Anaemia, blood loss and colorectal cancer

Introduction: Colorectal cancer (CRC) is the fourth most common cancer worldwide and strikes both sexes. The age-adjusted 5-year survival in Sweden was 60% in the early 21 st century. Approximately 50% of patients are anaemic at the time of diagnosis. Many patients need blood transfusion due to anaemia or surgical blood-loss. Blood transfusions administered to patients with CRC have been associated with an increase in the risk for cancer recurrence, independent of tumour stage. One long-term complication to abdominal surgery is small bowel obstruction (SBO) necessitating further surgery. Hypotheses: • Anaemia prior to surgery and perioperative red blood cell transfusion increase overall mortality and risk of recurrence in patients after curative resections for CRC. • Blood-loss in surgery for colon cancer impairs overall survival. • The amount of blood lost at index surgery for colon cancer increases the risk of future surgery for SBO due to adhesions. • Major blood loss during surgery for rectal cancer increases the risk for SBO due to adhesions or tumour recurrence and reduces overall survival. Materials and methods: All studies are retrospective cohort studies of prospectively collected data. All patients who had abdominal resection for CRC stage I-III at Karolinska University hospital from 2007 to 2010 were included in the study considering the effects of anaemia and blood transfusion. Information was retrieved from the Swedish Colorectal Cancer Registry and linked to information on transfusion and laboratory data on haemoglobin. Patient records were validated for recurrent disease. The studies on blood loss are based on all patients with CRC in the Uppsala-Örebro region 1997 to 2003. Data from the Swedish Rectal and Regional Colon Cancer Registries were linked to information on hospital admissions for SBO and abdominal pain. Patient charts for those undergoing surgery for diagnoses congruent with SBO were validated for cause of SBO. Statistics were calculated using non-parametric methods, logistic regression, and Cox Proportional Hazards regression analyses. Results: Anaemia prior to surgery for CRC increased the risk of overall mortality (HR 2.2; 95% CI: 1.4-3.3). The analyses also revealed a trend towards an association between preoperative anaemia and recurrence (HR 1.6; 95% CI: 0.99-2.6). No association between perioperative blood transfusion and risk of recurrence or overall mortality was found. Blood loss ≥ median (250 ml) impaired overall survival (HR 1.1; 95% CI: 1.0-1.2) after surgery for colon cancer. There was no association between blood loss and survival for the rectal cancer patients. A blood loss ≥ median for patients with colon cancer (250 ml) increased the risk of future surgery for SBO caused by tumour recurrence (HR 2.2; 95% CI: 1.1-4.3). The same was found for patients with rectal cancers who had blood loss ≥ median 800 ml (HR 10.5; 95% CI: 1.4-81.5). There was no increased risk for surgery for SBO caused by adhesions for colon or rectal cancer patients. Conclusions: Anaemia prior to surgery for CRC is a predictive factor for mortality and a trend was seen towards an association with recurrence. Additional effort should be given to study this topic. No association was established between a perioperative blood transfusion and future risk of recurrence or mortality. Blood loss at surgery for CRC should be kept to a minimum to decrease mortality in patients with colon cancer and reduce future risk for SBO due to tumour recurrence

Holocene sea level changes in the tierra del fuego region

Available sea level data from the Tierra del Fuego region cannot be combined Into a meaningful sea level graph as recently proposed (PORTER et al., 1984 and RABASSA et al., 1986) because these records are dominated by sites of local seismotectonic uplift; i.e., the exceptions, not the rule. The general sea level tendency (i.e., the rule), gives a sea level rise from 9,000 up to about 4,000 BP when the peak-level was reached. This Holocene maximum level was, however, at or Just above the present sea level; ranging from zero via 0.5-1.0 m up to 1-2 m above the present sea level. A preliminary regional eustatic curve is proposed. Presently available sea level data do not record any Holocene glacial Isostatic effects

Tsunamis in Sweden: Occurrence and Characteristics

In the last 13,000 years, there are 17 tsunami events recorded in Sweden. This chapter highlights the characteristics of two high-magnitude events from the deglacial period and three events from Late Holocene age

Should captive wild animals be used in research institutions?

No abstract availabl

Improving student success in difficult engineering education courses through Supplemental Instruction (SI) – what is the impact of the degree of SI attendance?

The customary way to determine whether an adopted Supplemental Instruction (SI) program has been successful or not is by comparing course results for two groups, SI attendees and non-attendees. The division of SI attendees and non-attendees is generally done rather arbitrarily by prescribing a minimum number of SI sessions a student has to attend to be considered an SI attendee. Although the SI attendee vs. non-attendee concept is powerful in some respects, it tends to cloud the benefit of attending SI sessions. That a higher SI attendance leads to better course results is perhaps taken for granted, but in the few further studies that have been made, the picture of SI attendance rates vs. course results is not overly clear. The present study aims to contribute to how the degree of SI attendance affects course results in an engineering context at a Swedish University. In the study we divide the students into four categories, those with high, average, low, and no SI attendance. In terms of student success in a course, it is found that there is a clear relation between the number of SI sessions attended and course success. Students with high SI attendance do best followed by students with average, low, and no SI attendance, respectively