Objective Poor sleep quality has been linked to inflammatory processes and worse disease outcomes in the context of many chronic illnesses, but less is known in conditions such as chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). This study examines the relationships between sleep quality, pro-inflammatory cytokines, and CFS/ME symptoms. Methods Sixty women diagnosed with CFS/ME were assessed using the Pittsburgh Sleep Quality Index (PSQI), Fatigue Symptom Inventory (FSI) and Center for Disease Control and Prevention (CDC)-based CFS/ME symptom questionnaires. Circulating plasma pro-inflammatory cytokine levels were measured by ELISA. Multiple regression analyses examined associations between sleep, cytokines and symptoms, controlling for age, education, and body mass index. Results Poor sleep quality (PSQI global score) was associated with greater pro-inflammatory cytokine levels: interleukin-1β (IL-1β) (β=0.258, p=0.043), IL-6 (β=0.281, p=0.033), and tumor necrosis factor-alpha (TNF-α) (β=0.263, p=0.044). Worse sleep quality related to greater fatigue severity (β=0.395, p=0.003) and fatigue-related interference with daily activities (β=0.464, p<0.001), and more severe and frequent CDC-defined core CFS/ME symptoms (β=0.499, p<0.001, and β=0.556, p<0.001, respectively). Conclusions Results underscore the importance of managing sleep-related difficulties in this patient population. Further research is needed to identify the etiology of sleep disruptions in CFS/ME and mechanistic factors linking sleep quality to symptom severity and inflammatory processes.

HighlightsPPP (pancreatic disease, panniculitis, polyarthritis) syndrome is a rare disease caused by pancreatitis or pancreatic cancer.Panniculitis and polyarthritis are the main characteristics of the syndrome.A high mortality rate and chronic sequel are reported.Surgical and endoscopic treatment may improve the prognosis of this condition.

FDG-PET provides a good prognostic value for PNETs. Present results must be further validated with larger sample studies.

4040 Background: Nab-paclitaxel in combination with gemcitabine has shown interesting clinical activity in patients with advanced pancreatic cancer (PDA) likely related to its ability to eliminate pancreas cancer stroma. In this study we explore clinical and pathological effects of the combination in patients with operable PDA. Methods: Patients with resectable o borderline resectable pancreatic cancer were treated with gemcitabine(1000mg/m2 days 1, 8 and 15) and nab-paclitaxel(125mg/m2 days 1, 8 and 15) for two cycles prior to surgery. Response was assessed by FDG-PET, CA199 levels and elastography, an EUS-based non invasive assessment of tumor stroma. Results: 16 patients were included into the study. 2 patients (12.5%) showed a progression disease (both with hepatic metastases) and were not operated. Median value for PET SUVmax decreased from 7,1 pre-treatment to 4,6 post-treatment(p=0.004), including 7(50%) of patients with a partial metabolic response and the mean CA199 decreased from 2654 to 52(p=0.02) with 43% patients having a more that 75 % decrement in tumor marker. The elastography ratio value diminished from 36 pre-treatment to 18 post-treatment(p=0.003) and correlated with improvement in SUVmax(p=0.04) and CA199 response(p=0,07). Grade 3-4 toxicities were neutropenia in 18% (none febrile neutropenia), thrombocytopenia in 12.5 and 6.2% transaminase elevation. So far 9 patients have been operated and in 8(89%) a complete resection (R0) was achieved. 1 patient had a complete pathological response and 4 patients had near complete responses with only a few(< 5%) residual tumor. In-depth analysis of stromal composition after treatment showed, compared to a series of 10 cases untreated and treated with conventional chemoradiation, decreased myofibroblast content, increase vessel density and distorted collagen fibers. Conclusions: Neoadjuvant treatment with gemcitabine plus nab-paclitaxel is feasible and results in significant clinical activity. Non-invasive elastography appears and attractive method to monitor tumor response. The rate of pathological responses and R0 resections in substantial for this setting. Biological studies of resected specimens show unique effects in tumor stroma.

Summary Pancreatic cancer is a major cause of death from cancer in both men and women in the USA and Europe. The disease causes pain and has a significant impact on the performance status of the patient. In a randomized trial vs 5-fluorouracil, the novel nucleoside analogue gemcitabine (GEMZAR®) has been shown to provide clinical benefit for patients (decreased pain and improved performance status) as well as to improve the time to tumour progression and survival for patients with the disease. There are also other new agents that are presented in this discussion, such as the multi-targeted antifolate MTA, capecitabine and the ONYX-015 adenovirus, which replicates in, and kills, only p53-abnormal cells, which have the potential to have an impact on this terrible disease.