Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Evaluating the protective role of carrier microparticles in preserving protein secondary structure within electrospun meshes

Direct incorporation of proteins into electrospun meshes using approaches such as blend electrospinning can promote adverse interactions with hydrophobic polymers, organic solvents and high voltage, potentially leading to loss of protein activity. However, pre-encapsulation within a protective carrier phase can preserve protein conformation by avoiding exposure to harsh processing conditions. In this study, bovine serum albumin (BSA) was loaded within cellulose microparticles (MPs) and the BSA-loaded MPs were dispersed in a solution of poly(ethylene oxide) (PEO). Particle-mesh composites were created using a sacrificial fiber/co-electrospinning approach in which the BSA/MP/PEO solution was simultaneously electrospun against a poly(caprolactone) (PCL) solution. Post-fabrication, sacrificial PEO fibers were selectively dissolved by treatment with ethanol. Microscopy, weight loss analysis and FTIR spectroscopy together confirmed selective dissolution of PEO fibers and the retention of BSA-loaded MPs within the PCL network without significant loss of either the MPs or the protein. Circular dichroism spectroscopy and intrinsic fluorescence measurements on BSA extracted from the co-electrospun meshes indicated minimal disruption to secondary structure, although partial sheet induction was observed. In contrast, direct exposure of BSA to four commonly used electrospinning solvents resulted in a large decrease in helical content and significant induction of sheets, revealing significant changes to the secondary structure. In summary, our results demonstrate the protective role of MPs in minimizing adverse effects of electrospinning on the secondary structure of incorporated protein. © 2020 Wiley Periodicals LLC

Preparation, Characterization and Assessment of the Novel Gelatin–tamarind Gum/Carboxymethyl Tamarind Gum-Based Phase-Separated Films for Skin Tissue Engineering Applications

<p>The current study delineates the development of novel gelatin–tamarind gum/carboxymethyl tamarind gum-based phase-separated films for probable skin tissue engineering applications. Polyethylene glycol was used as plasticizer. The films were characterized thoroughly using mechanical tester and impedance analyzer. Cell proliferation ability and drug release properties of the films were investigated. Mechanical studies indicated composition-dependent stress relaxation properties. Polysaccharide containing films supported better proliferation of human keratinocytes as compared to control. Drug-loaded films showed good antimicrobial properties against <i>Escherichia coli</i>. Analysis of the results indicated that the prepared films may be tried as matrices for skin tissue engineering.</p

An in-Depth Analysis of the Swelling, Mechanical, Electrical, and Drug Release Properties of Agar–Gelatin Co-Hydrogels

<p>Agar–gelatin-based co-hydrogels were prepared with different compositions of the agar and the gelatin fractions. The intermolecular hydrogen bonding was higher in the co-hydrogels as compared to the gelatin hydrogel. Swelling studies indicated diffusion-mediated swelling. The electrical stability of the co-hydrogels was higher as compared to the gelatin hydrogel. Though the firmness of the co-hydrogels was higher, Weichert model of viscoelasticity indicated that the inherent mechanical stability of the gelatin hydrogel was superior. The release of ciprofloxacin hydrochloride was predominately Fickian diffusion-mediated. In gist, the co-hydrogels can be tried as polymeric constructs for controlled drug delivery applications.</p

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas