Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Cultivo de microesferoides 3D para estudios de pluripotencialidad tumoral en líneas renales humanas

El carcinoma de células renales (CCR) constituye el cáncer urológico más letal, representa el 2-3% de todos los tumores y es la lesión sólida más frecuente en el riñón adulto. Dentro del grupo heterogéneo que engloba el CCR un 70-80% de éstos incluye el Carcinoma Renal de Células Claras (CRCC). Reciente evidencia sugiere que muchas enfermedades malignas son impulsadas por un compartimiento celular que muestra las propiedades de las células madre que se denominan células madre cancerígenas (CSC). Para lograr la identificación de esta subpoblación celular se ha desarrollado una metodología fenotípica alternativa basada en la formación de esferas in vitro. En este estudio, cómo análisis preliminar, se seleccionaron varias líneas celulares de RCC (Caki-2, Caki-1 y ACHN) y el control fue de células renales de origen embrionario (HEK-293). En la línea embrionaria renal HEK-293 formaron estructuras 3D exitosamente con aumento progresivo de tamaño durante todo el tiempo de ensayo pero de las tres líneas tumorales renales ensayadas (Caki-1, Caki-2 y ACHN), solo Caki-1 pudo formar esferas 3D estables, aunque sin crecimiento tridimensional a largo plazo. Basándonos en este análisis, se pudo determinar que se requieren estudios complementarios adicionales sobre al menos 2 de las 4 líneas celulares renales estudiadas para comprobar su carácter pluripotencial.Fil: Barnes, Tamara Eliana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Rodríguez, Juan Pablo. Universidad Nacional del Nordeste; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Olea, Gabriela Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Melana Colavita, Juan Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Aguirre, María Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaJornadas de comunicaciones cientificas en ciencias de la saludCorrientesArgentinaUniversidad Nacional del Nordeste. Facultad de Medicin

Irrigantes usados em dentes temporários e seu impacto citotóxico em fibroblastos de camundongos

La atención odontopedlátrica se encuentra limitada a tiempos de ejecución cortos necesitando mayor dependencia a agentes antimicrobianos de rápida eficacia para eliminar y prevenir cualquier desarrollo de microorganismos. Un gran número de irrigantes químicos son utilizados para la limpieza de los conductos radiculares. El objetivo del presente trabajo fue evaluar la citotoxicidad de irrigantes utilizados para la irrigación de conductos en piezas dentarias primarias y determinar la viabilidad, in vitro, en cultivo de fibroblastos de ratón (L-929), mediante el bioensayo de colorimetría rápida de MTT, a diferentes tiempos de incubación. Los irrigantes ensayados fueron: Hidróxido de Calcio (Ca (OH)2), Hipoclorito de sodio (NaCIO) y Fluoruro de Diamino Plata (FDP). La viabilidad de los fibroblastos a las drogas irrigantes se evaluó con diferentes dosis de los mismos y a diferentes tiempos, en función de la adherencia celular. Los ensayos fueron llevados a cabo por triplicado. Las células fueron fotografiadas y contabilizadas bajo microscopio óptico invertido. Los datos obtenidos, fueron analizados y graficados en manera descriptiva. Estos resultados mostraron que las células del grupo control se mantuvieron viables y sin modificaciones pertinentes. No obstante, se observó citotoxicidad celular y reducción de la viabilidad con los diferentes tratamientos dependiendo de las dosis y tiempos de exposición a los mismos. Cuando los fibroblastos se incubaron, durante I0 minutos, con las diferentes drogas (Ca (OH)2 FDP y NaCIO) y disoluciones, la viabilidad se vio afectada a la mayor concentración de cada droga; en la mayor concentración de NaCIO y Ca (OH)2 se produjeron los mayores porcentajes de alteración celular, sin embargo, solo con el NaCIO, hasta en las mínimas diluciones se registraron viabilidades inferiores a las registradas en el control.Odontopediatric care is limited to short execution times. It requires greater dependence on antimicrobial agents of rapid efficacy to eliminate and prevent any development of microorganisms. A large number of chemical irrigants are used to clean the root canals. The aim of the present work was to evaluate the cytotoxicity of irrigants used for the irrigation of the root canals in primary dental pieces and to determine the viability, in vitro, in culture of mouse fibroblasts (L-929), by means of the rapid MTT colorimetry bioassay, at different incubation times. The irrigants tested were: Calcium Hydroxide Ca (OH)2, Sodium Hypochlorite (NaCIO) and Diamine Silver Fluoride (FDP). The viability of fibroblasts to irrigating drugs was evaluated with different doses of them and at different times, depending on cell adhesion. The tests were carried out in triplicate. The cells were photographed and counted under an inverted optical microscope. The data obtained was analyzed and graphed in a descriptive way. These results showed that the cells of the control group remained viable and without relevant modifications. Nevertheless, cellular cytotoxicity and reduction of viability were observed with the different treatments depending on the doses and times of exposure to them. When the fibroblasts were incubated, for I0 minutes, with the different drugs Ca (OH)2, FDP and NaCIO) and solutions, the viability was affected at the highest concentration of each drug; in the highest concentration of NaCIO and Ca (OH)2, the highest percentages of cellular alteration were produced, however only with NaCIO, even in http://dx.doi.org/10.30972/rfo. 1213870 the lowest dilutions there were lower viabilities than those recorded in the control.O atendimento o do nto pedi àtri co é limitado a tempos de execudo curtos, exigindo maior dependència de agentes antimicrobianos de efìcàcia ràpida para eliminar e prevenir qualquer des envolví mento de microorganismos. Um grande número de Irrigantes químicos é usado para limpar os canals radiculares. O objetivo do presente traballio foi determinar a citotoxlcidade de irrigantes utilizados na irrig a lo de ductos em pe^as primárias odontológicas e determinar a viabilidade, in vitro, da cultura de fibroblastos de camundongos (L-929), por meio da colorimetria rápida de MTT. bioensaio, em diferentes tempos de incubalo. Os irrigantes testados foram: Hidróxido de Càlcio Ca (OH) , Hipoclorito de Sòdio (NaCIO) e Diamine Silver Fluoride (FDP). A viabilidade de fibroblastos para irrigar drogas foi avaliada com diferentes doses e em diferentes tempos, dependendo da adesào celular. Os testes foram realizados em triplicado. As células foram fotografadas e contadas sob um microscopio óptico invertido. Os dados obtidos foram analisados e representados graficamente de forma descritiva. Esses resultados mostraram que as células do grupo controle permaneceram viáveis e sem modificares relevantes. Entretanto, a citotoxicidade celular e a redudo da viabilidade foram observadas com os diferentes tratamientos, dependendo das doses e tempos de exposifáo a elas. Quando os fibroblastos foram incubados, por 10 minutos, com os diferentes fármacos Ca (OH)2, FDP e NaCIO) e solu^óos, a viabilidade foi afetada na maior concentrado de cada fármaco; na maior concentrado de NaCIO e Ca (OH)2, os maiores percentuais de alterado celular foram produzidos, porém apenas com NaCIO, mesmo ñas menores diluidos foram menores as viabilidades que as registradas no controle.Fil: Burlli, Yanina Daniela. Universidad Nacional del Nordeste. Facultad de Odontologia; ArgentinaFil: Cardoso, María Lorena. Universidad Nacional del Nordeste. Facultad de Odontologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; ArgentinaFil: Todaro, Juan Santiago. Universidad Nacional del Nordeste. Facultad de Medicina. Cátedra de Bioquímica; ArgentinaFil: Barnes, Tamara Eliana. Universidad Nacional del Nordeste. Facultad de Medicina. Cátedra de Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Química Básica y Aplicada del Nordeste Argentino. Universidad Nacional del Nordeste. Facultad de Ciencias Exactas Naturales y Agrimensura. Instituto de Química Básica y Aplicada del Nordeste Argentino; ArgentinaFil: Melana Colavita, Juan Pablo. Universidad Nacional del Nordeste. Facultad de Medicina. Cátedra de Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste; Argentina. Universidad Nacional del Nordeste. Facultad de Odontologia; Argentin

FTIR product study of the Cl-initiated oxidation products of CFC replacements: (E/Z)-1,2,3,3,3-pentafluoropropene and hexafluoroisobutylene

A product study of the reactions of (E/Z)-1,2,3,3,3-pentafluoropropene ((E/Z)-CF3CFCHF) and hexafluoroisobutylene ((CF3)2CCH2) initiated by Cl atoms were developed at 298 ± 2 K and atmospheric pressure. The experiments were carried out in a 1080 L quartz-glass environmental chamber coupledvia in situFTIR spectroscopy to monitor the reactants and products. The main products observed and their yields were as follows: CF3C(O)F (106 ± 9)% with HC(O)F (100 ± 8)% as a co-product for (E/Z)-CF3CFCHF, and CF3C(O)CF3(94 ± 5)% with HC(O)Cl (90 ± 7)% as a co-product for (CF3)2CCH2. Atmospheric implications of the end-product degradation are assessed in terms of their impact on ecosystems to help environmental policymakers consider HFOs as acceptable replacements.Fil: Rivela Fretes, Cynthia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Fisicoquímica; ArgentinaFil: Gibilisco, Rodrigo Gastón. Bergische Universität Wuppertal; AlemaniaFil: Tovar Ramos, Carmen Maria. Bergische Universität Wuppertal; AlemaniaFil: Barnes, Tamara Eliana. Bergische Universität Wuppertal; AlemaniaFil: Wiesen, Peter. Bergische Universität Wuppertal; AlemaniaFil: Blanco, Maria Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Fisicoquímica; ArgentinaFil: Teruel, Mariano Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; Argentina. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Fisicoquímica; Argentin

Degradation mechanism of 2-fluoropropene by Cl atoms: Experimental and theoretical products distribution studies

The gas-phase reaction products of 2-fluoropropene (2FP) with Cl atoms have been determined for the first time at 298 K and atmospheric pressure using a 1080 L quartz-glass photoreactor coupled with in situ FTIR spectroscopy to monitor reactants and products. Acetyl fluoride and formyl chloride were observed as the main products with yields of (106 ± 10)% and (100 ± 11)%, respectively. Electronic structure calculations of reactants, intermediates, products and transition states on a detailed mechanism of the reaction were performed by DFT procedures (BMK, M06, M062X/D3), as well as accurate composite methods on both the addition and abstraction reaction channels. From the joint experimental and theoretical studies, we concluded that the reaction occurs primarily via addition to the Cα carbon, with a smaller participation of the addition on the Cβ carbon, which is not produced directly from the separated reactants but from the CH3CFCH2Cl intermediate radical through a submerged transition state. The abstraction channel occurs at larger energies than the addition ones, and also presents a submerged transition state, with a lower barrier. No products arising from this channel are expected. The proposed mechanism explains also why formaldehyde, predicted as a product by former theoretical studies, is not found among the experimental products. The atmospheric implications of the reaction products are assessed. This journal isFil: Rivela Fretes, Cynthia Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; ArgentinaFil: Ladino Cardona, Miyer Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; ArgentinaFil: Blanco, Maria Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; ArgentinaFil: Barnes, Tamara Eliana. Wuppertal Institut Für Klima, Umwelt, Energie Ggmbh.; AlemaniaFil: Kieninger, Martina. Universidad de la República Facultad de Química; UruguayFil: Ventura, Oscar N.. Universidad de la República Facultad de Química; UruguayFil: Teruel, Mariano Andres. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigaciones en Físico-química de Córdoba. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Instituto de Investigaciones en Físico-química de Córdoba; Argentin

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London