Prospective Cohort Study

Secret History: Return of the Black Death Channel 4, 7-8pm In 1348 the Black Death swept through London, killing people within days of the appearance of their first symptoms. Exactly how many died, and why, has long been a mystery. This Secret History documentary follows experts as they pick through the evidence and reveal why the plague killed on such a scale. And they ask, what might be coming next?

Medscape

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

https://www.commed.vcu.edu/Chronic_Disease/2012/cochranrvwrschbias.pdf

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

physical activity and cancer fact sheet national cancer on this page what is physical activity what is known about the relationship between physical activity and cancer risk how might physical activity be, diet and cancer report american institute for cancer the american institute for cancer research aicr is the cancer charity that fosters research on diet and cancer prevention and educates the public about the results, download resources and toolkits world cancer research downloads for scientists from the wcrf aicr third expert report diet nutrition physical activity and cancer a global perspective, nutritional science university of washington school of public health school of public health nutritional science detailed course offerings time schedule are available for spring quarter 2019, 2019 aicr research conference american institute for about aicr we fund cutting edge research and give people practical tools and information to help them prevent and survive cancer more about aicr, agence fruits et l gumes frais aprifel the global fruit and veg newsletter is a monthly newsletter distributing to 29 countries involved in the promotion of the consumption of fruit and vegetable worldwide, world cancer research fund international we are experts in cancer prevention we analyse global research on diet nutrition physical activity cancer and make public health policy recommendations, the fractions of cancer attributable sciencedirect com a proportion of cancers at many body sites are attributable to potentially modifiable factors no global summaries of the preventable cancer burden have been, who controlling the global obesity epidemic more information obesity and overweight fact sheet who global strategy on diet physical activity and health who global database on body mass index, espen guidelines on nutrition in cancer patients gl nutrition in cancer patients outline o methods o1 basic information o2 methods o3 post publication impact a background a1 catabolic alterations in, un news global perspective human stories un news produces daily news content in arabic chinese english french kiswahili portuguese russian and spanish and weekly programmes in hindi urdu and bangla, recommended community strategies and measurements to table continued summary of recommended community strategies and measurements to prevent obesity in the united states strategies to encourage physical, food as medicine preventing treating the most dreaded food as medicine preventing treating the most dreaded diseases with diet, video resources bc cancer these videos help patients learn about their cancer and its treatment, prostate cancer nutrition and dietary supplements pdq nutrition methods and dietary supplements have been studied for prostate cancer prevention or treatment read about the history of research laboratory, who europe food safety food safety ingestion and handling of contaminated food causes significant illness and death worldwide across the who european region foodborne diseases, creating healthy food and eating environments policy and food and eating environments likely contribute to the increasing epidemic of obesity and chronic diseases over and above individual factors such as knowledge skills, health risks obesity prevention source harvard t h obesity and reproduction obesity can influence various aspects of reproduction from sexual activity to conception among women the association between, top nutrition schools undergraduate degree programs ncr want to know the top nutrition schools and best undergraduate degree programs here we review analyze rank rate them figure out which is best for you , overeating caloric restriction and breast cancer risk by this study analyzes the association of excessive energy intake and caloric restriction with breast cancer bc risk taking into account the individual, calcium what s best for your bones and health the possible increased risk of ovarian cancer high levels of galactose a sugar released by the digestion of lactose in milk have been studied as being, cancer protocol nutrition supplements cancer protocol nutrition supplements herbs enzymes note do not email me unless you would like a personalized protocol free with a suggested donation of 250

Food, Nutrition, Physical Activity, and the Prevention of Cancer : a Global Perspective : 食物、栄養、身体活動とがんの予防 : 世界的展望(後篇)

Importance
Rectal cancer management has significantly evolved over the last 2 decades.


Objective
This study aimed to evaluate trends in the characteristics, treatment, and outcomes of rectal adenocarcinoma across 16 years.


Design, Setting, and Participants
This retrospective, observational case series study used data from the National Cancer Database (NCDB) to evaluate patients diagnosed with rectal adenocarcinoma from 2004 through 2019. Data analysis was performed from March to May 2022.


Exposures
Trends in the treatment and outcomes of rectal adenocarcinoma in the US between 2004 and 2019 were explored. This period was subdivided into 4 equal periods: 2004-2007, 2008-2011, 2012-2015, and 2016-2019.


Main Outcomes and Measures
Patient and tumor characteristics, treatments, short-term outcomes, and overall survival.


Results
A total of 318 548 patients diagnosed with rectal adenocarcinoma were included in the analysis, 191 369 (60.1%) of whom were males and 127 179 (39.9%%) were females. The mean (SD) age of the patients was 63.5 (13.4) years, and 46 824 patients (14.8%) were younger than 50 years. Among the patients, 10 859 (3.4%) were of Asian race and ethnicity, 28 464 (8.9%) were Black, and 271 236 (85.1%) were White. The percentage of patients younger than 50 years who were diagnosed with rectal cancer increased by 1.5%, from 13.9% in period 1 to 15.4% in period 4. Patients in the last period (2016-2019) presented more often with stages III (36.2% vs 30.2% vs 25.0% vs 23.4%; P < .001) and IV (21.5% vs 19.3% vs 18.1% vs 18.6%; P < .001) disease compared with those in the remaining 3 periods. The use of chemotherapy (36.8% vs 48.1% vs 49.1% vs 47.0%; P < .001) and immunotherapy (0.4% vs 0.2% vs 3.5% vs 6.5%; P < .001) significantly increased across the 4 periods. Although neoadjuvant radiotherapy was used more often across the periods studied (28.6% in period 1 to 34.3% in period 4), the use of adjuvant radiotherapy was reduced by half (12.9% to 6.0%). The median (IQR) time from diagnosis to definitive surgery increased from 95 (15-126) days in period 1 to 128 (47-158) days in period 4. The rate of use of open surgery decreased by half (60.1% in period 2 to 30.1% in period 4), and the use of robotic surgery significantly increased (5.2% in period 2 to 28.4% in period 4). The conversion rate was significantly reduced (11.2% in period 2 to 7.3% in period 4) and the median (IQR) hospital stay decreased by 2 days, from 6 (3-9) days to 4 (2-7) days. The median (IQR) overall survival significantly increased across the periods (from 83.1 months [95% CI, 81.8-84.6 months] in period 1 to 92.1 months [95% CI, 90.2-93.6 months] in period 3; P < .001).


Conclusion and Relevance
The findings of this case series study suggest a treatment trend of increased use of chemotherapy, immunotherapy, sphincter-saving surgery, and minimally invasive surgery. In addition, the time between diagnosis and definitive surgery increased by a median of 33 days. This treatment trend was associated with a significant improvement in the overall survival, reduction in the conversion rate by 3.9%, and a 2-day shorter hospital stay. These findings have major clinical relevance to the management of rectal cancer. The improvements seen in short-term outcomes and survival of patients diagnosed with rectal cancer can probably be attributed to the treatment trends observed. Continued improvement in outcomes warrant further updates in treatments.

Trends in the Characteristics, Treatment, and Outcomes of Rectal Adenocarcinoma in the US From 2004 to 2019: A National Cancer Database Analysis.

Anastomotic leakage (AL) following colorectal anastomosis is one of the most dreaded complications of colorectal surgery. The negative impact of AL is not only restricted to the early morbidity and mortality related to the associated sepsis and systemic inflammatory response, but it can also extend to compromise long-term functional and oncologic outcomes [1, 2]. To prevent or at least reduce the incidence of AL, a number of methods have been described to ensure the competency and adequate perfusion of the anastomosis. The intraoperative air leak test is a frequently used method to identify mechanically insufficient colorectal anastomosis. In this test, the pelvis is filled with saline solution and the rectum is insufflated with air through a sigmoidoscope or a rectal tube, and the presence of air bubbles in the pelvis indicates AL [3–5]. Intraoperative endoscopic visualization of the anastomosis is another viable method to ensure mechanical competency of the anastomosis [6]. Another, more recent, method is indocyanine green fluorescence angiography, which is reportedly associated with reduced rates of AL and a change in the surgical plan in up to 13% of cases [7, 8]. However, it is not feasible to use the standard air leak test to assess the integrity of low coloanal anastomosis after restorative proctectomy. Hence, came the idea of the reverse leak test in which one surgeon fills the pelvis with saline solution while the patient is placed in the reverse Trendelenburg position (Fig. 1). Another surgeon transanally evaluates the anastomotic line. The presence of water leaking between the anastomotic line sutures (Fig. 2) is indicative of AL and necessitates reinforcement of the anastomosis with sutures until the fluid leak ceases (Fig. 3). This finding is more easily recognized during laparoscopy where the pneumoperitoneum helps force fluid mixed with gas from between the sutures. While with the standard air leak test air is injected through the rectum and air bubbles are noticed in the pelvis, the opposite is done for the reverse leak test, wherein the fluid in the pelvis allows leakage to be noted through the anal canal—thus the name “reverse”. In conclusion, the reverse leak test is a simple, feasible method of assessing the integrity of the transanal coloanal anastomosis for both open and laparoscopic restorative

The reverse leak test for the assessment of low coloanal anastomosis: technical note.

In the study by Sarveazad et al. adipose tissue-derived stem cells were injected to reinforce anal sphincter repair. The authors came to the conclusion that injection of stem cells during repair surgery for fecal incontinence may cause replacement of fibrous tissue, which may be a key point in treatment of fecal incontinence. The authors emphasized in their “Discussion” section that the ability of stem cells to differentiate into muscle fibers, replacing the fibrous tissue at the site of repair, is their main action, which may not be accurate. We think that healing of repaired anal sphincter begins with granulation tissue formation, which then matures into fibrous tissue that becomes infiltrated by muscle fibers from the approximated cut ends of the sphincter, resulting in regain of sphincter muscle continuity. This is supported by many experimental studies that have evaluated local injection of stem cells during sphincteroplasty in rats and shown that the injected stem cells do not differentiate into muscle fibers but may induce healing by a strong fibrous tissue. Further studies are needed to determine the main mechanism of action of mesenchymal stems cells in augmenting anal sphincter repair.

/pdf/comment-on-a-new-method-for-treating-fecal-incontinence-by-1c5umkw1so.pdf

Comment on "A new method for treating fecal incontinence by implanting stem cells derived from human adipose tissue: preliminary findings of a randomized double-blind clinical trial".

1 Balio glu MB, Akman YE, Ucpunar H, et al. Sacral agenesis: evaluation of accompanying pathologies in 38 cases, with analysis of long-term outcomes. Childs Nerv Syst 2016; 32: 1693–702. 2 Matzel KE, Kamm MA, St€ osser M, et al. Sacral spinal nerve stimulation for faecal incontinence: multicentre study. Lancet 2004; 363: 1270–6. 3 Thomas GP, Nicholls RJ, Vaizey CJ. Sacral nerve stimulation for faecal incontinence secondary to congenital imperforate anus. Tech Coloproctol 2013; 17: 227–9. 4 Castillo J, Crist obal L, Alonso J, et al. Sacral nerve stimulation lead implantation in partial sacral agenesis using intraoperative computerised tomography. Colorectal Dis 2016; 18: O330–3. 5 Falletto E1, Ganio E, Naldini G, Ratto C, Altomare DF. Sacral neuromodulation for bowel dysfunction: a consensus statement from the Italian group. Tech Coloproctol 2014; 18: 53–64.

Sameh Hany Emile

Papers

Trends in the Characteristics, Treatment, and Outcomes of Rectal Adenocarcinoma in the US From 2004 to 2019: A National Cancer Database Analysis.

The reverse leak test for the assessment of low coloanal anastomosis: technical note.

Comment on "A new method for treating fecal incontinence by implanting stem cells derived from human adipose tissue: preliminary findings of a randomized double-blind clinical trial".

Transperineal repair of third degree perineal tear and anterior rectocele with complete perineal body reconstruction - a video vignette.

Artificial Intelligence Compared to Alvarado Scoring System Alone or Combined with Ultrasound Criteria in the Diagnosis of Acute Appendicitis.