The relationship between cardiopulmonary exercise test variables, the systemic inflammatory response, and complications following surgery for colorectal cancer

Background: Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group. Methods: Patients who had undergone CPET prior to elective surgery for histologically confirmed colorectal cancer in a single centre between September 2008 and April 2017 were included. Preoperative VO2 at the anaerobic threshold (AT) and peak exercise were recorded, along with preoperative modified Glasgow Prognostic Score (mGPS) and CRP on each postoperative day. Results: Thirty-eight patients were included. The majority were male (30, 79%), over 65 years old (30, 79%), with colonic cancer (23, 61%) and node-negative disease (24, 63%). Fourteen patients (37%) had open surgery and 24 (63%) had a laparoscopic resection. A progressive reduction in VO2 at peak exercise was significantly associated with both increasing American Society of Anesthesiology (ASA) grade (median, ml/kg/min: ASA 1 = 22, ASA 2 = 19, ASA 3 = 15, ASA 4 = 12, p = 0.014) and increasing mGPS (median, ml/kg/min: mGPS 0 = 18, mGPS 1 = 16, mGPS 2 = 14, p = 0.039) There was no significant association between either VO2 at the AT or peak exercise and postoperative CRP. Conclusions: The present pilot study reports a possible association between preoperative CPET-derived measures of exercise tolerance, and the preoperative systemic inflammatory response, but not postoperative CRP in patients undergoing surgery for colorectal cancer

The impact of preoperative dexamethasone on the magnitude of the postoperative systemic inflammatory response and complications following surgery for colorectal cancer

Background: The magnitude of the postoperative systemic inflammatory response (SIR), as evidenced by C-reactive protein (CRP), is associated with both short- and long-term outcomes following surgery for colorectal cancer. The present study examined the impact of preoperative dexamethasone on the postoperative SIR and complications following elective surgery for colorectal cancer. Methods: Patients who underwent elective surgery, with curative intent, for colorectal cancer at a single center between 2008 and 2016 were included (n = 556) in this study. Data on the use of preoperative dexamethasone were obtained from anesthetic records, and its impact on CRP on postoperative days (PODs) 3 and 4, as well as postoperative complications, was assessed using propensity score matching (n = 276). Results: In the propensity score-matched cohort, preoperative dexamethasone was associated with fewer patients exceeding the established CRP threshold of 150 mg/L on POD 3 (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.26–0.70, p < 0.001) and fewer postoperative complications (OR 0.53, 95% CI 0.33–0.86, p = 0.009). Similar results for both POD 3 CRP and complications were observed when using propensity score-adjusted regression (OR 0.40, 95% CI 0.28–0.57 and OR 0.57, 95% CI 0.41–0.80, respectively) and propensity score stratification (OR 0.41, 95% CI 0.25–0.57 and OR 0.53, 95% CI 0.33–0.86, respectively). Conclusions: Preoperative dexamethasone was associated with a lower postoperative SIR and fewer complications following elective surgery for colorectal cancer

Exploring the compassion deficit debate

Several recent high profile failures in the UK health care system have promoted strong debate on compassion and care in nursing. A number of papers articulating a range of positions within this debate have been published in this journal over the past two and a half years. These articulate a diverse range of theoretical perspectives and have been drawn together here in an attempt to bring some coherence to the debate and provide an overview of the key arguments and positions taken by those involved. In doing this we invite the reader to consider their own position in relation to the issues raised and to consider the impact of this for their own practice. Finally the paper offers some sense of how individual practitioners might use their understanding of the debates to ensure delivery of good nursing care

A model integrating patch dynamics, competing species and the intermediate disturbance hypothesis

Barnes and Roderick [Barnes, B., Roderick, M., 2004. An ecological framework linking scales across space and time based on self-thinning. Theor. Population Biol. 66, 113-118] developed a mathematical model of patch dynamics, based on a time-dependent self-thinning mechanism. In this paper, we consider the ramifications of their modelling approach, in terms of its agreement with the concepts of competing species and the intermediate disturbance hypothesis. When considering more than one species we show that a form of the competing species model emerges as a natural consequence of the mathematics, with our model differing from traditional competition models in its derivation and nonlinear, time-dependent per capita growth rate. Further, we show that when disturbance is included in the formulation, the general predictions are in agreement with the intermediate disturbance hypothesis

Moving from Pattern to Process: Coexistence Mechanisms Under Intermediate Disturbance Regimes

Coexistence mechanisms that require environmental variation to operate contribute importantly to the maintenance of biodiversity. One famous hypothesis of diversity maintenance under disturbance is the intermediate disturbance hypothesis (IDH). The IDH proposes patterns of peaked diversity under intermediate disturbance regimes, based on a tension between competitively superior species and species which can rapidly colonize following disturbance. We review the literature, and describe recent research that suggests that more than one underlying mechanism can generate this unimodal diversity pattern in disturbed environments. Several exciting emerging research areas are identified, including interactions between disturbance types, operation of the IDH in multi-trophic systems, and changes in disturbance regimes. However, empirical work is still focussed on describing the IDH pattern, with little emphasis on identifying its mechanistic basis. We discuss how to extend methods for identifying different coexistence mechanisms, developed in the theoretical literature, to experimental research. In an attempt to operationalize these various ideas we outline a hypothetical IDH research programme. A solid understanding of the life history attributes of the component species and their responses to disturbance will facilitate identification of the coexistence mechanism(s) underlying the IDH pattern, and provide a framework by which empirical and theoretical results can be more fully integrated

Moving from Pattern to Process: Coexistence Mechanisms Under Intermediate Disturbance Regimes

Coexistence mechanisms that require environmental variation to operate contribute importantly to the maintenance of biodiversity. One famous hypothesis of diversity maintenance under disturbance is the intermediate disturbance hypothesis (IDH). The IDH proposes patterns of peaked diversity under intermediate disturbance regimes, based on a tension between competitively superior species and species which can rapidly colonize following disturbance. We review the literature, and describe recent research that suggests that more than one underlying mechanism can generate this unimodal diversity pattern in disturbed environments. Several exciting emerging research areas are identified, including interactions between disturbance types, operation of the IDH in multi-trophic systems, and changes in disturbance regimes. However, empirical work is still focussed on describing the IDH pattern, with little emphasis on identifying its mechanistic basis. We discuss how to extend methods for identifying different coexistence mechanisms, developed in the theoretical literature, to experimental research. In an attempt to operationalize these various ideas we outline a hypothetical IDH research programme. A solid understanding of the life history attributes of the component species and their responses to disturbance will facilitate identification of the coexistence mechanism(s) underlying the IDH pattern, and provide a framework by which empirical and theoretical results can be more fully integrated

How and why systemic inflammation worsens quality of life in patients with advanced cancer

Introduction: The presence of an innate host systemic inflammatory response has been reported to be a negative prognostic factor in a wide group of solid tumour types in both the operable and advanced setting, both local and distant. In addition, this host systemic inflammatory response is associated with both clinician reported patient performance status and self-reported measures of quality of life in patients with cancer. Areas covered: A variety of mechanisms are thought to underlie this, including the influence of the host immune response on physical symptoms such as pain and fatigue, its effect on organ systems associated with physical ability and well being such as skeletal muscle, and bone marrow. Furthermore, this innate inflammatory response is thought to have a direct negative impact on mood through its action on the central nervous system. Expert commentary: It is clear that the host systemic inflammatory response represents a target for intervention in terms of both improving quality of life and prognosis in patients with advanced cancer. Based on this paradigm, future research should focus both on pathways which might be targeted by novel agents, but also on whether existing anti-inflammatory drugs might be of benefit

Multiple incursion pathways for Helicoverpa armigera in Brazil show its genetic diversity spreading in a connected world

The Old World cotton bollworm Helicoverpa armigera was first detected in Brazil with subsequent reports from Paraguay, Argentina, Bolivia, and Uruguay. This pattern suggests that the H. armigera spread across the South American continent following incursions into northern/central Brazil, however, this hypothesis has not been tested. Here we compare northern and central Brazilian H. armigera mtDNA COI haplotypes with those from southern Brazil, Uruguay, Argentina, and Paraguay. We infer spatial genetic and gene flow patterns of this dispersive pest in the agricultural landscape of South America. We show that the spatial distribution of H. armigera mtDNA haplotypes and its inferred gene flow patterns in the southwestern region of South America exhibited signatures inconsistent with a single incursion hypothesis. Simulations on spatial distribution patterns show that the detection of rare and/or the absence of dominant mtDNA haplotypes in southern H. armigera populations are inconsistent with genetic signatures observed in northern and central Brazil. Incursions of H. armigera into the New World are therefore likely to have involved independent events in northern/central Brazil, and southern Brazil/Uruguay-Argentina-Paraguay. This study demonstrates the significant biosecurity challenges facing the South American continent, and highlights alternate pathways for introductions of alien species into the New World

Staging the tumor and staging the host: A two centre, two country comparison of systemic inflammatory responses of patients undergoing resection of primary operable colorectal cancer

Background: How systemic inflammation-based prognostic scores such as the modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR) differ across populations of patients with colorectal cancer (CRC) remains unknown. The present study examined the mGPS and NLR in patients from United Kingdom (UK) and Japan. Methods: Patients undergoing resection of TNM I-III CRC in two centres in the UK and Japan were included. Differences in clinicopathological characteristics and mGPS (0-CRP≤10 mg/L, 1-CRP>10 mg/L, 2-CRP>10 mg/L, albumin<35 g/L) and NLR (≤5/>5) were examined. Results: Patients from UK (n = 581) were more likely to be female, high ASA and BMI, present as an emergency (all P < 0.01) and have higher T stage compared to those from Japan (n = 559). After controlling for differences in tumor and host characteristics, patients from Japan were less likely to be systemically inflamed (OR: mGPS: 0.37, 95%CI 0.27–0.50, P < 0.001; NLR: 0.53, 95%CI 0.35–0.79, P = 0.002). Conclusion: Systemic inflammatory responses differ between populations with colorectal cancer. Given their prognostic value, reporting of systemic inflammation-based scores should be incorporated into future studies reporting patient outcomes. Summary: Although the systemic inflammatory response is recognised as a prognostic factor in patients with colorectal cancer, it is not clear how these may differ between distinct geographical populations. The present study examines differences in the prevalence of elevated systemic inflammatory responses (modified Glasgow Prognostic Score and neutrophil:lymphocyte ratio) between two populations undergoing resection of colorectal cancer in the United Kingdom and Japan

Partitioning the variance between space and time

Here we decompose the space-time variance of near-surface air temperature using monthly observations for the global land surface (excluding Antarctica) from 1901-2000. To do that, we developed a new method for partitioning the total space-time variance, here called the grand variance, into separate spatial and temporal components. The temporal component is, in turn, further partitioned into the variance relating to different time periods and we use monthly data to decompose intra- and inter-annual components of the variance. The results show that the spatial and temporal components of the variance of near-surface air temperature have both, on average, decreased over time primarily because of reductions in the equator-to-pole (northern) temperature gradient, and because in cold regions, winter is generally warming faster than summer. We also found that in most regions, the inter-annual variance in near-surface air temperature has increased