The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

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

Implementation of Crank-Nicolson scheme in cell dynamics simulation for diblock copolymers

Many computational techniques have been designed to study block copolymer systems. Cell Dynamics Simulation (CDS) technique is one of those. It is based on solving partial differential equations (PDEs) and is computationally very fast compared to other simulation methods. In this contribution the focus is made on finite difference schemes and their use in computer simulation of PDEs involved in diblock copolymers systems. The Crank-Nicolson (CN) scheme of finite difference method is implemented in CDS method. The CN scheme is unconditionally stable but slower compared to Forward Euler's method which is fast but not very stable

Efficacy of Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy In Treating Lower Pole Stones of 1-2 cms

Introduction Urologists are always inclined to find techniques with minimal complication and hospital stays with maximum stone-free rates to mitigate not only health concerns but financial burdens too. PCNL is known as the gold standard for large stones, however, RIRS is known for its less invasive and minor complications. Methodology This is a cross-sectional, prospective study conducted at the public hospital of Jamshoro. Patients with renal stones located at the lower pole, measuring 1-2 cm were included. Patients were evaluated before enrollment and detailed history was taken. Intraoperative and post-operative details were documented. SPSS 21 was used to analyze the data, and to assess significance chi-square test was used, a p-value &lt; 0.05 was considered significant. Results The mean age was 42.7 ± 12.8 and 43.2 ± 13.2 in the RIRS and PCNL groups respectively. The RIRS group showed 07 (17.5%) partial clearance cases while PCNL group showed 02 (5%). Hemoglobin drop was measured as minimal (&lt; 2.5ml) and excessive (&gt;2.5ml) after surgery, and only 01 (2.5%) cases of RIRS had excessive blood loss, PCNL group had higher hemoglobin drop cases with 3 (7.5%) cases. Blood transfusion was required in 1 (2.5%) and 2 (5%) cases in the RIRS and PCNL groups respectively. Conclusion RIRS can be beneficial in small stones while PCNL can be an ideal procedure for lower pole renal stones of 1-2 cm size

Effectiveness Of Double J Stent With Extracorporeal Shockwave Lithotripsy: An Analysis Of Stone-Free Rates

Introduction: Preservation of renal function and integrity is of profound importance and therefore renders stent-related symptoms a secondary concern. The usage of DJ stent is known for decades to support stone removal, this study aims to assess the effect of DJ stent after extracorporeal shock wave lithotripsy for stone removal and DJ stent-related complications in adult patients. Methods: This is a prospective, comparative study, Patients were selected after being diagnosed with established radiological evidence of a single radio-opaque stone ≤ 2 cm. The presence of the visible radio-opaque shadow post-procedure indicated residual stones and negative results. Primary follow-up was recommended after 2 weeks post-procedure and participants were inquired about all the anticipated complications, data was entered on SPSS version 23.0 for analysis. The chi-square test was applied to assess the significance and a p-value ≤ 0.05 was deemed significant for our results. Results: The sample size of the study was 150, sorted equally into two separated groups categorized by presence and absence of DJ stent after ESWL, stone size was almost similar to avoid any confounding factor with the mean value of 1.24 ± 0.2 in group A and 1.6 ± 0.1 in group B, with a p-value of 0.05. Hematuria was categorized within mild 6(4%) &amp; 7(4.6%), moderate 6(4%) &amp; 5(3.3%) while gross hematuria was reported in 1(0.6%) &amp; 2(1.3%) in group A and B respectively. Conclusion: This study concluded that using a DJ stent with ESWL does not help in the stone passage or improve stone-free rates of stone removal after breaking the calculi with shockwave lithotripsy

Effect of alcoholic and nano-particles additives on tribological properties of diesel–palm–sesame–biodiesel blends

This study focused on evaluating the lubricity of diesel–biodiesel fuel with oxygenated alcoholic and nano-particle additives. Fuel injection system lubrication depended primarily on the fuel used in the diesel engine. Palm–sesame oil blend was used to produce biodiesel using the ultrasound-assisted technique. B30 fuel sample as a base fuel was blended with fuel additives in different proportions prior to tribological behavior analysis. The lubricity of fuel samples measured using HFRR in accordance with the standard method ASTM D6079. All tested fuels’ Tribological behavior examined through worn steel balls and plates using scanning electron microscopy (SEM) to assess wear scar diameter and surface morphology. During the test run, the friction coefficient was measured directly by the HFRR tribometer system. The results exhibited that B10 (diesel) had a very poor coefficient of friction and wear scar diameter, among other tested fuels. The addition of oxygenated alcohol (ethanol) as a fuel additive in the B30 fuel sample decreased the lubricity of fuel and increased the wear and friction coefficient, among other fuel additives. B30 with DMC showed the least wear scar diameter among all tested fuels. B30 with nanoparticle TiO2 exhibited the best results with the least wear scar diameter and lowest friction coefficient among all other fuel samples. B30+DMC demonstrated significant improvement in engine performance (BTE) and carbon emissions compared to different tested samples. B30+TiO2 also showed considerable improvement in engine characteristics

Death in hospital following ICU discharge: insights from the LUNG SAFE study

ackground: To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods: The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conducted across 459 ICUs from 50 countries globally. This study aimed to understand the frequency and factors associated with death in hospital in patients who survived their ICU stay. We examined outcomes in the subpopulation discharged with no limitations of life sustaining treatments ('treatment limitations'), and the subpopulations with treatment limitations. Results: 2186 (94%) patients with no treatment limitations discharged from ICU survived, while 142 (6%) died in hospital. 118 (61%) of patients with treatment limitations survived while 77 (39%) patients died in hospital. Patients without treatment limitations that died in hospital after ICU discharge were older, more likely to have COPD, immunocompromise or chronic renal failure, less likely to have trauma as a risk factor for ARDS. Patients that died post ICU discharge were less likely to receive neuromuscular blockade, or to receive any adjunctive measure, and had a higher pre- ICU discharge non-pulmonary SOFA score. A similar pattern was seen in patients with treatment limitations that died in hospital following ICU discharge. Conclusions: A significant proportion of patients die in hospital following discharge from ICU, with higher mortality in patients with limitations of life-sustaining treatments in place. Non-survivors had higher systemic illness severity scores at ICU discharge than survivors