The fast and the fluoride: A pyridine derivative functionalized with tert-butyldimethylsilyl ether has been synthesized and used as a selective chromofluorogenic fluoride sensor in water/cetyltrimethylammonium bromide solutions. The chromofluorogenic response arises from the fluoride-induced hydrolysis of the silyl ether moiety, which generates a coloured and highly emissive phenolate anion. ; Financial support from the Spanish Government (project MAT2012-38429-C04-01) and the Generalitat Valencia (project PROMETEO/2009/016) is gratefully acknowledged. S. E. is grateful to the Generalitat Valenciana for his Santiago Grisolia fellowship. ; El Sayed Shihata Nasr, S.; Agostini, A.; Santos Figueroa, LE.; Martínez Mañez, R.; Sancenón Galarza, F. (2013). An Instantaneous and Highly Selective Chromofluorogenic Chemodosimeter for Fluoride Anion Detection in Pure Water. ChemistryOpen. 2(2):58-62. https://doi.org/10.1002/open.201300010 ; S ; 58 ; 62 ; 2 ; 2
Com início em 2008, o REUNI foi um dos programas de governo que visava ampliar o acesso à educação superior, resultado das reivindicações da sociedade civil por melhores condições. O objetivo desse artigo é analisar o programa REUNI a partir de indicadores quantitativos comparando antes da implantação do REUNI com os anos posteriores ao início do programa. Para isso, foram levantados indicadores como números de vagas, de ingressantes de matriculados, de concluintes, de professores, de técnicos e de cursos ao longo dos anos para uma análise comparativa. Os resultados mostraram uma melhora no que diz respeito aos indicadores buscados. Vale ressaltar que os dados levantados não apresentam uma metodologia de como foram tratados.
11 p.-5 fig.-3 tab. ; Background: Isobutanol is a candidate to replace gasoline from fossil resources. This higher alcohol can be produced from sugars using genetically modified microorganisms. Shimwellia blattae (p424IbPSO) is a robust strain resistant to high concentration of isobutanol that can achieve a high production rate of this alcohol. Nevertheless, this strain, like most strains developed for isobutanol production, has some limitations in its metabolic pathway. Isobutanol production under anaerobic conditions leads to a depletion of NADPH, which is necessary for two enzymes in the metabolic pathway. In this work, two independent approaches have been studied to mitigate the co-substrates imbalance: (i) using a NADH-dependent alcohol dehydrogenase to reduce the NADPH dependence of the pathway and (ii) using a transhydrogenase to increase NADPH level. ; Results: The addition of the NADH-dependent alcohol dehydrogenase from Lactococcus lactis (AdhA) to S. blattae (p424IbPSO) resulted in a 19.3% higher isobutanol production. The recombinant strain S. blattae (p424IbPSO, pIZpntAB) harboring the PntAB transhydrogenase produced 39.0% more isobutanol than the original strain, reaching 5.98 g L−1 of isobutanol. In both strains, we observed a significant decrease in the yields of by-products such as lactic acid or ethanol. ; Conclusions: The isobutanol biosynthesis pathway in S. blattae (p424IbPSO) uses the endogenous NADPH-dependent alcohol dehydrogenase YqhD to complete the pathway. The addition of NADH-dependent AdhA leads to a reduction in the consumption of NADPH that is a bottleneck of the pathway. The higher consumption of NADH by AdhA reduces the availability of NADH required for the transformation of pyruvate into lactic acid and ethanol. On the other hand, the expression of PntAB from E. coli increases the availability of NADPH for IlvC and YqhD and at the same time reduces the availability of NADH and thus, the production of lactic acid and ethanol. In this work it is shown how the expression of AdhA and PntAB enzymes in Shimwellia blattae increases yield from 11.9% to 14.4% and 16.4%, respectively. ; This work was supported by grants from Biopolis S.L., Spanish Ministry of Science and Innovation BIOSOS CEN20091040 (CENIT-CDTI), RTI2018-095584-B-C44 and MINECO CTQ2017- 84963-C2-1-R and the Community of Madrid and the Structural Funds from European Union (Ref: S2018/BAA-4532 (ALGATEC-CM)). The grant for one of the authors (MGA) with reference BES-2014-068344 is gratefully recognized. ; Peer reviewed
O luminol é um teste presuntivo para detecção de manchas de sangue, muito sensível, efetivo e seletivo. O objetivo deste trabalho é avaliar a eficácia do luminol na detecção de sangue após o entintamento das paredes em um local onde ocorreu um homicídio. Os peritos se dirigiram para a casa do suspeito e com o uso de uma espátula metálica retiraram parte do revestimento da parede do quarto e após nova aplicação do luminol observaram a mancha branco-azulada, intensa e de duração típica de sangue latente. Os fragmentos retirados da parede foram enviados para o laboratório de DNA que confirmou tratar-se de sangue da vítima. A aplicação dessa técnica no caso em questão encontrando manchas de sangue sob a pintura ajudou a perícia a traçar a dinâmica do evento, ficando mais clara a posição da vítima quando foi alvejada com tiros pelo seu agressor além de ligar aquele local à vítima. O luminol não é capaz de detectar sangue que está sob a tinta da parede. A deteção do sangue latente somente ocorre quando a camada de tinta é retirada.
[EN] Four probes (i.e. D1¿D4) for the selective and sensitive fluorogenic detection of HS2 have been prepared and characterised. HEPES (10 mM, pH 7.4)¿DMSO 99:1 v/v solutions of D1¿D4 are essentially non-fluorescent. Changes in the emission using D1¿D4 in the presence of anions (F2, Cl2, Br2, I2, N2 3 , CN2, SCN2, AcO2, CO22 3 , PO22 4 , SO22 4 , HS2 and OH2), biothiols (GSH, Cys, Hcy, Me ¿Cys and lipoic acid), reducing agents (SO22 3 and S2O22 3 ) and oxidants (H2O2) demonstrated that only HS2 is able to induce the appearance of intense emission bands in the 400¿ 520 nm range in the four probes. The selectivity observed was ascribed to a unique hydrogen sulfide-induced hydrolysis of the 2,4-dinitrophenyl ether moiety that yielded the corresponding free highly fluorescent alcohols. The potential detection of intracellular HS2 was also studied. ; Financial support from the Spanish Government (Project MAT2012-38429-C04-01) and the Generalitat Valencia (Project PROMETEO/2009/016) is gratefully acknowledged. S.E. is grateful to the Generalitat Valenciana for his Santiago Grisolia fellow. L.E.S.F. also thanks the Carolina Foundation and UPNFM-Honduras for his doctoral grant. ; El Sayed Shehata Nasr, S.; De La Torre, C.; Santos Figueroa, LE.; Martínez-Máñez, R.; Sancenón Galarza, F.; Orzáez, M.; Costero, AM. (2015). 2,4-dinitrophenyl ether-containing chemodosimeters for the selective and sensitive 'in vitro' and 'in vivo' detection of hydrogen sulfide. Supramolecular Chemistry. 27(4):244-254. https://doi.org/10.1080/10610278.2014.977286 ; S ; 244 ; 254 ; 27 ; 4
The COVID-19 pandemic brought about major changes in the lifestyle of the world population. Due to the lack of vaccines or a definitive treatment for disease, governments around the world have adopted social isolation and quarantine as methods to control the spread of the virus. Objective: Thus, the objective of this study was to discuss how social isolation and quarantine periods affected people's mental health and quality of life during the COVID-19 pandemic. Methods: An integrative literature review was carried out during the COVID-19 pandemic between March and September 2020, establishing the following guiding question: How did social isolation and quarantine affect the mental health and quality of life of the population in the COVID-19 pandemic? Results: The final sample consisted of nineteen (19) articles, two (2) addressed depression during the pandemic period, three (3) presented the pandemic and the relationship with sociodemographic aspects, five (5) analyzed mental health in the pandemic, four (4) reported the impact of COVID-19 on the population's style and quality of life and the last five (5) demonstrated the quality of human relationships and emotional aspects in the face of the pandemic. Conclusion: It was demonstrated that isolation and the quarantine period had a negative impact on the population's quality of life and long-term mental health. ; La pandemia de COVID-19 provocó cambios importantes en el estilo de vida de la población mundial. Debido a la ausencia de vacunas o de un tratamiento definitivo para la enfermedad, los gobiernos de todo el mundo han adoptado el aislamiento social y la cuarentena como métodos para controlar la propagación del virus. Objetivo: Por lo tanto, el objetivo de este estudio fue discutir cómo el aislamiento social y los períodos de cuarentena afectaron la salud mental y la calidad de vida de las personas durante la pandemia de COVID-19. Métodos: Se realizó una revisión integradora de la literatura durante la pandemia de COVID-19 entre marzo y septiembre de 2020, estableciendo la siguiente pregunta orientadora: ¿Cómo afectaron el aislamiento social y la cuarentena la salud mental y la calidad de vida de la población en la pandemia de COVID-19? Resultados: La muestra final constó de diecinueve (19) artículos, dos (2) abordaron la depresión durante el período pandémico, tres (3) presentaron la pandemia y la relación con aspectos sociodemográficos, cinco (5) analizaron la salud mental en pandemia, cuatro (4) reportaron el impacto del COVID-19 en el estilo y calidad de vida de la población y los últimos cinco (5) demostraron la calidad de las relaciones humanas y aspectos emocionales ante la pandemia. Conclusión: Se demostró que el aislamiento y el período de cuarentena tuvieron un impacto negativo en la calidad de vida y la salud mental a largo plazo de la población. ; A pandemia da COVID-19 trouxe grandes mudanças nos hábitos de vida da população mundial. Devido à ausência de vacinas ou um tratamento definitivo para doença, governos ao redor do mundo adotaram o isolamento social e a quarentena como métodos para controlar a propagação do vírus. Objetivo: Desta forma, o objetivo deste estudo foi discutir como o isolamento social e os períodos de quarentena afetaram a saúde mental e a qualidade de vida das pessoas durante a pandemia de COVID-19. Métodos: Realizou-se uma revisão integrativa de literatura durante a pandemia de COVID-19 entre março e setembro de 2020, estabelecendo seguinte pergunta norteadora: Como o isolamento social e a quarentena afetaram a saúde mental e a qualidade de vida da população na pandemia da COVID-19? Resultados: A amostra final foi composta por dezenove (19) artigos, dois (2) abordaram a depressão no período da pandemia, três (3) apresentaram a pandemia e a relação com os aspectos sociodemográficos, cinco (5) analisaram a saúde mental na pandemia, quatro (4) relataram o impacto da COVID-19 no estilo e qualidade de vida da população e os últimos cinco (5) demonstraram a qualidade dos relacionamentos humanos e aspectos emocionais frente a pandemia. Conclusão: Foi demonstrado que o isolamento e o período de quarentena impactaram de forma negativa na qualidade de vida e na saúde mental a longo prazo da população.
This study aimed to evaluate the inclusion of castor bean meal in the diet for lactating cows on Bracharia brizhanta pasture and its implications for nutritional and productive parameters. Eight crossbred cows were distributed in two 4 x 4 Latin squares, with four (0%; 3.33%; 6.66% and 10%) inclusion levels of castor bean meal in the total diet. The experiment consisted of four experimental periods of 21 days each. The digestibility and dry matter intake were estimated from fecal output, checked with the aid of external (chromium oxide) and internal (iNDF) indicators. Urine and milk were collected to determine the nitrogen balance and microbial protein production. The inclusion of different levels of castor bean meal in the diet for lactating cows did not affect the intake of dry matter and nutrients, and the same lack of effect was found for the digestibility of dry matter and total digestible nutrients, variation in body weight, milk production, chemical composition of milk, microbial production and nitrogen balance. The inclusion of up to 10% castor bean meal in the total diet did not influence productive parameters evaluated, and the use was conditioned to the price of castor bean meal.
During the COVID-19 pandemic, a lot of false information spread through social networks, reaching different community groups, and contributing to the failure in the prevention and correct treatment of the disease. This study aimed to outline the profile of people who received fake news related to health during the SARS-CoV-2 pandemic in 2020. This is a descriptive study with a quantitative approach carried out by health academics through a self-administered questionnaire made on Google Forms. A sample of 501 participants was obtained to analyze the participant sociodemographic profile, the content, and the most used ways of receiving fake news. The results indicate that the most received content by the participants was about health, followed by politics. According to the study, traditional communication media are the most reliable source in the search for information among participants, while WhatsApp and Facebook were cited as the most used social media in the dissemination of fake news, with the least reliable news. There is a need for further studies on this topic, to demonstrate which sociodemographic factors, influence the sharing of fake news. ; En la pandemia de COVID-19, falsas noticias han salido en las redes y llegado a la gente con un fallo en la prevención y en el tratamiento correcto. Este estudio ha tenido como objetivo perfilar el recibimiento de las falsas noticias relacionadas con la salud durante la pandemia del SARS-CoV-2 en 2020. De eso se trata, una pesquisa descriptiva de abordaje cuantitativa, realizada por académicos de la salud a través de formularios de Google, de donde se tomó una muestra de 501 aspirantes, donde se han podido analizar el perfil socio demográfico de los mismos, el contenido de las noticias falsas y los medios de disipación más utilizados. Los resultados indican que el contenido más recibido por los aspirantes han sido sobre la salud, seguido por la política. Entre los medios de comunicación tradicional se presentan más grande confianza por la busca de información entres los encuestados. Mientras WhatsApp y Facebook son relatados como unos de los más grandes medios de recepción de noticias falsas, siendo los mismos menos confiables en relación con las noticias allí presentes. Notase la necesidad de una investigación más profunda sobre este tema, para que sea posible la demostrará que los factores socio demográfico puede influencia el compartir las falsas noticias. ; Na pandemia da COVID-19, muitas informações falsas se espalharam pelas redes sociais, atingindo diferentes camadas populacionais e contribuindo para a falha na prevenção e no tratamento correto da doença. Este estudo teve como objetivo traçar o perfil de recebimento de fake news relacionadas à saúde durante a pandemia do SARS-CoV-2 em 2020. Trata-se de uma pesquisa do tipo descritivo de abordagem quantitativa, realizada por acadêmicos de saúde através de um questionário autoaplicável por meio do Google Forms, onde foram obtidas amostras de 501 participantes, podendo analisar o perfil sociodemográfico deles, o conteúdo das fake news e o meio mais utilizado em sua dissipação. Resultados indicam que o conteúdo mais recebido pelos participantes fora sobre saúde, seguido por política. Entre os meios de comunicação, as mídias tradicionais apresentaram maior confiança na busca de informações entre os respondentes. Enquanto o WhatsApp e o Facebook foram relatados como os maiores meios de recepção de fake news, sendo os menos confiáveis em relação às notícias ali presentes. Percebeu-se a necessidade de um aprofundamento nas investigações desta temática, para demonstrar que fatores sociodemográficos podem influenciar o compartilhamento de fake news.
WOS: 000393031600001 ; PubMed ID: 27939304 ; Background: The potential for global collaborations to better inform public health policy regarding major non-hypercholesterolaemia (FH), a common genetic disorder associated with premature cardiovascular disease, is yet to be reliably ascertained using similar approaches. The European Atherosclerosis Society FH Studies Collaboration (EAS FHSC) is a new initiative of international stakeholders which will help establish a global FH registry to generate large-scale, robust data on the burden of FH worldwide. Methods: The EAS FHSC will maximise the potential exploitation of currently available and future FH data (retrospective and prospective) by bringing together regional/national/international data sources with access to individuals with a clinical and/or genetic diagnosis of heterozygous or homozygous FH. A novel bespoke electronic platform and FH Data Warehouse will be developed to allow secure data sharing, validation, cleaning, pooling, harmonisation and analysis irrespective of the source or format. Standard statistical procedures will allow us to investigate cross-sectional associations, patterns of real-world practice, trends over time, and analyse risk and outcomes (e.g. cardiovascular outcomes, all-cause death), accounting for potential confounders and subgroup effects. Conclusions: The EAS FHSC represents an excellent opportunity to integrate individual efforts across the world to tackle the global burden of FH. The information garnered from the registry will help reduce gaps in knowledge, inform best practices, assist in clinical trials design, support clinical guidelines and policies development, and ultimately improve the care of FH patients. (C) 2016 Elsevier Ireland Ltd. ; Pfizer Independent Grant for Learning Change [16157823]; AmgenAmgen; MSD; Sanofi-AventisSanofi-Aventis; Latvian State Research Programme BIOMEDICINE; Czech RepublicCzech Republic Government [MZ CR AZV 15-28277A, 16-29084A] ; The present project has received support from a Pfizer Independent Grant for Learning & Change 2014 (No: 16157823) and from investigator initiated unrestricted research grants to the European Atherosclerosis Society from Amgen, MSD, and Sanofi-Aventis. The project in Latvia was supported by the Latvian State Research Programme BIOMEDICINE. The project in Czech Republic was partly supported by grants MZ CR AZV 15-28277A and 16-29084A.
WOS: 000445908000037 ; PubMed ID: 30270054 ; Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in similar to 2/3 countries. Lipoprotein-apheresis is offered in similar to 60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed. ; Pfizer Independent Grant for Learning Change 2014 [16157823]; AmgenAmgen; MSD; Sanofi-AventisSanofi-Aventis ; The EAS FHSC project has received support from a Pfizer Independent Grant for Learning & Change 2014 (No: 16157823) and from investigator-initiated unrestricted research grants to the European Atherosclerosis Society from Amgen, MSD, and Sanofi-Aventis.
Background and aims: Management of familial hypercholesterolaemia (FH) may vary across different settings due to factors related to population characteristics, practice, resources and/or policies. We conducted a survey among the worldwide network of EAS FHSC Lead Investigators to provide an overview of FH status in different countries. Methods: Lead Investigators from countries formally involved in the EAS FHSC by mid-May 2018 were invited to provide a brief report on FH status in their countries, including available information, programmes, initiatives, and management. Results: 63 countries provided reports. Data on FH prevalence are lacking in most countries. Where available, data tend to align with recent estimates, suggesting a higher frequency than that traditionally considered. Low rates of FH detection are reported across all regions. National registries and education programmes to improve FH awareness/knowledge are a recognised priority, but funding is often lacking. In most countries, diagnosis primarily relies on the Dutch Lipid Clinics Network criteria. Although available in many countries, genetic testing is not widely implemented (frequent cost issues). There are only a few national official government programmes for FH. Under-treatment is an issue. FH therapy is not universally reimbursed. PCSK9-inhibitors are available in similar to 2/3 countries. Lipoprotein-apheresis is offered in similar to 60% countries, although access is limited. Conclusions: FH is a recognised public health concern. Management varies widely across countries, with overall suboptimal identification and under-treatment. Efforts and initiatives to improve FH knowledge and management are underway, including development of national registries, but support, particularly from health authorities, and better funding are greatly needed.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.