Long-term survival and prognostic indicators in small (<or=2 cm) pancreatic cancer

OBJECTIVES

In a matched analysis, we investigated clinical, histopathological, and survival characteristics of small (

METHODS

From the Mayo pathology database, we identified 41 consecutive patients with small PaC and 94 matched controls with margin-negative PaC >2 cm. Two experienced pathologists, who were blinded to survival data, independently reviewed tumor stage and differentiation. Kaplan-Meier survival analysis and Cox proportional hazards models were applied for data analyses.

RESULTS

In patients with localized disease (stages I and II), survival was similar in small and large PaC but survival was significantly better in small PaC with regional nodal metastasis (stage III) as compared to similar stage large PaC (5-year survival 44 vs. 7%, median survival 58 vs.18 months, p < 0.001). Well-differentiated small and large PaC had similar median survival (76 vs. 74 months, p = NS). In multivariate analysis, tumor differentiation, not tumor size, was the only independent factor predicting survival in PaC (risk ratio, RR, for moderate vs. well- differentiated: 2.6, 95% confidence interval, CI, 1.5-4.5, and RR for poorly differentiated vs. well-differentiated: 5.0, 95% CI 2.4-10.1).

CONCLUSION

Tumor differentiation may be a better predictor of survival in resectable PaC than tumor stage.

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Key Words

• small pancreatic cancer
• tumor stage
• tumor differentiation
• survival prediction

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MESH Headings

• Aged
• Antineoplastic Agents/therapeutic use
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/therapy
• Prognosis
• Radiotherapy, Adjuvant

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Grants

• P50 CA102701-06 NCI NIH HHS
• P50 CA102701 NCI NIH HHS
• P50 CA 10270 NCI NIH HHS
• R01 CA 100685 NCI NIH HHS
• R01 CA100685 NCI NIH HHS
• R01 CA100685-04 NCI NIH HHS

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Learning and recall in subjects at genetic risk for Alzheimer's disease

Deficits in delayed recall of learned information may be an early marker of Alzheimer's disease (AD). The apolipoprotein E E4 allele and a positive family history (FH) are both genetic risk factors for AD. The authors cross-sectionally compared performance on the California Verbal Learning Test (CVLT) in 153 prospectively recruited normal elderly subjects (mean age 67 years, mean MMSE=28) stratified by genetic risk into four groups (E4+/FH+, E4+/FH-, E4-/FH+, E4-/FH-). Neither FH nor E4 status affected performance, except on List B (a distraction word list), on which the FH+ group performed worse. The high-risk group (E4+/FH+) also performed worse on List B than the low-risk group (E4-/FH-) but did not differ on other measures. Memory impairments associated with genetic or family history risk may not manifest until the person is much closer to the onset age of AD.

Role of protein kinase C isoenzymes in fatty acid stimulation of insulin secretion

Although hyperlipidemia is frequently associated with hyperinsulinemia. the stimulation of insulin secretion by fatty acids in the in vitro studies has remained a matter of constant debate, partly because of the uncertainty about a clearly defined mechanism to explain such a direct effect. In this study, we used a pharmacologic approach to test the hypothesis that protein kinase C (PKC) signal-transduction pathway is involved in fatty acid-stimulated insulin secretion. Isolated rat islets were perifused with either palmitate (C(16:0)) or linoleate (C(18:2)) in the absence or presence of selective inhibitors of PKC isoenzymes. Our results suggest a role for Ca2+-independent PKC isoenzymes in the signal transduction of fatty acid-stimulated insulin secretion. The data imply that either the nonconventional and/or atypical isoforms of PKC are involved in the stimulation of insulin release induced by fatty acids.

Vitamin B12 status in hospitalized elderly from nursing homes and the community

OBJECTIVE

To assess vitamin B(12) status in a large sample of hospitalized, inner-city older adults from nursing homes and communities with low socioeconomic status. To determine additionally if hypoalbuminemia can help identify older subjects who are at risk for vitamin B(12) deficiency.

DESIGN

A cross-sectional study of hospitalized, inner-city older residents.

SETTING

Acute Care Geriatrics Division, a 75-bed inpatient care service at Our Lady of Mercy Medical Center (OLMMC), a University Affiliate of New York Medical College.

PARTICIPANTS

A total of 466 older patients (aged 65 to 102 years) from the community (n = 374) and nursing homes (n = 92) who were admitted to the acute care geriatrics division from 1993 to 1996.

MEASUREMENTS

Patients admitted to the hospital had serum vitamin B(12) and albumin levels determined along with other nutritional parameters, routine blood tests, and physical examinations.

RESULTS

On admission, 19% of hospitalized subjects had marginal serum B(12) levels (200-350 pg/mL) and 6% had low serum B(12) levels (<200 pg/mL). Mean serum B(12) levels did not differ significantly between patients from nursing homes and those from the community. Sixty-four percent 64% of all patients had low serum albumin levels (alb < 3.5 g/dL), with patients from nursing homes showing significantly lower mean serum albumin than patients admitted from the community (P <.000). We observed no positive correlation between serum albumin and serum vitamin B(12) in our older hospitalized patients from either nursing homes or community.

CONCLUSIONS

In this sample of hospitalized older adults, 24% were found to have marginal or low serum B(12) status. Thus, we believe that periodic determinations of serum B(12) would be a useful addition to the general health and nutritional assessment in this age group. Our findings also suggest that hypoalbuminemia is not helpful as a predictor of low B(12) status in older hospitalized persons.

Early recognition of Alzheimer's disease: what is consensual? What is controversial? What is practical?

Alzheimer's disease is often unrecognized or misdiagnosed in its early stages. Despite the lack of curative treatments, there are compelling reasons why early recognition of Alzheimer's disease may offer substantial benefits. Early evaluation and diagnosis may offer opportunities to enhance patient safety, allow families to plan for the future, provide family education and support, and initiate the best treatment before more substantial neuronal loss occurs. Barriers to early diagnosis include failure of family or physicians to recognize the existence or importance of cognitive/functional changes and/or misperceptions regarding diagnostic requirements and treatment capabilities. There is consensus that high diagnostic accuracy can be achieved clinically, even by nonspecialists, using established criteria and practice parameters. Population-based screening programs for the elderly, genetic testing, yield of routine neuroimaging studies, and the diagnostic value of certain molecular markers remain controversial. This review highlights practical issues related to the initial clinical evaluation and differential diagnosis of Alzheimer's disease.

Reoxygenation injury affects isolated islet response to fatty acid stimulation

Hyperlipidemia is frequently associated with hyperinsulinemia, but because the effects of fatty acids on insulin secretion in in vitro studies using isolated perifused islets have mostly been described with supraphysiological concentrations of fatty acids, it has remained uncertain whether elevated lipid levels contribute to hyperinsulinemia by their direct stimulation of insulin secretion. In the present study, we have identified reoxygenation injury in isolated islet function as a contributing factor in the failure of physiological concentrations of free fatty acids to stimulate insulin secretion in isolated perifused islets. Reoxygenation of isolated islets is associated with the production of reactive oxygen species, which impair islet function. We have found that pretreatment of freshly isolated islets with the antioxidant glutathione (GSH), as well as a 24-hour preculture of isolated islets under appropriate conditions, enhanced their sensitivity to fatty acid stimulation.