Pancreatic ductal adenocarcinoma (PDAC) is the 3rd leading cause of cancer mortality in the United States. Hypoxic and hypercapnic tumor microenvironments have been suggested to promote tumor aggressiveness. The objective of this study was to evaluate the association between chronic obstructive pulmonary disease (COPD) and oncologic survival outcomes in patients with early-stage PDAC and periampullary cancers. In this case-control study, patients who underwent a pancreaticoduodenectomy during 2014–2021 were assessed. Demographic, perioperative, histologic, and oncologic data were collected. A total of 503 PDAC and periampullary adenocarcinoma patients were identified, 257 males and 246 females, with a mean age of 68.1 (±9.8) years and a mean pre-operative BMI of 26.6 (±4.7) kg/m². Fifty-two percent of patients (N = 262) reported a history of smoking. A total of 42 patients (8.3%) had COPD. The average resected tumor size was 2.9 ± 1.4 cm and 65% of the specimens (N = 329) were positive for lymph-node involvement. Kaplan–Meier analysis showed that COPD was associated with worse overall and disease-specific survival (p < 0.05). Cox regression analysis showed COPD to be an independent prognostic factor (HR = 1.5, 95% CI 1.0–2.3, p = 0.039) along with margin status, lymphovascular invasion, and perineural invasion (p < 0.05 each). A 1:3 nearest neighbor propensity score matching was also employed and revealed COPD to be an independent risk factor for overall and disease-specific survival (OR 1.8 and OR 1.6, respectively; p < 0.05 each). These findings may support the rationale posed by in vitro laboratory studies, suggesting an important impact of hypoxic and hypercapnic tumor respiratory microenvironments in promoting therapy resistance in cancer.

Background: The purpose of this study was to examine the relationship between various respiratory conditions, including hypercapnic respiratory disease, and a multitude of resected pancreatic lesions. Methods: This retrospective case-control study queried a prospectively maintained database of patients who underwent pancreaticoduodenectomy between January 2015 and October 2021. Patient data, including smoking history, medical history, and pathology reports, were recorded. Patients with no smoking history and no concomitant respiratory conditions were designated as the control group. Results: A total of 723 patients with complete clinical and pathological data were identified. Male current smokers showed increased rates of PDAC (OR 2.33, 95% CI 1.07–5.08, p = 0.039). Male patients with COPD had a markedly increased association with IPMN (OR 3.02, CI 1.08–8.41, p = 0.039), while females with obstructive sleep apnea had a four-fold increase in risk of IPMN compared to women in the control group (OR 3.89, CI 1.46–10.37, p = 0.009). Surprisingly, female patients with asthma had a decreased incidence of pancreatic and periampullary adenocarcinoma (OR 0.36, 95% CI 0.18–0.71. p < 0.01). Conclusion: This large cohort study reveals possible links between respiratory pathologies and various pancreatic mass-forming lesions.

Study Design: Observational study. Objective: To evaluate representation of countries and gross national income (GNI) at major international spine conferences. Methods: The 50 most attended spine conferences were identified via ChatGPT. Conferences were excluded if they (1) reference/are held in a single country, (2) emphasize one technique, (3) emphasize neurosurgery or orthopaedic spine, (4) have <2 years of conference programs available. Programs were reviewed (2022-2024) to identify invited speakers/award recipients, executive board members, and committee members and their country of practice. Countries were assigned GNI/capita from World Bank data. Results: Eurospine, GSC, IMAST, ISASS, NASS, and SRS met inclusion criteria (1462 unique invited speakers/awardees). Other than Eurospine, board members were predominantly from Northern America. Speakers were most commonly from Northern America (56.2%), with no representation from Southern Africa and Central Asia. Speakers were overwhelmingly from high-income countries (89.7%) with none from low-income countries. Speakers at GSC were the most globally representative, with 68.8% from countries diverse from GSC’s executive board. GSC and NASS had the greatest representation from lower-middle (9.7%) and upper-middle income countries (30.4%), respectively. USA and Germany had 867 (59.4%) invitees, while all of Africa had four. Committee members followed similar trends compared to invited speakers for region, country, and GNI/capita representation. Conclusions: Amongst major international conferences, a preponderance of invited speakers and committee members were from a small number of regions, particularly Northern America and Western Europe. Most speakers and committee members practice in high-income countries, with no representation from low-income countries.

Extracellular matrix (ECM) dysregulation plays a significant role in the development of intervertebral disc disease (IVDD). The ECM around the chondrocytes in the nucleus pulposus (NP) is unique in that it contains ColVI. While linked to chondrocyte proliferation in cartilage, ColVI’s specific role in IVD degeneration is less clear. Our aim was to determine the expression of ColVI in NP cells from degenerative IVDs, along with the effects of soluble ColVI on NP cells. Thus, we compared the expression levels of ColVI in human degenerated IVD samples, along with the effect of soluble ColVI on primary human NP cells. A higher Pfirrmann grade was associated with increased COL6A1 mRNA expression, with a 4.4-fold increase in Pfirrmann grade IV (p = 0.024) and a 5.3-fold increase in grade V compared to grade III (p = 0.014). Soluble ColVI increased NP cell proliferation compared to untreated controls, from 1.204-fold for 5 µg/mL (p < 0.001) and 1.335-fold for 10 µg/mL (p = 0.001). The most upregulated gene was IGF-1 (7.9-fold increase). Co-treatment of NP cells with ColVI and an ERK inhibitor showed significantly less IGF-1 mRNA upregulation compared to ColVI treatment alone (6.2-fold vs. 12.4-fold; p = 0.009). Our findings suggest that degenerating discs are associated with COL6A1 upregulation by NP cells; moreover, the addition of soluble ColVI to NP cells increases NP cell proliferation and IGF-1 expression.