Radiofrequency ablation and chemotherapy versus chemotherapy alone for locally advanced pancreatic cancer (PELICAN): study protocol for a randomized controlled trial.

BACKGROUND: Approximately 80% of patients with locally advanced pancreatic cancer (LAPC) are treated with chemotherapy, of whom approximately 10% undergo a resection. Cohort studies investigating local tumor ablation with radiofrequency ablation (RFA) have reported a promising overall survival of 26-34 months when given in a multimodal setting. However, randomized controlled trials (RCTs) investigating the effect of RFA in combination with chemotherapy in patients with LAPC are lacking. METHODS: The "Pancreatic Locally Advanced Unresectable Cancer Ablation" (PELICAN) trial is an international multicenter superiority RCT, initiated by the Dutch Pancreatic Cancer Group (DPCG). All patients with LAPC according to DPCG criteria, who start with FOLFIRINOX or (nab-paclitaxel/)gemcitabine, are screened for eligibility. Restaging is performed after completion of four cycles of FOLFIRINOX or two cycles of (nab-paclitaxel/)gemcitabine (i.e., 2 months of treatment), and the results are assessed within a nationwide online expert panel. Eligible patients with RECIST stable disease or objective response, in whom resection is not feasible, are randomized to RFA followed by chemotherapy or chemotherapy alone. In total, 228 patients will be included in 16 centers in The Netherlands and four other European centers. The primary endpoint is overall survival. Secondary endpoints include progression-free survival, RECIST response, CA 19.9 and CEA response, toxicity, quality of life, pain, costs, and immunomodulatory effects of RFA. DISCUSSION: The PELICAN RCT aims to assess whether the combination of chemotherapy and RFA improves the overall survival when compared to chemotherapy alone, in patients with LAPC with no progression of disease following 2 months of systemic treatment. TRIAL REGISTRATION: Dutch Trial Registry NL4997 . Registered on December 29, 2015. ClinicalTrials.gov NCT03690323 . Retrospectively registered on October 1, 2018.

"Non-Touch" Vena Cava Technique as an Improvement in Combined Lung and Liver Procurement in Controlled Donation After Circulatory Death.

The number of organs retrieved from donation after circulatory death (DCD) donors has continued to rise in recent years. The functional superiority of DCD organs is achieved when the lungs are perfused with cold perfusion and livers with normothermic regional perfusion (NRP). Thus, a precise surgical technique is required to combine thoracic and abdominal organ procurement. The technique used at our center consists of a rapid laparotomy and middle sternotomy, then the abdominal aorta (Ao) and abdominal inferior vena cava (VC) are cannulated and the descending thoracic Ao is cross-clamped. NRP is started at that point. As a variation of previously described techniques, the thoracic vena cava is not initially clamped in order to improve the return of blood volume to the NRP circuit. The pulmonary artery is cannulated to flush the lungs and the left atrial appendage is opened for drainage. After 120 minutes, NRP perfusion is stopped and the organs are flushed with cold preservation solution. In 2016, 3 livers and 6 lungs were harvested at our center using the technique described. After a minimum follow-up of 1 year, no evidence of biliary complications was observed. The combined procurement of lungs after room temperature perfusion and liver after NRP without initial clamping of the thoracic VC is feasible, with excellent function post-transplantation.

A hemicellulose B fraction from grape skin (Vitis vinifera, Palomino variety).

The structure of a hemicellulose B fraction (B-1) isolated from grape skins (Vitis vinifera) of the Palomino variety has been studied by methylation analysis, (1)H NMR and (13)C NMR spectroscopy, and partial acid hydrolysis. Hemicellulose B-1 appeared to be homogeneous by gel filtration with a weight-average molecular weight of 22 600. This polysaccharide is a linear xyloglucan chain composed of xylopyranosyl and glucopyranosyl residues linked by beta-(1-->4) glycosidic bonds. Attached to this backbone, 4-O-methyl-D-glucuronopyranosyl acid, D-glucopyranosyl, and L-fucopyranosyl residues occur at position 2 in a ratio of one residue for every five units of xylose in the main chain, with D-xylopyranosyl residues attached at position 6 of glucose units in a ratio of one residue for every two glucose-derived moieties in the main chain.

[Headache in a short-stay unit. A retrospective study of 140 cases]. / Cefalea en una unidad de estancia corta. Estudio retrospectivo de 140 casos.

OBJECTIVE: Our objective was to study those patients that warranted admission to our Short-Stay Unit (Observation Unit) with an incoming diagnosis of headache so as to determine the characteristics of the headache, analyze complementary explorations and their use and to establish the causes of the problem. PATIENTS AND METHODS: A retrospective review of the clinical history of patients admitted for headache between 1992 and 1997 was done, recording specific data according to pre-set objectives. RESULTS: One hundred forty patients were admitted with headache (2% of total admittance to the Unit. Sixty-one percent were males. Seventy cases were between 11 and 15 years old. The most frequent accompanying symptoms were vomiting (61%), fever (31%) and various concurrent infections (21%). Seventy-two cases (51%) presented an evolution of less than 24 hours before admittance. Frontal headache was the most common localization, 30.6% of the patients were awaken by the pain and 32% calmed with analgesics. CAT scan/70%) and skull X-ray (59%) were the most used complementary explorations. Ten CAT scans and 3 X-rays showed anomalies. Evolution was favorable in most cases. The most frequent diagnoses were headache associated with infections (31%), tension headaches (29%) and migraine (21%). Fourteen percent were non-specific headaches. A central nervous system tumor was diagnosed in 6 patients, where 5 showed papilledema on initial exploration. CONCLUSIONS: Headache, especially in adolescents, is a common cause of consultations to the emergency room. When not accompanied by other symptoms it is not usually precluding a severe disease. In an emergency room exploration, a complete neurological exam must be undergone, including retinal exam, leaving further complementary exams for those cases where the patient history suggests an organic alteration.

Structure of a hemicellulose A fraction in dietary fiber from the seed of grape variety Palomino (Vitis vinifera cv. palomino).

The structure of one of the hemicellulose A fractions (HA-1) extracted from the seeds of the grape variety Palomino (Vitis vinifera cv. Palomino) has been studied by means of methylation, 1H NMR, 13C NMR, and partial hydrolysis. This hemicellulose seems to be a homogeneous polysaccharide with an apparent molecular weight of 68 500. Its structure is that of an acidic xylan, a linear chain of beta-D-xylopyranosyl units, bonded together by (1-->4) glycosidic links, containing single alpha-D-xylopyranosyl and 4-O-methyl-alpha-D-glucopyranuronosyl residues joined by glycosidic links to position 2 of the xylose units of the main chain, in proportions of one residue to every 25 units of xylose.

Structure of a hemicellulose B fraction in dietary fiber from the seed of grape variety Palomino (Vitis vinifera cv. palomino).

The structure of one of the hemicellulose B fractions (HB-1) extracted from the seeds of the grape variety Palomino (Vitis vinifera cv. Palomino) has been studied by means of methylation analysis, 1H NMR, 13C NMR, and partial acid hydrolysis. This hemicellulose seems to be a homogeneous polysaccharide with an apparent molecular weight of 35 000. Its structure is that of an acidic arabinoxylan, a linear chain of beta-D-xylopyranosyl units, bonded together by (1-->4) glycosidic links, containing a single L-arabinofuranosyl, alpha-D-xylopyranosyl and 4-O-methyl-alpha-D-glucopyranuronosyl residues joined by glycosidic links to position 2 of the xylose units of the main chain, in proportions of one branch to every seven units of xylose.

New Coumarins from Pilocarpus goudotianus.

The leaves of PILOCARPUS GOUDOTIANUS afforded in addition to eight known coumarins three new ones, donatin, alloxanthoxyletol, and (+)-elisin. The structures were elucidated on the basis of spectroscopic evidence and chemical derivatives.