Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
We conducted a systematic review of the literature on the use of mobile phones for weight loss. A... more We conducted a systematic review of the literature on the use of mobile phones for weight loss. A total of 43 studies were identified on obese or overweight adults, aged 18 years or over. After review, ten articles met the inclusion criteria. There were 19–534 participants per study. Participants were from European, Asian and North American regions. The mean body mass index (BMI) of the subjects varied from 22 to 36 kg/m2. Two studies used text messaging or multimedia messaging. All the other studies used mobile-phone apps or web-based programmes that could be accessed from mobile phones as a part of a weight-loss intervention or for evaluating their potential for use and their acceptance. Most studies lasted 2–4 months and the maximum duration was 1 year. All but two studies showed reductions in the participants’ bodyweight, BMI, waist circumference and body fat in the various interventions. There appeared to be a proportional relationship between weight loss and programme use. The...
ABSTRACT Objective We studied the development of atypical squamous cells of undetermined signific... more ABSTRACT Objective We studied the development of atypical squamous cells of undetermined significance (ASCUS) and their importance depending on the dysplastic antecedents of the patient, age, and the type of the cell with atypia Material And Method We reviewed pap smears from 296 patients with a diagnosis of ASCUS, including ASC-US and ASC-H, diagnosed between 1995 and 1999 in the Department of Pathology of Hospital del Mar. The subsequent development of any grade of dysplasia was evaluated in relation to antecedents, the type of cell with atypia, and patient age Results Antecedents: The development of lowgrade squamous intraepithelial lesions (LSIL) was variable and was not related to the patient's previous history. The development of high-grade intraepithelial lesions (HSIL) showed a linear increase related to the severity of the antecedents. Age: The rate of LSIL was higher in women aged less than 45 years and that of HSIL was higher in women aged more than 45 years, but these differences were not statistically significant. Immature squamous cells: The rate of SIL of any grade was higher when the nuclear atypia developed in metaplastic cells, but these differences were not statistically significant Conclusions Antecedents seem to play an important role in lesion recurrence. Although the rate of HSIL is low, it increases according to the severity of previous lesions. The identification of ASCUS in women with a history of dysplasia may condition the progression and outcome of the dysplastic process. Moreover, HSIL seem to be more frequent when ASCUS develop in immature squamous cells. Although our results are not statistically significant, our data lend support to this hypothesis. Our findings confirm previous data concerning age reported in the literature. Because the rate of HSIL is higher in the first two years after diagnosis, cytological follow-up should be performed during this period
European Journal of Obstetrics & Gynecology and Reproductive Biology, Jul 1, 2021
OBJECTIVE Invasive cervical cancer is considered a young women's disease, however up to 20 % ... more OBJECTIVE Invasive cervical cancer is considered a young women's disease, however up to 20 % of cases develop cervical cancer at advanced ages. The aim was to characterize invasive cervical cancer in women aged 65 and older assessing age-specific survival differences. STUDY DESIGN A retrospective study including cervical cancer patients was conducted at Hospital del Mar Barcelona from July-2007 to December-2016. Women were stratified: <65 or ≥65years. Clinical and pathological data were collected. Multivariate analysis was used to compare outcomes. Adjusted hazard ratios with 95 % confidence intervals for disease-free survival, and overall survival were estimated using Cox proportional hazards models. RESULTS 124 patients with invasive cervical cancer (n = 87 < 65years and n = 37 ≥ 65years) were included. At diagnosis, 48.3 % of <65years patients were diagnosed at advanced stages, while 64.9 % in ≥65years (p = 0.018). Standard treatment was given to 83.9 % of patients in <65years group compared to 62.2 % in ≥65years (p = 0.015). Disease-free survival and overall survival showed no significant differences between groups. Age ≥65 did not predict worse disease-free survival (HR: 0.3 95 %CI, 0.04-3.1, p = 0.347) or overall survival (HR: 0.82 95 %CI, 0.3-2.3, p = 0.729). CONCLUSION Invasive cervical cancer was diagnosed at advanced stages and was treated less frequently with radical intention in patients ≥65years; overall survival and disease-free survival were similar to those cervical cancer diagnosed at younger ages.
Introduction/Background The diagnostic accuracy of endometrial biopsy has been related to the amo... more Introduction/Background The diagnostic accuracy of endometrial biopsy has been related to the amount of tissue. In endometrial cancer (EC) there is only moderate agreement on tumor grade between preoperative endometrial sampling and final diagnosis with the lowest agreement for grade 2 carcinoma. Since the amount of preoperative endometrial tumor tissue has not yet been related to the degree of discordance, we aim to determine this relation with regard to final tumor type and grade. Methodology Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), 582 preoperative endometrial biopsy samples of EC patients were retrospectively collected and classified into low-grade (grade 1–2) and high-grade carcinoma (grade 3). The endometrial tissue surface was digitally calculated using ImageJ software and the correlation between the amount of tissue and concordance of diagnosis was calculated. Results Agreement on tumor grade between preoperative endometrial sampling and final diagnosis was 62.5%. Up- or downgrading was found in respectively 27.1% and 10.3%. Clinically relevant up- or downgrading was found in respectively 7.8% and 27% of the cases. Premalignant endometrial tissue contained less endometrium compared to malignant endometrium (4.4 vs. 19.3 mm2,p=0.03). Serous EC contained less endometrial tissue compared with grade 1–3 endometrioid EC (13.0 vs. 19.1 mm2,p=0.017). The median endometrial tissue surfaces of grade 1-3 did not significantly differ from each other (18.7 vs. 19.8 vs. 24.1 mm2). Samples with a discordant diagnosis consisted of significantly more endometrial tissue compared to the concordant group (p=0.018). Conclusion Based on postoperative diagnosis, there is no difference in the amount of endometrial tissue between the different endometrial grades. However, there is a tendency to underestimate a sample with less and overestimate a sample with more endometrial tissue. Awareness is especially needed, in serous EC with in general less tissue. Disclosure Nothing to disclose.
Imputed dataset used for development of ENDORISK Bayesian network, to predict lymph node metastas... more Imputed dataset used for development of ENDORISK Bayesian network, to predict lymph node metastasis in endometrial cancer. These data were retrospectively collected from ten participating centers across Europe. These data belong to and include all variables for the statistical analyses conducted in the paper “Preoperative endometrial cancer risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model: an ENITEC development and external validation study”, by Casper Reijnen and colleagues. The objective of this paper was to develop and validate a preoperative Bayesian network to predict the risk of lymph node metastasis and survival in patients surgically treated for endometrial cancer. Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC) consortium. Ten participating centers included patients treated between February 1995 and August 2013 for International Federation of Gynecology and Obstetrics (FIGO) stage I-IV endometrioid endometrial carcinoma (EEC), or non-endometrioid endometrial carcinoma (NEEC)
Background This study aimed to determine the impact of pulmonary complications on death after sur... more Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery be...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
We conducted a systematic review of the literature on the use of mobile phones for weight loss. A... more We conducted a systematic review of the literature on the use of mobile phones for weight loss. A total of 43 studies were identified on obese or overweight adults, aged 18 years or over. After review, ten articles met the inclusion criteria. There were 19–534 participants per study. Participants were from European, Asian and North American regions. The mean body mass index (BMI) of the subjects varied from 22 to 36 kg/m2. Two studies used text messaging or multimedia messaging. All the other studies used mobile-phone apps or web-based programmes that could be accessed from mobile phones as a part of a weight-loss intervention or for evaluating their potential for use and their acceptance. Most studies lasted 2–4 months and the maximum duration was 1 year. All but two studies showed reductions in the participants’ bodyweight, BMI, waist circumference and body fat in the various interventions. There appeared to be a proportional relationship between weight loss and programme use. The...
ABSTRACT Objective We studied the development of atypical squamous cells of undetermined signific... more ABSTRACT Objective We studied the development of atypical squamous cells of undetermined significance (ASCUS) and their importance depending on the dysplastic antecedents of the patient, age, and the type of the cell with atypia Material And Method We reviewed pap smears from 296 patients with a diagnosis of ASCUS, including ASC-US and ASC-H, diagnosed between 1995 and 1999 in the Department of Pathology of Hospital del Mar. The subsequent development of any grade of dysplasia was evaluated in relation to antecedents, the type of cell with atypia, and patient age Results Antecedents: The development of lowgrade squamous intraepithelial lesions (LSIL) was variable and was not related to the patient&#39;s previous history. The development of high-grade intraepithelial lesions (HSIL) showed a linear increase related to the severity of the antecedents. Age: The rate of LSIL was higher in women aged less than 45 years and that of HSIL was higher in women aged more than 45 years, but these differences were not statistically significant. Immature squamous cells: The rate of SIL of any grade was higher when the nuclear atypia developed in metaplastic cells, but these differences were not statistically significant Conclusions Antecedents seem to play an important role in lesion recurrence. Although the rate of HSIL is low, it increases according to the severity of previous lesions. The identification of ASCUS in women with a history of dysplasia may condition the progression and outcome of the dysplastic process. Moreover, HSIL seem to be more frequent when ASCUS develop in immature squamous cells. Although our results are not statistically significant, our data lend support to this hypothesis. Our findings confirm previous data concerning age reported in the literature. Because the rate of HSIL is higher in the first two years after diagnosis, cytological follow-up should be performed during this period
European Journal of Obstetrics & Gynecology and Reproductive Biology, Jul 1, 2021
OBJECTIVE Invasive cervical cancer is considered a young women's disease, however up to 20 % ... more OBJECTIVE Invasive cervical cancer is considered a young women's disease, however up to 20 % of cases develop cervical cancer at advanced ages. The aim was to characterize invasive cervical cancer in women aged 65 and older assessing age-specific survival differences. STUDY DESIGN A retrospective study including cervical cancer patients was conducted at Hospital del Mar Barcelona from July-2007 to December-2016. Women were stratified: <65 or ≥65years. Clinical and pathological data were collected. Multivariate analysis was used to compare outcomes. Adjusted hazard ratios with 95 % confidence intervals for disease-free survival, and overall survival were estimated using Cox proportional hazards models. RESULTS 124 patients with invasive cervical cancer (n = 87 < 65years and n = 37 ≥ 65years) were included. At diagnosis, 48.3 % of <65years patients were diagnosed at advanced stages, while 64.9 % in ≥65years (p = 0.018). Standard treatment was given to 83.9 % of patients in <65years group compared to 62.2 % in ≥65years (p = 0.015). Disease-free survival and overall survival showed no significant differences between groups. Age ≥65 did not predict worse disease-free survival (HR: 0.3 95 %CI, 0.04-3.1, p = 0.347) or overall survival (HR: 0.82 95 %CI, 0.3-2.3, p = 0.729). CONCLUSION Invasive cervical cancer was diagnosed at advanced stages and was treated less frequently with radical intention in patients ≥65years; overall survival and disease-free survival were similar to those cervical cancer diagnosed at younger ages.
Introduction/Background The diagnostic accuracy of endometrial biopsy has been related to the amo... more Introduction/Background The diagnostic accuracy of endometrial biopsy has been related to the amount of tissue. In endometrial cancer (EC) there is only moderate agreement on tumor grade between preoperative endometrial sampling and final diagnosis with the lowest agreement for grade 2 carcinoma. Since the amount of preoperative endometrial tumor tissue has not yet been related to the degree of discordance, we aim to determine this relation with regard to final tumor type and grade. Methodology Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC), 582 preoperative endometrial biopsy samples of EC patients were retrospectively collected and classified into low-grade (grade 1–2) and high-grade carcinoma (grade 3). The endometrial tissue surface was digitally calculated using ImageJ software and the correlation between the amount of tissue and concordance of diagnosis was calculated. Results Agreement on tumor grade between preoperative endometrial sampling and final diagnosis was 62.5%. Up- or downgrading was found in respectively 27.1% and 10.3%. Clinically relevant up- or downgrading was found in respectively 7.8% and 27% of the cases. Premalignant endometrial tissue contained less endometrium compared to malignant endometrium (4.4 vs. 19.3 mm2,p=0.03). Serous EC contained less endometrial tissue compared with grade 1–3 endometrioid EC (13.0 vs. 19.1 mm2,p=0.017). The median endometrial tissue surfaces of grade 1-3 did not significantly differ from each other (18.7 vs. 19.8 vs. 24.1 mm2). Samples with a discordant diagnosis consisted of significantly more endometrial tissue compared to the concordant group (p=0.018). Conclusion Based on postoperative diagnosis, there is no difference in the amount of endometrial tissue between the different endometrial grades. However, there is a tendency to underestimate a sample with less and overestimate a sample with more endometrial tissue. Awareness is especially needed, in serous EC with in general less tissue. Disclosure Nothing to disclose.
Imputed dataset used for development of ENDORISK Bayesian network, to predict lymph node metastas... more Imputed dataset used for development of ENDORISK Bayesian network, to predict lymph node metastasis in endometrial cancer. These data were retrospectively collected from ten participating centers across Europe. These data belong to and include all variables for the statistical analyses conducted in the paper “Preoperative endometrial cancer risk stratification in endometrial cancer (ENDORISK) by a Bayesian network model: an ENITEC development and external validation study”, by Casper Reijnen and colleagues. The objective of this paper was to develop and validate a preoperative Bayesian network to predict the risk of lymph node metastasis and survival in patients surgically treated for endometrial cancer. Within the European Network for Individualized Treatment of Endometrial Cancer (ENITEC) consortium. Ten participating centers included patients treated between February 1995 and August 2013 for International Federation of Gynecology and Obstetrics (FIGO) stage I-IV endometrioid endometrial carcinoma (EEC), or non-endometrioid endometrial carcinoma (NEEC)
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