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<\/a>\u201cA patient with a rare and technically demanding cardiovascular case with a chronic Stanford Type B aortic dissection, had previously undergone an \u201celephant trunk\u201d graft and later received a thoracic endovascular aortic repair (TEVAR) that was inadvertently deployed into the false lumen\u2014the abnormal channel created when blood tears between layers of the aortic wall. This misplacement left the true and false lumens separated, driving unstable blood flow and raising the risk of organ injury, stroke, and rupture. To correct this, surgeons performed an electrified septostomy, using specialized instruments to create controlled openings between the two channels and restore a unified pathway for blood. The extraordinary anesthetic challenges of the operation required the need for precise blood-pressure control, advanced monitoring to distinguish pressures in each lumen, and continuous coordination with the surgical team as circulatory dynamics shifted rapidly during the septostomy. Emphasis was placed on protecting the spinal cord, kidneys, and brain\u2014organs highly vulnerable during descending aortic repairs. This underscored not only the complexity of managing chronic dissections altered by prior grafts but also the critical role anesthesiologists play in maintaining stability and preventing catastrophic complications during these high-risk, highly specialized procedures.\u201d<\/p>\n
Dain Shirmer<\/strong> MED\u201927: Predictors of two-year survival in patients receiving chemotherapy for metastatic pancreatic ductal adenocarcinoma (mPDAC): A single-center retrospective cohort study <\/strong><\/p>\n \u201cPancreatic ductal adenocarcinoma (PDAC) is a very deadly cancer, with most patients presenting with locally advanced or metastatic disease and a median overall survival of only 9\u201312 months. Curative therapy requires surgical resection, but fewer than 20% are eligible, leaving systemic chemotherapy\u2014most commonly modified FOLFIRINOX or gemcitabine\/nab-paclitaxel\u2014as the mainstay of treatment. Our single-center retrospective study evaluated predictors of \u22652-year survival in metastatic PDAC. Baseline characteristics, laboratory trajectories over six months, and Kaplan-Meier survival outcomes were compared between survivors <730 days and \u2265730 days. Several findings diverged from conventional teaching: survival outcomes for mFOLFIRINOX and gemcitabine\/nab-paclitaxel were similar\u2014consistent with emerging trials such as PASS-01. A notable prognostic signal was the neutrophil-to-lymphocyte ratio (NLR), which was significantly lower in long-term survivors at baseline and remained distinct over time, driven primarily by neutrophil count differences. Lung-only metastases also correlated with improved survival, aligning with limited but growing literature suggesting this subgroup may have more favorable tumor biology. Unresolved questions include whether liver dysfunction or systemic inflammation mediates survival differences and the ambiguous role of prior pancreatectomy in the likelihood of \u22652-year survival. Overall, our study highlights metastatic pattern and inflammation-related biomarkers, particularly NLR, as potential predictors of long-term survival in metastatic PDAC.\u201d<\/p>\n This project will be published in the spring and was inspired through my experience as a first-year medical student in the \"Translational Oncology Program for Scholars (TOPS),\" a paid summer research program for Geisel students sponsored by the Dartmouth Cancer Center.<\/p>\n<\/a>