Early-onset pancreatic cancer: an institutional series evaluating end-of-life care.

PURPOSE: Little is known about the use of palliative and hospice care and their impact on healthcare utilization near the end of life (EOL) in early-onset pancreatic cancer (EOPC). METHODS: Patients with EOPC (≤ 50 years) were identified using the institutional tumor registry for years 2011-2018, and demographic, clinical, and rates of referral to palliative and hospice services were obtained retrospectively. Predictors of healthcare utilization, defined as use of ≥ 1 emergency department (ED) visit or hospitalization within 30 days of death, place of death (non-hospital vs. hospital), and time from last chemotherapy administration prior to death, were assessed using descriptive, univariable, and multivariable analyses including chi-square and logistic regression models. RESULTS: A total of 112 patients with EOPC with a median age of 46 years (range, 29-50) were studied. Forty-four percent were female, 28% were Black, and 45% had metastatic disease. Fifty-seven percent received palliative care at a median of 7.8 weeks (range 0-265) following diagnosis. The median time between last chemotherapy and death was 7.9 weeks (range 0-102). Seventy-four percent used hospice services prior to death for a median of 15 days (range 0-241). Rate of healthcare utilization at the EOL was 74% in the overall population. Black race and late use of chemotherapy were independently associated with increase in ED visits/hospitalization and hospital place of death. CONCLUSIONS: Although we observed early referrals to palliative care among patients with newly diagnosed EOPC, short duration of hospice enrollment and rates of healthcare utilization prior to death were substantial.

Leisure craft sacrificial anodes as a source of zinc and cadmium to saline waters.

Sacrificial anodes are attached to the hulls of boats and marine structures to prevent corrosion. Their use inevitably leads to release of zinc as well as impurities in the zinc alloy such as cadmium to the saline environment. Risk assessments and source apportionment exercises require accurate assessments of the potential loads of chemicals into the environment. This research has surveyed a wide variety of zinc anodes for their composition to compare against a reported industry standard as well as using differing methodologies to determine the dissolution rate of zinc and cadmium from anodes. A zinc dissolution rate of 477 g/yr/kg of anode is proposed. Although most anodes tested had concentrations of cadmium within the prescribed limits set by the reported standard, calculated leaching rates from laboratory dissolution experiments suggested as much as 400 g per year of cadmium could leach from zinc anodes used on leisure vessels within UK waters.

CAR-T treatment for hematological malignancies.

Chimeric antigen receptor (CAR)-T-cell therapy has sparked a wave of optimism in hematological malignancies, reflected by the successful results of early clinical trials involving patients with pre-B-cell acute lymphoblastic leukemia, B-cell lymphomas and multiple myeloma. CAR-T-cell therapy is considered to be a novel immunotherapy treatment that has the potential for curing certain hematological cancers. However, as use of CAR-T-cell therapy has grown, new challenges have surfaced. These challenges include the process of manufacturing the CAR-T cells, the mechanisms of resistance that underlie disease relapse, adverse effects and cost. This review describes the published results of clinical trials and expected developments to overcome CAR-T resistance.

The Thessaly test for detection of meniscal tears: validation of a new physical examination technique for primary care medicine.

OBJECTIVE: To assess the validity of a new clinical test (Thessaly) as a means of detecting meniscal tears of the knee by comparing arthroscopic findings to a clinical examination finding. DESIGN: Retrospective cohort study. SETTING: All preoperative examinations were performed in the Department of Orthopedic Surgery, a secondary care center, Dwight David Eisenhower Army Medical Center, Fort Gordon, Georgia. PARTICIPANTS: 116 consecutive patients undergoing knee arthroscopy for suspected meniscal pathology. INTERVENTION: The Thessaly test was performed during the preoperative examination as previously described. The clinician supports the patient by holding their outstretched hands while the patient stands flatfooted. The patient then rotates their knee and body, internally and externally, three times, keeping the knee flexed at 20 degrees. Patients with suspected meniscal tears will experience joint-line discomfort. MAIN OUTCOME MEASURES: The Thessaly test performed at 20 degrees of flexion and arthroscopic surgical diagnosis. RESULTS: Of the 66 patients with a positive Thessaly test, 65 had an arthroscopically verified meniscal tear. The Thessaly test revealed a sensitivity of 90.3%, specificity of 97.7%, positive predictive value of 98.5%, negative predictive value of 86.0%, likelihood ratio for a positive test of 39.3, likelihood ratio for a negative test of 0.09, and diagnostic accuracy of 88.8%. The resulting kappa coefficient revealed a statistically significant level of agreement (P < 0.001) for the surgical diagnosis and the Thessaly test. CONCLUSIONS: The Thessaly test is a valid and reproducible physical examination technique for predicting meniscal tears. The Thessaly test shows promise as an easily performed maneuver that may have better diagnostic accuracy than traditional tests. However, this study was performed at a referral center; therefore, the diagnostic relevance cannot be appropriately applied to a more generalized population.