Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Neuroimaging-based classification of PTSD using data-driven computational approaches: A multisite big data study from the ENIGMA-PGC PTSD consortium

Background: Recent advances in data-driven computational approaches have been helpful in devising tools to objectively diagnose psychiatric disorders. However, current machine learning studies limited to small homogeneous samples, different methodologies, and different imaging collection protocols, limit the ability to directly compare and generalize their results. Here we aimed to classify individuals with PTSD versus controls and assess the generalizability using a large heterogeneous brain datasets from the ENIGMA-PGC PTSD Working group. Methods: We analyzed brain MRI data from 3,477 structural-MRI; 2,495 resting state-fMRI; and 1,952 diffusion-MRI. First, we identified the brain features that best distinguish individuals with PTSD from controls using traditional machine learning methods. Second, we assessed the utility of the denoising variational autoencoder (DVAE) and evaluated its classification performance. Third, we assessed the generalizability and reproducibility of both models using leave-one-site-out cross-validation procedure for each modality. Results: We found lower performance in classifying PTSD vs. controls with data from over 20 sites (60 % test AUC for s-MRI, 59 % for rs-fMRI and 56 % for D-MRI), as compared to other studies run on single-site data. The performance increased when classifying PTSD from HC without trauma history in each modality (75 % AUC). The classification performance remained intact when applying the DVAE framework, which reduced the number of features. Finally, we found that the DVAE framework achieved better generalization to unseen datasets compared with the traditional machine learning frameworks, albeit performance was slightly above chance. Conclusion: These results have the potential to provide a baseline classification performance for PTSD when using large scale neuroimaging datasets. Our findings show that the control group used can heavily affect classification performance. The DVAE framework provided better generalizability for the multi-site data. This may be more significant in clinical practice since the neuroimaging-based diagnostic DVAE classification models are much less site-specific, rendering them more generalizable

Differential Impact of Monsoon and Large Amplitude Internal Waves on Coral Reef Development in the Andaman Sea

The Andaman Sea and other macrotidal semi-enclosed tropical seas feature large amplitude internal waves (LAIW). Although LAIW induce strong fluctuations i.e. of temperature, pH, and nutrients, their influence on reef development is so far unknown. A better-known source of disturbance is the monsoon affecting corals due to turbulent mixing and sedimentation. Because in the Andaman Sea both, LAIW and monsoon, act from the same westerly direction their relative contribution to reef development is difficult to discern. Here, we explore the framework development in a number of offshore island locations subjected to differential LAIW- and SW-monsoon impact to address this open question. Cumulative negative temperature anomalies – a proxy for LAIW impact – explained a higher percentage of the variability in coral reef framework height, than sedimentation rates which resulted mainly from the monsoon. Temperature anomalies and sediment grain size provided the best correlation with framework height suggesting that so far neglected subsurface processes (LAIW) play a significant role in shaping coral reefs

Behavioral observations and measurements of aerial pheromone in a mating disruption trial against pea moth Cydia nigricana F (Lepidoptera, Tortricidae)

Synthetic sex pheromone of the pea moth Cydia nigricana, (E,E)-8,10-dodecadien-1-yl acetate (E8,E10-12:Ac), was applied in a 3-ha pea field at a rate of 17 g/ha, in two different dispenser formulations. Aerial concentrations within pea canopy, as determined by a field electroantennogram (EAG) apparatus, were 2 and 3 ng/m(3) in the two dispenser treatments. The validity of the EAG measurements was corroborated by sampling of field air, followed by gas chromatographic quantification of E8,E10-12:Ac. Males were attracted to fresh dispensers releasing E8,E10-12:Ac plus less than 2% of the antagonistic E, Z; Z, E; and Z, Z isomers. Two days after placement, the proportion of these isomers had increased to 6%. Males were then no longer attracted to the dispensers, but were observed to fly out of the treated field. Male attraction to calling females was almost entirely suppressed, and attraction to traps baited with synthetic pheromone was significantly reduced. Larval infestation in the pheromone-treated field was 2%, compared to 36% in a control field

Stocktake study of current fertilisation recommendations across Europe and discussion towards a more harmonised approach

26 Pág.The European Commission has set targets for a reduction in nutrient losses by at least 50% and a reduction in fertiliser use by at least 20% by 2030 while ensuring no deterioration in soil fertility. Within the mandate of the European Joint Programme EJP Soil ‘Towards climate-smart sustainable management of agricultural soils’, the objective of this study was to assess current fertilisation practices across Europe and discuss the potential for harmonisation of fertilisation methodologies as a strategy to reduce nutrient loss and overall fertiliser use. A stocktake study of current methods of delivering fertilisation advice took place across 23 European countries. The stocktake was in the form of a questionnaire, comprising 46 questions. Information was gathered on a large range of factors, including soil analysis methods, along with soil, crop and climatic factors taken into consideration within fertilisation calculations. The questionnaire was completed by experts, who are involved in compiling fertilisation recommendations within their country. Substantial differences exist in the content, format and delivery of fertilisation guidelines across Europe. The barriers, constraints and potential benefits of a harmonised approach to fertilisation across Europe are discussed. The general consensus from all participating countries was that harmonisation of fertilisation guidelines should be increased, but it was unclear in what format this could be achieved. Shared learning in the delivery and format of fertilisation guidelines and mechanisms to adhere to environmental legislation were viewed as being beneficial. However, it would be very difficult, if not impossible, to harmonise all soil test data and fertilisation methodologies at EU level due to diverse soil types and agro-ecosystem influences. Nevertheless, increased future collaboration, especially between neighbouring countries within the same environmental zone, was seen as potentially very beneficial. This study is unique in providing current detail on fertilisation practices across European countries in a side-by-side comparison. The gathered data can provide a baseline for the development of scientifically based EU policy targets for nutrient loss and soil fertility evaluation.This research was developed in the framework of the European Joint Program for SOIL ‘Towards climate-smart sustainable management of agricultural soils’ (EJP SOIL) funded by the European Union Horizon 2020 research and innovation programme (Grant Agreement NO. 862695).Peer reviewe

Obesity-associated improvements in metabolic profile through expansion of adipose tissue

Excess caloric intake can lead to insulin resistance. The underlying reasons are complex but likely related to ectopic lipid deposition in nonadipose tissue. We hypothesized that the inability to appropriately expand subcutaneous adipose tissue may be an underlying reason for insulin resistance and β cell failure. Mice lacking leptin while overexpressing adiponectin showed normalized glucose and insulin levels and dramatically improved glucose as well as positively affected serum triglyceride levels. Therefore, modestly increasing the levels of circulating full-length adiponectin completely rescued the diabetic phenotype in ob/ob mice. They displayed increased expression of PPARγ target genes and a reduction in macrophage infiltration in adipose tissue and systemic inflammation. As a result, the transgenic mice were morbidly obese, with significantly higher levels of adipose tissue than their ob/ob littermates, leading to an interesting dichotomy of increased fat mass associated with improvement in insulin sensitivity. Based on these data, we propose that adiponectin acts as a peripheral “starvation” signal promoting the storage of triglycerides preferentially in adipose tissue. As a consequence, reduced triglyceride levels in the liver and muscle convey improved systemic insulin sensitivity. These mice therefore represent what we believe is a novel model of morbid obesity associated with an improved metabolic profile