These allogeneic cells are easier to procure and amenable to tissue banking. Nevertheless, the limitations of adult stem/progenitor cells provide a rationale for deriving therapeutic cells from other sources. A third type of stem cell that has remarkable potential for regenerative medicine is the iPSC. In 2006, Yamanaka and MLN8237 clinical trial colleagues4 reported that mouse fibroblasts

could be reprogrammed into iPSCs by viral transduction of genes encoding four master regulators of pluripotency: octamer-binding Inhibitors,research,lifescience,medical transcription factor 3/4 (Oct 3/4) and SRY-related high-mobility-group (HMG) box protein-2 (Sox2), in combination with Krüppel-like factor 4 (Klf4) and c-Myc.4 Successful reprogramming of adult human fibroblast cells into human iPSCs based on defined transcription factors has been reported independently by Yamanaka (Oct 3/4. Sox2, Klf4, c-Myc)5 and James Thomson (Oct4, Sox2, Nanog, Lin28).6 Human iPSCs are potentially Inhibitors,research,lifescience,medical better alternatives to human embryonic

stem cells (hESCs) because they can be patient-specific Inhibitors,research,lifescience,medical and avoid the political and ethical dilemmas surrounding hESCs.5, 6 Human iPSCs are already having a substantial impact on cardiovascular medicine, and their potential for regenerative cardiovascular therapies Inhibitors,research,lifescience,medical is promising. How iPSCs are Changing Medicine: Their Use in Modeling Cardiovascular Diseases Because somatic cells from any individual can now be induced into pluripotency, it is possible to make disease-specific cell lines from our patients. Thus, we can create “disease-in-a-dish” models with iPSC technology. Using iPSC-derived cardiovascular cells, investigators have already generated new insights into the molecular mechanisms of inherited cardiovascular diseases. Elegant studies have been reported using iPSC-derived cardiomyocytes from patients with Inhibitors,research,lifescience,medical long

QT syndrome, 7, 8 LEOPARD syndrome,9 and Timothy syndrome10 in vitro. Exemplary of this approach is the work of the Dolmetsch group, which reprogrammed human skin fibroblasts Non-specific serine/threonine protein kinase from Timothy syndrome patients to generate human iPSCs and differentiated these cells into cardiomyocytes. Electrophysiological recording and calcium imaging studies of the iPSC-derived cardiomyocytes revealed that the cells manifested irregular electrical activity and contraction, with abnormal calcium transients and prolonged action potentials. If the “disease-in-a-dish” model faithfully recapitulates the cardiovascular disease of the patient, then it may become a useful tool to determine if a drug has the potential to exacerbate the condition or to uncover new therapeutic avenues.

5mg/dL (normal values 40–80mg/dL for normal glycemic levels). Lower than normal glucose levels were only seen in 3 patients out of 22. As reported in Table 3, 11 out of the 26 patients were treated by intrathecal liposomal AraC

and 2 by systemic chemotherapy. Table 3 Therapeutic management in the 26 patients of the cohort. In this cohort, no patient was treated by radiotherapy after diagnosis of neoplastic meningitis. Figure 1 reports overall survival in the entire cohort. This attained a median value of 22 weeks, Inhibitors,research,lifescience,medical in line with data from the literature. Figure 1 Assessment of possible prognostic factors showed that at univariate analysis, higher performance status, primary histology (breast versus others), less elevated CSF protein, and linear contrast enhancement at MRI versus nodular disease, as well as intrathecl chemotherapy

versus no intrathecal chemotherapy were associated with more prolonged survival. However, probably due to the low number of patients, no statistically significant differences were detected in subgroups at multivariate Inhibitors,research,lifescience,medical analysis. In Figure 2 the MRI images of a young female affected by neoplastic meningitis from breast cancer are reported; this 28-yr-old woman had a 2-year history of ductal carcinoma Her2-, hormone receptor-negative Inhibitors,research,lifescience,medical with positive lymphnodes at diagnosis. She had been treated with systemic chemotherapy, surgery, second-line chemotherapy associated with antiangiogenic therapy for relapse, and with RT on lymhnodes. 18 months after diagnosis, she developed fever and headache, with subsequent rapid development of confusion, cognitive deterioration, behavior abnormalities, and progression to stupor. On neurological examination at admission, the patients was responsive but Inhibitors,research,lifescience,medical not oriented in space and time, with signs of meningeal irritation.

She could not walk, the sitting position was maintained with difficulty. Inhibitors,research,lifescience,medical Cerebrospinal fluid analysis disclosed 90 cells (of which 85 malignant cells, cytokeratin-positive), with negative cultures, extremely low glucose levels (4mg%), and slightly increased total proteins (64mg%). Due to the very poor conditions, only palliative care was chosen for this patient, who died 4 weeks after diagnosis. Figure 2 Postcontrast T1-weighted MRI images of diffuse enhancement in cerebral sulci and linear enhancement surrounding the dorsolumbar spinal cord and the Afatinib ic50 lumbosacral roots in a 28-yr-old female with breast cancer. only Figure 3 shows her CSF cytology with a representative cytokeratin-positive tumor cell. Figure 3 CSF cytology with stain with peroxidase-conjugated anticytokeratin antibody and counterstain with haematoxylin (courtesy of Dr. E. Corsini, Fondazione IRCCS Istituto Neurologico Besta, Milano). This case underscores the heterogeneity of clinical course in neoplastic meningitis, since it conflicts with 2 other cases (both from a primary breast cancer) who are still alive at the present followup.

There was 1 postoperative death and 1 patient with no recurrences at 42 months. In the PM group, there were 20 patients with R1 resections and 11 of these patients recurred: 2 patients recurred with AUY-922 isolated PM, 3 patients developed isolated HM, 1 patient developed isolated pulmonary metastases, 2 patients developed both PM and HM, Inhibitors,research,lifescience,medical 2 patients developed both HM and pulmonary metastases, and there was insufficient data concerning the location of a recurrence in 1 patient. There were 9 patients with no recurrences at 18, 20, 22, 27, 31, 32, 32, 68, and 138 months. Concerning peritoneal recurrences,

there were 36% recurrences in the PM/HM group and 18% in the PM group (P=0.3). Concerning hepatic recurrences, there were 55% recurrences in the PM/HM group and 32% in the PM group (P=0.2). Currently, only 1/10 patients Inhibitors,research,lifescience,medical with R1 resection remain disease-free in the PM/HM group, while 9/20 patients with R1 resection remain disease free in the PM group (P=0.05). Overall survival and prognostic factors The median follow-up time was 57 months for the PM/HM group and 45 months for the PM group. The PM/HM group had a median overall survival (OS) of 15 months (95% CI: 6-46 months) and the PM group had a median OS of 34 months (95% CI: 19-37 months) as seen in Figure 1 (P=0.2). The disease free survival (DFS) was 10 months (95% CI: 3-14 months)

Inhibitors,research,lifescience,medical for the PM/HM group and 24 months (95% CI: 10-32 months) for the PM group (P=0.1). The three-year

OS was 30% in the PM/HM group and 47% in the PM group and the three-year DFS was 20% and 42%, respectively. Figure 1 Overall survival of colorectal peritoneal and hepatic metastases (PM/HM) vs. peritoneal metastases Inhibitors,research,lifescience,medical (PM) alone, P=0.2 There was only 1 univariate prognostic factor which was significant and it was the R1 resection variable. It did not maintain an independent prognostic Inhibitors,research,lifescience,medical value which is probably due to the fact that only 3 patients in the entire study were R2 resections and the rest R1. HM was not a negative prognostic factor in the prognosis analysis (Table 3). Table 3 Univariate and multivariable Cox proportional hazards analysis for overall survival (n=33) Morbidity and mortality There were 3 patients (27%) with grade III-IV morbidity in the PM/HM group and 6 patients (27%) in the PM group (P=1.0). There was one postoperative mortality in the PM/HM group and none in the PM group. The most common morbidity was postoperative infections Rolziracetam requiring intravenous antibiotics. Only one fistula occurred in the study (PM only group). Discussion This is a matched comparison of colorectal PM/HM treatment vs. PM treatment alone. Considering the tendency towards worse DFS and a significantly increased recurrence rate, the concomitant presence of HM should definitely be considered a negative prognostic factor even when only a solitary HM is present.

Regarding the average values of all participants over nine minutes of ECC, the no-flow time for 30:2 was significantly less than for 15:2. All ECC data comparing 15:2 and 30:2 are presented in Table ​Table2.2. All participants decompressed the chest incompletely during ECC (Table ​(Table2).2). Therefore, for both CVRs the Protein Tyrosine Kinase inhibitor compression amplitude was significantly lower for male and female participants as compared to the compression depth (data not shown, p < 0.001; t-test for paired data). As the decompression depth, however, did not change over the

nine minutes of ECC, further analyses were focused on both the compression depth and compression rate. Table 2 Values of external chest compression variables for the participants as means Inhibitors,research,lifescience,medical over a nine-minute period, for all participants and differentiated by gender. Minute-to-minute analysis of all participants showed a significant decrease Inhibitors,research,lifescience,medical in compression depth starting from minute four (94.8% of minute 1) for 15:2 (p < 0.05) and from minute three (95.3% of minute 1) for 30:2 (p < 0.05). Furthermore, female participants compressed more rapidly (p = 0.1) and significantly Inhibitors,research,lifescience,medical more shallowly (p = 0.04) than male participants (Figures ​(Figures2A2A and ​and2B2B). Figure 2 Minute-to-minute compression depth (A) and rate (B) during external chest compression performed

by male (n = 30) and female (n = 10) participants. A: Inhibitors,research,lifescience,medical Compression depth, male vs. female: p = 0.04; B: Compression rate, male vs. female: p = 0.1. Squares … Separation based on biometric data For the entire cohort, we found a significant correlation between gender and BMI as well as gender and HR75. Furthermore, a significant correlation between BMI and HR75 was seen (r = -0.58), potentially indicating BMI as an epiphenomenon of good physical fitness due to an increased muscle mass. Finally, significant differences in the quality of ECC were found between female and male participants with regards

Inhibitors,research,lifescience,medical to compression depth and rate (see Table ​Table2).2). We therefore analysed female and male participants separately. In addition, male and female participants were differentiated into groups with higher and lower values of BMI and HR75. The calculated median SB-3CT of each variable was set as the threshold between the high and low groups. Thus, half of the cohort (15 males and five females) represented the highs and the lows. The median values were as follows: For male participants BMI = 25.4 kg/m2 and HR75 = 130.5 bpm; for female participants BMI = 20.4 kg/m2 and HR75 = 167.0 bpm. In the following, for male participants lower BMI refers to participants with a BMI below 25.4 kg/m2; a higher BMI refers to participants with a BMI above 25.4 kg/m2. For females, a lower BMI refers to participants with a BMI below 20.4 kg/m2 and a higher BMI to participants with a BMI above 20.4 kg/m2. We found no significant correlation between BMI and HR75 (r = 0.33) for male participants.

They feel like the light has been turned off and they aren’t sure how to turn It on again. Depressed people are sad because they see themselves and/or the world as fundamentally flawed, Inadequate, or worthless. They feel like the world has no light or color or warmth. There is no light to turn on. Depression inhibits the capacity to experience positive emotions. Inhibitors,research,lifescience,medical Grief does not. Positive emotions occur as frequently as negative ones as early as a week after a loved one dies. Depression biases thinking in a negative direction. Grief does not. Depression interferes with the capacity to care about other people and to understand their good intentions. Grief turns a person inward, but the desire

to be with others and appreciation for the efforts Inhibitors,research,lifescience,medical of others is preserved. Both depression and grief take one out of ongoing life, but the reason for withdrawal is very different. In the words of author and scientist Kay Redfield Jamison: I

did not, after Richard died, lose my sense of who I was as a person, or how to navigate the basics of life, as one does in depression. I lost a man who had been the most important person in my life and around whom my future spun. I lost many of my dreams, but not the ability to dream. The loss of Richard was devastating, but it was not deadly. (Nothing Was the Same) It is very important Inhibitors,research,lifescience,medical that depression and grief not be confounded, because depression requires treatment and grief requires reassurance and support. Inhibitors,research,lifescience,medical We do someone a disservice by diagnosing depression if they are experiencing acute grief. Correspondingly, we do someone a disservice by calling it grief when a person is depressed. Moreover, depression-related inhibition of positive emotions,12 bias toward negative thinking,13 and interference with relationships can all impede successful mourning and predispose to complicated grief. Characteristics of successful mourning Mourning is the process by which bereaved people seek and find ways to turn the light on in the world again. From a clinical perspective, Inhibitors,research,lifescience,medical mourning is an array of psychological processes that can be roughly VEGFR inhibitor grouped as emotion

regulation and learning processes. When successful, mourning leads people to feel deeply connected to deceased loved ones while also able to imagine a satisfying future without them. After mourning successfully, a bereaved person is re-engaged in daily life, reconnected to others, and able to experience hope for a future with potential for joy and satisfaction. Sitaxentan Grief has been transformed and integrated. A successful mourning process entails effective emotion regulation and assimilation of new learning in long-term memory. Our loved ones exist in long-term memory, but there are different kinds of memory. Episodic, semantic, and implicit memory14-18 are inter-related but serve different functions, entail different brain systems, and have different properties. Close attachments are mapped in each of these systems, so each must be updated when a loved one dies.

Work conducted regarding cognitive processing during psychological trauma, such as the development of disorganized traumatic memories and PTSD, may be of use

in increasing understanding regarding the increased rate of PTSD among those with TBI.47 That is, alterations in consciousness associated with TBI may contribute to the development of disorganized traumatic memories and a subsequent, increased risk for PTSD. Co-occurrence may also exacerbate existing symptoms. For example, frank neurological insult, such as a TBI may exacerbate PTSD symptoms by creating an inability to self-regulate and inhibit, behavioral Inhibitors,research,lifescience,medical responses.31 Further study regarding the relationship between these two conditions is necessary Inhibitors,research,lifescience,medical to facilitate

increased understanding and ultimately develop assessment, and treatment, strategies for those with co-occurring disorders. Conclusions and implications for clinical practice Among those with TBI and/or PTSD neuropsychological measures in the context, of a comprehensive evaluation may help clarify an individual’s strengths and weaknesses. However, the overlap of cognitive disruption noted by those with PTSD and/or TBI suggests that such measures Inhibitors,research,lifescience,medical are unlikely to assist in differential diagnosis. This is certainly in part related to the “the complex interplay of neurological, psychological, and physical factors in veterans with [mild] TBI” and/or PTSD, and highlights the need Inhibitors,research,lifescience,medical for “specialized evaluation” and management (p 271).29 This stance is supported by best practices outlined in the Departments of Veterans Affairs and Defense updated mild TBI clinical practice guidelines.64 The fact that brain regions of selleckchem interest (eg, hippocampus) are involved

in complex cognitive processes such as learning and memory, and as such require a high degree of plasticity, are capable of “life-long neurogenesis,” and are vulnerable to physical and emotional insult have created significant challenges for those Inhibitors,research,lifescience,medical studying or working with individuals who have PTSD and/or TBI.37 To assist, resources are being deployed to develop biomarkers for both conditions. Carnitine palmitoyltransferase II Identification of such laboratory biomarkers may assist, in the early identification of each of these conditions, and as such facilitate timely intervention. However, until such biomarkers are identified, clinicians will be required to rely upon data (eg, clinical history, neuropsychological testing results, neuroimaging findings) which may or may not result, in a definitive diagnosis. The lack of definitive biomarkers can also place clinicians in the challenging position of determining how and when to use existing experimental data and/or employ newer imaging techniques in clinical practice.

The particularly stressful life event of her marital separation was also the impetus for her current disordered state of affairs, so work focused on ameliorating her interpersonal stress would be fundamental to achieving stable social rhythms. Once Anne’s therapist had completed the history-taking and interpersonal inventory, she and Anne moved into the intermediate phase of treatment. Anne’s therapist first began problem-solving with Anne about how to make her schedule more consistent at work. After discussing the nature of Anne’s relationship with her supervisor (good until she had started missing work), her therapist suggested she talk with her

supervisor about requesting set shifts

on a weekly Inhibitors,research,lifescience,medical basis. While Anne knew that, because of the nature of the restaurant business, it would be nearly impossible for her to have the same days off each week, she agreed that her boss might be BX-795 datasheet somewhat receptive to the idea of at least making her shifts take place during the same times each Inhibitors,research,lifescience,medical day, especially if it meant this would help her to be a more reliable employee. With Anne’s history of mania, her therapist suggested that she avoid Inhibitors,research,lifescience,medical the late-night shifts if at all possible. Anne’s supervisor was in fact amenable to her requests, and upon successfully obtaining a more stable work schedule, Anne and her therapist then went to work on regulating her sleep schedule. Using the SRM as a guide, Anne and her therapist agreed on set

times when Anne would go to bed at night and get up in the morning, aiming Inhibitors,research,lifescience,medical to have these times vary by no more than an hour, even on her days off. Anne’s therapist offered her education on sleep hygiene, and explained how getting better sleep would not only help her mood, but would also make her less clumsy and forgetful at work, thereby alleviating some of her work-related stress and worry. While this behavioral work was being done to help regulate Anne’s social Inhibitors,research,lifescience,medical rhythms, her therapist was simultaneously working with her on her role transition to being a single woman and dealing with the stress and oxyclozanide loneliness she felt as a result of her marital separation. Her therapist stressed the importance of creating a solid support network to help her through this difficult time, encouraging Anne to find ways to express her feelings about her current situation. Anne’s therapist knew from the II that Anne maintained a good relationship with her parents and had at least two female friends from high school with whom she remained close; however, she rarely saw either her parents or these girlfriends because she felt too depressed to leave her apartment other than to drag herself to work. She encouraged Anne to visit her parents on one of her days off and to make some arrangements to see one of her friends on the other day.

Angst et al3-98 found that the diagnostic stability of several nonbipolar depressive disorders (major depressive disorder, dysthymia, recurrent brief depression, and minor depression) was low (ie, high shifting from one disorder to another one), questioning the categorical classification of nonbipolar depression and supporting a spectrum of nonbipolar depressive disorders. Judd et al10-13 found, in bipolar I disorder and in bipolar II disorder, that, during the longterm course, minor GX15-070 research buy depressions and depressive symptoms were much more Inhibitors,research,lifescience,medical prevalent than mania/hypomania

and major depressive episodes (three times more frequent than syndromal depression and mania/hypomania), especially in bipolar II disorder. In both disorders, the number, duration, and severity of depressive Inhibitors,research,lifescience,medical symptoms fluctuated over time, as well as manic/hypomanic symptoms, supporting a dimensional/spectrum view of depression and mania/hypomania. Judd et al found that bipolar II depression was more likely Inhibitors,research,lifescience,medical than bipolar I depression to be long-lasting and to have a fluctuating course of severity and duration (ie, major and minor depressions, and depressive symptoms), and to have more anxiety disorder comorbidity. On the other hand, bipolar I disorder was more likely to have long-term

fluctuating manic/hypomanic/cycling episodes and manic/hypomanic symptoms. Patients were Inhibitors,research,lifescience,medical symptomatically ill for 50% of the weeks studied. In major depressive disorder, Judd et al found that minor depressions and depressive symptoms were much more common (three times) than major depressive episodes, and that symptom number, severity, and duration changed frequently, alternating over time. Patients were symptomatically ill for 60% of the weeks studied. The findings supported a spectrum view of nonbipolar depressive disorders.

The diagnostic validity of minor depression Inhibitors,research,lifescience,medical was supported by Rapaport et al.99 Minor depression was defined by the symptoms of the major depressive episode, which had to be less than five but more than two, lasting at least 2 weeks. Minor depression, compared with major depressive disorder, had more mood Histamine H2 receptor and cognitive symptoms, but not the classical neurovegetative symptoms. History of major depressive disorder was present in only 30%, the main finding supporting its diagnostic validity. The current status of minor depression is unclear. Recurrent brief depressive disorder Recurrent brief depressive disorder research criteria require meeting major depressive episode criteria, apart from the duration, which should be between at least 2 days but less than 2 weeks. It should occur at least once a month for 12 consecutive months. It must not meet criteria for major depressive episode, dysthymic disorder, mania, hypomania, or cyclothymic disorder.

RECIST criteria were used to assess response to treatment. For the evaluation of response, the extent of measurable disease was assessed by computerized tomography before the first cycle and after every 2 cycles. Time to progression was defined as the duration from the initiation of the regimen to the date of documented disease progression or death by any cause. Overall survival was defined as the duration from initiation of chemotherapy to the date of death or last follow-up. Statistical Inhibitors,research,lifescience,medical analysis Kaplan-Meier analysis was used for TTP and overall survival analyses and the log-rank test was used for comparisons. Survivors were censored on the date they were last known

to be alive. Results Patient characteristics Patient characteristics are shown in Table 1. No patient Inhibitors,research,lifescience,medical was withdrawn from the study. All patients had PS 0 or PS1. Two patients (4.9%) had gastroesophageal adenocarcinomas, 15 (36.6%) had corpus tumors, and 17 (41.5%) had antral tumors. Twenty-two patients (53.7%) had histopathologically grade III tumors and 19 (46.3%) had grade II tumors. Eight patients (19.5%) had locally advanced tumors and the remaining had metastatic disease. Median age of patients was 54 (range: 26-71). Table 1 Patient characteristics (n=41) Response to chemotherapy One-hundred fifty-nine Inhibitors,research,lifescience,medical courses of treatment were administered. The median delivered dose intensities of epirubicin, cisplatin,

and oral UFT were 91.8%,

92.5%, and 91.2%, respectively. The median number of chemotherapy cycles was 4 (range: 1-6) and average duration of follow-up was 12.7 Inhibitors,research,lifescience,medical months (range: 2.9-49.5) (Table 2). Table 2 Treatment response Three patients (7.3%) had complete response after 6 (n=2) or 4 cycles (n=1). Fifteen patients (36.6%) had partial response and 14 (34.1%) had stable disease. Nine patients (22%) showed progression. The overall Inhibitors,research,lifescience,medical response rate was 43.9% (complete response plus partial response) (95% CI; 28.5-60.3) (Table 2). Twelve patients (29.2%) required dose modification only once LY294002 manufacturer during treatment and 2 patients (4.9%) required dose modification twice. Of the 2 patients with locally advanced disease who underwent surgery after 6 cycles of chemotherapy, 1 is still alive and the other died due to postoperative complications. Brain metastasis developed in one patient after 3 cycles of chemotherapy. Toxicity The main grade III-IV non-hematological toxicities encountered with Resminostat the ECU regimen were nausea and vomiting (19.5%). Neutropenia was the main grade III-IV hematological toxicity (12.1%; Table 3). Grade III-IV diarrhea occurred in 4 patients (9.8%). Reasons for dose modifications were prolonged neutropenia, neutropenic fever, hypopotassemia, diarrhea, and anorexia. Table 3 Grade I-II to IV toxicity during ECU treatment (n=41) The most serious grade IV adverse events included acute renal failure (2.4%) and gastric perforation (2.4%).

In another pregnant patient with pancreatic cancer, labor was induced at 28 weeks and the patient then proceeded to the operating room for pancreaticoduodenectomy two weeks later (6). In each of the described

cases, no significant adverse fetal outcomes have been described from the surgical procedures alone. In all but one of these cases, the maternal outcome was reported to be uniformly poor. The use of gemcitabine in pregnancy has been described in non-small cell lung cancer and choriocarcinoma, with little to no teratogeneic effect when administered after the first trimester (7)-(9). A single patient received multi-agent chemotherapy including docetaxel, cisplatin, and gemcitabine Inhibitors,research,lifescience,medical during the first Inhibitors,research,lifescience,medical trimester of an unrecognized pregnancy without significant teratogenesis. Experience in breast cancer, lymphoma and leukemia suggest that chemotherapy can be considered in the second and third trimesters after a full disclosure of the potential risks (10),(11). The case described in this report is the first described in the literature for adjuvant chemotherapy for pancreatic cancer given Inhibitors,research,lifescience,medical while the patient is still pregnant. No adverse outcome has been seen in the child, nearly 24 months post delivery.

Even with these case reports, the potential teratogenic effects in the first trimester or during fetal organogenesis have not been systematically described in the literature, and this discussion Inhibitors,research,lifescience,medical in no way endorses their use during that phase. This case demonstrates many of the medical and interpersonal issues that complicate treating pregnant patients with

cancer. In this case, the patient’s primary goal was to bring a healthy infant to term, understanding the risks of the proposed Inhibitors,research,lifescience,medical treatments to herself and her fetus during the treatments. With no data to guide in this specific instance, the treatment team extrapolated data from other tumor types regarding safety and efficacy of the chosen treatments. The patient, and all involved physicians (surgeon, obstetrician, perinatologist, oncologists) were willing to accept an uncertain degree of risk to help achieve the patient’s objective of bringing the fetus to term. In spite of aggressive anticancer therapy, the patient manifest progressive disease rapidly, and eventually succumbed to her cancer. There is also debate in the oncology community about the efficacy of neoadjuvant chemotherapy with or without radiation, and studies are ongoing (12),(13). Her case demonstrates that both locoregional recurrence and distant recurrence need to be addressed in perioperative treatment. Her case also highlights the relatively limited effective treatment options for patients with pancreatic adenocarcinoma, and underscores the need for research in the treatment of this disease. see more Footnotes No potential conflict of interest.