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

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

Carboniferous high-pressure metamorphism of Ordovician protoliths in the Argentera Massif (Italy), Southern European Variscan belt

The age of high-pressure metamorphism is crucial to identify a suitable tectonic model for the vast Variscan orogeny. Banded HP granulites from the Gesso-Stura Terrain in the Argentera Massif, Italy, have been recently described (Ferrando et al., 2008) relicts of high-pressure metamorphism in the western part of the Variscan orogen. Bulk rock chemistry of representative lithologies reveals intermediate silica contents and calc-alkaline affinity of the various cumulate layers. Enrichment in incompatible elements denotes a significant crustal component in line with intrusion during Ordovician rifting. Magmatic zircon cores from a Pl-rich layer yield scattered ages indicating a minimum protolith age of 486 ± 7 Ma. Carboniferous zircons (340.7 ± 4.2 and 336.3 ± 4.1 Ma) are found in a Pl-rich and a Pl-poor layer, respectively. Their zoning, chemical composition (low Th/U, flat HREE pattern and Ti-in-zircon temperature) and deformation indicate that they formed during the high-pressure event before decompression and mylonitisation. The proposed age for high-pressure metamorphism in the Argentera Massif proves that subduction preceded anatexis by less than 20 Ma. The new data allow a first-order comparison with the Bohemian Massif, which is located at the eastern termination of the Variscan orogen. Similarities in evolution at either end of the orogen support a Himalayan-type tectonic model for the entire European Variscides

Paleo-European crust of the Italian Western Alps: Geological history of the Argentera Massif and comparison with Mont Blanc-Aiguilles Rouges and Maures-Tanneron Massifs

The "External Crystalline Massifs" of the Western Alps (Mont Blanc, Aiguilles Rouges, Grandes Rousses, Belledonne, Pelvoux, and Argentera) consist of a polymetamorphic Variscan basement, which was only marginally reworked during the Alpine tectonometamorphic cycle. These massifs experienced an early subduction event at peak metamorphic conditions of ~700°C and 1.5 GPa, followed by continental collision coupled with amphibolite-facies metamorphism, anatexis and exhumation to shallow crustal levels in the Carboniferous (see von Raumer et al., 1999 for a review). This contribution focuses on the magmatic and metamorphic history of the Argentera Massif, the southernmost and largest of the External Crystalline Massifs exposed in Italy. Its evolution from Ordovician to Early Permian is compared to that recorded in the Mont Blanc-Aiguilles Rouges Massif, the other External Crystalline Massif extensively exposed in the Italian Alps. Further comparison is drawn between these large massifs and the Maures-anneron Massif of Provence, France, the area of Variscan Europe nearest to Argentera