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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A Cross Sectional Analysis of Correlation of Heart Diameter and Cardio-Thoracic Ratio with Body Habitus for Evaluating Cardiac Enlargement: An Institutional Based Study

Background: The present study was conducted for assessing the correlation of Heart Diameter and Cardio-Thoracic Ratio with Body Habitus for Evaluating Cardiac Enlargement. Materials &amp; Methods: A total of 100 subjects were enrolled for the present study. All the patients were within the age range of 20 to 65 years. A postero-anterior chest radiograph was obtained followed by transverse Thoracic Diameter measurement. The transverse diameter of heart was the sum of maximum projections with the right and left heart borders. Heart Diameter and Cardio-Thoracic Ratio with Body Habitus was assessed. All the results were recorded in Microsoft excel sheet and were analysed by SPSS software. Results: Mean CTR among subjects with less than 30 years of age, 30 to 50 years of age and 51 to 65 years of age was 42.1%, 44.6% and 46.2% respectively. Mean HD among subjects with less than 30 years of age, 30 to 50 years of age and 51 to 65 years of age was 11.8 cm, 12.8 cm and 14.6 cm respectively. Mean CTR among males and female subjects was 43.2% and 44.1% respectively. Mean HD among males and females was 12.3 cm and 13.2 cm respectively. Mean CTR among subjects with BMI of less than 25 Kg/m2, 25 to 29.9 Kg/m2 and 30 &amp; above Kg/m2 was 44.6%, 45.9% and 46.1% respectively. Mean HD among subjects with BMI of less than 25 Kg/m2, 25 to 29.9 Kg/m2 and 30 &amp; above Kg/m2 was 12.3 cm, 13.9 cm and 14.1 cm respectively. Conclusion: Age was found to be significant predictor of cardiac enlargement as measured by Heart Diameter and Cardio-Thoracic Ratio with Body Habitus. Although non-significant, gender and BMI were also found to show considerable association with cardiac enlargement

Morphometric Analysis of Adult Human Vertebrae: An Institutional Based Study

Background: The vertebral column is composed of Vertebrae and intervertebral discs. It stretches right from the skull extending upto coccyx. The vertebral body is made up of trabecular bone (comprised of red marrow) surrounded by compact bone layer. Posteriorly and inferiorly, the spinous process projects from vertebral arch. T12 vertebra is exclusive in the sense that it marks the transition from thoracic to the lumbar vertebra. Hence; the present morphometric study was planned for assessing the adult human vertebrae.Materials &amp;Methods: A total of 40 dried human lumbar vertebras were collected. Vertebra with presence of congenital anomaly, disfigured or distorted structure was excluded. Pedicle height and pedicle width of all the specimens were measured. Pedicle height was assessed by measuring points just opposite each other on the upper and lower margins of the Pedicles in the vertical plane. Pedicle width was assessed by measuring the points on the medial and lateral surfaces of each Pedicle at right angle to the long axis of Pedicle.Results: A total of 40 dried human lumbar vertebras were collected. Mean lumbar vertebra height of L1, L2, L3, L4 and L5 was 5.11 mm, 15.56 mm, 14.95 mm, 13.95 mm and 13.65 mm respectively. Mean lumbar vertebra width of L1, L2, L3, L4 and L5 was 8.39 mm, 8.93 mm, 9.42 mm, 10.45 mm and 12.08 mm respectively.Conclusion: A constant increase in the mean pedicle width along with decrease in pedicle height is seen lumbar vertebra in the present study

Assessment of Anthropometric Measurements of External Ear Among Known Population: An Institutional Based Study

Background: The size, shape, position, and projection of the ear all influence the appearance of the individual. The present study was conducted to assess anthropometric measurements of external ear among known population.Materials &amp; Methods: 112 subjects of both genders were recruited, and measurement of ear was done. Data such as name, age, gender etc. was recorded. Pictures with camera were obtained on white paper. Various landmarks of the auricle were identified. Results: Out of 112 subjects, males were 60 and females were 52. The mean length was 64.5 mm in males and 63.1 mm in females. Width was 32.8 mm and 30.5 mm in males and females, length above tragus was 29.4 mm and 28.3 mm in males and females respectively, length below tragus was 21.0 mm and 20.4 mm, tragus length was 14.9 mm and 14.3 mm, concha length was 23.5 mm and 22.9 mm, concha width was 17.2 mm and 17.0 mm in males and females, lobule height was 12.4 mm and 11.5 mm, lobule width was 20.3 mm and 19.4 mm respectively.Conclusion: Assessment of parameters of ear is helpful in detecting various ear abnormalities

Study of Estimation of Stature from Measurements of Extremities Dimensions: A Radiological Study

Personal identification is one of the main tasks of forensic research. Stature, age, sex, and ancestry helps in narrowing down the pool of the possible victim matches in the forensic investigation process and thus provide useful clues to the investigating agency in establishing the identification of the individuals. Hence, the present study was conducted with the aim of assessing the stature from measurements of extremities dimension.Materials&amp; Methods: A total of 50 male cases and 50 female cases were enrolled in the present study. Only those were enrolled which were more than 20 years of age. Hand radiographs were taken. Dimensions were marked and length and breadth of hands was assessed. All the results were recorded and analysed. Results: Mean stature of males and females was 169.21 cm and 153.12 cm respectively. Mean right hand length was 18.12 cm and 16.95 cm respectively. Mean left hand length was 18.09 cm and 16.92 cm respectively. Mean left hand breadth was 8.89 cm and 7.49 cm respectively. While analysing statistically, it was seen that mean stature was significant correlated with hand length and hand breadth.Conclusion: Mean stature significantly correlates with hand length and hand breadth

Original Article Cheiloscopy: An Aid to Personal Identification in India

ABSTRACT Background: As said &quot;Identification is an individual&apos;s birth right&quot;. Identification of the individual is based on certain characteristics, which is unique to that individual. Cheiloscopy is the examination of lip prints, the lip prints are permanent and fixed, like fingerprint and palatal rugae, hence it can be used in personal identification. Aim: This study is undertaken to evaluate the uniqueness of lip print for personal identification Methods: The study was carried out on 400 subjects (200 male and 200 female) among the population of India. Lipstick was applied on the lips and print was taken on bond paper, the prints were divided into four quadrants and were analyzed by using magnifying lens and Suzuki and Tsuchihashi classification were used to identify the most common type of pattern among Indians for personal identification. Results: Our study shows that the most common type of pattern in Indian race was TYPE III (39%) and in all the quadrants (I, II, III, IV) most dominant pattern was type III in males and type II in females. Conclusion: The present study reveals that, there was no similarity in the lip print pattern of one individual with that of the other individual. The lip print pattern varies between the same age group people as well as among the population of same region

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy