The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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

Regulação da expressão dos receptores de fatores de crescimento fibroblásticos 3c e 4 (FGFR-3c e FGFR-4) em folículos antrais bovinos

Estudos recentes indicam o envolvimento do FGF-8 no controle do desenvolvimento folicular. O FGF-8 ativa preferencialmente o FGFR-3c e o FGFR-4, cuja expressão em folículos antrais ainda não foi determinada. No presente estudo, avaliou-se a expressão do FGFR-3c e -4 em células da teca e da granulosa de folículos antrais bovinos. e testou-se a hipótese de que a expressão destes genes é regulada durante o desenvolvimento fo!icular antral bovino. Ovários bovinos foram obtidos em matadouro local, folículos maiores que 5mm foram dissecados e medidos, células da teca e da granulosa foram separadas e o RNA total extraído. As concentrações de estradiol e de progesterona do fluido folicular foram determinadas por radioimunoensaio. Folículos com progesterona acima de 100ng/mL foram considerados atrésicos e excluídos da análise. Os folícu!.os restantes foram agrupados de acordo com a concentração de estradiol como se segue: (a) 20100; e (d) >100ng/mL. Além disso, os folículos foram divididos em três grupos de acordo com o tamanho: (a) 5-7; (b) 8-10 e (c) >10mm. Folículos inteiros entre 2 e 4mm de diâmetro foram incluídos na análise da expressão do FGFR-4. A expressão do FGFR-3c e FGFR-4 foi examinada por RT-PCR semiquantitativo com iniciadores espécie-específicos. O RT-PCR semiquantitativo foi validado pela escolha de números de ciclos de PCR e quantidade de RNA dentro da fase linear da curva de amplificação. A intensidade das bandas foi analisada por densitometria computadorizada. Em células da granulosa, houve correlação positiva entre a expressão do FGFR-3c e a concentração de estradiol no fluido folicular, em sintonia com níveis mais altos de RNAm em grupos com maiores concentrações de estradiol, e também aumentou com o diâmetro folicular. Em células da teca, a expressão do FGFR-3c também foi detectada,...Recent studies indicate the involvement of FGF-8 in the control of follicular development. FGF-8 preferentially activates FGFR-3c and FGFR-4, although the expression of these receptors has not been investigated in bovine antral follicles yet. In the present work, FGFR-3c and -4 gene expression was assessed in theca and granulosa cells from bovine antral follicles and the hypothesis that FGFR-3c and -4 gene expression is regulated during antral follicle development in cattle was tested. Bovine ovaries were obtained at a local abattoir, follicles greater than 5mm in diameter were dissected and measured, granulosa and theca cells were separated, and total RNA extracted. Estradiol and progesterone concentrations were measured in the follicular fluid by RIA. Follicles with progesterone levels above 100ng/mL were considered atretic and excluded from the analysis. Remaining follicles were grouped according to estradiol concentration as follows: (a) 20-100; and (d) >100ng/mL. In addition, follicles were divided into three groups according to size: (a) 57; (b) 8-10 and (c) >10mm. Whole follicles at 2-4mm in diameter were included in the analysis of FGFR-4 gene expression. FGFR-3c and FGFR-4 gene expression was examined by semi-quantitative RT-PCR using bovine specific primers. Semiquantitative RT-PCR was validated by choosing number of PCR cycles and amount of RNA within the linear range of the amplification curve. Band intensities were analyzed by computerized densitometry. In granulosa cells, FGFR-3c expression was positively correlated with estradiol concentration in the follicular fluid in agreement with higher mRNA levels in groups with higher estradiol concentrations, and also increased with follicle size. In theca cells, FGFR-3c gene expression was also detected but did not change with follicle size or estradiol concentration. For FGFR-4, gene expression was restrict...(Complete abstract click eletronic access below)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Efeito da idade e sexo sobre a concentração sérica de eritropoietina em equinos da raça Árabe

A EPO é um fator de crescimento glicoprotéico sintetizado pelas células adjacentes aos túbulos proximais renais regulada via mecanismo de "feed back" envolvendo a tensão de oxigênio tissular. Na baixa tensão de oxigênio arterial, a produção de EPO aumenta causando uma maior produção de eritrócitos na medula óssea. Devido ao pouco conhecimento da concentração de EPO sérica em equinos e a ausência de trabalhos sobre o efeito da idade e sexo sobre a sua concentração o trabalho teve como objetivo comparar a concentração sérica de eritropoietina em equinos da raça Árabe de sexos e idades diferentes. Foram utilizados 31 equinos da raça Árabe, com idades de seis a 12 meses (jovens) e acima de 24 meses (adultos), sendo 13 machos (seis jovens e sete adultos) e 18 fêmeas (oito jovens e 10 adultas), clinicamente sadios. As amostras de sangue foram colhidas por venipunção jugular e o soro armazenado até o momento do processamento. A concentração sérica de eritropoetina foi determinada pelo método de radioimunoensaio (RIA) utilizando kit comercial (EPO Trac TM125I RIA, Diagnostic Systems Laboratories, Webster, Texas, USA). Para análise estatística dos dados utilizou-se o Teste t de Student ao nível de 5% de significância (P<0,05). Não foram observadas diferenças significativas (P<0,05) quando se compararam os animais divididos entre sexos e as idades de seis a 12 meses (jovens) e acima de 24 meses (adultos). Conclui-se que a concentração de eritropoietina em equinos da raça Árabe independe do sexo e idade, e pode ser utilizada como valores de referência, porém ressalta-se a necessidade da obtenção de valores de referência para cada laboratório

Efeito da idade e sexo sobre a concentração sérica de eritropoietina em equinos da raça Árabe Effect of age and gender about the serum concentration of eritropoetin in Arabian horses

A EPO é um fator de crescimento glicoprotéico sintetizado pelas células adjacentes aos túbulos proximais renais regulada via mecanismo de "feed back" envolvendo a tensão de oxigênio tissular. Na baixa tensão de oxigênio arterial, a produção de EPO aumenta causando uma maior produção de eritrócitos na medula óssea. Devido ao pouco conhecimento da concentração de EPO sérica em equinos e a ausência de trabalhos sobre o efeito da idade e sexo sobre a sua concentração o trabalho teve como objetivo comparar a concentração sérica de eritropoietina em equinos da raça Árabe de sexos e idades diferentes. Foram utilizados 31 equinos da raça Árabe, com idades de seis a 12 meses (jovens) e acima de 24 meses (adultos), sendo 13 machos (seis jovens e sete adultos) e 18 fêmeas (oito jovens e 10 adultas), clinicamente sadios. As amostras de sangue foram colhidas por venipunção jugular e o soro armazenado até o momento do processamento. A concentração sérica de eritropoetina foi determinada pelo método de radioimunoensaio (RIA) utilizando kit comercial (EPO Trac TM125I RIA, Diagnostic Systems Laboratories, Webster, Texas, USA). Para análise estatística dos dados utilizou-se o Teste t de Student ao nível de 5% de significância (P<0,05). Não foram observadas diferenças significativas (P<0,05) quando se compararam os animais divididos entre sexos e as idades de seis a 12 meses (jovens) e acima de 24 meses (adultos). Conclui-se que a concentração de eritropoietina em equinos da raça Árabe independe do sexo e idade, e pode ser utilizada como valores de referência, porém ressalta-se a necessidade da obtenção de valores de referência para cada laboratório.<br>The erythropoietin (EPO) is a glicoproteic grow factor synthesized by the adjacent cells in the proximal renal tubes and controlled by feedback mechanism that involve the tension of tissular oxygen. In the presence of low tension of arterial oxygen, the production of EPO increases and it causes a major production of erythrocytes in the marrowbone. Due to poor knowledge of the serum concentration of erythropoietin in equines and the absence of information about the differences between age and gender, the aim of this study was to compare the serum concentration of erythropoietin in Arabian horses, clinically healthy with different age and gender. A total of 31 horses were used from 6 to 12 months old (young) and over 24 months old (adult), 13 males (six young and seven adult) and 18 females (eight young and ten adult) clinically healthy. Blood samples were collected from jugular vein using a vacuntainer with blood clot gel activator and the serum was separated by centrifugation and stored until the time of processing. The EPO serum concentration was measured by radioimmunoassay method (RIA) using a commercial kit (EPO Trac TM125I RIA, Diagnostic Systems Laboratories, Webster, Texas, USA). For statistical analysis of data were used the Student t test at 5% level of significance (P<0.05). It was not observed any statistic differences (P<0.05) between the sex and age of the animals from 6 to 12 months old and over of 24 months. We concluded that the concentration of the EPO in Arabian equines is independent of the sex and age, and can be used as reference values however it is very important and necessary to obtain references values for each laboratory

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment