Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

The Efficacy of Different Treatment Protocols in Pyometra with Respect to Reproductive Hormones and Indices in Dairy Cows

Early detection of the reproductive problems is fundamental to improve reproductive efficiency of dairy farms. Therefore, the study was performed to compare between two treatment protocols of pyometra to optimize reproductive performance of dairy cows. Based on rectal and ultrasonographic examinations, 30 cows suffered from pyometra were divided into; group1 (n=10) control group, group2 (n=10): treated with two injections of prostaglandin (PGF2α) plus systemic ceftiofur and group3 (n=10): treated with systemic ceftiofur. Ultrasonographic examination was performed before and 11 days after treatment. Blood samples were collected for analysis of progesterone (P4) and estradiol 17-ß just before and 11 days after treatment. Reproductive data was obtained regarding the1st and 2nd service conception rate (the 1st SCR and the 2nd SCR), number of services/conception (s/c) and days open. Ultrasonographic examination of the uterine horns appeared to be filled with hyperechoic granules in the lumen. However, the uterine horns at 11 days after treatment decreased in size and hyperechoic granules disappeared. No significant differences in P4 and estradiol 17- ß before and 11days after treatment. In cows received PGF2α+ ceftiofur, estradiol 17- ß was lower before treatment than 11 days after treatment. Significant improvement in the reproductive performance was recorded in treated cows with PGF2α+ceftiofur that manifested by marked increase in SCR and S/C as well as decrease in days open as compared with treated cows with ceftiofur only. It was concluded that double PGF2α injection+systemic ceftiofur is the best protocol to control pyometra that was pronounced by enhancement of reproductive performance in dairy cows

Efficacy of Co-synch Protocol on Normal Cyclic Dairy Cows with or Without Corpora Lutea

Improving reproductive efficiency, estrus synchronization and controlled breeding protocols are efficient management techniques in dairy cows. Therefore, the present study was designed to compare the efficacy of Co-synch protocol in the cows carrying corpora lutea (CL), without CL or with unexamined ovarian structure. Fifty-six cows were divided into 4 groups; control group1 (n=12) and Co-synch treated groups; group2: cows with unexamined ovarian structure group (n=9), group3: cows having only follicles without mature Cl (n=16) and group4: cows having mature Cl (n=19). Ultrasonography was performed before and after gonadotropin (GnRH) injection. Blood was collected for analysis of progesterone (P4) and estradiol 17-ß. Reproductive data was obtained regarding 1st service conception rate (1st SCR), number of services/conception (s/c) and days open. Ultrasonography revealed luteinization in cows without mature CL. While those having mature CL showed increase in the size of the CL or formation of accessory CL. Results revealed significant decrease in serum P4 before GnRH treatment in cows having no mature CL. Significant increase in serum P4 levels in all groups was recorded after GnRH treatment. Besides, the highest P4 level was assessed in cows having mature CL. Estradiol 17-ß was significantly decreased in cows having mature CL before and after treatment. Cows having mature CL revealed significant upgrade in the percentage of 1st SCR, decrease in s/c and shortening in days open as compared with other groups. In conclusion, applying Co-synch to the cows carrying CL is beneficial and promises protocol to improve reproductive performance in dairy cows

Efficacy of Co-synch Protocol on Normal Cyclic Dairy Cows with or Without Corpora Lutea

Improving reproductive efficiency, estrus synchronization and controlled breeding protocols are efficient management techniques in dairy cows. Therefore, the present study was designed to compare the efficacy of Co-synch protocol in the cows carrying corpora lutea (CL), without CL or with unexamined ovarian structure. Fifty-six cows were divided into 4 groups; control group1 (n=12) and Co-synch treated groups; group2: cows with unexamined ovarian structure group (n=9), group3: cows having only follicles without mature Cl (n=16) and group4: cows having mature Cl (n=19). Ultrasonography was performed before and after gonadotropin (GnRH) injection. Blood was collected for analysis of progesterone (P4) and estradiol 17-ß. Reproductive data was obtained regarding 1st service conception rate (1st SCR), number of services/conception (s/c) and days open. Ultrasonography revealed luteinization in cows without mature CL. While those having mature CL showed increase in the size of the CL or formation of accessory CL. Results revealed significant decrease in serum P4 before GnRH treatment in cows having no mature CL. Significant increase in serum P4 levels in all groups was recorded after GnRH treatment. Besides, the highest P4 level was assessed in cows having mature CL. Estradiol 17-ß was significantly decreased in cows having mature CL before and after treatment. Cows having mature CL revealed significant upgrade in the percentage of 1st SCR, decrease in s/c and shortening in days open as compared with other groups. In conclusion, applying Co-synch to the cows carrying CL is beneficial and promises protocol to improve reproductive performance in dairy cows

Polymer-Peptide Modified Gold Nanorods to Improve Cell Conjugation and Cell Labelling for Stem Cells Photoacoustic Imaging

The use of gold nanorods (GNRs) as a contrast agent in bioimaging and cell tracking has numerous advantages, primarily due to the unique optical properties of gold nanorods which allow for the use of infrared regions when imaging. Owing to their unique geometry, Au NRs exhibit surface plasmon modes in the near-infrared wavelength range, which is ideal for carrying out optical measurements in biological fluids and tissue. Gold nanorod functionalization is essential, since the Cetyltrimethyl ammonium bromide CTAB gold nanorods are toxic, and for further in vitro and in vivo experiments the nanorods should be functionalized to become optically stable and biocompatible. In the present study, gold nanorods with an longitudinal surface plasmon resonance (LSPR) position around 800 nm were synthesized in order to be used for photoacoustic imaging applications for stem cell tracking. The gold nanorods were functionalized using both thiolated poly (ethylene glycol) (PEG) to stabilize the gold nanorods surface and a CALNN–TAT peptide sequence. Both ligands were attached to the gold nanorods through an Au–sulfur bond. CALNN–TAT is known as a cell penetrating peptide which ensures endocytosis of the gold nanorods inside the mesenchymal stem cells of mice (MSCD1). Surface modifications of gold nanorods were achieved using optical spectroscopy (UV–VIS), electron microscopy (TEM), zeta-potential, and FTIR. Gold nanorods were incubated in MSCD1 in order to achieve a cellular uptake that was characterized by a transmission electron microscope (TEM). For photoacoustic imaging, Multi-Spectral Optoacoustic Tomography (MSOT) was used. The results demonstrated good cellular uptake for PEG–CALNN–TAT GNRs and the successful use of modified gold nanorods as both a contrast agent in photoacoustic imaging and as a novel tracking bioimaging technique