Biochemical characterization of colorectal carcinoma tissue

Kolorektalni karcinom je najčešći malignitet gastrointestinalnog trakta. Ciljevi ovog istraživanja bili su da se u KRK i zdravoj mukozi odrede: morfometrijska, teksturna i fraktalna analiza digitalizovanih mikrografa, koncentracija elemenata, parametri oksidativnog stresa, koncentracija masnih kiselina i biohemijski sastav uz pomoć infracrvene spektroskopije. U studiji preseka učestvovalo je 111 pacijenata starijih od 18 godina, operisanih zbog KRK, i podeljeni su u četiri grupe: sredovečni/stariji, muškarci/žene. U tumoru su značajno veće koncentracije K, Mg, Cu, Se, Ca, dok su Na, Zn, Cd, Hg i Cr u značajno manjoj koncetrciji. Odnos Cu/Zn značajno je veći u tumoru, pacijenti u više uznapredovalim stadijumima imaju veći odnos Cu/Zn. Pokazali smo značajno veće koncentracije MDA u tumorskom tkivu, kao i značajne razlike u sastavu masnih kiselina između tumorskog tkiva i zdrave mukoze. Najduže telomere su u tumorskom tkivu, a najkraće u zdravoj mukozi. Uočene su značajne razlike u vrednostima pojedinih patohistoloških mikrografa između stadijuma I. i II. sa jedne strane, i III. i posebno IV. sa druge. Prikazane su različite spektralne karakteristike zdravog i tumorskog tkiva. Rezultati ove studije pokazuju da je odnos bakar/cink značajan prognostički faktor za invazivnost i progresiju KRK; da je odnos AA/EPA pouzdan pokazatelj inflamatornog statusa tumora i progresije; veće vrednosti SI govore u prilog biološki manje agresivnog tumora i jačeg imunskog odgovora; u tumoru postoji povećana lipidna peroksidacija i okdidativni stres se dešava na nivou reaktivnih kiseoničnih, ali ne i azotnih vrsta. Najduže telomere su u tumorskom tkivu, potom u leukocitima periferne krvi, a najkraće u zdravoj mukozi. Na osnovu digitalnih mikrografa može se lako izdvojiti tumorsko tkivo od zdrave mukoze u stadijumu I i II, dok se u stadijumu IV dobijaju slični rezultati za tumorsko i zdravo tkivo. Na osnovu IR spektralnih karakteristika , u malignom tkivu prisutna je manja količina lipida i nukleinskih kiselina, dok se količina proteina uvećava.Colorectal cancer is the most common malignancy of the gastrointestinal tract. The objectives of this study were to determine in CRC and healthy mucosa: morphometric, textural and fractal analysis of digitized micrographs, elemental concentration, oxidative stress parameters, fatty acid concentration and biochemical composition using infrared spectroscopy. The cross-sectional study involved 111 patients over the age of 18 who underwent surgery due to CRC and were divided into four groups: middle-aged / elderly, men / women. The concentrations of K, Mg, Cu, Se, Ca are significantly higher in the tumor, while Na, Zn, Cd, Hg and Cr are in significantly lower concentrations. The Cu/Zn ratio is significantly higher in tumor, patients in more advanced stages have a higher Cu/Zn ratio. We showed significantly higher concentrations of MDA in tumor tissue, as well as significant differences in fatty acid composition between tumor tissue and healthy mucosa. The longest telomeres are in tumor tissue, and the shortest in healthy mucosa. Significant differences in the values of individual pathohistological micrographs between stages I and II were observed on one side, and III. and especially IV. on the other. Different spectral characteristics of healthy and tumor tissue were presented. Results of this study show that the Cu/Zn ratio is a significant prognostic factor for CRC invasiveness and progression; the AA/EPA ratio is a reliable indicator of tumor inflammatory status and progression; higher SI values support a biologically less aggressive tumor and a stronger immune response; there is increased lipid peroxidation in the tumor and oxidative stress occurs at the level of reactive oxygen species, but not nitrogen species. The longest telomeres are in tumor tissue, then in peripheral blood leukocytes, and the shortest in healthy mucosa. On the basis of digital micrographs, tumor tissue can be easily isolated from healthy mucosa in stages I and II, while in stage IV similar results are obtained. Based on the IR spectral characteristics, a smaller amount of lipids and nucleic acids is present in the malignant tissue, while the amount of protein increases

Fatty acid in colorectal cancer in adult and aged patients of both sexes

Purpose: Colorectal cancer represents the second most common type of cancer in Serbia. Alteration of lipid metabolism begins early, and can represent a central hallmark in cancer evolution. Fatty acids have various important functions as building components of cell membranes, as signaling molecules in immune responses and also manage the general cancer signaling network. The purpose of this study was to investigate the difference of various fatty acids content between colorectal cancer and adjacent healthy intestinal tissue in adult and aged patients of both sexes. Methods: 52 subjects participated in this study. Healthy colon mucosa and tumor tissue samples were obtained from patients previously diagnosed with colorectal carcinoma. Simplified method of Berstad et al was used for direct transesterification of total lipids in tumor and healthy mucosa tissue samples and separations of the methyl esters was carried out using a gas chromatograph equipped with a split/ splitless injector and a flame ionization detector. Results: 18 0, 18 1 n7, 20 3, 20 4, 20 5, 22 4, 22 5 22 6, SFA, PUFA, n6, n3 and AA/EPA were significantly higher in tumor tissue. On the other hand, 18 1 n9, 18 2, 18 3 n3, MUFA, n6/ n3 were significantly higher in healthy tissue. Conclusions: Saturation index (SI) could be a valuable tool to delineate robust immune response and worse prognosis in patients with colorectal cancer. Our study demonstrated significant differences in fatty acid profiles between tumor tissue and healthy mucosa. Parameters, such as gender, age, stage and mucinous component didn't influence altered fatty acid content

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Biochemical characterization of colorectal carcinoma tissue

Kolorektalni karcinom je najčešći malignitet gastrointestinalnog trakta. Ciljevi ovog istraživanja bili su da se u KRK i zdravoj mukozi odrede: morfometrijska, teksturna i fraktalna analiza digitalizovanih mikrografa, koncentracija elemenata, parametri oksidativnog stresa, koncentracija masnih kiselina i biohemijski sastav uz pomoć infracrvene spektroskopije. U studiji preseka učestvovalo je 111 pacijenata starijih od 18 godina, operisanih zbog KRK, i podeljeni su u četiri grupe: sredovečni/stariji, muškarci/žene. U tumoru su značajno veće koncentracije K, Mg, Cu, Se, Ca, dok su Na, Zn, Cd, Hg i Cr u značajno manjoj koncetrciji. Odnos Cu/Zn značajno je veći u tumoru, pacijenti u više uznapredovalim stadijumima imaju veći odnos Cu/Zn. Pokazali smo značajno veće koncentracije MDA u tumorskom tkivu, kao i značajne razlike u sastavu masnih kiselina između tumorskog tkiva i zdrave mukoze. Najduže telomere su u tumorskom tkivu, a najkraće u zdravoj mukozi. Uočene su značajne razlike u vrednostima pojedinih patohistoloških mikrografa između stadijuma I. i II. sa jedne strane, i III. i posebno IV. sa druge. Prikazane su različite spektralne karakteristike zdravog i tumorskog tkiva. Rezultati ove studije pokazuju da je odnos bakar/cink značajan prognostički faktor za invazivnost i progresiju KRK; da je odnos AA/EPA pouzdan pokazatelj inflamatornog statusa tumora i progresije; veće vrednosti SI govore u prilog biološki manje agresivnog tumora i jačeg imunskog odgovora; u tumoru postoji povećana lipidna peroksidacija i okdidativni stres se dešava na nivou reaktivnih kiseoničnih, ali ne i azotnih vrsta. Najduže telomere su u tumorskom tkivu, potom u leukocitima periferne krvi, a najkraće u zdravoj mukozi. Na osnovu digitalnih mikrografa može se lako izdvojiti tumorsko tkivo od zdrave mukoze u stadijumu I i II, dok se u stadijumu IV dobijaju slični rezultati za tumorsko i zdravo tkivo. Na osnovu IR spektralnih karakteristika , u malignom tkivu prisutna je manja količina lipida i nukleinskih kiselina, dok se količina proteina uvećava.Colorectal cancer is the most common malignancy of the gastrointestinal tract. The objectives of this study were to determine in CRC and healthy mucosa: morphometric, textural and fractal analysis of digitized micrographs, elemental concentration, oxidative stress parameters, fatty acid concentration and biochemical composition using infrared spectroscopy. The cross-sectional study involved 111 patients over the age of 18 who underwent surgery due to CRC and were divided into four groups: middle-aged / elderly, men / women. The concentrations of K, Mg, Cu, Se, Ca are significantly higher in the tumor, while Na, Zn, Cd, Hg and Cr are in significantly lower concentrations. The Cu/Zn ratio is significantly higher in tumor, patients in more advanced stages have a higher Cu/Zn ratio. We showed significantly higher concentrations of MDA in tumor tissue, as well as significant differences in fatty acid composition between tumor tissue and healthy mucosa. The longest telomeres are in tumor tissue, and the shortest in healthy mucosa. Significant differences in the values of individual pathohistological micrographs between stages I and II were observed on one side, and III. and especially IV. on the other. Different spectral characteristics of healthy and tumor tissue were presented. Results of this study show that the Cu/Zn ratio is a significant prognostic factor for CRC invasiveness and progression; the AA/EPA ratio is a reliable indicator of tumor inflammatory status and progression; higher SI values support a biologically less aggressive tumor and a stronger immune response; there is increased lipid peroxidation in the tumor and oxidative stress occurs at the level of reactive oxygen species, but not nitrogen species. The longest telomeres are in tumor tissue, then in peripheral blood leukocytes, and the shortest in healthy mucosa. On the basis of digital micrographs, tumor tissue can be easily isolated from healthy mucosa in stages I and II, while in stage IV similar results are obtained. Based on the IR spectral characteristics, a smaller amount of lipids and nucleic acids is present in the malignant tissue, while the amount of protein increases

A core outcome set for clinical studies of adhesive small bowel obstruction

Aim Adhesive small bowel obstruction (ASBO) is a common surgical emergency condition. Research in the field is plentiful; however, inconsistency in outcome reporting makes comparisons challenging. The aim of this study was to define a core outcome set (COS) for studies of ASBO. Methods The long list of outcomes was identified through systematic review, and focus groups across different geographical regions. A modified Delphi consensus exercise of three rounds was undertaken with stakeholder groups (patients and clinicians). Items were rated on a 9-point Likert scale. Items exceeding 70% rating at 7-9 were passed to the consensus meeting. New item proposals were invited in round 1. Individualised feedback on prior voting compared to other participants was provided. An international consensus meeting was convened to ratify the final COS. Results In round 1, 56 items were rated by 118 respondents. A total of 18 items reached consensus, and respondents proposed an additional 10 items. Round 2 was completed by 90 respondents, and nine items achieved consensus. In round 3, 80 surveys were completed; one item achieved consensus, and five borderline items were identified. The final COS included 26 outcomes, mapped to the following domains: Interventions, need for stoma, septic complications, return of gut function, patient reported outcomes, and recurrence of obstruction, as well as mortality, failure to rescue, and time to resolution. Conclusion This COS should be used in future studies in the treatment of adhesive SBO. Further studies to define a core measurement set are needed to identify the optimum tools to measure each outcome