Negligible Mortality Research Articles

Pathogens of the oak processionary moth Thaumetopoea processionea: Developing a user-friendly bioassay system and metagenome analyses for microorganisms

The oak processionary moth (OPM) Thaumetopoea processionea is a pest of oak trees and poses health risks to humans due to the urticating setae of later instar larvae. For this reason, it is difficult to rear OPM under laboratory conditions, carry out bioassays or examine larvae for pathogens. Biological control targets the early larval instars and is based primarily on commercial preparations of Bacillus thuringiensis ssp. kurstaki (Btk). To test the entomopathogenic potential of other spore-forming bacteria, a user-friendly bioassay system was developed that (i) applies bacterial spore suspensions by oak bud dipping, (ii) targets first instar larvae through feeding exposure and (iii) takes into account their group-feeding behavior. A negligible mortality in the untreated control proved the functionality of the newly established bioassay system. Whereas the commercial Btk HD-1 strain was used as a bioassay standard and confirmed as being highly efficient, a Bacillus wiedmannii strain was ineffective in killing OPM larvae. Larvae, which died during the infection experiment, were further subjected to Nanopore sequencing for a metagenomic approach for entomopathogen detection. It further corroborated that B.wiedmannii was not able to infect and establish in OPM, but identified potential insect pathogenic species from the genera Serratia and Pseudomonas.

Mathematical assessment of the roles of age heterogeneity and vaccination on the dynamics and control of SARS-CoV-2

The COVID-19 pandemic, caused by SARS-CoV-2, disproportionately affected certain segments of society, particularly the elderly population (which suffered the brunt of the burden of the pandemic in terms of severity of the disease, hospitalization, and death). This study presents a generalized multigroup model, with m heterogeneous sub-populations, to assess the population-level impact of age heterogeneity and vaccination on the transmission dynamics and control of the SARS-CoV-2 pandemic in the United States. Rigorous analysis of the model for the homogeneous case (i.e., the model with m = 1) reveal that its disease-free equilibrium is globally-asymptotically stable for two special cases (with perfect vaccine efficacy or negligible disease-induced mortality) whenever the associated reproduction number is less than one. The model has a unique and globally-asymptotically stable endemic equilibrium, for special a case, when the associated reproduction threshold exceeds one. The homogeneous model was fitted using the observed cumulative mortality data for the United States during three distinct waves (Waves A (October 17, 2020 to April 5, 2021), B (July 9, 2021 to November 7, 2021) and C (January 1, 2022 to May 7, 2022)) chosen to align with time periods when the Alpha, Delta and Omicron were, respectively, the predominant variants in the United States. The calibrated model was used to derive a theoretical expression for achieving vaccine-derived herd immunity (needed to eliminate the disease in the United States). It was shown that, using the one-group homogeneous model, vaccine-derived herd immunity is not attainable during Wave C of the pandemic in the United States, regardless of the coverage level of the fully-vaccinated individuals. Global sensitivity analysis was carried out to determine the parameters of the model that have the most influence on the disease dynamics and burden. These analyses reveal that control and mitigation strategies that may be very effective during one wave may not be so very effective during the other wave or waves. However, strategies that target asymptomatic and pre-symptomatic infectious individuals are shown to be consistently effective across all waves. To study the impact of the disproportionate effect of COVID-19 on the elderly population, we considered the heterogeneous model for the case where the total population is subdivided into the sub-populations of individuals under 65 years of age and those that are 65 and older. The resulting two-group heterogeneous model, which was also fitted using the cumulative mortality data for wave C, was also rigorously analysed. Unlike for the case of the one-group model, it was shown, for the two-group model, that vaccine-derived herd immunity can indeed be achieved during Wave C of the pandemic if at least 61% of the populace is fully vaccinated. Thus, this study shows that adding age heterogeneity into a SARS-CoV-2 vaccination model with homogeneous mixing significantly reduces the level of vaccination coverage needed to achieve vaccine-derived herd immunity (specifically, for the heterogeneous model, herd-immunity can be attained during Wave C if a moderate proportion of susceptible individuals are fully vaccinated). The consequence of this result is that vaccination models for SARS-CoV-2 that do not explicitly account for age heterogeneity may be overestimating the level of vaccine-derived herd immunity threshold needed to eliminate the SARS-CoV-2 pandemic.

Prevalence of Acute Bronchiolitis in Infants: About 167 Cases Seen in Pediatric Consultation at the Reference Health Center of the Commune I of Bamako (Mali)

Introduction: Bronchiolitis is a common respiratory disease in pediatrics. Its acute onset manifestations are most often observed in infants under 24 months of age, but at this age the respiratory system remains immature. The main pathogen of acute bronchiolitis in infants is respiratory syncytial virus (RSV). Materials and method: This is a descriptive and prospective study of the acute bronchiolitis in infants aged 0 to 24 months received at the pediatric consultation of the Reference Health Center of the Commune I of Bamako de Mars 2019 to February 2020. Results: In 12 months, 167 cases of acute bronchiolitis were seen at the pediatric consultation. The prevalence of bronchiolitis was 1.85%, the average age of infants was 8 months, and the boy/girl sex ratio was 1.6. The month of September represented the peak (31.1%). Infants aged 1 to 10 months accounted for 60% of hospitalizations. Mortality was 5.4%. Conclusion: bronchiolitis is a common pediatric consultation pathology, it remains worrying for parents with a more or less negligible mortality rate.

The response of epiphytic lichens on living and dead Pinus sylvestris to prescribed fires of varying severity

Prescribed burning can be used to restore forest ecosystems degraded by anthropogenic pressures. However, some species such as epiphytic lichens may be vulnerable to fire. We studied the effects of fire on epiphytic lichens on living and dead Pinus sylvestris (Scots pine) by surveying lichens up to two meters on the trunks 21 years after experimental and replicated prescribed burnings in pine-dominated boreal forests in Finland. We investigated three types of stands that had faced different levels of fire severity: 1) unburned semi-natural mature stands (i.e., control sites), 2) burned semi-natural mature stands, and 3) burned retention groups on clearcut sites. In the semi-natural mature stands, the fires were low-severity surface fires and induced negligible mortality in P. sylvestris. In the retention groups, the fires induced high tree mortality and made fresh deadwood the dominant substrate type. Low-severity fires reduced the occurrence of several species, but usually did not eliminate them. High-severity fires eliminated some species, but the abundant deadwood frequently hosted some species that were absent or infrequent on the unburned sites. Thus, the fires had only small effects on total species richness. However, fires substantially changed species composition: they reduced the occurrence of species associated with late-successional habitats, while increasing the occurrence of early-successional species. We also found fires to decrease the occurrence of microlichens and increase that of macrolichens. The magnitude of the compositional changes increased with fire severity. Our findings indicate that the high quantities of fresh deadwood in post-disturbance forests provide habitat only to a limited portion of deadwood-associated lichens. Fire can increase landscape-scale variation in epiphytic lichen communities, but we observed negative effects, which increased with fire severity, on lichen flora of conservation concern. Thus, we recommend prescribed burning to be applied primarily in sites with a history of intensive management. Fire should be avoided in sites with substrates that are fire-sensitive and important to lichen diversity.

Infection and histopathological consequences in Siamese fighting fish (Betta splendens) due to exposure to a pathogenic Mycobacterium chelonae via different routes

Mycobacteriosis, a chronic progressive disease in fish caused by Mycobacterium spp., is typically characterized by granulomatous lesions that illustrate its harmful pathogenesis. This study was initiated to understand the progression of mycobacteriosis in Siamese fighting fish (Betta splendens) through various transmission modes. Experimental infections were conducted using a pathogenic isolate of Mycobacterium chelonae originally derived from a naturally infected betta fish. The bacteria were administered by five different routes at three doses (approximately 105, 106, 107 CFU/fish or CFU/mL), including intraperitoneal (IP) and intramuscular (IM) injections, oral administration, immersion, and immersion with skin trauma. Acute infections, typified by short survival, non-specific gross signs, and severe organ necrosis, were frequently observed in the IP and IM methods. The median lethal dose (LD50) for these methods was 4.16 × 105 CFU/fish and 1.66 × 106 CFU/fish, respectively, within seven days following infection. Conversely, oral administration and immersion with or without skin trauma resulted in negligible fish mortality but triggered progressive chronic disease. Chronically infected fish survived the 28-day trial but exhibited macroscopic pathology such as emaciation, aesthetic deterioration, along with an increased presence of melanomacrophage centers (MMCs) in lymphoid tissues and/or systemic granulomas, as noted in histopathology. The results indicate that the course of M. chelonae infection is strongly correlated with the exposure routes, with injuries on the fish body and/or via the digestive tract being the most probable natural pathways. This study expands the understanding of the pathogenesis of Mycobacterium species in betta fish and emphasizes the need to mitigate risk factors associated with exposure routes to effectively control the disease.

Age-dependent acquisition of pathogenicity by SARS-CoV-2 Omicron BA.5.

Pathology studies of SARS-CoV-2 Omicron variants of concern (VOC) are challenged by the lack of pathogenic animal models. While Omicron BA.1 and BA.2 replicate in K18-hACE2 transgenic mice, they cause minimal to negligible morbidity and mortality, and less is known about more recent Omicron VOC. Here, we show that in contrast to Omicron BA.1, BA.5-infected mice exhibited high levels of morbidity and mortality, correlating with higher early viral loads. Neither Omicron BA.1 nor BA.5 replicated in brains, unlike most prior VOC. Only Omicron BA.5-infected mice exhibited substantial weight loss, high pathology scores in lungs, and high levels of inflammatory cells and cytokines in bronchoalveolar lavage fluid, and 5- to 8-month-old mice exhibited 100% fatality. These results identify a rodent model for pathogenesis or antiviral countermeasure studies for circulating SARS-CoV-2 Omicron BA.5. Further, differences in morbidity and mortality between Omicron BA.1 and BA.5 provide a model for understanding viral determinants of pathogenicity.

Comparing SARS-CoV-2 testing positivity rates and COVID-19 impact among different isolation strategies: a rapid systematic review and a modelling study.

The optimal isolation duration for patients with COVID-19 remains unclear. To support an update of World Health Organization (WHO)'s Living Clinical management guidelines for COVID-19 (https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2022.2), this rapid systematic review and modelling study addresses the effects of different isolation periods for preventing onward transmission leading to hospitalisation and death among secondary cases. We searched the WHO COVID-19 database for studies up to Feb 27, 2023. We included clinical studies of any design with COVID-19 patients confirmed by PCR test or rapid antigen test addressing the impact of any isolation strategy on preventing the spread of COVID-19. There were no restrictions on publication language, publication status, age of patients, severity of COVID-19, variants of SARS-COV-2, comorbidity of patients, isolation location, or co-interventions. We performed random-effects meta-analyses to summarise testing rates of persistent test positivity rates after COVID-19 infection. We performed pre-specified subgroup analyses by symptom status and meta-regression analyses for the proportion of fully vaccinated patients. We developed a model to compare the effects of three isolation strategies on onward transmission leading to hospitalisation and death. The three isolation strategies were (1) 5-day isolation, with no test to release; (2) removal of isolation based on a negative test; and (3) 10-day isolation, with no test to release. The model incorporates estimates of test positivity rates, effective reproduction number, isolation adherence, false negative rate, and hospitalisation rates or case fatality rates. To assess the impact of varying isolation adherence and false negative rates on rapid antigen testing, we conducted some sensitivity analyses. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence. The protocol is registered with PROSPERO (CRD42022348626). Fifteen studies addressing persistent test positivity rates including 4188 patients proved eligible. Asymptomatic patients (27.1%, 95% CI: 15.8%-40.0%) had a significantly lower rapid antigen test positive rate than symptomatic patients (68.1%, 95% CI: 40.6%-90.3%) on day 5. The rapid antigen test positive rate was 21.5% (95% CI: 0-64.1%; moderate certainty) on day 10. Our modelling study suggested that the risk difference (RD) for asymptomatic patients between 5-day isolation and 10-day isolation in hospitalisations (23 more hospitalisations of secondary cases per 10,000 patients isolated, 95% uncertainty interval (UI) 14 more to 33 more) and mortality (5 more per 10,000 patients, 95% UI 1 to 9 more) of secondary cases proved very small (very low certainty). For symptomatic patients, the potential impact of 5- versus 10-day isolation was much greater in hospitalisations (RD 186 more per 10,000 patients, 95% UI 113 more to 276 more; very low certainty) and mortality (RD 41 more per 10,000 patients, 95% UI 11 more to 73 more; very low certainty). There may be little or no difference between removing isolation based on a negative antigen test and 10-day isolation in the onward transmission leading to hospitalisation or death, but the average isolation period (mean difference-3 days) will be shorter for the removal of isolation based on a negative antigen test (moderate certainty). 5 days versus 10 days of isolation in asymptomatic patients may result in a small amount of onward transmission and negligible hospitalisation and mortality; however, in symptomatic patients, the level of onward transmission is concerning and may lead to high hospitalisation and death rates. The evidence is, however, very uncertain. This work was done in collaboration with WHO.

Robot-assisted radical cystectomy with intracorporeal reconstruction of urinary diversion by mechanical stapler: prospective evaluation of early and late complications.

Radical cystectomy with pelvic lymph node dissection is the gold standard treatment for non-metastatic muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. For years, the traditional open surgery approach was the only viable option. The widespread of robotic surgery led to its employment also in radical cystectomy to reduce complication rates and improve functional outcomes. Regardless of the type of approach, radical cystectomy is a procedure with high morbidity and not negligible mortality. Data available in the literature show how the use of staplers can offer valid functional outcomes, with an acceptable rate of complications shortening the operative time. The aim of our study was to describe the perioperative outcomes and complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) using a mechanical stapler. From January 2015 to May 2021, we enrolled patients who underwent RARC with pelvic node dissection and stapled ICUD (ileal conduit or ileal Y-shaped neobladder according to the Perugia ileal neobladder) in our high-volume center. Demographic features, perioperative outcomes and early (≤30 days) and late (>90 days) post-operative complications according to the Clavien-Dindo classification, were recorded for each patient. We also analyzed the potential linear correlation between demographic, pre-operative as well as operative features and the risk of post-operative complications. Overall, 112 patients who underwent RARC with ICUD were included with a minimum follow-up of 12 months. Intracorporeal Perugia ileal neobladder was performed in 74.1% of cases while ileal conduit was performed in 25.9%. The mean operative time, estimated intraoperative blood loss, and LOS were 289.1 ± 59.7 min, 390.6 ± 186.2 ml, and 17.5 ± 9.8 days, respectively. Early minor and major complications accounted for 26.7% and 10.8%, respectively. Overall late complications were 40.2%. The late most common complications were hydronephrosis (11.6%) and urinary tract infections (20.5%). Stone reservoir formation occurred in 2.7% of patients. Major complications occurred in 5.4%. In the sub-analysis, the mean operative time and the estimated blood loss improved significantly from the first 56 procedures to the last ones. RARC with ICUD performed by mechanical stapler is a safe and effective technique. Stapled Y-shaped neobladder did not increase the complication rate.

2D MoS2 and BN Nanosheets Damage Mitochondria through Membrane Penetration.

With the progression of nanotechnology, a growing number of nanomaterials have been created and incorporated into organisms and ecosystems, which raises significant concern about potential hazards of these materials on human health, wildlife, and the environment. Two-dimensional (2D) nanomaterials are one type of nanomaterials with thicknesses ranging from that of a single atom or of several atoms and have been proposed for a variety of biomedical applications such as drug delivery and gene therapy, but the toxicity thereof on subcellular organelles remains to be studied. In this work, we studied the impact of two typical 2D nanomaterials, MoS2 and BN nanosheets, on mitochondria, which are a type of membranous subcellular organelle that provides energy to cells. While 2D nanomaterials at a low dose exhibited a negligible cell mortality rate, significant mitochondrial fragmentation and partially reduced mitochondrial functions occurred; cells initiate mitophagy in response to mitochondrial damages, which cleans damaged mitochondria to avoid damage accumulation. Moreover, the molecular dynamics simulation results revealed that both MoS2 and BN nanosheets can spontaneously penetrate the mitochondrial lipid membrane through the hydrophobic interaction. The membrane penetration induced heterogeneous lipid packing resulting in damages. Our results demonstrate that even at a low dose 2D nanomaterials can physically damage mitochondria by penetrating the membrane, which draws attention to carefully evaluating the cytotoxicity of 2D nanomaterials for the potential biomedical application.

Alternative telomere maintenance mechanism in Alligator sinensis provides insights into aging evolution

Lifespan is a life-history trait that undergoes natural selection. Telomeres are hallmarks of aging, and shortening rate predicts species lifespan, making telomere maintenance mechanisms throughout different lifespans a worthy topic for study. Alligators are suitable for the exploration of anti-aging molecular mechanisms, because they exhibit low or even negligible mortality in adults and no significant telomere shortening. Telomerase reverse transcriptase (TERT) expression is absent in the adult Alligator sinensis, as in humans. Selection analyses on telomere maintenance genes indicated that ATM, FANCE, SAMHD1, HMBOX1, NAT10, and MAP3K4 experienced positive selection on A.sinensis. Repressed pleiotropic ATM kinase in A.sinensis suggests their fitness optimum shift. In ATM downstream, Alternative Lengthening of Telomeres (ALT)-related genes were clustered in a higher expression pattern in A.sinensis, which covers 10-15% of human cancers showing no telomerase activities. In summary, we demonstrated how telomere shortening, telomerase activities, and ALT contributed to anti-aging strategies.

Physiological response of channel (Ictalurus punctatus) and hybrid (I. punctatus x I. furcatus) catfish following Bolbophorus damnificus infection

The trematode Bolbophorus damnificus is associated with reduced production in farm-raised catfish in the southeastern United States. Previous research demonstrated that even mild outbreaks, which may go unnoticed by producers, can result in >60% reduction in net return due to decreased feeding and trematode-induced mortality. While infectivity rates in channel (Ictalurus punctatus) and hybrid catfish (I. punctatus x I. furcatus) are similar, hybrid catfish experience lower mortality when exposed to comparable numbers of Bolbophorus cercariae than channel catfish cohorts. This study compared physiological responses in channel (21.4 ± 0.93 g) and hybrid (27.5 ± 2.63 g) catfish fingerlings exposed to 450 cercariae/L. Fish were sampled over the next 49 days for hematocrit, hemoglobin, red blood cell (RBC) concentration, plasma glucose, plasma lactate, and plasma osmolality. Exposed channel and hybrid catfish experienced a dramatic drop in hematocrit, hemoglobin, and RBC concentration during the peak mortality window associated with metacercarial development, but recovered afterwards, suggesting an anemic response to the development of the parasite and subsequent recovery once metacercarial encapsulation is complete (∼15 days post-exposure). There were no differences over time in any of the plasma parameters measured, but there was an overall decreased osmolality in both exposed groups, suggesting a prolonged low-level stress response to infection. There was high mortality in the exposed channel catfish groups from days 9 to 15 post-infection, consistent with previous studies. Comparably, hybrids appeared healthy and active throughout the trial with only negligible mortality. In all trials, infected fish presented clinical signs consistent with B. damnificus infection and all exposed fish had visible metacercariae below the skin. There was a substantial anemic response in both catfish types, suggesting the physiological response to B. damnificus infection may not differ between channel and hybrid catfish and the significant differences in mortality may be attributed to survivor bias, hybrids greater tolerance of the anemic state or other unidentified factors. The biological and economic implications of these findings are unclear, but the behavioral differences observed between the two fish groups in reponse to B. damnificus, coupled with reduced mortality in hybrids, supports previous work indicating hybrids are more tolerant of B. damnificus infection and outbreaks in hybrid catfish may not yield the same deleterious effects as channel catfish.

Initial Results of Halifax Nail in Elderly Intertrochanteric Fracture

Background: Variety of implants (extramedullary and intramedullary) are available to fix intertrochanteric (IT) fracture but hardly any data is available that proves the superiority of one over other. Every implant is having its own advantage and disadvantages. The aim of this study is to analyze the results of Halifax nail in age group of 60 to 100 year age group. Materials and Methods: Total 15 cases of intertrochanteric fracture operated using Halifax nail in which youngest patient was 60 years male and oldest was 95 years female.13 cases operated in same hospital and 2 in two different hospitals. These patient were chosen randomly among elderly IT fracture admitted in hospital during August 2017 to January 2019. Results are analyze in term of Mobilization, pain control, union time, implant failure. Final outcome was evaluated as per Harris Hip Score. Result: Among 15 cases,13 follow up available, 2 patient were lost in follow up after natural death. Out of 13 patients (n = 13), 7 showed excellent, 5 showed good and one patient showed poor result as per Harris Hip Score. Conclusion: Results of Halifax nail for IT fractures in elderly was found to be highly encouraging. All patients had early union and none had implant failure. Early mobilization and negligible mortality and morbidity were other added advantages.

High-Volume Center Experience with Laparoscopic Adrenalectomy over Two Decades.

Background: Study aims to demonstrate single-institution two decades experience with lateral transperitoneal laparoscopic adrenalectomies. Methods: Retrospective study involved 991 operations grouped into 4 cohorts. Data was collected on the patients’ age, sex, side and size of the lesion, histopathological type, hormonal activity, conversion to open adrenalectomy, operating time, length of hospital stay, perioperative complications. Results: The operations were right-sided (n = 550), left-sided (n = 422), bilateral (n = 19). Mean tumor size was 41.9 mm. Histopathological examination revealed 442 adenomas, 191 nodular hyperplasias, 218 pheochromocytomas, 33 malignancies and 126 other lesions. 541 patients had hormonally active tumors. Mean operating time for unilateral laparoscopic adrenalectomy was 141 min. Mean length of hospital stay was 5.27 days. Intraoperative complications rate was 2.3%. Conversion rate was 1.5%. 54 of patients had 70 postoperative complications. Reoperation rate was 1%. Mortality rate was 0.1%. Statistically significant differences were found in all factors, apart from age, sex, side and size of the lesion, reoperations rate (p > 0.05). Conversions rate, complications rates, length of hospital stay were highest in the first group (p < 0.05). Operating time shortened in the first decade. Conclusions: Laparoscopic adrenalectomy is a safe procedure with negligible mortality. Conversions rate, perioperative complications rate, and length of hospital stay, significantly decreased over time.

Use of novel lab assays to examine the effect of pyrethroid-treated bed nets on blood-feeding success and longevity of highly insecticide-resistant Anopheles gambiae s.l. mosquitoes

BackgroundThere is a pressing need to improve understanding of how insecticide resistance affects the functional performance of insecticide-treated nets (ITNs). Standard WHO insecticide resistance monitoring assays are designed for resistance surveillance and do not necessarily provide insight into how different frequencies, mechanisms or intensities of resistance affect the ability of ITNs to reduce malaria transmission.MethodsThe current study presents some novel laboratory-based assays that attempt to better simulate realistic exposure of mosquitoes to ITNs and to quantify impact of exposure not only on instantaneous mortality, but also on blood-feeding and longevity, two traits that are central to transmission. The assays evaluated the performance of a standard ITN (Permanet® 2.0; Vestergaard Frandsen), a ‘next generation’ combination ITN with a resistance-breaking synergist (Permanet® 3.0) and an untreated net (UTN), against field-derived Anopheles gambiae sensu lato mosquitoes from Côte d’Ivoire exhibiting a 1500-fold increase in pyrethroid resistance relative to a standard susceptible strain.ResultsThe study revealed that the standard ITN induced negligible instantaneous mortality against the resistant mosquitoes, whereas the resistance-breaking net caused high mortality and a reduction in blood-feeding. However, both ITNs still impacted long-term survival relative to the UTN. The impact on longevity depended on feeding status, with blood-fed mosquitoes living longer than unfed mosquitoes following ITN exposure. Exposure to both ITNs also reduced the blood-feeding success, the time spent on the net and blood-feeding duration, relative to the untreated net.ConclusionAlthough a standard ITN did not have as substantial instantaneous impact as the resistance-breaking net, it still had significant impacts on traits important for transmission. These results highlight the benefit of improved bioefficacy assays that allow for realistic exposure and consider sub- or pre-lethal effects to help assess the functional significance of insecticide resistance.Graphical

Robotic central pancreatectomy: a systematic review and meta-analysis.

Central pancreatectomy is usually performed to excise lesions of the neck or proximal body of the pancreas. In the last decade, thanks to the advent of novel technologies, surgeons have started to perform this procedure robotically. This review aims to appraise the results and outcomes of robotic central pancreatectomies (RCP) through a systematic review and meta-analysis. A systematic search of MEDLINE, Embase, and Web Of Science identified studies reporting outcomes of RCP. Pooled prevalence rates of postoperative complications and mortality were computed using random-effect modelling. Thirteen series involving 265 patients were included. In all cases but one, RCP was performed to excise benign or low-grade tumours. Clinically relevant post-operative pancreatic fistula (POPF) occurred in 42.3% of patients. While overall complications were reported in 57.5% of patients, only 9.4% had a Clavien-Dindo score≥III. Re-operation was necessary in 0.7% of the patients. New-onset diabetes occurred postoperatively in 0.3% of patients and negligible mortality and open conversion rates were observed. RCP is safe and associated with low perioperative mortality and well preserved postoperative pancreatic function, although burdened by high overall morbidity and POPF rates.

Personalized Approach for Obese Patients Undergoing Endoscopic Sleeve Gastroplasty.

Obesity is a chronic, relapsing disease representing a major global health problem in the 21st century. Several etiologic factors are involved in its pathogenesis, including a Western hypercaloric diet, sedentariness, metabolic imbalances, genetics, and gut microbiota modification. Lifestyle modifications and drugs often fail to obtain an adequate and sustained weight loss. To date, bariatric surgery (BS) is the most effective treatment, but only about 1% of eligible patients undergo BS, partly because of its negligible morbidity and mortality. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive, endoscopic, bariatric procedure, which proved to be safe and effective. In this review, we aim to examine evidence supporting the role of a personalized and multidisciplinary approach, guided by a multidisciplinary team (MDT), for obese patients undergoing ESG, from patient selection to long-term follow-up. The cooperation of different health professionals, including an endocrinologist and/or obesity medicine physician, a bariatric surgeon, an endoscopist experienced in bariatrics, a registered dietitian, an exercise specialist, a behaviour coach, a psychologist, and a nurse or physician extender, aims to induce radical and sustained lifestyle changes. We also discussed the relationship between gut microbiota and outcomes after bariatric procedures, speculating that the characterization of gut microbiota before and after ESG may help develop new tools, including probiotics, to optimize weight loss outcomes.

Thoracic hydatid cysts: an analysis of surgical management in a tertiary care centre in India.

Though hydatidosis is a ubiquitous zoonosis endemic to India, there is a dearth of literature regarding the management of thoracic hydatid disease (THD) in India. There are no surgical guidelines available. The aim of this study is to analyse the details of THD operated upon in a tertiary care hospital in India and propose a protocol for its management. The case files of all adult patients operated upon for THD in our institution between 2009 and 2019 were retrieved and a retrospective study done. A total of 186 patients, 103 (55.4%) males and 83 (44.6%) females, with a mean age of 34.2years were studied. The commonest symptom was cough as in 83 (44.6%) patients. Complications were seen in 22 (11.8%) patients. Computerized tomogram (CT) was confirmatory in most patients. Isolated pulmonary disease was seen in 135 (72.6%) patients with 153 (82.3%) uni-lobar involvement. Right lower lobe was most frequently involved as in 56 (30.1%). Extra-pulmonary, intra-thoracic involvement was seen in 6 (3.2%) and synchronous extra-thoracic disease in 45 (24.2%) patients. All patients were initiated on anthelmintics. Postero-lateral thoracotomy was the commonest surgical approach. Twenty (10.7%) patients required lung resections. The mean hospital stay was 5.9days. Air leak, seen in 10 (5.4%) patients, was the commonest post-operative complication. There was single in-hospital mortality. Age, diabetes mellitus, secondary bacterial infection of the cyst and cyst characteristics were found to significantly affect the surgical outcomes. Surgery, the treatment of choice for THD, can be done with negligible morbidity and mortality and should be expedited to prevent complications. Risk factors should be identified pre-operatively for better decision-making. Adequate concurrent medical therapy may prevent recurrences. Prolonged follow-up is mandatory to detect late recurrences.

Excess all-cause mortality from January to August 2020: a temporal analysis in 20 countries

Analysis of all-cause mortality is an important tool to investigate the impact of the COVID-19 pandemic. This study aims to investigate the magnitude and potential determinants of excess all-cause mortality, from January until August 2020, using national mortality databases from 20 countries part of the C-MOR consortium. Excess weekly mortality for 2020 was calculated by comparing observed against expected weekly number of deaths for 2020. Expected 2020 weekly mortality was estimated using 2015-19 data based on a time series model adjusting for time trend and seasonality. The excess mortality was visualized against a stringency index (SI), based on nine government response indicators, downloaded from the Oxford COVID-19 Government Response Tracker. Brazil, Cyprus, France, Ireland, Italy, countries of the UK, Spain and the USA showed a substantial increase in the observed mortality during 2020, which lasted from 1 (Cyprus) to 7 (England and Wales, Scotland) weeks. Australia, Denmark and Georgia observed fewer than expected deaths, whereas in Austria, Estonia, Israel, Norway, Slovenia and Ukraine 2020 mortality was as expected. Italy, Spain, UK and Brazil enforced high SI measures at least after 3 weeks from the first COVID-19 death. Sweden and the USA did not apply high SI measures for the duration of this study. In Austria, Estonia, Israel, Norway, Cyprus, Georgia, Slovenia and Ukraine, measures of high SI were implemented within 2 weeks of the first COVID-19 death. The decreased mortality in Australia is probably attributed to different seasonality patterns coupled with strict control measures. Several but not all countries showed excess all-cause mortality. Excess mortality was shown to be influenced by the seasonality patterns of each country, as well as the promptness of governments to apply high SI control measures. As the pandemic continues, the lessons learned from the first months of the pandemic can prove useful to minimize increases in all-cause mortality.Key messages Some countries showed excess all-cause mortality between January and August 2020, whereas others displayed either negligible excess mortality or even a decrease in all-cause mortality.Excess mortality may be partly attributed to delayed application of strict control measures whereas lack of excess mortality may be due to seasonality and/or strict control measures.

Predictors of mortality in patients with right-side and cardiac device-related infective endocarditis, the esc-eorp euro-endo registry

Abstract Background/Introduction Mortality in right-sided infective endocarditis (RSIE) and cardiac device-related IE (CDRIE) rates have increased mainly due derived complications and heterogeneity of the disease. A better understanding of associated risk factors to mortality in these entities are required in order to develop an efficient therapy. Purpose The aim of this study was to assess 30-day mortality rate and variables associated in RSIE and CDRIE. Methods The ESC-EORP EURO-ENDO registry is a prospective multicenter observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Univariable analysis was performed to assess variables associated with 30-day mortality. Results Among 269 patients with RSIE, 24 patients (9.8%) died during the first 30-day of IE diagnosis. Cut-off value for best vegetation size related to 30-day mortality was vegetation length &amp;gt;19mm, with a HR = 2.88 (95% CI 1.26–6.58, p=0.01) and a Harrell's Concordance of 0.632. Factors associated with 30-days mortality by univariable analysis were: vegetation size &amp;gt;19mm (OR = 2.99, 95% CI [1.31–6.84], p=0.009), previous stroke or transient ischemic attack (OR = 5.10, 95% CI [1.19–21.88], p=0.029), HIV infection (OR = 3.52, 95% CI [1.03–12.10], p=0.046), chronic renal failure (OR = 2.66, 95% CI [1.06–6.71], p=0.038), congestive heart failure at admission (OR = 2.34, 95% CI [1.00–5.47], p=0.050) and severe regurgitation (OR = 3.77, 95% CI [1.56–9.09], p=0.003). On the other side, among the 227 patients with CDRIE, 24 patients (8.8%) died during the first 30-day of IE diagnosis. Factors associated with an increase in 30-day mortality by univariate analysis were: age per 10 years (OR = 1.49, 95% CI [1.02–2.18], p=0.039), heart failure history (OR = 3.88, 95% CI [1.39–10.80], p=0.009), congestive heart failure on admission (OR = 5.80, 95% CI [2.31–14.55], p&amp;lt;0.001) and cardiogenic shock on admission (OR = 13.37, 95% CI [3.75–47.64], p&amp;lt;0.001). An increase in left ventricular ejection fraction (LVEF) per 10% was a protective factor (OR = 0.66, 95% CI [0.49–0.90], p=0.008). Conclusions Patients with RSIE and CDRIE had a not negligible 30-day mortality rate (9.8% and 8.8%, respectively). Factors associated with RSIE and CDRIE mortality are different; while in the right side location, the mortality was related with vegetation size and comorbidities, in the case of CDRIE, the mortality was mainly associated to the presence of heart failure. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Euro-Endo registry by European Society of Cardiology

Incidence of lamprey marks on Lake Sturgeon ( Acipenser fulvescens Rafinesque, 1817) in the St. Clair – Detroit River System: Implications for Sea Lamprey ( Petromyzon marinus Linnaeus, 1758) effects

Laurentian Great Lakes Lake Sturgeon (Acipenser fulvescens) are hosts to lamprey species, including native Silver Lamprey (Ichthyomyzon unicuspis) and invasive Sea Lamprey (Petromyzon marinus). Silver Lamprey coevolved with Lake Sturgeon and cause negligible mortality, but Sea Lamprey can negatively affect Lake Sturgeon populations. Sea Lamprey abundance in Lake Erie has been above targets set by resource managers, with the St. Clair – Detroit River System (SCDRS) suspected as a source of Sea Lamprey production into Lake Erie. This study summarizes lamprey marking on Lake Sturgeon captured during agency assessment surveys in the SCDRS since 1996 and provides insight on the potential for Sea Lamprey to negatively affect Lake Sturgeon in the SCDRS. Lamprey marks (any lamprey species) were noted on 48.2% of Lake Sturgeon (2.5 marks/fish) and 3.3% of Lake Sturgeon assumed to be susceptible to mortality by Sea Lamprey (<760 mm TL; 0.06 marks/fish). Silver Lamprey were the only lamprey species found attached to Lake Sturgeon and there was no difference between oral disc diameters of Silver Lamprey and marks measured on Lake Sturgeon in Lake St. Clair and the lower St. Clair River (p = .45). Based on logistic regression, probability of at least one lamprey mark increased with Lake Sturgeon total length and was highest in Lake St. Clair. The probability of observing at least one lamprey mark on a 760 mm Lake Sturgeon was 8.1% or less for each sampling location in the SCDRS aside from Lake St. Clair (28.1%). Results suggest that parasitism of Lake Sturgeon by Sea Lamprey in the SCDRS is rare, particularly for Lake Sturgeon <760 mm TL. Low incidence of lamprey marks on Lake Sturgeon assumed to be susceptible to mortality from Sea Lamprey parasitism and zero occurrence of Sea Lamprey being observed attached to a Lake Sturgeon suggest Sea Lamprey at their current abundance likely have little effect on the Lake Sturgeon population in the SCDRS. Caution should be taken when using mark size to assign marks to lamprey species as there is substantial overlap among species oral disc diameters, potentially inflating the perceived impact of Sea Lamprey on Lake Sturgeon in areas with native lampreys.