The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the risk of open conversion, prolonging operating time and hospital stay. Preoperative stratification would improve consent, scheduling and identify appropriate training cases. The aim of this study was to develop a validated risk score for conversion for use in clinical practice. Patients and methods: Preoperative patient and disease-related variables were identified from a prospective cholecystectomy database (CholeS) of 8820 patients, divided into main and validation sets. Preoperative predictors of conversion were identified by multivariable binary logistic regression. A risk score was developed and validated using a forward stepwise approach. Results: Some 297 procedures (3.4%) were converted. The risk score was derived from six significant predictors: age (p = 0.005), sex (p &lt; 0.001), indication for surgery (p &lt; 0.001), ASA (p &lt; 0.001), thick-walled gallbladder (p = 0.040) and CBD diameter (p = 0.004). Testing the score on the validation set yielded an AUROC = 0.766 (p &lt; 0.001), and a score &gt;6 identified patients at high risk of conversion (7.1% vs. 1.2%). Conclusion: This validated risk score allows preoperative identification of patients at six-fold increased risk of conversion to open cholecystectomy

Determination of the leptonic branching ratios of the Z

The ratios of the numbers of Z bosons decaying to e+e−, μ+μ− and τ+τ− pairs to the number decaying to hadrons have been measured. The branching ratios and partial widths for each channel were determined and found to be equal, consistent with lepton universality. The mean leptonic branching ratio was found to be 0.0321 ± 0.0013 and the leptonic partial width to be 85.4 ± 5.3 MeV. The partial widths for hadronic decays and for invisible decays were deduced to be 1833 ± 116 MeV and 569 ± 92 MeV, respectively. The number of light neutrino types, assuming only the standard model value for the ratio , was found to be 3.35 ± 0.41

Search for a very light Higgs boson in Z decays

A search has been made for a very light Higgs boson in the processes e+e- → e+e-H and e+e- →μ+μ-H using data collected by ALEPH at the LEP e+e- collider at centre of mass energies close to the Z peak. The mass range between 0 and 57 MeV is unambigously excluded at the 95% confidence level. If we combine this with our previously published analysis, the complete range from 0 to 24 GeV is excluded at 95% CL. The search is extended to light Higgs bosons of the minimal supersymmetric standard model, with the result that all possibilities of coupling are excluded for Higgs masses below 3 GeV

A precise determination of the number of families with light neutrinos and of the Z boson partial widths

More extensive and precise results are reported on the parameters of Z decay. On the basis of 20 000 Z decays collected with the ALEPH detector at LEP we find Mz=91.182±0.026 (exp.) ±0.030 (beam) GeV, Γz=2.541±0.056 GeV and σhad0=41.4±0.8 nb. The partial widths for the hadronic and leptonic channels are Γhad=1804±44 MeV, Γe+e−=82.1±3.4 MeV, Γμ+μ−=87.9±6.0 MeV and Γτ+τ−=86.1±5.6 MeV, in good agreement with the standard model. On the basis of the average leptonic width Γℓ+ℓ−=83.9±2.2 MeV, the effective weak mixing angle is found to be sin2θw(Mz)=0.231±0.008. Usin g the partial widths calculated in the standard model, the number of light neutrino families is Nν=3.01±0.15 (exp.)±0.05 (theor.)

Search for excited neutrinos in Z decay

Excited neutrinos decaying into a neutrino and a photon are searched for in the ALEPH detector at LEP. No evidence is found for Z decay into v̄v∗ or v̄∗v∗ final states. Upper limits are derived on excited neutrino couplings up to excited neutrino masses close to the Z mass. Lower limits on the v∗ mass, independent of the v∗ decay modes, are deduced from the total Z width

Search for excited leptons in Z0 decay

We have looked for evidence of excited lepton production in Z0 decay observed in the ALEPH detector at LEP. We find no ℓℓγγ events and set new limits at 95% CL on ℓ∗ masses at 44.6, 44.6 and 41.2 GeV/c2 for respectively. Observed events in the ℓℓγ channels are consistent with radiative effects and we set limits for the first time on the coupling for ℓ∗ masses in the range up to 86 GeV/c2

Search for the neutral Higgs Boson from Z0 decay in the Higgs mass range between 11 and 24 GeV

A search for the neutral Higgs boson in the mass range above 11 GeV (above the threshold), using the process Z0→H0e+e−, Z0→H0μ+μ− and , is performed on data collected by the ALEPH detector corresponding to about 25 000 events of Z0→ hadrons. Combining all these processes, the mass range excluded is 11 GeV at 95% CL. Together with a previously published result from ALEPH, the mass range excluded is 32 MeV to 24 GeV at 95% CL. This result also extends the excluded mass region for neutral Higgs bosons from supersymmetry