Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.
The peripheral blood cells of one-yearold Chinese sturgeon (Acipenser sinensis) have been studied by light microscopy and transmission electron microscopy. The erythrocyte count was 84.86 · 10 4 cell mm -3 in the peripheral blood of the fish and that of leukocytes was 2.24 · 10 4 cell mm -3 . The erythrocytes and four main types of leucocyte-thrombocytes, lymphocytes, granulocytes (including neutrophils and eosinophils), and monocytes, were identified in the peripheral blood. In addition to normal erythrocytes, reticulocytes and division of erythrocytes were observed. Thrombocytes were the most numerous among the leukocytes, and the number of neutrophils with lobated nuclei was larger than for other fish. The structures of the erythrocytes, lymphocytes, monocytes, granulocytes, and thrombocytes of the fish were studied. The erythrocytes were almost completely devoid of organelles, except for some mitochondria and granules. A large number of vacuoles and a few organelles were observed in cytoplasm of the monocytes. There were many microvilli on the membrane and pseudopodialike cytoplasm bulge in the lymphocytes. The neutrophils were round or oval in shape with bilobed, trilobed, or multilobed nuclei whereas the eosinophils had big special granules, dark stained. There were many vesicles in some thrombocytes, which were related to its phagocytosis; some thrombocytes had almost no cytoplasm or organelles.
Haematological and serum biochemistry parameters were studied and compared between cultured and wild ecotypes of Dojo loach Misgurnus anguillicaudatus during the prime fishing season, i.e. May-August. Data were analysed for the impact of feeding regime and other ecological conditions on the physiology of fish. The results revealed that haemoglobin, cholesterol, total protein, creatinine and uric acid levels in the two ecotypes were significantly different (n = 56, df = 54, P < 0.05). In addition, red blood cell, glucose, triglyceride and urea nitrogen levels were significantly higher in cultured individuals (n = 56, df = 54, P < 0.01) than in their wild counterparts. In contrast, the white blood cell level in cultured fish was significantly (n = 56, df = 54, P < 0.01) lower than that in the wild ones. These differences can be attributed to the physiological acclimatization of the fish to their living conditions and feeding regime, which influences the energy metabolism and, consequently, the health of the fish.
A feeding trial was conducted for 8 weeks to evaluate the effects of graded levels of neutral phytase supplementation using pretreatment or spraying method on growth performance, body composition, bone mineral content and serum biochemical parameter in grass carp, Ctenopharyngodon idellus. A control diet without phytase was added and six additional diets were arranged as a 2 9 3 factorial with two methods (pretreatment or spraying) and three levels of phytase (500, 1000 or 1500 U kg À1 ). The results showed that supplemental phytase at different levels in the diet and with different application methods all improved weight gain, specific growth rate and protein efficiency ratio of grass carp (P < 0.05). The feed conversion ratio in phytase-supplemented groups was lower than the control. Dietary phytase addition reduced the lipid content in the whole body of grass carp. Phytase supplementation with different method increased ash and mineral (P, Ca, Mg and Zn) contents in whole-body and vertebra (P < 0.05). The increase in these mineral contents was also observed in the serum. Based on the results, we may conclude that: 1) supplemental dietary phytase, regardless of the application methodology, improved the growth performance and nutrient utilization in grass carp; 2) the pretreatment mode of phytase application was more effective than spraying at the same phytase level.
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