil moisture largely determines the responses of this forb-dominated alpine community to simulated climate warming.

Soil moisture mediates alpine life form and community productivity responses to warming.

Climate change is expected to alter primary production and community composition in alpine ecosystems, but the direction and magnitude of change is debated. Warmer, wetter growing seasons may increase productivity; however, in the absence of additional precipitation, increased temperatures may decrease soil moisture, thereby diminishing any positive effect of warming. Since plant species show individual responses to environmental change, responses may depend on community composition and vary across life form or functional groups. We warmed an alpine plant community at Niwot Ridge, Colorado continuously for four years to test whether warming increases or decreases productivity of life form groups and the whole community. We provided supplemental water to a subset of plots to alleviate the drying effect of warming. We measured annual above-ground productivity and soil temperature and moisture, from which we calculated soil degree days and adequate soil moisture days. Using an information-theoretic approach, we observed that positive productivity responses to warming at the community level occur only when warming is combined with supplemental watering; otherwise we observed decreased productivity. Watering also increased community productivity in the absence of warming. Forbs accounted for the majority of the productivity at the site and drove the contingent community response to warming, while cushions drove the generally positive response to watering and graminoids muted the community response. Warming advanced snowmelt and increased soil degree days, while watering increased adequate soil moisture days. Heated and watered plots had more adequate soil moisture days than heated plots. Overall, measured changes in soil temperature and moisture in response to treatments were consistent with expected productivity responses. We found that available soil moisture largely determines the responses of this forb-dominated alpine community to simulated climate warming.

The Relevance of the Interfacial Water Reactivity for Electrochemical CO Reduction on Copper Single Crystals.

The electrochemical reduction of CO2 is an important electrolysis reaction that enables the conversion of a waste gas to fuels or value-added chemicals. To make this reaction viable, a profound understanding of central intermediate steps, such as the CO electroreduction, is required. On Cu, the CO reduction reaction (CORR) is intimately linked to the hydrogen evolution reaction (HER) that proceeds via the reduction of water in alkaline or neutral electrolytes. Here, we demonstrate that the interaction of water or more specifically the water reduction kinetics on differently smooth Cu(100) and Cu(111) surfaces during the CORR in alkaline media significantly governs the CORR. On Cu(111), faster HER kinetics and the highest CORR activity are observed, even though HER and CORR onsets are more negative. While on Cu(100) small Cu ad-island clusters form in the cathodic potential range only when CO is present, structural changes appear on a larger length scale on Cu(111) both under CORR conditions and when no CO is present. These differences in the reconstruction characteristics may be attributed to the dominance of either the CORR and its intermediates or the HER on the different Cu surfaces. Therefore, the interfacial water reactivity is considered an essential activity descriptor for the CORR on Cu in alkaline media.

Diverse Interactions: Root-Nodule Formation and Herb-Layer Composition in Black Locust (Robinia pseudoacacia) Stands.

The black locust (Robinia pseudoacacia L.) is the second-most abundant deciduous tree in forest plantations, and one of the most important invasive woody species worldwide. The species has a strong transformer capacity, especially expressed by its nitrogen enrichment effect caused by nitrogen-fixing bacteria living in its root-nodules. The aim of this study was to explore the mutually interacting factors of nitrogen-fixing root-nodules, site characteristics, and herb-layer composition of 28 North Hungarian black locust stands. In the herb-layers of the study sites, a total of 121 plant species were identified, representing a relatively low species richness. The studied black locust stands showed high variability both in their herb-layer compositions and root-nodule formation, but no clear relationship could be demonstrated between these characteristics. The PCA component with which the species richness and Shannon-Wiener diversity index were strongly correlated was negatively associated with all root-nodule parameters (number, surface area, and weight), supporting the biodiversity-reducing effect of black locust by its nitrogen-fixing bacteria. All of the root-nodule parameters were negatively correlated with the PCA factor predominantly determined by stand age, confirming that the root-nodule biomass decreases as time progresses.

A new species of Entomobrya Rondani, 1861 (Collembola, Entomobryidae, Entomobryinae) from Croatia with the redescription of Entomobrya margaretae Gruia, 1967.

In the present paper, a new species of the genus Entomobrya is described from Croatia. E. silvicola sp. nov. has a unique colour pattern that distinguishes it from other Entomobrya species in Europe and worldwide. Besides the different colour pattern, there are notable differences in the dorsal macrochaetotaxy and other characters that distinguish the new species from the other Entomobrya sharing the same dorsal macrochaetotaxy formula of Abd IIIII. Herein, we also provide the redescription of E. margaretae Gruia, 1967, based on topotypic specimens, of which a neotype was designated.

Mitogenomes of the two historical species Seiraferrarii Parona, 1888 and Seirapallidipes Reuter, 1895 (Collembola, Entomobryidae, Seirinae) with their phylogenetic placement within Seirinae.

The present paper reports the first occurrence of Seiraferrarii Parona, 1888 from Hungary. On this occasion, molecular analyses were performed on both S.ferrarii and another historical species of the genus, S.pallidipes Reuter, 1895, originally described from Hungary. Using low-coverage whole-genome sequencing, the complete mitogenomes were assembled and annotated using MitoZ. To test the phylogenetic placement of both species, we performed maximum likelihood and Bayesian analyses using a matrix containing 14 Seirinae species and two outgroups. Both resultant trees showed that the European populations of the sampled Seira spp. likely derive from ancestral branches of Seirinae, compared to the Asian and American populations. Our results put in question the monophyly of the genus Seira, as already observed in previous studies.

Investigation on the true identity of Entomobryanigriventris Stach, 1929 (Collembola, Entomobryidae) with the description of a new species.

The present paper gives a detailed and illustrated redescription of Entomobryanigriventris Stach, 1929, and the description of a new species collected from open sand steppe habitat in Hungary. Based on the colour pattern, E.arenaria Winkler, Flórián & Dányi, sp. nov. is close to E.violaceolineata Stach, 1963 but differs from it by the morphology of the labral papillae and the dorsal macrochaetotaxy of the head, Th II, and Abd II-IV. The new species is also characterised by dark ventral body colouration in adult specimens. In this regard, an overview of European Entomobrya species in which the dark ventral side may occur is also provided.

Electroreduction of CO2 in a Non-aqueous Electrolyte-The Generic Role of Acetonitrile.

Transition metal carbides, especially Mo2C, are praised to be efficient electrocatalysts to reduce CO2 to valuable hydrocarbons. However, on Mo2C in an aqueous electrolyte, exclusively the competing hydrogen evolution reaction takes place, and this discrepancy to theory was traced back to the formation of a thin oxide layer at the electrode surface. Here, we study the CO2 reduction activity at Mo2C in a non-aqueous electrolyte to avoid such passivation and to determine products and the CO2 reduction reaction pathway. We find a tendency of CO2 to reduce to carbon monoxide. This process is inevitably coupled with the decomposition of acetonitrile to a 3-aminocrotonitrile anion. Furthermore, a unique behavior of the non-aqueous acetonitrile electrolyte is found, where the electrolyte, instead of the electrocatalyst, governs the catalytic selectivity of the CO2 reduction. This is evidenced by in situ electrochemical infrared spectroscopy on different electrocatalysts as well as by density functional theory calculations.

The Effects of Postacute Rehabilitation on Mortality, Chronic Care Dependency, Health Care Use, and Costs in Sepsis Survivors.

Rationale: Sepsis often leads to long-term functional deficits and increased mortality in survivors. Postacute rehabilitation can decrease long-term sepsis mortality, but its impact on nursing care dependency, health care use, and costs is insufficiently understood. Objectives: To assess the short-term (7-12 months postdischarge) and long-term (13-36 months postdischarge) effect of inpatient rehabilitation within 6 months after hospitalization on mortality, nursing care dependency, health care use, and costs. Methods: An observational cohort study used health claims data from the health insurer AOK (Allgemeine Ortskrankenkasse). Among 23.0 million AOK beneficiaries, adult beneficiaries hospitalized with sepsis in 2013-2014 were identified by explicit codes from the International Classification of Diseases, Tenth Revision. The study included patients who were nonemployed presepsis, for whom rehabilitation is reimbursed by the AOK and thus included in the dataset, and who survived at least 6 months postdischarge. The effect of rehabilitation was estimated by statistical comparisons of patients with rehabilitation (treatment group) and those without (reference group). Possible differential effects were investigated for the subgroup of ICU-treated sepsis survivors. The study used inverse probability of treatment weighting based on propensity scores to adjust for differences in relevant covariates. Costs for rehabilitation in the 6 months postsepsis were not included in the cost analysis. Results: Among 41,918 6-month sepsis survivors, 17.2% (n = 7,224) received rehabilitation. There was no significant difference in short-term survival between survivors with and without rehabilitation. Long-term survival rates were significantly higher in the rehabilitation group (90.4% vs. 88.7%; odds ratio [OR] = 1.2; 95% confidence interval [95% CI] = 1.1-1.3; P = 0.003). Survivors with rehabilitation had a higher mean number of hospital readmissions (7-12 months after sepsis: 0.82 vs. 0.76; P = 0.014) and were more frequently dependent on nursing care (7-12 months after sepsis: 47.8% vs. 42.3%; OR = 1.2; 95% CI = 1.2-1.3; P < 0.001; 13-36 months after sepsis: 52.5% vs. 47.5%; OR = 1.2; 95% CI = 1.1-1.3; P < 0.001) compared with those without rehabilitation, whereas total health care costs at 7-36 months after sepsis did not differ between groups. ICU-treated sepsis patients with rehabilitation had higher short- and long-term survival rates (short-term: 93.5% vs. 90.9%; OR = 1.5; 95% CI = 1.2-1.7; P < 0.001; long-term: 89.1% vs. 86.3%; OR = 1.3; 95% CI = 1.1-1.5; P < 0.001) than ICU-treated sepsis patients without rehabilitation. Conclusions: Rehabilitation within the first 6 months after ICU- and non-ICU-treated sepsis is associated with increased long-term survival within 3 years after sepsis without added total health care costs. Future work should aim to confirm and explain these exploratory findings.

Prognostic significance of mean corpuscular volume in patients with pancreatic ductal adenocarcinoma and multimodal treatment.

AIM OF THE STUDY: Mean corpuscular volume (MCV) has shown mounting evidence as a prognostic indicator in a number of malignancies. The aim of this study was to examine the prognostic potential of pretherapeutic MCV among patients with pancreatic ductal adenocarcinoma (PDAC) who underwent upfront resection or resection after neoadjuvant treatment (NT). PATIENTS AND METHODS: Consecutive patients with PDAC who underwent pancreatic resection between 1997 and 2019 were included in this study. Neoadjuvantly treated patients' serum MCV was measured before NT and before surgery. In patients undergoing upfront resection serum MCV was measured before surgery. Median MCV values were used as cut-off to distinguish high from low MCV values. RESULTS: Five hundred and forty-nine (438 upfront resected and 111 neoadjuvantly treated) patients were included in this study. Multivariate analysis revealed, that high MCV before and after NT, were independent negative prognostic factors for overall survival (P<0.01, respectively). Furthermore, the median MCV value from before to after NT increased significantly (P<0.001, Wilcoxon signed-rank test) and was (P=0.03, Wilcoxon rank sum test) associated with tumor response to NT. CONCLUSION: High MCV is an independent adverse prognostic factor in patients with resectable neoadjuvantly treated PDAC and may qualify as useful indicator to help physicians to provide personalized prognostication.