ObjectiveTo assess the influence of resection margins on survival for patients with resected pancreatic cancer treated within the context of the adjuvant European Study Group for Pancreatic Cancer-1 (ESPAC-1) study. Summary Background DataPancreatic cancer is associated with a poor long-term survival rate of only 10% to 15% after resection. Patients with positive microscopic resection margins (R1) have a worse survival, but it is not known how they fare in adjuvant studies. MethodsESPAC-1, the largest randomized adjuvant study of resectable pancreatic cancer ever performed, set out to look at the roles of chemoradiation and chemotherapy. Randomization was stratified prospectively by resection margin status. ResultsOf 541 patients with a median follow-up of 10 months, 101 (19%) had R1 resections. Resection margin status was confirmed as an influential prognostic factor, with a median survival of 10.9 months for R1 versus 16.9 months months for patients with R0 margins. Resection margin status remained an independent factor in a Cox proportional hazards model only in the absence of tumor grade and nodal status. There was a survival benefit for chemotherapy but not chemoradiation, irrespective of R0/R1 status. The median survival was 19.7 months with chemotherapy versus 14.0 months without. For patients with R0 margins, chemotherapy produced longer survival compared with to no chemotherapy. This difference was less apparent for the smaller subgroup of R1 patients, but there was no significant heterogeneity between the R0 and R1 groups. ConclusionsResection margin-positive pancreatic tumors represent a biologically more aggressive cancer; these patients benefit from resection and adjuvant chemotherapy but not chemoradiation. The magnitude of benefit for chemotherapy treatment is reduced for patients with R1 margins versus those with R0 margins. Patients with R1 tumors should be included in future trials of adjuvant treatments and randomization and analysis should be stratified by this significant prognostic factor.

This paper reports on the first two decades of research on smart cities by conducting a bibliometric analysis of the literature published between 1992 and 2012. The analysis shows that smart city research is fragmented and lacks cohesion, and its growth follows two main development paths. The first one is based on the peer-reviewed publications produced by European universities, which support a holistic perspective on smart cities. The second path, instead, stands on the grey literature produced by the American business community and relates to a techno-centric understanding of the subject. Divided along such paths, the future development of this new and promising field of research risks being undermined. For while the bibliometric analysis indicates that smart cities are emerging as a fast-growing topic of scientific enquiry, much of the knowledge which is generated about them is singularly technological in nature. In that sense, lacking the social intelligence, cultural artifacts, and environmental attributes which are needed for the ICT-related urban innovation such research champions to be smart in securing the physical infrastructure requirements of cities.

Subject to prospective validation, gemcitabine should not be used for patients with low tumor hENT1 expression.

Recent studies reveal a deep-rooted division in research on smart cities, which surfaces as a set of dichotomies that question whether smart city development should be based on a: (1) technology-led or holistic strategy; (2) double or quadruple-helix model of collaboration; (3) top-down or bottom-up approach; (4) mono-dimensional or integrated intervention logic. These dichotomies generate a critical knowledge gap because they suggest divergent hypotheses on what principles need to be considered when implementing strategies for enabling smart city development. This paper starts filling such a gap by reporting on the findings of a multiple case study analysis which is conducted into European best practices. In meeting this aim, four European cities considered to be leaders in the field of smart city development are analyzed to test the validity of the hypotheses emerging from each dichotomy. These cities are Amsterdam, Barcelona, Helsinki and Vienna. The results of this best practice analysis offer a series of critical insights into what strategic principles drive smart city development in Europe and generate scientific knowledge which helps to overcome the dichotomous nature of smart city research.

Allelism in glutathione S-transferase GSTM1 and GSTT1 has been suggested as a risk factor in various cancers. Accordingly, we describe a group of case-control studies carried out to identify associations between GSTT1 genotypes and susceptibility to lung, oral, gastric and colorectal cancers. The frequencies of the putatively high risk GSTT1 null genotype were not increased in the lung, oral or gastric cancer cases compared with controls but the frequency of this genotype was significantly increased (P = 0.0011, odds ratio = 1.88) in the colorectal cancer cases. No significant interactions between the GSTT1 and GSTM1 null genotypes types were identified in the cancer groups studied. Indeed, no significant associations between GSTM1 genotypes and susceptibility were identified though further evidence was obtained that the protective effect of GSTM1*A and GSTM1*B is not equal. The data complement studies showing that GSTT1 null is associated with an increased susceptibility to total ulcerative colitis and suggests that this enzyme is important in the detoxification of unidentified xenobiotics in the large intestine.

R1-direct resections were associated with significantly reduced overall and recurrence-free survival following pancreatic cancer resection. Resection margin involvement was also associated with an increased risk for local recurrence.

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