In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors' scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
ANPCyT, Argentina ; YerPhI, Armenia ; ARC, Australia ; BMWFW, Austria ; FWF, Austria ; ANAS, Azerbaijan ; SSTC, Belarus ; Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) ; Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) ; NSERC, Canada ; NRC, Canada ; CFI, Canada ; CERN ; CONICYT, Chile ; CAS, China ; MOST, China ; NSFC, China ; COLCIENCIAS, Colombia ; MSMT CR, Czech Republic ; MPO CR, Czech Republic ; VSC CR, Czech Republic ; DNRF, Denmark ; DNSRC, Denmark ; IN2P3-CNRS, CEA-DRF/IRFU, France ; SRNSFG, Georgia ; BMBF, Germany ; HGF, Germany ; MPG, Germany ; GSRT, Greece ; RGC, Hong Kong SAR, China ; ISF, Israel ; Benoziyo Center, Israel ; INFN, Italy ; MEXT, Japan ; JSPS, Japan ; CNRST, Morocco ; NWO, Netherlands ; RCN, Norway ; MNiSW, Poland ; NCN, Poland ; FCT, Portugal ; MNE/IFA, Romania ; MES of Russia, Russian Federation ; NRC KI, Russian Federation ; JINR ; MESTD, Serbia ; MSSR, Slovakia ; ARRS, Slovenia ; MIZS, Slovenia ; DST/NRF, South Africa ; MINECO, Spain ; SRC, Sweden ; Wallenberg Foundation, Sweden ; SERI, Switzerland ; SNSF, Switzerland ; Canton of Bern, Switzerland ; MOST, Taiwan ; TAEK, Turkey ; STFC, United Kingdom ; DOE, United States of America ; NSF, United States of America ; BCKDF, Canada ; CANARIE, Canada ; CRC, Canada ; Compute Canada, Canada ; COST, European Union ; ERC, European Union ; ERDF, European Union ; Horizon 2020, European Union ; Marie Sk lodowska-Curie Actions, European Union ; Investissements d' Avenir Labex and Idex, ANR, France ; DFG, Germany ; AvH Foundation, Germany ; Greek NSRF, Greece ; BSF-NSF, Israel ; GIF, Israel ; CERCA Programme Generalitat de Catalunya, Spain ; Royal Society, United Kingdom ; Leverhulme Trust, United Kingdom ; BMBWF (Austria) ; FWF (Austria) ; FNRS (Belgium) ; FWO (Belgium) ; Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) ; Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ) ; FAPERGS (Brazil) ; MES (Bulgaria) ; CAS (China) ; MoST (China) ; NSFC (China) ; COLCIENCIAS (Colombia) ; MSES (Croatia) ; CSF (Croatia) ; RPF (Cyprus) ; SENESCYT (Ecuador) ; MoER (Estonia) ; ERC IUT (Estonia) ; ERDF (Estonia) ; Academy of Finland (Finland) ; MEC (Finland) ; HIP (Finland) ; CEA (France) ; CNRS/IN2P3 (France) ; BMBF (Germany) ; DFG (Germany) ; HGF (Germany) ; GSRT (Greece) ; NKFIA (Hungary) ; DAE (India) ; DST (India) ; IPM (Iran) ; SFI (Ireland) ; INFN (Italy) ; MSIP (Republic of Korea) ; NRF (Republic of Korea) ; MES (Latvia) ; LAS (Lithuania) ; MOE (Malaysia) ; UM (Malaysia) ; BUAP (Mexico) ; CINVESTAV (Mexico) ; CONACYT (Mexico) ; LNS (Mexico) ; SEP (Mexico) ; UASLP-FAI (Mexico) ; MOS (Montenegro) ; MBIE (New Zealand) ; PAEC (Pakistan) ; MSHE (Poland) ; NSC (Poland) ; FCT (Portugal) ; JINR (Dubna) ; MON (Russia) ; RosAtom (Russia) ; RAS (Russia) ; RFBR (Russia) ; NRC KI (Russia) ; MESTD (Serbia) ; SEIDI (Spain) ; CPAN (Spain) ; PCTI (Spain) ; FEDER (Spain) ; MOSTR (Sri Lanka) ; MST (Taipei) ; ThEPCenter (Thailand) ; IPST (Thailand) ; STAR (Thailand) ; NSTDA (Thailand) ; TAEK (Turkey) ; NASU (Ukraine) ; SFFR (Ukraine) ; STFC (United Kingdom ; DOE (U.S.A.) ; NSF (U.S.A.) ; Marie-Curie programme ; Horizon 2020 Grant (European Union) ; Leventis Foundation ; A.P. Sloan Foundation ; Alexander von Humboldt Foundation ; Belgian Federal Science Policy Office ; Fonds pour la Formation a la Recherche dans l'Industrie et dans l'Agriculture (FRIA-Belgium) ; Agentschap voor Innovatie door Wetenschap en Technologie (IWT-Belgium) ; F.R.S.-FNRS (Belgium) ; Beijing Municipal Science & Technology Commission ; Ministry of Education, Youth and Sports (MEYS) of the Czech Republic ; Hungarian Academy of Sciences (Hungary) ; New National Excellence Program UNKP (Hungary) ; Council of Science and Industrial Research, India ; HOMING PLUS programme of the Foundation for Polish Science ; European Union, Regional Development Fund ; Mobility Plus programme of the Ministry of Science and Higher Education ; National Science Center (Poland) ; National Priorities Research Program by Qatar National Research Fund ; Programa Estatal de Fomento de la Investigacion Cientfica y Tecnica de Excelencia Maria de Maeztu ; Programa Severo Ochoa del Principado de Asturias ; EU-ESF ; Greek NSRF ; Rachadapisek Sompot Fund for Postdoctoral Fellowship, Chulalongkorn University (Thailand) ; Chulalongkorn Academic into Its 2nd Century Project Advancement Project (Thailand) ; Welch Foundation ; Weston Havens Foundation (U.S.A.) ; Canton of Geneva, Switzerland ; Herakleitos programme ; Thales programme ; Aristeia programme ; European Research Council (European Union) ; Horizon 2020 Grant (European Union): 675440 ; FWO (Belgium): 30820817 ; Beijing Municipal Science & Technology Commission: Z181100004218003 ; NKFIA (Hungary): 123842 ; NKFIA (Hungary): 123959 ; NKFIA (Hungary): 124845 ; NKFIA (Hungary): 124850 ; NKFIA (Hungary): 125105 ; National Science Center (Poland): Harmonia 2014/14/M/ST2/00428 ; National Science Center (Poland): Opus 2014/13/B/ST2/02543 ; National Science Center (Poland): 2014/15/B/ST2/03998 ; National Science Center (Poland): 2015/19/B/ST2/02861 ; National Science Center (Poland): Sonata-bis 2012/07/E/ST2/01406 ; Programa Estatal de Fomento de la Investigacion Cientfica y Tecnica de Excelencia Maria de Maeztu: MDM-2015-0509 ; Welch Foundation: C-1845 ; This paper presents the combinations of single-top-quark production cross-section measurements by the ATLAS and CMS Collaborations, using data from LHC proton-proton collisions at = 7 and 8 TeV corresponding to integrated luminosities of 1.17 to 5.1 fb(-1) at = 7 TeV and 12.2 to 20.3 fb(-1) at = 8 TeV. These combinations are performed per centre-of-mass energy and for each production mode: t-channel, tW, and s-channel. The combined t-channel cross-sections are 67.5 +/- 5.7 pb and 87.7 +/- 5.8 pb at = 7 and 8 TeV respectively. The combined tW cross-sections are 16.3 +/- 4.1 pb and 23.1 +/- 3.6 pb at = 7 and 8 TeV respectively. For the s-channel cross-section, the combination yields 4.9 +/- 1.4 pb at = 8 TeV. The square of the magnitude of the CKM matrix element V-tb multiplied by a form factor f(LV) is determined for each production mode and centre-of-mass energy, using the ratio of the measured cross-section to its theoretical prediction. It is assumed that the top-quark-related CKM matrix elements obey the relation |V-td|, |V-ts| « |V-tb|. All the |f(LV)V(tb)|(2) determinations, extracted from individual ratios at = 7 and 8 TeV, are combined, resulting in |f(LV)V(tb)| = 1.02 +/- 0.04 (meas.) +/- 0.02 (theo.). All combined measurements are consistent with their corresponding Standard Model predictions.