Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Global urban environmental change drives adaptation in white clover.

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Electroencephalogram with vagal stimulation value in disautonomic disorders.

Se realiza un estudio descriptivo de los Electroencefalogramas con maniobra vagal (EEGmv) en el Laboratorio de Neurofisiología Clínica del CIREN , se analizaron todos los EEGmv realizados en el período 1999-2003. De un total de 37 estudios realizados, 24 fueron del sexo femenino, 13 del sexo masculino, (21 niños, y adultos 16). Los estudios se realizaron en un Equipo MEDICID 4 Neuronic SA de producción cubana con software para recogida de EEG y EKG Track Walker. Del análisis realizado se obtuvo que no se presentó ninguna complicación que requiriera la intervención de anestesiología, además 18 maniobras fueron positivas para un 49% las cuales demostraron disfunción vaso-vagal, y 19 maniobras fueron negativas para un 51%. De estos la maniobra vagal fue positiva en 6 pacientes adultos para un 37% y negativa en 10 pacientes para un 62%. Por el contrario, en los niños estudiados, edad promedio (10-16 años) 9 presentaron la maniobra negativa para un 43% y 12 positiva para un 57% con la aparición de bradicardia y/o asistolia lo que sugiere que en esta edad propia del desarrollo es donde las disfunciones vaso-vagales tienden a aparecer con mayor frecuencia en nuestra casuística. Estos resultados evidencian la importancia de que se realice adecuadamente la indicación de este tipo de estudio para el correcto diagnóstico de la disfunción vaso-vagal que tiende a confundirse con otros cuadros clínicos.SUMMARY A descriptive study of the Electroencephalogram with vagal stimulation (EEGmv) was carried out in the Clinical Neurophysiology Department of the CIREN, during the period 1999-2003. A total of 37 recordings were carried out, 24 were female and 13 male (21 children and 16 adults). The approach was done in a MEDICID 4 equipment Neuronic SA produced in Cuba with software for polygraphy recording Track Walker. The use of anaesthetic assistant was not required. 18 studies were positive (49%) and were compatible with vagal syncope diagnosis, while 19 of them were negative (51%). This approach was positive in 6 adults patient (37%) and negative in 10 patients (62%). On the other hand, in paediatric people age range (10-16 years), 9 had negative (43%) and 12 positive results (57%) with the appearance of bradicardy and/or asistoly. These results support the assumption that at this age there is a high frequency of vaso-vagals dysfunctions. We recommend doing right indication of this kind of stimulation in order to obtain the actual diagnostic of vaso-vagal syncope that is usually confused with other disorders

Effects of Bcl-xL (wt) and Bcl-xL variants on <i>C</i>. <i>elegans</i> progeny fecundity.

<p>Number of <b>A)</b> total viable progeny, and <b>B)</b> percentages of eggs hatched in various transgenic strains and control worms. Each point show in the graphs represents data obtained from a single worm. Bars are means ± s.d. Arrows on top indicate statistical significance with <i>p<0</i>.<i>05</i> when compared to N2 control.</p

New national and regional bryophyte records, 45

Fil: Suarez, Guillermo Martin. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Flores, Jorge Rafael. Universidad Nacional de Tucumán. Facultad de Ciencias Naturales e Instituto Miguel Lillo; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ellis, L. T.. Natural History Museum; Reino UnidoFil: Ah Peng, C.. Université de La Réunion; FranciaFil: Aranda, S. C.. Museo Nacional de Ciencias Naturales; EspañaFil: Bednarek Ochyra, H.. Polish Academy of Sciences; PoloniaFil: Borovichev, E. A.. Russian Academy of Sciences; Rusia. Problems of the North 6 of the Kola Science Center of RAS; RusiaFil: Cykowska Marzencka, B.. Polish Academy of Sciences; PoloniaFil: Duarte, M. C.. Instituto de Investigação Científica Tropical; PortugalFil: Enroth, J.. University of Helsinki; Finlandia. Finnish Museum of Natural History; FinlandiaFil: Erzberger, P.. No especifica;Fil: Fedosov, V.. Lomonosov Moscow State University; RusiaFil: Fojcik, B.. University of Silesia; PoloniaFil: Gabriel, R.. Universidade dos Açores; PortugalFil: Coelho, M. C. M.. Universidade dos Açores; PortugalFil: Henriques, D. S. G.. Universidade dos Açores; PortugalFil: Ilina, O. V.. Interregional Nature Conservancy; RusiaFil: Gil Novoa, J. E.. Museum National D; FranciaFil: Morales Puentes, M. E.. Universidad Pedagogica y Tecnologica de Colombia; ColombiaFil: Gradstein, S. R.. Museum National D; FranciaFil: Gupta, R.. CSIR-National Botanical Research Institute; IndiaFil: Nath, V.. CSIR-National Botanical Research Institute; IndiaFil: Asthana, A. K.. CSIR-National Botanical Research Institute; IndiaFil: Koczur, A.. Polish Academy of Sciences; PoloniaFil: Lebouvier, M.. Universite de Rennes I; FranciaFil: Mesterházy, A.. No especifica;Fil: Mogro, F.. No especifica;Fil: Mezaka, A.. Rezekne Higher Education Institution; LetoniaFil: Németh, Cs.. Corvinus University Budapest; HungríaFil: Orgaz, J. D.. Hiroshima University; Japó