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|Pancreatic Neoplasms:
|Articles by Colin D. Johnson
Thu Jan 9 06:37:06 2020
|Between 2010 and 2020, Colin Johnson wrote the following 10 articles about Pancreatic Neoplasms.
|Pancreatic cancer. 2016
Kleeff, Jorg / Korc, Murray / Apte, Minoti / La Vecchia, Carlo / Johnson, Colin D / Biankin, Andrew V / Neale, Rachel E / Tempero, Margaret / Tuveson, David A / Hruban, Ralph H / Neoptolemos, John P. ·NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Duncan Building, Daulby Street, Liverpool L69 3GA, UK. · Department of General, Visceral and Pediatric Surgery, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany. · Departments of Medicine, and Biochemistry and Molecular Biology, Indiana University School of Medicine, the Melvin and Bren Simon Cancer Center, and the Pancreatic Cancer Signature Center, Indianapolis, Indiana, USA. · SWS Clinical School, University of New South Wales, and Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia. · Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy. · University Surgical Unit, University Hospital Southampton, Southampton, UK. · Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Garscube Estate, Bearsden, Glasgow, Scotland, UK. · QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia. · UCSF Pancreas Center, University of California San Francisco - Mission Bay Campus/Mission Hall, San Francisco, California, USA. · Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, New York, USA. · The Sol Goldman Pancreatic Cancer Research Center, Departments of Pathology and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. ·Nat Rev Dis Primers · Pubmed #27158978.
ABSTRACT: Pancreatic cancer is a major cause of cancer-associated mortality, with a dismal overall prognosis that has remained virtually unchanged for many decades. Currently, prevention or early diagnosis at a curable stage is exceedingly difficult; patients rarely exhibit symptoms and tumours do not display sensitive and specific markers to aid detection. Pancreatic cancers also have few prevalent genetic mutations; the most commonly mutated genes are KRAS, CDKN2A (encoding p16), TP53 and SMAD4 - none of which are currently druggable. Indeed, therapeutic options are limited and progress in drug development is impeded because most pancreatic cancers are complex at the genomic, epigenetic and metabolic levels, with multiple activated pathways and crosstalk evident. Furthermore, the multilayered interplay between neoplastic and stromal cells in the tumour microenvironment challenges medical treatment. Fewer than 20% of patients have surgically resectable disease; however, neoadjuvant therapies might shift tumours towards resectability. Although newer drug combinations and multimodal regimens in this setting, as well as the adjuvant setting, appreciably extend survival, ∼80% of patients will relapse after surgery and ultimately die of their disease. Thus, consideration of quality of life and overall survival is important. In this Primer, we summarize the current understanding of the salient pathophysiological, molecular, translational and clinical aspects of this disease. In addition, we present an outline of potential future directions for pancreatic cancer research and patient management.
|International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer. 2016
Takaori, Kyoichi / Bassi, Claudio / Biankin, Andrew / Brunner, Thomas B / Cataldo, Ivana / Campbell, Fiona / Cunningham, David / Falconi, Massimo / Frampton, Adam E / Furuse, Junji / Giovannini, Marc / Jackson, Richard / Nakamura, Akira / Nealon, William / Neoptolemos, John P / Real, Francisco X / Scarpa, Aldo / Sclafani, Francesco / Windsor, John A / Yamaguchi, Koji / Wolfgang, Christopher / Johnson, Colin D / Anonymous8350852. ·Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: firstname.lastname@example.com. · Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. · Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom. · Department of Radiation Oncology, University Hospitals Freiburg, Germany. · Department of Pathology and Diagnostics, University of Verona, Verona, Italy. · Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom. · Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. · Pancreatic Surgery Unit, Università Vita e Salute, Milano, Italy. · HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, United Kingdom. · Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan. · Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France. · NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom. · Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan. · Division of General Surgery, Yale University, New Haven, CT, United States of America. · Epithelial Carcinogenesis Group, CNIO-Spanish National Cancer Research Centre, Madrid, Spain. · Department of Surgery, University of Auckland, HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand. · Department of Advanced Treatment of Pancreatic Disease, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. · Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States of America. · University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom. ·Pancreatology · Pubmed #26699808.
ABSTRACT: BACKGROUND: Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. METHODS: A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent. RESULTS: Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines. CONCLUSION: The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
|Clinical Trial
|Health-Related Quality of Life in SCALOP, a Randomized Phase 2 Trial Comparing Chemoradiation Therapy Regimens in Locally Advanced Pancreatic Cancer. 2015
Hurt, Christopher N / Mukherjee, Somnath / Bridgewater, John / Falk, Stephen / Crosby, Tom / McDonald, Alec / Joseph, George / Staffurth, John / Abrams, Ross A / Blazeby, Jane M / Bridges, Sarah / Dutton, Peter / Griffiths, Gareth / Maughan, Tim / Johnson, Colin. ·Wales Cancer Trials Unit, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom. Electronic address: email@example.com. · Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Oxford University, NIHR Biomedical Research, Oxford, United Kingdom. · UCL Cancer Institute, London, United Kingdom. · Bristol Haematology and Oncology Centre, Bristol, United Kingdom. · Velindre Cancer Centre, Velindre Hospital, Cardiff, Wales, United Kingdom. · Beatson West of Scotland Cancer Centre, Glasgow, Scotland, United Kingdom. · Institute of Cancer and Genetics, Cardiff University, Cardiff, Wales, United Kingdom. · Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois. · Division of Surgery, Head and Neck, University Hospitals Bristol National Health Service Foundation Trust, Bristol and School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom. · Wales Cancer Trials Unit, College of Biomedical and Life Sciences, Cardiff University, Cardiff, Wales, United Kingdom. · Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom. · Southampton Clinical Trials Unit, Faculty of Medicine, Southampton University, Southampton General Hospital, Southampton, United Kingdom. · University Surgical Unit, Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom. ·Int J Radiat Oncol Biol Phys · Pubmed #26530749.
ABSTRACT: PURPOSE: Chemoradiation therapy (CRT) for patients with locally advanced pancreatic cancer (LAPC) provides survival benefits but may result in considerable toxicity. Health-related quality of life (HRQL) measurements during CRT have not been widely reported. This paper reports HRQL data from the Selective Chemoradiation in Advanced Localised Pancreatic Cancer (SCALOP) trial, including validation of the QLQ-PAN26 tool in CRT. METHODS AND MATERIALS: Patients with locally advanced, inoperable, nonmetastatic carcinoma of the pancreas were eligible. Following 12 weeks of induction gemcitabine plus capecitabine (GEMCAP) chemotherapy, patients with stable and responding disease were randomized to a further cycle of GEMCAP followed by capecitabine- or gemcitabine-based CRT. HRQL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the EORTC Pancreatic Cancer module (PAN26). RESULTS: A total of 114 patients from 28 UK centers were registered and 74 patients randomized. There was improvement in the majority of HRQL scales during induction chemotherapy. Patients with significant deterioration in fatigue, appetite loss, and gastrointestinal symptoms during CRT recovered within 3 weeks following CRT. Differences in changes in HRQL scores between trial arms rarely reached statistical significance; however, where they did, they favored capecitabine therapy. PAN26 scales had good internal consistency and were able to distinguish between subgroups of patients experiencing toxicity. CONCLUSIONS: Although there is deterioration in HRQL following CRT, this resolves within 3 weeks. HRQL data support the use of capecitabine- over gemcitabine-based chemoradiation. The QLQ-PAN26 is a reliable and valid tool for use in patients receiving CRT.
|Clinical Trial
|Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. 2013
Gurka, Marie K / Collins, Sean P / Slack, Rebecca / Tse, Gary / Charabaty, Aline / Ley, Lisa / Berzcel, Liam / Lei, Siyuan / Suy, Simeng / Haddad, Nadim / Jha, Reena / Johnson, Colin D / Jackson, Patrick / Marshall, John L / Pishvaian, Michael J. ·Department of Radiation Oncology, Georgetown University Hospital, Washington, DC 20007, USA. ·Radiat Oncol · Pubmed #23452509.
ABSTRACT: BACKGROUND: Concurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC. METHODS: Patients received gemcitabine, 1000 mg/m2 for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires. RESULTS: Between September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment. CONCLUSIONS: SBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.
|Exploring the patient experience of locally advanced or metastatic pancreatic cancer to inform patient-reported outcomes assessment. 2019
Herman, Joseph M / Kitchen, Helen / Degboe, Arnold / Aldhouse, Natalie V J / Trigg, Andrew / Hodgin, Mary / Narang, Amol / Johnson, Colin D. ·Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA. · DRG Abacus, Clinical Outcomes Assessment, Manchester, UK. · AstraZeneca, Gaithersburg, MD, USA. · Adelphi Values, Macclesfield, UK. · Department of Surgery, Advanced Practice Nursing, Johns Hopkins University, Baltimore, MD, USA. · Surgical Unit, University of Southampton, Southampton, SO16 6YD, UK. email@example.com. ·Qual Life Res · Pubmed #31273624.
ABSTRACT: PURPOSE: Pancreatic cancer and its treatments impact patients' symptoms, functioning, and quality of life. Content-valid patient-reported outcome (PRO) instruments are required to assess outcomes in clinical trials. This study aimed to: (a) conceptualise the patient experience of pancreatic cancer; (b) identify relevant PRO instruments; (c) review the content validity of mapped instruments to guide PRO measurement in clinical trials. METHODS: Qualitative literature and interviews with clinicians and patients were analysed thematically to develop a conceptual model of patient experience. PRO instruments were reviewed against the conceptual model to identify gaps in measurement. Cognitive debriefing explored PRO conceptual relevance and patients' understanding. RESULTS: Patients in the USA (N = 24, aged 35-84) and six clinicians (from US and Europe) were interviewed. Pre-diagnosis, pain was the most frequently reported symptom (N = 21). Treatments included surgery, radiation, chemotherapy, and immunotherapy. Surgery was associated with acute pain and gastrointestinal symptoms. Chemotherapy/chemoradiation side effects were cyclical and included fatigue/tiredness (N = 21), appetite loss (N = 15), bowel problems (N = 15), and nausea/vomiting (N = 15). Patients' functioning and well-being were impaired. The literature review identified 49 PRO measures; the EORTC QLQ-C30/PAN26 were used most frequently and mapped with interview concepts. Patients found the EORTC QLQ-C30/PAN26 to be understandable and relevant; neuropathic side effects were suggested additions. CONCLUSIONS: This is the first study to develop a conceptual model of patients' experience of metastatic/recurrent pancreatic cancer and explore the content validity of the EORTC QLQ-C30/PAN26 following therapeutic advances. The EORTC QLQ-C30/PAN26 appears conceptually relevant; additional items to assess neuropathic side effects are recommended. A recall period should be stated throughout to standardise responses.
|PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer. 2018
Ghaneh, Paula / Hanson, Robert / Titman, Andrew / Lancaster, Gill / Plumpton, Catrin / Lloyd-Williams, Huw / Yeo, Seow Tien / Edwards, Rhiannon Tudor / Johnson, Colin / Abu Hilal, Mohammed / Higginson, Antony P / Armstrong, Tom / Smith, Andrew / Scarsbrook, Andrew / McKay, Colin / Carter, Ross / Sutcliffe, Robert P / Bramhall, Simon / Kocher, Hemant M / Cunningham, David / Pereira, Stephen P / Davidson, Brian / Chang, David / Khan, Saboor / Zealley, Ian / Sarker, Debashis / Al Sarireh, Bilal / Charnley, Richard / Lobo, Dileep / Nicolson, Marianne / Halloran, Christopher / Raraty, Michael / Sutton, Robert / Vinjamuri, Sobhan / Evans, Jonathan / Campbell, Fiona / Deeks, Jon / Sanghera, Bal / Wong, Wai-Lup / Neoptolemos, John P. ·Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK. · Liverpool Cancer Research UK Cancer Trials Unit, University of Liverpool, Liverpool, UK. · Department of Mathematics and Statistics, Lancaster University, Lancaster, UK. · Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK. · Faculty of Medicine, University of Southampton, Southampton, UK. · Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. · Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK. · Department of Gastrointestinal Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. · Department of Surgery, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK. · Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. · Department of General Surgery, Wye Valley NHS Trust, Hereford, UK. · Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, UK. · Gastrointestinal and Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK. · Institute for Liver and Digestive Health, University College London Hospitals NHS Foundation Trust, London, UK. · Department of Surgery, Royal Free London NHS Foundation Trust, London, UK. · Department of Surgery, Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK. · Department of Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. · Department of Surgery, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK. · Department of Oncology, King's College Hospital NHS Foundation Trust, London, UK. · Department of Surgery, Morriston Hospital, Abertawe Bro Morgannwg University Health Board, Swansea, UK. · Department of Surgery, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. · Faculty of Medicine and Life Sciences, University of Nottingham, Nottingham, UK. · Department of Oncology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK. · Department of Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. · Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. · Department of Radiology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. · Department of Pathology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK. · Institute of Applied Health Research, University of Birmingham, Birmingham, UK. · Paul Strickland Scanner Centre, Mount Vernon Hospital, Middlesex, UK. ·Health Technol Assess · Pubmed #29402376.
ABSTRACT: BACKGROUND: Pancreatic cancer diagnosis and staging can be difficult in 10-20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. OBJECTIVE: To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. DESIGN: A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. PARTICIPANTS: Patients with suspected pancreatic malignancy. INTERVENTIONS: All patients to undergo PET/CT following standard diagnostic work-up. MAIN OUTCOME MEASURES: The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients' diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. RESULTS: Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUV CONCLUSION: PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. STUDY REGISTRATION: Current Controlled Trials ISRCTN73852054 and UKCRN 8166. FUNDING: The National Institute for Health Research Health Technology Assessment programme.
|Health-related Quality of Life and Functional Outcomes in 5-year Survivors After Pancreaticoduodenectomy. 2017
Fong, Zhi Ven / Alvino, Donna M / Castillo, Carlos Fernández-Del / Nipp, Ryan D / Traeger, Lara N / Ruddy, Margaret / Lubitz, Carrie C / Johnson, Colin D / Chang, David C / Warshaw, Andrew L / Lillemoe, Keith D / Ferrone, Cristina R. ·*Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA ‡Department of Psychology, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Department of Surgery, University of Southampton, Southampton, UK. ·Ann Surg · Pubmed #28657944.
ABSTRACT: OBJECTIVE: Our aim was to assess quality of life (QOL) and functionality in a large cohort of patients ≥5-years after pancreaticoduodenectomy (PD). BACKGROUND: Long-term QOL outcomes after PD for benign or malignant disease are largely undocumented. METHODS: We administered the EORTC QLQ-C30 questionnaire to patients who underwent PD for neoplasms from 1998 to 2011 and compared their scores with an age- and sex-matched normal population. Clinical relevance (CR) of differences was scored as small (5-10), moderate (10-20), or large (>20) based on validated interpretation of clinically important differences. RESULTS: Of 305 PD survivors, 245 (80.3%) responded, of whom 157 (64.1%) underwent PD for nonmalignant lesions. Median follow-up was 9.1 years (range 5.1 -21.2 yrs). New-onset diabetes developed in 10.6%; 50.4% reported taking pancreatic enzymes; 54.6% reported needing antacids. Compared with the age- and sex-adjusted controls, PD survivors demonstrated higher global QOL (78.7 vs 69.7, CR small, P < 0.001), physical (86.7 vs 77.9, CR small, P < 0.001) and role-functioning scores (86.3 vs 74.1, CR medium, P < 0.001). Using linear regression and adjusting for socioeconomic variables, there were no differences in QOL or functional scores in the benign versus malignant subgroups. Older age at operation was associated with worse physical-functioning (-0.4/yr, P = 0.008). Taking pancrelipase (-6.8, P = 0.035) or antacids (-6.3, P = 0.044) were both associated with lower social-functioning scores. CONCLUSIONS: Patients who had a PD demonstrated better global QOL, physical- and role-functioning scores at 5-years when compared with age- and sex-matched controls. Approximately half of the patients required pancreatic enzyme replacement, while only 11% developed new-onset diabetes.
|Pro-migratory and TGF-β-activating functions of αvβ6 integrin in pancreatic cancer are differentially regulated via an Eps8-dependent GTPase switch. 2017
Tod, Jo / Hanley, Christopher J / Morgan, Mark R / Rucka, Marta / Mellows, Toby / Lopez, Maria-Antoinette / Kiely, Philip / Moutasim, Karwan A / Frampton, Steven J / Sabnis, Durgagauri / Fine, David R / Johnson, Colin / Marshall, John F / Scita, Giorgio / Jenei, Veronika / Thomas, Gareth J. ·Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK. · Institute of Translational Medicine, University of Liverpool, Crown Street, Liverpool, UK. · Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Tremona Road, Southampton, UK. · Barts Cancer Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, UK. · IFOM FOM Foundation, Institute FIRC of Molecular Oncology and University of Milan, School of Medicine, Department of Oncology and Hemato-Oncology-DIPO, Via Adamello, Milan, Italy. ·J Pathol · Pubmed #28608476.
ABSTRACT: The integrin αvβ6 is up-regulated in numerous carcinomas, where expression commonly correlates with poor prognosis. αvβ6 promotes tumour invasion, partly through regulation of proteases and cell migration, and is also the principal mechanism by which epithelial cells activate TGF-β1; this latter function complicates therapeutic targeting of αvβ6, since TGF-β1 has both tumour-promoting and -suppressive effects. It is unclear how these different αvβ6 functions are linked; both require actin cytoskeletal reorganization, and it is suggested that tractive forces generated during cell migration activate TGF-β1 by exerting mechanical tension on the ECM-bound latent complex. We examined the functional relationship between cell invasion and TGF-β1 activation in pancreatic ductal adenocarcinoma (PDAC) cells, and confirmed that both processes are αvβ6-dependent. Surprisingly, we found that cellular functions could be biased towards either motility or TGF-β1 activation depending on the presence or absence of epidermal growth factor receptor pathway substrate 8 (Eps8), a regulator of actin remodelling, endocytosis, and GTPase activation. Similar to αvβ6, we found that Eps8 was up-regulated in >70% of PDACs. In complex with Abi1/Sos1, Eps8 regulated αvβ6-dependent cell migration through activation of Rac1. Down-regulation of Eps8, Sos1 or Rac1 suppressed cell movement, while simultaneously increasing αvβ6-dependent TGF-β1 activation. This latter effect was modulated through increased cell tension, regulated by Rho activation. Thus, the Eps8/Abi1/Sos1 tricomplex acts as a key molecular switch altering the balance between Rac1 and Rho activation; its presence or absence in PDAC cells modulates αvβ6-dependent functions, resulting in a pro-migratory (Rac1-dependent) or a pro-TGF-β1 activation (Rho-dependent) functional phenotype, respectively. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
|Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. 2012
Abu Hilal, Mohammad / Hamdan, Mohammed / Di Fabio, Francesco / Pearce, Neil W / Johnson, Colin D. ·Hepatobiliary-Pancreatic and Laparoscopic Surgical Unit, Southampton University Hospitals NHS Foundation Trust, Southampton, UK. firstname.lastname@example.com ·Surg Endosc · Pubmed #22179475.
ABSTRACT: BACKGROUND: Laparoscopic distal pancreatectomy (LDP) is being increasingly performed with some concerns regarding the cost of the minimally invasive approach. The purpose of this study was to assess the cost-effectiveness of LDP versus open distal pancreatectomy (ODP). METHODS: A retrospective clinical and cost-comparison analysis was performed for patients who underwent LDP vs. OPD between 2005 and 2011. Data considered for the comparison analysis were: operative costs (surgical procedure, operative time, blood transfusions), postoperative costs (laboratory testing, hospital stay, complication management, readmissions), and overall costs. RESULTS: Fifty-one distal pancreatectomies (laparoscopic = 35, open = 16) were performed during the study period. The median operative time was 200 (range, 120-420) min for LDP vs. 225 (range, 120-460) min for ODP (p = 0.93). Median blood loss was 200 (range, 50-900) mL for LDP vs. 394 (range, 75-2000) mL for ODP (p = 0.038). Median hospital stay was 7 (range, 3-25) days in the laparoscopic group vs. 11 (range, 5-46) days in the open group (p = 0.007). Complication rate was 40% for LDP vs. 69% in ODP (p = 0.075). Postoperative intervention was required in 11% of patients after LDP vs. 31% after ODP (p = 0.12). The average operative, postoperative, and overall cost was £6039 (range, £4276-£9500), £4547 (range, £1299-£13937), £10587 (range, £6508-£20303) vs. £5231 (range, £3409-£9330), £10094 (range, £2665-£39291), £15324 (range, £7209-£47484) for the LDP and ODP groups, respectively (p = 0.033; p = 0.006; p = 0.197). CONCLUSIONS: We showed that LDP is feasible and safe without having a negative impact on cost. Extensive experience in pancreatic and laparoscopic surgery is required to optimize surgical outcomes.
|Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy. 2011
Whistance, Robert N / Shah, Vallari / Grist, Emily R / Shearman, Clifford P / Pearce, Neil W / Odurny, Allan / Stedman, Brian / Johnson, Colin D. ·Department of Hepatobiliary and Pancreatic Surgery, Southampton General Hospital, UK. email@example.com ·Ann R Coll Surg Engl · Pubmed #21944786.
ABSTRACT: Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.


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text: Home > Entertainment 'Lovely, but…': Cherie Gil comments on Liza, Enrique's ABS-CBN Ball pose, fans react ABS-CBN News Posted at Oct 02 2018 05:44 PM Share Save Facebook Twitter LinkedIn Cherie Gil portrayed Luciana, the adoptive mother of Serena (Liza Soberano) and the biological mother of Tenten (Enrique Gil) in 'Dolce Amore.' Right-most is Italian actor Ruben Maria Soriquez, who played Serena's adoptive father, Roberto. ABS-CBN MANILA -- Cherie Gil, the onscreen mother of Liza Soberano and Enrique Gil in the 2016 drama series "Dolce Amore," did not hesitate to call out her "reel life children" regarding a pose they did for a photo at the recent ABS-CBN Ball, eliciting reactions from the tandem's loyal fans. The screen veteran, 55, left the comment on an Instagram photo shared by Soberano, where Enrique Gil is seen seated on a chair, with the "Darna" star, on the floor, resting on his leg. View this post on Instagram A post shared by Liza Soberano (@lizasoberano) on Sep 30, 2018 at 6:38pm PDT "Lovely, my reel life children," Cherie Gil wrote, "but next time, you (Soberano) sit on the chair while he lays and kisses the ground you step on. #slay Wouldn't that be more endearing? #morewiththetimes" A fan of "LizQuen," as the onscreen tandem is endearingly called, noticed Gil's comment, captured it in a screenshot, and shared it on Twitter. "Preach!" the fan tweeted in apparent agreement, tagging Gil's account. Quoting the fan's tweet, Gil said: "I ain't no preacher. But should I choose to, I think I've grown in years to have the right to. Nothing wrong in sharing my thoughts, is there?" Haha. I ain't no preacher. But should I choose to, I think I've grown in years to have the right to . Nothing wrong in sharing my thoughts is there ? https://t.co/JfkEVXcQRc — Cherie Gil (@Macherieamour) October 1, 2018 Gil's own tweet received a stream of comments from fans of "LizQuen," most of which addressed her as "madame" or "Mama Luciana," in reference to her "Dolce Amore" character. Fans mostly welcomed Gil's advice for their idols, with several saying they could see her point. And while others said they trusted Gil only has the best interest of "LizQuen" in mind, they expressed confidence that the pose is not indicative of the relationship of Soberano and Enrique Gil. we certainly think there's nothing wrong in sharing your thoughts madam..when it comes to LizQuen we know you mean well and you are just lovingly giving them a piece if your heart and mind.. 😉 just love love love — ForeverVille (@Forever_Ville) October 2, 2018 Nothing madame. We know you wish them well! And we have high regards for you! Hope you work with lizquen again soon! — www (@QUENHOPEFOREVER) October 1, 2018 As u said Ms Cherie your thoughts and that's perfectly ok. But we all know how Quen love Hopie very much. Maybe the picture was for aesthetic purposes only. But thank you and LizQuens love you much also. 😍 — 👣thankGOD👉She'sMINE😍🙏 (@mujer4554) October 2, 2018 Share Save Facebook Share on Twitter LinkedIn Cherie Gil, Liza Soberano, Enrique Gil, ABS-CBN Ball, ABSCBNBall2018 Read More: Cherie Gil Liza Soberano Enrique Gil ABS-CBN Ball ABSCBNBall2018


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Dear Professionally Integrated,
Here is a FREE paper and video I breakdown so you can have this information for yourselves and to further educate your patients, as well as document this in your notes. This paper suggests that instability is about 2 mm in the cervical spine, which is less than 3.5 mm that has been used for a very long time. However, these authors also suggest that INSTABILITY and a LOSS OF THE CERVICAL curve will cause trapezoidal deformation of the vertebral bodies. This whole website is dedicated to teaching you how to be a better doctor by . . .
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ALGIERS (Reuters) - Hundreds of Algerians took to the streets of the capital late on Tuesday to celebrate the departure of President Abdelaziz Bouteflika after 20 years of power, residents said.
Young people were waving Algerian flags or driving in convoys through the city center, where on Feb. 22 mass protests broke out against the veteran ruler.
"Allahu Akbar (God is Great)," shouted a man on a live television broadcast.
Bouteflika, 82, had earlier submitted his resignation, state media said.
Reporting by Algiers bureau; writing by Ulf Laessing; Editing by James Dalgleish


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While studying the feeding of the multitude in Matthew, a light came on within. The disciples wanted to turn the multitude away rather than feed them because they were coming from limitation of Good. It is certainly not just talking about food, but forgiveness, enlightenment, understanding and compassion. How often is Love withheld from someone that is different from us? Or even forgiveness, because we feel we are justified in being angry. There is plenty of Love to go around! Good multiplies as we share it. So does error!
The question arises "Am I really sure I understand what I am reading?" and I may hesitate to share it since it may not be correct. Then I quietly realize my understanding comes from God and cannot be wrong. Matthew 14:20 reads "and they all ate and were satisfied." To me, that means they all received what they needed.


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The reason why God must pick our spouse is because people will generally go for the wants only. God however will pick based on who you will need to live your best life. I've been watching married at first sight and wondered why these relationships don't always work. It's because these specialists simply collect everything you want and desire and deliver it to you on a plate. Like, surely if you knew how to pick your spouse wouldn't you be married?!? They pick based on surface knowledge. God however knows the heart of a man. I thank God that He chose my husband. Only because of what I know now would I pick my beloved to be my other whole every time.
My choice
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I am happy most of the time, sad every now and again. Challenged always. I want to write my story and share it, so..... View all posts by hoperising101


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Melton Hockey's next generation will be on show at the Junior State Championships in July.
Gabe Cumming, Grace Downes and Chloe Schwarze have all been named in the North West Metro Tigers teams for the tournament which pits the best players in the state against other.
For two of the three, it will be their first time at the championships, while Schwarze is returning to the competition after missing last year.
Mustangs chairman Royce Schwarze said it was a wonderful result for the players and the club.
"It is really good for them," he said.
"What they learn is massive as they're playing against the best players in the state.
"They see how competitive everyone is and they can bring it back to the club
"You can't get this experience at the local level."
For 17-year-old Schwarze, the championships are a moment she's been looking forward to.
She was part of the gold-medal winning team in 2017, but had to watch it all from the sidelines last year.
Two days out from the championships she hurt her knee, which ruled her out of trying out for last year's team.
Schwarze has been playing senior hockey since 2012, including making her top-side debut in 2015.
Her father said she was excited to go back and try and win another gold medal, this time in the under-18s.
"Chloe is especially excited," Royce Schwarze said.
"She was keen to go back and make amends after missing out last year. She's made a lot of good friends in the last six years."
For Downes and Cumming it will be a new experience.
Downes, who will play in the under-13s, has made the team in her first try.
Downes made her senior debut with the club last season, playing in both their Vic League 2 side and metro B north-west team.
Schwarze said it was great to see young players such as Downes playing at state level and with the senior sides at the club.
Cumming, who is still playing in under-16s at the Mustangs, made his senior debut this season in the men's metro B north-west side.
The 16-year-old has been named in the under-18 Tigers team.
Schwarze said he believed it was the first time the goalkeeper had tried out for the team.
He said it was tougher for the boys to make state teams.
"We've had a couple of boys make the side in recent years, but it's tough with a lot of the boys who try out for our zone are state reps.
"It means that there's only two or three spots available."
Schwarze said all the young talent at the club was encouraging for the future. He said seeing players at the higher level, would encourage more players to try out to make those teams.
Meanwhile on the weekend, the Melton's men's Vic League 3 side had a 3-2 win against RMIT.
Steve Lawrence scored two goals, while Teejay Lawrence scored the other goal.
Melton's Masters side had an easy 8-1 win at home against Melbourne High School Old Boys, while the metro men's side had a 3-1 win.