The Clinical Frailty Scale is a useful tool for predicting postoperative complications following elective colon cancer surgery at the age of 80 years and above: A prospective, multicentre observational study

Aim Identification of the risks of postoperative complications may be challenging in older patients with heterogeneous physical and cognitive status. The aim of this multicentre, observational study was to identify variables that affect the outcomes of colon cancer surgery and, especially, to find tools to quantify the risks related to surgery. Method Patients aged >= 80 years with electively operated Stage I-III colon cancer were recruited. The prospectively collected data included comorbidities, results of the onco-geriatric screening tool (G8), Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI) and Mini Nutritional Assessment-Short Form (MNA-SF), and operative and postoperative outcomes. Results A total of 161 patients (mean 84.5 years, range 80-97, 60% female) were included. History of cerebral stroke (64% vs. 37%, p = 0.02), albumin level 31-34 g/l compared with >= 35 g/l (57% vs. 32%, p = 0.007), CFS 3-4 and 5-9 compared with CFS 1-2 (49% and 47% vs. 16%, respectively) and American Society of Anesthesiologists score >3 (77% vs. 28%, P = 0.006) were related to a higher risk of complications. In multivariate logistic regression analysis CFS >= 3 (OR 6.06, 95% CI 1.88-19.5, p = 0.003) and albumin level 31-34 g/l (OR 3.88, 1.61-9.38, p = 0.003) were significantly associated with postoperative complications. Severe complications were more common in patients with chronic obstructive pulmonary disease (43% vs. 13%, p = 0.047), renal failure (25% vs. 12%, p = 0.021), albumin level 31-34 g/l (26% vs. 8%, p = 0.014) and CCI >6 (23% vs. 10%, p = 0.034). Conclusion Surgery on physically and cognitively fit aged colon cancer patients with CFS 1-2 can lead to excellent operative outcomes similar to those of younger patients. The CFS could be a useful screening tool for predicting postoperative complications.Peer reviewe

One-year functional outcomes of patients aged 80 years or more undergoing colonic cancer surgery: prospective, multicentre observational study

Background: Older patients are at high risk of experiencing delayed functional recovery after surgical treatment. This study aimed to identify factors that predict changes in the level of support for activities of daily living and mobility 1 year after colonic cancer surgery.Methods: This was a multicentre, observational study conforming to STROBE guidelines. The prospective data included pre-and postoperative mobility and need for support in daily activities, co-morbidities, onco-geriatric screening tool (G8), clinical frailty scale (CFS), operative data, and postoperative surgical outcomes.Results: A total of 167 patients aged 80 years or more with colonic cancer were recruited. After surgery, 30 per cent and 22 per cent of all patients had increased need for support and decreased motility. Multivariableanalysis with all patients demonstrated that preoperative support in daily activities outside the home (OR 3.23, 95 per cent c.i. 1.06 to 9.80, P = 0.039) was associated with an increased support at follow-up. A history of cognitive impairment (3.15, 1.06 to 9.34, P = 0.038) haemoglobin less than 120 g/l (7.48, 1.97 to 28.4, P = 0.003) and discharge to other medical facilities (4.72, 1.39 to 16.0, P = 0.013) were independently associated with declined mobility. With functionally independent patients, haemoglobin less than 120 g/l (8.31, 1.76 to 39.2, P = 0.008) and discharge to other medical facilities (4.38, 1.20 to 16.0, P = 0.026) were associated with declined mobility.Conclusion: Increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicts an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should focus on anaemia correction, nutritional status, and mobility with detailed rehabilitation plan.Greater increased need for support before surgery, cognitive impairment, preoperative anaemia, and discharge to other medical facilities predicted an increased need for support or declined mobility 1 year after colonic cancer surgery. Preoperative assessment and optimization should especially focus on anaemia correction, nutritional status, and mobility with a detailed rehabilitation plan.</p

Framing the concept of satellite remote sensing essential biodiversity variables: challenges and future directions

Although satellite-based variables have for long been expected to be key components to a unified and global biodiversity monitoring strategy, a definitive and agreed list of these variables still remains elusive. The growth of interest in biodiversity variables observable from space has been partly underpinned by the development of the essential biodiversity variable (EBV) framework by the Group on Earth Observations – Biodiversity Observation Network, which itself was guided by the process of identifying essential climate variables. This contribution aims to advance the development of a global biodiversity monitoring strategy by updating the previously published definition of EBV, providing a definition of satellite remote sensing (SRS) EBVs and introducing a set of principles that are believed to be necessary if ecologists and space agencies are to agree on a list of EBVs that can be routinely monitored from space. Progress toward the identification of SRS-EBVs will require a clear understanding of what makes a biodiversity variable essential, as well as agreement on who the users of the SRS-EBVs are. Technological and algorithmic developments are rapidly expanding the set of opportunities for SRS in monitoring biodiversity, and so the list of SRS-EBVs is likely to evolve over time. This means that a clear and common platform for data providers, ecologists, environmental managers, policy makers and remote sensing experts to interact and share ideas needs to be identified to support long-term coordinated actions

Measuring β-diversity by remote sensing: a challenge for biodiversity monitoring

Biodiversity includes multiscalar and multitemporal structures and processes, with different levels of functional organization, from genetic to ecosystemic levels. One of the mostly used methods to infer biodiversity is based on taxonomic approaches and community ecology theories. However, gathering extensive data in the field is difficult due to logistic problems, especially when aiming at modelling biodiversity changes in space and time, which assumes statistically sound sampling schemes. In this context, airborne or satellite remote sensing allows information to be gathered over wide areas in a reasonable time. Most of the biodiversity maps obtained from remote sensing have been based on the inference of species richness by regression analysis. On the contrary, estimating compositional turnover (β‐diversity) might add crucial information related to relative abundance of different species instead of just richness. Presently, few studies have addressed the measurement of species compositional turnover from space. Extending on previous work, in this manuscript, we propose novel techniques to measure β‐diversity from airborne or satellite remote sensing, mainly based on: (1) multivariate statistical analysis, (2) the spectral species concept, (3) self‐organizing feature maps, (4) multidimensional distance matrices, and the (5) Rao's Q diversity. Each of these measures addresses one or several issues related to turnover measurement. This manuscript is the first methodological example encompassing (and enhancing) most of the available methods for estimating β‐diversity from remotely sensed imagery and potentially relating them to species diversity in the field

Finding the essential : improving conservation monitoring across scales

To account for progress towards conservation targets, monitoring systems should capture not only information on biodiversity but also knowledge on the dynamics of ecological processes and the related effects on human well-being. Protected areas represent complex social-ecological systems with strong human-nature interactions. They are able to provide relevant information about how global and local scale drivers (e.g., climate change, land use change) impact biodiversity and ecosystem services. Here we develop a framework that uses an ecosystem-focused approach to support managers in identifying essential variables in an integrated and scalable approach. We advocate that this approach can complement current essential variable developments, by allowing conservation managers to draw on system-level knowledge and theory of biodiversity and ecosystems to identify locally important variables that meet the local or sub-global needs for conservation data. This requires the development of system narratives and causal diagrams that pinpoints the social-ecological variables that represent the state and drivers of the different components, and their relationships. We describe a scalable framework that builds on system based narratives to describe all system components, the models used to represent them and the data needed. Considering the global distribution of protected areas, with an investment in standards, transparency, and on active data mobilisation strategies for essential variables, these have the potential to be the backbone of global biodiversity monitoring, benefiting countries, biodiversity observation networks and the global biodiversity community

Control of Metabolic Homeostasis by Stress Signaling Is Mediated by the Lipocalin NLaz

Metabolic homeostasis in metazoans is regulated by endocrine control of insulin/IGF signaling (IIS) activity. Stress and inflammatory signaling pathways—such as Jun-N-terminal Kinase (JNK) signaling—repress IIS, curtailing anabolic processes to promote stress tolerance and extend lifespan. While this interaction constitutes an adaptive response that allows managing energy resources under stress conditions, excessive JNK activity in adipose tissue of vertebrates has been found to cause insulin resistance, promoting type II diabetes. Thus, the interaction between JNK and IIS has to be tightly regulated to ensure proper metabolic adaptation to environmental challenges. Here, we identify a new regulatory mechanism by which JNK influences metabolism systemically. We show that JNK signaling is required for metabolic homeostasis in flies and that this function is mediated by the Drosophila Lipocalin family member Neural Lazarillo (NLaz), a homologue of vertebrate Apolipoprotein D (ApoD) and Retinol Binding Protein 4 (RBP4). Lipocalins are emerging as central regulators of peripheral insulin sensitivity and have been implicated in metabolic diseases. NLaz is transcriptionally regulated by JNK signaling and is required for JNK-mediated stress and starvation tolerance. Loss of NLaz function reduces stress resistance and lifespan, while its over-expression represses growth, promotes stress tolerance and extends lifespan—phenotypes that are consistent with reduced IIS activity. Accordingly, we find that NLaz represses IIS activity in larvae and adult flies. Our results show that JNK-NLaz signaling antagonizes IIS and is critical for metabolic adaptation of the organism to environmental challenges. The JNK pathway and Lipocalins are structurally and functionally conserved, suggesting that similar interactions represent an evolutionarily conserved system for the control of metabolic homeostasis

Managerial Views of Corporate Impacts and Dependencies on Ecosystem Services : A Case of International and Domestic Forestry Companies in China

A line of research is emerging investigating the private sector impacts and dependencies on critical biodiversity and ecosystem services, and related business risks and opportunities. While the ecosystem services narrative is being forwarded globally as a key paradigm for promoting business sustainability, there is scarce knowledge of how these issues are considered at managerial level. This study thus investigates managerial views of corporate sustainability after the ecosystem services concept. We analyse interviews conducted with 20 managers from domestic and international forestry companies operating with a plantation-based business model in China. Content analysis was employed to analyse the data, with a focus on four key areas: (1) interviewee familiarity with the ecosystem services concept; (2) their views of corporate dependencies and impacts on ecosystem services; (3) related business risks and opportunities; and (4) viability of existing instruments and practices that can be employed in detecting and addressing business impacts and dependencies on ecosystem services. Through an inductive approach to the empirical findings, we refined a framework that holds operational value for developing company response strategies to ecosystem services impact/dependence assessment, ensuring that all issues are addressed comprehensively, and that related risks and opportunities are properly acknowledged.Peer reviewe

Susceptibility of low-density lipoprotein particles to aggregate depends on particle lipidome, ismodifiable, and associates with future cardiovascular deaths

Aims Low-density lipoprotein (LDL) particles cause atherosclerotic cardiovascular disease (ASCVD) through their retention, modification, and accumulation within the arterial intima. High plasma concentrations of LDL drive this disease, but LDL quality may also contribute. Here, we focused on the intrinsic propensity of LDL to aggregate upon modification. We examined whether inter-individual differences in this quality are linked with LDL lipid composition and coronary artery disease (CAD) death, and basic mechanisms for plaque growth and destabilization.Methods and results We developed a novel, reproducible method to assess the susceptibility of LDL particles to aggregate during lipolysis induced ex vivo by human recombinant secretory sphingomyelinase. Among patients with an established CAD, we found that the presence of aggregation-prone LDL was predictive of future cardiovascular deaths, independently of conventional risk factors. Aggregation-prone LDL contained more sphingolipids and less phosphatidylcholines than did aggregation-resistant LDL. Three interventions in animal models to rationally alter LDL composition lowered its susceptibility to aggregate and slowed atherosclerosis. Similar compositional changes induced in humans by PCSK9 inhibition or healthy diet also lowered LDL aggregation susceptibility. Aggregated LDL in vitro activated macrophages and T cells, two key cell types involved in plaque progression and rupture.Conclusion Our results identify the susceptibility of LDL to aggregate as a novel measurable and modifiable factor in the progression of human ASCVD