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

Local delivery of FK506 to a nerve allograft is comparable to systemic delivery at suppressing allogeneic graft rejection.

The objective of this study was to determine if locally delivered FK506 could prevent allogeneic nerve graft rejection long enough to allow axon regeneration to pass through the nerve graft. An 8mm mouse sciatic nerve gap injury repaired with a nerve allograft was used to assess the effectiveness of local FK506 immunosuppressive therapy. FK506-loaded poly(lactide-co-caprolactone) nerve conduits were used to provide sustained local FK506 delivery to nerve allografts. Continuous and temporary systemic FK506 therapy to nerve allografts, and autograft repair were used as control groups. Serial assessment of inflammatory cell and CD4+ cell infiltration into the nerve graft tissue was performed to characterize the immune response over time. Nerve regeneration and functional recovery was serially assessed by nerve histomorphometry, gastrocnemius muscle mass recovery, and the ladder rung skilled locomotion assay. At the end of the study, week 16, all the groups had similar levels of inflammatory cell infiltration. The local FK506 and continuous systemic FK506 groups had similar levels of CD4+ cell infiltration, however, it was significantly greater than the autograft control. In terms of nerve histmorphometry, the local FK506 and continunous systemic FK506 groups had similar amounts of myelinated axons, although they were significantly lower than the autograft and temporary systemic FK506 group. The autograft had significantly greater muscle mass recovery than all the other groups. In the ladder rung assay, the autograft, local FK506, and continuous systemic FK506 had similar levels of skilled locomotion performance, whereas the temporary systemic FK506 group had significanty better performance than all the other groups. The results of this study suggest that local delivery of FK506 can provide comparable immunosuppression and nerve regeneration outcomes as systemically delivered FK506

Modélisation géoprospective et simulation 3D immersive

International audienceThis article presents a new approach and the initial feedback in a research that seeks to provoke reflections and reactions to different stakeholders on future changes in their living territory. This project is divided into two stages. The first is a production of different scenarios of changes in land use, associated with a 3D virtual representation of landscape. The second stage is a participatory workshop in small groups of stakeholders. The shared collective thinking is based on 3D virtual representations of transformations of space that were chosen by the participants from an application designed for this project. The study area, located on the coastal zone of Alpes-Maritimes, is very threatened by fast and diffuse urbanization.Cet article présente la démarche, et les premiers retours d’expérience, d’une recherche destinée à susciter les réflexions et les réactions de différents types d’acteurs sur les transformations futures de leur territoire de vie. La démarche se décompose en deux temps, tout d’abord, réalisation de différents scénarios de changements de l’occupation du sol, avec, associée à chacun d’eux, une représentation paysagère en 3D. Puis, travail en petits groupes dans un atelier participatif. La réflexion collective partagée porte sur les représentations paysagères en 3D des transformations de l’espace, choisies, testées, par les participants, à partir d’une application conçue à cet effet. Le territoire d’étude, situé sur le littoral des Alpes-Maritimes, est un territoire très menacé par l’urbanisation diffuse galopante

Modélisation géoprospective et simulation 3D immersive

International audienceThis article presents a new approach and the initial feedback in a research that seeks to provoke reflections and reactions to different stakeholders on future changes in their living territory. This project is divided into two stages. The first is a production of different scenarios of changes in land use, associated with a 3D virtual representation of landscape. The second stage is a participatory workshop in small groups of stakeholders. The shared collective thinking is based on 3D virtual representations of transformations of space that were chosen by the participants from an application designed for this project. The study area, located on the coastal zone of Alpes-Maritimes, is very threatened by fast and diffuse urbanization.Cet article présente la démarche, et les premiers retours d’expérience, d’une recherche destinée à susciter les réflexions et les réactions de différents types d’acteurs sur les transformations futures de leur territoire de vie. La démarche se décompose en deux temps, tout d’abord, réalisation de différents scénarios de changements de l’occupation du sol, avec, associée à chacun d’eux, une représentation paysagère en 3D. Puis, travail en petits groupes dans un atelier participatif. La réflexion collective partagée porte sur les représentations paysagères en 3D des transformations de l’espace, choisies, testées, par les participants, à partir d’une application conçue à cet effet. Le territoire d’étude, situé sur le littoral des Alpes-Maritimes, est un territoire très menacé par l’urbanisation diffuse galopante

Computational Issues in Fluid Construction Grammar

Steels, Luc (ed.).This state-of-the-art-survey documents the Fluid Construction Grammar (FCG), a new formalism for the representation of lexicons and grammars, which has been used in a wide range of case studies for different languages, both for studying specific grammatical phenomena and design patterns, as for investigating language learning and language evolution. The book focuses on the many complex computational issues that arise when writing challenging real world grammars and hence emphasises depth of analysis rather than broad scope. The volume contains 13 contributions organized in 5 parts from "Basic", and "Implementation", over "Case Studies", and "Formal Analysis", up to 3 papers presenting a "Conclusion".N