Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The XXL survey: first results and future

The XXL survey currently covers two 25 sq. deg. patches with XMM observations of ~10ks. We summarise the scientific results associated with the first release of the XXL data set, that occurred mid 2016. We review several arguments for increasing the survey depth to 40 ks during the next decade of XMM operations. X-ray (z1 cluster density. It will eventually constitute a reference study and an ideal calibration field for the upcoming eROSITA and Euclid missions

Galectin-3, osteopontin and successful aging

Background: Individuals who reach exceptional longevity (100+ years of age) free of common chronic age diseases (i.e. ''dodgers'') arguably represent the paradigm of successful aging in humans. As such, identification of potential biomarkers associated with this phenomenon is of medical interest. Methods: We measured serum levels of galectin-3 and osteopontin, both of which have been shown to be linked with major chronic or aging-related disorders in younger populations, in centenarian ''dodgers'' (n=81; 40 men; 100-104 years) and healthy controls (n=41; 24 men, 70-80 years). Results: Both biomarkers showed significantly lower values (p<0.001) in the former (galectin-3: 2.4±1.7 vs. 4.8±2.8 ng/mL; osteopontin: 38.1±27.7 vs. 72.6±33.1 µg/mL). Logistic regression analysis identified the combination of these two biomarkers as a significant predictor variable associated with successful aging regardless of sex (p<0.001). The area under the curve (AUC) classified the ability of galectin-3 and osteopontin to predict the likelihood of successful aging as ''fair'' (AUC=0.75) and ''good'' (AUC=0.80), respectively. Particularly, the combination of the two biomarkers showed good discriminatory power for successful aging (AUC=0.86), with sensitivity=83% and specificity=74%. Conclusions: Lower levels of both galectin-3 and osteopontin are associated with successful aging, representing potential biomarkers of this condition. Our cross-sectional data must be however approached with caution. Further research is necessary to replicate the present preliminary results in other cohorts and to identify the potential use of galectin-3 and osteopontin as potential targets (or at least predictors) in future personalized anti-aging therapies

The XXL Survey: I. Scientific motivations - XMM-Newton observing plan - Follow-up observations and simulation programme

We present the XXL Survey, the largest XMM programme totaling some 6.9 Ms to date and involving an international consortium of roughly 100 members. The XXL Survey covers two extragalactic areas of 25 deg2 each at a point-source sensitivity of ~ 5E-15 erg/sec/cm2 in the [0.5-2] keV band (completeness limit). The survey's main goals are to provide constraints on the dark energy equation of state from the space-time distribution of clusters of galaxies and to serve as a pathfinder for future, wide-area X-ray missions. We review science objectives, including cluster studies, AGN evolution, and large-scale structure, that are being conducted with the support of approximately 30 follow-up programmes. We describe the 542 XMM observations along with the associated multi-lambda and numerical simulation programmes. We give a detailed account of the X-ray processing steps and describe innovative tools being developed for the cosmological analysis. The paper provides a thorough evaluation of the X-ray data, including quality controls, photon statistics, exposure and background maps, and sky coverage. Source catalogue construction and multi-lambda associations are briefly described. This material will be the basis for the calculation of the cluster and AGN selection functions, critical elements of the cosmological and science analyses. The XXL multi-lambda data set will have a unique lasting legacy value for cosmological and extragalactic studies and will serve as a calibration resource for future dark energy studies with clusters and other X-ray selected sources. With the present article, we release the XMM XXL photon and smoothed images along with the corresponding exposure maps. The XMM XXL observation list (Table B.1) is available in electronic form at the CDS. The present paper is the first in a series reporting results of the XXL-XMM survey

Membrane permeation of arginine-rich cell-penetrating peptides independent of transmembrane potential as a function of lipid composition and membrane fluidity

Cell-penetrating peptides (CPPs) are prominent delivery vehicles to confer cellular entry of (bio-) macromolecules. Internalization efficiency and uptake mechanism depend, next to the type of CPP and cargo, also on cell type. Direct penetration of the plasma membrane is the preferred route of entry as this circumvents endolysosomal sequestration. However, the molecular parameters underlying this import mechanism are still poorly defined. Here, we make use of the frequently used HeLa and HEK cell lines to address the role of lipid composition and membrane potential. In HeLa cells, at low concentrations, the CPP nona-arginine (R9) enters cells by endocytosis. Direct membrane penetration occurs only at high peptide concentrations through a mechanism involving activation of sphingomyelinase which converts sphingomyelin into ceramide. In HEK cells, by comparison, R9 enters the cytoplasm through direct membrane permeation already at low concentrations. This direct permeation is strongly reduced at room temperature and upon cholesterol depletion, indicating a complex dependence on membrane fluidity and microdomain organisation. Lipidomic analyses show that in comparison to HeLa cells HEK cells have an endogenously low sphingomyelin content. Interestingly, direct permeation in HEK cells and also in HeLa cells treated with exogenous sphingomyelinase is independent of membrane potential. Membrane potential is only required for induction of sphingomyelinase-dependent uptake which is then associated with a strong hyperpolarization of membrane potential as shown by whole-cell patch clamp recordings. Next to providing new insights into the interplay of membrane composition and direct permeation, these results also refute the long-standing paradigm that transmembrane potential is a driving force for CPP uptake

Age and Education Influencing Willingness in Men to Recommend Breast Cancer Screening: A Comparative Study of University Personnel and Clinical Attendees

Suleyman Buyukasik,1 Burak Kankaya,1 Yusuf Emre Altundal,1 Mustafa Ozgul,2 Fatemeh Atashbari,1 Aisha Abshir Hussain Osman,1 Halil Alis,1 Selin Kapan1 1Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey; 2Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USACorrespondence: Yusuf Emre Altundal, Department of General Surgery, Istanbul Aydin University Faculty of Medicine, Besyol Mah, Akasya Sok. No: 4 Kucukcekmece, Istanbul, 34295, Turkey, Email [email protected]: Breast cancer is a major global health concern. In some societies, male family members influence women’s healthcare decisions, yet their awareness and attitudes toward breast cancer screening remain poorly understood. Our research aimed to analyze awareness, knowledge, and willingness to recommend breast cancer screening among men from two distinct populations, and to examine how age and educational level influence willingness to recommend breast examinations for female family members.Patients and Methods: This prospective cross-sectional survey study included male academic staff at a university (University Personnel Group, n=105) and male patients visiting a hospital policlinic with non-breast-related complaints along with their male companions (Clinical Attendee Group, n=100). A 10-item structured questionnaire assessed demographics, knowledge about breast cancer, and attitudes toward mammography screening using statistical analysis.Results: Both groups demonstrated similar knowledge levels regarding breast cancer frequency in women (~55%), male breast cancer occurrence (~45%), and annual mammography necessity (~52%). The clinical attendee group showed significantly greater willingness to recommend breast examinations compared to the university personnel group (94.0% vs 74.3%, p&lt; 0.001). In the clinical attendee group, willingness increased with age (88.9% in ages 15– 25 to 100% in ages 40+), showing a significant positive trend (p&lt; 0.05). The university personnel group exhibited peak willingness (87.1%) in the 25– 40 age group, with lower rates in other age categories. Educational status strongly influenced willingness in the university personnel group, increasing from 33.3% at high school level to 87.8% at Master’s/Ph.D. level, while the clinical attendee group maintained high willingness (91.7– 100%) across all education levels.Conclusion: Our findings show patterns of breast cancer awareness and screening recommendation willingness between clinical attendees and university personnel. While basic knowledge about breast cancer was similar, willingness to recommend screening differed significantly, with age and education having differential impacts between groups.Keywords: breast cancer screening, male awareness, family support, age, educational status, cross-sectional surve

Analysis of Mammography BI-RADS Distribution and Follow-up Ultrasound Assessment: A Single-Center Study

Burak Kankaya,1 Suleyman Buyukasik,1 Yusuf Emre Altundal,1 Feyza Sonmez Topcu,2 Paria Rahmanbakhsh,1 Ayden Etemad,1 Selin Kapan,1 Halil Alis1 1Department of General Surgery, Faculty of Medicine, Istanbul Aydin University, Istanbul, Turkey; 2Department of Radiology, Faculty of Medicine, Istanbul Aydin University, Istanbul, TurkeyCorrespondence: Yusuf Emre Altundal, Department of General Surgery, Istanbul Aydin University Faculty of Medicine, Besyol Mah, Akasya Sok. No: 4, Kucukcekmece, Istanbul, 34295, Turkiye, Email [email protected]: Our study has three main aims: 1) to assess the distribution of Breast Imaging Reporting and Data System (BI-RADS) classifications in a cohort of Turkish women undergoing screening mammography, 2) to analyze the frequency and non-completion rates of recommended follow-up ultrasound (US) examinations, and 3) to examine the outcomes of completed follow-up US examinations. Our goal was to evaluate potential gaps in the current breast cancer screening process by analyzing BI-RADS classifications, follow-up completion rates, and outcomes of completed ultrasound examinations.Patients and Methods: This retrospective study analyzed 1761 Turkish women who underwent screening mammography from 2020– 2022 at the Istanbul Aydin University General Surgery Clinic, Istanbul, Turkey. We assessed the distribution of BI-RADS classifications, analyzed the frequency and non-completion rates of recommended follow-up US, and examined the outcomes of completed follow-up US examinations. Chi-square tests of independence and Spearman’s rank correlation test were used to analyze the data.Results: Our study revealed three key findings: 1) Over half of mammograms (55.9%) were classified as BI-RADS 0, requiring further imaging. 2) Nearly one-third of patients who recommended US examinations (31.91%) did not complete recommended follow-up ultrasound appointments. 3) Among those who completed follow-up ultrasonography, almost one-third (29.7%) were reclassified as BI-RADS 3 or higher. Notably, 2.3% (n=18) were classified as BI-RADS 4 or 5, suggesting findings suspicious for malignancy.Conclusion: Our findings highlight the crucial role of follow-up US in breast cancer screening. The high rate of initial BI-RADS 0 classifications using mammography, coupled with the significant non-completion rate for follow-up US examinations, particularly among older age groups, highlights potential gaps in the current screening process.Keywords: breast ultrasonography, mammography, breast cancer, early diagnosis, BI-RADS classificatio