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

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Data from: Newly discovered morphology of the Silurian sea spider Haliestes and its implications

The three-dimensionally preserved Haliestes dasos from the Silurian (Wenlock) Lagerstätte is the most complete fossil sea spider and the oldest unambiguous pycnogonid known from the fossil record. The discovery of two new specimens to add to the holotype reveals new features including proximal annulations of the appendages and segmentation of the trunk end, critical details for comparison with pycnogonids from the Devonian (Emsian) Hunsrück Slate and for the interpretation of the evolutionary significance of Palaeozoic genera. There is some evidence of sexual dimorphism. H. dasos was nektobenthic and its morphology indicates an unusual mode of feeding compared to living pycnogonids. The new morphological features of H. dasos are closely similar to those in Palaeoisopus problematicus from the Hunsrück Slate and it clearly belongs, together with that species, in stem Pycnogonida and not the crown group

Data from: Newly discovered morphology of the Silurian sea spider Haliestes and its implications

The three-dimensionally preserved Haliestes dasos from the Silurian (Wenlock) Lagerstätte is the most complete fossil sea spider and the oldest unambiguous pycnogonid known from the fossil record. The discovery of two new specimens to add to the holotype reveals new features including proximal annulations of the appendages and segmentation of the trunk end, critical details for comparison with pycnogonids from the Devonian (Emsian) Hunsrück Slate and for the interpretation of the evolutionary significance of Palaeozoic genera. There is some evidence of sexual dimorphism. H. dasos was nektobenthic and its morphology indicates an unusual mode of feeding compared to living pycnogonids. The new morphological features of H. dasos are closely similar to those in Palaeoisopus problematicus from the Hunsrück Slate and it clearly belongs, together with that species, in stem Pycnogonida and not the crown group

Supplementary information files for What have we learnt from quantitative case reports of acute lateral ankle sprains injuries and episodes of ‘giving-way’ of the ankle joint, and what shall we further investigate?

Supplementary information files for article What have we learnt from quantitative case reports of acute lateral ankle sprains injuries and episodes of ‘giving-way’ of the ankle joint, and what shall we further investigate? Lateral ankle sprains are a commonly incurred injury in sports. They have a high recurrence rate and can lead to the development of persistent injury associated symptoms. We performed a quantitative synthesis of published case reports documenting the kinematics of acute lateral ankle sprains and episodes of “giving-way” of the ankle joint to provide a comprehensive description of the mechanisms. A systematic literature search was conducted to screen records within MEDLINE® and EMBASE® . Additional strategies included manual search of specific journals as well as contacting researchers in relevant communities to retrieve unpublished data. Twenty-four cases were included in the quantitative synthesis; 11 from individual case reports and 13 from four separate case series. Two authors independently reviewed all articles and extracted ankle joint kinematic data. Excessive ankle inversion was the most pronounced kinematic pattern observed across all included cases, with a mean peak inversion angle of 67.5° (range 2.0 to 142) and a mean peak inversion velocity of 974°/s (range 468 to 1752). This was followed by internal rotation and plantar flexion, respectively. A homogeneous linear function revealed a mean inversion velocity across all cases of 337°/s (range 117 to 1400; R2 =0.78; p<0.0001)

Summary statistics of UK Biobank blood pressure genome-wide association studies (GWAS) using 337,422 unrelated white European individuals

Three blood pressure traits were analysed: systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP; the difference between SBP and DBP). Mean SBP and DBP values from automated values were calculated. After calculating blood pressure values, SBP and DBP were adjusted for medication use by adding 15 and 10 mm Hg to their values, respectively, for individuals reported to be taking blood pressure–lowering medication.For the UK Biobank genome-wide association studies (GWAS), we performed linear mixed model (LMM) association testing under an additive genetic model of the three continuous, medication-adjusted blood pressure traits (SBP, DBP, PP) for all measured and imputed genetic variants (Data Field-22828) with minor allele frequency (MAF) >=1% and imputation score>=0.3 in dosage format using the BOLT-LMM (v2.4.1) software. Covariates were age, age2, sex, BMI, genotyping array and 10PCs. Genomic inflation was not applied to the GWAS summary statistics.Sample QC was described below:We included up to 337,422 individuals from UK Biobank for the purpose of this project. We followed UK Biobank sample-based quality control criteria (Nature 2018;562:203-209); excluded were samples/individuals based on the following criteria: (i) outliers in heterozygosity and missingness, (ii) self-reported gender not consistent with genetic data inferred gender (ii) sample call rate (computed using probesets internal to Affymetrix