Association of metabolic equivalent of task (MET) score in length of stay in hospital following radical cystectomy with urinary diversion:a multi-institutional study

PURPOSE: The Metabolic equivalent of task (MET) score is used in patients’ preoperative functional capacity assessment. It is commonly thought that patients with a higher MET score will have better postoperative outcomes than patients with a lower MET score. However, such a link remains the subject of debate and is yet unvalidated in major urological surgery. This study aimed to explore the association of patients’ MET score with their postoperative outcomes following radical cystectomy. METHODS: We used records-linkage methodology with unique identifiers (Community Health Index/hospital number) and electronic databases to assess postoperative outcomes of patients who had underwent radical cystectomies between 2015 and 2020. The outcome measure was patients’ length of hospital stay. This was compared with multiple basic characteristics such as age, sex, MET score and comorbid conditions. A MET score of less than four (< 4) is taken as the threshold for a poor functional capacity. We conducted unadjusted and adjusted Cox regression analyses for time to discharge against MET score. RESULTS: A total of 126 patients were included in the analysis. Mean age on date of operation was 66.2 (SD 12.2) years and 49 (38.9%) were female. A lower MET score was associated with a statistically significant lower time-dependent risk of hospital discharge (i.e. longer hospital stay) when adjusted for covariates (HR 0.224; 95% CI 0.077–0.652; p = 0.006). Older age (adjusted HR 0.531; 95% CI 0.332–0.848; p = 0.008) and postoperative complications (adjusted HR 0.503; 95% CI 0.323–0.848; p = 0.002) were also found to be associated with longer hospital stay. Other comorbid conditions, BMI, disease staging and 30-day all-cause mortality were statistically insignificant. CONCLUSION: A lower MET score in this cohort of patients was associated with a longer hospital stay length following radical cystectomy with urinary diversion. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11255-021-02813-x

Patient-derived mutations within the N-terminal domains of p85α impact PTEN or Rab5 binding and regulation

The p85α protein regulates flux through the PI3K/PTEN signaling pathway, and also controls receptor trafficking via regulation of Rab-family GTPases. In this report, we determined the impact of several cancer patient-derived p85α mutations located within the N-terminal domains of p85α previously shown to bind PTEN and Rab5, and regulate their respective functions. One p85α mutation, L30F, significantly reduced the steady state binding to PTEN, yet enhanced the stimulation of PTEN lipid phosphatase activity. Three other p85α mutations (E137K, K288Q, E297K) also altered the regulation of PTEN catalytic activity. In contrast, many p85α mutations reduced the binding to Rab5 (L30F, I69L, I82F, I177N, E217K), and several impacted the GAP activity of p85α towards Rab5 (E137K, I177N, E217K, E297K). We determined the crystal structure of several of these p85α BH domain mutants (E137K, E217K, R262T E297K) for bovine p85α BH and found that the mutations did not alter the overall domain structure. Thus, several p85α mutations found in human cancers may deregulate PTEN and/or Rab5 regulated pathways to contribute to oncogenesis. We also engineered several experimental mutations within the p85α BH domain and identified L191 and V263 as important for both binding and regulation of Rab5 activit

A good life for all within planetary boundaries

Humanity faces the challenge of how to achieve a high quality of life for over 7 billion people without destabilizing critical planetary processes. Using indicators designed to measure a ‘safe and just’ development space, we quantify the resource use associated with meeting basic human needs, and compare this to downscaled planetary boundaries for over 150 nations. We find that no country meets basic needs for its citizens at a globally sustainable level of resource use. Physical needs such as nutrition, sanitation, access to electricity and the elimination of extreme poverty could likely be met for all people without transgressing planetary boundaries. However, the universal achievement of more qualitative goals (for example, high life satisfaction) would require a level of resource use that is 2–6 times the sustainable level, based on current relationships. Strategies to improve physical and social provisioning systems, with a focus on sufficiency and equity, have the potential to move nations towards sustainability, but the challenge remains substantial

Persistent Place-Making in Prehistory: the Creation, Maintenance, and Transformation of an Epipalaeolithic Landscape

Most archaeological projects today integrate, at least to some degree, how past people engaged with their surroundings, including both how they strategized resource use, organized technological production, or scheduled movements within a physical environment, as well as how they constructed cosmologies around or created symbolic connections to places in the landscape. However, there are a multitude of ways in which archaeologists approach the creation, maintenance, and transformation of human-landscape interrelationships. This paper explores some of these approaches for reconstructing the Epipalaeolithic (ca. 23,000–11,500&nbsp;years BP) landscape of Southwest Asia, using macro- and microscale geoarchaeological approaches to examine how everyday practices leave traces of human-landscape interactions in northern and eastern Jordan. The case studies presented here demonstrate that these Epipalaeolithic groups engaged in complex and far-reaching social landscapes. Examination of the Early and Middle Epipalaeolithic (EP) highlights that the notion of “Neolithization” is somewhat misleading as many of the features we use to define this transition were already well-established patterns of behavior by the Neolithic. Instead, these features and practices were enacted within a hunter-gatherer world and worldview

Valorisation of Biowastes for the Production of Green Materials Using Chemical Methods

With crude oil reserves dwindling, the hunt for a sustainable alternative feedstock for fuels and materials for our society continues to expand. The biorefinery concept has enjoyed both a surge in popularity and also vocal opposition to the idea of diverting food-grade land and crops for this purpose. The idea of using the inevitable wastes arising from biomass processing, particularly farming and food production, is, therefore, gaining more attention as the feedstock for the biorefinery. For the three main components of biomass—carbohydrates, lipids, and proteins—there are long-established processes for using some of these by-products. However, the recent advances in chemical technologies are expanding both the feedstocks available for processing and the products that be obtained. Herein, this review presents some of the more recent developments in processing these molecules for green materials, as well as case studies that bring these technologies and materials together into final products for applied usage

Climatic trends in continental shelf waters off Ghana and in the Gulf of Guinea, 1963-1992

Using time series analyses, some physical parameters of the continental shelf waters of the Gulf of Guinea were examined. Analysis of coastal sea surface temperatures from Ghana and Ivory Coast, and offshore sea surface temperatures from the Gulf of Guinea clearly shows spatial and inter-annual patterns of cooling in coastal waters of West Africa. The behaviour of the decomposed trend of coastal and offshore sea surface temperatures, sub-surface: temperature measured at 100 m depth off Ghana and salinity showed that the observational period (1963-1992) could be divided into three climatic periods: the period before 1972, from 1972 to 1982, and the period after 1982. In the first period, sea surface temperature at both coastal and offshore areas and bottom temperature declined and coastal salinity was relatively low. The second period was a cold one with less than average sea surface and sea bottom temperatures. The mixed layer was narrow with the thermocline remaining shallower than its: long-term average position. Coastal and bottom salinity (measured at the 100 m depth) were relatively high but the seasonal variation was minimal. This period of significant change in the physical components of the ecosystem of the Ghanaian shelf waters has hitherto not been documented in the literature. In the final phase, temperatures were high, and salinity was low and erratic. The observed localised environmental changes are consistent with global changes in the Gulf of Guinea and possibly in the tropical Atlantic basin.Les résultats dˈune analyse de séries temporelles de paramètres de lˈenvironnement du plateau continental du golfe de Guinée sont présentés. Une analyse de la température de surface côtière illustre les types de variabilité spatio–temporelle dans cette région. La température côtière, la température au large, ainsi que la température et la salinité de sub-surface (100 m) devant le Ghana montrent que la période 1963–1992 peut être divisée en trois épisodes : avant 1972, de 1972 à 1982 et après 1982. Dans la première période, la température de surface, tant à la côte quˈau large, ainsi que la température sur le fond se refroidissent, la salinité côtière restant basse. La seconde période est une période froide, caractérisée par des anomalies négatives de la température de surface et de fond. La couche de mélange est réduite et la thermocline se situe à une profondeur moindre que celle de la moyenne « climatique ». La température côtière et la salinité sur le fond (100 m) sont relativement élevées mais lˈamplitude des variations saisonnières est minimale. Cette période de changements de lˈécosystème du Ghana nˈavait pas été décrite jusquˈà présent. Dans la dernière phase, les températures sont élevées et la salinité basse, avec un comportement irrégulier. Les changements observés sont cohérents avec les changements globaux dans le golfe de Guinée et dans lˈAtlantique Sud