No abstract

Background The eradication rate of Helicobacter pylori has declined, mainly due to antimicrobial resistance. To overcome resistance‐associated treatment failure, the efficacy of culture‐based, susceptibility‐guided therapy was demonstrated as the first‐line eradication therapy for H pylori infection. Aims To evaluate the efficacy of culture‐based therapy as the first‐line eradication therapy in regions with high levels of antimicrobial resistance. Methods Helicobacter pylori‐positive patients without previous eradication treatment history were recommended to undergo culture to determine the minimal inhibitory concentration (MIC). If they consented, 7‐day clarithromycin‐containing PPI triple; 7‐day esomeprazole, moxifloxacin, and amoxicillin (MEA) therapy; or 7‐ or 14‐day esomeprazole, bismuth, metronidazole, and tetracycline (quadruple) therapy were administered based on the agar dilution‐determined MIC. Eradication, treatment compliance, and adverse events were examined. Results In total, 74 patients were enrolled, and 69 patients completed the protocols. The overall resistance rates to amoxicillin, clarithromycin, metronidazole, and moxifloxacin were 6.7%, 31.0%, 41.8%, and 39.2%, respectively. The patients were allocated to the PPI triple (n = 50), MEA (n = 8) or quadruple (n = 16) therapy. The eradication rate in the intention‐to‐treat analysis was 93.1% (69 of 74 patients). The eradication rates in the per‐protocol analysis were 100.0% (69 of 69 patients). Epigastric pain, nausea, and vomiting were less common than those of other empirical therapies. Conclusions Culture‐based, susceptibility‐guided therapy is effective first‐line eradication therapy, especially in regions with high levels of antimicrobial resistance.

Negative-margin resection is crucial to favorable prognosis in patients with pancreatic ductal adenocarcinoma. However, the definition of a negative superior mesenteric artery margin (SMAM) varies. The College of American Pathologists defines positive SMAM as the presence of tumor cells at the margin, whereas the European protocol is based on a 1 mm clearance. In this study, we examined the prognostic significance of the SMAM distance in 411 consecutive pancreatic ductal adenocarcinoma patients who completed neoadjuvant therapy and pancreaticoduodenectomy. Per College of American Pathologists criteria, 32 (7.8%) had positive margins, and 379 (92.2%) had negative margins. Among margin-negative group, SMAM was ≤ 1, 1.0 to 5.0, and >5.0 mm in 66, 145, and 168 patients, respectively. There was no difference in either disease-free survival (DFS) or overall survival (OS) between the positive-margin group and SMAM ≤ 1 mm (P > 0.05). However, patients with SMAM 1.0 to 5.0 mm had better OS than those with positive margins or SMAM ≤ 1 mm (P = 0.02). Patients with SMAM > 5.0 mm had better DFS and OS than those with SMAM 1.0 to 5.0 mm and those with positive margins or SMAM ≤ 1 mm (P < 0.01). By multivariate analysis, the SMAM distance, tumor differentiation, lymph node metastasis, and histopathologic tumor response grade were independent prognostic factors for both DFS and OS. SMAM distance correlated with lower ypT and AJCC stages, smaller tumor size, better histopathologic tumor response grade, fewer lymph node metastases, and recurrences (P < 0.05). Thus our results strongly support use of SMAM > 1 mm for R0 resection in posttherapy pancreaticoduodenectomy specimens.

Aims This study is to examine the significance of the number and ratio of positive nodes in post neoadjuvant therapy pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Methods and results Our study population consisted of 398 consecutive PDAC patients, who completed neoadjuvant therapy and PD between 1999 and 2012. Lymph node status was classified as ypN0 (node negative), ypN1 (1–2 positive nodes) and ypN2 (≥3 positive nodes) and correlated with disease-free survival (DFS) and overall survival (OS). The ypN0, ypN1 and ypN2 was present in 183 (46.0%), 117 (29.4%) and 98 (24.6%) patients respectively. Additionally, 162 (40.7%) had a lymph node ratio (LNR) ≤ 0.19 and 53 (13.3%) had a LNR > 0.19. Patients with ypN1 disease had shorter DFS and OS than those with ypN0 disease, but better DFS and OS than those with ypN2 disease (P<0.05). Similarly, patients with a LNR≤0.19 had better DFS and OS than those with a LNR≤0.19 (P<0.001). In multivariate analysis, both the number of positive nodes and LNR were independent prognostic factors for DFS and OS. Conclusions Subclassification of post-therapy node positive group into ypN1 (1–2 positive nodes) and ypN2 (≥ 3 positive nodes) should be incorporated into the AJCC staging of PDAC patients.

Our data suggest that ECMO use may not affect platelet activation during the first 3 days of ECMO. Plasma beta-TG levels may allow assessment of the time-dependent extent of ECMO-induced platelet dysfunction in patients with acute respiratory failure.