The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

THE PERILS OF BEING A SPY: A CRITICAL ANALYSIS OF CASINO ROYALE (2006) THEME SONG YOU KNOW MY NAME

The present article offers a critical analysis of the Theme Song You Know My Name that accompanies and serves as the title song for the 21st James Bond film Casino Royale (2006). A reboot of the Bond franchise, Casino is credited with introducing more physical and psychological realism to the series compared to previous instalments. As such, the song paints a picture of the constant perils that characterize the life of a secret agent along with the personal sacrifices (s)he needs to make in service of country and the greater good. Moreover, it raises pertinent questions regarding the psychological effects of taking lives, whether in self-defense or for safety and security of the country. The themes of death, killing, failure, betrayal, and the need of sacrifices on part of the agent are explored through an interesting blending or interweaving of ‘voices’ of past and prospective secret agents along with warnings from Fate and Bond’s own reply. The analysis goes on to reveal the depth and richness of meaning in lyrics which at first sight or hearing might be considered devoid of emotional or psychological depth and realism.</jats:p

Airway management in patients with maxillofacial trauma – A retrospective study of 177 cases

Background: Airway management in maxillofacial injuries presents with a unique set of problems. Compromised airway is still a challenge to the anesthesiologist in spite of all modalities available. Maxillofacial injuries are the result of high-velocity trauma arising from road traffic accidents, sport injuries, falls and gunshot wounds. Any flaw in airway management may lead to grave morbidity and mortality in prehospital or hospital settings and as well as for reconstruction of fractures subsequently. Methods: One hundred and seventy-seven patients of maxillofacial injuries, operated over a period of one and half years during July 2008 to December 2009 in Al-Nahdha hospital were reviewed. All patients were reviewed in depth with age related type of injury, etiology and techniques of difficult airway management. Results: The major etiology of injuries were road traffic accidents (67%) followed by sport (15%) and fall (15%). Majority of patients were young in the age group of 11-30 years (71 %). Fracture mandible (53%) was the most common injury, followed by fracture maxilla (21%), fracture zygoma (19%) and pan-facial fractures (6%). Maxillofacial injuries compromise mask ventilation and difficult airway due to facial fractures, tissue edema and deranged anatomy. Shared airway with the surgeon needs special attention due to restrictions imposed during surgery. Several methods available for securing the airway, both decision-making and performance, are important in such circumstances. Airway secured by nasal intubation with direct visualization of vocal cords was the most common (57%), followed by oral intubation (17%). Other methods like tracheostomy and blind nasal intubation was avoided by fiberoptic bronchoscopic nasal intubation in 26% of patients. Conclusion: The results of this study indicated that surgically securing the airway by tracheostomy should be revised compared to other available methods. In the era of rigid fixation of fractures and the possibility of leaving the patient without wiring an open mouth and alternative techniques like fiberoptic bronchoscopic intubation, it is unnecessary to carry out tracheostomy for securing the airway as frequently as in the past

READING LOKI (2021): FREE WILL AND DETERMINISM, RESISTANCE TO AUTOCRATIC IDEOLOGY, AND QUEER REPRESENTATION IN THE SERIES

The present research paper undertakes a detailed analysis of the central themes of the television series Loki (2021), a continuation of the Marvel Cinematic Universe (MCU) on the small screen. The first and last episode of the show are especially significant for their grappling with the age-old uncertainty over Free Will and Determinism. The revelation of the autocratic nature of the Time Variance Authority (TVA) (controlled by the secretive Time Keepers who in turn are revealed to have been created by the elusive He Who Remains) and its involvement in the dissemination of a particular ideology and propaganda provides the narrative an opportunity to explore the theme of resistance to autocratic rule (represented in the character of Sylvie) and the ideology and propaganda spread by autocratic rulers and/or institutions (the former represented by the Time Keepers and He Who Remains whereas the latter by the Time Variance Authority [TVA]). However, with the series itself calling into question the (alleged) benefits of Free Will and assuming a pessimistic, if not critical, stance over post-revolutionary conditions has led to the show being interpreted by some as conservative in nature or in favour of maintaining status-quo. Through the characters of C – 20 and Sylvie respectively the series also directs our attention to the likely fate awaiting those who (after being enlightened) start questioning the official ideology or rise up in opposition to it. Finally, the paper attempts to situate the Queering of Loki, the series’ titular character, which constitutes a small but significant step towards including sexualities other than the dominant heterosexual within the MCU, in the wider context of the history of the representation of diverse sexualities in the MUC and critical reactions to it.</jats:p

FROSTIAN ANTICIPATION AND RESCUING ROCHESTER: DECONSTRUCTION AND READER-RESPONSE CRITICISM IN READINGS OF JANE EYRE (1847) AND WIDE SARGASSO SEA (1966)

The present article argues that Robert Frost’s poem “For Once, Then, Something” (1923) anticipates, by virtue of its latent similarities to them, the theory of Deconstruction propounded by Jacques Derrida, and Reader-Response Criticism which developed through the work of a number of important theorists, one of them being Stanley Fish. The validity of the interpretation is tested by juxtaposing it, in brief, on Charlotte Brontë’s novel Jane Eyre (1847) and Jean Rhys’ Wide Sargasso Sea (1966), a postcolonial, Feminist re-reading or re-writing of Brontë’s work, especially one of literature’s great enigmatic figure – Bertha Antoinetta Rochester/Mason – and one of the novel’s central character – Edward Fairfax Rochester. Indeed, Bertha had been readily interpreted by many lay readers as an obstacle, if not an outright antagonist, in the union of Jane and Edward before the publication of Rhys’ insightful novel that is a prequel to or provides the backstory of crucial characters and events found in Brontë’s work. Moreover, the researchers also launch an enquiry that seeks to understand whether Rochester has been disproportionately or undeservedly demonized, at least since the publication of Rhys’ novel. This inquiry, which stems from both the insight provided by the reading of Frost’s poem and a position put forward by Fish, (re)reads Brontë’s text to see if it provides any clue, opening, or hint for an alternative response by which Rochester can be rescued from critical opprobrium he is often subjected to, whether before or after the publication of Wide Sargasso Sea.</jats:p

THE LITTLE THINGS (2021): A CRITICAL STUDY WITH SPECIAL REFERENCE TO SE7EN (1995)

The present paper attempts to offer a critical analysis of John Lee Hancock’s neo-noir crime thriller The Little Things (2021). Apart from the readily apparent intertextual indebtedness of Hancock’s film to David Fincher’s classic neo-noir crime thriller Se7en (1995), a critical and comparative study of similarities and differences between the two films makes it apparent that while both dismantle the notion of individual moral infallibility even if the person happens to be a law enforcement official, Hancock’s film not only creates an equally morally complex world but one which explores additional themes of individual guilt, complicity, and cover-up; uncertainty or ambiguity that prevents mental peace and closure; the possibility, justification, and reasonableness of turning saviour for a member of the police force who ends up committing a crime due to an error of judgement or after being provoked by the suspected criminal; the degree to which the personal lives of police officers investigating gruesome crimes such as serial killings could be adversely affected; the error of assuming guilt based on past misdemeanours and unintended consequences of police interrogation; and law enforcement officials overreaching their powers while acting upon their conviction or hunch, desperately wanting facts to conform to their theories. Moreover, the ending of The Little Things can arguably be said to be more ambiguous, disturbing, shocking, and unsettling compared to that of Se7en on the one hand yet more humane on the other which enables the film to have a distinct pride of place within the noir-crime genre.</jats:p