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The Philippines is an archipelago that relies on marine resources. Butuan Bay in the Philippines supports aquaculture, which can contribute to and can be impacted by plastic pollution. However, the microplastics (MP) in milkfish, an important aquaculture species in the area, are yet to be ascertained. This study determined the prevalence of microplastics in the surrounding seawater and in the gut of adult milkfish from cages in Butuan and Nasipit in Butuan Bay. Water samples in Nasipit and Butuan contain 0.20 items/L and 1.00 items/L, respectively. MPs in milkfish in Butuan (10.27 items/individual) were significantly higher than in Nasipit (5.40 items/individual). A total of 235 MPs in 29 out of 30 fish samples (97 %) from the two sites were detected. The dominant MP shape and color were fiber and blue, respectively. The presence of microplastics in the milkfish may indicate a possible risk to the fish species and human health. [Display omitted] • Microplastics (MP) were detected in 97 % of fish samples. • Higher MP in water resulted in higher ingestion by milkfish. • Milkfish in cages in Butuan City has higher MP than in Nasipit. • Ethylene-vinyl acetate was the most dominant polymer type. [ABSTRACT FROM AUTHOR]

Abstract: Novel methods of correlating damage evolution measurement techniques are explored to produce improved constitutive equations that better account for the effect of initial inclusion distributions on damage softening behaviour. Based on ex situ, high resolution, synchrotron tomographic quantification of the three-dimensional interactions of damage formed during hot deformation of free cutting steel, a new parameter to account for the effect of inclusions on damage is proposed. Uniaxial tensile samples deformed at 1100°C and a strain rate of 0.1s−1 were interrupted at various strains prior to failure. Ex situ synchrotron X-ray computed tomography (sCT) was then used to quantify the growth of damage in the hot deformation of a leaded free cutting steel. Void growth is related to nucleated microvoids at inclusions. The number and volume fraction of voids were calculated for each tensile sample, allowing quantification of the evolving ductile damage via the measured increase in average void diameter after each strain increment. The equivalent diameter, spacing and volume fraction of inclusions were measured at the different interrupt strains. The local strain and stress state, evaluated using the finite element method at the microscale, were related to the local void populations. There was evidence that after necking the damage localized due to clustered inclusions. Damage localization was confirmed with a three-dimensional micromechanics model of 100 inclusions, whose distribution was taken directly from the sCT results, and a novel approach to extract the damage fraction is presented. A new parameter was introduced to account for inclusion size, spacing and clustering, which was validated against the sCT results. [Copyright &y& Elsevier]

Background & Aims: The incidence of intraductal papillary mucinous neoplasm (IPMN) is believed to be increasing; we investigated whether this is the result of increasing burden of disease or more diagnostic scrutiny. Methods: In a retrospective cohort study, we calculated a trend in reported incidence of IPMN using data collected from Olmsted County, Minnesota, from 1985 to 2005. Total IPMN cases from the Olmsted database were identified through a keyword and International Classification of Diseases, 9th revision, search using a database from the Rochester Epidemiology Project, with all cases verified by subsequent chart review. The subsequent rate of IPMN-related carcinoma was calculated using data from the national Surveillance Epidemiology and End Results-9 database, reflecting trends from 1982 to 2007. Cases of IPMN-related carcinoma were identified in the Surveillance Epidemiology and End Results-9 database by limiting the search to histology codes for noninvasive and invasive IPMN. Results: Between 1985 and 2005, there was a 14-fold increase in the age- and sex-adjusted incidence of IPMN, from 0.31 to 4.35 per 100,000 persons. From 2000 to 2001, the rate of reported carcinoma increased from 0.008 to 0.032 per 100,000 persons, but stabilized afterward, with a rate of 0.06 per 100,000 persons in 2007. Mortality from all causes of pancreatic cancer was stable between 1975 and 2007 (approximately 11 deaths per 100,000 individuals). Conclusions: The incidence of IPMN has increased in the absence of an increase in IPMN-related or overall pancreatic cancer–related mortality, so it likely results from an increase in diagnostic scrutiny, rather than greater numbers of patients with clinically relevant disease. [Copyright &y& Elsevier]

Study Aims: To determine if neoadjuvant FOLFOX/FOLFIRI is associated with improved disease-free survival (DFS) or overall survival (OS) in patients with colorectal metastases (CRM) to the liver.Methods: Ninety-nine patients (from 457 eligible) with CRM that underwent hepatic resection during 2000 to 2005 were included. Group 1 (n = 44) patients received neoadjuvant FOLFOX/FOLFIRI, and Group 2 (n = 55) did not receive neoadjuvant therapy.Results: There were 58% men. The median age for Group 1 was 58 and Group 2, 64 (p = 0.03). OS for Group 1 at 1, 3, and 5 years was 93%, 62%, and 51%, respectively, with a median OS of 5.8 years. In Group 2 survival at 1l, 3, and 5 years was 90%, 63%, and 45%, respectively, with a median OS of 3.7 years (HR 1.06, p = 0.87). The DFS for Group 1 at 1, 3, and 5 years was 51%, 20%, and 20%, with a median DFS of 1.1 years and Group 2 at 1, 3, and 5 years was 58%, 32%, and 32% (median DFS-1.2 years; HR = 1.24, p = 0.45).Conclusions: Neoadjuvant FOLFOX/FOLFIRI was employed more frequently in younger patients with CRM; however, neoadjuvant chemotherapy for CRM was not significantly associated with an increase in OS or DFS, despite additional adjuvant therapy. [ABSTRACT FROM AUTHOR]

Abstract: Bark beetle infestation is a well-known cause of historical low-level disturbance in southwestern ponderosa pine forests, but recent fire exclusion and increased tree densities have enabled large-scale bark beetle outbreaks with unknown consequences for ecosystem function. Uninfested and beetle-infested plots (n =10 pairs of plots on two aspects) of ponderosa pine were compared over one growing season in the Sierra Ancha Experimental Forest, AZ to determine whether infestation was correlated with differences in carbon (C) and nitrogen (N) pools and fluxes in aboveground biomass and soils. Infested plots had at least 80% of the overstory ponderosa pine trees attacked by bark beetles within 2 years of our measurements. Both uninfested and infested plots stored ∼9kgCm−2 in aboveground tree biomass, but infested plots held 60% of this aboveground tree biomass in dead trees, compared to 5% in uninfested plots. We hypothesized that decreased belowground C allocation following beetle-induced tree mortality would alter soil respiration rates, but this hypothesis was not supported; throughout the growing season, soil respiration in infested plots was similar to uninfested plots. In contrast, several results supported the hypothesis that premature needlefall from infested trees provided a pulse of low C:N needlefall that altered soil N cycling. The C:N mass ratio of pine needlefall in infested plots (∼45) was lower than uninfested plots (∼95) throughout the growing season. Mineral soils from infested plots had greater laboratory net nitrification rates and field resin bag ammonium accumulation than uninfested plots. As bark beetle outbreaks become increasingly prevalent in western landscapes, longer-term biogeochemical studies on interactions with other disturbances (e.g. fire, harvesting, etc.) will be required to predict changes in ecosystem structure and function. [Copyright &y& Elsevier]

Background: The study of long-term complications after pancreaticoduodenectomy (PD) for malignant disease has been problematic given the paucity of patients with long-term survival after diagnosis and surgical resection. We therefore studied patients who were surgically treated with a PD for a benign diagnosis to evaluate long-term anastomotic durability.Methods: A retrospective analysis of 122 patients who had PD performed in the interval 1993-2003 inclusive for benign pancreatic diseases was undertaken. Long-term morbidity and mortality (specifically biliary, pancreaticojejunostomy [PJ], and gastrojejunostomy [GJ] strictures) were evaluated.Results: Gender was equally represented with 53% female and 47% male. The median age at surgery was 55 years (range 15-81 years). The three most frequent diagnoses were chronic pancreatitis (40%), intraductal papillary mucinous neoplasm (16%), and cystic neoplasms (9%). Median follow-up in the 95 patients alive at last follow-up was 4.1 years (10 days-12.6 years). The 5- and 10-year survival rates were 83% (76, 91%) and 62% (49%, 78%), respectively. The observed survival was significantly lower than the expected survival in an age- and gender-matched U.S. white population, p<0.001 (one-sample log-rank test). The 5- and 10-year cumulative probability of biliary stricture was 8% (2%, 14%) and 13% (4%, 22%), respectively. For pancreatic strictures the 5- and 10-year rates were 5% (0%, 9%) and 5% (0%, 9%), respectively. No GJ strictures were noted. The management of biliary strictures was primarily with dilatation and stent (78%) and less commonly operative intervention (22%). Pancreatic strictures required surgery alone (25%), surgery followed by endoscopic intervention (25%), or endoscopic therapy alone (50%).Conclusion: Intervention for anastomotic strictures after pancreaticoduodenectomy is uncommon. Biliary strictures can usually be treated nonoperatively with dilation and stent. Our study likely underestimates the incidence of stricture formation. Prospective imaging studies may be warranted for a more accurate assessment of the rate of long-term anastomotic complications. [ABSTRACT FROM AUTHOR]

Several definitions for pancreatic leakage after pancreaticodoudenectomy exist, and the reported range of 2-50% underscores this variation. The goal was to determine if drain data alone was predictive of a leak and validate International Study Group on Pancreatic Fistula (ISGPF) leak criteria. Participating surgeons entered de-identified data into a web-based database designed to collect Whipple-related data. Definitions used were the ISGPF definition, > or = 3 days, amylase 3x normal; and Sarr's definition, > or = 5 days, amylase 5x normal, > 30 ml. We compared how well these two definitions were at detecting a leak and its complications. There were 1,507 cases submitted from 16 international institutions. A pancreaticoduodenectomy (PPPD) was performed in 76.2%. Drain placement occurred in 98.0%. Using the ISGPF definition, the pancreatic leak rate was 26.7 and 14.3% with the Sarr definition. There were more grades A and B leaks detected by the ISGPF definition. Both determined grade C leaks equally. Both definitions correlated with an increased length of stay (LOS), need for percutaneous drains, reoperation, and delayed gastric emptying (DGE). Neither was associated with an increased risk of intensive care unit (ICU) stay or 30-day mortality. The ISGPF was able to capture more patients with clinically relevant leaks than Sarr's criteria; however, the ability to detect a leak by drain data alone is imperfect. [ABSTRACT FROM AUTHOR]

Gallbladder cancer is one of the most lethal carcinomas and continues to pose many challenges for surgeons. Identifiable risk factors for carcinoma of the gallbladder include cholelithiasis, an anomalous pancreaticobiliary junction, and focal mucosal microcalcifications. Adenocarcinoma is the primary histologic type in most patients and the tumor is frequently associated with Kras and p53 mutations. Radiologic and endoscopic advances in endoscopic ultrasonography and magnetic resonance cholangiopancreatogram, plus helical computed tomography, have enhanced preoperative staging. Surgical options include cholecystectomy for disease limited to the mucosa (Tis/T1) or a radical cholecystectomy (subsegmental resection of segments IVB and V plus a hepatoduodenal ligament lymphadenectomy) for advanced disease without signs of distant metastasis (T2-4/N0-N2). Some surgeons have advocated more radical hepatic resection including extended right hepatectomy or central bisegmentectomy plus caudate lobectomy. Japanese surgeons have reported studies that included patients having a pancreaticoduodenectomy to improve distal ductal margins and lymphadenectomy for T3 and T4 cancers. These patients have a lower rate of local recurrence but no survival advantage. Options for adjuvant therapy remain limited. Radiation therapy with fluorouracil radiosensitization is the most commonly used postoperative treatments. Current trials are investigating the role of capecitabine, oxaliplatin, and bevacizumab in the management of gallbladder carcinoma. [ABSTRACT FROM AUTHOR]

The concept that complex surgical procedures should be performed at high-volume centers to improve surgical morbidity and mortality is becoming widely accepted. We wanted to determine if there were differences in the treatment of patients with gastric cancer between community cancer centers and teaching hospitals in the United States. Data from the 2001 Gastric Cancer Patient Care Evaluation Study of the National Cancer Data Base comprising 6,047 patients with gastric adenocarcinoma treated at 691 hospitals were assessed. The mean number of patients treated was larger at teaching hospitals (14/year) when compared to community centers (5-9/year) (p<0.05). The utilization of laparoscopy and endoscopic ultrasonography were significantly more common at teaching centers (p<0.01). Pathologic assessment of greater than 15 nodes was documented in 31% of specimen at community hospitals and 38% at teaching hospitals (p<0.01). Adjusted for cancer stage, chemotherapy and radiation therapy were utilized with equal frequency at all types of treatment centers. The 30-day postoperative mortality was lowest at teaching hospitals (5.5%) and highest at community hospitals (9.9%) (p<0.01). These data support previous publications demonstrating that patients with diseases requiring specialized treatment have lower operative mortality when treated at high-volume centers. [ABSTRACT FROM AUTHOR]

The growth of megacities in seismically active regions around the world often includes the construction of seismically unsafe buildings and infrastructures due to an insufficient knowledge of existing seismic hazard and/or economic constraints. Minimization of the loss of life, property damage, and social and economic disruption due to earthquakes depends on reliable estimates of seismic hazard. We have produced a suite of seismic hazard estimates for Mexico, the Caribbean, and Central and South America. One of the preliminary maps in this suite served as the basis for the Caribbean and Central and South America portion of the Global Seismic Hazard Map (GSHM) published in 1999, which depicted peak ground acceleration (pga) with a 10% chance of exceedance in 50 years for rock sites. Herein we present maps depicting pga and 0.2 and 1.0 s spectral accelerations (SA) with 50%, 10%, and 2% chances of exceedance in 50 years for rock sites. The seismicity catalog used in the generation of these maps adds 3 more years of data to those used to calculate the GSH Map. Different attenuation functions (consistent with those used to calculate the U.S. and Canadian maps) were used as well. These nine maps are designed to assist in global risk mitigation by providing a general seismic hazard framework and serving as a resource for any national or regional agency to help focus further detailed studies required for regional/local needs. The largest seismic hazard values in Mexico, the Caribbean, and Central and South America generally occur in areas that have been, or are likely to be, the sites of the largest plate boundary earthquakes. High hazard values occur in areas where shallow-to-intermediate seismicity occurs frequently. [Copyright &y& Elsevier]

The article presents the case report of a 45-year-old white man who became acutely ill with fever, chills, and nausea for 3 weeks. He had received cimetidine and naproxen for 6 weeks. A diagnosis of acute allergic interstitial nephritis was made and a renal biopsy was performed. It is stated that the case illustrates the importance of recognizing druginduced interstitial nephritis.

Abstract: Primary pancreatic cystic neoplasms are being recognized with increasing frequency due to modern imaging techniques. In addition to the more common cystic neoplasms—serous cystadenoma, primary mucinous cystic neoplasm, and intraductal papillary mucinous neoplasm—there are many other less common neoplasms that appear as cystic lesions. These cystic neoplasms include solid pseudopapillary neoplasm of the pancreas (the most common rare cystic neoplasm), cystic neuroendocrine neoplasm, cystic degeneration of otherwise solid neoplasms, and then the exceedingly rare cystic acinar cell neoplasm, intraductal tubular neoplasm, angiomatous neoplasm, lymphoepithelial cysts (not true neoplasms), and few others of mesenchymal origin. While quite rare, the pancreatic surgeon should at the least consider these unusual neoplasms in the differential diagnosis of potentially benign or malignant cystic lesions of the pancreas. Moreover, each of these unusual neoplasms has their own natural history/tumor biology and may require a different level of operative aggressiveness to obtain the optimal outcome. [Copyright &y& Elsevier]

Objectives: Although lymphatic spread is common in intrahepatic cholangiocarcinoma (ICC), lymphadenectomy is not widely performed as part of operative resection in this disease. The objectives of this study were to assess national trends for lymphadenectomy and its impact on survival in patients with ICC. Methods: The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry was queried to identify patients with ICC ( n= 4893) reported during 1988-2007. Kaplan-Maier and Cox proportional hazards regression were used to analyse survival. Results: Five-year overall survival (OS) was 5.2%. Lymph node (LN) status was available for 48.9% ( n= 2391) of patients. Histologic LN evaluation was performed in 13.5% ( n= 658) of patients for a median of two (interquartile range: 1-3) LNs. During the study period, the frequency of histologic LN assessment ( P= 0.78) did not change in liver resection patients. In the 733 resected patients, positive vs. negative LN status was associated with worse 5-year OS of 8.4% vs. 25.9%, respectively (hazard ratio = 1.8; P < 0.001). Conclusions: Nodal status is an important prognostic factor for survival in patients diagnosed with ICC. In the USA, few patients undergo hepatic resection with lymphadenectomy; therefore, the clinical benefit of formal lymphadenectomy in ICC remains unknown. [ABSTRACT FROM AUTHOR]

Background: New-onset diabetes mellitus after a pancreaticoduodenectomy (PD) remains poorly defined. The aim of this study was to define the incidence and predictive factors of immediate post-resection diabetes mellitus (iPRDM). Methods: Retrospective review of patients undergoing PD from January 2004 through to July 2010. Immediate post-resection diabetes mellitus was defined as diabetes requiring pharmacological treatment within 30 days post-operatively. Logistic regression was conducted to identify factors predictive of iPRDM. Results: Of 778 patients undergoing PD, 214 were excluded owing to pre-operative diabetes ( n= 192), declined research authorization ( n= 14) or death prior to hospital discharge ( n= 8); the remaining 564 patients comprised the study population. iPRDM occurred in 22 patients (4%) who were more likely to be male, have pre-operative glucose intolerance, or an increased creatinine, body mass index (BMI), pre-operative glucose, operative time, tumour size or specimen length compared with patients without iPRDM ( P < 0.05). On multivariate analysis, pre-operative impaired glucose intolerance ( P < 0.001), pre-operative glucose ≥ 126 ( P < 0.001) and specimen length ( P= 0.002) were independent predictors of iPRDM. A predictive model using these three factors demonstrated a c-index of 0.842. Discussion: New-onset, post-resection diabetes occurs in 4% of patients undergoing PD. Factors predictive of iPRDM include pre-operative glucose intolerance, elevated pre-operative glucose and increased specimen length. These data are important for patient education and predicting outcomes after PD. [ABSTRACT FROM AUTHOR]

Background: Primary gastrointestinal stromal tumours (GISTs) of the duodenum are rare. The aim of this study was to review the surgical management of GISTs in this anatomically complex region. Methods: Retrospective review from January 1999 to August 2011 of patients with primary GISTs of the duodenum. Results: Forty-one patients underwent resection of duodenal GISTs. All operations were performed with intent to cure with negative margins of resection. The most common location of origin was the second portion of the duodenum. Local excision ( n= 19), segmental resection with primary anastomosis ( n= 11) and a pancreatoduodenectomy ( n= 11) were performed. Two patients underwent an ampullectomy with local excision. Peri-operative mortality and overall morbidity were 0 and 12, respectively. Patients with high-risk GISTs ( P= 0.008) and those who underwent a pancreatoduodenectomy ( P= 0.021) were at a greater risk for morbidity. The median follow-up was 18 months. Eight patients developed recurrence. High-risk GISTs and neoplasms with ulceration had the greatest risk for recurrence ( P= 0.017, P= 0.029 respectively). The actuarial 3- and 5-year survivals were 85% and 74%, respectively. Conclusion: The choice and type of resection depends on the proximity to the ampulla of Vater, involvement of adjacent organs and the ability to obtain negative margins. The morbidity depends on the type of procedure for GIST. [ABSTRACT FROM AUTHOR]

Background: Anaplastic pancreatic cancer (APC) is a rare subtype of pancreatic ductal adenocarcinoma (PDA) that can carry a worse overall survival (OS) when compared with other variants. However, the presence of osteoclast-like giant cells (OCGCs) in APC specimens can predict improved OS. The aim of this study was to evaluate the OS of patients with APC (with and without OCGCs) compared with patients with other subtypes of PDA using a population-based registry. Study Design: We identified all patients in the Surveillance, Epidemiology and End Results (SEER) database with pathologically confirmed APC and PDA diagnosed between 1988 and 2008. Overall survival was evaluated using Kaplan-Meier and Cox proportional hazard regression. Results: The study cohort included 5,859 (94.3%) patients with PDA and 353 (5.7%) with APC. Overall survival for all patients with APC was significantly worse than for patients with PDA (hazard ratio [HR] = 1.9; 95% CI, 1.7−2.1; p < 0.001); however, in the subgroup of resected patients, APC (n = 81) had similar OS to PDA (n = 3,517) (HR = 0.9; 95% CI, 0.7−1.2; p = 0.37). Patients with APC tumors with OCGCs (n = 11) demonstrated improved OS when compared with all other APC variants without OCGCs (n = 342) (HR = 0.3; 95% CI, 0.1−0.7; p = 0.004), but this survival difference was not observed in the subgroup of resected patients (HR = 0.5; 95% CI, 0.2−1.4; p = 0.18). Conclusions: Anaplastic pancreatic cancer is a rare malignancy with poor OS. The diagnosis of APC with OCGCs is predictive of improved OS compared with other patients with APC. This survival benefit, however, is not observed in patients with resected disease. [ABSTRACT FROM AUTHOR]

Abstract: Intraductal papillary mucinous neoplasms (IPMNs) represent about 25% of all primary pancreatic cystic neoplasms and are increasingly recognized during the last two decades. They are characterized by intraductal proliferation of neoplastic mucinous cells forming papillary projections into the pancreatic ductal system, which is typically dilated and contains globules of mucus. IPMNs may be multifocal and have malignant potential. Modern imaging is essential in establishing preoperative diagnosis and in differentiating different subtypes of IPMNs (i.e., main-duct vs. branch-type disease). Endoscopic retrograde or magnetic resonance cholangiopancreatography accurately delineate the morphologic changes of the pancreatic ductal system. Endoscopic ultrasonography (usually used in conjunction with image-guided FNA and analysis of the aspirated material) is commonly used for differential diagnosis of IPMNs from other pancreatic cystic lesions. Surgical resection (usually anatomic pancreatectomy, depending on the location of the disease) is the treatment of choice. Total pancreatectomy may occasionally be required in selected patients, but is associated with formidable long-term morbidity. A conservative approach has recently been proposed for carefully selected patients with branch-duct IPMNs. Recurrences following surgical resection can be observed, especially in patients with multifocal disease or in the presence of underlying malignancy. [Copyright &y& Elsevier]

Abstract: Primary pancreatic cystic neoplasms have been recognized increasingly during the two recent decades and include mainly serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. Serous cystic neoplasms represent about 30% of all cystic neoplasms of the pancreas and are characterized by their microcystic appearance (on imaging, macroscopically, and microscopically) and their benign biologic behavior. Modern diagnostic methodology allows the preoperative diagnosis with an acceptable accuracy. Currently, indications for resection of serous cystic neoplasms of the pancreas include the presence of symptoms, size > 4 cm (because these ‘large’ neoplasms have a more rapid growth rate and probably will soon become symptomatic), and any uncertainty about the diagnosis of a serous versus a mucinous cystic neoplasm. Resection should also be considered for lesions in the body/tail of the pancreas. Conservative treatment is a reasonable option in selected patients (for example in the presence of small, asymptomatic lesions in the pancreatic head, especially in the frail or elderly patient). [Copyright &y& Elsevier]

Abstract: Mucinous cystic neoplasms (MCNs) of the pancreas represent one of the most common primary pancreatic cystic neoplasms, accounting for approximately half of these cases. MCNs are observed almost exclusively in women, and most commonly are located in the body/tail of the pancreas. In contrast to SCNs, MCNs have malignant potential. Proliferative changes (hyperplasia with or without atypia, borderline changes, non-invasive or carcinomas in-situ, and invasive carcinomas) can often be observed within the same neoplasm. Several risk factors for the presence of underlying malignancy within an MCN have recently been recognized. Cross-sectional imaging is of key importance for the diagnostic evaluation of patients with a cystic pancreatic lesion. Cyst fluid examination (cytology, biochemical/genetic analysis) is possible by using fine needle aspiration of the MCN, usually under endoscopic guidance, and may provide useful information for the differential diagnosis. Since MCNs have malignant potential, surgical resection is the treatment of choice. [Copyright &y& Elsevier]

Background: The surgical treatment of metastatic, nonfunctional pancreatic neuroendocrine carcinoma (nPNEC) is not well defined. Existing series are confounded by inclusion of patients with metastatic functional tumors or gastrointestinal carcinoid. Our hypothesis was that the surgical treatment of metastatic nPNEC provides favorable perioperative and oncologic outcomes. Study Design: We performed a retrospective review of all patients undergoing surgical treatment of metastatic nPNEC to the liver from 1987 through 2008 at the Mayo Clinic. Data are presented as medians with ranges. Results: Seventy-two patients were identified, with a median age of 57 years (range 28 to 77 years) and median body mass index (BMI) of 26 kg/m2 (range 18 to 40 kg/m2). Operative intent of resection was curative in 39 (54%) or palliative (≥90% tumor debulking) in 32 (44%). Median number of tumors treated and median tumor size were 8 (range 1 to 30) and 4.5 cm (range 0.3 to 20 cm), respectively. Tumor grade was 1 or 2 in 97%, and angioinvasion was identified in 55 (76%) patients. Postoperative morbidity and mortality were 50% and 0%, respectively. Among the 72 patients, overall survivals at 1, 5 and 10 years were 97.1%, 59.9%, and 45.0%, respectively. Among the 39 patients with a complete (R0) resection, the 1- and 5-year disease-free survivals were 53.7% and 10.7%, respectively. For patients undergoing debulking of ≥90% tumor burden, the 1- and 5-year survivals free of progression were 58.1% and 3.5%, respectively. Conclusions: Surgical treatment of metastatic nPNEC to the liver with curative intent or for palliative ≥90% debulking provides favorable oncologic outcomes. Despite a high incidence of tumor recurrence, 5-year survival rates are encouraging and appear to justify an aggressive surgical approach in these patients. [ABSTRACT FROM AUTHOR]

Background: Biliary intraductal papillary mucinous neoplasm (B-IPMN) has been proposed as a unique clinicopathologic disease with distinct histopathologic features, although wide acceptance remains controversial. A recent consensus conference classified pancreatic IPMN (P-IPMN) into 4 subtypes (ie, gastric, intestinal, pancreatobiliary, oncocytic) based on morphologic appearance and mucin (MUC) staining properties. The aim of this study was to determine whether B-IPMN has similar histopathologic and immunologic subtypes to P-IPMN. Study Design: Specific immunostaining for MUC1, MUC2, and deleted for pancreas cancer, locus 4 were performed on specimens from 19 patients with a histopathologic diagnosis of B-IPMN. Immunostaining patterns of B-IPMN were correlated with histopathology. Results: Based on histopathology, the following subtypes of B-IPMN were identified: pancreatobiliary n = 9 (47%), intestinal n = 8 (42%), oncocytic n = 2 (11%), and gastric n = 0 (0%). Pancreatobiliary and oncocytic subtypes of B-IPMN were positive for MUC1 and negative for MUC2, and intestinal subtypes were positive for MUC2 and negative for MUC1. Thirteen of the 19 B-IPMN were associated with invasive carcinoma; loss of deleted for pancreas cancer, locus 4 was found in 6 of 13 invasive components and in 3 of 19 noninvasive components of B-IPMN. Five-year survival for patients with resected B-IPMN and invasive carcinoma was 38%, which is similar to that for resected P-IPMN with invasive carcinoma. Conclusions: Histopathologic subtypes and type-specific MUC expression patterns of B-IPMN resemble those of P-IPMN. MUC1 expression and/or absence of MUC2 expression, which correlate with aggressive features of P-IPMN, were found in B-IPMN and correlate with invasive B-IPMN. Loss of deleted for pancreas cancer, locus 4 parallels the findings observed in P-IPMN. These findings provide additional support that B-IPMN is a unique entity with similarities to main duct P-IPMN. [ABSTRACT FROM AUTHOR]

Abstract: Our changing understanding of cystic abnormalities within the pancreas, and especially for cystic neoplasms of the pancreas, has led to a sea change in recognition, management, and interest in these lesions over the last 30 years. Unimagined improvements in cross-sectional imaging, better understanding of the natural biology, aggressiveness of mucinous versus serous epithelial neoplasms, and acknowledgment of the premalignant mucinous neoplasm led to tremendous interest in cystic neoplasms in all realms of pancreatology, including gastroenterologists, radiologists, pathologists, and surgeons alike. The introduction of evermore-sensitive imaging modalities, diagnostic maneuvers, and laboratory tests have led to new considerations in management, no longer limited to mucinous versus serous epithelial pathologies. The following unanswered questions remain: (1) How aggressively should small (<3 cm) asymptomatic lesions be approached and managed? (2) Are intraductal papillary mucinous neoplasms (IPMN) a localized field defect or a global abnormality potentially affecting the entire pancreatic ductal tree? (3) Does IPMN involve a different etiopathogenesis than the pancreatic intraepithelial neoplasia (PANin) progression? (4) Is there a familial form of IPMN involving a genomic or epigenetic change? and (5) Does the predilection to extrapancreatic neoplasms in patients with IPMN involve an underlying, more global genomic or epigenetic phenomena? This treatise will address these concepts. [Copyright &y& Elsevier]

Abstract: This second of two companion papers presents the latest advances of an international team on the thermochemical copper–chlorine (Cu–Cl) cycle of hydrogen production. It specifically focuses on simulations, thermochemical data, advanced materials, safety, reliability and economics of the Cu–Cl cycle. Aspen Plus simulations of various system configurations are performed to improve the cycle efficiency. In addition, simulations based on exergo-economic and exergy-cost-energy-mass (EXCEM) methods for system design are presented. Modeling of the linkage between nuclear and hydrogen plants demonstrates how the Cu–Cl cycle would be integrated with an SCWR (Super Critical Water Reactor; Canada’s Generation IV reactor). Chemical potentials, solubilities, formation of Cu(I) and Cu(II) complexes and properties of Cu2OCl2, Cu(I) and Cu(II) chloride species are reported. In addition, the development of new advanced materials with improved corrosion resistance is presented. In particular, the performance of new anode electrode structures and thermal spray coatings is presented. This companion set of two papers presents new advances in a range of key enabling technologies for the thermochemical copper–chlorine cycle. [Copyright &y& Elsevier]

Abstract: Advancement of the thermochemical copper–chlorine (Cu–Cl) cycle for hydrogen production is reviewed and discussed in this paper. Individual unit operations and their linkage into an integrated cycle are being developed by a Canadian consortium, as part of the Generation IV International Forum (GIF) for hydrogen production with the next generation of nuclear reactors. This paper focuses on the consortium’s latest advances on the Cu–Cl cycle, particularly with respect to hydrogen production with Canada’s Generation IV reactor, called SCWR (Super-Critical Water Reactor). Other heat sources may also be utilized for the Cu–Cl cycle, such as solar energy or industrial waste heat. In this first of two companion papers, recent developments in Canada’s nuclear hydrogen program are reported, specifically unit operation experiments of the Cu–Cl cycle and system integration. The following second companion paper will present system modeling with Aspen Plus, corrosion resistant materials, thermochemistry, safety, and reliability aspects of the Cu–Cl cycle. [Copyright &y& Elsevier]

Background: Mirizzi syndrome (MS) is characterized by extrinsic compression of the common hepatic duct by stones impacted in the cystic duct or gallbladder neck. Open cholecystectomy (OC) has been the standard treatment; however, laparoscopy has challenged this approach. Study Design: The objective of this study was to review our clinical experience with MS since the introduction of laparoscopic cholecystectomy (LC) and determine the impact of alternative approaches. We conducted a retrospective review of patients with MS from January 1987 to December 2009. Results: There were 36 patients with MS among 21,450 cholecystectomies (frequency 0.18%). Seventeen were women. The most common presenting symptoms were abdominal pain (n = 23) and jaundice (n = 19). Preoperative diagnostic studies included ultrasonography (n = 27), CT (n = 24), and endoscopic retrograde cholangiopancreatography (n = 32). Cholecystectomy was performed in 35 patients; LC was initiated in 15 and OC in 21. Conversion rate from LC to OC was 67%. Five patients who had successful LC had type I MS. Of the patients who underwent LC with conversion or OC, 14 had type I and 16 had type II MS. The cystic duct for type I and the bile duct for type II MS were managed diversely according to surgeon''s preference. There was no operative mortality. Morbidity was 31% with Clavien class I in 2, IIIa in 4, IIIb in 1, and IV in 3 patients. Mean hospitalization was 9 days (range 2 to 40 days). Mean follow-up was 37 months (range 1 to 187 months). Conclusions: Low incidence and nonspecific presentation of MS precludes referral and substantive individual experience. Although LC may be applicable in selected patients with type I MS, OC remains the standard of care. [Copyright &y& Elsevier]