The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study / El impacto de la fuga anastomótica después de la resección curativa del cáncer de colon en la supervivencia a largo plazo: un estudio de cohorte retrospectivo

Introduction: Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection. Methods: A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by Kaplan–Meier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival. Results: A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,02–4,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05). Conclusion: AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.(AU)

Objetivo: La fuga anastomótica (FA) es una complicación postoperatoria temida en la cirugía del cáncer de colon por asociación con mayor morbimortalidad, aunque su impacto en la supervivencia a largo plazo no es consensuado. Nuestro objetivo fue investigar el efecto de la FA en la supervivencia a largo plazo de pacientes sometidos a resección curativa del cáncer de colon. Métodos: Se realizó un estudio de cohorte retrospectivo unicéntrico de pacientes consecutivos intervenidos quirúrgicamente entre 01/01/2010 y el 31/12/2019. El análisis de supervivencia se realizó por el método de Kaplan-Meier para evaluar la supervivencia global (SG) y condicional y una regresión de Cox para evaluar los factores de riesgo con efecto en la supervivencia. Resultados: De 2351 pacientes sometidos a cirugía colorrectal, se incluyeron 686 con cáncer de colon. FA afectó 57 pacientes (8,3%) y se asoció con mayor morbimortalidad postoperatoria, duración de estancia hospitalaria y reingresos (P < 0,05). La SG fue inferior en el grupo de fuga (Hazard Ratio 2,08 [1,02–4,24]). La SG condicional a los 30, 90 días y 6 meses fue inferior en el grupo de fugas (P < 0,05), pero no a 1 año. Los factores de riesgo que se asociaron con SG reducida incluyeron la FA, clasificación ASA más alta y quimioterapia adyuvante retrasada/perdida. FA no afectó la recurrencia local y distante (P > 0.05). Conclusiones: FA tiene un impacto negativo en la supervivencia, con efecto más pronunciado sobre la mortalidad a corto plazo, pero no es asociado con la progresión de la enfermedad oncológica.(AU)

The impact of anastomotic leakage after curative colon cancer resection on long-term survival: A retrospective cohort study.

INTRODUCTION: Anastomotic leakage (AL) is one of the most feared postoperative complications in colon cancer surgery due to an association with increased morbidity and mortality, although its impact on long-term survival is not consensual. The aim of this study was to investigate the influence of AL on long-term survival of patients undergoing curative colon cancer resection. METHODS: A single-centre retrospective cohort study was designed. Clinical records of all consecutive patients undergoing surgery at our institution between 01/01/2010 and 12/31/2019 were reviewed. Survival analysis was performed by Kaplan-Meier method to estimate overall and conditional survival and Cox regression to search for risk factors impacting survival. RESULTS: A total of 2351 patients submitted to colorectal surgery were screened for eligibility, of which 686 with colon cancer were included. AL occurred in 57 patients (8,3%) and was associated with higher postoperative morbidity and mortality, length of stay and early readmissions (P < 0,05). Overall survival was inferior in the leakage group (Hazard Ratio 2,08 [1,02-4,24]). Conditional overall survival at 30, 90 days and 6 months was also inferior in the leakage group (P < 0,05), but not at 1 year. Risk factors independently associated with reduced overall survival included AL occurrence, higher ASA classification and delayed/missed adjuvant chemotherapy. AL did not impact local and distant recurrence (P > 0,05). CONCLUSION: AL has a negative impact on survival. Its effect is more pronounced on short-term mortality. AL does not appear to be associated with disease progression.

Remineralization, color stability and surface roughness of tooth enamel brushed with activated charcoal-based products.

OBJECTIVE: To evaluate the effect of activated charcoal-based (AC) products on color alteration, remineralizing potential and surface roughness of dental enamel. MATERIALS AND METHODS: Bovine incisors were cut into 6 × 6 × 2 mm fragments. Initial color (EasyShade, Vita) and surface roughness (Surfcorder SE1700, Kosakalab) readings were performed. Fragments were separated into five groups (n = 17) according to the treatment: Control: Fluoride toothpaste (Colgate Total 12, Colgate); Charcoal + NaF: AC toothpaste (ACT) with sodium fluoride (Colgate Natural Extracts, Colgate); Charcoal + MFP + n-HA: ACT with sodium monofluorophosphate and nanohydroxyapatite (Black is White, Curaprox); Charcoal: Fluoride-free ACT (ProActive, Hinode); and Charcoal powder: AC powder. Simulated toothbrushing was performed and final color and surface roughness readings were obtained. Fragments were then polished, and initial microhardness (HMV-2, Shimatzu) readings were done. Samples were artificially demineralized and brushed again. Final microhardness readings were taken. Data were statistically analyzed. RESULTS: Fluoride-free charcoal presented the lowest surface roughness alteration (p < 0.05). Charcoal powder had the lowest color change (p < 0.05) and negative values for whiteness index for dentistry alteration. All the groups presented values below whiteness acceptability threshold and negative relative microhardness values. Control showed the highest remineralizing potential (p < 0.05). CONCLUSIONS: ACPs did not produce color alteration different from the fluoride toothpaste, except for Charcoal powder that caused less color change. ACPs caused surface roughness alteration similar to the fluoride toothpaste. ACT with fluoride and AC powder did not have remineralizing potential. CLINICAL SIGNIFICANCE: Activated charcoal-based products (ACP) promise effective tooth whitening and quick results, without teeth damage. In addition, some ACPs contain fluoride in toothpaste composition and promise rehardening potential. However, ACPs are not as effective as other whitening agents and can alter the surface roughness of the enamel. Even if the ACPs contain fluoride or other remineralizing agents, they might be ineffective.

Surviving rectal cancer at the cost of a colostomy: global survey of long-term health-related quality of life in 10 countries.

BACKGROUND: Colorectal cancer management may require an ostomy formation; however, a stoma may negatively impact health-related quality of life (HRQoL). This study aimed to compare generic and stoma-specific HRQoL in patients with a permanent colostomy after rectal cancer across different countries. METHOD: A cross-sectional cohorts of patients with a colostomy after rectal cancer in Denmark, Sweden, Spain, the Netherlands, China, Portugal, Australia, Lithuania, Egypt, and Israel were invited to complete questionnaires regarding demographic and socioeconomic factors along with the Colostomy Impact (CI) score, European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and five anchor questions assessing colostomy impact on HRQoL. The background characteristics of the cohorts from each country were compared and generic HRQoL was measured with the EORTC QLQ-C30 presented for the total cohort. Results were compared with normative data of reference European populations. The predictors of reduced HRQoL were investigated by multivariable logistic regression, including demographic and socioeconomic factors and stoma-related problems. RESULTS: A total of 2557 patients were included. Response rates varied between 51-93 per cent. Mean time from stoma creation was 2.5-6.2 (range 1.1-39.2) years. A total of 25.8 per cent of patients reported that their colostomy impairs their HRQoL 'some'/'a lot'. This group had significantly unfavourable scores across all EORTC subscales compared with patients reporting 'no'/'a little' impaired HRQoL. Generic HRQoL differed significantly between countries, but resembled the HRQoL of reference populations. Multivariable logistic regression showed that stoma dysfunction, including high CI score (OR 3.32), financial burden from the stoma (OR 1.98), unemployment (OR 2.74), being single/widowed (OR 1.35) and young age (OR 1.01 per year) predicted reduced stoma-related HRQoL. CONCLUSION: Overall HRQoL is preserved in patients with a colostomy after rectal cancer, but a quarter of the patients interviewed reported impaired HRQoL. Differences among several countries were reported and socioeconomic factors correlated with reduced quality of life.

Results of Surgery in Lung Cancer - A Retrospective Study of a Single Center Experience.

OBJECTIVES: Surgery provides the best chance for cure in patients with non-small-cell lung cancer stage I or II, but only a small portion of all new cases diagnosed are eventually suitable for surgical resection. Our goal was to appraise the surgical outcomes including survival and progression rates in patientswith histological diagnosis of lung cancer. METHODS: Between 1st August 2012 and 30th June 2018, the patients with histological lung cancer diagnosis that underwent surgical resection with a curative intent at the department of Cardiothoracic Surgery of Centro Hospitalar Univer- sitário de São João were included. RESULTS: The majority of patients were pathological stage I and the most performed surgery was a lobectomy (90.6%). The hospitality mortality was 1,3% and the rate of complication was 26,1%. Patients with forced expiratory volume in 1 second (FEV1) less than 80% had higher (statistically significant difference) frequency of complications. Active smokers, Eastern Co- operative Oncology Group Performance Status (ECOG PS)value different than 0 and FEV1 inferior to 80% had a higher mean length of drainage and higher mean length of stay (statistically significant difference). The overall survival was 92,6% at 1 year, 87,7 % in 2 years and 79,1% in 5 years. The overall survival according to pathological stages were similar when compared with the literature. CONCLUSIONS: Ours results are similar to international centers and we should be more alert to preoperative assessment.

Life with a stoma across five European countries-a cross-sectional study on long-term rectal cancer survivors.

PURPOSE: Stoma-related problems are known to be important to patients and potentially affect everyday life. The prevalence of stoma-related problems in rectal cancer survivors remains undetermined. This study aimed to examine aspects of life with a long-term stoma, stoma management, and stoma-related problems and explore the impact of stoma-related problems on daily life. METHODS: In total, 2262 patients from 5 European countries completed a multidimensional survey. Stoma-related problems were assessed using the Colostomy Impact score. Multivariable regression analysis, after adjusting for potential confounding factors, provided odds ratio (OR) and 95% confidence intervals (CI) for stoma-related problems' association with restrictions in daily life. RESULTS: The 2262 rectal cancer survivors completed the questionnaire at a median of 5.4 years (interquartile range 3.8-7.6) after stoma formation. In the total sample, leakage (58%) and troublesome odour (55%) were most prevalent followed by skin problems (27%) and pain (21%). Stoma-related problems were more prevalent in patients with parastomal bulging. A total of 431 (19%) reported feeling restricted in daily activities in life with a stoma. Leakage, odour, skin problems, stool consistency, and frequent appliance changes were significantly associated with restrictions in daily life. The highest risk of experiencing restrictions was seen for patients having odour (OR 2.74 [95% CI: 1.99-3.78]) more than once a week and skin problems (OR 1.77 [95% CI: 1.38-2.27]). CONCLUSION: In this large cohort with rectal cancer, stoma-related problems were highly prevalent and impacted daily life. Supportive care strategies should entail outreach to patients with a long-term stoma.

Thymoma and myasthenia gravis - an observational study at a tertiary center.

INTRODUCTION: Acquired Myasthenia Gravis (MG) is a rare autoimmune neurological disorder characterized by fluctu- ating paresis of the skeletal muscle due to pathogenic antibodies against the acetylcholine receptor or other elements of the neuromuscular plaque. There is a close relation between MG and thymoma. We aimed to characterize a population of patients with Myasthenia Gravis associated thymoma (MGAT). METHODS: Retrospective and longitudinal study in all patients with MGAT observed at a tertiary center between 2009 and 2020. We assessed epidemiological, clinical, laboratory and therapeutic features of both MG and thymoma. RESULTS: We found 18 patients with an average age of 53 ± 16.2, 13 of them females. Most patients (n=15) presented the generalized MG form. Most frequent Masaoka staging was II (n=7). Regarding the WHO histopathological classification of thymoma, most patients (n=11) presented with type B2 or B3. Thirteen patients underwent extended thymectomy (12 by median sternotomy and 1 by VATS). Of the remaining 5 patients, 4 of them underwent a CT scan guided biopsy, and 1 patient did not accept further work-up. Seven patients were classified as R0 for surgical resection margins and only one of them had recurrence of thymoma. Besides surgery, oncological treatment included radiotherapy and chemotherapy. Five patients expe- rienced a myasthenic crisis during the course of the disease. Three deaths occurred in the studied population. CONCLUSIONS: This study helped to pinpoint important aspects concerning therapeutic orientation of MGAT patients, such as the clinical impact of thymectomy in the course of MGAT, the oncological prognostic value of surgical resection mar- gins, and the importance of preoperative intravenous immunoglobulin. Management of MGAT patients is only possible with a multidisciplinary approach.

Doppler Broadening of Neutron Cross-Sections Using Kaniadakis Entropy.

In the last seven years, Kaniadakis statistics, or κ-statistics, have been applied in reactor physics to obtain generalized nuclear data, which can encompass, for instance, situations that lie outside thermal equilibrium. In this sense, numerical and analytical solutions were developed for the Doppler broadening function using the κ-statistics. However, the accuracy and robustness of the developed solutions contemplating the κ distribution can only be appropriately verified if applied inside an official nuclear data processing code to calculate neutron cross-sections. Hence, the present work inserts an analytical solution for the deformed Doppler broadening cross-section inside the nuclear data processing code FRENDY, developed by the Japan Atomic Energy Agency. To do that, we applied a new computational method called the Faddeeva package, developed by MIT, to calculate error functions present in the analytical function. With this deformed solution inserted in the code, we were able to calculate, for the first time, deformed radiative capture cross-section data for four different nuclides. The usage of the Faddeeva package brought more accurate results when compared to other standard packages, reducing the percentage errors in the tail zone in relation to the numerical solution. The deformed cross-section data agreed with the expected behavior compared to the Maxwell-Boltzmann.

Surgical treatment for a patient with immunoglobulin G4-related lung disease.

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune fibroinflammatory disease, and isolated lung disease is a rare phenomenon. IgG4-RD frequently mimics primary pulmonary malignancy. It has been described in association with malignancies, including lung cancer, but it remains unclear if it increases the risk of malignancy. We report the case of a patient who had a left lower lobectomy after relapse while receiving corticotherapy. The pathological findings confirmed the diagnosis of IgG4-RD. After 2 months, the thoracic computerized tomography scan showed an important left pleural effusion that could be a consequence of the recent intervention or a relapse of IgG4-RD.

Sequential Post-Heading Applications for Controlling Wheat Blast: A 9-Year Summary of Fungicide Performance in Brazil.

Wheat blast, caused by Pyricularia oryzae Triticum lineage, is a major constraint to wheat production, mainly in the tropics of Brazil, where severe epidemics have been more frequent. We analyzed disease and wheat yield data from 42 uniform field trials conducted over 9 years (2012 to 2020) to assess whether the percent control and yield response were influenced by fungicide type, region (tropical or subtropical), and year. Six treatments were selected, all evaluated in at least 19 trials. Two fungicides were applied as solo active ingredients (MANCozeb, and TEBUconazole), and four were premixes (AZOXystrobin plus TEBU, TriFLoXystrobin plus PROThioconazole, TFLX plus TEBU, and PYRAclostrobin plus EPOXiconazole). Percent control, calculated from back-transforming estimates by a meta-analysis network model fitted to the log of the means, ranged from 43 to 58%, with all but PYRA plus EPOX showing efficacy >52% on average, not differing among them. The variation in both efficacy and yield response was explained by region, and all but TEBU performed better in the subtropics than in the tropics. Yield response from using three sequential sprays was approximately two times greater in the subtropics (319 to 532 kg/ha) than in the tropics (149 to 241.3 kg/ha). No significant decline in fungicide efficacy or yield response was observed in 9 years of study for any of the fungicides. These results reinforce the need to improve control by adopting an integrated management approach in the tropics given poorer performance and lower profitability, especially for the premixes, than in the subtropics.

Identification of Fusarium head blight resistance loci in two Brazilian wheat mapping populations.

Fusarium head blight (FHB) is a disease of wheat (Triticum aestivum L.) that causes major yield losses in South America, as well as many other wheat growing regions around the world. FHB results in low quality, contaminated grain due to the production of mycotoxins such as deoxynivalenol (DON). In Brazil, FHB outbreaks are increasing in frequency and are currently controlled by fungicides which are costly and potentially harmful to the wider environment. To identify the genetic basis of resistance to FHB in Brazilian wheat, two mapping populations (Anahuac 75 × BR 18-Terena and BR 18-Terena × BRS 179) segregating for FHB resistance were phenotyped and quantitative trait loci (QTL) analysis was undertaken to identify genomic regions associated with FHB-related traits. A total of 14 QTL associated with FHB visual symptoms were identified, each of which explained 3.7-17.3% of the phenotypic variance. Two of these QTL were stable across environments. This suggests FHB resistance in Anahuac 75, BR 18-Terena and BRS 179 is controlled by multiple genetic loci that confer relatively minor differences in resistance. A major, novel QTL associated with DON accumulation was also identified on chromosome 4B (17.8% of the phenotypic variance), as well as a major QTL associated with thousand-grain weight on chromosome 6B (16.8% phenotypic variance). These QTL could be useful breeding targets, when pyramided with major sources of resistance such as Fhb1, to improve grain quality and reduce the reliance on fungicides in Brazil and other countries affected by FHB.

Translation and international validation of the Colostomy Impact score.

AIM: Optimal oncological resection in cancers of the lower rectum often requires a permanent colostomy. However, in some patients a colostomy may have a negative impact on health-related quality of life (HRQoL). The Colostomy Impact (CI) score is a simple questionnaire that identifies patients with stoma dysfunction that impairs HRQoL by dividing patients into 'minor' and 'major' CI groups. This aim of this study is to evaluate construct and discriminative validity, sensitivity, specificity and reliability of the CI score internationally, making it applicable for screening and identification of patients with stoma-related impaired HRQoL. METHOD: The CI score was translated in agreement with WHO recommendations. Cross-sectional cohorts of rectal cancer survivors with a colostomy in Australia, China, Denmark, the Netherlands, Portugal, Spain and Sweden were asked to complete the CI score, the European Organization for Research and Treatment of Cancer (EORTC) quality of life 30-item core questionnaire, the stoma-specific items of the EORTC quality of life 29-item colorectal-specific questionnaire and five anchor questions assessing the impact of colostomy on HRQoL. RESULTS: A total of 2470 patients participated (response rate 51%-93%). CI scores were significantly higher in patients reporting reduced HRQoL due to their colostomy than in patients reporting no reduction. Differences in EORTC scale scores between patients with minor and major CI were significant and clinically relevant. Sensitivity was high regarding dissatisfaction with a colostomy. Regarding evaluation of discriminative validity, the CI score relevantly identified groups with differences in HRQoL. The CI score proved reliable, with equal CI scores between test and retest and an intraclass correlation coefficient in the moderate to excellent range. CONCLUSION: The CI score is internationally valid and reliable. We encourage its use in clinical practice to identify patients with stoma dysfunction who require further attention.

Esophageal varices: A rare non-cardiac finding in echocardiography.

A 43-years-old patient with hepatitis C and HIV co-infection was referred to debridement of a left sternoclavicular septic arthritis. Due to suspicion of endocarditis, the patient underwent transthoracic echocardiogram which revealed an mass posterior to left atrium and descending aorta. A thoracic computed tomography revealed esophageal varices. Transesophageal echocardiogram was not performed. The patient has progressed favorably.

THE DEVELOPMENT OF BRONCHOPLEURAL FISTULA.

A 66-year-old male with an aspergiloma in the upper left lobe was submitted to a wedge resection in December 2019. Pneumostasis was performed using biological glue and afterward the test of submersion in water showed no significant alveolopleural leak. In the immediate postoperative period, the patient presented an expanded lung parenchyma and moderate alveolopleural leakage that gradually decreased. A month later the patient was readmitted in intensive care unit with an acute respiratory distress after a sudden episode of coughing with abundant and purulent sputum and significant increase in alveolopleural leakage. Intraoperatively it was found that the pulmonary parenchyma covering the segmental bronchi was necrotic.

THORACIC SURGERY IN A COVID-19 FRONTLINE HOSPITAL. ARE THE PATIENTS SAFE?

INTRODUCTION AND OBJECTIVES: COVID-19 pandemic forced a change in health care resources and provision due to the emergence of a new group of patients, requiring extraordinary protective measures and the adoption of new organization for the treatment of urgent or priority COVID-19 negative patients. We reviewed our practice during the first pandemic period to evaluate our surgical outcomes and identify if patients COVID-19 negative submitted to thoracic surgery had an increased risk of being infected or die. METHODS: We retrospectively reviewed our surgical results between 11th March and 15th May 2020. Thirty patients underwent thoracic surgery at the Department of Cardiothoracic Surgery of Centro Hospitalar Universitário de São João. RESULTS: None of the patients was COVID-19 positive and cross-transmission of the disease was not recognized. The majority of patients were admitted from home, with a high priority indication, namely an oncological disease. There was only one case of in-hospital mortality. CONCLUSION: During the first wave of the pandemic it was safe to be admitted and submitted to thoracic surgery at CHUSJ. Our patients, including oncological patients, received the adequate surgical treatment without an increase of risk of death or infection.

Embolization Of Implanon Devices Lung Sparing Videoassisted Thoracic Surgery.

A 31-year-old-woman with an etonogestrel implant on her left upper arm presented with unfavorable change in her menstrual bleeding pattern and requested for its removal. The non-palpable device was perceptible in the left hemithorax by radiography. Thoracic computed-tomography showed migration to a sublobar branch of the left lower pulmonary artery. Despite the absence of thoracic symptoms and the lack of management guidelines, the device was removed by a lung sparing approach with videoassisted thoracic surgery, due to the unknown long-term effect of the embolized implant.

Uniportal video-assisted thoracic surgery bullectomy in vanishing lung syndrome - What about giant bullae?

A 36-year-old-woman, smoker, without other relevant medical history, presented with symptoms of dyspnea, right localized chest pain, and non-productive cough. On the emergency department, the chest X-ray was interpreted as a giant right pneumothorax and a chest drain was inserted. Thoracic computed tomography demonstrated a giant emphysematous bulla with 23 cm on her right upper lobe. We report the first uniportal video-assisted thoracic surgery bullectomy for a bulla greater than 20 cm, in a patient with vanishing lung syndrome.

Una mujer de 36 años de edad, fumadora, se presentó en la sala de emergencias por disnea, tos y dolor torácico derecho. La radiografía fue interpretada como neumotórax y se colocó un tubo de drenaje. La tomografía computarizada del tórax mostró una bulla enfisematosa gigante, de aproximadamente 23 cm. Reportamos el primer caso de bullectomía por uniportal VATS en una paciente con síndrome del pulmón evanescente que presentaba una bulla mayor de 20 cm.

Dissecting the genetic basis of wheat blast resistance in the Brazilian wheat cultivar BR 18-Terena.

BACKGROUND: Wheat blast, caused by Magnaporthe oryzae Triticum (MoT) pathotype, is a global threat to wheat (Triticum aestivum L.) production. Few blast resistance (R) genes have been identified to date, therefore assessing potential sources of resistance in wheat is important. The Brazilian wheat cultivar BR 18-Terena is considered one of the best sources of resistance to blast and has been widely used in Brazilian breeding programmes, however the underlying genetics of this resistance are unknown. RESULTS: BR 18-Terena was used as the common parent in the development of two recombinant inbred line (RIL) F6 populations with the Brazilian cultivars Anahuac 75 and BRS 179. Populations were phenotyped for resistance at the seedling and heading stage using the sequenced MoT isolate BR32, with transgressive segregation being observed. Genetic maps containing 1779 and 1318 markers, were produced for the Anahuac 75 × BR 18-Terena and BR 18-Terena × BRS 179 populations, respectively. Five quantitative trait loci (QTL) associated with seedling resistance, on chromosomes 2B, 4B (2 QTL), 5A and 6A, were identified, as were four QTL associated with heading stage resistance (1A, 2B, 4A and 5A). Seedling and heading stage QTL did not co-locate, despite a significant positive correlation between these traits, indicating that resistance at these developmental stages is likely to be controlled by different genes. BR 18-Terena provided the resistant allele for six QTL, at both developmental stages, with the largest phenotypic effect conferred by a QTL being 24.8% suggesting that BR 18-Terena possesses quantitative resistance. Haplotype analysis of 100 Brazilian wheat cultivars indicates that 11.0% of cultivars already possess a BR 18-Terena-like haplotype for more than one of the identified heading stage QTL. CONCLUSIONS: This study suggests that BR 18-Terena possesses quantitative resistance to wheat blast, with nine QTL associated with resistance at either the seedling or heading stage being detected. Wheat blast resistance is also largely tissue-specific. Identification of durable quantitative resistances which can be combined with race-specific R gene-mediated resistance is critical to effectively control wheat blast. Collectively, this work facilitates marker-assisted selection to develop new varieties for cultivation in regions at risk from this emerging disease.

Low rectal cancer treatment strategies: a cohort study assessing watch and wait.

PURPOSE: Treatment strategies for low rectal cancer have been evolving toward achieving less treatment morbidity with the same oncological success-we aimed to assess the results of the new watch and wait (W&W) strategy in our cohort. METHODS: A tertiary care cohort study was conducted. New patients with rectal adenocarcinoma up to 6 cm from the anal margin, cM0, locally staged higher than cT1N0, evaluated between November 2014 and October 2018, were included. All 93 patients received neoadjuvant radiotherapy ± chemotherapy. Re-evaluation was planned 8-12 weeks after the end of treatment. Patients showing clinical complete response (cCR) were given the choice of either to proceed to surgery or to enter W&W. RESULTS: Of the 93 patients, 82.8% were re-evaluated and 20.8% had cCR. Patients in clinical stages II/III were significantly less likely to achieve cCR than those in stage I (p = 0.017). After a mean follow-up of 17.44 months, there were 4 regrowths in the 16 patients under W&W, all submitted to R0 surgery, ypN0; there were no deaths or local recurrences; one patient with regrowth had distant recurrence. Sixty patients underwent direct surgery after a mean follow-up of 16.23 months; 3 patients had local and distant recurrences; 7 others had only distant recurrences; there were 8 deaths. There were no statistically significant differences between patients under W&W and patients who underwent direct surgery regarding local or distant recurrences, or death (p > 0.9; p = 0.44; p = 0.19, respectively). CONCLUSION: The W&W strategy for low rectal cancer achieved the same oncological outcomes as the traditional strategy while sparing some patients from surgery.