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

Lupinus montanus: chemical characterization of organs

Introduction Lupinus montanus is a herbaceous perennial plant found in pine and oak forests between 2500 and 4100 meters above sea level and flowers blooms between May and September. It is widely diffused in all Mexico and populations were found between the south of United States of America until Guatemala. It is well known that L. montanus produce quinolizidine alkaloids as part of a defence strategy against herbivores. However, very few is know about the presence of other compounds. Aim of present work was to obtain a chemical profile of L. montanus with special focus on flavonoids, alkaloids and proteins. Methods Plants and seeds of L. montanus were collected in the Iztaccihuatl volcano slope (N 19\ub0 04\u2019 58,7\u201d ; W 0,98\ub0 39\u2019 35,7\u201d) at 3581 m above sea level. Biological material was air-dried at 50\ua0\ub0C. For proximal analysis, seeds were manually separated and milled. The flour was analysed for fat, ash and crude protein using the AOAC (1990) methods. For the analysis of flavonoid, leaf, thallus, root and flower sample was extracted with methanol and analysed by HPLC and NMR. Alkaloids were extracted following the classical protocol of Wink (1995).Results and discussion/conclusions The proximal analysis showed that seeds present 15,5% fat, 40,7 % protein, 2,5 % of ashes. Methanol extract of leaf, thallus, root and flower was analyzed by HPLC and NMR, showing that flavonoids are found in every part of the plant, but specially in leaves, where acacetine, apigenine (and their glycosides), orientine, luteoline (and their glycosides, vitexine, 3\u2019 hidroxyvitexine and some other unidentified flavonoids were found. Alkaloid extracts of leaf, thallus, root and flower were analyzed by GC-MS. Leaf is the organ where got the higher diversity of alkaloids and seeds is the part with the highest concentration. Classical profile was found, with quinolizidine alkaloids like sparteine, isosparteine, lupanine, dehydrolupanine and two new compounds undescribed for L.montanus,hexa (methoxymethyl) melamine and sophocarpine. Financial Support: SIP-IPN (20110739), Erasmus-Mundus Program and CONACyT (100808)

Pedagogical reflection on Desire and Perspectives for an Education to identity.

Desire is a human dimension that plays a central role in personal formation of identity. The contribution aims to develop a pedagogical reflection on desire in dialogue with the most current perspectives of psychoanalysis and philosophy that underline desire as a "tension" and an "invisible center of gravity" capable to direct the actions of human being. The aim of a pedagogical reflection is to rediscover desire as a "vector" that moves the search for oneself to help future generations to explore their identity

Outcomes during anticoagulation in patients with symptomatic vs. incidental splanchnic vein thrombosis

Introduction: Current guidelines recommend the use of anticoagulant therapy in patients with symptomatic splanchnic vein thrombosis (SVT) and suggest no routine anticoagulation in those with incidental SVT. Methods: We used the RIETE (Registro Informatizado Enfermedad Trombo Emb\uf3lica) registry to assess the rate and severity of symptomatic venous thromboembolism (VTE) recurrences and major bleeding events appearing during the course of anticoagulation in patients with symptomatic or incidental SVT. Results: In March 2017, 521 patients with SVT were recruited. Of them, 212 (41%) presented with symptomatic SVT and 309 had incidental SVT. Most (93%) patients received anticoagulant therapy (median, 147 days). During the course of anticoagulation, 20 patients developed symptomatic VTE recurrences (none died) and 26 had major bleeding (fatal bleeding, 5). On multivariable analysis, patients with incidental SVT had a non-significantly higher risk for symptomatic VTE recurrences (adjusted hazard ratio [HR]: 2.04; 95%CI: 0.71\u20135.88) and a similar risk for major bleeding (HR: 1.12; 95%CI: 0.47\u20132.63) than those with symptomatic SVT. Active cancer was associated with at increased risk for VTE recurrences (HR: 3.06; 95%CI: 1.14\u20138.17) and anaemia (HR: 4.11; 95%CI: 1.45\u201311.6) or abnormal prothrombin time (HR: 4.10; 95%CI: 1.68\u201310.1) were associated with at increased risk for major bleeding. Conclusions: The rates of recurrent SVT and major bleeding were similar between patients with incidental or symptomatic SVT. Because the severity of bleeding complications during anticoagulation may outweigh the severity of VTE recurrences in both groups, further studies should identify those SVT patients who benefit from anticoagulant therapy

Identifying gene-environment interactions in schizophrenia: Contemporary challenges for integrated, large-scale investigations

Recent years have seen considerable progress in epidemiological and molecular genetic research into environmental and genetic factors in schizophrenia, but methodological uncertainties remain with regard to validating environmental exposures, and the population risk conferred by individual molecular genetic variants is small. There are now also a limited number of studies that have investigated molecular genetic candidate gene-environment interactions (G 7 E), however, so far, thorough replication of findings is rare and G 7 E research still faces several conceptual and methodological challenges. In this article, we aim to review these recent developments and illustrate how integrated, large-scale investigations may overcome contemporary challenges in G 7 E research, drawing on the example of a large, international, multi-center study into the identification and translational application of G 7 E in schizophrenia. While such investigations are now well underway, new challenges emerge for G 7 E research from late-breaking evidence that genetic variation and environmental exposures are, to a significant degree, shared across a range of psychiatric disorders, with potential overlap in phenotype. \ua9 2014 The Author

Premorbid Adjustment and IQ in Patients With First-Episode Psychosis: A Multisite Case-Control Study of Their Relationship With Cannabis Use

Psychotic patients with a lifetime history of cannabis use generally show better cognitive functioning than other psychotic patients. Some authors suggest that cannabis-using patients may have been less cognitively impaired and less socially withdrawn in their premorbid life. Using a dataset comprising 948 patients with first-episode psychosis (FEP) and 1313 population controls across 6 countries, we examined the extent to which IQ and both early academic (Academic Factor [AF]) and social adjustment (Social Factor [SF]) are related to the lifetime frequency of cannabis use in both patients and controls. We expected a higher IQ and a better premorbid social adjustment in psychotic patients who had ever used cannabis compared to patients without any history of use. We did not expect such differences in controls. In both patients and controls, IQ was 3 points higher among occasional-users than in never-users (mean difference [M-diff] = 2.9, 95% CI = [1.2, 4.7]). Both cases and control daily-users had lower AF compared to occasional (M-diff = -0.3, 95% CI = [-0.5; -0.2]) and never-users (M-diff = -0.4, 95% CI = [-0.6; -0.2]). Finally, patient occasional (M-diff = 0.3, 95% CI = [0.1; 0.5]) and daily-users (M-diff = 0.4, 95% CI = [0.2; 0.6]) had better SF than their never-using counterparts. This difference was not present in controls (F-group*frequency(2, 2205) = 4.995, P = .007). Our findings suggest that the better premorbid social functioning of FEP with a history of cannabis use may have contributed to their likelihood to begin using cannabis, exposing them to its reported risk-increasing effects for Psychotic Disorders

Digital Modernism Heritage Lexicon

The book investigates the theme of Modernism (1920-1960 and its epigones) as an integral part of tangible and intangible cultural heritage which contains the result of a whole range of disciplines whose aim is to identify, document and preserve the memory of the past and the value of the future. Including several chapters, it contains research results relating to cultural heritage, more specifically Modernism, and current digital technologies. This makes it possible to record and evaluate the changes that both undergo: the first one, from a material point of view, the second one from the research point of view, which integrates the traditional approach with an innovative one. The purpose of the publication is to show the most recent studies on the modernist lexicon 100 years after its birth, moving through different fields of cultural heritage: from different forms of art to architecture, from design to engineering, from literature to history, representation and restoration. The book appeals to scholars and professionals who are involved in the process of understanding, reading and comprehension the transformation that the places have undergone within the period under examination. It will certainly foster the international exchange of knowledge that characterized Modernism