Search

Background: Post‐pancreaticoduodenectomy haemorrhage is a potentially life‐threatening complication. Delay in the detection and subsequent management of complications contribute significantly to post‐operative mortality and morbidity associated with pancreaticoduodenectomy. Methods: All patients undergoing pancreaticoduodenectomy at an Australian‐based tertiary referral center between 2017 and 2022 were reviewed retrospectively. We identified those patients who suffered a post‐pancreaticoduodenectomy haemorrhage and further analysed those patients who had their post‐pancreaticoduodenectomy haemorrhage identified on repeated CT imaging performed within 24 h of their previous CT scan. Results: A total of 232 pancreaticoduodenectomies were identified for analysis during the study period, of which 23 patients (9.9%) suffered a post‐pancreaticoduodenectomy haemorrhage. We present four patients who had their post‐pancreaticoduodenectomy haemorrhage identified on repeat CT scan in the setting of a recent (within 24 h) CT scan which showed no evidence of active haemorrhage or pseudoaneurysm formation. All patients received prompt and definitive endovascular management through stent insertion or coil embolization resulting in successful cessation of bleeding. Three patients made an uncomplicated recovery thereafter. Unfortunately, one patient died as a complication of the bleed despite early and definitive endovascular intervention. Conclusion: Our study highlights the importance of having a low threshold for repeated CT imaging in the post‐pancreaticoduodenectomy setting, particularly when there remains a high index of suspicion clinically for a post‐operative complication, even in the context of previous benign imaging. Given the complexity of pancreaticoduodenectomy, we believe early detection with liberal imaging allows the best chance at successfully managing the morbidity and mortality associated in the post‐pancreaticoduodenectomy setting. [ABSTRACT FROM AUTHOR]

Background: Advances in technology and techniques have allowed for robotic distal pancreatectomies to be readily performed in patients at high volume centres. This study describes the experience of a single surgeon during the learning curve and transition from open to robotic distal pancreatectomy in Australia, a traditionally low volume pancreatic surgery country. Methods: All patients undergoing distal pancreatectomy at an Australian-based tertiary referral centre between 2010 and 2021 were reviewed retrospectively. Demographic, clinicopathologic and survival data were analysed to compare perioperative and oncological outcomes between patients who underwent open, laparoscopic and robotic distal pancreatectomies. Results: A total of 178 distal pancreatectomies were identified for analysis during the study period. Ninety-one open distal pancreatectomies (ODP), 48 laparoscopic distal pancreatectomies (LDP), and 39 robotic distal pancreatectomies (RDP) were performed. Robotic distal pancreatectomy was non-inferior with respect to perioperative outcomes and yielded statistically non-significant advantages over LDP and ODP. Conclusion: RDP is feasible and can be performed safely in well-selected patients during the learning phase at large pancreatic centres in a traditionally low-volume country like Australia. Referral to large pancreatic centres where access to the robotic platform and surgeon experience is not a barrier, and where a robust multidisciplinary team meeting can take place, remains pivotal in the introduction and transition toward the robotic approach for management of patients with pancreatic body or tail lesions. [ABSTRACT FROM AUTHOR]

Background: The early and accurate diagnosis of pancreatic ductal adenocarcinoma is vital for improving the efficacy of therapeutic interventions and to provide patients with the best chance of survival. While endoscopic ultrasound‐fine needle aspiration (EUS‐FNA) has been demonstrated to be a reliable and accurate diagnostic tool for solid pancreatic neoplasms, the ongoing management of patients with a high clinical suspicion for malignancy but with a negative EUS‐FNA biopsy result can prove a challenge. Methods: We describe five patients from a single centre who presented for further work‐up of a pancreatic mass and/or imaging features concerning for a periampullary malignancy. Results: All patients had at least one EUS‐FNA biopsy performed which returned no malignant cells on cytology. Despite these negative cytology results, all patients underwent further invasive investigation through upfront resection (pancreaticoduodenectomy) or extra‐pancreatic biopsy (laparoscopic biopsy of peritoneal nodule) due to worrisome features on imaging, biochemical factors and clinical presentation culminating in a high degree of suspicion for malignancy. The final tissue histopathological diagnosis in all patients was pancreatic ductal adenocarcinoma. Conclusion: This case series highlights the important clinical findings, imaging and biochemical features which need to be considered in patients who have high suspicion for malignancy despite having a negative EUS‐FNA cytology result. In these patients with a high index of suspicion, surgical intervention through an upfront resection or further invasive investigation should not be delayed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to develop and assess an organizational intervention consisting of psychological first aid (PFA) and Open Space Technology (OST), and its impact on individual resilience and perceived organization support. Design/methodology/approach: The study used a non-experimental, pre-test and post-test design. Measures of employee post-trauma, resilience and organizational support were measured before and after the PFA intervention. Findings: Paired sample t-tests revealed significant pre/post-increases in individual resilience and perceived organization support. Correlational analysis revealed that resilience was associated with perceived organization support. Evaluations revealed that participants found the small group sharing, information about coping and the open space problem-solving activities particularly worthwhile. Research limitations/implications: A limitation of the study was the lack of a randomized control group in the design. Future research may utilize more robust designs such as experimental and longitudinal studies to evaluate impact. Practical implications: This study indicates how the use of an organization-based intervention can be adopted for employees who undergo an emergency in their workplace. The combination of PFA and OST was found to be valuable in improving individual resilience and perceived organization support. In addition, OST can better facilitate problem-solving performance in intact groups, as it enhances collective interaction and community efficacy among survivors. Originality/value: The study contributes to the dearth of knowledge on the use of PFA when used in an intact organization as part of its crisis intervention. [ABSTRACT FROM AUTHOR]

Heterochromatin protein 1 (HP1) has an essential role in heterochromatin formation and mitotic progression through its interaction with various proteins. We have identified a unique HP1α-binding protein, POGZ (pogo transposable element-derived protein with zinc finger domain), using an advanced proteomics approach. Proteins generally interact with HP1 through a PxVxL (where x is any amino-acid residue) motif; however, POGZ was found to bind to HP1α through a zinc-finger-like motif. Binding by POGZ, mediated through its zinc-finger-like motif, competed with PxVxL proteins and destabilized the HP1α–chromatin interaction. Depletion experiments confirmed that the POGZ HP1-binding domain is essential for normal mitotic progression and dissociation of HP1α from mitotic chromosome arms. Furthermore, POGZ is required for the correct activation and dissociation of Aurora B kinase from chromosome arms during M phase. These results reveal POGZ as an essential protein that links HP1α dissociation with Aurora B kinase activation during mitosis. [ABSTRACT FROM AUTHOR]

Drug coated balloons (DCB) are a commonly used endovascular option for treating patients presenting with symptomatic peripheral vascular disease. DCB have illustrated to increase primary patency and thus have been a popular choice in addressing restenosis caused by neointimal hyperplasia. Pseudoaneurysms (PSA) are a common vascular pathology, the causes of which include iatrogenic, trauma, stent fractures and angioplasty balloon overuse. Herein, we describe the case where a patient developed multiple superficial femoral artery (SFA) PSA potentially secondary to the subintimal application of paclitaxel., (Crown Copyright © 2021 Published by Elsevier Inc. on behalf of University of Washington.)

We demonstrate that a (3-aminopropyl)triethoxysilane-treated glass surface is superior to an untreated glass surface for coating with extracellular matrix (ECM) proteins when used as a cell culture substrate to observe cell physiology and behavior. We found that MDCK cells cultured on untreated glass coated with ECM removed the coated ECM protein and secreted different ECM proteins. In contrast, the cells did not remove the coated ECM protein when seeded on (3-aminopropyl)triethoxysilane-treated (i.e., silanized) glass coated with ECM. Furthermore, the morphology and motility of cells grown on silanized glass differed from those grown on non-treated glass, even when both types of glass were initially coated with laminin. We also found that cells on silanized glass coated with laminin had higher motility than those on silanized glass coated with fibronectin. Based on our results, we suggest that silanized glass is a more suitable cell culture substrate than conventional non-treated glass when coated by ECM for observations of ECM effects on cell physiology.