Risk factors for recurrence of stage I/II (TNM) colorectal adenocarcinoma in patients undergoing surgery with curative intent

Objective: Evaluate risk factors for colorectal cancer recurrence after surgical treatment. Methods: Sixty-five patients with colorectal adenocarcinoma, stage I and II (TNM), undergoing curative-intent surgery and followed for five years were studied. Presence of adjuvant/neo adjuvant therapy, tumor differentiation degree, lymphatic and venous vascular infiltration, depth of tumor invasion, and disease staging was analyzed, using recurrence relative risk ratios for each parameter calculated at two years, after two years and five years of follow up. Results: At five years, recurrence was 21.4% (14/65), with equal incidence (10.7%) for the separated periods. Only lymphatic and venous vascular infiltration showed statistically significant association with recurrence during times analyzed. Relative risk (RR) of recurrence was significantly related to the presence of lymphatic infiltration [RR = 6 (1.3 – 28.5) p = 0.01] and venous infiltration [RR = 9.5 (2.6 – 34.9) p < 0.001] after two years of follow-up. At five years follow-up, only venous infiltration remained with significant relative risk for recurrence [RR = 3.9 (1.8 – 8.8) p < 0.001]. In a multivariate analysis, only venous vascular infiltration was associated with recurrence [accuracy 81.5% (p < 0.001)]. Conclusion: In this series, the factors associated with risk of colorectal cancer recurrence were the presence of lymphatic and venous vascular infiltration. Resumo: Objetivo: Analisar fatores de risco para recidiva de câncer colorretal após tratamento cirúrgico. Método: Avaliou-se 65 pacientes com adenocarcinoma colorretal, estadio I e II (TNM), submetidos à cirurgia com intenção curativa, acompanhados por cinco anos após a operação. Analisou-se presença de tratamento adjuvante/neoadjuvante, grau de diferenciação do tumor, infiltração vascular linfática e venosa, profundidade de invasão tumoral e estadiamento da doença, estabelecendo-se para cada um o risco relativo de recidiva aos dois anos, após dois anos e aos cinco anos de seguimento. Resultados: Recidiva global em cinco anos foi 21,4% (14/65), com idêntica incidência (10,7%) nos períodos separados. Somente as infiltrações vasculares linfáticas e venosas apresentaram associação estatisticamente significativa com a recidiva nos períodos de análise. Encontrou-se risco relativo (RR) estatisticamente significativo após dois anos relacionados à presença de infiltração linfática [RR = 6 (1,3 – 28,5) p = 0,01] e infiltração venosa [RR = 9,5 (2,6 – 34,9) p < 0,001]. Após cinco anos, apenas a infiltração venosa manteve a significância estatística, com risco relativo elevado para ocorrência de recidiva [RR = 3,9 (1,8 – 8,8) p < 0.001]. Na análise multivariada apenas a presença de infiltração vascular venosa com 81,5% de acerto foi associada à recidiva (p < 0.001). Conclusão: Nesta série, os únicos fatores associados com risco de recidiva do câncer colorretal foram a presença de infiltração vascular linfática e venosa. Keywords: Neoplastic invasiveness, Adenocarcinoma, Prognosis, Colorectal neoplasms, Palavras-chave: Invasividade neoplásica, Adenocarcinoma, Prognóstico, Neoplasias colorretai

INTERSEPT study: we still need more clarity

Universidade Federal de São Paulo, Hosp São Paulo, Anesthesiol & Crit Care Dept, BR-04024900 São Paulo, BrazilHosp Dona Helena, BR-89204205 Joinville, SC, BrazilHosp Procardiaco, BR-22280000 Rio de Janeiro, BrazilUniv Fed Paraiba, Univ Hosp, BR-58000000 Joao Pessoa, Paraiba, BrazilHosp Base, Intens Care Div, Dept Internal Med, Fac Med Sao Jose Rio Preto, BR-15090000 Sao Jose Do Rio Preto, SP, BrazilHosp Copa DOr, BR-22031011 Rio de Janeiro, BrazilHosp Santo Amaro, BR-40210320 Salvador, BA, BrazilHosp Portugues, Salvador, BA, BrazilHosp Salvador, Salvador, BA, BrazilCtr Hosp UNIMED, BR-89204060 Joinville, SC, BrazilUniversidade Federal de São Paulo, Hosp São Paulo, Anesthesiol & Crit Care Dept, BR-04024900 São Paulo, BrazilWeb of Scienc

MaNGA 8313-1901 : gas accretion observed in a blue compact dwarf galaxy

Gas accretion is an important process in the evolution of galaxies, but it has limited direct observational evidences. In this paper, we report the detection of a possible ongoing gas accretion event in a blue compact dwarf (BCD) galaxy, MaNGA 8313-1901, observed by the Mapping Nearby Galaxies and Apache Point Observatory (MaNGA) program. This galaxy has a distinct off-centered blue clump to the northeast (the NE clump) that shows low metallicity and enhanced star formation. The kinematics of the gas in the NE clump also seems to be detached from the host BCD galaxy. Together with the metallicity drop of the NE clump, it suggests that the NE clump likely has an external origin, such as gas accretion or galaxy interaction, rather than an internal origin, such as an H II complex in the disk. After removing the underlying host component, we find that the spectrum of the “pure” clump can match very well with a modeled spectrum containing a stellar population of the young stars (7 Myr) only. This may imply that the galaxy is experiencing an accretion of cold gas, instead of a merger event involving galaxies with significant preexisting old stars. We also find signs of another clump (the SW clump) at the southwest corner of the host galaxy, and the two clumps may share the same origin of gas accretion

Galaxy evolution in compact groups I: Revealing a transitional galaxy population through a multiwavelength approach

Compact groups of galaxies (CGs) show members with morphological disturbances, mainly products of galaxy-galaxy interactions, thus making them ideal systems to study galaxy evolution, in high-density environment. To understand how this environment affects the properties of galaxies, we select a sample of 340 CGs in the Stripe 82 region, for a total of 1083 galaxies, and a sample of 2281 field galaxies as a control sample. By performing a multi-wavelength morphological fitting process using S-PLUS data, we divide our sample into early-type (ETG), late-type (LTG), and transition galaxies using the r-band S\'ersic index and the colour (u-r). We find a bimodal distribution in the plane of the effective radius-S\'ersic index, where a secondary "peculiar" galaxy population of smaller and more compact galaxies is found in CGs, which is not observed in the control sample. This indicates that galaxies are undergoing a morphological transformation in CGs. In addition, we find significant statistical differences in the distribution of specific Star Formation Rate (sSFR) when we compare both environments for LTGs and ETGs. We also find a higher fraction of quenched galaxies and a lower median sSFR in CGs than in the control sample, suggesting the existence of environmental effects favoring the cessation of star formation, regardless of galaxy type. Our results support the notion that CGs promote morphological and physical transformations, highlighting their potential as ideal systems for galaxy pre-processing.Comment: 17 pages, 15 figures. Accepted for publication in MNRA

SDSS IV MaNGA : metallicity and ionisation parameter in local star-forming galaxies from Bayesian fitting to photoionisation models

We measured gas-phase metallicity, ionisation parameter, and dust extinction for a representative sample of 1795 local star-forming galaxies using integral field spectroscopy from the SDSS-IV MaNGA survey. We self-consistently derive these quantities by compar ing observed line fluxes with photoionisation models using a Bayesian framework. We also present the first comprehensive study of the [S iii]λλ9069,9532 nebular lines, which have long been predicted to be ideal tracers of the ionisation parameter. However, we find that current photoionisation model predictions substantially over-predict the intensity of the [S iii] lines, while broadly reproducing other observed optical line ratios. We discuss how to nonetheless make use of the information provided by the [S iii] lines by setting a prior on the ionisation parameter. Following this approach, we derive spatially resolved maps and radial profiles of metallicity and ionisation parameter. The metallicity radial profiles derived are comparable with previous works, with metallicity declining toward the outer parts and showing a flattening in the central regions. This is in agreement with infall models of galaxy formation, which predict that spiral discs build up through accretion of material, leading to an inside-out growth. On the other hand, ionisation parameter radial profiles are flat for low-mass galaxies, while their slope becomes positive as galaxy mass increases. However, the ionisation parameter maps we obtain are clumpy, especially for low-mass galaxies. The ionisation parameter is tightly correlated with the equivalent width of Hα [EW(Hα)], following a nearly universal relation, which we attribute to the change of the spectral shape of ionising sources due to ageing of Hii regions. We derive a positive correlation between ionisation parameter and metallicity at fixed EW(Hα), in disagreement with previous theoretical work that predict an anti-correlation

The Science Case for Multi-Object Spectroscopy on the European ELT

This White Paper presents the scientific motivations for a multi-object spectrograph (MOS) on the European Extremely Large Telescope (E-ELT). The MOS case draws on all fields of contemporary astronomy, from extra-solar planets, to the study of the halo of the Milky Way and its satellites, and from resolved stellar populations in nearby galaxies out to observations of the earliest 'first-light' structures in the partially-reionised Universe. The material presented here results from thorough discussions within the community over the past four years, building on the past competitive studies to agree a common strategy toward realising a MOS capability on the E-ELT. The cases have been distilled to a set of common requirements which will be used to define the MOSAIC instrument, entailing two observational modes ('high multiplex' and 'high definition'). When combined with the unprecedented sensitivity of the E-ELT, MOSAIC will be the world's leading MOS facility. In analysing the requirements we also identify a high-multiplex MOS for the longer-term plans for the E-ELT, with an even greater multiplex (>1000 targets) to enable studies of large-scale structures in the high-redshift Universe. Following the green light for the construction of the E-ELT the MOS community, structured through the MOSAIC consortium, is eager to realise a MOS on the E-ELT as soon as possible. We argue that several of the most compelling cases for ELT science, in highly competitive areas of modern astronomy, demand such a capability. For example, MOS observations in the early stages of E-ELT operations will be essential for follow-up of sources identified by the James Webb Space Telescope (JWST). In particular, multi-object adaptive optics and accurate sky subtraction with fibres have both recently been demonstrated on sky, making fast-track development of MOSAIC feasible.Comment: Significantly expanded and updated version of previous ELT-MOS White Paper, so there is some textual overlap with arXiv:1303.002

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Microcirurgia endoscópica transanal e tratamento adjuvante no câncer retal precoce

RACIONAL: A excisão total do mesorreto é considerada a operação padrão no tratamento dos tumores do reto, apesar de não existir comprovação científica de que ela deva ser usada para todos os estádios da doença. Tem sido demonstrado que em casos escolhidos de tumores retais, resultados promissores podem ser conseguidos com tratamento local por microcirurgia endoscópica transanal. Tais tumores, denominados de câncer retal precoce, são tumores T1 - menores do que 4 cm -, bem diferenciados sem invasão angiolinfática pT1 Sm1. Como o risco de comprometimento linfonodal nesses tumores é de aproximadamente 3%, a ressecção local teria grande chance de ser curativa. OBJETIVO: Apresentar os resultados de uma série prospectiva não randômica de pacientes portadores de câncer retal precoce submetidos ao tratamento local por microcirurgia endoscópica transanal. MÉTODOS: Entre 2002 e 2010, 38 pacientes avaliados por protocolo pré-operatório como portadores câncer retal precoce foram submetidos à ressecção local endoscópica microcirúrgica de toda a parede retal com o tumor quando localizado entre 2 e 8 cm da linha pectínea. A avaliação pré-operatória consistiu de toque retal, retossigmoidoscopia rígida para macrobiópsias, enema opaco e/ou colonoscopia, ultrassonografia endoretal e abdominal, tomografia axial computadorizada do abdome, radiografia do tórax e dosagem sérica do CEA. Realizou-se seguimento pós-operatório endoscópico e ultrassonográfico endoretal a cada três meses nos dois primeiros anos, e a cada seis nos próximos três anos, além de dosagem do CEA a cada seis meses nesse mesmo período de cinco anos. Avaliou-se a recidiva tumoral, morbidade e mortalidade. RESULTADOS: Após avaliação anatomopatológica da lesão, 29 cânceres retais precoces foram categorizados como de baixo risco e nove sendo de alto. O seguimento na série variou de um a sete anos. Recidiva tumoral foi confirmada em dois casos dos 38 (5,26%), uma lesão considerada de alto e a outra de baixo risco. CONCLUSÃO: Microcirurgia endoscópica transanal, associada ou não à quimioradioterapia, pode ser considerada atualmente o padrão-ouro na ressecção retal local, apresentando resultados animadores em casos escolhidos de tumores retais precoces de baixo risco