Venous thromboembolism in patients with pancreatic adenocarcinoma: Disease burden and initiation of ambulatory thromboprophylaxis.

BACKGROUND/OBJECTIVES: Ambulatory thromboprophylaxis (AT) in patients with pancreatic adenocarcinoma (PAC) reduces venous thromboembolism (VTE) risk and is recommended for patients receiving systemic chemotherapy. We evaluated VTE rates, severity, timing, and risk factors in PAC patients as well as AT rates and initiation times. METHODS: Patients diagnosed with PAC were included. Data collected included patient demographics, medical history, PAC diagnosis, development of VTE, AT, and bleeding episodes. VTE was defined as a DVT or a PE. Patients were classified as receiving AT for VTE prevention if they received a prescription for outpatient anticoagulation. RESULTS: The cohort included 243 PAC patients. VTE occurred in 24 %. Overall, 52 % developing VTE were hospitalized and 5 % died as a result of the VTE. Of those who developed VTE 50 % were diagnosed within the first 2 months of PAC diagnosis. Univariate predictors of elevated VTE risk included an elevated Onkotev score, metastasis at diagnosis, male gender and not receiving AT. Multivariate predictors of elevated VTE risk included male gender (P = 0.014) and not receiving AT (P = 0.001). Overall, 30 % of patients received AT. The median time from diagnosis to initiation of AT was 43 days. Major bleeding occurred in 5.8 %. Patients receiving AT were not at a significantly increased risk of major bleeding (p = 0.5). Patients with intestinal tumor invasion were at significantly increased risk of major bleeding (P = 0.021). CONCLUSION: VTE risk is significant and morbid in PAC patients. AT rates are low, and initiation is often delayed. Therapeutic endoscopists diagnosing PAC may be helpful in AT initiation.

Parameterization of pharmaceutical emissions and removal rates for use in UK predictive exposure models: steroid estrogens as a case study.

Newly available prescription data has been used along with census data to develop a localised method for predicting pharmaceutical concentrations in sewage influent and effluent for England, and applied to a case study: the steroid estrogens estrone, 17ß-estradiol, and 17α-ethinylestradiol in a selected catchment. The prescription data allows calculation of the mass consumed of synthetic estrogens, while use of highly localised census data improves predictions of naturally excreted estrogens by accounting for regional variations in population demographics. This serves two key purposes; to increase the accuracy of predictions in general, and to call attention to the need for more accurate predictions at a localised and/or catchment level, especially in light of newly proposed regulatory measures which may in the future require removal of steroid estrogens by sewage treatment facilities. In addition, the general lack of measured sewage works data necessitated the development of a novel approach which allowed comparison of localised predictions to average national measurements of influent and effluent. Overall in the case study catchment, estrogen predictions obtained using the model described herein were within 95% confidence intervals of measured values drawn from across the UK, with large improvements to predictions of EE2 being made compared with previous predictive methods.

The nutritional teamwork approach: prevention and regression of cataracts in rats.

WE HAVE TAKEN ADVANTAGE OF A NEWLY ASSIMILATED PRINCIPLE IN NUTRITION: no nutrient by itself should be expected to prevent or cure any disease; nutrients as such always work cooperatively in metabolism as a team.By feeding galactose-containing diets to young rats, cataracts are regularly produced. When, however, we furnished galactose-fed animals with what may be considered a well balanced, full team of nutrients, cataract prevention was accomplished. On four galactose-containing diets supplied with a full team of nutrients, not a single cataract developed in 24 rats (48 eyes). On four diets using the same dietary galactose challenge, accompanied with inadequate nutritional teams, 47 out of 48 eyes developed cataracts. Diets of intermediate quality induced the development of intermediate numbers of cataracts. Cataracts once formed were regressed slowly and incompletely by shifting the animals to a diet similar to that which had previously been found to protect against cataract formation. The significance of these findings for nutritional research and for attacks on the problems of human cataracts and other ailments is discussed.

The "trophic" value of foods.

Foods must furnish (i) calories, which can readily be measured, and (ii) raw materials necessary for the building and maintenance of metabolic machinery which makes possible fuel utilization. We have called this "beyond-calorie" quality of food its "trophic" value. This concept has more unity than appears on the surface, and is capable of approximate measurement by biological testing as our experiments show. The trophic value of a food cannot be ascertained from food composition tables because only a smattering of the necessary information is commonly furnished. A food cannot support life if it is missing, or deficient with respect to, any one of the necessary nutrients. A tabulation which includes only a few nutrients-e.g., calcium, thiamin, riboflavin, niacin, phosphorus, and iron-can be woefully misleading, especially if these individual nutrients have been added by way of fortification. THE MEASUREMENT WE HAVE APPLIED TO A NUMBER OF FOODS IS POTENTIALLY VALUABLE FOR COMPARING SIMILAR FOOD PRODUCTS: two grains, two breads, two milk products, or for comparison of the same food grown, processed, or preserved in different ways. By using essentially this method we have found that barnyard eggs are somewhat superior to battery eggs, but that whether they are fertile or infertile makes no difference. We are of the opinion that extensive biological testing of many commercial food products is highly desirable to help promote human health and better internal environments for our cells and tissues.

The nutritive value of single foods.

This is an extension of an earlier study in which we found that while commercial "enriched" bread alone would not support the life of weanling rats in a 90-day test, enrichment could be updated at low cost, with the result that rats consuming the improved bread alone lived during the test period and grew seven times as fast. Prominent nutritionists criticized this study on the basis that bread is not eaten alone and that other single foods are likewise deficient. It was stated: "the experiments you performed would have given the same or similar results if you had begun with milk, eggs, meat, or any other food". Skepticism regarding this statement led to experimental trials in which milk, meat, eggs, and several other foods, including breakfast cereals, were fed singly to groups of animals. Eggs proved to be a remarkably complete food, and milk exhibited about the same excellence until the iron deficiency became evident after about two months. "Enriched" breakfast foods and macaroni were highly deficient and could be improved greatly by supplementation.As an outgrowth of this study, we are developing a method of biological testing which is incomparably better for evaluating foods than consulting food composition tables. On the basis of the tabulated data alone one might conclude that "enriched" puffed rice, for example, is only slightly inferior nutritionally to eggs. Our experiments have shown this assumption to be grossly in error.