Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

A relação entre o dano de isquemia/reperfusão e o estímulo à fibrogênese em modelo experimental em fígado de ratos : comparando diferentes soluções de preservação

Introdução e objetivos: O transplante de fígado é o tratamento de escolha para muitas doenças agudas e crônicas do fígado. Embora a sobrevida tenha melhorado consideravelmente, a recidiva é frequente, especialmente na hepatite C. O dano de isquemia-reperfusão (I/R) é uma das principais causas de má-função do enxerto precocemente após um transplante hepático e influencia de forma adversa a sobrevida dos pacientes. Assim, utilizando-se a solução de preservação que propicie maior proteção ao dano de I/R e menos estresse oxidativo, deveremos ter menor produção de citocinas que desencadeiam o processo de fibrogênese,o qual sabemos estar presente na recidiva do vírus C. O emprego de uma solução de preservação que leve a menor dano de I/R deve influenciar no processo de fibrogênese, o que justifica seu estudo. Materiais e métodos: Fígados obtidos de 25 ratos Wistar machos foram divididos em 5 grupos experimentais, conforme a solução de preservação utilizada: solução fisiológica; solução da Universidade de Wisconsin (UW); fructose 1,6- bisfosfato( FBP); solução de SNAC 200 e solução de UW + SNAC (SNAC+UW). Os níveis de AST, ALT e LDH foram determinados em amostras do líquido de preservação em 2, 4 e 6 horas de isquemia a frio. Após 6 h, os fígados foram submetidos ao modelo de reperfusão hepática ex-situ por 15 minutos. AST, ALT, LDH e renina foram determinadas no sangue após a reperfusão. Foram seccionados fragmentos hepáticos para histologia, determinação de TBARS, catalase e glutationa, além da análise da expressão imunohistoquímica de TGF-β1e receptor AT1. Resultados: Em comparação à UW, durante a preservação a frio, AST foi significativamente menor nos grupos SF, FBP e SNAC 200 (p=0,001); ALT foi menor no grupo FBP (p= 0,023) e LDH foi menor nos grupos FBP e SNAC 200 p=(0,007). Após a reperfusão, os níveis séricos de AST, ALT, LDH e TBARS não diferiram entre os grupos. Os valores de catalase foram significativamente mais elevados com SNAC+UW (p= 0,013). Os valores de glutationa foram significativamente mais elevados com UW em relação a SF, FBP e SNAC 200 (p= 0,004). Os níveis de renina foram maiores para SNAC+UW comparando com FBP e SNAC (p=0,014) Não houve sinais histológicos de dano de preservação em nenhuma amostra, assim como não houve expressão hepática de TGF-β1e receptor AT1. Conclusão: neste modelo experimental de dano de reperfusão precoce, o dano de preservação promoveu elevação na atividade da renina,o primeiro passo para a fibrogênese. SNAC 200, um doador de óxido nítrico e FBP demonstraram efeito protetor neste contexto, tendo sido superiores a UW.Background/aims: Liver transplantation has been the standard treatment for patients suffering from acute and chronic liver disease. Although survival rate has improved considerably, relapses are frequent especially in patients with hepatitis C. Ischemia-reperfusion injury (I/R) is the one of the major causes of poor graft function early after liver transplantation and adversely influences patients’ survival. Therefore, using a preservation solution that shows a higher protective effect from I/R injury and lesser oxidative stress may lower the production of cytokines which are known for their role in fibrogenesis related to the relapse of C virus. Preservation solutions which lesser I/R injury and may prevent from fibrogenesis are an area of clinical interest that should be extensively studied. Materials and methods: Livers from 25 adult male Wistar rats were randomly assigned into five experimental groups according to preservation solution used: saline solution (SS); University of Wisconsin (UW) solution; Fructose 1, 6- biphosphate (FBP), SNAC 200 solution and UW solution + SNAC (SNAC+UW). AST, ALT and LDH were determined in samples in preservation solutions at 2, 4 and 6 hours of cold ischemia. After 6 hours, livers were applied to hepatic reperfusion models ex-situ for 15 minutes. Then, blood samples were taken for screening AST, ALT, LDH and renin levels after the reperfusion. Hepatic fragments were processed for histological studies, determination of TBARS, catalase and glutathione and expression of TGF-β1 and AT1 receptor. Results: Comparing to UW solution during cold storage, AST was significantly lower than in SS, FBP and SNAC 200 groups (p=0.001); ALT was lower in FBP group (p= 0.023) and LDH was lower in FBP and SNAC 200 groups (p=0.007). After reperfusion, serum levels of AST, ALT, LDH and TBARS showed no significant differences among the groups. Catalase was significantly higher in the SNAC+UW group (p=0.013). Compared to UW group, glutathione concentration was significantly higher in SS, FBP e SNAC 200 (p=0.004). Renin levels were higher in SNAC+UW group comparing to FBP and SNAC groups (p=0.014) No histological signs of preservation injury were found in the hepatic samples studied and expressions of TGF-β1and AT1 receptor were not detected either. Conclusion: In this experimental model of early reperfusion injury, preservation damages showed higher levels of renin which is widely known as the first stage of fibrogenesis. SNAC 200, NO donor and FBP showed a higher protective effect than UW in our study

A relação entre o dano de isquemia/reperfusão e o estímulo à fibrogênese em modelo experimental em fígado de ratos : comparando diferentes soluções de preservação

Introdução e objetivos: O transplante de fígado é o tratamento de escolha para muitas doenças agudas e crônicas do fígado. Embora a sobrevida tenha melhorado consideravelmente, a recidiva é frequente, especialmente na hepatite C. O dano de isquemia-reperfusão (I/R) é uma das principais causas de má-função do enxerto precocemente após um transplante hepático e influencia de forma adversa a sobrevida dos pacientes. Assim, utilizando-se a solução de preservação que propicie maior proteção ao dano de I/R e menos estresse oxidativo, deveremos ter menor produção de citocinas que desencadeiam o processo de fibrogênese,o qual sabemos estar presente na recidiva do vírus C. O emprego de uma solução de preservação que leve a menor dano de I/R deve influenciar no processo de fibrogênese, o que justifica seu estudo. Materiais e métodos: Fígados obtidos de 25 ratos Wistar machos foram divididos em 5 grupos experimentais, conforme a solução de preservação utilizada: solução fisiológica; solução da Universidade de Wisconsin (UW); fructose 1,6- bisfosfato( FBP); solução de SNAC 200 e solução de UW + SNAC (SNAC+UW). Os níveis de AST, ALT e LDH foram determinados em amostras do líquido de preservação em 2, 4 e 6 horas de isquemia a frio. Após 6 h, os fígados foram submetidos ao modelo de reperfusão hepática ex-situ por 15 minutos. AST, ALT, LDH e renina foram determinadas no sangue após a reperfusão. Foram seccionados fragmentos hepáticos para histologia, determinação de TBARS, catalase e glutationa, além da análise da expressão imunohistoquímica de TGF-β1e receptor AT1. Resultados: Em comparação à UW, durante a preservação a frio, AST foi significativamente menor nos grupos SF, FBP e SNAC 200 (p=0,001); ALT foi menor no grupo FBP (p= 0,023) e LDH foi menor nos grupos FBP e SNAC 200 p=(0,007). Após a reperfusão, os níveis séricos de AST, ALT, LDH e TBARS não diferiram entre os grupos. Os valores de catalase foram significativamente mais elevados com SNAC+UW (p= 0,013). Os valores de glutationa foram significativamente mais elevados com UW em relação a SF, FBP e SNAC 200 (p= 0,004). Os níveis de renina foram maiores para SNAC+UW comparando com FBP e SNAC (p=0,014) Não houve sinais histológicos de dano de preservação em nenhuma amostra, assim como não houve expressão hepática de TGF-β1e receptor AT1. Conclusão: neste modelo experimental de dano de reperfusão precoce, o dano de preservação promoveu elevação na atividade da renina,o primeiro passo para a fibrogênese. SNAC 200, um doador de óxido nítrico e FBP demonstraram efeito protetor neste contexto, tendo sido superiores a UW.Background/aims: Liver transplantation has been the standard treatment for patients suffering from acute and chronic liver disease. Although survival rate has improved considerably, relapses are frequent especially in patients with hepatitis C. Ischemia-reperfusion injury (I/R) is the one of the major causes of poor graft function early after liver transplantation and adversely influences patients’ survival. Therefore, using a preservation solution that shows a higher protective effect from I/R injury and lesser oxidative stress may lower the production of cytokines which are known for their role in fibrogenesis related to the relapse of C virus. Preservation solutions which lesser I/R injury and may prevent from fibrogenesis are an area of clinical interest that should be extensively studied. Materials and methods: Livers from 25 adult male Wistar rats were randomly assigned into five experimental groups according to preservation solution used: saline solution (SS); University of Wisconsin (UW) solution; Fructose 1, 6- biphosphate (FBP), SNAC 200 solution and UW solution + SNAC (SNAC+UW). AST, ALT and LDH were determined in samples in preservation solutions at 2, 4 and 6 hours of cold ischemia. After 6 hours, livers were applied to hepatic reperfusion models ex-situ for 15 minutes. Then, blood samples were taken for screening AST, ALT, LDH and renin levels after the reperfusion. Hepatic fragments were processed for histological studies, determination of TBARS, catalase and glutathione and expression of TGF-β1 and AT1 receptor. Results: Comparing to UW solution during cold storage, AST was significantly lower than in SS, FBP and SNAC 200 groups (p=0.001); ALT was lower in FBP group (p= 0.023) and LDH was lower in FBP and SNAC 200 groups (p=0.007). After reperfusion, serum levels of AST, ALT, LDH and TBARS showed no significant differences among the groups. Catalase was significantly higher in the SNAC+UW group (p=0.013). Compared to UW group, glutathione concentration was significantly higher in SS, FBP e SNAC 200 (p=0.004). Renin levels were higher in SNAC+UW group comparing to FBP and SNAC groups (p=0.014) No histological signs of preservation injury were found in the hepatic samples studied and expressions of TGF-β1and AT1 receptor were not detected either. Conclusion: In this experimental model of early reperfusion injury, preservation damages showed higher levels of renin which is widely known as the first stage of fibrogenesis. SNAC 200, NO donor and FBP showed a higher protective effect than UW in our study

Relação entre concentrações séricas de procolágeno tipo III, ácido hialurônico com achados histopatológicos do fígado em doadores de sangue anti-HCV positivos

Racional - Marcadores sorológicos têm sido propostos para monitorar fibrose hepática em doença crônica do fígado. Dentre os marcadores de fibrose, ácido hialurônico e procolágeno tipo III têm sido estudados nestes pacientes. Objetivo - Avaliar a associação de marcadores séricos de fibrose com achados histológicos. Métodos - Foi realizado estudo transversal prospectivo em doadores de sangue anti-HCV positivos. A população estudada incluiu homens e mulheres com idade entre 18-60 anos com provas de função hepática alteradas (níveis de alanina aminotransferase ≥1.5 vezes do normal e alterações de dois ou mais dos seguintes: qualquer alteração nos níveis de alanina aminotransferase, aspartato aminotransferase, bilirrubina conjugada, gamaglobulina, gamaglutamiltranspeptidase, albumina, plaquetas, níveis de fosfatase alcalina ≥1,5 vezes o valor normal, tempo de protrombina abaixo de 70% e acima de 60%). Quarenta e nove pacientes foram submetidos a biopsia hepática e coleta de sangue para análise de procolágeno tipo III, ácido hialurônico e provas funcionais hepáticas. Resultados - Não houve relação entre elevação de provas de função hepática e a presença de fibrose - ALT (≥1,5 vezes acima do normal, risco de fibrose = 18,8%; <1,5 vezes, 11,8%). Procolágeno tipo III elevado foi correlacionado com 66,7% chances de fibrose, enquanto nível normal, 9,3%. Ácido hialurônico, quando elevado, demonstrou chance de 33,3% de fibrose; quando normal, 12.5%. Conclusões - Não houve associação entre provas de função hepática, ácido hialurônico e fibrose, mas houve entre esta última e procolágeno tipo III. Talvez este marcador possa ser útil para avaliar fibrose em pacientes com hepatite crônica pelo vírus C.Background - Serologic markers have been proposed for monitoring hepatic fibrosis in chronic liver disease. Among fibrosis markers, type III procollagen (PIIIP) and hyaluronic acid have been studied in these patients. Aim - To evaluate the association between these serum markers with histological findings. Methods - A prospective cross-sectional study was carried out with HCV-positive blood donors. The studied population included men and women whose age ranged from 18 to 60 years, with elevated liver function tests [ALT levels ≥ 1.5 times the normal value and alterations of two or more of the following: any changes in the levels of ALT, aspartate aminotransferase, conjugated bilirrubin, gammaglobulin, gammaglutamyltranspeptidase, albumin, platelet count; alkaline phosphatase levels ≥1.5 times the normal value, or prothrombin time below 70% and above 60%]. Fourty-nine patients were submitted to liver biopsy, blood analysis of PIIIP, hyaluronic acid, besides liver function tests. Results - Liver function tests were not associated with tissular fibrosis, as assessed by ALT (≥1.5 times above normal, fibrosis risk=18.8%; <1.5 times, 11.8%). Elevated PIIIP was correlated with 66.7% chance of fibrosis, whereas normal levels, 9.3%. Hyaluronic acid, when elevated, gave a chance of 33.3% of fibrosis; when normal, 12.5%. Conclusions - There was no association between liver function tests, hyaluronic acid and fibrosis. However, PIIIP was related with liver fibrosis. Maybe, this marker should be useful to assess fibrosis in patients with chronic hepatitis C

Relationship between serum concetrations of type III procollagen, hyluronic acid and histopathological findings in the liver of HCV-positive blood donors

BACKGROUND: Serologic markers have been proposed for monitoring hepatic fibrosis in chronic liver disease. Among fibrosis markers, type III procollagen (PIIIP) and hyaluronic acid have been studied in these patients. AIM: To evaluate the association between these serum markers with histological findings. METHODS: A prospective cross-sectional study was carried out with HCV-positive blood donors. The studied population included men and women whose age ranged from 18 to 60 years, with elevated liver function tests [ALT levels > 1.5 times the normal value and alterations of two or more of the following: any changes in the levels of ALT, aspartate aminotransferase, conjugated bilirrubin, gammaglobulin, gammaglutamyltranspeptidase, albumin, platelet count; alkaline phosphatase levels >1.5 times the normal value, or prothrombin time below 70% and above 60%]. Fourty-nine patients were submitted to liver biopsy, blood analysis of PIIIP, hyaluronic acid, besides liver function tests. RESULTS: Liver function tests were not associated with tissular fibrosis, as assessed by ALT (>1.5 times above normal, fibrosis risk=18.8%; <1.5 times, 11.8%). Elevated PIIIP was correlated with 66.7% chance of fibrosis, whereas normal levels, 9.3%. Hyaluronic acid, when elevated, gave a chance of 33.3% of fibrosis; when normal, 12.5%. CONCLUSION: There was no association between liver function tests, hyaluronic acid and fibrosis. However, PIIIP was related with liver fibrosis. Maybe, this marker should be useful to assess fibrosis in patients with chronic hepatitis C

Um breve balanço da pesquisa sobre violência escolar no Brasil A brief survey of the research on school violence in Brazil

O artigo realiza balanço da pesquisa sobre as relações entre violência e escola no Brasil, após 1980. Examina os raros diagnósticos quantitativos em torno do tema e a produção discente (dissertações e teses) na pós-graduação em Educação, no mesmo período. Apesar de ainda ser incipiente, a produção já traça um quadro importante do fenômeno no Brasil, mostrando as principais modalidades: ações contra o patrimônio - depredações, pichações - e formas de agressão interpessoal, sobretudo entre os próprios alunos. Durante esse período a violência em meio escolar tanto foi examinada como decorrência de um conjunto significativo de práticas escolares inadequadas, quanto foi investigada como um dos aspectos que caracterizam a violência na sociedade contemporânea. Nesse último enfoque, parte dos trabalhos pesquisou a dinâmica de funcionamento de escolas situadas em áreas sob a influência do tráfico de drogas ou do crime organizado e um pequeno conjunto buscou entender o comportamento dos alunos como uma forma de sociabilidade marcada pelas agressões e pequenos delitos, caracterizada como incivilidade, que se origina na crise do processo civilizatório da sociedade contemporânea.<br>The article surveys the research on the relationships between violence and school in Brazil after 1980. It examines the rare quantitative diagnostics about the issue, and the theses and dissertations produced in graduate programs in Education in the same period. Although still incipient those studies already draw an important picture of the phenomenon in Brazil, displaying the leading modes of violence: acts against property - vandalism, graffiti - and interpersonal aggression, mainly among the pupils. During this period, violence at school has been examined both as a consequence of a significant set of inadequate school practices, and as one of the aspects that characterizes the violence of contemporary society. Under the latter viewpoint, some of the works have investigated the dynamics of the workings of schools located in areas influenced by drug traffic or organized crime, and a small subset tried to understand the behavior of pupils as a socialization marked by aggressions and petty crime, characterized as incivility originated in the crisis of civilizatory process of contemporary society