Background and Aim: Early and accurate diagnosis of pancreatic cancer (PC) is important. Our aim was to identify potential volatile organic compounds (VOCs) in the bile that can help distinguish PC from chronic pancreatitis (CP). Methods: In this prospective observational study, bile was aspirated in patients undergoing ERCP for CP and PC. The head space of bile from PC and CP patients was analyzed using mass spectrometry. Results: The study included a discovery cohort of 57 patients (PC = 46, CP = 11) and a validation cohort of 31 patients (PC = 19, CP = 12). Using logistic regression analysis, the model [0.158* age + 9.747* log (ammonia) - 3.994* log (acetonitrile) + 5.044* log (trimethylamine) -30.23] successfully identified patients with PC with a sensitivity of 93.5% and specificity of 100%; likelihood ratio: 40.9; Area under the curve [AUC] = 0.98; 95% confidence interval [CI]: 0.95-1.00. The diagnostic accuracy of this model was confirmed in the second independent validation cohort. Conclusion: The measurement of VOCs in bile helps to accurately distinguish PC from CP. (NCT02531607)

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Unexpectedly decreased left ventricular global systolic function can be difficult to manage, even for patients undergoing elective cardiac surgery, and should prompt a multidisciplinary discussion. Therefore, in this review, we discuss the evidence describing key perioperative variables expected to influence left ventricular systolic function to facilitate this discussion.

While PD-1 inhibitors have revolutionized the treatment of metastatic NSCLC and the drugs are overall well tolerated, a small percentage of patients develop immune mediated liver injury due to reactive cytotoxic T lymphocytes as the reactivated T cells attack other tissues, including the liver. Generally, this has been seen consistently across the entire drug class, not specific to single agents. We present a rare case of immune mediated liver toxicity specific to Pembrolizumab that was subsequently not observed with Nivolumab, despite both drugs having identical mechanisms of actions. Patient has had multiple serial labs and imaging studies showing no progression of her disease, stable on Nivolumab. This case highlights the need for further investigation regarding the mechanism of Immune mediated liver toxicity/ injury that may be specific to single agents and not necessarily a drug class.

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