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

juliangehring/Bootstrap.jl: Bootstrap v2.0.0

Version 2.0.0 Interface changes Put the function argument first in the signatures (#26): Changes the bootstrap signature to have the function argument come first: bootstrap(statistic::Function, data, sampling). The old syntax has been deprecated and will be removed in a future version. Integrate better with StatsBase function names (#24): Integrates with the naming of the equivalent functions in StatsBase.jl: Renames ci to confint and se to stderror. The old function names have been deprecated, and will be supported until the next major release. The motivation for these change is outlined in #23. Changes Build the html documentation directly with Documenter (#28, #25) Support julia v0.7 and v1.0, drop support for julia v0.6 (#33) Support Requires julia 0.7 or v1.

juliangehring/Bootstrap.jl: Bootstrap v2.4.0

&lt;h2&gt;Version 2.4.0&lt;/h2&gt; &lt;h3&gt;Changes&lt;/h3&gt; &lt;ul&gt; &lt;li&gt;Extend compatibility for &lt;code&gt;Statistics&lt;/code&gt;, &lt;code&gt;StatsBase&lt;/code&gt;, &lt;code&gt;StatsModels&lt;/code&gt; and &lt;code&gt;Random&lt;/code&gt;.&lt;/li&gt; &lt;li&gt;Clarify return value of &lt;code&gt;confint&lt;/code&gt;. Contributed by Hector Perez (@hdavid16) (#95).&lt;/li&gt; &lt;li&gt;Update doc strings. Contributed by Hector Perez (@hdavid16) (#95).&lt;/li&gt; &lt;li&gt;Update documentation.&lt;/li&gt; &lt;/ul&gt

juliangehring/Bootstrap.jl: Bootstrap v2.4.0

&lt;h2&gt;Version 2.4.0&lt;/h2&gt; &lt;h3&gt;Changes&lt;/h3&gt; &lt;ul&gt; &lt;li&gt;Extend compatibility for &lt;code&gt;Statistics&lt;/code&gt;, &lt;code&gt;StatsBase&lt;/code&gt; and &lt;code&gt;StatsModels&lt;/code&gt;.&lt;/li&gt; &lt;li&gt;Clarify return value of &lt;code&gt;confint&lt;/code&gt;. Contributed by Hector Perez (@hdavid16) (#95).&lt;/li&gt; &lt;li&gt;Update docstrings. Contributed by Hector Perez (@hdavid16) (#95).&lt;/li&gt; &lt;li&gt;Update documentation.&lt;/li&gt; &lt;/ul&gt

JuliaDiff/ChainRules.jl: v1.57.0

&lt;h2&gt;ChainRules v1.57.0&lt;/h2&gt; &lt;p&gt;&lt;a href="https://github.com/JuliaDiff/ChainRules.jl/compare/v1.56.0...v1.57.0"&gt;Diff since v1.56.0&lt;/a&gt;&lt;/p&gt; &lt;p&gt;&lt;strong&gt;Merged pull requests:&lt;/strong&gt;&lt;/p&gt; &lt;ul&gt; &lt;li&gt;CompatHelper: add new compat entry for Statistics at version 1, (keep existing compat) (#748) (@github-actions[bot])&lt;/li&gt; &lt;li&gt;Add rule for with_logger (#749) (@oxinabox)&lt;/li&gt; &lt;li&gt;Add version bounds for stdlibs (#750) (@oxinabox)&lt;/li&gt; &lt;/ul&gt

A dynamic three-step mechanism drives the HIV-1 pre-fusion reaction

Little is known about the intermolecular dynamics and stoichiometry of the interactions of the human immunodeficiency virus type 1 (HIV-1) envelope (Env) protein with its receptors and co-receptors on the host cell surface. Here we analyze timeresolved HIV-1 Env interactions with T-cell surface glycoprotein CD4 (CD4) and C-C chemokine receptor type 5 (CCR5) or C-X-C chemokine receptor type 4 (CXCR4) on the surface of cells, by combining multicolor super-resolution localization microscopy (direct stochastic optical reconstruction microscopy) with fluorescence fluctuation spectroscopy imaging. Utilizing the primary isolate JR-FL and laboratory HXB2 strains, we reveal the time-resolved stoichiometry of CD4 and CCR5 or CXCR4 in the prefusion complex with HIV-1 Env. The HIV-1 Env pre-fusion dynamics for both R5- and X4-tropic strains consists of a three-step mechanism, which seems to differ in stoichiometry. Analyses with the monoclonal HIV-1-neutralizing antibody b12 indicate that the mechanism of inhibition differs between JR-FL and HXB2 Env. The molecular insights obtained here identify assemblies of HIV-1 Env with receptors and co-receptors as potential novel targets for inhibitor design

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

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

AimThe 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.MethodsThis 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.ResultsOverall, 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 ConclusionOne 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