Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Etude de la déshydratation osmotique pour la formulation et la stabilisation d'écorces de bigarades (Citrus aurantium)

L'objectif de ce travail est le contrôle de l'amertume des écorces de bigarades par couplage d'un blanchiment thermique à une déshydratation osmotique en vue de leur valorisation comme produits semi-confits. Les traitements envisagés à cet effet sont la déshydratation-imprégnation par immersion dans des solutions de saccharose (DII, 40-60 °Brix, 25-50°C, 6 h) et la déshydratation osmotique à sec (DS, saccharose en poudre, 25°C, 6 h). Deux modes de blanchiment sont mis en oeuvre afin d'améliorer les performances de la déshydratation osmotique et de stabiliser enzymatiquement les écorces : blanchiment à la vapeur (V, 100 °C-5 min) et blanchiment à l'eau (E, 85-60 min et 95°C-10 min). Les couplages issus des diverses combinaison s entre les prétraitements thermiques et les traitements osmotiques sont étudiés (V + DII, E + DII, V + DS, E + DS). Les transferts de matières y compris ceux des composés amers sont abordés via une approche cinétique. Un examen microscopique des produits blanchis et déshydratés est également mis en oeuvre afin de caractériser leur micro structure. Le profil sensoriel des écorces obtenues par différents traitements est établi afin de discriminer les différences entre produits et d'évaluer l'efficacité de chaque traitement sur la modulation de l'amertume. Trois glycosides de flavanones amers majoritaires sont identifiés dans les écorces de bigarades : la naringine, la néohespéridine et la néoériocitrine. La porosité élevée des écorces de bigarades (0,43) favorise le phénomène d'imbibition en liquide externe au cours du blanchiment à l'eau et au cours de la DII dans les solutions à faible concentration (40 °Brix). Ce phénomène est également observé pendant la première heure de la DII dans les solutions à forte concentration en sucre (60 °Brix). Des pertes significatives en composés amers sont notées au cours du blanchiment à l'eau et aussi au cours des traitements osmotiques. Ce résultat intéressant montre que la déshydratation osmotique permet non seulement d'édulcorer les écorces mais aussi d'éliminer une partie des composés amers. Cependant, les pertes qui découlent de la DII sont plus importantes que celles obtenues par DS. Le blanchiment à la vapeur, par ailleurs, n'a pas d'effet sur les flavanones amères. A l'échelle microscopique, les répercussions du blanchiment à l'eau se sont traduites par un gonflement des cellules de l'albédo et des parois cellulaires du flavédo. Le blanchiment à la vapeur préserve l'intégrité de la structure des écorces et diminue leur porosité par expulsion de gaz occlus dans les pores. Les traitements osmotiques provoquent la diminution de la taille des cellules de l'albédo et l'augmentation du volume des pores. Par ailleurs, la DS entraine le retrait des écorces et l'étirement des cavités à huiles essentielles. Les deux modes de blanchiment accélèrent et augmentent les per tes en eau en diminuant la porosité des écorces Par ailleurs, seul le blanchiment à l'eau permet d'accroitre les gains en sucre au cours de la DII et la DS. Les pertes en composés amers sont favorisées par les 2 modes de blanchiment mais elles sont plus importantes après un blanchiment à l'eau. Les résultats de l'évaluation sensorielle révèlent une différence significative entre les produits. Les écorces les plus appréciées sont les écorces les plus sucrées et les moins amères. Ces écorces sont obtenues par couplage des traitements osmotiques (DS et DII) au blanchiment à l'eau. Elles sont cependant instables du point de vue microbiologique. Des traitements complémentaires de stabilisation doivent être envisagés pour les préserver. (Résumé d'auteur

Fortification of Traditional Fermented Milk “Lben” with Date Powder: Physicochemical and Sensory Attributes

The main objective of this study was to evaluate the effect of date powder supplementation on the main quality attributes of “Lben” a traditional fermented milk. Physicochemical and sensory analyses of fortified Lben showed that supplementation with date powder (6%; w/v) conducted to a decrease in acidity and an increase in pH, with a slight decrease in the final lactic bacteria count. Lben fortification with date powder improved its overall acceptability, induced an increase in color and odor intensities, and enhanced the balance of the sweet/sour tastes. Additionally, fortification resulted in the development of fruity and sweet tastes in Lben

Effects of Osmotic Treatments on Modulating Bitter Flavanones Glycosides Contents and Microstructure of Citrus aurantium Peels

International audienc

Effects of Blanching on Flavanones and Microstructure of Citrus aurantium Peels

International audienc

Amino acids and protein profiles of defatted camel and cow milk fractions: correlation with their in vitro antioxidant and antidiabetic activities

International audienceIntroduction: This work presents proteins, amino acids profiles and antioxidant and properties of camel and cow milk fractions produced using an integrated coagulation-centrifugation process. Methods: Antioxidant activity using DPPH radical scavenging assay; and antidiabetic activity antidiabetic activity using in vitro alpha-amylase inhibitory activity were assessed on defatted milk fractions and their extracts using water/ethanol or HCl/ethanol solvents. Protein profiles and amino acids composition were analyzed by high-performance liquid chromatography.Results and discussions: The predominant protein found in cow and camel milk was 13 -casein in sodium caseinate, 13-lactoglobulin was found in the whey of cow milk, whereas alpha-lactalbumin was detected in the whey fractions of camel. The primary amino acids (comprising 1% to 5.2%) in skim milk and sweet whey milk were leucine, proline, and lysine. However, acid whey, casein fractions (sodium caseinate, and 13 -casein) from both camel and cow milk exhibited elevated concentrations of histidine, leucine, lysine and proline (1.12 -6.62%). Camel milk and its different protein fractions showed an interesting in vitro alpha-amylase inhibitory activity varying, according to different milk fractions and extraction methods, from 19.10 +/- 1.40 to 97.40 +/- 1.50%. Whatever the used method, the whey fractions from camel milk, both acid and sweet, displayed ed the highest antioxidant activity. Principal components analysis showed a positive correlation between the total phenols content, antioxidant (DPPH assay) and antidiabetic (alpha amylase inhibition test) activities within the milk fractions. Sweet and acid cow milk fractions seem to be the most promising for deeper exploration of in vivo biological activities and are promising milk derivatives for specific nutritional diet and/or functional food formulation

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research