Palliative bypass surgery for patients with advanced pancreatic adenocarcinoma: experience from a tertiary center.

BACKGROUND: As advances in oncological treatment continue to prolong the survival of patients with non-resectable pancreatic ductal adenocarcinoma (PDAC), decision-making regarding palliative surgical bypass in patients with a heavy disease burden turns challenging. Here we present the results of a pancreatic surgery referral center. METHODS: Patients that underwent palliative gastrojejunostomy and/or hepaticojejunostomy for advanced, non-resectable PDAC between January 2010 and November 2018 were retrospectively assessed. All patients were taken to a purely palliative surgery with no curative intent. The postoperative course as well as short and long-term outcomes was evaluated in relation to preoperative parameters. RESULTS: Forty-two patients (19 females) underwent palliative bypass. Thirty-one underwent only gastrojejunostomy (22 laparoscopic) and 11 underwent both gastrojejunostomy and hepaticojejunostomy (all by an open approach). Although 34 patients (80.9%) were able to return temporarily to oral intake during the index admission, 15 (35.7%) suffered from a major postoperative complication. Seven patients (16.6%) died from surgery and another seven within the following month. Nine patients (21.4%) never left the hospital following the surgery. Mean length of hospital stay was 18 ± 17 days (range 3-88 days). Mean overall survival was 172.8 ± 179.2 and median survival was 94.5 days. Age, preoperative hypoalbuminemia, sarcopenia, and disseminated disease were associated with palliation failure, defined as inability to regain oral intake, leave the hospital, or early mortality. CONCLUSIONS: Although palliative gastrojejunostomy and hepaticojejunostomy may be beneficial for specific patients, severe postoperative morbidity and high mortality rates are still common. Patient selection remains crucial for achieving acceptable outcomes.

When the "Tabula" is Anything but "Rasa:" What Determines Performance in the Auditory Statistical Learning Task?

How does prior linguistic knowledge modulate learning in verbal auditory statistical learning (SL) tasks? Here, we address this question by assessing to what extent the frequency of syllabic co-occurrences in the learners' native language determines SL performance. We computed the frequency of co-occurrences of syllables in spoken Spanish through a transliterated corpus, and used this measure to construct two artificial familiarization streams. One stream was constructed by embedding pseudowords with high co-occurrence frequency in Spanish ("Spanish-like" condition), the other by embedding pseudowords with low co-occurrence frequency ("Spanish-unlike" condition). Native Spanish-speaking participants listened to one of the two streams, and were tested in an old/new identification task to examine their ability to discriminate the embedded pseudowords from foils. Our results show that performance in the verbal auditory SL (ASL) task was significantly influenced by the frequency of syllabic co-occurrences in Spanish: When the embedded pseudowords were more "Spanish-like," participants were better able to identify them as part of the stream. These findings demonstrate that learners' task performance in verbal ASL tasks changes as a function of the artificial language's similarity to their native language, and highlight how linguistic prior knowledge biases the learning of regularities.

Perioperative Interventions to Reduce Surgical Site Infections: A Review.

Surgical site infections (SSIs) contribute to increased health care costs and morbidity after procedures as well as prolonged length of stay. Perioperative personnel can use a variety of interventions to help reduce SSI incidence; however, all strategies are not effective for all patients (eg, antibiotic prophylaxis). Results of randomized controlled trials show that some SSI reduction strategies are generally effective, including preoperative skin antisepsis with an alcohol-based agent, closing surgical wounds with triclosan-coated suture, and applying a negative pressure wound therapy device to open and closed wounds. Study results do not show that irrigating clean wounds with crystalloid solutions containing antibiotics or routinely using plastic drapes with or without impregnated iodophor or silver nylon-impregnated dressings significantly reduces SSI incidence. Perioperative leaders should support the implementation of strategies to prevent SSIs and work with interdisciplinary team members to develop an SSI prevention bundle that will meet the needs of their patients.

Scalp Leiomyosarcoma: Diagnosis and Treatment During a Global Pandemic With COVID-19.

Leiomyosarcoma is an aggressive, uncommon sarcoma effecting smooth muscle tissue. Prompt tissue diagnosis and staging workup are keys to preventing distant metastasis. Identification of this rare sarcoma has become increasingly difficult with decreased ability to seek out non-coronavirus disease 2019 (COVID-19) medical care. The pandemic has caused a widespread healthcare demand with providers reaching their full capacity causing care and resources to be shifted to the pandemic. We have experienced an 83-year-old male who significantly delayed to seek any medical attention for his scalp lesion for several months due to a combination of fear and decreased available appointments. Since the patient presented with a delayed scalp leiomyosarcoma, he required an extensive excision and flap reconstruction for the lesion. This case sheds light on the importance of weighing the risks and benefits associated with cancer management during the pandemic for both patients and healthcare providers. The healthcare system's response to the pandemic also played a role in this case as well, with shorter appointment times and decreased frequency of follow-up. As a result, the pandemic has had a catastrophic impact on the diagnostic pathway for cancer. This case report discusses the difficulties in diagnosing and treating a rare cancer such as scalp leiomyosarcoma amidst the global pandemic and the importance of telemedicine in improving future outcomes.

Linguistic entrenchment: Prior knowledge impacts statistical learning performance.

Statistical Learning (SL) is typically considered to be a domain-general mechanism by which cognitive systems discover the underlying statistical regularities in the input. Recent findings, however, show clear differences in processing regularities across modalities and stimuli as well as low correlations between performance on visual and auditory tasks. Why does a presumably domain-general mechanism show distinct patterns of modality and stimulus specificity? Here we claim that the key to this puzzle lies in the prior knowledge brought upon by learners to the learning task. Specifically, we argue that learners' already entrenched expectations about speech co-occurrences from their native language impacts what they learn from novel auditory verbal input. In contrast, learners are free of such entrenchment when processing sequences of visual material such as abstract shapes. We present evidence from three experiments supporting this hypothesis by showing that auditory-verbal tasks display distinct item-specific effects resulting in low correlations between test items. In contrast, non-verbal tasks - visual and auditory - show high correlations between items. Importantly, we also show that individual performance in visual and auditory SL tasks that do not implicate prior knowledge regarding co-occurrence of elements, is highly correlated. In a fourth experiment, we present further support for the entrenchment hypothesis by showing that the variance in performance between different stimuli in auditory-verbal statistical learning tasks can be traced back to their resemblance to participants' native language. We discuss the methodological and theoretical implications of these findings, focusing on models of domain generality/specificity of SL.