Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Mortality, morbidity, growth and development of babies weighing 501–1000 grams and 1001–1500 grams at birth

During the five-year period, January 1980 to December 1984, 149 babies of extremely low birthweight (ELBVV; 501–1000 g) and 296 of very low birthweight (VLBVV; 1001–1500 g) were admitted to King's College Hospital, Neonatal Intensive Care Unit. The survival rates were 51.7 % and 82.8 % respectively. There were more peri- and postnatal problems in the ELBVV babies than the VLBW babies and these differences were highly significant. All surviving babies born between January 1980 and December 1982 were followed up until aged two. The ELBW children had a higher incidence of neuro-developmental sequelae than those of VLBW especially when both major and minor problems were considered. Their developmental quotients were lower at one and two years. Significantly more ELBW children were of short stature and low weight (<3rd centile). By two years of age the differences between ELBW and VLBW children in stature and mean DQ had lessened

Cyclometallated platinum(II) complexes of 1,3-di(2-pyridyl)benzenes : tuning excimer emission from red to near-infrared for NIR-OLEDs

The Pt(ii) complex N^C2^N-1,3-di(2-pyridyl)benzene platinum chloride (PtL1Cl) is known to display efficient triplet luminescence in the green region of the spectrum, and to form an unusually emissive excimer that emits around 690 nm. In this contribution, the introduction of trifluoromethyl groups into either the 4- or 5-position of the pyridyl rings of the ligand is shown to lead to a red-shift in the excimer band, moving it into the near infra-red (NIR) region. The new ligands, synthesised by either Suzuki or Stille cross-coupling methods, are 1,3-bis(4-(trifluoromethyl)pyridin-2-yl) benzene HL27, 1,3-bis(4-(trifluoromethyl)pyridin-2-yl)-4,6- difluorobenzene HL28, and 1,3-bis(5-(trifluoromethyl)pyridin-2-yl)-4, 6-difluorobenzene HL29, from which the corresponding Pt(ii) complexes PtLnCl have been prepared. The monomer and excimer emission energies in solution are compared with those of PtL1Cl and PtL22Cl {HL22 = 1,3-di(2-pyridyl)-4,6-difluorobenzene}. The order for the monomer can be rationalised in terms of the stabilising effects of the F atoms and the CF3 groups on the HOMO and LUMO respectively. The order of excimer emission proves to be subtly different, but the most red-shifted complex in both cases is PtL27Cl. The electroluminescence of neat films of the complexes as emitting layers in OLEDs displays uniquely excimer-like emission, extending well into the technologically important NIR region

Serum IGF-I levels and IGF-I gene splicing in muscle of healthy young males receiving rhGH

Objective: Elevated growth hormone (GH) levels lead to increased circulating insulin-like growth factor-I (IGF-I), but the effects oil localised muscle IGF-I splice variant expression is not known. The effects of rhGH administration. with or without an acute bout Of high resistance exercise, were measured oil serum IGF-I and oil the mRNA levels of IGF-I splice variants in the vastus lateralis muscle of healthy young men. Design: The Study was a randomised double blind trial with a crossover design. Seven subjects were randomly assigned to a group receiving daily injections of rhGH (0.075 IU kg(-1) day(-1)) or placebo for a two week period. Following a one month washout. the groups were reversed. Results: Administration of rhGH increased circulating IGF-I from 31.8 +/- 3.2 to 109 +/- 5.4 nmol/L (p &lt;0.05). There was no effect of the exercise bout. RNA was extracted from muscle biopsies obtained from exercised and non-exercised legs 2.5 h after the cessation of the exercise. Transcript expression was measured using Real-time QPCR. There was no effect of either exercise or rhGH administration oil IGF-I 5' (Class 1 or Class 2) or 3' (IGF-IEa, or MGF) transcripts. Conclusion: Although rhGH administration has all effect oil liver IGF-I expression, as shown by increase ill circulating IGF-I. muscle IGF-I expression is unaffected ill Young healthy Subjects with normal GH profile. The findings contrast with those of a Previous Study in which GH deficient elderly men showed higher Muscle IGF-I 3' splice variant levels following rhGH administration with and without resistance training. Unlike in the liver, muscle Class 1 and 2 IGF-1 expression do not change significantly following administration of rhGH. (C) 2008 Elsevier Ltd. All rights reserved

Data from: Experimental swap of Anopheles gambiae's assortative mating preferences demonstrates key role of X-chromosome divergence island in incipient sympatric speciation.

Although many theoretical models of sympatric speciation propose that genes responsible for assortative mating amongst incipient species should be associated with genomic regions protected from recombination, there are few data to support this theory. The malaria mosquito, Anopheles gambiae, is known for its sympatric cryptic species maintained by pre-mating reproductive isolation and its putative genomic islands of speciation, and is therefore an ideal model system for studying the genomic signature associated with incipient sympatric speciation. Here we selectively introgressed the island of divergence located in the pericentric region of the X chromosome of An. gambiae s.s. into its sister taxon An. coluzzii through 5 generations of backcrossing followed by two generations of crosses within the introgressed strains that resulted in An. coluzzii-like recombinant strains fixed for the M and S marker in the X chromosome island. The mating preference of recombinant strains was then tested by giving virgin recombinant individuals a choice of mates with X-islands matching and non-matching their own island type. We show through genetic analyses of transferred sperm that recombinant females consistently mated with matching island-type males thereby associating assortative mating genes with the X-island of divergence. Furthermore, full-genome sequencing confirmed that protein-coding differences between recombinant strains were limited to the experimentally swapped pericentromeric region. Finally, targeted-genome comparisons showed that a number of these unique differences were conserved in sympatric field populations, thereby revealing candidate speciation genes. The functional demonstration of a close association between speciation genes and the X-island of differentiation lends unprecedented support to island-of-speciation models of sympatric speciation facilitated by pericentric recombination suppression