Mortality on Mount Everest, 1921-2006: descriptive study

Objective To examine patterns of mortality among climbers on Mount Everest over an 86 year period

Healthcare Staff Perceptions and Misconceptions regarding Antibody Testing in the United Kingdom: Implications for the next steps for antibody screening

Background Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. a number of published comment and editorial articles raising concerns about antibody testing in this context. We present perceptions of NHS healthcare workers in relation to SARS-CoV-2 antibody testing. Methods Electronic survey regarding perceptions towards SARS-CoV-2 antibody testing which was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing. Results In total, 560 healthcare workers completed the survey (80% female; 25% of BAME background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean “social distancing is less important”, with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives. Conclusions NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients

C3d‐positive donor‐specific antibodies have a role in pretransplant risk stratification of cross‐match‐positive HLA‐incompatible renal transplantation : United Kingdom multicentre study

Anti‐HLA‐antibody characteristics aid to risk‐stratify patients and improve long‐term renal graft outcomes. Complement activation by donor‐specific antibody (DSA) is an important characteristic that may determine renal allograft outcome. There is heterogeneity in graft outcomes within the moderate to high immunological risk cases (cross‐match‐positive). We explored the role of C3d‐positive DSAs in sub‐stratification of cross‐match‐positive cases and relate to the graft outcomes. We investigated 139 cross‐match‐positive living‐donor renal transplant recipients from four transplant centres in the United Kingdom. C3d assay was performed on serum samples obtained at pretreatment (predesensitization) and Day 14 post‐transplant. C3d‐positive DSAs were found in 52 (37%) patients at pretreatment and in 37 (27%) patients at Day 14 post‐transplant. Median follow‐up of patients was 48 months (IQR 20.47–77.57). In the multivariable analysis, pretreatment C3d‐positive DSA was independently associated with reduced overall graft survival, the hazard ratio of 3.29 (95% CI 1.37–7.86). The relative risk of death‐censored five‐year graft failure was 2.83 (95% CI 1.56–5.13). Patients with both pretreatment and Day 14 C3d‐positive DSAs had the worst five‐year graft survival at 45.5% compared with 87.2% in both pretreatment and Day 14 C3d‐negative DSA patients with the relative risk of death‐censored five‐year graft failure was 4.26 (95% CI 1.79, 10.09). In this multicentre study, we have demonstrated for the first time the utility of C3d analysis as a distinctive biomarker to sub‐stratify the risk of poor graft outcome in cross‐match‐positive living‐donor renal transplantation

HLA antibody incompatible renal transplantation : long-term outcomes similar to deceased donor transplantation

Background. HLA incompatible renal transplantation still remains one of best therapeutic options for a subgroup of patients who are highly sensitized and difficult to match but not much is known about its long-term graft and patient survival. Methods. One hundred thirty-four HLA incompatible renal transplantation patients from 2003 to 2018 with a median follow of 6.93 y were analyzed retrospectively to estimate patient and graft survivals. Outcomes were compared with groups defined by baseline crossmatch status and the type and timings of rejection episodes. Results. The overall patient survival was 95%, 90%, and 81%; and graft survival was 95%, 85%, and 70% at 1, 5, and 10 y, respectively. This was similar to the first-time deceased donor transplant cohort. The graft survival for pretreatment cytotoxic-dependent crossmatch (CDC) positive crossmatch group was significantly low at 83%, 64%, and 40% at 1, 5, and 10 y, respectively, compared with other groups (Bead/CDC, P = 0.007; CDC/Flow, P = 0.001; and microbead assay/flow cytometry crossmatch, P = 0.837), although those with a low CDC titer (<1 in 2) have comparable outcomes to the CDC negative group. Female patients in general fared worse in both patient and graft survival outcomes in each of the 3 groups based on pretreatment crossmatch, although this did not reach statistical significance. Antibody-mediated rejection was the most frequent type of rejection with significant decline in graft survival by 10 y when compared with no rejection (P < 0.001). Rejection that occurred or continued to occur after the first 2 wk of transplantation caused a significant reduction in graft survivals (P < 0.001), whereas good outcomes were seen in those with a single early rejection episode. Conclusions. One-, 5-, and 10-y HLA incompatible graft and patient survival is comparable to deceased donor transplantation and can be further improved by excluding high-CDC titer cases. Antibody-positive female patients show worse long-term survival. Resolution of early rejection is associated with good long-term graft survival

Cerebral haemodynamics in man : clinical and applied observations

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The Prognostic Value of Cardiopulmonary Exercise Testing in Vascular Surgery Patients

We read with considerable interest the article by Young et al. published recently in this journal. The article described a systematic review of the literature relating to the use of preoperative cardiopulmonary exercise testing (CPET) in patients undergoing vascular surgery. The eight authors of this systematic review reported results from six studies (although this was stated as seven in the abstract). Of those six studies, the largest three all reported that CPET was a useful predictor of outcome in patients undergoing abdominal aortic aneurysm repair. We note that one of these, by McEnroe and Wilson, was actually a retrospective audit of 119 patients, presented in abstract form at a scientific meeting, thus fulfilling the authors' criteria for ‘grey literature’. The other three peer-reviewed studies mentioned in the review were all of 30 or fewer patients and were therefore likely to lack the power to detect the influence of CPET results on patient outcome. One of the studies, Kothmann et al., did not even report outcome data and was designed as a test of inter-individual (test–retest) variability; it is difficult to understand why such a study was included in a systematic review of this nature. All of the ‘grey literature’ articles listed in the article (eight studies) supported the use of CPET in the setting of AAA repair. Another recent publication, not included in this review article, further advocates the role of CPET in the setting of aortic aneurysm repair, reporting that in the 185 patients in whom there was outcome data, anaerobic threshold (AT) was the only predictor of survival at 30 days, 90 days and 1 year. We found the authors' conclusion that “CPET should not be used to guide routine practice in the absence of evidence” in conflict with the presented results. We believe that the evidence to date suggests CPET is valuable prognostic assessment in abdominal aortic aneurysm surgery and as such merits consideration as a pre-operative investigation. Other popular perioperative practices such as the use of clinical risk scores, biomarkers and preassessment are supported by considerably less evidence