Global Forum of Cancer Surgeons: Cancer Surgery During the COVID-19 Pandemic: Impact and Lessons Learned.

BACKGROUND: The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of COVID-19 pandemic on cancer surgery. METHODS: A panel session (virtual) was held at the annual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care to address the impact of COVID-19 on cancer surgery globally. Following the virtual meeting, a questionnaire was sent to all the leaders to gather additional opinions. The input obtained from all the leaders was collated and analyzed to understand how cancer surgeons from across the world adapted in real-time to the impact of COVID-19 pandemic. RESULTS: The surgical oncology leaders noted that the COVID-19 pandemic led to severe disruptions in surgical cancer care across all domains of clinical care, education, and research. Several new changes/protocols associated with increased costs were implemented to deliver safe care. Leaders also noted that preexisting disparities in care were exacerbated, and the pandemic had a detrimental effect on well-being and financial status. CONCLUSIONS: The COVID-19 pandemic has led to severe disruptions in surgical cancer care globally. Leaders of the GFCS opined that new strategies need to be implemented to prepare for any future catastrophic events based on the lessons learned from the current events. The GFCS will embark on developing such a roadmap to ensure that surgical cancer care is preserved in the future regardless of any catastrophic global events.

A comparison of the immune response of 2003 commercial turkeys and a 1966 randombred strain when fed representative 2003 and 1966 turkey diets.

The immunological performance of modern turkeys (one-third each of the Nicholas Turkey, British United Turkeys of America, and Hybrid Turkey strains) hatched in 2003 (2003 strain) was compared with that of a randombred control turkey strain (RBC2) established in calendar year 1966, when fed representative 1966 and 2003 type diets. The 2003 strain had a higher BW and bursa of Fabricius weight relative to total BW compared with the RBC2 strain (P = 0.0001) when measured at 12 and 13 d of age, respectively. Total antibody response against SRBC did not differ between strains, nor were any differences observed in the IgM antibody levels either during a primary or secondary SRBC challenge. However, RBC2 poults had higher IgG levels (P = 0.02) than the 2003 strain at 7 d post secondary SRBC challenge. No significant differences were observed in the phytohemagglutinin phosphate-mediated toe-web lymphoblastic response. However, the 2003-strain turkeys seemed to have a better swelling response (P = 0.06) than the RBC2-strain turkeys when measured at 24 h post phytohemagglutinin phosphate injection. The modern turkeys also had higher mononuclear phagocytic system function, as measured by clearance of carbon particles from the bloodstream 5 min post intravenous injection of colloidal carbon (P = 0.02). These results indicate that selection over the years of turkeys for improved performance traits has had no adverse effects on most of the immune system indicators when examined prior to sexual maturity in the current study.

Role of iodine-131 MIBG scanning in the management of paediatric patients with neuroblastoma.

OBJECTIVES: To evaluate the role of iodine-131 metoiodobenzylguanidine (iodine-131 MIBG) scanning in the management of paediatric patients with neuroblastoma. SUBJECTS AND METHODS: Forty-three iodine-131 MIBG scans were performed on 26 children, 18 male and 8 female, ranging in age from 8 months to 11 years. Bone scan, computed tomography (CT) images and findings of bone marrow biopsy were compared with the iodine-131 MIBG scan findings. RESULTS: Of the 26 patients, 18 (69%) showed abnormal iodine-131 MIBG avidity and were proven to have a neural crest tumour on histology. The remaining 8 (31%) patients had normal iodine-131 MIBG scans, and histology showed a malignancy other than a neural crest tumour. Iodine-131 MIBG scans showed the primary site in 16 of 17 patients while CT showed 14 primary sites. In follow-up studies, the results were as follows: iodine-131 MIBG showed no evidence of disease in 4 compared with 3 on CT, persistent disease in 2 on iodine-131 MIBG and 4 on CT; recurrence in 1 on iodine-131 MIBG and 0 on CT; MIBG scans detected double the number of bony lesions compared with bone scans. The findings on iodine-131 MIBG scans and bone marrow biopsy were in agreement in 16/18 cases. Patients in whom iodine-131 MIBG scans showed disease resolution had better clinical outcomes. CONCLUSION: The findings indicate that iodine-131 MIBG scanning is useful for the diagnosis, staging, evaluation of response to therapy and detection of recurrences in patients with neuroblastoma. It exhibited a clear advantage over CT in detecting the primary site and soft issue metastases and was also superior to bone scanning in detecting skeletal metastases. It also reliably demonstrated bone marrow involvement.

A comparison of the immune response of a 2001 commercial broiler with a 1957 randombred broiler strain when fed representative 1957 and 2001 broiler diets.

Immunocompetence of the 2001 Ross 308 broiler strain and the 1957 Athens Canadian Randombred Control (ACRBC) strain was compared when they were given diets representative of those that were being used in 1957 and 2001. Antibody response against SRBC, in vivo lymphoproliferation against Phytohemagglutinin-P (PHA-P), and inflammatory and phagocytic responses of the macrophages were measured. The Ross 308 strain on the 2001 diet had higher BW at 24 d of age (P = 0.0001), whereas the ACRBC had greater lymphoid organ weights (except thymus) relative to BW (P < or = 0.003). The ACRBC strain showed greater antibody responses against SRBC than the 2001 Ross 308 birds for much of the trial (P < or = 0.0362). However, the Ross 308 broilers had greater PHA-P-induced toe-web swelling response (P < or = 0.0129). Inflammatory exudate cell numbers were higher in the Ross 308 broilers than in the ACRBC birds (P = 0.0261). The percentage of macrophages that phagocytized SRBC was comparable between the two strains, but the number of SRBC phagocytized by individual macrophages was higher (P = 0.0122) in the Ross 308 broiler than in the ACRBC chickens. Nitrite production by macrophages following lipopolysacharide stimulation was comparable between the two strains. Interactions of diet, strain, and sex were inconsistent among all parameters tested. In conclusion, the current study suggested that genetic selection for improved broiler performance has resulted in a decrease in the adaptive arm of the immune response but an increase in the cell-mediated and inflammatory responses.

Interactions of poult enteritis and mortality syndrome-associated reovirus with various cell types in vitro.

An avian reovirus, ARV-CU98, has recently been isolated from poults experiencing poult enteritis and mortality syndrome (PEMS). To further understand ARV-CU98 and its role in PEMS, the current study investigates interactions of ARV-CU98 with various cell types in vitro. When macrophages, B cells, T cells, and liver cells of chicken or turkey origin were co-incubated with ARV-CU98, only cells of liver origin demonstrated cytopathic effects, the presence of viral antigen, and reduced metabolic activity over time. Furthermore, distinctive pockets of viral particles were evident in electron microscopic examination of a chicken hepatocellular carcinoma (LMH) cell line, but not in a chicken macrophage cell line (MQ-NCSU) co-incubated with virus. Additional evidence of viral replication in LMH, cells but not MQ-NCSU cells was demonstrated by the presence of two viral bands (43 and 145 kD size) in cell lysates from LMH cells exposed to ARV-CU98. Although not capable of being infected by ARV-CU98, MQ-NCSU cells do appear to be activated by the virus since IL-1 mRNA expression is increased in MQ-NCSU cells 2 h after addition of the virus. LMH cells exposed to the virus demonstrate a decrease in IL-1 mRNA expression by 8 to 10 h after addition of the virus, perhaps corresponding to the initiation of infection by the virus. In conclusion, this study demonstrates that ARV-CU98 actively infects and replicates in LMH cells, but not in lymphocytes or macrophages, suggesting that the liver may be a target and site of replication of ARV-CU98 in poults experiencing PEMS.

Xanthogranulomatous pyelonephritis presenting as a pseudotumor in a 2-month-old boy.

The authors report on a 2-month-old boy presenting with a right renal mass. Investigations including ultrasound scan and computed tomogram were suggestive of a renal tumor. A right nephrectomy was performed with great difficulty because of dense adhesions to the adjacent structures. Cut section of the specimen showed the entire kidney to be replaced by cheesy-yellow areas. Histological examination was suggestive of xanthogranulomatous pyelonephritis. Although rare at this age, xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass in children. The lesion is unique among the inflammatory conditions in closely mimicking renal tumours clinically. A thorough histological examination also is suggested because the features can get confused easily with those of renal tumors.

Rapid communication: Cervical Chlamydia trachomatis in women at low risk for infection.

BACKGROUND: Evidence suggests that the bacterium Chlamydia trachomatis can cause asymptomatic genital infection in persons at risk for acquisition of the organism. We employed 2 independent molecular screening systems to assess such inapparent cervical chlamydial infections in low-risk female patients attending general (non-STD) clinics in 2 locations. METHODS: Three hundred seventy-five cervical swab samples were obtained in duplicate from patients attending a general women's clinic (278 samples) and a colposcopy clinic (97 samples). One set of samples from the general clinic was screened by a highly-specific molecular hybridization system, using a probe targeting the chlamydial 16S ribosomal RNA; the other set was screened with the use of the Chlamydiazyme test. Samples from the colposcopy clinic were screened using a sensitive and specific polymerase chain reaction (PCR) assay system targeting chlamydia; the duplicates were assayed by direct fluorescent antibody assay (DFA). RESULTS: Of the 278 patients screened by RNA-directed hybridization, 6.5% were positive for C. trachomatis, in contrast to screening of duplicate samples via Chlamydiazyme, which indicated that 3.6% were infected. PCR-based screening of the additional 97 patients gave a positivity rate of 17.5% for the organism, whereas DFA on duplicate samples from this group showed only 7.5% positive. CONCLUSIONS: These observations suggest that the level of asymptomatic cervical C. trachomatis infection is significant even in women who are at low risk for such infections; the data also indicate that results from standard laboratory screening for chlamydia should be viewed with caution.

Primary midline cranial vault lymphoma simulating a parasagittal meningioma: the role of angiography in preoperative diagnosis.

Primary non-Hodgkin's lymphoma (NHL) of the skull with extra- and intracranial extension without systemic or skeletal manifestation in a non-immunocompromised patient is extremely rare. Up to date, only nine such cases have been reported in the literature and in none was the lesion located in the midline. The authors report a unique case of a primary NHL involving the midline of the cranium. The lesion presented as a slowly growing scalp swelling mimicking a parasagittal meningioma. The angiographic findings of mild vascularity in the periphery of the tumor and downward displacement of a patent superior sagittal sinus indicated that the lesion was unlikely to be a meningioma. Neurosurgeons must maintain a broad differential diagnosis in any patient with a scalp mass eroding through the skull and associated neurological symptoms or signs. An intraoperative frozen section is recommended since the identification of a lymphoma is likely to influence the neurosurgeon's decision about the extent of the surgical excision.