Thirty-six patients underwent curative resection of a primary pancreatic carcinoma from January 1977 to September 1987; 26 had Whipple resections, seven had total pancreatectomies, and three had distal pancreatectomies. Twenty-six patients manifested recurrent disease, four died of intercurrent disease, and six were apparently cured. Median survival was 11.5 months with actuarial survival at 2 and 5 years of 32% and 17%, respectively. Of the eventual recurrences, 19% were local only (pancreatic bed, regional nodes, adjacent organs, and immediately adjacent peritoneum) and 73% had a component of local failure. All patients failing did so with a component in the intraabdominal cavity. Peritoneal (42%) and hepatic failures (62%) were common. Extraabdominal metastases were documented in only 27%, but never as a sole site. Fourteen patient and tumor characteristics were evaluated for any relationships with failure or survival. No single variable independently predicted for local failure. However, a group of three (age > 60 years, T2 or T3 stage, and location of tumor in the body or tail) was associated with a substantial local failure risk (85% of all patients with local failure). Multivariate analysis showed that low tumor grade (P = O.oOZ), female sex (P = 0.002), and adjuvant radiation (P = 0.02) were all independent predictors of prolonged survival. Ten patients were treated in an adjacent setting. Those given 55 Gy or greater had improved local control (50% versus 25%) and cure (33% versus none) when compared with patients treated to lower doses. The authors conclude that local failure after curative resection remains a significant problem and further efforts to improve local control are warranted. However, peritoneal and hepatic relapses occur frequently. Thus, adjuvant treatment strategies using wide-field radiation techniques or intraperitoneal therapy, in combination with local tumor bed irradiation and chemotherapy, should be explored. Cancer 66:56-61,1990. ANCREATIC CARCINOMA remains a devastating P problem for the patient as well as those charged with its management. By recent estimates, this malignancy will account for 3% of the total cancer incidence in adults and 5% of the total deaths, taking 24,500 lives in the US in 1988.' Moreover, the incidence has risen over the last 40 years.2 Even in the highly selected subgroup that undergoes "curative" resection, the expected 5-year survival is in the range of 0% to 18%,3 with median survivals of 10 to 14 month^.^,^ For the remainder of patients, approximately one third will have unresectable locoregional disease only and the rest will have metastases at pre~entation.~ In patients who have undergone complete resection, a previous randomized study from the Gastrointestinal Tumor Study Group (GITSG) as well as a follow-up non-randomized registration study have shown a survival advantage for patients treated with postoperative combined radiation and 5-fluorouracil (5-FU).637 In light of this 56

Magnetic resonance (MR) imaging and computed tomography (CT) are commonly used to image the vertebral column in dogs with thoracolumbar myelopathy. The purpose of this prospective study was to compare diagnostic sensitivity and observer agreement for these two tests in a group of dogs with surgically confirmed thoracolumbar myelopathy due to intervertebral disk herniation (IVDH). All included dogs had MR imaging followed by non--contrast CT using standardized protocols. Two board--certified radiologists and one board--certified neurologist interpreted each imaging study independently without knowledge of clinical or surgical findings. The operating surgeon was aware of MR findings but not CT findings at the time surgical findings were recorded. Forty--four dogs met the inclusion criteria. The sensitivity of CT was 88.6% (79.5%--94.2%) and of MR was 98.5%(95% confidence interval, 94.1%--99.7%) for diagnosis of intervertebral disk herniation.Specificity was not calculated, as all dogs had IVDH at surgery. Magnetic resonance imaging was more accurate than CT for correctly identifying the site of intervertebral disk herniation--associated spinal cord compression and differentiating disk extrusion versus protrusion. Computed tomography was less accurate for diagnosis of lesion location for peracute cases of IVDH, as well as for chondrodystrophic, female, older and smaller (<7kg) dogs. Inter--rater agreement was good for determining lesion lateralization for both MR and CT (κ=0.687, 95% CI=0.552, 0.822, P=0.002, and κ=0.692, 95% CI=0.542, 0.842, P=0.003). Findings from the current study indicated that MR imaging was more sensitive 3 and accurate than non--contrast CT for diagnosis and characterization of thoracolumbar myelopathy due to IVDH in dogs.

Tendon injuries (tendinopathies) are common in human and equine athletes and characterized by dysregulated collagen matrix, resulting in tendon damage. We have previously demonstrated a functional role for microRNA29a (miR29a) as a post-transcriptional regulator of collagen 3 expression in murine and human tendon injury. Given the translational potential, we designed a randomized, blinded trial to evaluate the potential of a miR29a replacement therapy as a therapeutic option to treat tendinopathy in an equine model that closely mimics human disease. Tendon injury was induced in the superficial digital flexor tendon (SDFT) of 17 horses. Tendon lesions were treated 1 week later with an intralesional injection of miR29a or placebo. miR29a treatment reduced collagen 3 transcript levels at week 2, with no significant changes in collagen 1. The relative lesion cross-sectional area was significantly lower in miR29a tendons compared to control tendons. Histology scores were significantly better for miR29a-treated tendons compared to control tendons. These data support the mechanism of microRNA-mediated modulation of early pathophysiologic events that facilitate tissue remodeling in the tendon after injury and provides a strong proof of principle that a locally delivered miR29a therapy improves early tendon healing.

Objectives: We assessed the growth, distribution, and characteristics of pediatric intensive care in 2016. Design: Hospitals with PICUs were identified from prior surveys, databases, online searching, and clinician networking. A structured web-based survey was distributed in 2016 and compared with responses in a 2001 survey. Setting: PICUs were defined as a separate unit, specifically for the treatment of children with life-threatening conditions. PICU hospitals contained greater than or equal to 1 PICU. Subjects: Physician medical directors and nurse managers. Interventions: None. Measurements and Main Results: PICU beds per pediatric population (< 18 yr), PICU bed distribution by state and region, and PICU characteristics and their relationship with PICU beds were measured. Between 2001 and 2016, the U.S. pediatric population grew 1.9% to greater than 73.6 million children, and PICU hospitals decreased 0.9% from 347 to 344 (58 closed, 55 opened). In contrast, PICU bed numbers increased 43% (4,135 to 5,908 beds); the median PICU beds per PICU hospital rose from 9 to 12 (interquartile range 8, 20 beds). PICU hospitals with greater than or equal to 15 beds in 2001 had significant bed growth by 2016, whereas PICU hospitals with less than 15 beds experienced little average growth. In 2016, there were eight PICU beds per 100,000 U.S. children (5.7 in 2001), with U.S. census region differences in bed availability (6.8 to 8.8 beds/100,000 children). Sixty-three PICU hospitals (18%) accounted for 47% of PICU beds. Specialized PICUs were available in 59 hospitals (17.2%), 48 were cardiac (129% growth). Academic affiliation, extracorporeal membrane oxygenation availability, and 24-hour in-hospital intensivist staffing increased with PICU beds per hospital. Conclusions: U.S. PICU bed growth exceeded pediatric population growth over 15 years with a relatively small percentage of PICU hospitals containing almost half of all PICU beds. PICU bed availability is variable across U.S. states and regions, potentially influencing access to care and emergency preparedness.

The purpose of this study was to describe application and machine accuracy for a new computed tomography (CT) guided, frameless, stereotactic brain biopsy system in dogs. Heads from ten canine cadavers were secured to a bite-plate with six attached fiducial markers and imaged using CT. Fiducialized CT images were imported into stereotactic software and spherical phantom lesions between 3.9 and 5.5 mm in diameter were created in six locations. Infrared cameras and reflective markers were used to register fiducials to the reconstructed image set. Coordinates in the X, Y, and Z planes were identified for each lesion center. Iohexol (1.5 μl of 240 mgI/ml) was injected into the center of each lesion and CT scans were repeated. Pre- and postinjection CT images for each cadaver were fused using the system software. Application accuracy was calculated using the center of each phantom lesion and the center of each injected contrast material location. Machine accuracy was calculated using a phantom with known distances between four fixed points in the X, Y, and Z planes. Mean application accuracy in the first 5 cadavers was 4.3 mm (95% confidence interval [CI] 2.9-4.3 mm) and in the second 5 cadavers was 2.9 mm (95% CI 2-3.9 mm). The more superficial lesions were targeted significantly less accurately than the deeper lesions (P = 0.0183). Median machine accuracy was 0.1 mm and the range was 0.1-0.2 mm. Findings supported use of the new biopsy system for canine brain lesions >3.9 mm in diameter.