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Background: Extended resections (i.e., major hepatectomy and/or pancreatoduodenectomy) are rarely performed for gallbladder cancer (GBC) because outcomes remain inconclusive. Data regarding extended resections from Western centers are sparse. This Dutch, multicenter cohort study analyzed the outcomes of patients who underwent extended resections for locally advanced GBC., Methods: Patients with GBC who underwent extended resection with curative intent between January 2000 and September 2018 were identified from the Netherlands Cancer Registry. Extended resection was defined as a major hepatectomy (resection of ≥ 3 liver segments), a pancreatoduodenectomy, or both. Treatment and survival data were obtained. Postoperative morbidity, mortality, survival, and characteristics of short- and long-term survivors were assessed., Results: The study included 33 patients. For 16 of the patients, R0 resection margins were achieved. Major postoperative complications (Clavien Dindo ≥ 3A) occurred for 19 patients, and 4 patients experienced postoperative mortality within 90 days. Recurrence occurred for 24 patients. The median overall survival (OS) was 12.8 months (95% confidence interval, 6.5-19.0 months). A 2-year survival period was achieved for 10 patients (30%) and a 5-year survival period for 5 patients (15%). Common bile duct, liver, perineural and perivascular invasion and jaundice were associated with reduced survival. All three recurrence-free patients had R0 resection margins and no liver invasion., Conclusion: The median OS after extended resections for advanced GBC was 12.8 months in this cohort. Although postoperative morbidity and mortality were significant, long-term survival (≥ 2 years) was achieved in a subset of patients. Therefore, GBC requiring major surgery does not preclude long-term survival, and a subgroup of patients benefit from surgery.

The article presents the current performance capacity in 11-15 year old Dutch adolescents who participated in an incremental cycle test (n = 509) and or in a shuttle run test (N = 1,198). Cycle test results increased significantly with age in both genders, also after normalization to body weight. Shuttle run test results increased significantly with age only in boys. Compared with previous data, the absolute performance capacity in the cycle tests was comparable to data from 15 years ago, whereas the performance capacity normalized to kg body weight and the shuttle run test results seem to be fairly lower compared with the former data.

A recent meta-analysis showed that foods with a low Glycemic Index (GI) have a clinically useful effect on glycemic control in patients with diabetes. Although diabetes-specific enteral formulas are commonly used for diabetic patients with insufficient oral intake, not much is known about the GI of these formulas. Therefore the purpose of this study was to assess the GI of several diabetes-specific formulas and to compare them with standard formulas. The randomised, double blinded, crossover study included twelve products which were tested in 7-10 individuals from a pool of 14 healthy volunteers. After an overnight fast, volunteers were given a portion of a product containing 25 grams of carbohydrate or the reference feed (200 ml containing 25 gram glucose) on different occasions in random order. Postprandial blood glucose levels were measured in venous whole blood for two hours after intake of the products and positive incremental area under the curve (AUC) was calculated for both the products and the reference feed. The GI of the test products was determined by dividing AUC (test products) by the AUC (reference feed). Enteral formulas varied widely in their GI values with the diabetes-specific enteral formulas being characterized by a significant (P=0.004) lower GI (average +/-SEM: 19.4 +/- 1.8) than standard formulas (42.1 +/- 5.9). However, there was an overlap between the two types of formulas. Three of the diabetes-specific formulas had significantly lower GI than 3 of the standard products. Although there is some overlap with the GI of diabetes-specific and standard formulas, certain diabetes-specific formulas had very low GI values, which may be clinically beneficial due to better glycemic control. Therefore the use of diabetes-specific formulas with a low GI should be the preferred option for the nutritional management of diabetic patients in need of nutritional support.

In a study of 689 male homosexuals 290 (42%) were found to have antibodies to hepatitis A virus. The 399 men who did not have antibodies were followed up for up to 690 days, and 35 cases of hepatitis A were detected. The attack rate at the end of the study was 14%. The incidence climbed steadily, indicating that the cases of hepatitis A did not occur in clusters. Statistical analysis showed that the prevalence of antibodies to hepatitis A virus was significantly correlated with the duration of homosexual activity (p less than 0.006), and this was independent of age. The incidence of hepatitis A was found to be correlated with the number of different sexual partners in the preceding six months. It is concluded that hepatitis A is a sexually transmitted disease among homosexual men in countries with a low rate of exposure to hepatitis A during childhood.

The efficacy of a heat-inactivated hepatitis B virus (HBV) vaccine, containing 3 micrograms-HBsAg, was studied among a group of 800 susceptible homosexual men. The trial was conducted randomized, placebo-controlled and double blind. At the trial end point (21.5 months) the attack-rate for all HBV infections together was 4.8% among vaccinees and 23.8% among the placebos (p less than 0.0001). Four months after the first injection 89% of the vaccinees had formed anti-HBs and this percentage declined only slightly during the follow-up period. Maximum titers were reached 5 months after the first vaccination. None of the vaccinees who responded to the vaccine with anti-HBs greater than or equal to 1 mIU/ml developed a HBsAg positive infection. The vaccine had no serious side-effects.

The prevalence and incidence of cytomegalovirus (CMV) infections were studied in a group of homosexual men. Of the 710 participants, 501 (70.6%) had complement fixing antibodies to CMV on entry to the study. During the follow up (maximum 23 months) 69 CMV infections were found: 50 primary infections among the 209 seronegative men (attack rate 27.3%), and 19 recurrent infections among the 501 seropositive men (attack rate 6.2%). The prevalence of antibody to CMV was correlated with four characteristics of the participants' lifestyles: duration of homosexual activity, number of different sexual partners, history of syphilis, and anal sexual contact. Among the seronegative men, the incidence of primary infection with CMV correlated with a history of syphilis and anal sexual contact. We conclude that infections with CMV are highly prevalent among homosexual men, and that anal sexual contact plays an important part in the transmission of this virus.