Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Circadian regulation of hormone signaling and plant physiology

The survival and reproduction of plants depend on their ability to cope with a wide range of daily and seasonal environmental fluctuations during their life cycle. Phytohormones are plant growth regulators that are involved in almost every aspect of growth and development as well as plant adaptation to myriad abiotic and biotic conditions. The circadian clock, an endogenous and cell-autonomous biological timekeeper that produces rhythmic outputs with close to 24-h rhythms, provides an adaptive advantage by synchronizing plant physiological and metabolic processes to the external environment. The circadian clock regulates phytohormone biosynthesis and signaling pathways to generate daily rhythms in hormone activity that fine-tune a range of plant processes, enhancing adaptation to local conditions. This review explores our current understanding of the interplay between the circadian clock and hormone signaling pathways

Minimal growth factor conditions for PTOL.

All growth is expressed as percent viability respective to control (complete WENRAS media), with minimal growth factor media required to supported >50% viability assessed for each organoid. Minimal conditions highlighted for each as applicable, including ENRA for Panc129 (A), NRAS for Panc193 (Bii), A for Panc268 (Cii), R for Panc269 (D), ENRA for Panc271 (Eii), media without supplemented growth factor for Panc 272 (F), ENRA for Panc308 (G) and Panc320 (H). These are additionally highlighted in table form (I). The organoids without minimal growth factor conditions highlighted required all growth factors (WENRAS) for growth (Bi, Ci, Ei). W = 50% Wnt3a. E = 50 ng/ml EGF. N = Noggin. R = R-spondin. A = 500 nM A38-01 (ALK inhibitor). S = 10 uM SB202190 (p38 MAPK inhibitor). Statistical analysis done via one-way ANOVA.</p

Summary of pancreatic organoids Wnt/R-spondin dependency established through growth factor dependency and Wnt pathway inhibition.

Summary of pancreatic organoids Wnt/R-spondin dependency established through growth factor dependency and Wnt pathway inhibition.</p