The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Cement mantle fatigue failure in total hip replacement: experimental and computational testing

One possible loosening mechanism of the femoral component in total hip replacement is fatigue cracking of the cement mantle. A computational method capable of simulating this process may therefore be a useful tool in the preclinical evaluation of prospective implants. In this study, we investigated the ability of a computational method to predict fatigue cracking in experimental models of the implanted femur construct. Experimental specimens were fabricated such that cement mantle visualisation was possible throughout the test. Two different implant surface finishes were considered: grit blasted and polished. Loading was applied to represent level gait for two million cycles. Computational (finite element) models were generated to the same geometry as the experimental specimens, with residual stress and porosity simulated in the cement mantle. Cement fatigue and creep were modelled over a simulated two million cycles. For the polished stem surface finish, the predicted fracture locations in the finite element models closely matched those on the experimental specimens, and the recorded stem displacements were also comparable. For the grit blasted stem surface finish, no cement mantle fractures were predicted by the computational method, which was again in agreement with the experimental results. It was concluded that the computational method was capable of predicting cement mantle fracture and subsequent stem displacement for the structure considered

A tribute to Sally E. Smith

International audienceProf. Sarah (Sally) E. Smith, a long‐standing New Phytologist Advisory Board member, and friend to the journal, died in September 2019. Sally will be remembered not only for her outstanding body of work, but for her friendship, mentorship and leadership of the mycorrhizal research community. By way of tribute we invited colleagues of Sally to share their recollections, and we publish this Virtual Issue in her memory.Sally was born in 1941, and received Bachelor and PhD degrees from Cambridge University, UK, before relocating to Adelaide, Australia in the late 1960s, alongside her husband Andrew (FA) Smith. Upon arrival in Adelaide, Sally undertook a number of positions at the University of Adelaide’s Botany Department, followed by research work at the Waite Research Institute. In 1991 she was appointed Senior Lecturer in the Department of Soil Science, and she received a Doctorate of Science from the University of Adelaide that same year. Sally was appointed Professor in 1995.Sally was elected a Fellow of the Australian Academy of Science in 2001, and, among numerous awards, she received an Australian Centenary Medal for contribution to Australian society and services to biology (2003), the Taylor (2006) and Prescott (2012) medals of the Australian Society of Soil Science, and the International Mycorrhiza Society’s Eminent Mycorrhiza Researcher Award (2019). Sally was also Honorary Professor at the Research Centre for Eco‐Environmental Sciences (Chinese Academy of Sciences), and an Honorary Research Professor at the Chinese Agricultural University, Beijing.Sally officially retired in 2006, but remained very active, holding an Adjunct and later Emeritus Chair at the University of Adelaide, contributing to many international meetings, including the 2014, 33rd New Phytologist Symposium ‘Networks of Power and Influence: Ecology and Evolution of Symbioses between Plants and Mycorrhizal Fungi’ (Bender et al., 2014), and continuing to act as an Advisory Board Member at New Phytologist, providing much‐valued critical insight and advice to our Editors. Her reviews, even when she disagreed, were always supportive and positive; she often provided much detailed advice and her large view of the literature to the authors.In January 2019, New Phytologist published a Profile of Sally (Smith, 2019), which outlines her achievements in more detail, but importantly, it also highlights her many personal qualities. In the profile, Sally outlined the successes and challenges she faced throughout her career, but she also dwells on the many friendships and relationships she developed; her warmth, and generosity, is evident throughout the piece, and also in the personal recollections outlined below (Fig. 1). In a way, Sally is still here with us. We are still prepared to hear her unforgettable voice at conferences; we still use the precious and irreplaceable textbook ‘Mycorrhizal symbiosis’ she wrote with David Read, which will forever remind us of the first steps of our research community and the broad view she had of the symbiosis (Smith & Read, 2008). Sally will be greatly missed, as a scientist, friend, colleague and mentor