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Pancreatic ductal adenocarcinoma contributes significantly to global cancer-related deaths, featuring only a 10% survival rate over five years. The quest for novel tumor markers is critical to facilitate early diagnosis and tailor treatment strategies for this disease, which is key to improving patient outcomes. In pancreatic ductal adenocarcinoma, these markers have been demonstrated to play a crucial role in early identification, continuous monitoring, and prediction of its prognosis and have led to better patient outcomes. Nowadays, biopsy specimens serve to ascertain diagnosis and determine tumor type. However, liquid biopsies present distinct advantages over conventional biopsy techniques. They offer a noninvasive, easily administered procedure, delivering insights into the tumor's status and facilitating real-time monitoring. Liquid biopsies encompass a variety of elements, such as circulating tumor cells, circulating tumor DNA, extracellular vesicles, microRNAs, circulating RNA, tumor platelets, and tumor endothelial cells. This review aims to provide an overview of the clinical applications of liquid biopsy as a technique in the management of pancreatic cancer.

Introduction: Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention. Methods: Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296). Results: A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective. Conclusions: IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.

Aims to provide flexible, effective and personalized online learning service, micro learning has gained wide attention in recent years as more people turn to use fragment time to grasp fragmented knowledge. Widely available online knowledge sharing is one of the most representative approaches to micro learning, and it is well accepted by online learners. However, information overload challenges such personalized online learning services. In this paper, we propose a deep cross attention recommendation model to provide online users with personalized resources based on users’ profile and historical online behaviours. This model benefits from the deep neural network, feature crossing, and attention mechanism mutually. The experiment result showed that the proposed model outperformed the state-of-the-art baselines.

© 2020, The Author(s). Introduction: Liver resection (LR) in patients with liver metastasis from colorectal cancer remains the only curative treatment. Perioperative chemotherapy improves prognosis of these patients. However, there are concerns regarding the effect of preoperative chemotherapy on liver regeneration, which is a key event in avoiding liver failure after LR. The primary objective of this systematic review is to assess the effect of neoadjuvant chemotherapy on liver regeneration after (LR) or portal vein embolization (PVE) in patients with liver metastasis from colorectal cancer. The secondary objectives are to evaluate the impact of the type of chemotherapy, number of cycles, and time between end of treatment and procedure (LR or PVE) and to investigate whether there is an association between degree of hypertrophy and postoperative liver failure. Methods: This meta-analysis will include studies reporting liver regeneration rates in patients submitted to LR or PVE. Pubmed, Scopus, Web of Science, Embase, and Cochrane databases will be searched. Only studies comparing neoadjuvant vs no chemotherapy, or comparing chemotherapy characteristics (bevacizumab administration, number of cycles, and time from finishing chemotherapy until intervention), will be included. We will select studies from 1990 to present. Two researchers will individually screen the identified records, according to a list of inclusion and exclusion criteria. Primary outcome will be future liver remnant regeneration rate. Bias of the studies will be evaluated with the ROBINS-I tool, and quality of evidence for all outcomes will be determined with the GRADE system. The data will be registered in a predesigned database. If selected studies are sufficiently homogeneous, we will perform a meta-an

The combination of several antihypertensives drugs for the treatment of hypertension is common and useful, though sometimes difficult to deal with a possible overdose or adverse effects. We report the case of a young patient who required intensive care for severe and prolonged hypotension with hypoperfusion and metabolic acidosis after the estimated ingestion of 1280 mg of candesartan and 500 mg of amlodipine for attempted suicide, assuming the first citation in the literature of an overdose by this therapy. We describe the clinical and laboratory status of the patient during the first 25 hours of evolution and the treatment applied, with special emphasis on the pathophysiology caused by the pharmacological characteristics of both drugs., La asociación de varios hipotensores para el tratamiento de la hipertensión arterial suele ser una práctica frecuente y útil, aunque en ocasiones puede dificultar el manejo de una sobredosificación o de posibles efectos adversos. Se presenta el caso de un paciente joven que requirió cuidados intensivos por hipotensión grave y prolongada con hipoperfusión y acidosis metabólica, tras la ingesta estimada de 1280 mg de candesartán y 500 mg de amlodipino por intento autolítico, suponiendo la primera citación en la literatura de una sobredosis por esta combinación terapéutica. Se describe la situación clínica y analítica del enfermo durante las primeras 25 horas de su evolución y el tratamiento al que fue sometido, haciendo especial énfasis en la fisiopatología provocada por las características farmacológicas de ambos medicamentos.

En este trabajo se pretende responder a cuestiones clave para el desarrollo y optimización de los cultivos acuícolas en el entorno del Parque Natural Bahía de Cádiz, sus relaciones con la actividad antrópica, y el estrés ecológico que puede derivar de determinadas actuaciones esporádicas o accidentales en zonas de cultivo. Durante 2 ciclos de producción de doradas (Sparus aurata), coincidiendo con el desarrollo de actividades de fomento próximas a las salinas de cultivo, se realizó un seguimiento en la calidad del ecosistema mediante el estudio analítico (detergentes, metales, etc.) y físico-químico (nitritos, nitratos, fosfatos, amonio) del agua, y las respuestas de biomarcadores celulares de estrés y/o contaminación (citocromo P-450/CYPIA, metalotioneinas/MTs) e histopatología en los principales órganos diana. Las perturbaciones medio-ambientales (detergentes, metales, sólidos en suspensión, etc.) favorecen procesos de estrés fisiológico y la aparición de especies parasitarias oportunistas en las especies cultivadas, mayoritariamente protozoos ciliados y dinoflagelados de ciclo directo. Durante el periodo de estudio se observaron episodios de mortandad importantes e incremento de epizootias parasitarias en general, y protozoosis en particular (Cryptocaryon irritans y Amyloodinium ocellatum), condicionados por la calidad del ecosistema (sedimento-agua). Los protozoos ectoparásitos de ciclo directo son adecuados bioindicadores de la salud del ecosistema y el impacto antrópico. La presencia de contaminantes inorgánicos y orgánicos en las salinas de la Bahía de Cádiz pueden ser responsables de la inducción de MTs y CYP1A en hígado y branquias. El cese de las actuaciones antrópicas, en este caso relacionadas con el acondicionamiento de tramos de vía férrea en la zona, conlleva la recuperación gradual y progresiva del ecosistema, y salud y bienestar de la biota acuática.

These are the results of the research “Experience of thoracic pain in women with myocardial infarction”. It is a phenomenological qualitative study aimed at knowing the experience of thoracic pain among women who have suffered acute myocardial infarction. It was carried out with nine women whose mean age was 52, mostly housewives, personally interviewed by the researcher. Interviews were carried out using the in depth system, being the fundamental basis of the study, accounts of experiences related to the phenomenon under study. This study identified elements that constitute the experience of thoracic pain in women during the infarction,described according to personal perspectives of each woman interviewed. Results of the pain experience now permit one to describe the experience as complex, frightening, with nuances given by previous instances and experiences, as well as accompanied by fears of having the possibility of dying, which constitute physical, psychological and emotional realms in a woman’s life., O presente trabalho apresenta os resultados da pesquisa: “Experiência de dor torácica na mulher com infarto agudo do miocárdio”. Este trabalho é um estudo qualitativo fenomenológico que visa conhecer a experiência de dor torácica da mulher que sofreu um infarto agudo do miocárdio. Realizou-se um levantamento com nove mulheres cuja média de idade foi de 52 anos, principalmente donas-de-casa, entrevistadas pessoalmente pela pesquisadora. O sistema de entrevista foi de profundidade, onde a narração das experiências perante o fenômeno de interesse era a base fundamental do estudo. O estudo permitiu identificar os elementos constitutivos da experiência de dor torácica na mulher durante o infarto, descritos sob a perspectiva pessoal de cada entrevistada. Os resultados da experiência de dor permitem apontar que ela é complexa, atemorizante, com matizes que dependem das situações e vivências anteriores, e que vão acompanhados de sentimentos de medo ante a possibilidade de morrer e que comprometem os âmbitos físicos, psicológicos e emocionais da mulher., Se presentan los resultados de la investigación “La experiencia del dolor torácico en la mujer con infarto agudo del miocardio”. Es un estudio cualitativo fenomenológico, que indagó sobre la experiencia del dolor torácico de la mujer que ha sufrido un infarto agudo del miocardio. Se realizó con nueve mujeres cuyo promedio de edad era de 52 años, en su mayoría amas de casa, entrevistadas personalmente por la investigadora. Se utilizó el sistema de entrevista a profundidad, siendo la base fundamental del estudio las narraciones de las experiencias ante el fenómeno de interés. El estudio permitió identificar los elementos constitutivos de la experiencia de dolor torácico en la mujer durante el infarto, descritos bajo la perspectiva personal de cada entrevistada. Los resultados de la experiencia del dolor permiten señalar que es compleja, atemorizante, con matices dados por las situaciones y vivencias previas, y se acompaña de sentimientos de temor ante la posibilidad de morir, que comprometen los ámbitos físicos, psicológicos y emocionales de la vida de la mujer.