PDlim2 Selectively Interacts with the PDZ Binding Motif of Highly Pathogenic Avian H5N1 Influenza A Virus NS1

The multi-functional NS1 protein of influenza A virus is a viral virulence determining factor. The last four residues at the C-terminus of NS1 constitute a type I PDZ domain binding motif (PBM). Avian influenza viruses currently in circulation carry an NS1 PBM with consensus sequence ESEV, whereas human influenza viruses bear an NS1 PBM with consensus sequence RSKV or RSEV. The PBM sequence of the influenza A virus NS1 is reported to contribute to high viral pathogenicity in animal studies. Here, we report the identification of PDlim2 as a novel binding target of the highly pathogenic avian influenza virus H5N1 strain with an NS1 PBM of ESEV (A/Chicken/Henan/12/2004/H5N1, HN12-NS1) by yeast two-hybrid screening. The interaction was confirmed by in vitro GST pull-down assays, as well as by in vivo mammalian two-hybrid assays and bimolecular fluorescence complementation assays. The binding was also confirmed to be mediated by the interaction of the PDlim2 PDZ domain with the NS1 PBM motif. Interestingly, our assays showed that PDlim2 bound specifically with HN12-NS1, but exhibited no binding to NS1 from a human influenza H1N1 virus bearing an RSEV PBM (A/Puerto Rico/8/34/H1N1, PR8-NS1). A crystal structure of the PDlim2 PDZ domain fused with the C-terminal hexapeptide from HN12-NS1, together with GST pull-down assays on PDlim2 mutants, reveals that residues Arg16 and Lys31 of PDlim2 are critical for the binding between PDlim2 and HN12-NS1. The identification of a selective binding target of HN12-NS1 (ESEV), but not PR8-NS1 (RSEV), enables us to propose a structural mechanism for the interaction between NS1 PBM and PDlim2 or other PDZ-containing proteins

Outcome of radiotherapy in T1 glottic carcinoma: A population-based study

We evaluated the radiation outcome and prognostic factors in a population-based study of early (T1N0M0) glottic carcinoma. Survival parameters and prognostic factors were evaluated by uni- and multivariate analysis in 316 consecutive irradiated patients with T1 glottic carcinoma in the Comprehensive Cancer Center West region of the western Netherlands. Median follow-up was 70 months (range 1-190 months). Five and ten-year local control was 86 and 84%. Disease specific survival was 97% at 5 and 10 years. In multivariate analysis, pre-existent laryngeal hypertrophic laryngitis was the only predictive factor for local control (relative risk = 3.0, P = 0.02). Comorbidity was prognostic for overall survival. No factor was predictive for disease specific survival. Pre-existent laryngeal hypertrophic laryngitis is a new risk factor associated with reduced local control in T1 glottic carcinoma treated with radiotherapy

Modelled land use and land cover change emissions – a spatio-temporal comparison of different approaches

This is the final version. Available on open access from Copernicus Publications via the DOI in this recordCode and data availability: Scripts and data are available upon request from the corresponding author.Quantifying the net carbon flux from land use and land cover changes (fLULCC) is critical for understanding the global carbon cycle and, hence, to support climate change mitigation. However, large-scale fLULCC is not directly measurable and has to be inferred from models instead, such as semi-empirical bookkeeping models and process-based dynamic global vegetation models (DGVMs). By definition, fLULCC estimates are not directly comparable between these two different model types. As an important example, DGVM-based fLULCC in the annual global carbon budgets is estimated under transient environmental forcing and includes the socalled loss of additional sink capacity (LASC). The LASC results from the impact of environmental changes on land carbon storage potential of managed land compared to potential vegetation and accumulates over time, which is not captured in bookkeeping models. The fLULCC from transient DGVM simulations, thus, strongly depends on the timing of land use and land cover changes mainly because LASC accumulation is cut off at the end of the simulated period. To estimate the LASC, the fLULCC from pre-industrial DGVM simulations, which is independent of changing environmental conditions, can be used. Additionally, DGVMs using constant present-day environmental forcing enable an approximation of bookkeeping estimates. Here, we analyse these three DGVM-derived fLULCC estimations (under transient, pre-industrial, and present-day forcing) for 12 models within 18 regions and quantify their differences as well as climate-and CO2-induced components and compare them to bookkeeping estimates. Averaged across the models, we find a global fLULCC (under transient conditions) of 2:00:6 PgC yr1 for 2009-2018, of which 40% are attributable to the LASC (0:80:3 PgC yr1). From 1850 onward, the fLULCC accumulated to 18956 PgC with 4015 PgC from the LASC. Around 1960, the accumulating nature of the LASC causes global transient fLULCC estimates to exceed estimates under presentday conditions, despite generally increased carbon stocks in the latter. Regional hotspots of high cumulative and annual LASC values are found in the USA, China, Brazil, equatorial Africa, and Southeast Asia, mainly due to deforestation for cropland. Distinct negative LASC estimates in Europe (early reforestation) and from 2000 onward in the Ukraine (recultivation of post-Soviet abandoned agricultural land), indicate that fLULCC estimates in these regions are lower in transient DGVM compared to bookkeeping approaches. Our study unravels the strong dependence of fLULCC estimates on the time a certain land use and land cover change event happened to occur and on the chosen time period for the forcing of environmental conditions in the underlying simulations. We argue for an approach that provides an accounting of the fLULCC that is more robust against these choices, for example by estimating a mean DGVM ensemble fLULCC and LASC for a defined reference period and homogeneous environmental changes (CO2 only)

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The El Niño–Southern Oscillation’s effect on summer heatwave development mechanisms in Australia

We investigate how the El Niño–Southern Oscillation (ENSO) affects the mechanisms and development of heatwaves in Australia. There are three fundamental mechanisms through which heat can accumulate in the atmosphere to generate temperatures high enough, and long-lasting enough to cause a heatwave. First, heat is advected, usually from lower latitudes, via a slow moving synoptic high pressure system; second, via diabatic heating of the boundary layer by the land surface; and third, via the subsidence of high potential temperature air which warms adiabatically as it approaches the heatwave affected region. Using an atmospheric model, we examine how ENSO affects these three mechanisms using prescribed sea surface temperatures characteristic of El Niño and La Niña conditions. By generating multiple ensembles of the same ENSO conditions, we can generate many ENSO realisations and examine how this large-scale mode of variability influences Australian heatwaves. We find that heatwave frequency and duration in the north and northeast are primarily affected by ENSO through land surface processes, soil moisture and changes in the surface energy balance. The importance of atmosphere–land coupling in ENSO related heatwave variability may help explain El Niño events with unusually few heatwaves and improve seasonal heatwave predictions. Other heatwave development mechanisms, such as the advection of heat and the subsidence of adiabatically warming air, are more important for the southern regions of Australia, but the influence of ENSO is weaker. The southeast tends to receive little influence from ENSO