Determination of "borderline resectable" pancreatic cancer - A global assessment of 30 shades of grey.

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. METHODS: In this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. RESULTS: Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. CONCLUSION: Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

Pacing and stroke kinematics in 200-m kayak racing.

Pacing profiles of 19 elite and sub-elite 200-m kayak athletes were examined through stroke-by-stroke analysis, using GPS/accelerometer methodology. Stroke rates and lengths were also quantified across multiple race segments. Whilst athletes reached peak velocity at between 40 and 60 m, it was not possible to determine specifically whether an all-out or positive strategy was employed. Race times were strongly and negatively correlated with the acceleration over the first ~25% of race distance (r = -0.95 ± 0.04) as well as average velocity over the first 30 m of the race (r>-0.9), i.e. faster starts were associated with faster finishing times. Furthermore, the maintenance of velocity, stroke rate and stroke length after reaching their maxima were strongly associated with race times. Stroke rates were higher (Cohen's d = 5.19) in the elite than sub-elite athletes (group categorisation based on race times), but there were no substantial differences in stroke rates between athletes within the elite cohort. Nonetheless, longer stroke lengths were associated with faster race times within the elite cohort (r = -0.48 to -0.85). The current study suggests that faster rates of acceleration and the ability to exhibit greater stroke lengths at relatively high stroke rates are determinants of 200-m kayak race performance.

Relationships Between Midthigh Pull Force Development and 200-m Race Performance in Highly Trained Kayakers.

ABSTRACT: Pickett, CW, Nosaka, K, Zois, J, and Blazevich, AJ. Relationships between midthigh pull force development and 200-m race performance in highly trained kayakers. J Strength Cond Res 35(10): 2853-2861, 2021-While increased lower-limb force production during kayaking has been shown to be related to increased boat velocity, poor relationships between maximal deadlift test performances and 200-m race time have been observed previously. This discrepancy may result from either a lack of movement pattern or temporal force production specificity between the test and kayak paddling. The isometric midthigh pull (MTP) test is commonly used in strength testing and quantifies temporal and peak force production, with the lower limbs positioned in a more kayak-specific manner than the deadlift test. Midthigh pull force data collected from 11 high-level kayak athletes were analyzed for both reliability and correlations with 200-m race time and deadlift isoinertial strength 3 repetition maximum (3RM). Strong consideration was given to the collection, processing, and analysis of the MTP data, which markedly affected the study results. Correlations between race time and MTP peak force and rates of force development were poor to moderate (r = -0.49 to 0.07). Strong to very strong relationships (r = 0.66-0.79) were found between forces developed early in the MTP (<0.15 seconds) and deadlift 3RM strength tests but were poor for later time-specific force development (r ≤ 0.12). However, poor reliability was found for force measured up to ≤0.25 seconds from the point of force onset (intraclass correlation coefficient >0.8). Owing to the relatively weak relationships with 200-m race time, and the large variability of the data, it may not be wise to include the MTP in the testing and training of 200-m kayak athletes.

Maximal Upper-Body Strength and Oxygen Uptake Are Associated With Performance in High-Level 200-m Sprint Kayakers.

Pickett, CW, Nosaka, K, Zois, J, Hopkins, WG, and Blazevich, AJ. Maximal upper-body strength and oxygen uptake are associated with performance in high-level 200-m sprint kayakers. J Strength Cond Res 32(11): 3186-3192, 2018-Current training and monitoring methods in sprint kayaking are based on the premise that upper-body muscular strength and aerobic power are both important for performance, but limited evidence exists to support this premise in high-level athletes. Relationships between measures of strength, maximal oxygen uptake (V[Combining Dot Above]O2max), and 200-m race times in kayakers competing at national-to-international levels were examined. Data collected from Australian Canoeing training camps and competitions for 7 elite, 7 national, and 8 club-level male sprint kayakers were analyzed for relationships between maximal isoinertial strength (3 repetition maximum bench press, bench row, chin-up, and deadlift), V[Combining Dot Above]O2max on a kayak ergometer, and 200-m race time. Correlations between race time and bench press, bench row, chin-up, and V[Combining Dot Above]O2max were -0.80, -0.76, -0.73, -0.02, and 0.71, respectively (90% confidence limits ∼±0.17). The multiple correlation coefficient for 200-m race time with bench press and V[Combining Dot Above]O2max was 0.84. Errors in prediction of 200-m race time in regression analyses were extremely large (∼4%) in relation to the smallest important change of 0.3%. However, from the slopes of the regressions, the smallest important change could be achieved with a 1.4% (±0.5%) change in bench-press strength and a 0.9% (±0.5%) change in V[Combining Dot Above]O2max. Substantial relationships were found between upper-body strength or aerobic power and 200-m performances. These measures may not accurately predict individual performance times, but would be practicable for talent identification purposes. Training aimed at improving upper-body strength or aerobic power in lower performing athletes could also enhance the performance in 200-m kayak sprints.