Search

Background: Ductal pancreatic adenocarcinoma (PDAC) still has a dismal prognosis even when deemed resectable. A cancer free resection margin (R0) is associated with a more favourable prognosis than the presence of tumour cells at resection margin (R1). However, the precise definition of the R0 status is still a matter of debate in PDAC. For a more accurate determination of R0 in PDAC the concept of circumferential resection margins (CRM) has been established and has been incorporated into the German national S3 guideline on exocrine pancreatic cancer. However, an international standardized nomenclature of CRM is still missing, and the clinical value of the CRM concept is not yet fully established. Here we evaluate whether the CRM status as defined in the national German S3 guideline corresponds with overall and progression free survival in PDAC using data from the regional cancer registry of the State of Baden Württemberg in Germany., Methods: Data from the cancer registry of the State of Baden-Württemberg, Germany, were used to assess the relationship between CRM-status and progression free survival (PFS) as well as 3-year overall survival (OS) using documented patients diagnosed with resectable ductal adenocarcinoma of the pancreas between 2015 and 2020. Patients were residents of the State of Baden-Württemberg and underwent surgery for PDAC. The R-status was assessed according to the national German S3 guideline with R0 wide/CRM- when CRM is > 1 mm from the tumour, R0 narrow/CRM + when CRM is ≤ 1 mm from the tumour and R1 when tumour cells are found at the resection margin., Results: In total we identified 1098 cases surgically treated for pancreatic cancer and fulfilling the inclusion criteria. 340 patients had an R0 wide/CRM- resection, 410 patients an R0 narrow/CRM + resection, and 348 patients an R1 resection. The R0 wide/CRM- status was associated with a significantly increased median OS rate compared to the other two groups (51,5%, 37,4% and 26,7% for R0 wide/CRM-, R0 narrow/CRM + and R1, respectively). mPFS was also longer in the R0 wide/CRM- group. These findings were robust with regards to grading and tumour location., Conclusions: CRM is prognostic for patients with resectable PDAC making the pathological assessment of the R-status according to the CRM concept worthwhile., (© 2024. The Author(s).)

Background: Despite demographic changes, there is still no systematic and comparable differentiation of nursing care reporting on a small-scale level in Germany, where outpatient long-term care is depicted. This article presents findings of care assessment data of the Medical Service of Bavaria and draws conclusions for future reporting on nursing., Methods: For the analysis, anonymised initial long-term care assessments of the Bavarian Medical Service of 2019 were evaluated exemplarily using descriptive methods. The study describes the characteristics of persons with a care level recommendation, the distribution of care level categories, medical diagnoses and degree of independence in the areas of life., Results: The persons assessed were on average 80 years old. At the time of the initial assessment, the largest proportion of persons with an assigned care level lived in an outpatient setting. Care level (PG) 1 (slight impairment of independence or abilities) was assigned to 35.1% of the insured, PG 2 (considerable impairment) to 43.1%, PG 3 (severe impairment) to 16.6%, PG 4 and 5 (most severe impairment) were each rarely assigned at the time of the initial assessment (3.9% and 1.4%, respectively). Medical diagnoses were dominated by gait and mobility disorders, unspecified dementia, heart failure and senility. In particular, there were impairments in the areas of 'mobility' and 'organisation of everyday life and social contacts'., Conclusions: The data available from the German Medical Service may be highly relevant to health research and policy and may provide a basis for planning interventions in long-term care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

It is generally assumed that butterflies, as is the case with many holometabolous insects, rely primarily on nutrients gathered by larval feeding for somatic maintenance and fecundity. These reserves can be supplemented by adult feeding and in some cases by nuptial gifts passed from the males to the females during mating. Recent findings indicate that female butterflies detect and prefer nectar with high levels of amino acids, thus calling new attention to this nutritive source. Polyandrous species can further supplement their larval stores with additional nuptial gifts. This study examined how mating frequency of the polyandrous butterfly Pieris napi affects the female's preference for nectar amino acids. Females of this species generally detect and prefer nectar mimics containing amino acids. However, nectar amino acid preference is significantly lower in mated females. Furthermore, nectar amino acid preference increases when females are not allowed to remate, whereas the preference of twice-mated females remains constant at a lower level. These results indicate a versatile response of females to nectar amino acids, depending on their nutritional status; they may even switch their source of amino acids between adult feeding and nuptial gifts.

For the conventional X-ray therapy the Röntgenverordnung demands the examination of the dose rate in the radiation beam. The measurements and the results are demonstrated. Over a long period the X-ray equipment shows a constant dose rate. Controls of the technical devices and situations of danger are explained.