Avoiding futile chemotherapy in metastatic pancreatic ductal adenocarcinoma (PDAC) patients by monitoring response to treatment is of utmost importance. A novel biomarker for monitoring treatment response in PDAC, using mutant circulating tumor DNA (ctDNA), is proposed. Results, although limited by small sample numbers, suggest that ctDNA can be an effective marker for disease monitoring and that ctDNA level over time is a better predictor of survival than the dynamics of the commonly used biomarker CA19-9. Therefore, ctDNA analysis can be a useful tool for monitoring PDAC treatment response. These results should be further validated in larger sample numbers.

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Context.— Medical education in pathology relies on the accumulation of experience gained through inspection of numerous samples from each entity. Acquiring sufficient teaching material for rare diseases, such as Hirschsprung disease (HSCR), may be difficult, especially in smaller institutes. The current study makes use of a previously developed decision support system using a decision support algorithm meant to aid pathologists in the diagnosis of HSCR. Objective.— To assess the effect of a short training session on algorithm-assisted HSCR diagnosis. Design.— Five pathologists reviewed a data set of 568 image sets (1704 images in total) selected from 50 cases by the decision support algorithm and were tasked with scoring the images for the presence or absence of ganglion cells. The task was repeated a total of 3 times. Each pathologist had to complete a short educational presentation between the second and third iterations. Results.— The training resulted in a significantly increased rate of correct diagnoses (true positive/negative) and a decreased need for referrals for expert consultation. No statistically significant changes in the rate of false positives/negatives were detected. Conclusions.— A very short (<10 minutes) training session can greatly improve the pathologist's performance in the algorithm-assisted diagnosis of HSCR. The same approach may be feasible in training for the diagnosis of other rare diseases.

Methods: This was a prospective study that included normal fetuses screened between 11 and 13 weeks of gestation. We measured the distance between the posterior limit of the mesencephalon to the occipital bone in the same axial view as the one required for the biparietal diameter (BPD) assessment, at this gestational age. The reference ranges were calculated using quantile regression, according to the Crown-rump length (CRL), BPD, and gestational age. Results: Data analysis included 428 ultrasound measurements. We observed a good, linear correlation between mesencephalon to occiput (MO) distance and CRL, BPD, or gestational age. It increased linearly with advancing gestation (log10MO =-0.1834 + 0.0092*CRL, r2 = 0.48, p < 0.0001) and was independent of maternal demographic characteristics and intracranial translucency. In our study, the 1st percentile of the normal MO distance varies from 1.31 mm at a CRL of 45 mm to 2.08 mm at a CRL of 84 mm. Conclusions: We described a simple measurement between the midbrain and the occipital bone, obtained in axial view. Integration into the routine screening in association with the "crash sign" and recognizing the lower extreme values could lead to an early diagnosis of open spina bifida.

Background/Aim: Vitamin D receptor (VDR) has been shown to suppress desmoplasia in pancreatic ductal adenocarcinoma (PDAC). Our aim was to assess the clinical effects of VDR expression and its correlation with collagen content in the desmoplasia of PDAC patients. Patients and Methods: This is a retrospective analysis of 127 patients with peritumoral desmoplasia resected for PDAC. VDR expression and collagen content were assessed by immunohistochemistry and correlated with clinical outcome. Results: Patients were classified into those with high and those with low VDR expression. High VDR expression was associated with improved overall survival (OS) in localized disease (N0) (median= 33; p=0.01). Patients with high vs. low collagen content had improved OS [34, (range=22.3-45.6 months) vs. 17, (range=14.4-19.6 months), p<0.001]. The number of VDR+ cells was the same for patients with either high or low collagen content. Conclusion: Protective desmoplasia is associated with increased VDR expression and collagen content.