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

Diseno de un horno electrico para tratamientos termicos

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Impact of Malaria Control on Mortality and Anemia among Tanzanian Children Less than Five Years of Age, 1999-2010.

Mainland Tanzania scaled up multiple malaria control interventions between 1999 and 2010. We evaluated whether, and to what extent, reductions in all-cause under-five child mortality (U5CM) tracked with malaria control intensification during this period.Four nationally representative household surveys permitted trend analysis for malaria intervention coverage, severe anemia (hemoglobin <8 g/dL) prevalence (SAP) among children 6-59 months, and U5CM rates stratified by background characteristics, age, and malaria endemicity. Prevalence of contextual factors (e.g., vaccination, nutrition) likely to influence U5CM were also assessed. Population attributable risk percentage (PAR%) estimates for malaria interventions and contextual factors that changed over time were used to estimate magnitude of impact on U5CM.Household ownership of insecticide-treated nets (ITNs) rose from near zero in 1999 to 64% (95% CI, 61.7-65.2) in 2010. Intermittent preventive treatment of malaria in pregnancy reached 26% (95% CI, 23.6-28.0) by 2010. Sulfadoxine-pyrimethamine replaced chloroquine in 2002 and artemisinin-based combination therapy was introduced in 2007. SAP among children 6-59 months declined 50% between 2005 (11.1%; 95% CI, 10.0-12.3%) and 2010 (5.5%; 95% CI, 4.7-6.4%) and U5CM declined by 45% between baseline (1995-9) and endpoint (2005-9), from 148 to 81 deaths/1000 live births, respectively. Mortality declined 55% among children 1-23 months of age in higher malaria endemicity areas. A large reduction in U5CM was attributable to ITNs (PAR% = 11) with other malaria interventions adding further gains. Multiple contextual factors also contributed to survival gains.Marked declines in U5CM occurred in Tanzania between 1999 and 2010 with high impact from ITNs and ACTs. High-risk children (1-24 months of age in high malaria endemicity) experienced the greatest declines in mortality and SAP. Malaria control should remain a policy priority to sustain and further accelerate progress in child survival

Trends in 5-year estimates of all-cause neonatal, infant, and under-five year mortality rates in Mainland Tanzania, 1990–2010.

<p>Footnote: Each rate presented as the mid-point of the five-year interval it reflects (e.g., 2010 survey, measuring mortality 2005–2009, was plotted at 2007). Mortality among children 1–59 months of age declined 54% between 1999 and 2010 (from 111 to 57 deaths per 1000 live births) compared to the 45% relative decline for the traditional 0–59 month age group described in text.</p

Timeline depicting years when national-level implementation of specific malaria control policies and interventions began in Mainland Tanzania, 2000–2010.

<p>Timeline depicting years when national-level implementation of specific malaria control policies and interventions began in Mainland Tanzania, 2000–2010.</p

Conceptual framework for constructing an adequacy and plausibility assessment to support the Mainland Tanzania malaria impact evaluation.

<p>Conceptual framework for constructing an adequacy and plausibility assessment to support the Mainland Tanzania malaria impact evaluation.</p

Severe anemia prevalence and all-cause mortality (deaths per 1000 live births) according to age group (A) and (B) and malaria endemicity (C) and (D), respectively.

<p>Severe anemia prevalence and all-cause mortality (deaths per 1000 live births) according to age group (A) and (B) and malaria endemicity (C) and (D), respectively.</p

The measurement of the Pb-206(n,gamma) cross section and stellar implications

The neutron capture cross section of (206)Pb has been measured at the CERN n_TOF spectrometer using a setup of two C(6)D(6) detectors. In the energy interval from 1 eV to 600 keV the cross section is dominated by resonances, which were analyzed via the R-matrix analysis code SAMMY. In the relevant energy ranges for stellar nucleosynthesis, i. e., at thermal energies of kT = 8 keV and kT = 23 keV, the present Maxwellian average cross section differs by 20% and 9% from the recommended values of Bao et al respectively. From the new cross section the s-abundance of (206)Pb could be reliably determined as 70( 4)%. This result is of importance in order to test and constrain r-process abundance calculations in the actinide region, because the r-process portion of (206)Pb is dominated by alpha-back decays of short-lived transbismuth isotopes