Species of honeydew producing insects useful to apiculture in Greece

Μέχρι σήμερα έχουν αναφερθεί στην Ελλάδα 38 είδη μελιτογόνων εντόμων. Τα τελευταία χρόνια, άλλα δέκα είδη εντόμων των οποίων τις μελιτώδεις εκκρίσεις βόσκουν και εκμεταλλεύονται οι μέλισσες βρέθηκαν στη χώρα μας. Τα είδη αυτά, που ανήκουν στα Hemiptera-Homoptera είναι τα: οι αφίδες Acyrthosiphon caraganae (Cholodkovsky) σε ποντίκια (Coluteci arborescens L.), Corylobiuiii avellanae (Schrank) σε φουντουκιά (Corylus avellana L.), Hyalopterus amygdalì(Blanchard) σε αμυγδαλιά (Prunus diilcis (Miller) D. A. Webb), Cinara juniperi (De Geer) σε κέδρο (Juniperus spp.), Cinara tujufiliiui (del Guercio) σε τούγια (Thuja spp.), Phillaphis fagi (L.) σε οξυά (Fagus silvatica L.), Pterocallis maculata (Von Heyden) σε κλήθρα (Alnus glutinosa Gärth.) και Tuberculoides eggleri Börnes (Quercus spp.). Από αυτές οι τρεις πρώτες ανήκουν στην οικογένεια Aphididae, δύο στην οικογένεια Lachnidae και οι τρεις τελευταίες στην οικογένεια Drepanosiphidae. Τα κοκκοειδή Aclerda berlesei Buffa της οικογένειας Aclerdidae σε καλάμι (Arundo donax L.), και Physokermes piceae Schrank της οικογένειας Coccidae σε έλατο (Abies cephalonica Loud.).Από τα δέκα αυτά μελιτογόνα έντομα δύο, τα C. tujujìlina και Ph. piceae, αναφέρονται για πρώτη φορά στην πανίδα της χώρας, η δε αφίδα Cinara juniperi και το κοκκοειδές Aclerda berlesei παρουσιάζουν το μεγαλύτερο μελισσοκομικό ενδιαφέρον.In many countries of Europe as well as in Greece a high percentage (40-70%) of the honey production derives from honeydew producing insects which belong to Hemiptem-Homoptera and mainly to the superfamilies Aphidoidea, Coccoidea, Psyloidea and Aleuroidea. To identify these useful to apiculture insects in Greece, a survey work has been carried out since 1977. From this research thirty eight species were observed and listed in the period of 1977-1983. Fifty eight species producing honeydew exploited by bees have been also observed in Central Europe. At least 120 species of honeydew pro­ducing insects (Rhynchota), on various host plants, have been recorded in Greece, therefore the number of insects useful to apiculture might be higher. This work aimed at finding more sources of honey production in our country and for this reason a survey was carried out in many areas to collect and identify the honeydew producing insects on which bees were observed to forage. The work was based on the method used previously. For that, sampling was carried out everywhere bees were observed to forage on insects honeydew. Bees were captured and examined according to the method described by Gary and Lorenzen to find out if and when the bees forage on this honeydew. The data collected during this period, 1984 to 1989, are recorded in this note. List of Species: I) Aphidoidea: A) Aphididae: 1) Acyrthosiphon caraganae (Cholodkovsky) (Aphidinae). It was found on the shrub Colutea arborescens L. at Portaria, Pelion, in May 1986. The bees forage from late April to June. This host plant exists almost all over Greece, but in high numbers in Peloponnesus, Sterea Hellas and Thessaly. A. caraganae was found in all these areas, while the bees were observed to forage on this aphid. 2) Corylobium avellanae (Schrank) (Aphidinae). It was observed on filbert trees (Corylus avellana L.) in the Grevena area in 1984 and later in Aghia, Larissa co. and Katerini, Pieria co. It is found on the under side of the leaf and pro­duces honeydew from May to mid July. 3) Hyalopterus ainvgdafi (Blanchard) (Aphidinae). This aphid appears at high population levels on almond trees (Prunus dulcis (Miller) D.A. Webb.) in Locrida and Attiki (Central Greece) and on the island of Kea. It produces large quantities of honeydew in May, June, July. B) Lachnidae: 1) Cinara juniperi (De Geer) (Cinarinae). It was observed on Juniperus spp. in Giona mountain, in May 1986, at an altitude where the fir trees grow. The bees forage from May to early June. This honeydew is produced earlier than that excreted by the coccid Physokerines hemicryphus Dalman which lives on fir trees, and is very useful to apiculture in Greece. There are indications that the existence of this aphid close to fir forests, is a prediction that the coccid P. hemicryphus is going to attain high populations at the same year, but this has to be verified. 2) Cinara tujufilina (del Guercio) (Cinarmae). This aphid was observed on ornamental Thuja spp. in Votanikos Athens and Kiphissia, Attiki in April 1984. The bees forage late in April to May. This insect is new to the Greek fauna. C) Drepanosiphidae: 1) Phyllaphis phagi (L.) (Phyllaphidinae). Common aphid on Fagus silvatica L. It was found almost everywhere this host exists as in the mountains of Iti, Tymphristos, Pelion, Vermion and others. This insect produces honeydew in May, June and July. 2) Pterocallis maculata (Von Heyden) (Drepanosiphinae). It was found at low population levels on Alnus q1tifinosa Garth. in the mountains Pelion and Olympus in Central Greece in May 1987. This aphid produces honeydew in May, June and July. 3) Tuberculoides eggleri Burnes (Drepanosiphinae). This aphid was found on various species of Quercus spp. on the mountains, Zeria, Kalidromon, Iti, Pelion and Olympus, at relatively small population levels. The hon­eydew appears in May. II) Coccoidea: A) Aclerdidae: 1) Aclerda berlesei Buffa. This scale insect was found in Korinthia in July 1988 on Arundo donor L.. later it was observed everywhere this host-plant was sampled as in Lamia, Tricalla, Larissa, Platamonas (Central Greece). The population of this insect is always in high levels and it produces large quantities of honeydew. The honeydew appears early in June and continues in July, August and early September. The bees forage on it, mainly in August. The honey from this honeydew has good appearance, good taste but has not so good smell. B) Coccidae 1) Physokertnes piceae Schrank. This scale was recently found at low population levels on fir trees in Parnassus and Giona mountains in Central Greece and this is the first record in Greek fauna. All, but Aclerda berlesei, abovementioned species are recorded also in Central Europe as honeydew producing insects. It seems that amongst these ten honeydew producing insects, the most important for the apiculture of Greece are the aphid C. juniperi and the scale A. berlesei

Cyclophilins in Ischemic Heart Disease: Differences Between Acute and Chronic Coronary Artery Disease Patients

Background: Cyclophilins (Cyps) are a family of peptidyl-prolyl cis/trans isomerases consistently involved in cardiovascular diseases through the inflammation pathway. This study aims to investigate the serum levels of Cyps (CypA, CypB, CypC and CypD) in patients with coronary artery disease (CAD) and the correlation with clinical characteristics and inflammation parameters. Methods: We developed an observational prospective study with a total of 125 subjects: 40 patients with acute CAD, 40 patients with chronic CAD and 45 control volunteers, in whom serum levels of Cyps (CypA, CypB, CypC and CypD), interleukins and metalloproteinases were measured. Results: CypA levels increased significantly in CAD patients compared with control subjects, but no differences were noted between acute CAD (7.80 +/- 1.30 ng/mL) and chronic CAD (5.52 +/- 0.76 ng/mL) patients (P = 0.13). No differences in CypB and CypD levels were showed between CAD patients and controls and between acute CAD and chronic CAD patients. In relation with CypC, the levels in CAD patients were significantly higher compared to controls (32.42 +/- 3.71 pg/mL vs. 9.38 +/- 1.51 pg/mL, P 17.5 pg/mL cut-off point, and it was significantly associated with older age, hypertension, dyslipidemia and more extensive CAD in acute and chronic CAD groups. Conclusions: CypA and CypC levels are increased in CAD patients. High CypC serum levels could be a novel biomarker in CAD patients correlating with a more severe disease

RNA-sequencing analysis of a multistep and hit-and-run cell and animal model of KSHV tumorigenesis reveal the roles of mutations, CpG methylation, and viral-infection footprints in oncogenesis

Human viral oncogenesis is the consequence of cell transformation mediated by virally encoded oncogenes in combination with host oncogenic alterations. Kaposi’s sarcoma (KS), caused by the Kaposi’s sarcoma-associated herpes virus (KSHV), is an AIDS-associated cancer characterized by angiogenesis and spindle-cells proliferation. KSHV-infected KS lesions are composed of latently-infected cells, as well as cells expressing lytic genes that have been implicated in the development of the KS angioproliferative phenotype. The existence of KS lesions with varying levels of KSHV-infected cells suggests also the existence of virus-independent “hit-and-run” mechanisms of sarcomagenesis, whereby viral infection irreversibly induce genetic or epigenetic oncogenic alterations in host cells. We have integrated genetic mutations, changes in expression signatures and methylation analysis to dissect genetic and epigenetic signaling pathways in an unbiased manner in the mECK36 mouse model of KSHV tumorigenesis. Pathway analysis of differential expressed genes (DEGs) showed KSHV lytic switch, DNA methylation and Epigenetic as the most regulated pathways during KSHV-dependent in vivo tumorigenesis. Methylation analysis data indicates that during the development of KSHV-infected tumors the most changes were towards hypo-methylation of tissues specific genes and oncogenic signature pathways, on the other hand during viral loss and development of KSHV-negative tumors changes are towards hyper-methylation. Mutational analysis of KSHV-infected cells and tumors revealed a set of mutations, including mutations in three inflammasome-related IFN response genes, that were absent in KSHV-infected cells but present in all KSHV-infected tumors in the same loci pointing to clonal selection “in vivo”. This result suggests that in the context of in vivo tumorigenesis both these mutations and the virus may determine tumor growth. On the other hand, clustering analysis of mutations driving KSHV-negative tumors reveal a network comprising PDGFRA D842V, Pak1 and Nucleolin mutations implicated in cell proliferation. Our results have uncovered novel specific aspects of the interplay between host oncogenic alterations and virus-induced transcriptional effects as well as the epigenetic changes induced by KSHV infection and tumorigenesis. The existence virally-induced irreversible genetic and epigenetic oncogenic alterations support the possibility for hit-and-run KSHV sarcomagenesis which is consistent with pathological and clinical findings. AUTHOR SUMMARY We performed whole genome RNA sequencing and CpG DNA methylation analysis in a mouse bone-marrow endothelial-lineage cells (mEC) transfected with the KSHVBac36 (mECK36 cells), that are able to form KSHV-infected tumors in nude mice, which were thoroughly characterized as KS-like tumors. This unique model allowed us to dissect genetic and epigenetic mechanisms of KSHV dependent and hit-and-run sarcomagenesis. We found that during KSHV in vivo lytic switch and KSHV-dependent tumorigenesis DNA methylation and Epigenetic regulation are among the most host-regulated pathways. CpG DNA methylation analysis during transformation supports the notion that loss of methylation (hypo-methylation) is the major epigenetic change during this process. Sequence analysis of KSHV-positive tumors revealed that KSHV tumorigenesis not only selects for the presence of the virus but also pre-existing host mutations that allow the KSHV oncovirus to express the oncogenic lytic program and creates a permissive environment of inflammation and viral tumorigenesis providing a selective advantage in vivo.Centro de Investigaciones Inmunológicas Básicas y Aplicada

Palynological and chemical volatile components of tipically autumnal honeys of the western Mediterranean

[EN] Twenty-five samples of autumnal honeys from the western Mediterranean (Mallorca and Eivissa, Balearic Islands) were examined for pollen content (qualitative and quantitative melissopalynological analysis), moisture, electrical conductivity, colour, sensorial qualities and volatile components. Quantitative analysis showed that the honey contained Maurizio's Class II: 64%, Class III: 28%, Class IV: 4% and Class V: 4%. Fifty-four pollen types, with an average number of 16.68 per sample, were identified, belonging to 29 botanical families. Only two taxa (Ceratonia siliqua and Erica multiflora) were found in all samples. Seventeen samples were unifloral (68%) - ten (40%) of C. siliqua, six (24%) of E. multiflora and one (4%) of Hedera helix. All honeys have a low honeydew index (<?0.09%), while the values for electrical conductivity and water content were high. The major honey volatile components are: cis- and trans-linalool oxides (64.2%) and hotrienol (10.4%) for the carob (C. siliqua) and trans-linalool oxide (13.4%), p-menthane-1,8-diol (11.1%), safranal (9.7%), limonene (5,4%), -pinene (3.7%) and oxoisophorone (3.4%) for the winter heather (E. multiflora).The authors would like to extend their gratitude to the Mallorca Rural 'Leader plus' programme and the beekeepers of Mallorca and Eivissa for their support and friendly collaboration. The authors also thank an anonymous reviewer for useful comments and suggestions on an earlier version of the manuscript.Boi, M.; Llorens Molina, JA.; Cortés, L.; Lladó, G.; Llorens, L. (2013). Palynological and chemical volatile components of tipically autumnal honeys of the western Mediterranean. Grana. 52(2):93-105. doi:10.1080/00173134.2012.744774S93105522Andrade, P. B., Amaral, M. T., Isabel, P., Carvalho, J. C. M. F., Seabra, R. M., & Proença da Cunha, A. (1999). 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Journal of Chromatography A, 1216(9), 1458-1462. doi:10.1016/j.chroma.2008.12.066Castro-Vázquez, L., Díaz-Maroto, M. C., González-Viñas, M. A., & Pérez-Coello, M. S. (2009). Differentiation of monofloral citrus, rosemary, eucalyptus, lavender, thyme and heather honeys based on volatile composition and sensory descriptive analysis. Food Chemistry, 112(4), 1022-1030. doi:10.1016/j.foodchem.2008.06.036Conti, M. E., Stripeikis, J., Campanella, L., Cucina, D., & Tudino, M. B. (2007). Characterization of Italian honeys (Marche Region) on the basis of their mineral content and some typical quality parameters. Chemistry Central Journal, 1(1). doi:10.1186/1752-153x-1-14Custódio, L., Serra, H., Nogueira, J. M. F., Gonçalves, S., & Romano, A. (2006). Analysis of the Volatiles Emitted by Whole Flowers and Isolated Flower Organs of the Carob Tree Using HS-SPME-GC/MS. Journal of Chemical Ecology, 32(5), 929-942. doi:10.1007/s10886-006-9044-9Cuevas-Glory, L., Ortiz-Vázquez, E., Pino, J. A., & Sauri-Duch, E. (2012). Floral classification of Yucatan Peninsula honeys by PCA & HS-SPME/GC-MS of volatile compounds. International Journal of Food Science & Technology, 47(7), 1378-1383. doi:10.1111/j.1365-2621.2012.02983.xDe Bolòs, O., & Molinier, R. (1984). Vegetation of the Pityusic Islands. Biogeography and Ecology of the Pityusic Islands, 185-221. doi:10.1007/978-94-009-6539-3_9De Maria, C. A. B., & Moreira, R. F. A. (2003). Compostos voláteis em méis florais. Química Nova, 26(1), 90-96. doi:10.1590/s0100-40422003000100016Guyot, C., Scheirman, V., & Collin, S. (1999). Floral origin markers of heather honeys: Calluna vulgaris and Erica arborea. Food Chemistry, 64(1), 3-11. doi:10.1016/s0308-8146(98)00122-8Herrera, J. (1988). Pollination Relationships in Southern Spanish Mediterranean Shrublands. The Journal of Ecology, 76(1), 274. doi:10.2307/2260469Jerković, I., & Marijanović, Z. (2010). 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Bee World, 59(4), 139-157. doi:10.1080/0005772x.1978.11097714Martins, R. C., Lopes, V. V., Valentão, P., Carvalho, J. C. M. F., Isabel, P., Amaral, M. T., … Silva, B. M. (2008). Relevant principal component analysis applied to the characterisation of Portuguese heather honey. Natural Product Research, 22(17), 1560-1582. doi:10.1080/14786410701825004Melliou, E., & Chinou, I. (2011). Chemical constituents of selected unifloral Greek bee-honeys with antimicrobial activity. Food Chemistry, 129(2), 284-290. doi:10.1016/j.foodchem.2011.04.047Pendleton, M. (2006). Descriptions of melissopalynological methods involving centrifugation should include data for calculating Relative Centrifugal Force (RCF) or should express data in units of RCF or gravities (g). Grana, 45(1), 71-72. doi:10.1080/00173130500520479Pérez, R. A., Sánchez-Brunete, C., Calvo, R. M., & Tadeo, J. L. (2002). Analysis of Volatiles from Spanish Honeys by Solid-Phase Microextraction and Gas Chromatography−Mass Spectrometry. 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A study of variation in the pollen spectra of honeys sampled from the Baixa Limia‐Serra do Xurés Nature Reserve in north‐west Spain. Grana, 45(2), 137-145. doi:10.1080/00173130600708537Seijo, M. C., Jato, M. V., Aira, M. J., & Iglesias, I. (1997). Unifloral honeys of Galicia (north-west Spain). Journal of Apicultural Research, 36(3-4), 133-140. doi:10.1080/00218839.1997.11100939Terrab, A., Diez, M. J., & Heredia, F. J. (2003). Palynological, physico-chemical and colour characterization of Moroccan honeys: III. Other unifloral honey types. International Journal of Food Science and Technology, 38(4), 395-402. doi:10.1046/j.1365-2621.2003.00713.xTERRAB, A., PONTES, A., HEREDIA, F. J., & DÍEZ, M. J. (2004). A preliminary palynological characterization of Spanish thyme honeys. Botanical Journal of the Linnean Society, 146(3), 323-330. doi:10.1111/j.1095-8339.2004.00335.xTerrab, A., Valdés, B., & Josefa Díez, M. (2003). Pollen analysis of honeys from the Mamora forest region (NW Morocco). 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CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Background: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. Methods: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. Results: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). Conclusion: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction

Programa Gallego de Atenci?n al Infarto Agudo de Miocardio. Protocolo de actuaci?n para pacientes con s?ndrome coronario agudo con elevaci?n del segmento ST en Galicia

A enfermidade coronaria sup?n un importante problema de sa?de p?blica debido ? s?a incidencia crecente e a que constit?e a principal causa de morte no mundo. no ?mbito da Comunidade Aut?noma de Galicia, p?xose en marcha en maio de 2005 o Programa Galego de Atenci?n ao Infarto Agudo de Miocardio (PROGALIAM). Este programa foi un dos primeiros en implantarse en Espa?a (s? por detr?s dos de Murcia e Navarra). Debido ao tempo transcorrido, viuse necesario adaptar o Progaliam do ano 2005 ?s novas e actuais evidencias, e ?s actuais recomendaci?ns das Gu?as de Pr?ctica Cl?nica. ? por iso, que na Direcci?n Xeral de Asistencia Sanitaria, constitu?use un grupo de traballo formado por cardi?logos intervencionistas das 7 ?reas sanitarias, as? como profesionais m?dicos de Atenci?n Primaria e Urxencias.La enfermedad coronaria supone un importante problema de salud p?blica debido a su incidente creciente y la que constituye la principal causa de muerte en el mundo. en el ?mbito de la Comunidad Aut?noma de Galicia, se puso en marcha en mayo de 2005 el Programa Gallego de Atenci?n al Infarto Agudo de Miocardio (PROGALIAM). Este programa fue uno de los primeros en implantarse en Espa?a (solo por detr?s de los de Murcia y Navarra). Debido al tiempo transcurrido, se vio necesario adaptar el Progaliam del a?o 2005 a las noticias y actuales evidencias, y a las actuales recomendaciones de las Gu?as de Pr?ctica Cl?nica. Es por eso, que en la Direcci?n General de Asistencia Sanitaria, se constituy? un grupo de trabajo formado por cardi?logos intervencionistas de las 7 ?reas sanitarias, as? como profesionales m?dicos de Atenci?n Primaria y Urgencias

An overview of anti-diabetic plants used in Gabon: Pharmacology and Toxicology

© 2017 Elsevier B.V. All rights reserved.Ethnopharmacological relevance: The management of diabetes mellitus management in African communities, especially in Gabon, is not well established as more than 60% of population rely on traditional treatments as primary healthcare. The aim of this review was to collect and present the scientific evidence for the use of medicinal plants that are in currect by Gabonese traditional healers to manage diabetes or hyperglycaemia based here on the pharmacological and toxicological profiles of plants with anti-diabetic activity. There are presented in order to promote their therapeutic value, ensure a safer use by population and provide some bases for further study on high potential plants reviewed. Materials and methods: Ethnobotanical studies were sourced using databases such as Online Wiley library, Pubmed, Google Scholar, PROTA, books and unpublished data including Ph.D. and Master thesis, African and Asian journals. Keywords including ‘Diabetes’ ‘Gabon’ ‘Toxicity’ ‘Constituents’ ‘hyperglycaemia’ were used. Results: A total of 69 plants currently used in Gabon with potential anti-diabetic activity have been identified in the literature, all of which have been used in in vivo or in vitro studies. Most of the plants have been studied in human or animal models for their ability to reduce blood glucose, stimulate insulin secretion or inhibit carbohydrates enzymes. Active substances have been identified in 12 out of 69 plants outlined in this review, these include Allium cepa and Tabernanthe iboga. Only eight plants have their active substances tested for anti-diabetic activity and are suitables for further investigation. Toxicological data is scarce and is dose-related to the functional parameters of major organs such as kidney and liver. Conclusion: An in-depth understanding on the pharmacology and toxicology of Gabonese anti-diabetic plants is lacking yet there is a great scope for new treatments. With further research, the use of Gabonese anti-diabetic plants is important to ensure the safety of the diabetic patients in Gabon.Peer reviewedFinal Accepted Versio

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