The impact of preoperative dexamethasone on the magnitude of the postoperative systemic inflammatory response and complications following surgery for colorectal cancer

Background: The magnitude of the postoperative systemic inflammatory response (SIR), as evidenced by C-reactive protein (CRP), is associated with both short- and long-term outcomes following surgery for colorectal cancer. The present study examined the impact of preoperative dexamethasone on the postoperative SIR and complications following elective surgery for colorectal cancer. Methods: Patients who underwent elective surgery, with curative intent, for colorectal cancer at a single center between 2008 and 2016 were included (n = 556) in this study. Data on the use of preoperative dexamethasone were obtained from anesthetic records, and its impact on CRP on postoperative days (PODs) 3 and 4, as well as postoperative complications, was assessed using propensity score matching (n = 276). Results: In the propensity score-matched cohort, preoperative dexamethasone was associated with fewer patients exceeding the established CRP threshold of 150 mg/L on POD 3 (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.26–0.70, p < 0.001) and fewer postoperative complications (OR 0.53, 95% CI 0.33–0.86, p = 0.009). Similar results for both POD 3 CRP and complications were observed when using propensity score-adjusted regression (OR 0.40, 95% CI 0.28–0.57 and OR 0.57, 95% CI 0.41–0.80, respectively) and propensity score stratification (OR 0.41, 95% CI 0.25–0.57 and OR 0.53, 95% CI 0.33–0.86, respectively). Conclusions: Preoperative dexamethasone was associated with a lower postoperative SIR and fewer complications following elective surgery for colorectal cancer

The relationship between cardiopulmonary exercise test variables, the systemic inflammatory response, and complications following surgery for colorectal cancer

Background: Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group. Methods: Patients who had undergone CPET prior to elective surgery for histologically confirmed colorectal cancer in a single centre between September 2008 and April 2017 were included. Preoperative VO2 at the anaerobic threshold (AT) and peak exercise were recorded, along with preoperative modified Glasgow Prognostic Score (mGPS) and CRP on each postoperative day. Results: Thirty-eight patients were included. The majority were male (30, 79%), over 65 years old (30, 79%), with colonic cancer (23, 61%) and node-negative disease (24, 63%). Fourteen patients (37%) had open surgery and 24 (63%) had a laparoscopic resection. A progressive reduction in VO2 at peak exercise was significantly associated with both increasing American Society of Anesthesiology (ASA) grade (median, ml/kg/min: ASA 1 = 22, ASA 2 = 19, ASA 3 = 15, ASA 4 = 12, p = 0.014) and increasing mGPS (median, ml/kg/min: mGPS 0 = 18, mGPS 1 = 16, mGPS 2 = 14, p = 0.039) There was no significant association between either VO2 at the AT or peak exercise and postoperative CRP. Conclusions: The present pilot study reports a possible association between preoperative CPET-derived measures of exercise tolerance, and the preoperative systemic inflammatory response, but not postoperative CRP in patients undergoing surgery for colorectal cancer

How and why systemic inflammation worsens quality of life in patients with advanced cancer

Introduction: The presence of an innate host systemic inflammatory response has been reported to be a negative prognostic factor in a wide group of solid tumour types in both the operable and advanced setting, both local and distant. In addition, this host systemic inflammatory response is associated with both clinician reported patient performance status and self-reported measures of quality of life in patients with cancer. Areas covered: A variety of mechanisms are thought to underlie this, including the influence of the host immune response on physical symptoms such as pain and fatigue, its effect on organ systems associated with physical ability and well being such as skeletal muscle, and bone marrow. Furthermore, this innate inflammatory response is thought to have a direct negative impact on mood through its action on the central nervous system. Expert commentary: It is clear that the host systemic inflammatory response represents a target for intervention in terms of both improving quality of life and prognosis in patients with advanced cancer. Based on this paradigm, future research should focus both on pathways which might be targeted by novel agents, but also on whether existing anti-inflammatory drugs might be of benefit

The Arts and Sciences Face the Eighties: Beyond the Boundaries of Our Disciplines

Three Syracuse University faculty members discuss the academic mission on the occasion of the installation of Gershon Vincow as dean of the College of Arts and Sciences. Page 65

Effects of two forms of intrareticular selenium supplements on beef cow selenium status and on the transfer of selenium from dam to offspring

Two concurrent studies were conducted to evaluate the effect of selenium (Se) supplementation on beef cows. Trial 1 was designed to evaluate the safety and efficacy of two intrareticular Se supplementation delivery systems. Trial 2 was designed to evaluate the transfer of Se across the placenta and through the colostrum in beef cows. One hundred fifty, selenium (Se) deficient, pregnant crossbred beef cows were assigned to 1 of 4 treatment groups: group A, negative control; group B, 1 Dura-Se bolus at 0 and 119 d; group C, 1 Dura-se at 0 d; and group D, 2 Permasel pellets at 0 d. Cattle were maintained on selenium deficient pastures or forages prepared from these pastures. Blood samples were collected from cows before treatment administration (0 time) and thereafter at 28, 52, 119, and 220 d. Calves from cows selected for data collection above were sampled at birth. Blood samples were collected from calves, prior to suckling, and were analyzed for whole blood selenium (WBSe) concentration. Colostrum samples were collected from dams and analyzed for total Se concentration. Additional samples were collected from calves 24-48 hours post suckling and analyzed for WBSe concentration and serum creatine kinase (CK) level. Weight and health data were recorded on all cows at each blood collection date. Birth weight, sex, and health were recorded on all calves at parturition. Whole blood selenium concentration of cows from all supplemented groups were significantly higher (P<.001) than controls at all sample dates after treatments began. By the end of the 220 d study, treatment group B attained significantly higher (P<.001) WBSe concentrations than any other group. Calves from all Se treated groups had significantly (P<.001) higher WBSe concentrations, both pre- and post-suckling, than controls. Post-suckle WBSe concentration of calves were not significantly (P>.05) different than pre-suckle concentrations in any of the groups. Colostrum selenium concentration from Se supplemented cows were significantly (P.001) higher than from control cows. No difference (P>.05) was determined in plasma CK activities or birth weights between groups of calves. Seven animals died, two of which showed signs of Se deficiency. Necropsy of 5 calves provided no evidence linking these deaths to selenium treatments. No differences (P>.05) in mortality between groups were determined

Staging the tumor and staging the host: A two centre, two country comparison of systemic inflammatory responses of patients undergoing resection of primary operable colorectal cancer

Background: How systemic inflammation-based prognostic scores such as the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR) differ across populations of patients with colorectal cancer (CRC) remains unknown. The present study examined the mGPS and NLR in patients from United Kingdom (UK) and Japan. Methods: Patients undergoing resection of TNM I-III CRC in two centres in the UK and Japan were included. Differences in clinicopathological characteristics and mGPS (0-CRP≤10 mg/L, 1-CRP&gt;10 mg/L, 2-CRP&gt;10 mg/L, albumin&lt;35 g/L) and NLR (≤5/&gt;5) were examined. Results: Patients from UK (n = 581) were more likely to be female, high ASA and BMI, present as an emergency (all P &lt; 0.01) and have higher T stage compared to those from Japan (n = 559). After controlling for differences in tumor and host characteristics, patients from Japan were less likely to be systemically inflamed (OR: mGPS: 0.37, 95%CI 0.27–0.50, P &lt; 0.001; NLR: 0.53, 95%CI 0.35–0.79, P = 0.002). Conclusion: Systemic inflammatory responses differ between populations with colorectal cancer. Given their prognostic value, reporting of systemic inflammation-based scores should be incorporated into future studies reporting patient outcomes. Summary: Although the systemic inflammatory response is recognised as a prognostic factor in patients with colorectal cancer, it is not clear how these may differ between distinct geographical populations. The present study examines differences in the prevalence of elevated systemic inflammatory responses (modified Glasgow Prognostic Score and neutrophil:lymphocyte ratio) between two populations undergoing resection of colorectal cancer in the United Kingdom and Japan

Upper cenozoic chronostratigraphy of the southwestern Amazon Basin

The lack of numerical age dates for upper Cenozoic strata of the Amazon Basin has prevented resolution of its geologic history and accurate dating of important paleofaunas. Here we present results of magnetostratigraphy and 40Ar/39Ar dating of two volcanic ash deposits from the Madre de Dios Formation of eastern Peru. The two ash ages, 9.01 ± 0.28 Ma and 3.12 ± 0.02 Ma, provide the first numerical age data necessary for accurate interpretation of late Tertiary sedimentation in Amazonia and establish approximate time constraints for the last major cycle of Cenozoic deposition within the southwestern Amazon Basin. The older ash age also provides a minimum age for numerous Amazonian paleofaunas, which allows a more definitive correlation of these paleofaunas with those in other regions of South America

The relationship between anaesthetic technique, clinicopathological characteristics and the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colon cancer

Background/aim: The magnitude of the postoperative systemic inflammatory response (SIR) is now recognised to be associated with both short and long-term outcomes in patients undergoing surgery for colon cancer. During such surgery, it is unclear whether the anaesthetic regimens influence the magnitude of the postoperative SIR, independent of other factors. The aim of the present study was to examine the association between anaesthetic agents, clinicopathological characteristics and the magnitude of the postoperative SIR in patients undergoing elective surgery for colon cancer. Methods: Patients with colon cancer who underwent elective open or laparoscopic surgery between 2008 and 2016 (n = 409) were studied at a single center. The relationship between type of anaesthesia, surgical technique; open (n = 241) versus laparoscopic (n = 168) and clinicopathological characteristics was examined by using chi-square testing. The chi-square test was used to determine which anaesthetic group influences the POD 2 CRP for only patients undergoing elective open colon surgery. Results: The majority of patients were &lt;75 years old, male, normal weight or obese, underwent open surgery and had regional anaesthesia, in particular an epidural approach. There was a significant association between type of anaesthesia and post-operative CRP on day 2 (p &lt;0.001) in patients undergoing open surgery but not laparoscopic surgery. Other factors associated with type of anaesthesia included; year of operation (p &lt;0.01), surgical technique (p &lt;0.001), and preoperative dexamethasone (p &lt;0.01). Conclusion: In patients undergoing surgery for elective colon cancer, the type of anaesthesia varied over time. The type of anaesthesia appears to influence the magnitude of the postoperative SIR on post-operative day 2 in open surgery but not laparoscopic surgery. Future work using prospective study design is required to better define this relationship