Analysis of delayed surgical treatment and oncologic outcomes in clinical stage I non-small cell lung cancer

Importance: The association between delayed surgical treatment and oncologic outcomes in patients with non-small cell lung cancer (NSCLC) is poorly understood given that prior studies have used imprecise definitions for the date of cancer diagnosis. Objective: To use a uniform method to quantify surgical treatment delay and to examine its association with several oncologic outcomes. Design, Setting, and Participants: This retrospective cohort study was conducted using a novel data set from the Veterans Health Administration (VHA) system. Included patients had clinical stage I NSCLC and were undergoing resection from 2006 to 2016 within the VHA system. Time to surgical treatment (TTS) was defined as the time between preoperative diagnostic computed tomography imaging and surgical treatment. We evaluated the association between TTS and several delay-associated outcomes using restricted cubic spline functions. Data analyses were performed in November 2021. Exposure: Wait time between cancer diagnosis and surgical treatment (ie, TTS). Main Outcomes and Measures: Several delay-associated oncologic outcomes, including pathologic upstaging, resection with positive margins, and recurrence, were assessed. We also assessed overall survival. Results: Among 9904 patients who underwent surgical treatment for clinical stage I NSCLC, 9539 (96.3%) were men, 4972 individuals (50.5%) were currently smoking, and the mean (SD) age was 67.7 (7.9) years. The mean (SD) TTS was 70.1 (38.6) days. TTS was not associated with increased risk of pathologic upstaging or positive margins. Recurrence was detected in 4158 patients (42.0%) with median (interquartile range) follow-up of 6.15 (2.51-11.51) years. Factors associated with increased risk of recurrence included younger age (hazard ratio [HR] for every 1-year increase in age, 0.992; 95% CI, 0.987-0.997; P = .003), higher Charlson Comorbidity Index score (HR for every 1-unit increase in composite score, 1.055; 95% CI, 1.037-1.073; P \u3c .001), segmentectomy (HR vs lobectomy, 1.352; 95% CI, 1.179-1.551; P \u3c .001) or wedge resection (HR vs lobectomy, 1.282; 95% CI, 1.179-1.394; P \u3c .001), larger tumor size (eg, 31-40 mm vs \u3c10 mm; HR, 1.209; 95% CI, 1.051-1.390; P = .008), higher tumor grade (eg, II vs I; HR, 1.210; 95% CI, 1.085-1.349; P \u3c .001), lower number of lymph nodes examined (eg, ≥10 vs \u3c10; HR, 0.866; 95% CI, 0.803-0.933; P \u3c .001), higher pathologic stage (III vs I; HR, 1.571; 95% CI, 1.351-1.837; P \u3c .001), and longer TTS, with increasing risk after 12 weeks. For each week of surgical delay beyond 12 weeks, the hazard for recurrence increased by 0.4% (HR, 1.004; 95% CI, 1.001-1.006; P = .002). Factors associated with delayed surgical treatment included African American race (odds ratio [OR] vs White race, 1.267; 95% CI, 1.112-1.444; P \u3c .001), higher area deprivation index [ADI] score (OR for every 1 unit increase in ADI score, 1.005; 95% CI, 1.002-1.007; P = .002), lower hospital case load (OR for every 1-unit increase in case load, 0.998; 95% CI, 0.998-0.999; P = .001), and year of diagnosis, with less recent procedures more likely to have delay (OR for each additional year, 0.900; 95% CI, 0.884-0.915; P \u3c .001). Patients with surgical treatment within 12 weeks of diagnosis had significantly better overall survival than those with procedures delayed more than 12 weeks (HR, 1.132; 95% CI, 1.064-1.204; P \u3c .001). Conclusions and Relevance: Using a more precise definition for TTS, this study found that surgical procedures delayed more than 12 weeks were associated with increased risk of recurrence and worse survival. These findings suggest that patients with clinical stage I NSCLC should undergo expeditious treatment within that time frame

Inhaled medications for chronic obstructive pulmonary disease predict surgical complications and survival in stage I non-small cell lung cancer

BACKGROUND: Lung function is routinely assessed prior to surgical resection for non-small cell lung cancer (NSCLC). Further assessment of chronic obstructive pulmonary disease (COPD) using inhaled COPD medications to determine disease severity, a readily available metric of disease burden, may predict postoperative outcomes and overall survival (OS) in lung cancer patients undergoing surgery. METHODS: We retrospectively evaluated clinical stage I NSCLC patients receiving surgical treatment within the Veterans Health Administration from 2006-2016 to determine the relationship between number and type of inhaled COPD medications (short- and long-acting beta2-agonists, muscarinic antagonists, or corticosteroids prescribed within 1 year before surgery) and postoperative outcomes including OS using multivariable models. We also assessed the relationship between inhaled COPD medications, disease severity [measured by forced expiratory volume in 1 second (FEV1)], and diagnosis of COPD. RESULTS: Among 9,741 veterans undergoing surgery for clinical stage I NSCLC, patients with COPD were more likely to be prescribed inhaled medications than those without COPD [odds ratio (OR) =5.367, 95% confidence interval (CI): 4.886-5.896]. Increased severity of COPD was associated with increased number of prescribed inhaled COPD medications (P\u3c0.0001). The number of inhaled COPD medications was associated with prolonged hospital stay [adjusted OR (aOR) =1.119, 95% CI: 1.076-1.165), more major complications (aOR =1.117, 95% CI: 1.074-1.163), increased 90-day mortality (aOR =1.088, 95% CI: 1.013-1.170), and decreased OS [adjusted hazard ratio (aHR) =1.061, 95% CI: 1.042-1.080]. In patients with FEV1 ≥80% predicted, greater number of prescribed inhaled COPD medications was associated with increased 30-day mortality (aOR =1.265, 95% CI: 1.062-1.505), prolonged hospital stay (aOR =1.130, 95% CI: 1.051-1.216), more major complications (aOR =1.147, 95% CI: 1.064-1.235), and decreased OS (aHR =1.058, 95% CI: 1.022-1.095). When adjusting for other drug classes and covariables, short-acting beta2-agonists were associated with increased 90-day mortality (aOR =1.527, 95% CI: 1.120-2.083) and decreased OS (aHR =1.087, 95% CI: 1.005-1.177). CONCLUSIONS: In patients with early-stage NSCLC, inhaled COPD medications prescribed prior to surgery were associated with both short- and long-term outcomes, including in patients with FEV1 ≥80% predicted. Routine assessment of COPD medications may be a simple method to quantify operative risk in early-stage NSCLC patients

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

A comparative evaluation of intraperitoneal instillation of 0.25% ropivacine alone or with dexmedetomidine for postoperative analgesia following laparoscopic cholecystectomy

Intraperitoneal instillation of local anesthetic agent with or without adjuvant in laparoscopic surgeries is a common practice now a days. This study aimed to assess the efficacy and safety of addition of dexmedetomidine (1µg/kg) to 0.25% ropivacaine by intraperitoneal instillation for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. This prospective, randomized, double blind study was conducted on 80 patients of &nbsp;American society of Anaesthesiologists (ASA) &nbsp;grade I and II, either sex, aged 18 to 60 years enrolled for laparoscopic cholecystectomy to receive either Ropivacaine (0.25%) 30ml + 5 ml&nbsp; Normal saline (NS) in group R (n=40) or Ropivacaine (0.25%) 30ml + Dexmedetomidine (1µg/kg) + 5ml with NS&nbsp; in group RD (n=40) by intraperitoneal instillation, before removing trocar. All&nbsp; patients received infiltration of 20mL of (0.25%)&nbsp; ropivacaine at trocar insertion site, being 6 ml in umbilical incision, 6 ml in epigastric incision and&nbsp; 4 ml in both working portals after gall bladder removal. Duration of analgesia using &nbsp;Visual analog scale (VAS) score, total amount of rescue analgesic in 24 hrs, hemodynamic parameters, and any adverse effects were monitored. Student t test was used to analyze the metric parameters and chi square test was used to compare the categorical variables.&nbsp

A Comparative Evaluation of Intraperitoneal Instillation of 0.25% Ropivacine Alone or with Dexmedetomidine for Postoperative Analgesia Following Laparoscopic Cholecystectomy

Intraperitoneal instillation of local anesthetic agent with or without adjuvant in laparoscopic surgeries is a common practice now a days. This study aimed to assess the efficacy and safety of addition of dexmedetomidine (1µg/kg) to 0.25% ropivacaine by intraperitoneal instillation for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. This prospective, randomized, double blind study was conducted on 80 patients of &nbsp;American society of Anaesthesiologists (ASA) &nbsp;grade I and II, either sex, aged 18 to 60 years enrolled for laparoscopic cholecystectomy to receive either Ropivacaine (0.25%) 30ml + 5 ml&nbsp; Normal saline (NS) in group R (n=40) or Ropivacaine (0.25%) 30ml + Dexmedetomidine (1µg/kg) + 5ml with NS&nbsp; in group RD (n=40) by intraperitoneal instillation, before removing trocar. All&nbsp; patients received infiltration of 20mL of (0.25%)&nbsp; ropivacaine at trocar insertion site, being 6 ml in umbilical incision, 6 ml in epigastric incision and&nbsp; 4 ml in both working portals after gall bladder removal. Duration of analgesia using &nbsp;Visual analog scale (VAS) score, total amount of rescue analgesic in 24 hrs, hemodynamic parameters, and any adverse effects were monitored. Student t test was used to analyze the metric parameters and chi square test was used to compare the categorical variables.&nbsp

Transfer of metals from crude oil impacted soils to some native wetland species, the Niger-delta, Nigeria: Implications for phytoremediation potentials

In this study, wetland species growing naturally in the surrounding of two crude oil facilities were sampled and screened for their phytoremediation potentials for zinc, lead, nickel, chromium and cadmium in soil. Concentrations of metals in the root and shoot samples of the wetland species alongside the rhizosphere soil were determined. Metal accumulation in wetland species exceeded the permissible limits, but it was still within phytotoxic thresholds except for chromium. The use of a bioconcentration factor and a transfer factor to screen the wetland species for phytoremediation potentials identified six out of the eight studied species as multi-elemental phytostabilizers of metals in soil. In addition, five of the eight wetland species displayed potentials for phytoextraction of metal, though there was no multi-elemental phytoextractor among the wetland species. Paspalum vaginatum, Andropogon tectorum and Kyllinga squamata portend potential abilities to phytoextract nickel. In addition, Setaria longiseta and Pteridium aquilinum also showed strong potential to phytoextract lead and cadmium respectively from soil. This screening assessment is hoped to be useful in the applications of a cost-effective green technology to remediate heavy metals in contaminated soil

From Camera to Deathbed: Understanding Dangerous Selfies on Social Media

Selfie culture has emerged as a ubiquitous instrument for self portrayal in recent years. To portray themselves differently and attractive to others, individuals may risk their life by clicking selfies in dangerous situations. Consequently, selfies have claimed 137 lives around the world since March 2014 until December 2016. In this work, we perform a comprehensiv analysis of the reported selfie-casualties and note various reasons behind these deaths. We perform an in-depth analysis of such selfies posted on social media to identify dangerous selfies and explore a series of statistical models to predict dangerous posts. We find that our multimodal classifier using combination of text-based, image-based and location-based features performs the best in spotting dangerous selfies. Our classifier is trained on 6K annotated selfies collected on Twitter and gives 82% accuracy for identifying whether a selfie posted on Twitter is dangerous or not