Pain affects 70-80% of patients with pancreatic adenocarcinoma and remains inadequately controlled in more than half of cases. Beyond its impact on quality of life, pain is now recognized as an independent prognostic factor, reflecting the unique neurobiological features of this malignancy. Perineural invasion drives a bidirectional dialogue between cancer cells and the peripheral nervous system, in which neurotrophic factors, neuropeptides, and immune mediators fuel both nociception and tumour progression. Current pain management relies on the WHO analgesic ladder supplemented by adjuvant agents (gabapentinoids, duloxetine, corticosteroids) and interventional procedures including celiac plexus neurolysis, intrathecal opioid delivery, and palliative radiotherapy. Recent advances, notably celiac plexus radiosurgery and evidence favouring early neurolysis, challenge the prevailing reactive approach. This review examines the pathophysiology of pancreatic cancer pain, critically appraises available treatments, identifies gaps in current evidence, and argues for a proactive, multimodal strategy initiated at diagnosis rather than reserved for refractory disease.
The treatment of aortic valve disease in small annuli remains a debated topic in terms of prosthetic choice - biological or mechanical - and risk of patient prosthesis mismatch. The clinical data of the 241 patients who received a small size sutureless prosthesis from the Sorin Universal REgistry on Aortic Valve Replacement (SURE-AVR) (NCT02679404) were analysed at 30 days and at follow-up. The mean age was 75.5 ± 7.8 years (89.2
Many options are available concerning the graft fixation in ACL reconstruction, one of them being a suspensory device. Our study aimed to compare the strength of two different devices of fixation (suspensory device vs screw) on the tibia. We enrolled 80 patients older than 18 years with an isolated ACL tear confirmed at the MRI, divided into two comparative groups for a prospective study. The only factor which changed was the tibial fixation. The surgical treatment, performed by a unique surgeon, used the same inside-out technique for the two groups, with a ST4-strand graft. Various intraoperative parameters were studied like the time of the tourniquet, the diameter of the graft or an associated meniscus tear. The AP knee laxity was evaluated at 6 months and 1 year after the surgery by a TELOS test. We also compared the two groups with subjective and objective surveys. We can conclude that the suspensory device can offer the same strengthening.
Background The use of interstitial glucose monitoring devices such as Flash Glucose Monitoring has been shown to be beneficial in patients with type 1 diabetes (T1DM). However, these devices have been little studied in patients with diabetes treated by chronic haemodialysis (HD). Methods The goal of this prospective, observational, multicentric, study was to evaluate the analytical performance of the FreeStyle Libre® 2 (FSL2) sensor in T1DM patients during HD sessions. During three HD sessions, interstitial glucose concentrations (ISFG) given by the FSL2 were compared, every 15 minutes, with blood glucose concentration (BG) obtained simultaneously. BG concentrations were measured by two different glucometers: the Accu-Chek Guide® and the StatStrip® meter. Results Twelve hemodialysis patients were included. Mean age was 54 ± 11 years. Mean diabetes duration was 36.5 ± 11.6 years and dialysis vintage was 35 ± 22 months. A total of 565 pairs of ISFG/BG values were available for analysis. The mean absolute relative difference, defined as the mean of the absolute relative differences between the ISFG and BG measurements, was 17.4% and 20.9% when the ISFG were compared to the StatStrip glucometer or Accu-Chek Guide, respectively. Interstitial results tend to underestimate blood results but all values were classified as having clinically acceptable error. The differences observed remained stable during the dialysis session and were not associated with the ultrafiltration rate. Conclusion The use of the FSL2 interstitial glucose monitoring device in HD patients with T1DM is clinically acceptable, even though the accuracy of the device is generally poorer than in studies including non-dialysis patients.
Objectives The primary objective of this study was to describe and compare the motivation of parents/guardians to bring children with low-acuity conditions to a tertiary-care pediatric emergency department (ED) versus a clinic before and after the pandemic. The secondary objectives were to describe and compare the demographic and clinical characteristics of the population studied and the impact of the pandemic on their access to primary care services. Methods This is a cross-sectional study based on a survey administered to parents/guardians of patients presenting with low-acuity conditions at one of two EDs. Results The respondents numbered 659. Children were brought to a pediatric ED generally because of the perceived urgency of the condition, the presumed resource availability in the pediatric ED and the unavailability of the primary care physician. However, most respondents ( n = 438, 66.5%) indicated preference for a clinic. More respondents before than during the pandemic reported they had been unable to find a doctor outside the ED (48.6% before COVID vs 26.8% during COVID, p < 0.001) but patients during the pandemic were less likely to seek care in a primary care practice or walk-in clinic (30.0% during COVID vs 48.6% before COVID, p < 0.001). In addition, the number of respondents presenting with symptoms of infection decreased by more than half after the pandemic began while the proportion of musculoskeletal and psychiatric complaints doubled. Conclusion Although the pandemic has altered the landscape of presenting complaints and pediatric healthcare-seeking behaviors, most respondents indicated they would prefer to receive care in a clinic. This finding contradicts the view that most pediatric ED visits for low-acuity conditions are by choice rather than perceived necessity. Prioritizing improved access to primary care resources would better address the preferences and expectations of parents/guardians.
