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

C-type lectin receptor expression is a hallmark of neutrophils infiltrating the skin in epidermolysis bullosa acquisita

Inflammatory epidermolysis bullosa acquisita (EBA) is characterized by a neutrophilic response to anti-type VII collagen (COL7) antibodies resulting in the development of skin inflammation and blistering. The antibody transfer model of EBA closely mirrors this EBA phenotype.To better understand the changes induced in neutrophils upon recruitment from peripheral blood into lesional skin in EBA, we performed single-cell RNA-sequencing of whole blood and skin dissociate to capture minimally perturbed neutrophils and characterize their transcriptome.Through this approach, we identified clear distinctions between circulating activated neutrophils and intradermal neutrophils. Most strikingly, the gene expression of multiple C-type lectin receptors, which have previously been reported to orchestrate host defense against fungi and select bacteria, were markedly dysregulated. After confirming the upregulation of Clec4n, Clec4d, and Clec4e in experimental EBA as well as in lesional skin from patients with inflammatory EBA, we performed functional studies in globally deficient Clec4e-/- and Clec4d-/- mice as well as in neutrophil-specific Clec4n-/- mice. Deficiency in these genes did not reduce disease in the EBA model.Collectively, our results suggest that while the upregulation of Clec4n, Clec4d, and Clec4e is a hallmark of activated dermal neutrophil populations, their individual contribution to the pathogenesis of EBA is dispensable

Landmarks in gynæcology /

Mode of access: Internet.Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center;Previous: Rush Winslow.University of Chicago Library's copy 1 from the Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center at the University of Chicago

A treatise on the diseases of females : disorders of menstruation.

Bradford, T.L. Homoeopathic bib. of the U.S.,Mode of access: Internet.Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center;University of Chicago Library's copy 1 from the Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center at the University of Chicago

Klinische und anatomische Beiträge zur Pathologie des Gehirns /

Mode of access: Internet.Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center;University of Chicago Library's copy 2 from the Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center at the University of Chicago

Disease duration and the integrity of the nigrostriatal system in Parkinson’s disease

Objective: To investigate the degree of nigrostriatal degeneration in Parkinson disease (PD) patients at different disease durations following diagnosis.Method: Brains of PD patients (n=28) with disease durations of 1-27 years from the time of diagnosis and normal elderly controls (n=7) were examined. Sections of the putamen and SNc were processed for tyrosine hydroxylase and dopamine transporter immunohistochemistry. Stereological quantitative assessments of putaminal dopaminergic fiber density and estimates of the number of melanin-containing and tyrosine hydroxylase immunoreactive neurons in the SNc were performed by blinded investigators.Results: There was only modest loss of staining for dopaminergic markers in the dorsal putamen at 1 year after diagnosis and variable loss (moderate to marked) at 3 years. By 4 years post-diagnosis and thereafter, there was consistent and severe loss of staining in the dorsal putamen with only an occasional individual abnormal dopaminergic fiber detected. Some dopaminergic fibers were detected in the ventral and medial aspects of the putamen, presumably en route to the caudate nucleus. Stereological estimates of striatal dopaminergic fibers and SNc neurons demonstrated modest reductions at 1-3 years followed by an exponential decline that was largely complete by 5-7 years from the time of diagnosis. Interpretation: Degeneration of nigrostriatal dopaminergic terminals is relatively modest in years 1-3, but is virtually complete by 5 years after diagnosis. Loss of nigral neurons lags behind striatal denervation, consistent with the possibility that nigrostriatal degeneration begins as an axonopathy. These findings have important implications for studies of putative neuroprotective therapies

The medical profession : being the essay to which was awarded the first Carmichael prize of £200 by the Council of the Royal College of Surgeons, Ireland, 1879 /

Includes index.Cover and half-title: Carmichael prize essay.Mode of access: Internet.Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center;University of Chicago Library's copy 1 from the Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center at the University of Chicago

Atlas and principles of bacteriology /

Translation of: Atlas und Grundriss der Bakteriologie und Lehrbuch der speziellen bakteriologischen Diagnostik.Mode of access: Internet.Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center;University of Chicago Library's copy 2 and 3 from the Stanton A. Friedberg, M.D. Rare Book Collection of Rush University Medical Center at the University of Chicago

Additional file 2 of Implicating genes, pleiotropy, and sexual dimorphism at blood lipid loci through multi-ancestry meta-analysis

Additional file 2: Table S2. Association results for the multi-ancestry index SNPs with the gene prioritization