Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Overview of the RFX Fusion Science Program

With a program well-balanced among the goal of exploring the fusion potential of the reversed field pinch (RFP) and that of contributing to the solution of key science and technology prob- lems in the roadmap to ITER, the European RFX-mod device has produced a set of high-quality results since the last 2010 Fusion Energy Conference. RFX-mod is a 2 MA RFP, which can also be operated as a tokamak and where advanced confinement states have 3D features studied with stellarator tools. Self-organized equilibria with a single helical axis and improved confinement (SHAx) have been deeply investigated and a more profound understanding of their physics has been achieved. First wall conditioning with Lithium provides a tool to operate RFX at higher density than before, and application of helical magnetic boundary conditions favour stationary SHAx states. The correlation between the quality of helical states and the reduction of magnetic field errors acting as seed of magnetic chaos has been robustly proven. Helical states provide a unique test-bed for numerical codes conceived to deal with 3D effects in all magnetic configura- tions. In particular the stellarator equilibrium codes VMEC and V3FIT have been successfully adapted to reconstruct RFX-mod equilibria with diagnostic input. The border of knowledge has been significantly expanded also in the area of feedback control of MHD stability. Non-linear dynamics of tearing modes and their control has been modelled, allowing for optimization of feedback models. An integrated dynamic model of the RWM control system has been developed integrating the plasma response to multiple RWMs with active and passive conducting structures (CarMa model) and with a complete representation of the control system. RFX has been oper- ated as a tokamak with safety factor kept below 2, with complete active stabilization of the p2, 1q Resistive Wall Mode (RWM). This opens the exploration of a broad and interesting operational range otherwise excluded to standard tokamaks. Control experiments and modelling led to the design of a significant upgrade of the RFX-mod feedback control system to dramatically enhance computing power and reduce system latency. The possibility of producing D-shaped plasmas is being explore

Search for High-energy Neutrinos from Binary Neutron Star Merger GW170817 with ANTARES, IceCube, and the Pierre Auger Observatory

The Advanced LIGO and Advanced Virgo observatories recently discovered gravitational waves from a binary neutron star inspiral. A short gamma-ray burst (GRB) that followed the merger of this binary was also recorded by the Fermi Gamma-ray Burst Monitor (Fermi-GBM), and the Anticoincidence Shield for the Spectrometer for the International Gamma-Ray Astrophysics Laboratory (INTEGRAL), indicating particle acceleration by the source. The precise location of the event was determined by optical detections of emission following the merger. We searched for high-energy neutrinos from the merger in the GeV--EeV energy range using the ANTARES, IceCube, and Pierre Auger Observatories. No neutrinos directionally coincident with the source were detected within $\pm500$ s around the merger time. Additionally, no MeV neutrino burst signal was detected coincident with the merger. We further carried out an extended search in the direction of the source for high-energy neutrinos within the 14-day period following the merger, but found no evidence of emission. We used these results to probe dissipation mechanisms in relativistic outflows driven by the binary neutron star merger. The non-detection is consistent with model predictions of short GRBs observed at a large off-axis angle.Comment: 22 pages, 2 figure

First measurement of time-dependent CP violation in Bs0→K+K− B_s^0\to K^+K^- decays

Direct and mixing-induced CP-violating asymmetries in B-s(0) -> K+K- decays are measured for the first time using a data sample of p p collisions, corresponding to an integrated luminosity of 1.0 fb(-1), collected with the LHCb detector at a centre-of-mass energy of 7 TeV. The results are C-KK = 0.14 +/- 0.11 +/- 0.03 and S-KK = 0.30 +/- 0.12 +/- 0.04, where the first uncertainties are statistical and the second systematic. The corresponding quantities are also determined for B-0 -> pi(+)pi(-) decays to be C-pi pi = -0.38 +/- 0.15 +/- 0.02 and S-pi pi = -0.71 +/- 0.13 +/- 0.02, in good agreement with existing measurements