In conclusion NF in the vast majority of cirrhotic

In conclusion, NF in the vast majority of cirrhotic patients was caused by Gram-negative bacilli, β-hemolytic streptococci, oxacillin-sensitive S. aureus, and oxacillin-resistant S. aureus. NF in patients with LC was significantly associated with a high mortality rate, and hypoalbuminemia (serum albumin <2.5 g/dL), with high mortality. Further studies are needed to assess whether resuscitation with albumin-containing solutions lowers the mortality rate in these patients.
Introduction Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer deaths in the Western world, and is the 10th most common cancer in Taiwan. Complete surgical resection still remains the only therapeutic option for PDAC, but only 10% of patients are candidates for curative surgery. The overall 5-year survival rate is 5–10%, which is much lower than that of resectable pancreatic cancer in general (25–35%). Malignant tumors usually comprise a heterogeneous cell population having different biologic properties, of which a small population of cancer cells, or so-called cancer stem cells (CSCs), promote tumor formation and growth. The existence of CSCs was first proved in acute myelogenous leukemia and subsequently verified in breast and dopamine antagonist drugs tumors. Al-Hajj et al reported a phenotypically distinct and relatively rare population having CD44+, CD24−, and epithelial-specific antigen+, and stated that the tumor-initiating cell lineage was responsible for the propagation of human metastatic breast cancer cells. Pancreatic CSCs have not been identified until Li et al described a subpopulation of tumor cells from PDAC tissue with increased tumorigenic potential in mice. They also identified putative CSCs in PDAC based on the expression of the surface markers CD44, CD24, and epithelial specific antigen. The expression of CD44 variants has been reported to correlate with a poor prognosis in colon cancer. Overexpression of CD44 has also been demonstrated to be associated with poor prognoses in head and neck squamous-cell carcinoma. In human pancreatic cancer samples, CD44 expression was reported to correlate with the histologic grade, and patients with CD44-positive tumors showed a poor prognosis. The present study was designed to compare the prognosis of PDAC patients with positive or negative expression of CD44 in tumor cells after surgical resection.
Materials and methods
Results
Discussion The prognosis of PDAC is extremely poor, because the cancer usually invades the surrounding tissues and metastasizes to lymph nodes, liver, or peritoneum at the time of diagnosis. CD44 is an adhesion molecule and membrane receptor for hyaluronan, and is involved in cell motility and metastasis. The gene encoding CD44 generates a variety of isoforms by alternative splicing, which predominantly affects the extracellular membrane-proximal structure of CD44 proteins. Prince et al demonstrated that CD44 cells isolated from primary head and neck carcinoma have the ability to self-renew and differentiate in an in vivo mouse model, and the CD44 subpopulation in primary tumors vary from 0.1% to 42%. In other tumors, multiple cell surface markers may be used to purify CSCs, and CD44 has been used as one of the CSC markers. CD44 is a member of the transmembrane glycoprotein family, with a large number of isoforms identified in many human tissues and particularly high expression in proliferating cells and squamous cell epithelium. The CD44 variant 6 (v6) molecule has been noted as a marker for tumor metastasis and prognosis in several tumors. Although Gansauge et al reported that lower serum levels of soluble CD44 v6 were significantly associated with poor prognosis in patients with PDAC, this might not be the true reflection of prognosis of CD44+ in patients with PDAC. Gotoda et al first reported that CD44 v2 and CD44 v6 may be useful markers of a poor prognosis. In this study, we demonstrated that the overexpression of CD44 had a statistically significant association with decreased 5-year overall survival in patients with PDAC after surgery. The prognosis of patients with CD44− was better with significantly improved survival, but the tumor staging between the two groups of patients showed no such difference. The main factor seems to be related to the presence or absence of tumor stem cells in their PDAC.