34 research outputs found

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

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

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    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

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

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    This 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

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

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    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

    Bleeding and hemostasis during normo- and hypothermia : studies on porcine and rat models [Elektronisk resurs]

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    Background: Numerous animal studies have shown protective effects of hypothermia (HT) on hemorrhagic shock. These findings do not correlate with clinical findings, were studies on trauma registers have shown that HT is an independent factor of death when associated with trauma. HT affects hemostasis, but is just one of many factors that cause the coagulopathy often seen in trauma patients with uncontrolled bleedings. To what extent HT per se contributes to the hemorrhage and hence, the deterioration of shock is virtually unknown. In this thesis we investigate HTs impact on uncontrolled hemorrhage, but also if rebleeding volumes could be affected by hemostatic drugs or different resuscitation regimes. Methods: I: 18 pigs were randomized to HT (n = 10) or normothermia (NT) (n = 8). A volume controlled hemorrhagic shock was induced by a 40 % exsanguination of estimated blood volume (EBV). HT animals were cooled to 32.5 degrees C and rewarmed again after 2 hours. The observation time (OT) was 420 minutes. II: 23 pigs were randomized to receive tranexamic acid (n = 11) or placebo (n = 12). Uncontrolled hemorrhage was induced by lacerating the aorta, producing an exsanguination estimated to 35 40 % of EBV. These animals were not actively cooled. Rebleeding events were monitored by ultrasonic probes. OT was 130 minutes. Thrombelastography (TEG) was used to evaluate coagulation changes in study I and II. III: 40 rats were randomized to HT (n = 20) or NT (n = 20). Uncontrolled hemorrhage was induced by puncturing the femoral artery, producing an exsanguination estimated to 24 % of EBV. HT animals were cooled to 30 degrees C and rewarmed again at 90 minutes. The incidence, on-set time, duration and volume of rebleedings were followed. OT was 180 minutes. IV: 60 rats, all cooled and processed according to the protocol of study III, were randomized to 3 different resuscitation groups; Low (LRe), Medium (MRe) or High (HRe) or Medium resuscitation +Desmopressin (MRe + D) (n = 4 x 15). Results: I: HT induced a coagulopathy apparent at temperatures 35 degrees C. Much higher blood pressure, induced by cooling, was seen in the HT group. IV: There were significantly higher rebleeding volumes in the HRe group and a trend towards higher mortality in the LRe group. No significant differences in the number or volume of rebleeding and no difference in mortality between the MRe + D and MRe groups was seen. Conclusions: HT induces a coagulopathy that is reversible upon rewarming. During trauma and uncontrolled hemorrhage, other factors than HT contribute to this coagulopathy. Hemodynamic changes provoked by cooling and HT, i.e. a rise in blood pressure, contribute to repeated rebleeding and hence, continuous hemorrhage. An MRe resuscitation regime seems most beneficial for outcome during HT and uncontrolled hemorrhage. Tranexamic acid at NT and desmopressin at HT conditions does not reduce rebleeding in penetrating trauma with uncontrolled hemorrhage

    Hypothermia Increases Rebleeding During Uncontrolled Hemorrhage in the Rat

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    Trauma registers show that hypothermia (HT) is an independent risk factor for death during hemorrhagic shock, although experimental animal studies indicate that HT may be beneficial during these conditions. However, the animal models were not designed to detect the expected increase in bleeding caused by HT. In a new model for uncontrolled bleeding, 40 Sprague-Dawley rats were exposed to a standardized femoral artery injury and randomized to either normothermia or HT. Ketamine/midazolam was used to minimize hemodynamic changes due to the anesthesia. The hypothermic rats were cooled to 30 degrees C and rewarmed again at 90 min. The study period was 3 h. The incidence, onset time, duration, and volume of bleedings as well as hemodynamic and metabolic changes were recorded. There was no difference between groups with respect to the initial bleeding. Rebleedings occurred among 60% of the animals in both groups. Hypothermic rebleeders had more, larger, and longer rebleedings, resulting in a total rebleeding volume amounting to 41% of their estimated blood volume. The corresponding figure for the normothermic rebleeders was 3% (P less than 0.001). Total rebleeding volume was significantly larger in the hypothermic group, even at body temperatures greater than 35 degrees C. We conclude that the risk of rebleeding from a femoral injury is greater in the presence of cooling and HT. The larger rebleeding volumes seen even at body temperatures greater than 35 degrees C indicate that factors other than temperature-induced coagulopathy also contributed to the increased hemorrhage.</p

    The impact of the type of lake catchment on the mercury content in perche

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    Raita Čilipāna maģistra darbs “Ezera sateces baseina tipa ietekme uz dzīvsudraba saturu asaros”. Maģistra darba mērķis ir izvērtēt ezera sateces baseina ietekmi uz dzīvsudraba saturu asaros. Maģistra darbā tika kvantitatīvi noteikts dzīvsudraba saturs Liepājas ezera, Ķīšezera, Burtnieka un Alūksnes ezerā mītošajos asaru muskuļaudos, izmantojot atomu absorbcijas spektrometrijas metodes. Literatūras apskatā ir apkopota informācija par dzīvsudraba ietekmi uz cilvēka organismu, galvenajiem dzīvsudraba dabiskās emisijas un antropogēnās emisijas avotiem. Veikta pētījumā apskatīto ezeru aprakstu izveide, aprakstot to sateces baseinā esošos potenciālos piesārņotājus un tā struktūru. Atslēgas vārdi: Dzīvsudrabs, asaris, Ķīšezers, Burtnieks, Alūksnes ezers, Liepājas ezers, ezera sateces baseinsRaitis Čilipān`s the title of master work thesis "The impact of the type of lake catchment on the mercury content in perche." Master thesis aims to assess the The impact of the type of lake catchment on the mercury content in perche. The content of mercury was quantified in the master's thesis using atomic absorption spectrometry methods on the muscle tissues of perch found in the following lakes: Liepāja, Ķīšezers, Burtnieks and Alūksne. The literature review summarizes the effects of mercury on the human body, the main sources of natural mercury emissions and anthropogenic emissions. The description of the lakes researched in this study outlines the potential contaminants in the catchment area and its structure. Keywords: Mercury, perche, Ķīšezers, Burtnieks, Alūksnes ezers, Liepājas ezers, lake catchmen
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