8,372 research outputs found

    Effect of centre volume on pathological outcomes and postoperative complications after surgery for colorectal cancer: results of a multicentre national study

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    Background: The association between volume, complications and pathological outcomes is still under debate regarding colorectal cancer surgery. The aim of the study was to assess the association between centre volume and severe complications, mortality, less-than-radical oncologic surgery, and indications for neoadjuvant therapy.Methods: Retrospective analysis of 16,883 colorectal cancer cases from 80 centres (2018-2021). Outcomes: 30-day mortality; Clavien-Dindo grade >2 complications; removal of >= 12 lymph nodes; non-radical resection; neoadjuvant therapy. Quartiles of hospital volumes were classified as LOW, MEDIUM, HIGH, and VERY HIGH. Independent predictors, both overall and for rectal cancer, were evaluated using logistic regression including age, gender, AJCC stage and cancer site.Results: LOW-volume centres reported a higher rate of severe postoperative complications (OR 1.50, 95% c.i. 1.15-1.096, P = 0.003). The rate of >= 12 lymph nodes removed in LOW-volume (OR 0.68, 95% c.i. 0.56-0.85, P = 12 lymph nodes removed was lower in LOW-volume than in VERY HIGH-volume centres (OR 0.57, 95% c.i. 0.41-0.80, P = 0.001). A lower rate of neoadjuvant chemoradiation was associated with HIGH (OR 0.66, 95% c.i. 0.56-0.77, P < 0.001), MEDIUM (OR 0.75, 95% c.i. 0.60-0.92, P = 0.006), and LOW (OR 0.70, 95% c.i. 0.52-0.94, P = 0.019) volume centres (vs. VERY HIGH).Conclusion: Colorectal cancer surgery in low-volume centres is at higher risk of suboptimal management, poor postoperative outcomes, and less-than-adequate oncologic resections. Centralisation of rectal cancer cases should be taken into consideration to optimise the outcomes

    Chapter 17 - Raman Spectroscopy

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    Breakthrough pain in patients with multiple myeloma: a secondary analysis of IOPS MS study

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    OBJECTIVE: The aim of this study was to characterize breakthrough pain (BTcP) in patients with multiple myeloma (MM). PATIENTS AND METHODS: This was a secondary analysis of a large multicenter study of patients with BTcP. Background pain intensity and opioid doses were recorded. The BTcP characteristics, including the number of BTcP episodes, intensity, onset, duration, predictability, and interference with daily activities were recorded. Opioids prescribed for BTcP, time to achieve a meaningful pain relief after taking a medication, adverse effects, and patients’ satisfaction were assessed. RESULTS: Fifty-four patients with MM were examined. In comparison with other tumors, in patients with MM BTcP was more predictable (p=0.04), with the predominant trigger being the physical activity (p<0.001). Other BTcP characteristics, pattern of opioids used for background pain and BTcP, satisfaction and adverse effects did not differ. CONCLUSIONS: Patients with MM have their own peculiarities. Given the peculiar involvement of the skeleton, BTcP was highly predictable and triggered by movement

    Antioxidant-Enriched Diet on Oxidative Stress and Inflammation Gene Expression: A Randomized Controlled Trial

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    The Mediterranean Diet (MedDiet) is associated with beneficial effects against chronic non-communicable diseases (CNCDs). In particular, the content of micronutrients leads to an improvement of the oxidative and inflammatory profiles. A randomized, parallel, controlled study, on 24 subjects, was conducted to evaluate if 2-week supplementation with a mixed apple and bergamot juice (MAB juice), had a positive impact on the body composition, the biochemical profile, and oxidative and inflammatory gene expression (Superoxide dismutase (SOD1), Peroxisome Proliferator-Activated Receptor γ (PPARγ), catalase (CAT), chemokine C-C motif ligand 5 (CCL5), Nuclear Factor Kappa B Subunit 1 (NFKB1), Vitamin D Receptor (VDR), and Macrophage Migration Inhibitory Factor (MIF)), respect to a MedDiet. Body composition evaluation analysis showed a gain in lean mass (p &lt; 0.01). Moreover, a significant reduction in total cholesterol/HDL index (p &lt; 0.01) was pointed out between the two groups. Gene expression analysis highlighted an increase in MIF (p ≤ 0.05), PPARγ (p &lt; 0.001), SOD1 (p ≤ 0.05), and VDR (p ≤ 0.05) expressions when comparing MedDiet and MedDiet + MAB juice groups. These data based on the nutrigenomics approach demonstrated that supplementing 2 weeks of MAB juice to the MedDiet could contribute to a reduction in the risk of CNCDs

    Early postoperative risk stratification in patients with pancreatic fistula after pancreaticoduodenectomy

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    Background: Early stratification of postoperative pancreatic fistula according to severity and/or need for invasive intervention may improve outcomes after pancreaticoduodenectomy. This study aimed to identify the early postoperative variables that may predict postoperative pancreatic fistula severity.Methods: All patients diagnosed with biochemical leak and clinically relevant-postoperative pancreatic fistula based on drain fluid amylase &gt;300 U/L on the fifth postoperative day after pancreaticoduodenectomy were identified from a consecutive cohort from Birmingham, UK. Demographics, intraoperative parameters, and postoperative laboratory results on postoperative days 1 through 7 were retrospectively extracted. Independent predictors of clinically relevant-postoperative pancreatic fistula were identified using multivariable binary logistic regression and converted into a risk score, which was applied to an external cohort from Verona, Italy. Results: The Birmingham cohort had 187 patients diagnosed with postoperative pancreatic fistula (biochemical leak: 99, clinically relevant: 88). In clinically relevant-postoperative pancreatic fistula pa-tients, the leak became clinically relevant at a median of 9 days (interquartile range: 6-13) after pan-creaticoduodenectomy. Male sex (P = .002), drain fluid amylase-postoperative day 3 (P &lt; .001), c-reactive protein postoperative day 3 (P &lt; .001), and albumin-postoperative day 3 (P = .028) were found to be sig-nificant predictors of clinically relevant-postoperative pancreatic fistula on multivariable analysis. The multivariable model was converted into a risk score with an area under the receiver operating characteristic curve of 0.78 (standard error: 0.038). This score significantly predicted the need for invasive intervention (postoperative pancreatic fistula grades B3 and C) in the Verona cohort (n = 121; area under the receiver operating characteristic curve: 0.68; standard error = 0.06; P =.006) but did not predict clinically relevant -postoperative pancreatic fistula when grades B1 and B2 were included (area under the receiver operating characteristic curve 0.52; standard error = 0.07; P = .802). Conclusion: We developed a novel risk score based on early postoperative laboratory values that can accurately predict higher grades of clinically relevant-postoperative pancreatic fistula requiring invasive intervention. Early identification of severe postoperative pancreatic fistula may allow earlier intervention. Crown Copyright (c) 2022 Published by Elsevier Inc. All rights reserved

    z-GAL: A NOEMA spectroscopic redshift survey of bright Herschel galaxies

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    Using the IRAM NOrthern Extended Millimetre Array (NOEMA), we conducted a Large Programme (z-GAL) to measure redshifts for 126 bright galaxies detected in the Herschel Astrophysical Large Area Survey (H-ATLAS), the HerMES Large Mode Survey (HeLMS), and the Herschel Stripe 82 (HerS) Survey. We report reliable spectroscopic redshifts for a total of 124 of the Herschel-selected galaxies. The redshifts are estimated from scans of the 3 and 2-mm bands (and, for one source, the 1-mm band), covering up to 31 GHz in each band, and are based on the detection of at least two emission lines. Together with the Pilot Programme, where 11 sources had their spectroscopic redshifts measured, our survey has derived precise redshifts for 135 bright Herschel-selected galaxies, making it the largest sample of high-z galaxies with robust redshifts to date. Most emission lines detected are from 12CO (mainly from J = 2–1 to 5–4), with some sources seen in [CI] and H2O emission lines. The spectroscopic redshifts are in the range 0.8 < z < 6.55 with a median value of z = 2.56 ± 0.10, centred on the peak epoch of galaxy formation. The linewidths of the sources are large, with a mean value for the full width at half maximum ΔV of 590 ± 25 km s−1 and with 35% of the sources having widths of 700 km s−1 < ΔV < 1800 km s−1. Most of the sources are unresolved or barely resolved on scales of ∼2 to 3″ (or linear sizes of ∼15 − 25 kpc, unlensed). Some fields reveal double or multiple sources in line emission and the underlying dust continuum and, in some cases, sources at different redshifts. Taking these sources into account, there are, in total, 165 individual sources with robust spectroscopic redshifts, including lensed galaxies, binary systems, and over-densities. This paper presents an overview of the z-GAL survey and provides the observed properties of the emission lines, the derived spectroscopic redshifts, and a catalogue of the entire sample. The catalogue includes, for each source, the combined continuum and emission lines’ maps together with the spectra for each of the detected emission lines. The data presented here will serve as a foundation for the other z-GAL papers in this series reporting on the dust emission, the molecular and atomic gas properties, and a detailed analysis of the nature of the sources. Comparisons are made with other spectroscopic surveys of high-z galaxies and future prospects, including dedicated follow-up observations based on these redshift measurements, are outlined

    z-GAL: A NOEMA spectroscopic redshift survey of bright Herschel galaxies: III. Physical properties

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    The z-GAL survey observed 137 bright Herschel-selected targets with the IRAM Northern Extended Millimeter Array, with the aim to measure their redshift and study their properties. Several of them have been resolved into multiple sources. Consequently, robust spectroscopic redshifts have been measured for 165 individual galaxies in the range 0.8 < z < 6.5. In this paper we analyse the millimetre spectra of the z-GAL sources, using both their continuum and line emission to derive their physical properties. At least two spectral lines are detected for each source, including transitions of 12CO, [CI], and H2O. The observed 12CO line ratios and spectral line energy distributions of individual sources resemble those of local starbursts. In seven sources the para-H2O (211−202) transition is detected and follows the IR versus H2O luminosity relation of sub-millimetre galaxies. The molecular gas mass of the z-GAL sources is derived from their 12CO, [CI], and sub-millimetre dust continuum emission. The three tracers lead to consistent results, with the dust continuum showing the largest scatter when compared to 12CO. The gas-to-dust mass ratio of these sources was computed by combining the information derived from 12CO and the dust continuum and has a median value of 107, similar to star-forming galaxies of near-solar metallicity. The same combined analysis leads to depletion timescales in the range between 0.1 and 1.0 Gyr, which place the z-GAL sources between the ‘main sequence’ of star formation and the locus of starbursts. Finally, we derived a first estimate of stellar masses – modulo possible gravitational magnification – by inverting known gas scaling relations: the z-GAL sample is confirmed to be mostly composed by starbursts, whereas ∼25% of its members lie on the main sequence of star-forming galaxies (within ±0.5 dex)

    The evolving landscape of COVID‐19 and post‐COVID condition in patients with chronic lymphocytic leukemia: A study by ERIC, the European research initiative on CLL

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    In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria. Patients infected during the most recent phases of the pandemic, though carrying a higher comorbidity burden, were less often hospitalized, rarely needed intensive care unit admission, or died compared to patients infected during the initial phases. The 4-month overall survival (OS) improved through the phases, from 68% to 83%, p = .0015. Age, comorbidity, CLL-directed treatment, but not vaccination status, emerged as risk factors for mortality. Among survivors, 6.65% patients had a reinfection, usually milder than the initial one, and 16.5% developed post-COVID condition. The latter was characterized by fatigue, dyspnea, lasting cough, and impaired concentration. Infection severity was the only risk factor for developing post-COVID. The median time to resolution of the post-COVID condition was 4.7 months. OS in patients with CLL improved during the different phases of the pandemic, likely due to the improvement of prophylactic and therapeutic measures against SARS-CoV-2 as well as the emergence of milder variants. However, mortality remained relevant and a significant number of patients developed post-COVID conditions, warranting further investigations

    Breakthrough pain in patients with multiple myeloma: a secondary analysis of IOPS MS study

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    OBJECTIVE: The aim of this study was to characterize breakthrough pain (BTcP) in patients with multiple myeloma (MM).PATIENTS AND METHODS: This was a sec-ondary analysis of a large multicenter study of patients with BTcP. Background pain intensity and opioid doses were recorded. The BTcP char-acteristics, including the number of BTcP ep-isodes, intensity, onset, duration, predictabil-ity, and interference with daily activities were recorded. Opioids prescribed for BTcP, time to achieve a meaningful pain relief after taking a medication, adverse effects, and patients' satis- faction were assessed.RESULTS: Fifty-four patients with MM were ex-amined. In comparison with other tumors, in pa-tients with MM BTcP was more predictable (p=0.04), with the predominant trigger being the physical ac-tivity (p &lt; 0.001). Other BTcP characteristics, pattern of opioids used for background pain and BTcP, sat-isfaction and adverse effects did not differ.CONCLUSIONS: Patients with MM have their own peculiarities. Given the peculiar involve-ment of the skeleton, BTcP was highly predict-able and triggered by movement
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