Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (VT) size was 500 ml, or 7 to 9 ml kg1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P < 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P < 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high VT and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome

Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - An observational study in 29 countries

BACKGROUND Limited information exists about the epidemiology and outcome of surgical patients at increased risk of postoperative pulmonary complications (PPCs), and how intraoperative ventilation was managed in these patients. OBJECTIVES To determine the incidence of surgical patients at increased risk of PPCs, and to compare the intraoperative ventilation management and postoperative outcomes with patients at low risk of PPCs. DESIGN This was a prospective international 1-week observational study using the ‘Assess Respiratory Risk in Surgical Patients in Catalonia risk score’ (ARISCAT score) for PPC for risk stratification. PATIENTS AND SETTING Adult patients requiring intraoperative ventilation during general anaesthesia for surgery in 146 hospitals across 29 countries. MAIN OUTCOME MEASURES The primary outcome was the incidence of patients at increased risk of PPCs based on the ARISCAT score. Secondary outcomes included intraoperative ventilatory management and clinical outcomes. RESULTS A total of 9864 patients fulfilled the inclusion criteria. The incidence of patients at increased risk was 28.4%. The most frequently chosen tidal volume (V T) size was 500 ml, or 7 to 9 ml kg−1 predicted body weight, slightly lower in patients at increased risk of PPCs. Levels of positive end-expiratory pressure (PEEP) were slightly higher in patients at increased risk of PPCs, with 14.3% receiving more than 5 cmH2O PEEP compared with 7.6% in patients at low risk of PPCs (P ˂ 0.001). Patients with a predicted preoperative increased risk of PPCs developed PPCs more frequently: 19 versus 7%, relative risk (RR) 3.16 (95% confidence interval 2.76 to 3.61), P ˂ 0.001) and had longer hospital stays. The only ventilatory factor associated with the occurrence of PPCs was the peak pressure. CONCLUSION The incidence of patients with a predicted increased risk of PPCs is high. A large proportion of patients receive high V T and low PEEP levels. PPCs occur frequently in patients at increased risk, with worse clinical outcome.</p

Isolation and characterization of a human glioblastoma cell line

The characterization of a glioblastoma cells line represents an important achievement in the field of brain tumor research activity, which enables the researchers to obtain strong results with a wide recognition by the scientific community. The objective of this study was to develop a standardized glioblastoma cells line using the resources obtained entirely from the national research projects. The tumor samples was initially obtained intraoperative from a 58 years-old female patient, with the preoperative written consent of the patient. The histopathological exam showed a grad IV WHO glioma (glioblastoma). The sample was prepared by manual fragmentation into pieces up to few millimeters each, followed by enzymatic digestions using different concentration of trypsin. Then, the cellular line was cultivated for more then 100 passages using Dulbecco Modified Eagle's medium enrich with 10% fetal bovine serum. The characterization of the glioblastoma line was made by the evaluation of cells proliferation (growth curve), by morphological studies, by studying the karyotype of the cells and by immunohistochemistry studies for the identification of the specific markers (glial fibrillary acidic proteins - GFAP, vimentin) of the tumor cells. The determination of the expression/amplification of the receptors tyrosine kinases (PDGFR and more important EGFR) is in progress. The characterization of a glioblastoma cells line represents an essential step in order to obtain a better in vitro and in vivo experimental model for glioblastoma

European Administration. Normative Fundaments and Systemic Models

Making use of the relevant literature in the area, this paper proposes a systemic approach to the European administration. The difficulty of the research design stems from the inconsistency of the regulations European treaties exhibit, as well as from the sectorial approaches, mostly of legal nature, on the conceptualization of the EU administration. To this we add the complexity of the analyzed process which, under the conditions set by the EU enlargement tends to overcome, both in sphere and content, many of the administrations of the federal states or international organizations. The systemic model we propose is a complex system, of a mixed architecture. It is there that the self-regulatory processes have a unique specificity and make use of both a legal foundation and of complementary processes such are those of Europeanization, convergence and administrative dynami

Bringing the policy in: a new typology of national referendums

Scholarship has categorized referendums predominantly along their procedural and institutional features. This paper moves beyond these formal dimensions, argues that the policy subjected to a popular vote is the missing link and proposes a complementary typology based on the policy areas. This typology fosters comparisons across countries, political systems and over time within one policy area, thus serving as a powerful analytical tool for further analyses. At the same time, the typology maps out the history of referendum use showing the chronology of salient issues in different societies. The empirical evidence draws on an original dataset of 630 nationwide referendums in Europe between 1793 and 2019

Direct democracy and subjective regime legitimacy in Europe

While much research focuses on the causes and consequences of direct democracy and regime legitimacy, little attention has been paid to the potential relationship between them. In an attempt to fill this void, this paper focuses on the legal provisions for direct democracy and its use. The key argument is that possibilities for the public’s direct involvement reflect high importance given to citizens, openness of the regime towards different modes of decision-making, and ways to avoid unpopular institutions. Consequently, citizens are likely to accept and support the regime, improving or maintaining its legitimacy. The cross-national analysis includes 38 European countries ranging from transition countries to established democracies. It uses bivariate statistical analysis and country-level data collected from legislation, secondary sources, and aggregate surveys