The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Development of new catalytic reactions in N-acyliminium ion chemistry initiated by triflimidic acid : diastereoselectivity and multi-catalysis

L'acide malique est un produit naturel peu couteux. Les N,O-acetals dérivés d’acide malique sont régulièrement utilisés en chimie des ions N-acyliminiums endocycliques. L’utilisation de cette classe très populaire de précurseurs d’ions N-acyliminiums stéréopurs est à quelques exceptions près limitée aux di-acétoxylactames. Les couplages par formation de liaisons C-C de ces intermédiaires cationiques avec divers nucléophiles sont souvent décrites pour conduire à un diastéréocontrôle insuffisant. Dans cette éventualité, la séparation du mélange des diastéréoisomères formés peut également être un problème. Par conséquent, le développement de nouveaux N,O-acétals dérivés d'acide malique susceptibles d'améliorer la diastéréosélectivité de ce type d' α-amidoalkylations (et/ou de faciliter la séparation des deux diastéréoisomères), qui sont fréquemment utilisées comme étape clé dans des synthèses multiétapes de produits naturels ou leurs analogues, est souhaitable. Le travail décrit dans ce manuscrit se situe dans ce contexte, il détaille la préparation d'une librairie de nouveaux N,Oacétals stéréopurs et leur utilisation dans de nouvelles transformations, catalytiques et diastéréosélectives basées sur la chimie des ions N-acyliminiums. Cette thèse décrit l'amélioration de la diastéréosélectivité intrinsèque trans des réactions d'α- amidoalkylation d'éthers d'énol silylés par des ions N-acyliminiums optiquement purs dérivés d'acide malique catalysées par le super acide l'acide triflimidique. Nous démontrons que la nature des deux partenaires réactionnels peut être modulée pour améliorer le rapport diastéréoisomérique jusqu'à des valeurs très élevées de 98:2. Dans une seconde phase de ce travail, le développement d'une séquence cascade multicatalytique "one-pot" associant une amidoalkylation intermoléculaire de type Friedel- Crafts acido-catalysée avec une a-hydroarylation intramoléculaire catalysée par des complexes cationiques d'or, est présentée. Cette méthodologie combine deux thèmes en vogue en synthèse organique, à savoir l'organocatalyse et la catalyse à l'or, et permet un accès extrêmement rapide à de nouvelles structures polyhétérocycliques complexes fusionnées chirales.Malic acid is an inexpensive natural product which is widely used as a chiral source in natural product synthesis. N,O-acetals derived from malic acid are regularly used in N-acyliminium ions endocyclic chemistry. The use of this very popular class of iminium ion precursors is mainly limited to stereopure 4,5-di-acetoxy lactams, the C-C bond coupling reactions of which with various nucleophiles are frequently reported to exhibit insufficient diastereocontrol. Moreover, the subsequent separation of the resulting mixture of diastereoisomers might also be an issue. Hence, developing novel N,O-acetalic malic acid derivatives is desirable in order to improve the diastereoselectivity of this type of α-amidoalkylation reactions (and/or to facilitate the separation of diastereomers) which are frequently used as a pivotal step in the context of multi-step syntheses of natural products and analogues. The work described in this manuscript lies in this context, with the preparation of a library of novel stereopure N,O-acetals and their subsequent use in new, catalytic and diastereoselective transformations based on N-acyliminiums ions chemistry. This thesis firstly describes the improvement of the intrinsic trans diastereoselectivity of the α-amidoalkylation reactions of silyl enol ethers with N-acyliminium ions derived from malic acid, generated in situ under triflimidic acid catalysis. It is shown that the structure of both reaction partners can be tuned to raise diastereomeric ratios to very high levels up to 98:2. In a second phase of this work, the development of a multicatalytic cascade sequence involving an intermolecular Friedel-Crafts type -amidoalkylation catalyzed by triflimidic acid, followed by an intramolecular hydroarylation catalyzed by cationic gold(I) complexes, is presented. The methodology developed in this second part of our work combines two hot contemporary topics of organic synthesis, namely organocatalysis and gold catalysis, and allows extremely fast access to new, sophisticated fused polyheterocyclic chiral structures

Gold catalysis: A one-pot intermolecular Fridel-Crafts type α-amidoalkylation/hydroarylation sequences by N-acyliminium ion chemistry

International audienc

Kineococcus radiotolerans Dps forms a heteronuclear Mn-Fe ferroxidase center that may explain the Mn-dependent protection against oxidative stress

International audienceThe combined use of Tf2NH and L(Au)+X- as a dual or binary catalytic system clearly improves the efficiency and enlarges the scope of the tandem intermolecular Friedel-Crafts α-amidoalkylation/intramolecular hydroarylation sequence, compared to an "all gold" multicatalysis approach. © 2015 American Chemical Society

The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% 47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% 32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% 27.9-42.8] and 33.3% 25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license