Actual 5-year survival after resection of pancreatic adenocarcinoma was 12%. AJCC stage and negative margins were the only significant predictors of long-term survival. Early detection and intervention for patients with pancreatic cancer is crucial.

Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%-50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45-e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery. METHODS Systematic Search Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009), a comprehensive search of the National Library of Medicine's PubMed database, Embase, Scopus database, Proquest, PsychInfo, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed through May 31, 2018. Through partnerships with Library Services at the University of Alabama Birmingham, keywords and medical subject heading (MESH) terms used in the search included "health literacy, " "surgical, " "post-operative, " and "surgery. " The entire search string for each database along with the number of screened abstracts can be found in Table A. Two authors (S.J.B. and I.C.D.S M.) who are experienced researchers independently evaluated abstracts of the 673 articles obt...

Intraductal oncocytic papillary neoplasm(IOPN) of the pancreas is classified as a variant of intraductal papillary mucinous neoplasm(IPMN) in the WHO guidelines. However, the neoplastic cells of IOPNs are unique, with distinctive architecture/oncocytic cytoplasm. Although molecular/immunohistochemical features of other IPMN variants have been extensively studied, those of IOPNs have not been well characterized. Expression profile of antibodies associated with genetic alterations previously described for ductal adenocarcinomas(DAs) and IPMNs(SMAD4/β-catenin/p53/mesothelin/claudin-4) as well as with antibodies to mucins and differentiation markers(MUC1/MUC2/MUC5AC/MUC6/CDX2/HepPar-1) was investigated in 24 IOPNs and 22 IPMNs to assess the similarities/differences between these tumors. Expression of mesothelin and claudin-4 were dissimilar between these tumor types: a higher proportion of IOPNs labeled with mesothelin[21/24(87.5%) of IOPNs, 6/22(27%) of IPMNs, p<0.001], while the reverse was true for claudin-4[2/23(9%) of IOPNs, 9/22(41%) of IPMNs, p=0.01]. The results of immunolabeling for SMAD4/β-catenin/p53 were similar in both: None of the cases showed SMAD4 loss in the intraductal components and only 1/21(5%) of IOPNs and 2/22(9%) of IPMNs revealed abnormal β-catenin expression(p=0.49). Nuclear p53 accumulation was seen mostly in architecturally complex/high grade dysplasia areas in both. Immunolabeling for MUC proteins showed that almost all lesions expressed MUC5AC. 12/24(50%) of IOPNs and 6/22(27%) of IPMNs(p=0.11) labeled for MUC1, whereas 7/24(29%) of IOPNs and 10/22(45%) of IPMNs labeled for MUC2(p=0.25). MUC6 was expressed in 8/9(89%) of IOPNs(strong) and 6/21(29%) of IPMNs(weak)(p=0.002). 14/23(61%) of IOPNs and 4/22(18%) of IPMNs labeled for HepPar-1(p=0.003). These results show that IOPNs have distinct immunoprofile and provide support for the proposition that IOPN is a distinct entity developing through a mechanism different from other pancreatic ductal neoplasms.

We introduce a novel, sensitive, and specific method of lymphatic mapping that utilizes NV1066-guided cancer cell-specific viral production of GFP to enable real-time intraoperative detection of lymphatic metastases.