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First, to assess the impact of the number of examined lymph nodes (ELNs) on staging and survival after distal pancreatectomy (DP) for pancreatic adenocarcinoma (PDAC). Second, to identify the minimum number of ELNs (MNELNs) ensuring an accurate detection of nodal involvement. Third, to reappraise the role of lymph node (LN) parameters, including N-status and lymph node ratio (LNR).In contrast with pancreatoduodenectomy, information on LN staging and the MNELN required in DP is lacking.Patients undergoing DP for PDAC at 2 academic hospitals from 2000 through 2013 were retrospectively analyzed. The eighth edition of the American Joint Committee on Cancer staging system was used. The MNELN was estimated using the binomial probability law. Survival analyses were performed separately for node-negative and node-positive patients using univariable and multivariable models.The study population consisted of 240 patients. The median number of ELN was 21, significantly lower in node-negative patients as compared with node-positive patients (18.5 vs 24.0; P = 0.001). The proportion of node-positive patients increased with increasing numbers of ELNs, whereas LNR showed an inverse trend. The estimated MNELN was 20. The number of ELN (≥ or20) was an independent prognostic factor only in node-negative patients [odds ratio (OR) 3.23 for ELN20), suggesting a stage migration effect. In node-positive patients, N2-class, but not LNR, was a significant predictor of survival at multivariable analysis (OR 1.68).The number of ELN affects nodal staging in body/tail PDAC. At least 20 LNs are required for correct staging. N-status is superior to LNR in predicting survival of node-positive patients.

OBJECTIVE: To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D).METHODS: An international cross-sectional study including 23 026 T1D children (2-18 years, duration of diabetes ≥1 year) participating in the SWEET prospective, multicenter diabetes registry. Body mass index SD score (BMI-SDS) was calculated using the World Health Organization BMI charts. Children were categorized as UW (BMI-SDS < -2SD), OW (+1SD < BMI-SDS ≤ +2SD), and obese (OB) (BMI-SDS > +2SD). Hierarchic regression models were applied with adjustment for sex, age, and duration of diabetes.RESULTS: The prevalence of UW, OW, and obesity was: 1.4%, 22.3%, and 7.3% in males and 0.6%, 27.2%, and 6.8% in females. Adjusted BMI-SDS was significantly higher in females than in males (mean ± SEM: 0.54 ± 0.05 vs 0.40 ± 0.05, P < 0.0001). In males, BMI-SDS significantly decreased by age (P < 0.0001) in the first three age categories 0.61 ± 0.06 (2 to <10 years), 0.47 ± 0.06 (10 to <13 years), 0.34 ± 0.05 (13 to <16 years). In females, BMI-SDS showed a U-shaped distribution by age (P < 0.0001): 0.54 ± 0.04 (2 to <10 years), 0.39 ± 0.04 (10 to <13 years), 0.55 ± 0.04 (13 to <16 years). BMI-SDS increased by diabetes duration (<2 years: 0.38 ± 0.05, 2 to <5 years: 0.44 ± 0.05, and ≥5 years: 0.50 ± 0.05, P < 0.0001). Treatment modality did not affect BMI-SDS. Adjusted HbA1c was significantly higher in females than in males (8.20% ± 0.10% vs 8.06% ± 0.10%, P < 0.0001). In both genders, the association between HbA1c and BMI-SDS was U-shaped with the highest HbA1c in the UW and obesity groups.CONCLUSIONS: The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.

Abstract Oral Lichen Planus (OLP) is an inflammatory chronic disease, its potential of malignant transformation is widely known, especially for lesions affecting mucosa. This letter aims to highlight, thanks to results obtained from a long-term observation of one hundred patient suffering from OLP, the importance to set proper and sufficiently long follow-ups. An important evidence observed is the malignant developing after 4 years of observation in 4 cases of 8. This leads to conclude that follow-up for OLP lesions is required to be as long as possible in order to timeously intercept malignant transformations of these lesions and to perform a realistic early diagnosis. Final suggestion is to design more prospective studies based of long observation period.

An extensive literature has focused on the impact of new public management (NPM) oriented structural changes on academics’ practice and identity. These critical studies have been resolute in concluding that NPM inevitably leads to a degeneration of academics’ ethos and values. Drawing from the moral philosophy of Alasdair MacIntyre, we argue that these previous analyses have overlooked the moral agency of the academics and their role in ‘moralizing’ and consequently shaping the ethical nature of their practices. The paper provides a new theoretical understanding of NPM-oriented reforms in light of the virtue ethics approach, thereby directing the attention to the moral character and moral agency of academics. Our analysis of interviews collected in the business department of a Danish university provides an example of how individuals have divergent ethical understandings of these structural changes and enact/resist pre-defined social roles in different ways. While in some cases the NPM agenda of the institutions has triggered internal moral conflict and a crisis of moral character, in other cases the new logic resonates with academics’ values and evaluative standards. Partially departing from the theoretical ground of MacIntyre (1981), we conclude that academics can play a crucial role in shaping the morality of NPM-oriented institutions and in transforming these settings into suitable contexts for the cultivation of virtues.