Pancreatic collections are a common complication of acute pancreatitis. In Latin America, information on the types of pancreatic collections and their management is limited and may vary between regions depending on the availability of highly specialised and minimally invasive treatment resources.

Retrospective cohort of patients with acute pancreatic collections secondary to acute pancreatitis treated at the Hospital Universitario San Ignacio, Bogotá (Colombia) between 2012-2023. Clinical characteristics, laboratory profiles and treatment received were described, comparing those who had a fatal outcome with those who did not.

Of 689 patients with acute pancreatitis, 113 presented with pancreatic collection (55.1% women, mean age 55 years). Of these, 47.8% presented with acute necrotic collection, 36.3% with acute fluid collection, 9.7% with walled-off necrosis and 6.2% with pancreatic pseudocyst. C-reactive protein, BUN, creatinine levels (at admission and at 48 hours), PaO2/FiO2 (at admission and at 48 hours) and antibiotic use were significantly associated with mortality (P<0.05). The majority of acute necrotic collections, walled-off necrosis and pseudocysts received interventional management, with minimally invasive and combined management being more common than surgical management. Antibiotic management was used in 48.6% of collections, although microbiological isolation was performed in only 24.7% of cases.

Acute collections are a common and heterogeneous complication of pancreatitis, requiring intervention more often in complicated collections. Certain laboratory parameters seem to be more associated with mortality.

• Pancreatic collections are a common complication of acute pancreatitis.

• Their management depends on the availability of specialized and minimally invasive resources.

• A study conducted on 689 patients with acute pancreatitis showed that 113 developed pancreatic collections.

• Acute pancreatic collections are frequent and heterogeneous complications of pancreatitis.

• Some altered laboratory parameters (creatinine, urea, C-reactive protein, and FiO2) seem to be more associated with mortality.

Pancreaticoduodenectomy is the procedure of choice for the treatment of resectable pancreaticoduodenal tumours. It has been proposed that jaundice is associated with worse outcomes, but the usefulness of preoperative biliary drainage in these patients is still controversial.

Retrospective cohort study of patients undergoing Whipple procedure at the Hospital Universitario San Ignacio, Bogotá (Colombia), between January 2010 and June 2023. The cohort of patients who underwent preoperative biliary drainage was compared with those who went directly operated on. Comorbidities, functional status and procedural characteristics were recorded. The outcomes, including mortality and intraoperative and 30-day postoperative complications, were compared between groups.

A total of 98 patients were included, 49 of whom underwent preoperative biliary drainage. In this group, there was a higher proportion of patients with pathological stage II and III disease (77.5 vs 49.0, P=0.04) and higher preoperative bilirubin levels (median 6.4 vs 4.9 mg/dL; P=0.02). There were no differences in intraoperative (10.2% vs 14.3%; P=0.34) or postoperative (61.2% vs 51%; P=0.15) complications, but 30-day mortality was higher in patients with biliary drainage (8.2 vs 20.4%; P=0.03).

Our data suggest that there are no differences in postoperative complications. The higher mortality rate in patients with preoperative biliary drainage may be related to differences in baseline patient characteristics and/or delays between biliary drainage and Whipple procedure.

• The usefulness of preoperative biliary drainage in patients undergoing Whipple procedure is still controversial.

• Our data suggest that there are no differences in postoperative complications.

• 30-day mortality is higher in patients with biliary drainage maybe related to differences in baseline characteristics and/or delays between biliary drainage and Whipple procedure.

Despite significant strides in the management of metastatic solid tumors over the past few decades, metastatic disease remains a major clinical challenge, often leading to unfavorable patient outcomes. Circulating tumor cells (CTCs), which shed from the primary tumor, have the potential to disseminate and establish distant metastases, contributing to disease progression and reduced survival rates. Removal of CTCs via extracorporeal blood filtration could have significant therapeutic implications.

A 51-year-old woman was diagnosed with metastatic poorly differentiated adenocarcinoma after presenting with severe abdominal pain. She deferred conventional chemotherapy options and elected treatment with CTC removal using an extracorporeal blood filter. After 9-12 filtration sessions of treatment over 12 months, she reported significant clinical improvement and staging scans demonstrated stable disease without evidence of new metastases.

Therapeutic modalities that explore CTC removal via blood filtration may potentially have promising clinical benefits. More prospective studies are required to determine the utility of this therapeutic strategy in patients with metastatic solid tumors. Our patient demonstrated significant clinical improvement with scans demonstrating stable disease.

Sentinel lymph node (SLN) staging is essential in breast cancer. Superparamagnetic iron oxide nanoparticles (SPIO) is a tracer where the optimal injection technique is yet not defined. The aim was to evaluate SLN detection using 0.1 ml SPIO intradermally compared to technetium-99 m (Tc99) ± blue dye.

Patients planned for breast surgery and SLN biopsy received 0.1 ml SPIO intradermally at the areolar border or over the tumour. Tc99 ± blue dye was administered per clinical routine. Magnetic, radioactive, or blue nodes were removed and analysed separately. SLN detection and numbers, concordance, and skin discoloration were analysed.

A total of 216 patients were included at five hospitals. Median age was 63 years, tumour size 15.9 mm, and 91.7% underwent breast conservation. SPIO was injected a median of 12 days before surgery. SLN detection was 211/216 (97.7%; 95% c.i.: 94.7 to 99.2) and 215/216 (99.5%; 95% c.i.: 98.6 to 100.0) for SPIO and Tc99 ± blue dye (P = 0.111) respectively. In total, 403 SLNs were removed; 341 detected by SPIO and 349 by Tc99 ± blue dye. The median number of SLNs was 1 (iqr: 1-2) for both tracer methods. Among 46 SLN-positive patients, 42 were correctly staged with both tracers, two with SPIO only and two with Tc99 ± blue dye only. Skin discoloration was evaluated in 107 patients. The median discoloured area was 0 cm2 (iqr: 0-0.7) among 49 patients with the injection site surgically removed and 1.3 cm2 (iqr: 0.6-2.8) among 58 without removal.

An ultra-low dose of 0.1 ml intradermal injection of SPIO was non-inferior to Tc99 ± blue dye for SLN detection. Skin discoloration was limited and further reduced by removal during surgery.

This study was designed to reveal the profound association between follicular fluid vitamin D (25(OH)D) levels and the health status of women with polycystic ovary syndrome (PCOS), with the aim of laying a solid scientific foundation for the development of more precise treatment strategies for PCOS. By exploring the correlation between follicular 25(OH)D level and endocrine function, ovarian function and insulin resistance in women with PCOS, it is hoped that the potential value of this level in clinical practice can be realized. From June 2021 to March 2024, 153 women with infertility mainly due to PCOS were selected. According to the Rotterdam criteria, they were divided into phenotypes A-D, with 72 cases (47.06%), 36 cases (23.53%), 18 cases (11.76%), and 27 cases (17.65%), respectively. Forty-six healthy controls with gender and age matching were included. Endocrine function was evaluated by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and dehydroepiandrosterone sulfate. Ovarian function (ovarian volume and number of follicles) and insulin resistance index (HOMA-IR) were also assessed. PCOS patients with different phenotypes were divided into vitamin D deficiency (VDD) group (<20 ng/mL) and non-VDD group (≥20 ng/mL) according to 25(OH)D levels. The correlation between follicular fluid 25(OH)D and differential clinical features was evaluated. We found that 25(OH)D in follicular fluid of PCOS women was lower than that of controls (P<0.001). Phenotype A and B had higher LH and LH/FSH than phenotype D (P<0.05) and were hyperandrogenic, whereas phenotype D had normal or low androgens and no hyperandrogenic symptoms (P<0.05). In terms of ovarian function, PCOS women with phenotypes A, C, and D had large ovarian volumes, with more follicular fluid in A and C than in B (P<0.05). There were no significant differences in FBG, HOMA-IR, insulin sensitivity and follicular fluid 25-(OH)D among the four groups (P>0.05). In the phenotype A and B cohorts, the LH/FSH ratio, ovarian volume, and HOMA-IR of the VDD group were higher than those of the non-VDD group. There was a weak and negative correlation between follicular fluid 25(OH)D and LH/FSH levels and HOMA-IR, and a moderate correlation with ovarian volume. To sum up: PCOS women have lower follicular fluid 25(OH)D. When VDD is present, patients with phenotype A and B have higher levels of insulin resistance characteristics. Although follicular fluid 25-(OH)D does not show statistically significant differences across the different PCOS phenotypic cohorts, specific phenotypes A and B exhibit more pronounced insulin resistance profiles in those individuals with VDD.

Growing evidence suggests that chronic hepatitis B (CHB) patients with high viremia are at a high risk of developing hepatocellular carcinoma (HCC) even with normal alanine transaminase (ALT) levels. This study aimed to evaluate the cost-effectiveness of initiating antiviral therapy in patients in an indeterminate phase of CHB, defined as those who do not clearly fit into the established four phases categorised by serum HBV DNA and ALT levels.

A cost-utility analysis was conducted using a Markov model to compare the incremental cost-effectiveness ratio (ICER) of initiating antiviral therapy at the indeterminate phase ('treat-Indet') versus delaying treatment until chronic hepatitis ('untreated-Indet'). A hypothetical cohort of 10 000 patients in the indeterminate phase (60% male, HBV DNA 4-8 log₁₀ IU/mL, ALT < 40 IU/L, 50% HBeAg-positivity) was simulated over a 10-year horizon. Input parameters were obtained from a Korean multicentre historical cohort.

From a healthcare system perspective, the ICER of the treat-Indet strategy was US$12050/quality-adjusted life-year (QALY), indicating cost-effectiveness under the local willingness-to-pay threshold of US$25000/QALY. From a societal perspective, the ICER was less than 0, indicating lower costs. A U-shaped association was identified between baseline HBV DNA levels and the ICER, as HBV DNA levels of 6-7 log₁₀ IU/mL were associated with the lowest ICER (US$2018/QALY), followed by 5-6 (US$7233/QALY), 7-8 (US$19677/QALY) and 4-5 log₁₀ IU/mL (US$24570/QALY), following the order of HCC risk.

Initiating antiviral therapy in high-viremic indeterminate phase CHB patients with normal ALT levels was cost-effective compared with delaying treatment until chronic hepatitis.

Although smoking cessation remains the most effective preventive measure against lung cancer, the implementation of low-dose computed tomography screening has facilitated early tumor detection, increasing the need for less invasive surgical approaches. This study evaluated the efficacy of segmentectomy vs. lobectomy for early-stage non-small cell lung cancer (NSCLC) in northern Italy.

The analysis included 200 patients with stage I NSCLC, selected from a cancer registry. Of these, 100 underwent lobectomy and 100 underwent segmentectomy. We calculated loco-regional and distant recurrences, overall survival, and disease-free survival (DFS).

Over a median follow-up of 6.3 years, segmentectomy was associated with a lower recurrence rate (28%) compared to lobectomy (35%) and a lower incidence of distant metastases (39.6% vs. 60.4%). Multivariable analysis showed a greater risk of recurrence in patients undergoing lobectomy [OR 1.32; 95% CI: 0.71-2.45] and in females [OR 1.69; 95% CI: 0.89-3.18], while a decreased risk was observed among elderly patients over 70 years [OR 0.72; 95% CI: 0.39-1.32] and those with adenocarcinoma histology [OR 0.82; 95% CI: 0.41-1.64]. Five-year survival was higher in the segmentectomy group (67%; 95% CI: 57-76) compared to the lobectomy group (55%; 95% CI: 45-65); a similar result was observed for DFS: 59% (95% CI: 48-68) versus 47% (95% CI 37-57). The risk of death appeared lower in the segmentectomy group [HR 0.85; 95% CI: 0.59-1.22].

The outcomes appear to favor segmentectomy, as previously demonstrated in clinical trials. The observed effects are less pronounced, due to the absence of patient selection in this real-world setting.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the sole curative option for myeloid malignancies, though high toxicity from conditioning regimens and complications like graft-versus-host disease (GVHD) limit its success. The potential benefit of incorporating decitabine (DAC) into conditioning regimens for acute myeloid leukemia (AML) and intermediate-to-high-risk myelodysplastic syndromes (MDS) patients in remission remains unclear.

We conducted a retrospective, single-center study analyzing data from January 2016 to December 2020 at the First Affiliated Hospital of Ningbo University with a median follow-up of 45.05 months (range, 1-96 months). Outcomes were compared between patients receiving DAC+HSCT versus HSCT alone, with primary endpoints of 5-year overall survival (OS), progression-free survival (PFS), and relapse rate. Secondary analyses examined outcomes by remission status (CR1 vs. others) and age subgroups (< 31.5 years). Immune cell subsets (CD3-CD56+ NK cells) were evaluated for GVHD correlation.

The DAC+HSCT group exhibited 5-year OS of 51.9% and PFS of 46.1%, compared to 67% OS and 56.5% PFS in the HSCT-only group. The 5-year relapse rate was 16.9% for DAC+HSCT versus 23.2% for HSCT alone. DAC did not significantly improve outcomes in complete remission (CR1) patients but improved OS and PFS in patients under 31.5 years of age. Elevated CD3-CD56+ NK cells in the DAC+HSCT group were associated with higher incidence of severe acute GVHD (aGVHD).

While DAC conditioning did not provide overall survival benefit for AML/MDS patients undergoing allo-HSCT, it improved outcomes in younger individuals (< 31.5 years). Higher NK cell proportions may serve as a potential biomarker for early aGVHD intervention, warranting further investigation into risk-stratified conditioning approaches.

Pediatric cancer patients experience unique and multifaceted sleep disturbances due to the disease, treatment regimens, and the hospital environment. These disruptions can detrimentally impact neurocognitive functioning, emotional well-being, and overall quality of life, making accurate sleep assessment critical yet challenging in this population.

To examine and evaluate the current tools used to assess sleep quality in pediatric oncology patients, with a focus on their reliability, feasibility, and relevance to clinical and research settings.

A scoping review methodology was employed to identify and synthesize studies using various sleep assessment tools in pediatric cancer populations. Tools reviewed included actigraphy, sleep diaries, validated sleep scales, and polysomnography. Studies were analyzed for general reliability, feasibility in clinical and research contexts, and applicability to pediatric oncology-specific concerns.

The review found that while actigraphy and sleep diaries are frequently used because of their noninvasive nature and relative ease of implementation, limitations exist in terms of consistency and interpretability. Sleep scales varied in their psychometric properties and relevance across age groups and treatment phases. Polysomnography, though considered the gold standard, was less feasible in routine clinical settings because of its complexity and cost. Across tools, variability was observed in the alignment between measured parameters and clinically relevant sleep issues in pediatric cancer patients.

A wide range of tools exists for assessing sleep in pediatric oncology, each with distinct strengths and limitations. Selection of the most appropriate tool should consider the specific sleep concern, patient age, clinical context, and resource availability. This review provides a framework for clinicians and researchers to make informed choices, encouraging thoughtful integration of sleep assessments into both practice and study design.

Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies.

Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date.

A total of 7564 patients with HCC (3691 pre-NMP; 3874 NMP era) and 354 patients with CCA (193 pre-NMP; 161 NMP era) were waitlisted over the study period. NMP-era patients had a higher probability of transplant at 1 year from listing for both HCC (59% vs. 49%, p < 0.001) and CCA (71% vs. 56%, p = 0.012). Patients with HCC also had a lower risk of death or waitlist dropout (14% vs. 16% at 1 year, p = 0.016). After adjustment for other factors affecting probability of transplant in HCC, the NMP era (aSHR 1.26, 95% CI 1.18-1.34, p < 0.001) and transplantation at a high-volume NMP center (aSHR 1.13, 95% CI 1.05-1.22, p = 0.002) were both still associated with higher transplant probability.

NMP has promise in improving access to liver transplantation for oncologic indications.