Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Towards Linked Agricultural MetaData: Directions of the agINFRA Project

The agINFRA project focuses on the production of interoperable data in agriculture, starting from the vocabularies and KOS used to classify and an-notate them. In this paper we report on our first steps in the direction of con-tributing to a LOD of agricultural data. In particular we look at germplasm data and soil data, which are still widely missing from the LOD landscape, seeming-ly because information managers in this field are still not very familiar with LOD practices. This is why this paper also recaps the basics of LOD publishing, which will be applied in the agINFRA project

Preliminary Work Towards Publishing Vocabularies for Germplasm and Soil Data as Linked Data

The agINFRA project focuses on the production of interoperable data in agriculture, starting from the vocabularies and KOS used to classify and an-notate them. In this paper we report on our first steps in the direction of con-tributing to a LOD of agricultural data. In particular we look at germplasm data and soil data, which are still widely missing from the LOD landscape, seeming-ly because information managers in this field are still not very familiar with LOD practices

Cognitively enriched physical activity may foster motor competence and executive function as early as preschool age: a pilot trial

The relation between physical activity, motor skills and cognitive function in children is receiving considerable attention, but it is important to define which physical activity is the best for the joint development of motor and cognitive domains. The cognitively enriched PA seem the best type on the development of motor skills and executive functions core at preschool age,This is crucial on framework of pedagogical approaches to motor and cognitive development promotion through early quality PA experience

Effects of baby swimming on motor and cognitive development: a pilot trial

Contact with water, even from birth, may be an important experience for child development. In this work, we aimed to investigate if baby swimming might influence infant development in motor and cognitive domains. We assigned infants to either a 10-week baby swimming intervention (n = 12; M age = 13 months (SD) = 7) or a control group (n = 15; M age = 22 months (SD) = 6). We assessed motor development with the Peabody Developmental Motor Scales (2nd edition, PDMS-2) and cognitive development with core tests of executive functions: delayed response for working memory, object retrieval for inhibition, and A-not-B for response shifting. Non-parametric analyses revealed that infants in the baby-swimming group improved in gross, fine, and total motor skills, and showed marginally better inhibition speed and shifting accuracy, with associated gains of shifting accuracy and fine and total motor skills. Even with in this small-sized convenience sample, this pilot study revealed promising benefits from baby swimming on motor development that warrant further study. This preliminary work paves the way for replication and illustrates what effect sizes may be expected in sufficiently powered well-designed follow-up research targeted to aid the joint development of motor and cognitive skills as early as infancy

Exposing vocabularies for soil as Linked Open Data

Standards to describe soil properties are well established, with many ISO specifications and a few international thesauri available for specific applications. Besides, in recent years, the European directive on ‘‘Infrastructure for Spatial Information in the European Community (INSPIRE)” has brought together most of the existing standards into a well defined model. However, the adoption of these standards so far has not reached the level of semantic interoperability, defined in the paper, which would facilitate the building of data services that reuse and combine data from different sources. This paper reviews standards for describing soil data and reports on the work done within the EC funded agINFRA project to apply Linked Data technologies to existing standards and data in order to improve the interoperability of soil datasets. The main result of this work is twofold. First, an RDF vocabulary for soil concepts based on the UML INSPIRE model was published. Second, a KOS (Knowledge Organization System) for soil data was published and mapped to existing relevant KOS, based on the analysis of the SISI database of the CREA of Italy. This work also has a methodological value, in that it proposes and applies a methodology to standardize metadata used in local scientific databases, a very common situation in the scientific domain.Finally, this work aims at contributing towards a wider adoption of the INSPIRE directive, by providing an RDF version of it

Landscaping the use of semantics to enhance the interoperability of agricultural data: First deliverable of the RDA Agrisemantics Working Group

In this document we aim at composing a high level overview of the use of semantics in the production, exchange and use of agricultural data. In particular, we focus on the use of semantics for data management, and the resources, tools and services available for its production. ​We ​also look at the current research trends in the area