Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Open innovation and firm performance: the role of organizational mechanisms

Purpose – The purpose of this paper is to examine the relationship between the use of open innovation (OI) practices and firm performance, and the role of organizational mechanisms (OMs) (formalization and decentralization) as moderator variables. Design/methodology/approach – The authors build a theoretical framework to define a set of hypotheses that are then verified in an empirical study. These theoretical propositions are tested by using the data gathered from a survey addressed to 244 firms in Spanish low- and medium-technology industries. Findings – With regard to inbound practices, the practices oriented to cooperate with partners in a R&D context have a positive influence. The results show that outbound practices, either by direct generation of revenues from licensing payments or, more indirectly, through the indirect marketing and technical benefits that can stem from revealing have a positive effect on firm performance. Coupled practices, which are related to participation in clusters and innovation networks, have the highest impact on firm performance. In the industrial context examined, decentralization exerts a positive effect which enhances the effect of outbound practices meanwhile formalization reduces their positive effect. Practical implications – This study helps practitioners in low- and medium-technology firms to determine which OI practices are most beneficial to firm performance and how formalization and decentralization can influence the relationship between OI and firm performance. Originality/value – This study helps determine the influence of OI practices in terms of inbound, outbound and coupled types through an analysis of low- and medium-technology firms. The OI literature is enriched by the types herein of the role of OMs, which includes an analysis of how formalization and decentralization moderate the influence of OI practices on firm performance

Haem Biosynthesis and Antioxidant Enzymes in Circulating Cells of Acute Intermittent Porphyria Patients.

The aims of the present study were to explore the expression pattern of haem biosynthesis enzymes in circulating cells of patients affected by two types of porphyria (acute intermittent, AIP, and variegate porphyria, VP), together with the antioxidant enzyme pattern in AIP in order to identify a possible situation of oxidative stress. Sixteen and twelve patients affected by AIP and VP, respectively, were analysed with the same numbers of healthy matched controls. Erythrocytes, neutrophils and peripheral blood mononuclear cells (PBMCs) were purified from blood, and RNA and proteins were extracted for quantitative real time PCR (qRT-PCR) and Western-blot analysis, respectively. Porhobilinogen deaminase (PBGD) and protoporphyrinogen oxidase (PPOX) gene and protein expression was analysed. Antioxidant enzyme activity and gene expression were additionally determined in blood cells, together with protein carbonyl content in plasma. PBMCs isolated from AIP patients presented low mRNA levels of PBGD when compared to controls, while PBMCs isolated from VP patients presented a decrease in PPOX mRNA. PPOX protein content was higher in AIP patients and lower in VP patients, compared to healthy controls. Regarding antioxidant enzymes, PBMCs and erythrocyte superoxide dismutase (SOD) presented statistically significant higher activity in AIP patients compared to controls, while catalase activity tended to be lower in these patients. No differences were observed regarding antioxidant gene expression in white blood cells. Circulating cells in AIP and VP patients present altered expression of haem biosynthetic enzymes, which could be useful for the differential diagnosis of these two types of porphyria in certain difficult cases. AIP patients present a condition of potential oxidative stress similar to VP patients, evidenced by the post-transcriptional activation of SOD and possible catalase impairment

Deep-sea impacts of climate interventions

Ocean manipulation to mitigate climate change may harm deep-sea ecosystem

Primer sequences and conditions used in the quantitative real time PCR analysis.

<p>Primer sequences and conditions used in the quantitative real time PCR analysis.</p

Effects of acute intermittent porphyria (AIP) and variegate porphyria (VP) on erythrocyte porphobilinogen deaminase (PBGD) and protoporphyrinogen oxidase (PPOX) protein content.

<p>Total protein content in the control group was normalized to 100% (dashed line). Statistical analysis: Student’s t-test for unpaired data. (*) indicates statistically significant differences between porphyria and control groups (p < 0.05). C1: Control for AIP patients. C2: Control for VP patients.</p

Effects of acute intermittent porphyria (AIP) and variegate porphyria (VP) on PBMCs porphobilinogen deaminase (PBGD) and protoporphyrinogen oxidase (PPOX) gene expression (A) and protein content (B, C).

<p>(A) The relative quantification was performed by standard calculations considering 2^(-ΔΔCt). mRNA levels of control subjects were arbitrarily referred to as 1 (dashed line). (B) Total protein content in the control group was normalized to 100% (dashed line). Results are expressed as mean ± sem. Statistical analysis: Student’s t-test for unpaired data. (*) indicates statistically significant differences between porphyria and control groups (p < 0.05). C1: Control for AIP patients. C2: Control for VP patients.</p

Digital Pathology Enables Automated and Quantitative Assessment of Inflammatory Activity in Patients with Chronic Liver Disease

Traditional histological evaluation for grading liver disease severity is based on subjective and semi-quantitative scores. We examined the relationship between digital pathology analysis and corresponding scoring systems for the assessment of hepatic necroinflammatory activity. A prospective, multicenter study including 156 patients with chronic liver disease (74% nonalcoholic fatty liver disease-NAFLD, 26% chronic hepatitis-CH etiologies) was performed. Inflammation was graded according to the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network system and METAVIR score. Whole-slide digital image analysis based on quantitative (I-score: inflammation ratio) and morphometric (C-score: proportionate area of staining intensities clusters) measurements were independently performed. Our data show that I-scores and C-scores increase with inflammation grades (p ρ = 0.85–0.88), but only moderate for NAFLD (ρ = 0.5–0.53). I-score (p = 0.008) and C-score (p = 0.002) were higher for CH than NAFLD. Our MATLAB algorithm performed better than QuPath software for the diagnosis of low-moderate inflammation (p p < 0.001). In conclusion, quantitative and morphometric metrics of inflammatory burden obtained by digital pathology correlate well with pathologists’ scores, showing a higher accuracy for the evaluation of CH than NAFLD