No abstract

Objective: The aim of this study was to investigate variation in the frequency of resections for colorectal cancer liver metastases across the English NHS. Background: Previous research has shown significant variation in access to liver resection surgery across the English NHS. This study uses more recent data to identify whether inequalities in access to liver resection still persist. Methods: All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2012 were identified in the COloRECTal cancer data Repository (CORECT-R). All episodes of care, occurring within 3 years of the initial bowel operation, corresponding to liver resection were identified. Result: During the study period 157,383 patients were identified as undergoing major resection for a colorectal tumor, of whom 7423 (4.7%) underwent ≥1 liver resections. The resection rate increased from 4.1% in 2005, reaching a plateau around 5% by 2012. There was significant variation in the rate of liver resection across hospitals (2.1%–12.2%). Patients with synchronous metastases who have their primary colorectal resection in a hospital with an onsite specialist hepatobiliary team were more likely to receive a liver resection (odds ratio 1.22; 95% confidence interval, 1.10–1.35) than those treated in one without. This effect was absent in resection for metachronous metastases. Conclusions: This study presents the largest reported population-based analysis of liver resection rates in colorectal cancer patients. Significant variation has been observed in patient and hospital characteristics and the likelihood of patients receiving a liver resection, with the data showing that proximity to a liver resection service is as important a factor as deprivation.

Experimental results are presented of an acid autocatalytic reaction (the bromate-sulfite clock reaction) performed in water-in-oil (w/o) microemulsions with neutral (Triton X-100, TX) or cationic (CTAB) surfactants. The characteristics of the pH-sensitive reaction in the stirred system are found to depend on the molar ratio of water to surfactant (ω 0 ) and the nature of the surfactant. The well-stirred reaction (clock) time is faster in the TX w/o microemulsion and slower in the CTAB w/o microemulsion compared to the aqueous phase clock. The pH change is reduced in the TX system and the initial and final pH are shifted to higher values in the CTAB system. The unstirred water-in-oil microemulsions support propagating acid reaction fronts with speeds up to a factor of 10 lower than the aqueous phase fronts. The results are explained through consideration of the effect of the confinement of water in the nanosized droplets on rates and equilibria and assuming front propagation is driven by the diffusion of hydrated reverse micelles.

Colorectal cancer is the fourth most common cancer in the UK, with around 42 000 new cases per year, and the second leading cause of cancer-related death [1]. Approximately 20% of colorectal cancer patients will have metastases at diagnosis and they will subsequently become apparent in up to 50% of people [2]. Around 5%-15% of patients with cancer of the colon will develop metastases in the lungs during the disease course, and such spread is proportionally more common in rectal cancer patients, because of the difference

The evolution of disease or the progress of recovery of a patient is a complex process, which depends on many factors. A quantitative description of this process in real-time by a single, clinically measurable parameter (biomarker) would be helpful for early, informed and targeted treatment. Organ transplantation is an eminent case in which the evolution of the post-operative clinical condition is highly dependent on the individual case. The quality of management and monitoring of patients after kidney transplant often determines the long-term outcome of the graft. Using NMR spectra of blood samples, taken at different time points from just before to a week after surgery, we have shown that a biomarker can be found that quantitatively monitors the evolution of a clinical condition. We demonstrate that this is possible if the dynamics of the process is considered explicitly: the biomarker is defined and determined as an optimal reaction coordinate that provides a quantitatively accurate description of the stochastic recovery dynamics. The method, originally developed for the analysis of protein folding dynamics, is rigorous, robust and general, i.e., it can be applied in principle to analyze any type of biological dynamics. Such predictive biomarkers will promote improvement of long-term graft survival after renal transplantation, and have potentially unlimited applications as diagnostic tools.