Does neoadjuvant treatment in resectable pancreatic cancer improve overall survival? A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Neoadjuvant chemotherapy may improve overall survival (OS) in 'borderline' resectable pancreatic cancer (RPC). Whether the results are the same in upfront RPC is unknown. MATERIALS AND METHODS: To evaluate the association of neoadjuvant treatment and survival outcomes in RPC, a systematic literature review was carried out including prospective randomized trials of neoadjuvant treatment versus upfront surgery. Articles indexed in PubMed, Embase and Scopus were evaluated. Data regarding systemic treatment regimens, R0 resection rates, disease-free survival (DFS) and OS were extracted. The outcomes were compared using a random-effects model. The index I2 and the graphs of funnel plot were used for the interpretation of the data. RESULTS: Of 3229 abstracts, 6 randomized controlled trials were considered eligible with a combined sample size of 805 RPC patients. Among the trials, PACT-15, PREP-02/JSAP-05 and updated long-term results from PREOPANC and NEONAX trials were included. Combining the studies with meta-analysis, we could see that neoadjuvant treatment in RPC does not improve DFS [hazard ratio (HR) 0.71 (0.46-1.09)] or OS [HR 0.76 (0.52-1.11)], without significant heterogeneity. Interestingly, R0 rates improved ∼20% with the neoadjuvant approach [HR 1.2 (1.04-1.37)]. It is important to note that most studies evaluated gemcitabine-based regimens in the neoadjuvant setting. CONCLUSIONS: Neoadjuvant chemotherapy or chemoradiation does not improve DFS or OS in RPC compared to upfront surgery followed by adjuvant treatment. Neoadjuvant treatment improves R0 rates by ∼20%. Randomized ongoing trials are eagerly awaited with more active combined regimens including modified FOLFIRINOX.

Impaired responses to gliadin and gut microbes of immune cells from mice with altered stress-related behavior and premature immune senescence.

Stress is associated with impaired communication between the nervous and immune systems leading to immunosenescence and increased disease risk. We investigated whether leukocytes from mice with altered stress-related behavior and premature immunosenescence, as well as from chronologically aged mice differently responded ex vivo to celiac disease (CD) triggers (gliadin) and intestinal bacteria by ELISA and flow cytometry and differed in microbiota composition. We found that altered stress-related behavior and premature immunosenescence led to alterations in T lymphocytes and cytokine release of immune cells basally and in response to peptic fragments of gliadin and commensal and pathogenic bacteria, possibly increasing susceptibility to CD in adulthood.

Ovariectomy, a model of menopause in rodents, causes a premature aging of the nervous and immune systems.

Ovariectomy in rodents is a good model for mimicking human ovarian hormone loss. This work studies the consequences of ovariectomy on the nervous and immune systems in the context of biological aging. Ovariectomy accelerates the process of aging by impairing the sensorimotor abilities (with loss of muscular vigor and impaired equilibrium and traction capacities) and the exploratory capacities (with reduction of vertical exploratory activity). It also leads to a premature immunosenescence with regard to chemotaxis index, lymphoproliferative response and natural killer activity, parameters investigated in the spleen and axillary nodes. Therefore, ovariectomy deteriorates homeostasis and may be a model of premature aging.

Early maternal deprivation in rats: a proposed animal model for the study of developmental neuroimmunoendocrine interactions.

Adult animals that had been subjected to a single prolonged episode of maternal deprivation (MD) [24 h, postnatal day (PND) 9-10] show long-term behavioral alterations that resemble specific symptoms of schizophrenia. Moreover, at adolescence MD rats showed depressive-like behavior and altered motor responses. According to the neurodevelopmental hypothesis, certain behavioral abnormalities observed in MD animals may be related to altered neurodevelopmental processes triggered by MD-induced elevated glucocorticoids in relevant specific brain regions. We review here these neuroendocrine effects and show new data indicating that the MD procedure induces diverse detrimental effects on the immune system that are already revealed in the short term (PND 13) and persist into adulthood. These long-lasting effects might be related to altered hypothalamus-pituitary-adrenal axis activity and to social as well as nutrition-related factors. In fact, MD induces long-lasting decreases in body weight. In view of our findings we propose the present MD procedure as a potentially useful model to analyze developmental interactions between early psychophysiological stress and immunodeficient states.

[Cerebrovascular disorders in Uberlandia: I. Mortality]. / Doenças cerebrovasculares em Uberlândia: I. Mortalidade.

We have analyzed 1361 death certificates, during the year of 1982 in Uberlandia (Brazil), all deaths of residents and not deathbirths. In 47% the deaths were assisted by a physician and the cause of death proved. The first basic cause of death found was cardiovascular diseases (23.3%). The second, infectious diseases particularly Chagas' disease (14.9%) and the third traumatic lesions and poisonings (14.4%). Cerebrovascular diseases were the seventh basic cause of death (6.5%) but the third most related disease at the death certificates (12.7%). It is important to stress that the mortality index change considerably if we consider the disease as a basic cause of death or in more than one position in the death certificate. For instance in Uberlandia the index for CVD was 30 and 63/100.000 inab/year, respectively. The carriers of arterial hypertension presented CVD related at death certificate 10 times more than in the not carriers of hypertension.