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

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

Carbon and water dynamics of a bioenergy crop (Cynara cardunculus L.) under different meteorological conditions in a semi-arid region

To evaluate the environmental adaptability of cultivated cardoon (Cynara cardunculus L.) its water use efficiency [(WUE) – ratio between net ecosystem exchange (NEE) and evapotranspiration (ET)] was analysed. The crop was cultivated in South Italy and WUE was evaluated at different time scales during two seasons: wet and dry. Even if the crop development is similar in the two seasons, plants delay their development in the presence of drought, showing, in this way, an improvement in their adaptability. Seasonal WUE in the dry season is greater than in the wet one by +11.2%, and this is also confirmed at monthly and daily scale. Hourly analysis around the full development phase shows that WUE is greater during the wet season than during the dry one, this being explainable when considering the impact of the drivers [(photosynthetically active radiation (PAR), vapour pressure deficit (VPD), and air temperature (Tair)] on CO2 and H2O exchanges by stomatal regulation. The saturation values of NEE in function of PAR (threshold 2.5 MJ m–2h–1) and VPD (threshold 10 hPa) are greater during the wet season than the dry one. Furthermore, also the linear relationships between ET and PAR and VPD showed higher slopes in the wet season than in the dry one. Drought causes reduction in both photosynthesis and evapotranspiration by stomatal regulation, however, the photosynthesis process is surely more sensitive to water stress than the crop transpiration, thus demonstrating the good adaptability of this crop to scarce water availability of semi-arid conditions

Representativeness of Carbon Dioxide Fluxes Measured by Eddy Covariance over a Mediterranean Urban District with Equipment Setup Restrictions

The CO2 fluxes measured by the eddy covariance technique (EC) are presented for a district of the urban area of Bari (Italy). The applicability of the EC method was satisfied even though the measurements were taken at a limited height. The CO2 fluxes are representative of an area with public offices and schools, the university campus, green areas, and busy roads with intensive traffic during school and office times. The measurements were carried out in March–June, covering late winter, characterized by huge vehicle traffic and domestic heating, until late spring, characterized by reduced activities for schools and the university. The source area was determined as a function of atmospheric stability, for data with the ratio between measurement-height/buildings-height in the range of 1.3–1.5. The measured CO2 fluxes were compared to gas consumption values. The results show that the district is a strong source of CO2 during the winter. Emissions were drastically reduced (−82%) after the heating was switched off, and a further decrease in CO2 emissions (−50%) occurred with the reduction of school activities, partly due to the mitigating effect of green areas with large trees in the area

Item Analysis of a Selected Bank from the Voluntary HIV-1 Counseling and Testing Efficacy Study Group

A 15-item questionnaire, that is part of the HIV-1 VCT dataset, has been considered in this paper, following a Rasch analysis – by means of the Partial Credit Model. We begin by reviewing the different methods of maximum likelihood estimation of the parameters of the model. We then focus on five among the most popular Rasch measurement softwares that implement these estimation methods. The questionnaire results to have the qualities of a good measure of attitude, in the population, towards the use of the condom- but a gender-based Differential Item Functioning has been detected for several items in the test

Short-term effects of conversion to no-tillage on respiration and chemical - physical properties of the soil: a case study in a wheat cropping system in semi-dry environment

La non lavorazione dei terreni (NT) è considerata una pratica agricola utile al fine di preservare il carbonio organico (C) nel suolo, tuttavia c\u92è ancora una grande incertezza sulle misure agronomiche più idonee a ridurre le perdite di anidride carbonica (CO2) dai suoli agricoli. In questo studio, misure sia di emissioni di CO2 in campo che di attività di mineralizzazione microbica sono state connesse alle proprietà chimiche e fisiche del suolo in un sistema colturale a grano duro soggetto a clima semi-arido in cui la NT, praticata da soli 4 anni, è stata confrontata con la lavorazione convenzionale (CT). I risultati non hanno evidenziato differenze significative tra CT e NT, confermando tempi simili nel turnover del C organico nei due trattamenti, probabilmente dovuti al fatto che il sistema NT era giovane (4 anni) e le misure sono avvenute lontano dalla lavorazione del terreno. Parole chiave: Sequestro del C, agricoltura conservativa, emissioni di CO2, respirazione basale eterotrofa, mineralizzazione del C

Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes