Oncologic management of ampullary cancer: International survey among surgical and medical oncologists.

BACKGROUND: Ampullary adenocarcinoma (AAC) is a rare neoplasm which as a result is lacking specific treatment guidelines. This international survey study was performed to gain insight in the current daily practice of AAC. METHODS: Surgeons and medical oncologists, whom were members of the Dutch Pancreatic Cancer Group, International Study Group on Ampullary Cancer, International Hepato-Pancreato-Biliary Association, European and International Consortium on Minimally Invasive Pancreatic Surgery, or contributed to (peri)ampullary cancer research, were invited through email and newsletters between January and October 2021. RESULTS: Overall, 217 surgeons and medical oncologists completed the survey. Most of the respondents work in Europe (60%), and in a pancreatic expertise center (86%). The majority of respondents (87%) stated that the histological AAC subtype (e.g. intestinal vs. pancreatobiliary) was determined in the resection specimen. Neoadjuvant treatment for resectable disease was considered by 24% and adjuvant therapy by 90% of the respondents, with 80% of them choosing adjuvant chemotherapy alone. The formation of multidisciplinary teams, improvement in resection procedures, increased availability of chemotherapy regimens, and increased knowledge on tumor biology were considered as the most important developments in the last five years. The necessity for randomized controlled trials was mentioned by 50% of the respondents. CONCLUSIONS: This international survey highlights the existing variation in the management of patients with AAC, especially regarding the use of (neo)adjuvant therapy. More data from trials and international registries are needed to develop evidence-based guidelines on surgical and oncological management with the ultimate aim to improve outcomes for patients with AAC.

Hysteretic magnetoresistance in nanowire devices due to stray fields induced by micromagnets.

We study hysteretic magnetoresistance in InSb nanowires due to stray magnetic fields from CoFe micromagnets. Devices without any ferromagnetic components show that the magnetoresistance of InSb nanowires commonly exhibits either a local maximum or local minimum at zero magnetic field. Switching of microstrip magnetizations then results in positive or negative hysteretic dependence as conductance maxima or minima shift with respect to the global external field. Stray fields are found to be in the range of tens of millitesla, comparable to the scale over which the nanowire magnetoresistance develops. We observe that the stray field signal is similar to that obtained in devices with ferromagnetic contacts (spin valves). We perform micromagnetic simulations which are in reasonable agreement with the experiment. The use of locally varying magnetic fields may bring new ideas for Majorana circuits in which nanowire networks require control over field orientation at the nanoscale.

[The seizure of medical records; views on the limits of confidentiality law]. / Het medisch dossier in beslag; beschouwing over grenzen van het verschoningsrecht.

In the Netherlands the seizure of a medical file by the justice department without the consent of the possessor of the file, is formally forbidden. Nevertheless, medical files are being seized occasionally for juridical reasons, to the distress of the medical profession. It is concluded that the possessor of a medical file cannot object before a court of law to the seizure by the justice department. There is a need to change Dutch law so that doctors or hospitals will in fact have that possibility.

Specific suppression of mixed lymphocyte reactions by alloactivated cells is correlated with cytotoxicity.

Mixed lymphocyte reaction (MLR)-activated lymphoblasts can suppress both proliferation and the induction of cell-mediated lysis (CML) when added to a subsequent MLR. Antigen specificity and the mechanism of MLR-induced suppression was investigated, with special emphasis on the exclusion of cell-mediated stimulator cell lysis as the cause of suppression. We studied the suppressive properties of nine MLR-activated cultures, selected because of their specific suppressive properties. Suppression of a given MLR was obtained when the stimulator cell carried at least one of the mismatched HLA antigens of the original stimulator. The mismatched antigen which activated suppression was an HLA class I antigen in 3 out of 9 cases, an HLA class II antigen in another 3 cases. In the remaining 3 cases suppression was observed when either an HLA class I or an HLA class II antigen was shared between the original stimulator and stimulator cell of the MLR. When analyzed on the same panel, a positive linear correlation between suppression of an MLR and CML activity against the stimulator cell was found. We also observed that both the original MLR (A*B) and the reserve MLR (B*A) could be suppressed by these anti-A suppressor cells. These results are compatible with the hypothesis that in the protocol studied suppression is mediated by lysis of the stimulator cells.

A new approach of ordered mixing applied to digitoxin tablets.

In ordered mixing it is assumed that mixing very different amounts of two materials is improved by adsorption of small particles onto large carrier particles. This hypothesis could be confirmed with tablets of 120 mg containing 0.1 mg digitoxin, prepared by dry coating of particles.