The Education and Training of Artisans for the Informal Sector in Tanzania

Teaching/Communication/Extension/Profession,

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

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

In reply to "Hynes S.O. et al. Back to the future: routine morphological assessment of the tumour microenvironment is prognostic in stage II/III colon cancer in a large population-based study"

No abstract available

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

Evaluation of a tumor microenvironment-based prognostic score in primary operable colorectal cancer

Purpose: The tumor microenvironment is recognized as an important determinant of progression and outcome in colorectal cancer. The aim of the present study was to evaluate a novel tumor microenvironment–based prognostic score, based on histopathologic assessment of the tumor inflammatory cell infiltrate and tumor stroma, in patients with primary operable colorectal cancer. Experimental Design: Using routine pathologic sections, the tumor inflammatory cell infiltrate and stroma were assessed using Klintrup–Mäkinen (KM) grade and tumor stroma percentage (TSP), respectively, in 307 patients who had undergone elective resection for stage I–III colorectal cancer. The clinical utility of a cumulative score based on these characteristics was examined. Results: On univariate analysis, both weak KM grade and high TSP were associated with reduced survival (HR, 2.42; P = 0.001 and HR, 2.05; P = 0.001, respectively). A cumulative score based on these characteristics, the Glasgow Microenvironment Score (GMS), was associated with survival (HR, 1.93; 95% confidence interval, 1.36–2.73; P < 0.001), independent of TNM stage and venous invasion (both P < 0.05). GMS stratified patients in to three prognostic groups: strong KM (GMS = 0), weak KM/low TSP (GMS = 1), and weak KM/high TSP (GMS = 2), with 5-year survival of 89%, 75%, and 51%, respectively (P < 0.001). Furthermore, GMS in combination with node involvement, venous invasion, and mismatch repair status further stratified 5-year survival (92% to 37%, 93% to 27%, and 100% to 37%, respectively). Conclusions: The present study further confirms the clinical utility of assessment of the tumor microenvironment in colorectal cancer and introduces a simple, routinely available prognostic score for the risk stratification of patients with primary operable colorectal cancer

Response of benthic cave invertebrates to organic pollution events

1.Even though the fragility and vulnerability of subterranean ecosystems (caves, groundwater and hyporheic habitats) is widely acknowledged, the impacts of anthropogenic disturbances have been poorly quantified when compared to surface waters. In particular, limited data exist regarding the impact of organic pollution upon aquatic cave invertebrate communities. 2.The Peak-Speedwell Cavern system (Derbyshire, UK) was affected by two organic pollution events, during a 7–year study (1997-2003), originating from the same source in the surface catchment but resulting in markedly different ecological responses. The first event led to the elimination of most taxa from affected sites while the second resulted in an increase in abundance of organisms within the cave associated with the increased availability of trophic resources. The second event also coincided with the invasion of the stygophilic amphipod, Gammarus pulex, at a site where it had not previously been recorded. 3.Recovery of the invertebrate community following both organic pollution events occurred within 12-months. Recolonisation of the affected sites was facilitated by annual flooding of the cave and by the presence of refugia on unaffected subterranean tributaries. 4.The data highlight the problems associated with the conservation and management of subterranean ecosystems where impacts in distant surface catchments may have unseen repercussions for the subterranean environment. Aquatic subterranean habitats are not widely monitored and the impacts of pollution/disturbance may not be detected in surface waters for some time, if at all, due to dilution effects. Caves supporting obligate subterreanean organisms (stygobites) are particularly vulnerable to these pressures and require clear management strategies to protect both the subterranean and surface catchments which support them

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

A comparative study on the in vitro antibacterial activity of the pneumatophores of Heritiera fomes and Xylocarpus moluccensis

Se evaluó la actividad antibacteriana in vitro de los extractos de etanol de los neumatóforos de Xylocarpus moluccensis (Familia: Meliaceae) y Heritiera fomes (Familia: Sterculiaceae) frente a diversas cepas bacterianas utilizando el ensayo de difusión en disco. Ambos extractos presentaron perfi les antibacterianos similares, y las zonas de inhibición fueron >10 mm en la mayoría de los casos. Estos extractos presentaron la máxima actividad frente a aerógenos Enterobacter, siendo las zonas de inhibición de 19 y 21 mm, respectivamente. La concentración inhibitoria mínima (CIM) se determinó mediante el método de dilución en caldo de cultivo. El extracto de X. moluccensis fue el más potente frente a Shigella boydii y Shigella sonnie (CIM = 200 y 300 μg/mL, respectivamente). Se puede asumir que X. moluccensis y H. fomes podrían ser fuentes potenciales de nuevos descubrimientos para el desarrollo de fármacos.The ethanol extracts of the pneumatophores of Xylocarpus moluccensis (Family: Meliaceae) and Heritiera fomes (Family: Sterculiaceae) were assessed for in vitro antibacterial activities against a number of bacterial strains using the disc diffusion assay. Both extracts showed similar antibacterial profi les, and the zones of inhibitions were >10 mm in the most cases. These extracts exhibited the most prominent activity against Enterobacter aerogenes, with the zones of inhibition of 19 and 21 mm, respectively. The minimum inhibitory concentration (MIC) was determined by the broth dilution method. The extract of X. moluccensis was the most potent against Shigella boydii and Shigella sonnie (MIC = 200 and 300 μg/mL, respectively). It can be assumed that that X. moluccensis and H. fomes could be potential sources for novel ‘lead’ discovery for antibacterial drug development