Influence of caseload and surgical speciality on outcome following surgery for colorectal cancer: a review of evidence Part 2: Long-term outcome

OBJECTIVE: We reviewed recent literature to assess the impact of hospital caseload, surgeon's caseload and education on long-term outcome following colorectal cancer surgery. METHOD: We searched the MEDLINE and Cochrane Library databases for relevant literature starting from 1992. We selected hospital caseload, surgeon's caseload and surgeon's education, type of hospital, and surgeon's experience as variables of interest. Measures of outcome were recurrence-free survival and overall survival, and for rectal cancer frequency of permanent stoma. We reviewed the 34 studies according to tumour location: colonic cancer, rectal cancer, or colorectal cancer. We described the studies individually and performed a meta-analysis whenever it was considered appropriate. RESULTS: For colonic cancer, overall survival improved with increasing hospital caseload, odds ratio (OR) 1.22 [95% confidence interval (CI) 1.16-1.28], and surgeon's education. For rectal cancer, overall survival improved with increasing hospital caseload, OR 1.38 (95% CI 1.19-1.60), and, possibly by surgeon' education and experience. Cancer-free survival was strongly influenced by surgeon's education. The colostomy rate was less in high caseload hospitals, OR 0.76 (95% CI 0.68-0.85). For colorectal cancer, overall survival improved with surgeon's education. CONCLUSION: The data have provided evidence that long-term survival following colorectal cancer surgery in general improved significantly with increasing hospital caseload and surgeon's education.     

Enteric pathogens and their isolation at a cancer hospital in Pakistan

Diarrhoeal diseases remain a major cause of mortality and morbidity in developing countries. However, due to lack of funds, supply problems and some inexperience, some laboratories have difficulty identifying a causative agent in stool samples. In the year following the opening of the Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan, the microbiology department had not isolated a single enteric pathogen. From January 1996, new culture techniques were introduced, with a resulting increase (10%) in identification of these pathogens. In addition, the introduction of formol-ether concentration made a significant contribution to the number of intestinal parasites seen. This report demonstrates how simple microbiology methods made a difference to the running of the department and, ultimately, to the patients.     

Sperm priming reveals specific autoreactive lymphocyte clones

Human spermatozoa from 18 donors were used to prime lymphocytes from 15 donors in a total of 60 different combinations. The sperm primed lymphocytes were tested in second culture against a total of 60 autologous and 180 allogeneic x-ray irradiated cells. We found that lymphocytes primed for 10–12 days in first culture with allogeneic spermatozoa showed highly significant responses in second culture to leukocytes autologous to the responder. The degree of autologous reactivity between specific subjects ranged from weak to significantly higher than the usual preferential primed lymphocyte typing reaction seen in a secondary mixed leukocyte culture reaction. These findings indicate that healthy human volunteers possess a set of self-reactive lymphocytes that can be detected by priming with allogeneic sperm in specific combinations.     

Identification of a type 1 diabetes-associated CD4 promoter haplotype with high constitutive activity

CD4 is a candidate gene in autoimmune diseases, including Type 1 diabetes mellitus (T1DM), because the CD4 receptor is crucial for appropriate antigen responses of CD4(+) T cells. We previously found linkage between a CD4-1188(TTTTC)(5-14) promoter polymorphism and T1DM. In the present study, we screened the human CD4 promoter for mutations and identified three frequent single nucleotide polymorphisms (SNPs): CD4-181C/G, CD4-521C/G and CD4-1050T/C. The SNPs are in strong linkage disequilibrium (LD) and association with the CD4-1188(TTTTC)(5-14) alleles, and we observed nine CD4 promoter haplotypes, of which four are frequent. We genotyped the SNPs in 253 Danish T1DM families (1129 individuals) and found evidence for linkage and association of a CD4 (A4(-1188)T(-1050)G(-521)C(-181)) haplotype to T1DM. In reporter studies, we show that (1) the T1DM-associated CD4 haplotype encodes high constitutive promoter activity and (2) the CD4-181G variant encodes higher stimulated promoter activity than the CD4-181C variant. This difference is in part neutralized in the frequently occurring CD4 promoter haplotypes by the more upstream genetic variants. Thus, we report functional impact of a novel CD4-181C/G SNP on stimulated CD4 promoter activity and the identification of a novel CD4 haplotype with high constitutive promoter activity that is linked and associated with T1DM.     

Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n=126) or not (n=129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA(1c) level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.     

A pilot study of cadre training to promote responsible self-medication in Indonesia: Which is better specific or general modules?

In 2015, the Indonesian Government initiated ‘Smart Use of Medications Movement’ (‘GeMa CerMat’) which included cadre training to promote responsible self-medication. Evaluation of a pilot training conducted across Indonesia suggested the need to improve those training modules. This study aimed to assess cadre’ knowledge gained following training with newly developed general or specific training modules. Five types of modules were developed and used to train cadres at five Community Health Centres (CHCs) in Surabaya, Indonesia: 1) Sidosermo CHC (general-drugs module), 2) Tenggilis CHC (common cold drugs module), 3) Gunung Anyar CHC (analgesic drugs module), 4) Kalirungkut CHC (anti-diarrhoeal drugs module), and 5) Jagir CHC (indigestion drugs module). Cadres’ knowledge improvements were evaluated using pre-/post-test scores and the difference scores depending on the module being tested. Multifactorial ANOVA explored the effects of the type of module on difference scores. A total of 279 cadres across five CHCs were involved in the training, giving response rates from 65% to 93%. There was an increase in the post-test scores after the training with all modules. However, significant differences were reported only for the specific-drugs module groups (all p < .001). Furthermore, the general module group had the lowest difference score (1.12; 95% CI [−0.45, 2.92]) while the common cold module group had the highest gain (5.02; 95% CI [1.95, 5.17]). Multifactorial ANOVA revealed that there was a significant main effect of the type of modules on difference scores [F (4, 263) = 8.37, p <.001]. In conclusion, this preliminary study indicated that the development of modules for specific minor illnesses could be beneficial in facilitating effective community-based training to promote responsible self-medication in Indonesia. The priority for therapeutic areas chosen for the module should be based on the local needs. Further research is required to confirm the findings in broader community members.     

Characterization of recast Nafion films by small- and wide-angle X-ray scattering

Room temperature recast Nafion

1 General formula:

films, prepared under different humidities in the curing atmosphere, were characterized by small- and wide-angle X-ray scattering (SAXS and WAXS). SAXS reveals that the humidity influences the size of the ionic clusters in these polymer films. It was found that the number and size of ionic clusters increases with increasing relative humidity. WAXS indicates the presence of locally ordered regions of the backbone polymer. These results allow a qualitative understanding of the electrochemical behaviour of Nafion recast films cured at different humidities, as described in the literature.