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Simple Summary: Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers, with only 13% of patients surviving beyond five years. Effective treatment often requires a combination of surgery, chemotherapy, and/or radiation, depending on the stage of the disease. However, many patients do not receive care that follows established guidelines. In this study, we analyzed the treatment patterns of over 50,000 patients in California and found that fewer than half received guideline-concordant care. Patients who did receive care aligned with guidelines lived significantly longer, with a median survival of 10 months compared to 3 months for others. Certain groups, including Hispanic and Black patients, those without insurance, and those with other health conditions, were less likely to receive proper care. These findings underscore the need to address barriers to guideline-based treatment to improve survival rates and outcomes for patients with PDAC. (1) Background: Comprehensive evaluation of guideline-concordant care (GCC) across all PDAC stages has yet to be thoroughly conducted. This study aimed to characterize treatment patterns and assess factors associated with receiving GCC among patients with pancreatic ductal adenocarcinoma (PDAC) in California. (2) Methods: Data on adult patients with PDAC were extracted from the California Cancer Registry (2004–2020). GCC is defined according to the recommendations provided by the National Comprehensive Cancer Network. We used multivariable logistic regression to identify factors associated with receiving GCC. A Cox model was used to examine the association of GCC with overall survival. (3) Results: A total of 50,346 PDAC patients were included (stage 1: 10%; stage 2: 25%; stage 3: 11%; stage 4: 54%). Only 46.7% of all patients received GCC (stage 1: 20%; stage 2: 40%; stage 3: 69%; stage 4: 50%). Only 31% of stage 1 patients underwent surgery. Factors inversely associated with receiving GCC were Hispanic ethnicity (OR 0.78; p < 0.001), Black race (OR 0.74; p < 0.001), having no insurance (OR 0.40; p < 0.001]), and a Charlson–Deyo score of ≥2 (OR 0.68; p < 0.001). Adherence to GCC was associated with improved survival (Hazard Ratio 0.39; p < 0.001). Notably, patients with stage 1 PDAC who received GCC had a median survival of 47 months vs. 8 months for those who did not. (4) Conclusions: Although stage 1 PDAC patients have the greatest potential for survival with GCC, only 20% of patients received such treatment. Thus, it is crucial to identify and address the modifiable factors contributing to these suboptimal care patterns. [ABSTRACT FROM AUTHOR]

Background and Aims: The Hemorrhoidal Disease Symptom Score (HDSS) is a tool that is scored based on five main symptoms: pain, bleeding, itching, soiling, and prolapse. Furthermore, the Short Health Scale (SHS) is a measurement tool of subjective health and health‐related quality of life. This study was performed to validate the Farsi‐translated Hemorrhoidal Disease Symptom Score (HDSS), and Scale Short Health Scale adapted for hemorrhoidal disease (SHS‐HD) as a measure of symptom severity in patients with hemorrhoid disease. Methods: In this study, HDSS and SHS‐HD were translated into Farsi. Participants with confirmed hemorrhoid disease completed the questionnaire. Subsequently, the questionnaire's discriminative validity, convergent validity, reliability, sensitivity, and specificity were evaluated. Results: Data from 31 patients were analyzed (mean age 39.68; 71% male). The results of the analysis showed good internal consistency as Cronbach's α for HDSS and SHS were 0.994 and 0.995 respectively. Spearman's correlation coefficient for the test–retest comparison was 0.986 (p < 0.01). The responses demonstrated good convergent validity. Moreover, the comprehension and suitability of each question were rated as excellent (Pearson's correlation coefficient = 0.3). Conclusions: Our findings revealed that the Farsi translation of the HDSS and SHS‐HD can be a valuable tool for evaluating the symptom severity in patients with hemorrhoid disease. [ABSTRACT FROM AUTHOR]

The main aim of the current study was to develop a chitosan hydrogel containing Aloe vera gel and Ethylenediaminetetraacetic acid (EDTA) as the wound healing materials. Chitosan with the concentration of (2% w/v) was prepared in AA (0.5%, v/v) and Tetrasodium EDTA (0.01% w/w) and AV (0.5% v/v) were added to the prepared polymer solution. As prepared solution was cross‐linked by β‐GP with the weight ratio of 1/6 w/w (1 chitosan and 6 β‐GP). The characterization of the hydrogels showed that the hydrogels have porous structures and interconnected pores with the pores size range from 41.5 ± 14 to 48.3 ± 11 μm. The swelling and weight loss measurements of the hydrogels showed that the hydrogels could swell up to 240% of their initial weight during 8 h and loss 79.7 ± 3.5% of the initial weight during 14 days. The antibacterial studies depicted that the prepared Cs/tEDTA/AV hydrogel inhibited the growth of Staphylococcus aureus (the minimum inhibition concentration, MIC of 73 ± 4.8) and Pseudomonas aeruginosa (the MIC of 40 ± 7.9). Moreover, the prepared hydrogels were hemocompatible (Cs/tEDTA/AV: OD of 0.24 ± 0.30) and biocompatible (Cs/tEDTA/AV: OD of 0.38 ± 0.01). At the final stage, the wound healing assessments in the animal model revealed that the application of the prepared hydrogels effectively enhanced the wound healing process. In conclusion, the results confirmed the efficacy of the prepared hydrogels as the wound healing materials. [ABSTRACT FROM AUTHOR]

Introduction: Pancreatoduodenectomy (PD) may occasionally be indicated for complete removal of periampullary (duodenal and ampullary) adenomas (PAs). As compared with malignant indications, PD for benign or pre-malignant disease is often associated with increased morbidity. While the Spigelman classification assesses malignancy risk for familial adenomatous polyposis (FAP)-related duodenal adenomas, no malignancy risk score (MRS) exists for non-FAP related PAs. We developed a MRS for non-FAP related PAs undergoing PD to weigh risk of malignancy and postoperative morbidity., Methods: We retrospectively analyzed patients with non-FAP related PA who underwent PD at eight institutions (2010-2022). Patient and lesion factors associated with final malignant pathology were identified using multivariable logistic regression to create MRS. Postoperative complications were assessed according to MRS., Results: Of 127 patients, 59 (46.5%) had evidence of malignancy on final pathology. The odds of malignancy were higher in patients with older age ≥65 years (OR3.2, p=0.01), bile duct ≥9mm (OR3.3, p=0.009), preoperative symptoms (OR7.7, p=0.002), and high-grade dysplasia (HGD, OR7.5, p<0.001). A MRS was derived ranging from 0 to 6: age≥65=1, bile duct≥9mm=1, symptomatic=2, HGD=2. Patients were stratified into low (MRS1-2, n=26), intermediate (MRS3-4, n=59), and high-risk groups (MRS5-6, n=26), with malignancy rates increasing with MRS (10.3%, 44.1%, and 88.2%, p<0.001). Patients in the no/low-risk group (MRS0-2) had higher odds of major postoperative complications compared with patients in the intermediate/high-risk group (MRS≥3, OR2.9, p=0.047)., Conclusion: This novel MRS stratifies the risk of malignancy in non-FAP related PAs managed with PD. This score can be used to counsel patients who may require PD for complete tumor removal about their risk of harboring malignancy and their risk of major postoperative complications., (Copyright © 2025 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the feasibility of developing a computer vision algorithm that uses preoperative computed tomography (CT) scans to predict superior mesenteric artery (SMA) margin status in patients undergoing Whipple for pancreatic ductal adenocarcinoma (PDAC), and to compare algorithm performance to that of expert abdominal radiologists and surgical oncologists., Summary Background Data: Complete surgical resection is the only chance to achieve a cure for PDAC; however, current modalities to predict vascular invasion have limited accuracy., Methods: Adult patients with PDAC who underwent Whipple and had preoperative contrast-enhanced CT scans were included (2010-2022). The SMA was manually annotated on the CT scans, and we trained a U-Net algorithm for SMA segmentation and a ResNet50 algorithm for predicting SMA margin status. Radiologists and surgeons reviewed the scans in a blinded fashion. SMA margin status per pathology reports was the reference., Results: Two hundred patients were included. Forty patients (20%) had a positive SMA margin. For the segmentation task, the U-Net model achieved a Dice Similarity Coefficient of 0.90. For the classification task, all readers demonstrated limited sensitivity, although the algorithm had the highest sensitivity at 0.43 (versus 0.23 and 0.36 for the radiologists and surgeons, respectively). Specificity was universally excellent, with the radiologist and algorithm demonstrating the highest specificity at 0.94. Finally, the accuracy of the algorithm was 0.85 versus 0.80 and 0.76 for the radiologists and surgeons, respectively., Conclusions: We demonstrated the feasibility of developing a computer vision algorithm to predict SMA margin status using preoperative CT scans, highlighting its potential to augment the prediction of vascular involvement., Competing Interests: Conflicts of Interest: None, (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)