Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Moving beyond the 'CAP' of the Iceberg: Intrinsic connectivity networks in fMRI are continuously engaging and overlapping

Resting-state functional magnetic resonance imaging is currently the mainstay of functional neuroimaging and has allowed researchers to identify intrinsic connectivity networks (aka functional networks) at different spatial scales. However, little is known about the temporal profiles of these networks and whether it is best to model them as continuous phenomena in both space and time or, rather, as a set of temporally discrete events. Both categories have been supported by series of studies with promising findings. However, a critical question is whether focusing only on time points presumed to contain isolated neural events and disregarding the rest of the data is missing important information, potentially leading to misleading conclusions. In this work, we argue that brain networks identified within the spontaneous blood oxygenation level-dependent (BOLD) signal are not limited to temporally sparse burst moments and that these event present time points (EPTs) contain valuable but incomplete information about the underlying functional patterns. We focus on the default mode and show evidence that is consistent with its continuous presence in the BOLD signal, including during the event absent time points (EATs), i.e., time points that exhibit minimum activity and are the least likely to contain an event. Moreover, our findings suggest that EPTs may not contain all the available information about their corresponding networks. We observe distinct default mode connectivity patterns obtained from all time points (AllTPs), EPTs, and EATs. We show evidence of robust relationships with schizophrenia symptoms that are both common and unique to each of the sets of time points (AllTPs, EPTs, EATs), likely related to transient patterns of connectivity. Together, these findings indicate the importance of leveraging the full temporal data in functional studies, including those using event-detection approaches.

Understanding the translocation and bioaccumulation of cadmium in the Enshi seleniferous area, China: Possible impact by the interaction of Se and Cd

Selenium (Se) plays an indispensable role in minimizing cadmium (Cd) hazards for organisms. However, their potential interactions and co-exposure risk in the naturally Se-Cd enriched paddy field ecosystem are poorly understood. In this study, rice plants with rhizosphere soils sampled from the Enshi seleniferous region, China, were investigated to resolve this confusion. Here, translocation and bioaccumulation of Cd showed some abnormal patterns in the system of soil-rice plants. Roots had the highest bioaccumulation factors of Cd (range: 0.30-57.69; mean: 11.86 ± 14.32), and the biomass of Cd in grains (range: 1.44-127.70 μg, mean: 36.55 ± 36.20 μg) only accounted for ∼10% of the total Cd in whole plants (range: 14.67-1363.20 μg, mean: 381.25 ± 387.57 μg). The elevated soil Cd did not result in the increase of Cd concentrations in rice grains (r² = 0.03, p > 0.05). Most interestingly, the opposite distribution between Se and Cd in rice grains was found (r² = 0.24, p < 0.01), which is contrary to the positive correlation for Se and Cd in soil (r² = 0.46, p < 0.01). It is speculated that higher Se (0.85-11.46 μg/g), higher Se/Cd molar ratios (mean: 5.42 ≫1; range: 1.50-12.87), and higher proportions of reductive Se species (IV, 0) of the Enshi acidic soil may have the stronger capacity of favoring the occurrence of Se binding to Cd ions by forming Cd-Se complexes (Se^2- + Cd²⁺ =CdSe) under reduction conditions during flooding, and hence change the Cd translocation from soil to roots. Furthermore, the negative correlation (r² = 0.25, p < 0.05) between the Cd translocation factor (TF_{whole grains/root}) and the roots Se indicates that Cd translocation from the roots to rice grains was suppressed, possibly by the interaction of Se and Cd. This study inevitably poses a challenge for the traditional risk assessment of Cd and Se in the soils-crops-consumers continuum, especially in the seleniferous area.

A new method of predicting the contribution of TGM to Hg in white rice: Using leaf THg and implications for Hg risk control in Wanshan Hg mine area

Rice plants accumulate Hg from the soil and ambient air, however, evaluating the contribution of Hg from these two sources remains challenging. Here, we proposed a practical method to predict the contribution of total gaseous mercury (TGM) to Hg in white rice in Wanshan Hg mine area (WMM). In this study, rice was planted in the same low-Hg soil at different sites of WMM with varying TGM levels. Comparing to the control sites at IG (Institute of Geochemistry, Guiyang), TGM is the dominant source of Hg in rice leaves and white rice at TB (Tianba) and ZJW (Zhangjiawan) sites of WMM. Subsequently, a good correlation between the Hg concentrations in rice leaves and the concentration contributions of TGM to Hg in white rice was obtained. Such a correlation enabled feasible quantification of the contribution of TGM to Hg in white rice collected from the Wanshan Hg mine. The contribution of TGM to Hg in white rice across the WMM area was also estimated, demonstrating that white rice receives 14-83% of Hg from the air. Considering the high contribution of TGM to Hg in white rice, we compared the relative health risks of Hg via inhalation and rice consumption and found that inhalation, rather than rice consumption, was the major pathway for bioaccessible Hg exposure in adults at high-TGM sites. This study provides new knowledge of Hg biogeochemistry in Hg-mining areas.

370 Evaluating Knowledge of Common Surgical Instruments During Early Surgical Training in the United Kingdom: A Call for Formalised Training?

Aim

Knowledge of surgical instruments and their use is essential to effective surgical practice, enabling efficient task-specific utilisation and promoting clear intraoperative communication; thus, reducing the risk of error. However, variations in surgical instruments across different specialities and eponymous names can pose barriers to learning for early surgical trainees. There is a paucity of data on surgical instrument knowledge among early surgical trainees, and their knowledge acquisition route.

Method

questionnaire was distributed among early surgical trainees (ST3 and below) between 18 August 2020 and 18 November 2020 across various UK regions. Respondents were asked to answer ten multiple-choice questions to assess their surgical instrument knowledge levels. Respondents were also asked about their training level, experience, and opinion regarding formal surgical instrument teaching.

Results

Thirty-seven trainees responded to the questionnaire. The majority (81%) received no formal surgical instrument training. Most respondents (96%) feel they would benefit from formal training. The average test score was 50%. There was no evidence of improved performance with formal training, though the formal training received averaged less than one hour. Higher scores were associated with increased seniority and training years, indicating most trainees are learning ‘on-the-job‘.

Conclusions

There is generally an unsatisfactory level of knowledge in surgical instruments in early surgical trainees. Trainees have also overwhelmingly indicated a desire for formalised training on surgical instruments. The authors believe the lack of formal training may contribute to this knowledge gap and intend to design a new short course to address this.

704 An Audit of Marking of Cutaneous Lesions in A Two-Week Wait Skin Malignancy Service

Aim

Clinical photography enhances a medical record and facilitates communication with other professionals involved in care. It is utilised frequently in the management of skin malignancy. The essence of good photography lies in accurate identification of the cutaneous lesion in question. National guidelines and local policy advise the use of circumferential marking to delineate a lesion of interest, and an alphabetical system for marking of multiple lesions. We audited compliance to standards for medical illustrations of cutaneous lesions in the two-week wait skin cancer clinic at University Hospital North Durham.

Method

Prospective audit of patients attending the clinic over a 7-day period (07/09/20-15/09/20). Data was collated from electronic records on a number of variables.

Results

175 patients met inclusion criteria. The majority (n = 160, 89.9%) were referred for a single lesion, the rest for multiple lesions. Hospital clinical photography was obtained in 148 patients (83.2%). Marking was deemed inappropriate in 44.6% of those in which clinical photography was obtained. Of these 66 cases, 12 cases were multiple lesions marked without letters, 52 had an incorrect indicator for the lesion (such as arrows or dots, allowing more ambiguous interpretation), and 8 had no indicator at all. Incidentally, one patient was photographed with dressings covering the lesions.

Conclusions

Compliance with standards for demarcation of skin lesions for clinical photography was found to be poor. This permits the wrong identification of lesions in future treatment episodes and could potentially have a significant impact on care. We propose the introduction of a referral document illustrating correct marking guidelines.

Effects of light regime on the hatching performance, body development and serum biochemical indexes in Beijing You Chicken

The paper aimed to study the effects of light regime during the incubation on hatching performance, body development and serum biochemical indexes in Beijing You Chicken (BYC). A total of 1,408 BYC eggs were randomly allocated into 4 groups: 24 h dark as the control (Inc24D); 3 light regimes were 8 h light and 16 h dark group (Inc8L:16D); 12 h light and 12 h dark group (Inc12L:12D); 16 h light and 8 h dark group (Inc16L:8D), respectively. There were 352 eggs in each group, 4 replicates each group and 1 tray each replicate, 88 eggs each tray. Light-emitting diode (LED) strips, white light with temperature of 4,500 to 5,000 K, 150 to 200 lx were set up. The results showed that light regimes had no significant effects on hatching rate of eggs, hatching rate of fertile eggs and healthy rate of chicks (P > 0.05), but the hatching rate of eggs was the lowest in the Inc24D group (87.22%), and the highest in the Inc12L:12D group (93.64%); Lighted incubation significantly affected the incidence of leg problems of 1-day-old chicks (P < 0.05). The incidence rate of leg problems was the highest in the Inc24D group (4.21%), and was decreased in Inc12L:12D and Inc16L:8D groups (P < 0.05). Femur length in the Inc12L:12D group was greater than that in the Inc24D and Inc16L:8D groups (P = 0.011), but there were no differences between Inc8L:16D group and other three groups (P > 0.05). The relative brain weight of 1-day-old chicks was higher in Inc24D and Inc16L:8D groups than in Inc8L:16D group (P = 0.052), but had no difference with Inc12L:12D group. Light regimes during incubation had no effects on serum total protein, albumen, globulin, and urea nitrogen content of 1-day-old chicks (P > 0.05), while the globulin content in Inc12L:12D group was numerically greater than in other three groups (P = 0.063). Lysozyme content in Inc12L:12D group was higher than that in the Inc24D and Inc8L:16D groups (P < 0.05), but had no difference with that in Inc16L:8D group. Light regime had no effect on serum total antioxidant capability (T-AOC) (P > 0.05), but significantly affected the activities of glutathione peroxidase (GSH-Px) and total superoxide dismutase (T-SOD) (P < 0.05). The GSH-Px and T-SOD activities in the Inc12L:12D group were higher than those in the Inc24D and Inc8L:16D groups. The MDA content of Inc24D was the highest (9.67 nmol/mL) compared to the others, which was very close to the significant level (P = 0.056). In conclusion, 12 h light and 12 h dark incubation has the potential to improve the hatching performance of BYC eggs, benefit for the long bone development, improve some serum immune and antioxidant indexes, and reduce the leg problems in 1-day-old chicks.

Occurrence of various viruses and recent evidence of SARS-CoV-2 in wastewater systems

Viruses are omnipresent and persistent in wastewater, which poses a risk to human health. In this review, we summarise the different qualitative and quantitative methods for virus analysis in wastewater and systematically discuss the spatial distribution and temporal patterns of various viruses (i.e., enteric viruses, Caliciviridae (Noroviruses (NoVs)), Picornaviridae (Enteroviruses (EVs)), Hepatitis A virus (HAV)), and Adenoviridae (Adenoviruses (AdVs))) in wastewater systems. Then we critically review recent SARS-CoV-2 studies to understand the ongoing COVID-19 pandemic through wastewater surveillance. SARS-CoV-2 genetic material has been detected in wastewater from France, the Netherlands, Australia, Italy, Japan, Spain, Turkey, India, Pakistan, China, and the USA. We then discuss the utility of wastewater-based epidemiology (WBE) to estimate the occurrence, distribution, and genetic diversity of these viruses and generate human health risk assessment. Finally, we not only promote the prevention of viral infectious disease transmission through wastewater but also highlight the potential use of WBE as an early warning system for public health assessment.

[Efficacy and safety of ticagrelor versus clopidogrel in Chinese patients with acute coronary syndrome treated with glycoprotein Ⅱb/Ⅲa receptor antagonist]

Objective: To explore the efficacy and safety of ticagrelor versus clopidogrel in acute coronary syndrome (ACS) Chinese patients using glycoprotein Ⅱb/Ⅲa inhibitor (GPI). Methods: The data from CCC-ACS (Improving Care for Cardiovascular Disease in China-ACS) project were systematically reviewed in ACS patients with GPI. The patients were divided into ticagrelor and clopidogrel groups. A logistic analysis and propensity score matching (PSM) were performed to compare occurrences of major cardiovascular events (MACE) and bleeding events between the two groups during hospitalization. Results: A total of 63 641 ACS patients were collected from 150 hospitals. Logistic regression analyses showed that there was no statistically significant difference in the reduction of MACE between ticagrelor and clopidogrel when using GPI (OR=0.881, 95%CI 0.599-1.296; P=0.521). However, major bleeding rate was higher in the ticagrelor group than that in the clopidogrel group (OR=1.401, 95%CI 1.075-1.852; P=0.013). Similar results were observed after PSM. No statistic difference in MACE between the ticagrelor and clopidogrel group (OR=0.919, 95%CI 0.613-1.376; P=0.681). Major bleeding rate was higher in the ticagrelor group (OR=1.559, 95%CI 1.130-2.150; P=0.007). Conclusion: In ACS patients with GPI, ticagrelor did not reduce MACE, but increased the major bleeding risk compared with clopidogrel.

The impact of PM2.5 on lung function in adults with asthma

OBJECTIVE: To conduct a systematic review of the literature and assess the effect of PM2.5 (particulate matter with diameter <2.5 μm) exposure on lung function in adults with asthma.METHODS: We searched all literature published between 1 January 2010 and 26 March 2019 in the EMBASE, PubMed, Cochrane Central Library, Chinese National Knowledge Infrastructure (CNKI), Wanfang and Chinese Biomedical Literature (CBM) databases. The studies were assessed for analytic methods, risk of bias and results of statistical analysis.RESULTS: The selected studies all had a low or moderate risk of bias. Overall, PM2.5 exposure was positively associated with a decrease in forced expiratory volume in 1 sec (FEV₁)/forced vital capacity (FVC) in adults with asthma (standardised mean difference 0.20, 95% CI 0.02-0.38; P = 0.03).CONCLUSION: We observed a negative correlation between PM2.5 exposure and FEV₁/FVC in patients with asthma. Our meta-analysis provides evidence suggesting that PM2.5 is a risk factor for acute asthma exacerbation in adults.

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Dark Energy Survey Year 1 Results: Cosmological Constraints from Cluster Abundances, Weak Lensing, and Galaxy Correlations

We present the first joint analysis of cluster abundances and auto or cross-correlations of three cosmic tracer fields: galaxy density, weak gravitational lensing shear, and cluster density split by optical richness. From a joint analysis (4×2pt+N) of cluster abundances, three cluster cross-correlations, and the auto correlations of the galaxy density measured from the first year data of the Dark Energy Survey, we obtain Ω_{m}=0.305_{-0.038}^{+0.055} and σ_{8}=0.783_{-0.054}^{+0.064}. This result is consistent with constraints from the DES-Y1 galaxy clustering and weak lensing two-point correlation functions for the flat νΛCDM model. Consequently, we combine cluster abundances and all two-point correlations from across all three cosmic tracer fields (6×2pt+N) and find improved constraints on cosmological parameters as well as on the cluster observable-mass scaling relation. This analysis is an important advance in both optical cluster cosmology and multiprobe analyses of upcoming wide imaging surveys.

[Reliability and validity of Stanford Presenteeism Scale (SPS-6) in Chinese occupational population]

Objective: To investigate the reliability and validity of Stanford attendance scale (sps-6) in the study of attendance among professional groups. Methods: In August, 2018, the 1455 employees from 81 workplaces in Beijing, Shanghai, Jiangsu and Guangdong were randomly investigated as the subjects. The reliability and validity of sps-6 were analyzed by using the internal consistency reliability (Cronbach's coefficient) , half split half coefficient, content validity, integration validity, discrimination validity, cluster analysis and structural validity analysis. Results: Cronbach's coefficients of sps-6 scale, working process and work results were 0.692, 0.918 and 0.907, respectively; Guttman of scales and dimensions The split half coefficients were 0.792, 0.803 and 0.794, respectively; Pearson correlation coefficients of the total score of each item and scale were 0.526-0.673 (P<0.01) ; the qualification rate of set validity and differentiation validity were 100%; the results of cluster analysis supported the theoretical basis for the formation of the scale. The general non-standard fitting index (TLI) =0.982, approximate error mean square root mean square (RMSEA) =0.071, comparative fit index (CFI) =0.990, fit goodness index (GFI) =0.987, modified fit goodness index (AGFI) =0.965, Norm fit index (NFI) =0.990. The results showed that the scale had higher structural validity, and the results of sps-6 in the occupational population were (21.36±4.04) , and the distribution was normal (deviation was 0.053, peak was 0.023) . The scores of sps-6 scale were statistically different in various charactoristics of gender, age, education level, marital status, annual income, position, position level and industry (P< 0.01) . Conclusion: Stanford attendance scale has high reliability and validity, and can be applied to the study of attendance in professional groups.

Somatotropin increases plasma ceramide in relation to enhanced milk yield in cows

Recombinant bovine somatotropin (rBST) changes metabolism to spare glucose for milk synthesis in cows. Ceramides inhibit insulin responsiveness in bovine adipocytes and are associated with insulin resistance and milk production in cows. The mechanisms by which rBST supports lactation may involve ceramide. Eight multiparous lactating Holstein cows were enrolled in a 2 × 2 replicated Latin square design with 14-d periods. Cows received a single rBST injection (Posilac; Elanco Animal Health, Indianapolis, IN; 0.062 mg/kg BW) or no injection (CON). An epinephrine challenge, insulin tolerance test, and liver biopsy were performed. Somatotropin enhanced the conversion of feed nutrients into milk components and increased plasma free fatty acid (FFA) concentrations (P < 0.01). Area-under-the-curves for FFA in response to epinephrine and insulin were greater in rBST-treated cows. In response to insulin, glucose concentrations (20- and 30-min post-challenge) and insulin area-under-the-curve were higher with rBST treatment (P < 0.05, <0.10, and <0.01), suggesting insulin resistance. Somatotropin modified the plasma lipidome. For example, rBST decreased plasma di- and triacylglycerol levels (eg, DG-50:1 and TG-18:0/16:0/16:1), phosphatidylcholines and sphingomyelins (P < 0.05). Somatotropin increased plasma total and very-long-chain (C22:0-, C24:0-, C26:0-) ceramide concentrations (P < 0.01). Liver ceramide concentrations were not modified. Plasma ceramides were positively correlated with circulating FFA (r ~ 0.57; P < 0.05) and milk yield (r ~ 0.63; P < 0.05). We conclude that rBST administration modifies the bovine lipidome and increases plasma ceramide concentrations in association with increased milk production in cows.

Exogenous selenium (cadmium) inhibits the absorption and transportation of cadmium (selenium) in rice

Antagonism between selenium (Se) and cadmium (Cd) has been demonstrated in plants. However, a mutual suppression threshold for Se and Cd has not been identified in previous studies using Cd or Se individually. To fill this knowledge gap, we determined the levels of Se and Cd in various tissues of rice under concentration gradients of Se and Cd with different Se application times via hydroponic experiments. The results showed that the application of exogenous Se or Cd reduced the uptake and transport of the other. When the molar ratio of Se/Cd (R (Se/Cd)) was higher than 1, the concentration and transfer factor of Cd (TF-Cd) in all parts of rice simultaneously reached the lowest values. The minimum Se absorption in rice was obtained at R (Cd/Se) greater than 20, while no inhibition threshold was found for Se transport. In addition, approximately 1:1 R (Se/Cd) was observed in roots and the addition of exogenous Cd or Se promoted the enrichment of the other element in roots. These data suggested a mutual inhibition of Se and Cd in their absorption, transportation and accumulation in rice, which might be related to the formation of insoluble Cd-Se complexes in roots. This study provided new insights into a plausible explanation of the interactions between Se and Cd and contributed to the remediation and treatment of combined Se and Cd pollution in farmland systems.

Three-year outcomes of selective incomplete versus complete revascularization in heart failure patients receiving multivessel percutaneous coronary intervention

Background

Heart failure (HF) patients with multi-vessel disease (MVD) are often associated with comorbidities to limit the possibility to achieve complete revascularization (CR) in percutaneous coronary intervention (PCI). The planned selective incomplete revascularization (SIR) may be an alternative opinion for these patients.

Purpose

To investigate 3-year clinical outcomes of SIR versus CR in HF patients with MVD in a real-word registry.

Methods

A total of 566 HF patients with MVD receiving either SIR or CR were enrolled. SIR was planned pre-PCI based on clinical exams to avoid non-viable tissue revascularization. Major adverse cardiac events (MACEs) was a composite of in-hospital death, recurrent myocardial infarction, any revascularization, and all-cause death at 3-year follow-up.

Results

There was no significant differences between SIR and CR groups in in-hospital death, any revascularization, all-cause death and MACEs (24.3% vs. 24.9%, p=0.922). However, SIR had a significant lower incidence of recurrent myocardial infarction than CR (3.2% vs. 7.2%, p=0.032).

Conclusion

The 3-year outcomes of PCI with planned SIR were completely comparable to with CR in HF patients with MVD. Planned SIR can be an opinion for HF patients with MVD who are not suitable to achieve CR.

Kaplan-Meier curve of 3-year MACEs

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Chang Gung Medical Research Program