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

Phylotranscriptomics suggests the jawed vertebrate ancestor could generate diverse helper and regulatory T cell subsets

This study was supported by The Royal Society Research Grant RG130789 awarded to HD, as well as by a University of Aberdeen Centre for Genome-Enabled Biology and Medicine PhD studentship and Marine Alliance for Science and Technology for Scotland (MASTS) research grant SG363 awarded to AKR.Peer reviewedPublisher PD

Seasonal Reproductive Biology of the Bignose Fanskate Sympterygia acuta (Chondrichthyes, Rajidae)

Most skates are adapted to shelf and slope environments experiencing less seasonal variation than coastal ecosystems. Here, we analyze the reproductive ecology of Sympterygia acuta. We hypothesize that, like its congener Sympterygia bonapartii, S. acuta has a seasonal reproductive cycle. To test this hypothesis, we examined multiple lines of evidence: (1) time of appearance of females carrying egg cases and wild neonates; (2) seasonal variation in gonadosomatic index and follicle diameter, as indicators of reproductive activity; and (3) egg-laying season, incubation time, and fecundity in captive individuals. A total of 351 specimens were examined. Size at 50 % maturity was 475 and 478 mm total length for males and females, respectively. A marked seasonal reproductive cycle was observed. Both gonadosomatic index and follicle diameter of wild adult females increased from winter to spring and reached their lowest value during summer. Fecundity was, on average, 52 eggs per female per laying season. Egg laying of captive females peaked between August and December; eggs hatched after 119–131 days. This schedule predicts the appearance of neonates in the wild by January through April. Accordingly, wild neonates and young-of-the-year were observed between January and May. Unlike most other skates, southwest Atlantic Sympterygia species are adapted to life in shallow, coastal waters, matching the seasonality of the coastal environment with egg-laying activity in spring and hatching in summer. These shallow coastal waters, which are important in the life cycle of Sympterygia spp., are threatened by human impacts.Fil: Mabragaña, Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; ArgentinaFil: Lucifora, Luis Omar. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; ArgentinaFil: Corbo, Maria de Lourdes. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentina. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; ArgentinaFil: Díaz de Astarloa, Juan Martín. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencia Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentin