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"Cameron, John"
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Impact of Sarcopenia on Outcomes Following Resection of Pancreatic Adenocarcinoma
Introduction
Assessing patient-specific risk factors for long-term mortality following resection of pancreatic adenocarcinoma can be difficult. Sarcopenia—the measurement of muscle wasting—may be a more objective and comprehensive patient-specific factor associated with long-term survival.
Methods
Total psoas area (TPA) was measured on preoperative cross-sectional imaging in 557 patients undergoing resection of pancreatic adenocarcinoma between 1996 and 2010. Sarcopenia was defined as the presence of a TPA in the lowest sex-specific quartile. The impact of sarcopenia on 90-day, 1-year, and 3-year mortality was assessed relative to other clinicopathological factors.
Results
Mean patient age was 65.7 years and 53.1 % was male. Mean TPA among men (611 mm
2
/m
2
) was greater than among women (454 mm
2
/m
2
). Surgery involved pancreaticoduodenectomy (86.0 %) or distal pancreatectomy (14.0 %). Mean tumor size was 3.4 cm; 49.9 % and 88.5 % of patients had vascular and perineural invasion, respectively. Margin status was R0 (59.0 %) and 77.7 % patients had lymph node metastasis. Overall 90-day mortality was 3.1 % and overall 1- and 3-year survival was 67.9 % and 35.7 %, respectively. Sarcopenia was associated with increased risk of 3-year mortality (HR = 1.68;
P
< 0.001). Tumor-specific factors such as poor differentiation on histology (HR = 1.75), margin status (HR = 1.66), and lymph node metastasis (HR = 2.06) were associated with risk of death at 3-years (all
P
< 0.001). After controlling for these factors, sarcopenia remained independently associated with an increased risk of death at 3 years (HR = 1.63;
P
< 0.001).
Conclusions
Sarcopenia was a predictor of survival following pancreatic surgery, with sarcopenic patients having a 63 % increased risk of death at 3 years. Sarcopenia was an objective measure of patient frailty that was strongly associated with long-term outcome independent of tumor-specific factors.
Journal Article
Freud in Cambridge
Freud may never have set foot in Cambridge - that hub for the twentieth century's most influential thinkers and scientists - but his intellectual impact there in the years between the two World Wars was immense. This is a story that has long languished untold, buried under different accounts of the dissemination of psychoanalysis. John Forrester and Laura Cameron present a fascinating and deeply textured history of the ways in which a set of Freudian ideas about the workings of the human mind, sexuality and the unconscious, affected Cambridge men and women - from A.G. Tansley and W.H.R. Rivers to Bertrand Russell, Bernal, Strachey and Wittgenstein - shaping their thinking across a range of disciplines, from biology to anthropology, and from philosophy to psychology, education and literature. Freud in Cambridge will be welcomed as a major intervention by literary scholars, historians and all readers interested in twentieth-century intellectual and scientific life.
BOOK
The Predicted Cross Value for Genetic Introgression of Multiple Alleles
Han et al. introduce a new metric, the Predicted Cross Value (PCV), for selecting breeding parents. Unlike estimated breeding values, which represent... We consider the plant genetic improvement challenge of introgressing multiple alleles from a homozygous donor to a recipient. First, we frame the project as an algorithmic process that can be mathematically formulated. We then introduce a novel metric for selecting breeding parents that we refer to as the predicted cross value (PCV). Unlike estimated breeding values, which represent predictions of general combining ability, the PCV predicts specific combining ability. The PCV takes estimates of recombination frequencies as an input vector and calculates the probability that a pair of parents will produce a gamete with desirable alleles at all specified loci. We compared the PCV approach with existing estimated-breeding-value approaches in two simulation experiments, in which 7 and 20 desirable alleles were to be introgressed from a donor line into a recipient line. Results suggest that the PCV is more efficient and effective for multi-allelic trait introgression. We also discuss how operations research can be used for other crop genetic improvement projects and suggest several future research directions.
Journal Article
Assessment of using Google Trends for real-time monitoring of infectious disease outbreaks: a measles case study
Measles remains a significant threat to children worldwide despite the availability of effective vaccines. The COVID-19 pandemic exacerbated the situation by leading to the postponement of supplementary measles immunization activities. Along with this postponement, measles surveillance also deteriorated, with the lowest number of submitted specimens in over a decade. In this study, we focus on measles as a challenging case study due to its high vaccination coverage, which leads to smaller outbreaks and potentially weaker signals on Google Trends. Our research aimed to explore the feasibility of using Google Trends for real-time monitoring of infectious disease outbreaks. We evaluated the correlation between Google Trends searches and clinical case data using the Pearson correlation coefficient and Spearman’s rank correlation coefficient across 30 European countries and Japan. The results revealed that Google Trends was most suitable for monitoring acute disease outbreaks at the regional level in high-income countries, even when there are only a few weekly cases. For example, from 2017 to 2019, the Pearson correlation coefficient was 0.86 (
p
-value< 0.05) at the prefecture level for Okinawa, Japan, versus 0.33 (
p
-value< 0.05) at the national level for Japan. Furthermore, we found that the Pearson correlation coefficient may be more suitable than Spearman’s rank correlation coefficient for evaluating the correlations between Google Trends search data and clinical case data. This study highlighted the potential of utilizing Google Trends as a valuable tool for timely public health interventions to respond to infectious disease outbreaks, even in the context of diseases with high vaccine coverage.
Journal Article
The Impact of Postoperative Complications on the Administration of Adjuvant Therapy Following Pancreaticoduodenectomy for Adenocarcinoma
Background
The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy (PD) for adenocarcinoma is still unclear.
Methods
A retrospective review of all patients undergoing PD at our institution between 1995 and 2011 was performed. Clinicopathological data, including Clavien–Dindo complication grade, time to adjuvant therapy (TTA), and survival, were analyzed.
Results
A total of 1,144 patients underwent PD for adenocarcinoma between 1995 and 2011. The overall complication rate was 49.1 % and clinically severe complications (≥IIIb) occurred in 4.2 %. Overall, 621 patients (54.3 %) were known to have received adjuvant therapy. The median TTA was 60 days. Although the presence of a complication was associated with a delay in TTA (
p
=
0.002), the grade of complication was not (
p
=
0.112). On multivariate analysis, only age > 68 years (
p
<
0.001) and length of stay >9 days (
p
=
0.002) correlated with no adjuvant therapy. Patients with postoperative complications were more likely to receive single adjuvant chemotherapy or radiation therapy (31.4 %) than were patients without complications (17.1 %;
p
<
0.001). Patients without a complication had a longer median survival compared with patients who experienced complications (19.5 vs. 16.1 months;
p
=
0.001). Patients without complications who received adjuvant therapy had longer median survival than patients with complications who received no adjuvant therapy (22.5 vs. 10.7 months;
p
<
0.001). Multivariate analysis demonstrated that complications [hazard ratio (HR) 1.16;
p
=
0.023] and adjuvant therapy (HR 0.67;
p
<
0.001) were related to survival.
Conclusion
Complications and no adjuvant therapy are common following PD for adenocarcinoma. Postoperative complications delay TTA and reduce the likelihood of multimodality adjuvant therapy. Identifying patients at increased risk for complications and those unlikely to receive adjuvant therapy warrants further investigation as they may benefit from a neoadjuvant approach.
Journal Article