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

Determination of trace amounts of sulfur dioxide and inorganic sulfide in the environment by biamperometric titration

A titulação biamperométrica mostra possibilidades mais amplas que as relatadas em livros-texto, podendo-se analisar traços com elevadas precisão e exatidão. Duas aplicações foram demonstradas no presente trabalho: as determinações de SO2 e S-- inorgânico em efluentes, com enormes vantagens sobre os respectivos métodos espectrofotométricos. Em poucos minutos pode-se determinar 13 ppb de SO2 (recolhidos em TCM) com precisão de 7,7% e de 10 ppb de H2S (após separação do efluente) com precisão de 8,1%. Foram efetuadas anâlises de amostras naturais gentilmente cedidas pela CETESB e confrontadas com os métodos de referência, encontrando-se perfeita concordância nos resultados.The biamperometric titration as studied, shows wider possibilities than classical interpretation reported in the text-books. This technique studied in this thesis shows tremendous applications in trace analysis, with higer accuracy and precision. In the present thesis, two applications of The technique were made: the determinations of SO2 in the atmosphere and inorganic S-- in waters, with advantages over the respective spectrophotometric methods. In few minutes one can determine 13 ppb the SO2 (absorved in TCM) with 7,7% accuracy and 10 ppb the S-- (after recovery in ZnAc2) with 8,1% accuracy. Natural samples offered by CETESB (Environmental Protection Agency of the State of São Paulo) and the results found were in good agreement with those obtained by the reference methods

Determination of trace amounts of sulfur dioxide and inorganic sulfide in the environment by biamperometric titration

A titulação biamperométrica mostra possibilidades mais amplas que as relatadas em livros-texto, podendo-se analisar traços com elevadas precisão e exatidão. Duas aplicações foram demonstradas no presente trabalho: as determinações de SO2 e S-- inorgânico em efluentes, com enormes vantagens sobre os respectivos métodos espectrofotométricos. Em poucos minutos pode-se determinar 13 ppb de SO2 (recolhidos em TCM) com precisão de 7,7% e de 10 ppb de H2S (após separação do efluente) com precisão de 8,1%. Foram efetuadas anâlises de amostras naturais gentilmente cedidas pela CETESB e confrontadas com os métodos de referência, encontrando-se perfeita concordância nos resultados.The biamperometric titration as studied, shows wider possibilities than classical interpretation reported in the text-books. This technique studied in this thesis shows tremendous applications in trace analysis, with higer accuracy and precision. In the present thesis, two applications of The technique were made: the determinations of SO2 in the atmosphere and inorganic S-- in waters, with advantages over the respective spectrophotometric methods. In few minutes one can determine 13 ppb the SO2 (absorved in TCM) with 7,7% accuracy and 10 ppb the S-- (after recovery in ZnAc2) with 8,1% accuracy. Natural samples offered by CETESB (Environmental Protection Agency of the State of São Paulo) and the results found were in good agreement with those obtained by the reference methods

Evaluation of Cu, Mn, and Se in Vegetables Using Ultrasonic Extraction and GFAAS Quantification

This paper proposes a method for the determination of copper, manganese, and selenium in vegetables of conventional and organic farming in the state of So Paulo/Brazil using ultrasonic extraction of analytes and subsequent quantification by graphite furnace atomic absorption spectrometry (GFAAS). Using 0.10 mol L(-1) of hydrochloric acid as the extracting solution, the following optimal extraction conditions were established: sample mass of 100 mg, sample grain size of < 60 mu m, sonication time of five cycles of 40 s, and sonication power of 136 W. The analytes were determined by GFAAS, applying drying temperatures of 90 A degrees C to 250 A degrees C, pyrolysis temperature of 1,300 A degrees C, atomization temperature of 2,300 A degrees C, and cleaning temperature of 2,800 A degrees C. Palladium nitrate was co-injected with the samples as a chemical modifier and tungsten as a permanent modifier. The accuracy and precision of the proposed extraction method were evaluated based on a certified standard, RM 8433 Corn Bran (NIST RM 8433). The results obtained by the ultrasonic extraction method were equivalent to those obtained by the method of acid mineralization of samples in a microwave oven. However, the proposed methodology reduces the analytical time considerably, favoring the analytical speed. Moreover, the quantity of residues generated and discharged into the environment is also considerably lower.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit