Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

The WY domain of an RxLR effector drives interactions with a host target phosphatase to mimic host regulatory proteins and promote Phytophthora infestans infection

Plant pathogens manipulate the cellular environment of the host to facilitate infection and colonization, often leading to plant diseases. To accomplish this, many specialized pathogens secrete virulence proteins called effectors into the host cell, which subvert processes such as immune signalling, gene transcription, and host metabolism. Phytophthora infestans, the causative agent of potato late blight, employs an expanded repertoire of RxLR effectors with WY domains to manipulate the host through direct interaction with protein targets. However, our understanding of the molecular mechanisms underlying the interactions between WY effectors and their host targets remains limited. In this study, we performed a structural and biophysical characterization of the P. infestans WY effector, Pi04314, in complex with the potato Protein Phosphatase 1-c (PP1c). We elucidate how Pi04314 uses a WY domain and a specialised C-terminal loop carrying a KVxF motif that interact with conserved surfaces on PP1c, known to be used by host regulatory proteins for guiding function. Through biophysical and in planta analyses, we demonstrate that Pi04314 WY or KVxF mutants lose their ability to bind PP1c. The loss of PP1c binding correlates with changes in PP1c nucleolar localisation and a decrease in lesion size in plant infection assays. This study provides insights into the manipulation of plant hosts by pathogens, revealing how effectors exploit key regulatory interfaces in host proteins to modify their function and facilitate disease.</p

Под знаменем Ленина. 1989. № 155

Robert Nozick initiated one of the most inspired and inspiring discussions in political philosophy with his 1974 response in Anarchy, State, and Utopia to John Rawls’s 1971 account of distributive justice in A Theory of Justice. These two works have informed an enormous amount of subsequent, especially liberal, discussions of economic justice, where Nozick’s work typically functions as a resource for those defending more right-wing (libertarian) positions, whereas Rawls’s has been used to defend various left-wing stances. Common to these discussions, as found in politics generally (where similar kinds of arguments frequently are used to defend right and the left-wing policies and conclusions) is that they end in rather stubborn stalemates: the right defending minimal states while the left defends more extensive states. Interesting, too, is that both Nozick and Rawls take themselves to be consistent with, inspired by, and furthering Kant’s freedom project in the development of their own theories of justice. In this paper, I start by outlining the structures of these debates with an emphasis on the original disagreements between Nozick and Rawls. I then show how neither theory actually employed Kant’s own theory of justice, but rather drew on or out (presumed) implications of his ethical theory. In the final sections, I argue that if Nozick and Rawls had instead used Kant’s theory of justice and not his ethics, not only would their individual theories have been stronger, but they could have found ways of overcoming the unproductive stalemates that characterize their own as well as subsequent related discussions of economic justice as we currently find them in much scholarly and contemporary political debate