Estimation of blood volume and blood loss in primary total hip and knee replacement:An analysis of formulae for perioperative calculations and their ability to predict length of stay and blood transfusion requirements

INTRODUCTION: Blood loss continues to be a common surgical risk in total hip (THR) and knee replacements (TKR). Accurate prediction of blood loss permits appropriate counselling of risks to patients, target optimisation and forecasting future transfusion requirements. We compared blood volume formulae of Moore and Nadler, and blood loss formulae of Liu, Mercuriali, Bourke, Ward, Gross, Lisander and Meunier, to assess associations between calculated values with length of stay and transfusion requirements and determine which are useful in contemporary practice. METHODS: We retrospectively studied patients undergoing primary THR and TKR. We collected data on patient demographics, surgical interventions, pre- and postoperative haemoglobin and haematocrit values, length of stay and blood transfusion requirements. Spearman correlation tests and least squares multiple linear regression were performed. RESULTS: 149 THRs and 90 TKRs in 239 patients were analysed over four months. There was a very strong correlation between blood volume formulae. There were multiple very strong and strong associations between blood loss formulae. Bourke correlated significantly to length of stay, and Liu, Mercuriali, Lisander and Meunier correlated for incidence of transfusion. CONCLUSION: Accurate estimation of perioperative blood loss is increasingly important as demand for joint replacement surgery increases in an ageing population. If the primary interest is the association of blood loss and length of stay, Bourke's formula should be preferred. If the primary interest is calculating risk of transfusion, the formulae of Liu or Meunier should be preferred. The formulae of Mercuriali and Lisander are becoming redundant in contemporary practice

Multi-scale analysis of the water-energy-food nexus in the Gulf region

We quantify the heavily oil-dominated WEF nexus in three Gulf Cooperation Council (GCC) countries (Kuwait, Qatar and Saudi Arabia) across spatial scales and over time, using available empirical data at the national level, and explore the exposure to nexus stresses (groundwater depletion) in other countries through virtual water trade. At the domestic scale, WEF trade-offs are fairly limited; while all sectors require considerable amounts of energy, the requirements for water and food production are modest compared to other uses. At the international scale, revenues from oil exports in the GCC allow the region to compensate for low food production and scarce water availability. This dependency is dynamic over time, increasing when oil prices are low and food prices are high. We show how reducing domestic trade-offs can lead to higher exposure internationally, with rice imports originating in regions where groundwater is being depleted. However, Saudi Arabia's increased wheat imports, after reversing its food self-sufficiency policy, have had limited effects on groundwater depletion elsewhere. Climate change mitigation links the WEF nexus to the global scale. While there is great uncertainty about future international climate policy, our analysis illustrates how implementation of measures to account for the social costs of carbon would reduce the oil and gas revenues available to import food and desalinate water in the GCC

Multi-scale analysis of the water-energy-food nexus in the Gulf region

We quantify the heavily oil-dominated WEF nexus in three Gulf Cooperation Council (GCC) countries (Kuwait, Qatar and Saudi Arabia) across spatial scales and over time, using available empirical data at the national level, and explore the exposure to nexus stresses (groundwater depletion) in other countries through virtual water trade. At the domestic scale, WEF trade-offs are fairly limited; while all sectors require considerable amounts of energy, the requirements for water and food production are modest compared to other uses. At the international scale, revenues from oil exports in the GCC allow the region to compensate for low food production and scarce water availability. This dependency is dynamic over time, increasing when oil prices are low and food prices are high. We show how reducing domestic trade-offs can lead to higher exposure internationally, with rice imports originating in regions where groundwater is being depleted. However, Saudi Arabia’s increased wheat imports, after reversing its food self-sufficiency policy, have had limited effects on groundwater depletion elsewhere. Climate change mitigation links the WEF nexus to the global scale. While there is great uncertainty about future international climate policy, our analysis illustrates how implementation of measures to account for the social costs of carbon would reduce the oil and gas revenues available to import food and desalinate water in the GCC

Characterising the water-energy-food nexus in Kuwait and the Gulf region

Economic challenges as a result of the recent fluctuations in oil prices have exposed unprecedented risks to Kuwait and the other Gulf Cooperation Council (GCC) states, including securing long-term sustainable access to and use of water and food resources. The strong interlinkages between the availability of water, energy, and food resources have been termed the Water–Energy–Food (WEF) nexus. Here, we characterise the nexus for Kuwait across different spatial scales, reviewing available literature and focussing on empirical data from the most widely used global and regional databases on water, energy and food. While there are certainly issues of water scarcity, trade-offs between sectors at the domestic level are limited. At the international scale, high oil export revenues shield Kuwait from the immediate impacts of higher prices in food imports, but they expose Kuwait to water scarcity and food production risks in other countries. At the global scale, we consider climate change mitigation linkages with Kuwait’s WEF nexus. Whilst there is great uncertainty about future international climate policy and its implications for oil and gas revenues in Kuwait, our analysis illustrates how implementation of policy measures to account for the social costs of carbon could be significant

Impact of Bacillus Calmette-Guérin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 infection

There is little evidence around the potentially protective role of previous Bacillus Calmette-Guerin (BCG) vaccination on postoperative mortality in patients with perioperative SARS-CoV-2 vaccination. Prior BCG vaccination did not protect SARS-CoV-2 infected patients against postoperative pulmonary complications and 30-day mortality

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 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). 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

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

Preclinical comparison of novel rotator cuff repair scaffolds

Background: Rotator cuff tears affect up to 16% of the adult population, but inadequate treatment options are currently available. Our research group has developed a range of degradable scaffolds, manufactured from electrospinning and weaving, designed to assist the tendon repair both biologically and mechanically. The scaffolds have been successfully tested in vitro, however, to further assess the potential of these materials for clinical applications, an in vivo study is necessary. Aim: The overall aim of this study was to assess the safety and biocompatibility of the scaffolds in vivo. The objectives included optimisation of the weaving process and assessment of the systemic and local host reaction to scaffolds upon implantation. Methodology: The weaving process was first optimised to achieve satisfactory mechanical properties for the woven components. For the in vivo study, four different scaffolds were implanted into the shoulder of Lewis rats. The infraspinatus was transected and repaired using the scaffolds and at six timepoints up to 5 months, the shoulder joint was dissected for histological assessment. The foreign body response was assessed by hematoxylin and eosin (H&amp;E) staining and by evaluating the presence of foreign body giant cells (FBGCs). Results and Discussion: The optimisation of the weaving process resulted in the development of scaffolds with improved tensile strength. Upon implantation, most scaffolds did not indicate any severe adverse reaction. However histology revealed that the presence of large quantities of electrospun material elicits a strong foreign body reaction, with significantly more FBGCs in the group which had an electrospun scaffold compared to the positive control. Conclusion: Scaffolds containing no or moderate electrospun materials seemed to be well tolerated by the rats and appear safe for human use. However, implanting large volumes of electrospun material may elicit an unwanted foreign body reaction and more in vivo work is needed to understand its tissue integration.</p

Détermination et étude des propriétés optiques des couches minces de palladium

A brief description is given of the preparation of thin films, and of the methods used for their measurement (spectrophotometry, phase-changes, X-rays and electron-microscopy). Optical constants of palladium are given in the spectral region between 2 000 and 25 000 Å and these are discussed.Description succinte de la préparation des couches minces, ainsi que des méthodes de mesure utilisées (spectrophotométrie, déphasages, études aux rayons X et au microscope électronique). Constantes optiques du palladium dans la région spectrale comprise entre 2 000 et 25 000 Å, et quelques remarques à leur sujet