The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Interaction effects between estrogen receptor α and vitamin D receptor genes on age at menarche in Chinese women

Aim: To evaluate whether estrogen receptor α(ER-α) and vitamin D receptor (VDR) genes are associated with the age at menarche in Chinese women. Methods: A total of 390 pre-menopausal Chinese women were genotyped at the ER-α PvuII, XbaI, and VDR ApaI loci using polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP). Results: Neither the ER-α gene nor the VDR gene individually had significant effects on the age at menarche in our subjects (P>0.10). However, evidence of interaction effects between the two genes were observed: with the aa genotype at the VDR ApaI locus, subjects with haplotype PX at the ER-α gene had, on average, 6 months later onset of menarche than the non-carriers (P=0.01). Conclusion: We found that neither the ER-α gene or the VDR gene had a significant association with the age at menarche individually. However, potential interaction effects between the two genes were observed in Chinese women. ©2005 CPS and SIMM.link_to_subscribed_fulltex

Physically Abused Children’s Adjustment at the Transition to School: Child, Parent, and Family Factors

Childhood physical abuse predicts emotional/behavioral, self-regulatory, and social problems. Yet factors from multiple ecological levels contribute to children’s adjustment. The purpose of this study was to examine the degree to which the social-emotional adjustment of physically abused children in first grade would be predicted by a set of child-, parent-, and family-level predictors in kindergarten. Drawing on a short-term longitudinal study of 92 physically abused children and their primary caregivers, the current study used linear regression to examine early childhood child (i.e., gender, IQ, child perceptions of maternal acceptance), parent (i.e., parental mental health), and family relationship (i.e., sensitive parenting, hostile parenting, family conflict) factors as predictors of first grade internalizing and externalizing symptomatology, emotion dysregulation, and negative peer interactions. We used a multi-method, multi-informant approach to measuring predictors and children’s adjustment. Internalizing symptomatology was significantly predicted by child IQ, parental mental health, and family conflict. Externalizing symptomatology and emotion dysregulation were predicted by child IQ. Although a large proportion of variance in measures of adjustment was accounted for by the set of predictors, few individual variables were unique predictors of child adjustment. Variability in the predictors of adjustment for physically abused children underscores the need for individualized treatment approaches

Impact of intra-daily SST variability on ENSO characteristics in a coupled model

This paper explores the impact of intra-daily Sea Surface Temperature (SST) variability on the tropical large-scale climate variability and differentiates it from the response of the system to the forcing of the solar diurnal cycle. Our methodology is based on a set of numerical experiments based on a fully global coupled ocean–atmosphere general circulation in which we alter (1) the frequency at which the atmosphere sees the SST variations and (2) the amplitude of the SST diurnal cycle. Our results highlight the complexity of the scale interactions existing between the intra-daily and inter-annual variability of the tropical climate system. Neglecting the SST intra-daily variability results, in our CGCM, to a systematic decrease of 15% of El Niño—Southern Oscillation (ENSO) amplitude. Furthermore, ENSO frequency and skewness are also significantly modified and are in better agreement with observations when SST intra-daily variability is directly taken into account in the coupling interface of our CGCM. These significant modifications of the SST interannual variability are not associated with any remarkable changes in the mean state or the seasonal variability. They can therefore not be explained by a rectification of the mean state as usually advocated in recent studies focusing on the diurnal cycle and its impact. Furthermore, we demonstrate that SST high frequency coupling is systematically associated with a strengthening of the air-sea feedbacks involved in ENSO physics: SST/sea level pressure (or Bjerknes) feedback, zonal wind/heat content (or Wyrtki) feedback, but also negative surface heat flux feedbacks. In our model, nearly all these results (excepted for SST skewness) are independent of the amplitude of the SST diurnal cycle suggesting that the systematic deterioration of the air-sea coupling by a daily exchange of SST information is cascading toward the major mode of tropical variability, i.e. ENSO

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

AimThis study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.MethodThis was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.ResultsFrom 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age &gt;70&nbsp;years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7&nbsp;days) but higher mortality (1.7% versus 1.1%).ConclusionSurgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks