Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Liquid biopsies come of age: towards implementation of circulating tumour DNA

Improvements in genomic and molecular methods are expanding the range of potential applications for circulating tumour DNA (ctDNA), both in a research setting and as a ‘liquid biopsy’ for cancer management. Proof-of-principle studies have demonstrated the translational potential of ctDNA for prognostication, molecular profiling and monitoring. The field is now in an exciting transitional period in which ctDNA analysis is beginning to be applied clinically, although there is still much to learn about the biology of cell-free DNA. This is an opportune time to appraise potential approaches to ctDNA analysis, and to consider their applications in personalized oncology and in cancer research.We would like to acknowledge the support of The University of Cambridge, Cancer Research UK (grant numbers A11906, A20240, A15601) (to N.R., J.D.B.), the European Research Council under the European Union's Seventh Framework Programme (FP/2007-2013)/ERC Grant Agreement n. 337905 (to N.R.), the Cambridge Experimental Cancer Medicine Centre, and Hutchison Whampoa Limited (to N.R.), AstraZeneca (to R.B., S.P.), the Cambridge Experimental Cancer Medicine Centre (ECMC) (to R.B., S.P.), and NIHR Biomedical Research Centre (BRC) (to R.B., S.P.). J.G.C. acknowledges clinical fellowship support from SEOM

Efeito da Energia, Relação Energia: Proteína e Fase de Crescimento Sobre o Desempenho e Composição de Carcaça de Frangos de Corte Effect of Energy, Energy: Protein Ratio and Growing Phase on The Performance and Carcass Composition of Broilers

Dois experimentos (EXP) avaliaram os efeitos da redução de proteína bruta (PB) em dietas com alta (A) (3.200kcal EM/kg) e baixa (B) (2.900kcal EM/kg) energia, sobre o desempenho e composição de carcaças de frangos de corte machos. Os níveis de PB foram reduzidos para obter as relações energia: proteína (E:PB) 139, 146, 153 e 160 (kcal/%) para as dietas iniciais (EXP 1), e 160, 167, 174 e 181(kcal/%) para as dietas de crescimento (EXP 2), em ambos os níveis de energia, mantendo constantes os níveis de MET+CIS e LIS. Todas as aves receberam uma mesma dieta antes (EXP 2) ou após (EXP 1) o fornecimento das dietas experimentais. O fornecimento das dietas A proporcionou melhor desempenho, no entanto resultou em maior deposição de gordura nas carcaças. No EXP 1, as aves alimentadas com as dietas B apresentaram ganho de peso (GP) similar àquelas alimentadas com as dietas A no período total (1 a 42 dias), porém melhor conversão calórica (CC) (kcal/kg) (p<0,01). Foi observada também melhor CC, com relação E:PB 139. Menores níveis de PB dietética resultaram, algumas vezes, em um menor GP, porém sempre foi verificada uma pior CC nas relações mais amplas E:PB. Em ambos os Experimentos (EXP), o maior nível de energia e a redução da PB dietética melhoraram a utilização da PB consumida.<br>Two experiments (EXP) were carried out to investigate the effects of crude protein (CP) levels reduction in high-energy (H) (3.200kcal ME/kg) and low-energy (L) (2.900kcal ME/kg) diets, on the performance and carcass composition of male broiler chickens. The CP levels were decreased to meet the following energy: protein (E:PB) ratios: 139, 146, 153 and 160 (kcal/%) for starter diets (EXP 1) and 160, 167, 174 and 181 (kcal/%) for grower diets (EXP 2), in both energy levels, keeping MET + CIS and LYS levels at the same concentration. All birds received a same diet before (EXP 2) or after (EXP 1) feeding the experimental diets. Feeding H diets resulted in better performance, but also in higher carcass fat deposition. In EXP 1, birds fed with L diets during the starter period had similar body weight gain (BWG), in the total period (1 to 42 days), than those H diets, however with better caloric conversion (kcal/kg) (CC). Also, the best CC was obtained with E:PB of 139. Lower BWG, sometimes occurred with lower levels of dietary CP, but in all experiments the CC was decreased with wider E:PB ration. In both EXP, protein utilization was improved with higher levels of dietary energy and with lower levels of dietary CP

Attractive and repulsive factors act through multi-subunit receptor complexes to regulate nerve fiber growth

In the nervous system, attractive and repulsive factors guide neuronal growth, pathfinding and target innervation during development, learning and regeneration after injury. Repulsive and growth-inhibitory factors, such as some ephrins, semaphorins, netrins and myelin-associated growth inhibitors, restrict nerve fiber growth, whereas neurotrophins, and other ephrins, semaphorins and netrins attract fibers and promote neurite growth. Several of these guidance molecules also play crucial roles in vasculogenesis, and regulate cell migration and tissue formation in different organs. Precise and highly specific signal transduction in space and time is required in all these cases, which primarily depends on the presence and function of specific receptors. Interestingly, many of these ligands act through multi-subunit receptor complexes. In this Commentary, we review the current knowledge of how complexes of the receptors for attractive and repulsive neurite growth regulatory factors are reorganized in a spatial and temporal manner, and reveal the implications that such dynamics have on the signaling events that coordinate neurite fiber growth

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

AimThe 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.MethodsThis 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.ResultsOverall, 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 ConclusionOne 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