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

Lithium-ion capacitor safety assessment under electrical abuse tests based on ultrasound characterization and cell opening

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Phosphorylation and DNA Binding of HJURP Determine Its Centromeric Recruitment and Function in CenH3CENP-A Loading

Centromeres, epigenetically defined by the presence of the histone H3 variant CenH3, are essential for ensuring proper chromosome segregation. In mammals, centromeric CenH3CENP-A deposition requires its dedicated chaperone HJURP and occurs during telophase/early G1. We find that the cell-cycle-dependent recruitment of HJURP to centromeres depends on its timely phosphorylation controlled via cyclin-dependent kinases. A nonphosphorylatable HJURP mutant localizes prematurely to centromeres in S and G2 phase. This unregulated targeting causes a premature loading of CenH3CENP-A at centromeres, and cell-cycle delays ensue. Once recruited to centromeres, HJURP functions to promote CenH3CENP-A deposition by a mechanism involving a unique DNA-binding domain. With our findings, we propose a model wherein (1) the phosphorylation state of HJURP controls its centromeric recruitment in a cell-cycle-dependent manner, and (2) HJURP binding to DNA is a mechanistic determinant in CenH3CENP-A loading

Sciurus aureogaster (Rodentia: Sciuridae)

Sciurus aureogaster (Cuvier, 1829) is a sciurid commonly called the red-bellied squirrel. S. aureogaster is a medium-bodied tree squirrel quite variable in color throughout the range; partial and complete melanism are common. One of 28 species in the genus, the red-bellied squirrel is endemic to Mexico and Guatemala, and introduced to the Florida Keys, USA. Two subspecies are recognized, the nominate form S. a. aureogaster, which occurs in eastern Mexico, and S. a. nigrescens, which occurs in central and western Mexico and southwestern Guatemala. Red-bellied squirrels inhabit a wide variety of ecosystems and plant communities, are diurnal, arboreal, and use leaf nests and tree cavities for nesting. S. aureogaster feeds primarily on acorns (Quercus) and pine (Pinus) seeds throughout most of the range, but individuals are known to damage corn and other plantation crops including cacao. Litter size ranges between 1 and 4 young. The red-bellied squirrel is listed as of “Least Concern” by the International Union for Conservation of Nature and Natural Resources

Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published the complete 2023 GOLD report, which can be freely downloaded from its web page (www.goldcopd.org) together with a“pocket guide” and a “teaching slide set”. It contains important changes compared to earlier versions, and incorporates 387 new references. Here, we present an executive summary of this GOLD 2023 report that (1) summarizes aspects that are relevant from a clinician’s perspective and (2) updates evidence published since the prior executive summary in 2017

Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published the complete 2023 GOLD report, which can be freely downloaded from its web page (www.goldcopd.org) together with a“pocket guide” and a “teaching slide set”. It contains important changes compared to earlier versions, and incorporates 387 new references. Here, we present an executive summary of this GOLD 2023 report that (1) summarizes aspects that are relevant from a clinician’s perspective and (2) updates evidence published since the prior executive summary in 2017

Air pollution and COPD: GOLD 2023 committee report

Exposure to air pollution is a major contributor to the pathogenesis of COPD worldwide. Indeed, most recent estimates suggest that 50% of the total attributable risk of COPD may be related to air pollution. In response, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Scientific Committee performed a comprehensive review on this topic, qualitatively synthesised the evidence to date and proffered recommendations to mitigate the risk. The review found that both gaseous and particulate components of air pollution are likely contributors to COPD. There are no absolutely safe levels of ambient air pollution and the relationship between air pollution levels and respiratory events is supra-linear. Wildfires and extreme weather events such as heat waves, which are becoming more common owing to climate change, are major threats to COPD patients and acutely increase their risk of morbidity and mortality. Exposure to air pollution also impairs lung growth in children and as such may lead to developmental COPD. GOLD recommends strong public health policies around the world to reduce ambient air pollution and for implementation of public warning systems and advisories, including where possible the use of personalised apps, to alert patients when ambient air pollution levels exceed acceptable minimal thresholds. When household particulate content exceeds acceptable thresholds, patients should consider using air cleaners and filters where feasible. Air pollution is a major health threat to patients living with COPD and actions are urgently required to reduce the morbidity and mortality related to poor air quality around the world

Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published the complete 2023 GOLD report, which can be freely downloaded from its web page (www.goldcopd.org) together with a“pocket guide” and a “teaching slide set”. It contains important changes compared to earlier versions, and incorporates 387 new references. Here, we present an executive summary of this GOLD 2023 report that (1) summarizes aspects that are relevant from a clinician’s perspective and (2) updates evidence published since the prior executive summary in 2017

Evolution of wound management throughout history

<p><strong>Background</strong></p><p>Wound management practices have evolved significantly over the course of human history. From the early remedies of the Neanderthals in 60,000 B.C. to the sophisticated techniques of contemporary medicine, the treatment of wounds has undergone various phases of evolution. This paper delves into the intricate history of wound management, spanning from ancient civilizations to the modern era.</p><p>Beginning with the significance of wound classification, the study traces the development of wound management practices in different historical periods. It highlights the role of various civilizations, such as the Sumerians and the ancient Egyptians, in the early advancements of wound care. The document extensively covers the contributions of key figures like Hippocrates and Galen, who made significant strides in the understanding and treatment of wounds.</p><p>The paper also emphasizes the critical transition from traditional and empirical wound care to a more scientific approach, as demonstrated by the works of Joseph Lister and Louis Pasteur. It discusses pivotal moments in the timeline, such as the advent of antiseptics and the recognition of the role of microorganisms in wound infections. Furthermore, it underlines the contemporary efforts to integrate advanced technologies, such as artificial intelligence, into wound management for early identification of non-healing wounds.</p><p>Overall, the paper reflects on the profound historical context of wound care and the persistent advancements that continue to shape contemporary medical practices, emphasizing the importance of understanding the historical trajectory for the effective treatment of wounds in modern medicine.</p><p> </p><p><strong>Keywords: </strong>Wounds, history of wound management, wound dressings.</p&gt