Review: An integrated graphical tool for analysing impacts and services provided by livestock farming.

Livestock farming is criticized for negatively impacting the environment, concerns about animal welfare and the impact of excessive meat consumption on human health. However, livestock farming provides other underappreciated and poorly communicated benefits to society in terms of employment, product quality, cultural landscapes and carbon storage by grasslands. Few attempts have been made so far to simultaneously consider the services and impacts provided by livestock production. Here, we propose an integrated graphical tool, called the 'barn' to explicitly summarize the synergies and trade-offs between services and impacts provided by livestock farming. It illustrates livestock farming interacting with its physical, economic and social environment along five interfaces: (i) Markets, (ii) Work and employment, (iii) Inputs, (iv) Environment and climate, (v) Social and cultural factors. This graphical tool was then applied by comparing two contrasting livestock production areas (high livestock density v. grassland-based), and the dominant v. a niche system within a crop-livestock area. We showed the barn could be used for cross-comparisons of services and impacts across livestock production areas, and for multi-level analysis of services and impacts of livestock farming within a given area. The barn graphically summarizes the ecological and socio-economic aspects of livestock farming by explicitly representing multiple services and impacts of different systems in a simple yet informative way. Information for the five interfaces relies on available quantitative assessments from the literature or data sets, and on expert-knowledge for more qualitative factors, such as social and cultural ones. The 'barn' can also inform local stakeholders or policy-makers about potential opportunities and threats to the future of livestock farming in specific production areas. It has already been used as a pedagogical tool for teaching the diversity of services and impacts of livestock systems across Europe and is currently developed as a serious game for encouraging knowledge exchange and sharing different viewpoints between stakeholders.

Review: Associations among goods, impacts and ecosystem services provided by livestock farming.

Livestock is a major driver in most rural landscapes and economics, but it also polarises debate over its environmental impacts, animal welfare and human health. Conversely, the various services that livestock farming systems provide to society are often overlooked and have rarely been quantified. The aim of analysing bundles of services is to chart the coexistence and interactions between the various services and impacts provided by livestock farming, and to identify sets of ecosystem services (ES) that appear together repeatedly across sites and through time. We review three types of approaches that analyse associations among impacts and services from local to global scales: (i) detecting ES associations at system or landscape scale, (ii) identifying and mapping bundles of ES and impacts and (iii) exploring potential drivers using prospective scenarios. At a local scale, farming practices interact with landscape heterogeneity in a multi-scale process to shape grassland biodiversity and ES. Production and various ES provided by grasslands to farmers, such as soil fertility, biological regulations and erosion control, benefit to some extent from the functional diversity of grassland species, and length of pasture phase in the crop rotation. Mapping ES from the landscape up to the EU-wide scale reveals a frequent trade-off between livestock production on one side and regulating and cultural services on the other. Maps allow the identification of target areas with higher ecological value or greater sensitivity to risks. Using two key factors (livestock density and the proportion of permanent grassland within utilised agricultural area), we identified six types of European livestock production areas characterised by contrasted bundles of services and impacts. Livestock management also appeared to be a key driver of bundles of services in prospective scenarios. These scenarios simulate a breakaway from current production, legislation (e.g. the use of food waste to fatten pigs) and consumption trends (e.g. halving animal protein consumption across Europe). Overall, strategies that combine a reduction of inputs, of the use of crops from arable land to feed livestock, of food waste and of meat consumption deliver a more sustainable food future. Livestock as part of this sustainable future requires further enhancement, quantification and communication of the services provided by livestock farming to society, which calls for the following: (i) a better targeting of public support, (ii) more precise quantification of bundles of services and (iii) better information to consumers and assessment of their willingness to pay for these services.

Effects of essential oils from Liquidambar orientalis Mill. leaves on growth performance, carcass and some organ traits, some blood metabolites and intestinal microbiota in broilers.

1. This study was carried out to investigate the effects of liquidambar essential oils (LEO) isolated from Turkish sweet gum (Liquidambar orientalis Mill.) leaves on growth performance, carcass, edible inner organs (EIO), gastrointestinal traits (gut), some blood metabolites and jejunum microbiota in broilers. 2. A total of 375 one-d-old male broilers (Ross 308) were randomly allocated to 5 treatments with 5 pens with 15 birds. The birds were fed on diets without antibiotics (CONT), with antibiotic (50 mg per kg, AB), with LEOs at 0.0405 (0.04LEO), 0.0811 (0.08LEO) or 0.1622 (0.16LEO) g/kg feed up to 42 d of age. The levels of LEOs included to diets were determined according to in vitro antimicrobial activity. 3. From d 1 to 42, the 0.08LEO treatment had higher live weight gain (LWG) compared to others. The 0.08LEO treatment increased feed intake (FI) compared to the CONT, AB and 0.04LEO. However, the feed conversion ratio (FCR) of these birds was lower than those in the AB and 0.16LEO treatments. From 1 to 42 d of age for LWG, the effects were quadratic and cubic, while those for FI and FCR were cubic and quadratic, respectively. Birds that fed 0.08LEO and AB diets had higher and lower carcass weights (CW) than those that fed other diets. The effect of LEO levels was cubic on the CW. The 0.08LEO and 0.16LEO decreased abdominal fat (AF) weight compared to the AB. The blood cholesterol decreased by the 0.04LEO and 0.08LEO treatments compared to the CONT. For the blood cholesterol, the effects of LEO levels were cubic. The 0.08LEO treatments decreased Escherichia coli counts in jejunum compared to the CONT and 0.16LEO. 4. Feeding a diet with LEO at 0.0811 g/kg might increase the LWG, FI and weights of carcass and AF, whereas it might decrease blood cholesterol and E. coli counts without affecting blood high-density lipoprotein, low-density lipoprotein, triglyceride, glucose, aspartate transaminase and alanine transaminase concentrations.

Antioxidant effect of erdosteine and lipoic acid in ovarian ischemia-reperfusion injury.

OBJECTIVE: To investigate the effects of erdosteine and alpha lipoic acid (ALA) in a rat model of ovarian ischaemia-reperfusion injury. STUDY DESIGN: Forty-eight female Wistar albino rats were separated, at random, into six groups of eight rats. The groups were classified as: sham, torsion, detorsion, detorsion+erdosteine 100mg/kg, detorsion+alpha lipoic acid (ALA) 100mg/kg, and detorsion+erdosteine+ALA. The investigators executing the biochemical and histological analyses were blinded to the randomization until the end of the study. RESULTS: The TOS (Total Oxidant Status) and OSI (Oxidative Stress Index) levels are higher in the Torsion and Detorsion groups when compared with the ones in the Sham group (p<0.05). Strong correlation was found between OSI and total histological score in the sham, torsion and detorsion groups (r=0.765, p<0.001). The mean levels of TOS and OSI in the rats that received erdosteine and/or ALA were significantly lower compared with the sham, torsion and detorsion groups (p<0.05). Mean TOS and mean OSI were lower in the detorsion+erdosteine+ALA group compared with the detorsion+erdosteine and detorsion+ALA groups (p<0.05). In comparison with the detorsion group, the numbers of primordial follicles (p=0.006) and primary follicles (p=0.036) were increased in the groups that received erdosteine and/or ALA. CONCLUSIONS: Erdosteine and ALA decreased ischaemia-reperfusion injury in an experimental rat ovarian torsion model; combination treatment had a greater effect than either agent alone. Treatment with erdosteine and/or ALA was found to preserve the loss of reproductive capacity normally observed after ovarian torsion.

Farming system design for innovative crop-livestock integration in Europe.

The development of integrated crop-livestock systems (ICLS) is a major challenge for the ecological modernisation of agriculture but appears difficult to implement at a large scale. A participatory method for ICLS design has been developed and implemented in 15 case studies across Europe, representing a range of production systems, challenges, constraints and resources for innovation. Local stakeholders, primarily farmers, but also cooperatives, environmental-association representatives and natural-resource managers, were involved in the identification of challenges and existing initiatives of crop-livestock integration; in the design of new options at field, farm and territory levels; and then in qualitative multicriteria assessment of these options. A conceptual framework based on a conceptual model (crops, grasslands, animals) was developed to act as a boundary object in the design step and invite innovative thinking in 'metabolic' and 'ecosystemic' approaches. A diversity of crops and grasslands interacting with animals appeared central for designing sustainable farming systems at the territory level, providing and benefitting from ecosystem services. Within this diversity, we define three types of integrated systems according to their degrees of spatial and temporal coordination: complementarity, local synergy, territorial synergy. Moreover, the options for cooperation and collective organisation between farmers and other stakeholders in territories to organise and manage this diversity of land use revealed opportunities for smart social innovation. The qualitative multicriteria assessment identified farmer workload as the main issue of concern while demonstrating expected benefits of ICLS simultaneously for economic, agronomic, environmental and social criteria. This study concludes that participatory design of ICLS based on a generic multi-level and multi-domain framework and a methodology to deal with a local context can identify new systems to be tested. Further assessment and redesign work will be performed in later stages of the European FP7 CANTOGETHER project.

Licorice induced hypokalemia, edema, and thrombocytopenia.

Licorice originates from the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid, and has a mineralocorticoid-like effect. Chronic intake of licorice induces a syndrome similar to that found in primary hyperaldosteronism. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypertension, hypokalemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this case report, an association of hypokalemia, edema, and thrombocytopenia that is developed due to the excessive intake of licorice is presented. There are case reports in the literature, which suggest that toxicity findings may emerge with hyperaldosteronism-like manifestations such as hypokalemia, edema, and hypertension. However, any knowledge of thrombocytopenia as a resultant was not encountered among these reported toxic effects. Our case is important because it shows that the excessive intake of licorice may cause a toxic effect in the form of thrombocytopenia. This report is the first presented case to show thrombocytopenia due to licorice syrup consumption.

Comparison of methods for assessing the impact of different disturbances and nutrient conditions upon functional characteristics of grassland communities.

BACKGROUND AND AIMS: Predicting the response of plant communities to variation in resources and disturbance is still a challenge, because findings depend on how ecological gradients are characterized and how grassland functional composition is assessed. Focusing on leaf dry matter content (LDMC), the efficacy of different methods for evaluating the best response of plant communities to either environmental or disturbance change is examined. METHODS: Data were collected on 69 grasslands located at four sites in the Pyrenees and Massif Central. N-Ellenberg indices and plant nutrient content (Ni) were compared to assess fertility, and either LDMC (meas) measured or calculated from a trait database for which traits were measured under the same environmental conditions (db). Management regime (MR) was characterized in terms of categories (grazing, cutting) and plant height. KEY RESULTS: LDMCdb was positively correlated to LDMCmeas, but depended significantly on site temperature. N-Ellenberg and Ni were significantly correlated, and there was a significant effect of MR and temperature. LDMC responded to fertility, MR and temperature. Replacing MR by plant height in an REML analysis reduced the uncertainty of the LDMC prediction. LDMC was correlated to plant height at community level, whereas the correlation was weak at species level. Differences in LDMC between plant communities under any of the management regimes were significantly correlated to the standing herbage mass. CONCLUSION: The N-Ellenberg index is a better indicator of fertility than Ni which is short-term and environment-dependent. LDMC taken from a database allows plant trait variation due to species abundance (excluding variation due to trait plasticity in response to management) to be captured. So the former is better suited for assessing agricultural services that mainly depend on plant phenology and tissue composition. LDMC responded to defoliation regime in addition to fertility because plant height is roughly correlated with LDMC at plant community level.

Antimicrobial activity and chemical composition of endemic Centaurea cariensis subsp. niveo-tomentosa.

The antimicrobial activity of the n-hexane, chloroform, ethyl acetate and ethyl alcohol extracts of the aerial parts of Centaurea cariensis subsp. niveo-tomentosa was evaluated against microorganisms, including multi-antibiotic resistant bacteria, using the paper disc diffusion method. The chemical composition of the chloroform extract of this plant was determined by gas chromatography and gas chromatography-mass spectrometry. The chloroform extract exhibited significant antibacterial activity for all bacteria tested, which are important pathogens. The major compounds of the chloroform extract were caryophyllene oxide (20.79%), spathulenol (14.73%), beta-eudesmol (9.27%), beta-caryophyllene (6.84%), n-cetylalcohol (6.27%), cubenol (5.23%) and cis-alpha-santalol (4.67%), respectively.

Chemical composition of endemic Scorzonera sandrasica and studies on the antimicrobial activity against multiresistant bacteria.

The present study describes the antimicrobial activity and chemical composition of Scorzonera sandrasica Hartvig et Strid (Family Asteraceae), endemic to Turkey. The antimicrobial activity of the hexane, chloroform, ethyl acetate, and ethanol extracts of the aerial parts of S. sandrasica was evaluated against microorganisms, including multiresistant bacteria, using a paper disc diffusion method. The chemical composition of the chloroform extract of the plant was determined by gas chromatography and gas chromatography-mass spectrometry. The major compounds of the chloroform extract of the plant were caryophyllene oxide (19.7%), manoyl oxide (16.5%), and manool (11.3%), respectively. The extracts had antibacterial activity; however, no antifungal activity was observed against the two fungi. In particular, the ethanol and chloroform extracts exhibited significant activity against multiresistant strains of Stenotrophomonas maltophilia.

Chemical composition of endemic Centaurea austro-anatolica and studies of its antimicrobial activity against multi-resistant bacteria.

Hexane, chloroform, ethyl acetate and ethanolic extracts of the aerial parts of Centaurea austro-anatolica Hub.-Mor. (Asteraceae) were evaluated against microorganisms, including multiresistant bacteria, using a paper disc diffusion method. The chloroform extract exhibited significant antibacterial activity toward all bacteria tested. The chemical composition of the chloroform extract was determined by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). The major compounds of the extract were caryophyllene oxide (21.32 %), spathulenol (10.86 %), n-tricosanol (9.58 %) and geranyl isovalerate (8.71 %).

In vitro study of antibacterial activity on multi-resistant bacteria and chemical composition of the chloroform extract of endemic Centaurea drabifolia subsp. cappadocica.

The antimicrobial activity of the n-hexane, chloroform, ethyl acetate and ethanol extracts of the aerial parts of C. drabifolia S.M. subsp. cappadocica (DC.) Wagenitz (Asteraceae) was evaluated against microorganisms including multi-antibiotic resistant bacteria using the paper disc diffusion method. The chemical composition of the chloroform extract of this plant was determined by gas chromatography and gas chromatography-mass spectrometry. The chloroform extract exhibited significant antibacterial activity against all the bacteria tested, except Stenotrophomonas maltophilia MU63. The major compounds of the chloroform extract were spathulenol (14.1%), caryophyllene oxide (12.5%), octadecanol (10.2%), ethyl palmitate (7.7%), [Z,Z]-10,12-hexadecadienal (6.0%), 3-hydroxy p-anisaldehyde (5.9%) and pentacosane (5.8%).

Antimicrobial activity and chemical composition of Senecio sandrasicus on antibiotic resistant staphylococci.

The antimicrobial activity of hexane, chloroform, ethyl acetate and ethanol extracts of the aerial parts of S. sandrasicus P.H.Davis (Asteraceae), endemic to Sandras mountain (Turkey), were determined. The antimicrobial activity of the extracts on microorganisms including multi-resistant staphylococci were evaluated using the disc diffusion method. The strains of multi-resistant staphylococci and the other standart bacteria were inhibited by some extracts. The volatile organic compouds of S. sandrasicus was determined by Gas Chromatography (GC) and Gas Chromatography-Mass Spectrometry (GC-MS). The major compounds of hexane extract were aromadendrene oxide 2 (13.3%), spathulenol (12.5%) and beta-caryophylene (11.8%), respectively.

Rapid screening for co-infection of HIV and HCV in pregnant women in Benin City, Edo State, Nigeria.

BACKGROUND: Human Immunodeficiency virus (HIV) and Hepatitis C virus (HCV) are both major global health concerns as they cause high mortality and morbidity in the developing countries. However, while data exists for the co-infection in other countries, little or no information can be found with regard to the sero-prevalence of HIV and HCV co-infection in Nigeria, albeit in pregnant women attending antenatal care clinics in Benin City, Nigeria. OBJECTIVE: The objective of the study was to determine the sero-prevalence of HIV and HCV among pregnant women seeking antenatal care in Benin City. METHODS: In determining the sero-prevalence in a cross-sectional study, 200 pregnant women, aged between 15 and 49 years were screened for HIV and HCV using rapid screening test kits. Using closed ended structured questionnaires; the respondents volunteered socio-demographic information associated with risk factors of HIV and HCV acquisition. RESULTS: Results indicated sero-prevalence of HIV and HCV in the sampled population was 3% and 5% respectively. Thirty three percent of the pregnant women that were HCV positive were co-infected with HIV-1 infection. HIV sero-prevalence was highest in the age group, 25-29 representing 5.1%, while HCV sero-prevalence was noted highest among the women in the age group 30-34 years, representing 7.9%. Two percent of the pregnant women had equivocal (ambivalent) HIV-1 results. CONCLUSION: The study has shown a prevalence of HIV-HCV co-infection among the tested pregnant women in Benin City and more epidemiological surveys are needed in larger scale to decipher the prevalence in other states of Nigeria.

Reptile bite in pregnancy.

Reptile bites are rarely seen cases in emergency departments. But particularly in the warm summer months, the prevalence is relatively higher in rural areas. Snakebites during pregnancy is little known and only a few cases have been reported in the literature. However, in case of pregnancy, the outcomes may be different both for mother and the fetus. Interestingly, there is limited number of reptile bite cases during pregnancy in the literature. We report here a woman who was bitten at her 28th week of gestation. Obstetric consultation with ultrasonography was performed and seen that fetus was normal according to a 28-week gestation. We infused four vials of antiserum in a period of 1 h in a saline solution. In all, 30 min after the initiation of the antiserum infusion, the lesion started to regress. Her obstetric consultation was repeated 1 h, 36 h, and before discharge were performed and seen that the fetus was normal. After a period of five days, the patient and fetus were evaluated once more, and nothing was abnormal for both.

Association of left ventricular diastolic function abnormalities with aortic elastic properties in asymptomatic patients with type 2 diabetes mellitus. A tissue doppler echocardiographic study.

BACKGROUND: The aim of this study was to investigate the association between the aortic elastic properties and the left ventricular diastolic function measured by tissue Doppler echocardiography (TDE) in asymptomatic type 2 diabetes mellitus. METHODS: Fifty-seven asymptomatic patients with type 2 diabetes (33 women, mean age: 49 +/- 6 years) and 25 healthy control subjects (19 women, mean age: 46 +/- 7 years) were included in the present study. Diastolic filling indices were measured by conventional (CE) and tissue Doppler echocardiography. The aortic elastic properties [Aortic stiffness index (ASI), aortic distensibility and strain] were measured as previous definition. RESULTS: Compared with control subjects, the ratio of LV diastolic abnormalities measured by CE and TDE were found higher in patients with type 2 diabetes (36% and 73.6%, p = 0.001, respectively, and 52% and 89.4%, p < 0.001, for septal annulus; 48% and 89.4%, p < 0.001 for septal basal respectively). The ASI was significantly higher (p < 0.001), aortic distensibility and aortic strain were also significantly lower in patients with type 2 diabetes than control subjects (p < 0.001 and p < 0.001 respectively). In the regression analysis, Ao distensibility was correlated to age (beta = -0.299, p = 0.004), septal basal Em/Am ratio (beta =0.543, p < 0.001) and HDL-cholesterol (beta = 0.192, p = 0.039). ASI was also correlated only to age (beta = 0.255, p = 0.044), the presence of diabetes mellitus (beta = 0.304, p = 0.009), mitral A wave (beta = 0.322, p = 0.013) and mitral annulus Em wave (beta = -0.505, p < 0.001). CONCLUSION: The aortic elastic function is impaired in asymptomatic patients with type 2 diabetes. Increased ASI and decreased Ao distensibility are closely associated with diastolic filling indices measured by CE and TDE.

A spreadsheet model for developing field indicators and grazing management tools to meet environmental and production targets for dairy farms.

Changes in livestock farm structure, such as increasing land area per animal, as well as developments in national and European agricultural policies may lead to changes in grazing and fertilizer management practices for environmental or economic reasons. To facilitate choices and the learning of new practices at the farm level, such as the amount of land to allocate for grazing or of fertilizer to apply, we propose to combine a simplified grass growth and N model with two sward indicators. One assesses the sward nitrogen status to evaluate animal excreted N; the other assesses the standing herbage mass to characterize the grazing management. Following a description of the model (first part), we use it as a research tool for highlighting grazing management (second part). First we analyze how stocking rate, N excreted, grazing and N use efficiency varied according to management (i.e., the time between two grazing events), sward (N status, leaf lifespan) and weather characteristics. Next we use it for determining field indicator thresholds at key periods that allow agricultural and environmental aims to be met; these thresholds being intended to give guidance to meet farmers' objectives. In the last part, we illustrate how to combine model and field indicators for planning and monitoring a management strategy suitable for the management of risks.

Acute angle-closure glaucoma precipitated by local tiotropium absorption.

Acute angle-closure glaucoma is a rare form of glaucoma occurring when the filtration mechanism for the aqueous humor is obstructed by apposition of the peripheral iris to the trabecular meshwork. It may be precipitated by pupillary dilatation in a predisposed eye. In this case report, a possible relationship between local tiotropium absorption and acute angle-closure glaucoma attack is presented.

QTc dispersion and P-wave dispersion during migraine attacks.

The aim of this study was to investigate increase of QTc dispersion and P-wave dispersion during migraine attacks. Fifty-five patients (16-65 years of age, 49 women, six men) with migraine were included in our study. Heart rate, QTc interval, maximum and minimum QTc interval, QTc dispersion, maximum and minimum P-wave duration and P-wave dispersion were measured from 12-lead ECG recording during migraine attacks and pain-free periods. ECGs were transferred to a personal computer via a scanner and then used for magnification of x400 by Adobe Photoshop software. Maximum QTc interval (454 +/- 24 ms vs. 429 +/- 23 ms, P < 0.001), QTc interval (443 +/- 26 ms vs. 408 +/- 22 ms, P < 0.001) and QTc dispersion (63 +/- 18 ms vs. 43 +/- 14 ms, P < 0.001) were found significantly higher during migraine attacks compared with pain-free periods. Maximum P-wave duration (107 +/- 11 ms vs. 100 +/- 11 ms, P < 0.001) and P-wave dispersion (45 +/- 13 ms vs. 35 +/- 13 ms, P < 0.001) were found higher during migraine attacks than pain-free periods. We concluded that migraine attacks are associated with increased QTc and P-wave dispersion compared with pain-free periods.

Effect of obesity on P-wave dispersion and QT dispersion in women.

OBJECTIVE: The aim of this study was to investigate the effect of obesity on dispersion of P-wave duration and QTc interval in obese women. METHODS: Forty-two obese women (Body mass index (BMI)=40+/-3 kg/m(2), mean age 45+/-9 years) and compared age-matched (BMI=22+/-1 kg/m(2), mean age 41+/-6 years) twenty-five non-obese women were included in our study. Maximum and minimum P-wave duration, P-wave dispersion (difference between the maximum and the minimum P-wave duration), maximum and minimum QTc interval, and QTc dispersion (the difference between the maximum and the minimum QTc interval) were measured from 12-lead ECG. ECG's were transferred to a personal computer via a scanner and then used for magnification of 400 times by Adobe Photoshop software. RESULTS: There was significant difference in BMI (40+/-3 vs 22+/-1 kg/m(2), P<0.001, respectively) between obese and non-obese women. Obese women had higher Max. P-wave duration (116+/-11 vs 94+/-14 ms, P<0.001), P-wave dispersion (51+/-15 vs 26+/-11 ms, P<0.001), Max. QTc interval (449+/-38 vs 419+/-30 ms, P<0.001) and QTc dispersion (57+/-23 vs 38+/-15 ms, P<0.001) compared to non-obese women. A significant correlation was found between BMI and Max. P-wave duration (r=0.584, P<0.001), P-wave dispersion (r=0.621, P<0.001), Max. QTc interval (r=0.410, P<0.001), and QTc dispersion (r=0.429, P<0.001). In the linear regression analysis, compared to co-morbidity factors such as age, hypertension, diabetes mellitus and smoking, there was significant association between only BMI and electrocardiographic values (P-wave and QTc dispersion). CONCLUSION: We concluded that obesity caused significant increase in P-wave and QTc dispersion. Therefore, obese women may not only be under the risk of ventricular arrhythmias, but also they may under the risk of atrial arrhythmias.

Palliative treatment of advanced pancreatic carcinoma in community-based oncology group practices.

This study was aimed at evaluating the feasibility, effectiveness, and toxicity of palliative chemotherapy/supportive care in patients with advanced pancreatic cancer being treated on an outpatient basis. A retrospective analysis was performed on 127 consecutive, unselected patients with advanced pancreatic cancer in four community-based oncology group practices. Median age was 63 years and WHO performance status ranged from 0 to 3. Forty-three patients (34%) had locally advanced disease, and 84 patients (66%) had distant metastases; 94 patients (74%) received cytotoxic treatment during the course of their disease, and 33 (26%) received best supportive care only. First-line treatment consisted of gemcitabine (1,000 mg/m2 on days 1, 8, and 15 of a 28-day cycle) in 81 patients (86%), 5-fluorouracil (5-FU) in 8 patients (9%), radiochemotherapy in 4 patients (4%), and radiation therapy only in 1 patient (1%). A total of 1,501 gemcitabine treatments were given during the study period. Toxicity was moderate. Four patients (3%) required hospitalization for treatment-related side effects, and 111 patients (88%) died during the observation period. Symptom control, as measured by reduction of pain medication, was seen in 25% of patients receiving gemcitabine, whereas no reduction in pain medication was seen in the best supportive care group. The median survival of patients receiving cytotoxic treatment (mainly gemcitabine) was 42 weeks, and the median survival of patients receiving best supportive care was 21 weeks. The overall survival rate at 6, 12, 24, and 36 months was 65%, 32%, 14%, and 7%, respectively. Based on these outcomes, it appears that patients with locally advanced and metastatic pancreatic cancer benefit from adequate palliative treatment, including cytotoxic chemotherapy with gemcitabine, and this can be accomplished on an outpatient basis.