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  • Oxford University Press (OUP)  (9)
  • 1
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e103-e112
    Abstract: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P & lt; 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P & lt; 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P & lt; 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P & lt; 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P & lt; 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2006309-X
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  • 2
    In: BJS Open, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-06), p. 403-414
    Type of Medium: Online Resource
    ISSN: 2474-9842 , 2474-9842
    URL: Issue
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2902033-5
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  • 3
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 10 ( 2022-09-09), p. 995-1003
    Abstract: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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  • 4
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 110, No. 7 ( 2023-06-12), p. 804-817
    Abstract: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2006309-X
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  • 5
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. 11 ( 2021-11-11), p. 1274-1292
    Abstract: To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2006309-X
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  • 6
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 37, No. Supplement_3 ( 2022-05-03)
    Abstract: Alterations in protein homeostasis in tubular cells lead to endoplasmic reticulum (ER) stress activating the unfolded protein response (UPR) pathway, which contributes to repair or aggravate the renal damage [1]. This pathway is initiated by three major protein sensors (IRE1α, PERK and ATF6) that activate their corresponding transcription factors (TF), XBP1, ATF4 and ATF6, respectively, to ultimately regulate the transcription of numerous genes essential for cell survival. However, an exacerbated activation of the UPR pathway can also lead to the expression of genes related to inflammation and fibrosis, cell death or autophagy contributing to perpetuate the renal damage [2] . The balance between these two processes (adaptive/maladaptive response) is mediated not only by the length and strength of the initial stimulus, but also by changes in the chromatin structure that may induce or repress gene transcription. Epigenetic changes are mainly mediated by the expression and recruitment of epigenetic enzymes, such as histone methyltransferases (HMTs) and demethylases (HDMs) to target genes in order to modify their expression. Thus, the aim of this study pursues to identify the epigenetic changes mediated by the histone methylation (H3K9 and H3K27) in the UPR pathway and to explore the role of the epigenetic drugs as potential treatments for kidney disease. METHOD The tubular epithelial cell line, HK2, was used to analyse the epigenetic changes in vitro before and after induction of ER stress mediated by Thapsigargin (Tg), an ER Ca2+ 2'-ATPase inhibitor and strongUPR inductor. Specific pharmacological inhibitors of the G9a and EZH2 HMTs, BIX-01 294 and GSK126, respectively, and of the JMJD3 and KDM4C HDMs, GSKJ4 and SD-70, respectively, or small interfering RNAs were used. The recruitment of these epigenetic enzymes and the presence of the H3K9me3 and H3K27me3 repressive histone marks were analysed by chromatin immunoprecipitation (ChIP) and coimmunoprecipitation assays. RESULTS HK-2 treatment with the BIX-01 294 or GSK126 pharmacological inhibitors or specific gene silencing of the G9a and EZH2 enzymes reveals an increase of the expression of ATF4 and XBP1 TFs, without inducing changes in ATF6 transcription. Moreover, this effect is additive to the one observed with Tg, indicating that changes in the chromatin structure are required for a full transcription and UPR activation. These results correlated with a lower recruitment of G9a and EZH2, and decreased H3K9me3 and H3K27me3 levels at the promoter region of ATF4 and XBP1 genes, corresponding with the increased transcription of these TFs. G9a and EZH2 HMTs act in coordination, so inhibition of G9a significantly reduces the recruitment of EZH2 and H3K27me3 levels to the regulatory region of ATF4 and XBP1 genes, and vice versa with EZH2 inhibition. In addition, enrichment in the global acetylation levels at histone H3 and H4 was observed, cooperatively facilitating the opening of the chromatin and the accessibility to transcriptional regulators. In accordance with these results, we demonstrate that blockage of the JMJD3 and KDM4C enzymes, responsible for demethylation of H3K9me3 and H3K27me3 marks, respectively, using the SD-70 and GSKJ4 epigenetic drugs, inhibits ATF4 and XBP1 expression under ER stress conditions and, consequently, the triggering of a maladaptative response. CONCLUSION Changes in the chromatin dynamics mediated by the H3K9me3 and H3K27me3 histone marks are key to regulate the expression of the UPR transcription factors ATF4 and XBP1 after ER stress activation. Pharmacological treatment with the epigenetic drugs SD-70 and GSKJ4 blocks the expression of these TFs and thus, the activation of the pathophysiological processes that contribute to aggravate renal damage triggered by the UPR pathway activation. [1] Yan M., et al. Endoplasmic reticulum stress in ischemic and nephrotoxic acute kidney injury. Ann Med. 2018, 50: 381–390. [2] Hetz, C.; et al. Mechanisms, regulation and functions of the unfolded protein response. Nat Rev Mol Cell Biol. 2020, 21: 421–438.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 1465709-0
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  • 7
    In: Nephrology Dialysis Transplantation, Oxford University Press (OUP), Vol. 38, No. Supplement_1 ( 2023-06-14)
    Abstract: The vitamin D receptor (VDR) is a nuclear receptor that acts as a ligand-induced transcription factor regulating the renal expression of numerous genes with anti-inflammatory and anti-fibrotic effects, among others. For that, VDR requires the binding of its ligand, 1,25 (OH)2D3, to further heterodimerize with its co-activator, RXR, and translocate into the nucleus. Vitamin D deficiency in patients with renal disease leads to a decrease in VDR-mediated signaling and, consequently, of its beneficial functions. Additionally, these patients have intestinal dysbiosis, which leads to alterations in the production of microbial metabolites. Short-chain fatty acids (SCFAs) are metabolites with a clear anti-inflammatory and immunoregulatory role. Until now, some studies have studied their role as regulators of the inflammation and oxidative stress during the renal damage.1,2 However, their role in the VDR-mediated signaling in the kidney and the potential consequences to prevent the progression of the disease have not yet been explored in detail. Method The tubular epithelial cell line, HK2, was used to analyze the effect of the SCFAs, Propionate (Prop,1-15mM) and Butyrate (But, 0.5-3 mM), in the VDR expression and their target-genes. In vitro treatment with histone deacetylases (HDACs) inhibitors and specific HDAC1 and HDAC3 siRNAs were used to determine the role of both SCFAs as epigenetic remodelers. The binding of VDR to HDAC1/3 and RXR was determined by ChIP and co-immunoprecipitation assays. The in vivo effect of these SCFAs was evaluated in an acute kidney injury mice model induced by folic acid (250 mg/kg) and administration of Prop (200mg/kg) or But (500mg/kg) at different time points. The expression of VDR and its target genes, inflammatory cell infiltration, renal damage markers and renal function parameters were evaluated at shorter (24h) and longer times (40 days). Results Treatment of tubular cells with Prop and But induces, in a dose-dependent manner, the VDR gene transcription. This effect is similar to the one obtained by using specific inhibitors and siRNA treatments against HDAC1/3. We determine using ChIP assay, that HDAC1/3 are recruited to the promoter regions of the VDR gene, blocking its expression. In presence of Prop and But, these HDACs are displaced, increasing the acetylation levels and VDR transcription. Moreover, Prop and But prevent the degradation of VDR by the proteasome, increasing its stability and enhancing VDR protein levels. In the presence of both SCFAs, VDR dimerizes with RXR initiating its translocation to the nucleus and allowing the transcription of its dependent genes, such as Cyp24a1 and E-cadherin. Of note, VDR activation by Prop and But is additive to the effect achieved by the vitamin D alone. In vivo studies reported that administration of Prop or But prevents the loss of VDR expression 24h after induction of the damage, leading to its activation and to the expression of its target genes. Additionally, a decrease in the recruitment of neutrophils to the kidney was observed associated to a reduced expression of IL-6. These changes are accompanied by a decrease of the kidney damage markers (KIM-1 and NGAL) and a significant reduction of the creatinine and blood urea nitrogen serum levels. In a second model of AKI-to CKD transition, administration of both SCFAs shows a decrease in the inflammatory (Ccl20, Ccl2, Lif, Ltb, Csf2SF2, Il18, Ccl5, Tnf-α) and pro-fibrotic markers (Fsp1, α-Sma, Col1a1, Fn1) and a partial recovery of the glomerular filtration rate at long term. Conclusion Propionate and Butyrate, not only induce the VDR gene transcription in renal tubular cells but are also able to stabilize and activate the VDR protein. Accordingly, both metabolites are able to restore the loosed expression and activation of VDR due to induced renal damage, reduce the infiltration of immune cells, and partially recover the renal function. Thus, strategies aimed to increase the propionate and butyrate levels with postbiotics could be useful to ameliorate the AKI renal damage and CKD transition.
    Type of Medium: Online Resource
    ISSN: 0931-0509 , 1460-2385
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 1465709-0
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  • 8
    In: JNCI: Journal of the National Cancer Institute, Oxford University Press (OUP), Vol. 112, No. 6 ( 2020-06-01), p. 590-598
    Abstract: More than 180 single nucleotide polymorphisms (SNPs) associated with breast cancer susceptibility have been identified; these SNPs can be combined into polygenic risk scores (PRS) to predict breast cancer risk. Because most SNPs were identified in predominantly European populations, little is known about the performance of PRS in non-Europeans. We tested the performance of a 180-SNP PRS in Latinas, a large ethnic group with variable levels of Indigenous American, European, and African ancestry. Methods We conducted a pooled case-control analysis of US Latinas and Latin American women (4658 cases and 7622 controls). We constructed a 180-SNP PRS consisting of SNPs associated with breast cancer risk (P  & lt; 5 × 10–8). We evaluated the association between the PRS and breast cancer risk using multivariable logistic regression, and assessed discrimination using an area under the receiver operating characteristic curve. We also assessed PRS performance across quartiles of Indigenous American genetic ancestry. All statistical tests were two-sided. Results Of 180 SNPs tested, 142 showed directionally consistent associations compared with European populations, and 39 were nominally statistically significant (P  & lt; .05). The PRS was associated with breast cancer risk, with an odds ratio per SD increment of 1.58 (95% confidence interval [CI = 1.52 to 1.64) and an area under the receiver operating characteristic curve of 0.63 (95% CI = 0.62 to 0.64). The discrimination of the PRS was similar between the top and bottom quartiles of Indigenous American ancestry. Conclusions The 180-SNP PRS predicts breast cancer risk in Latinas, with similar performance as reported for Europeans. The performance of the PRS did not vary substantially according to Indigenous American ancestry.
    Type of Medium: Online Resource
    ISSN: 0027-8874 , 1460-2105
    RVK:
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2992-0
    detail.hit.zdb_id: 1465951-7
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  • 9
    In: Europace, Oxford University Press (OUP), Vol. 25, No. 9 ( 2023-08-02)
    Abstract: Left ventricular ejection fraction (LVEF) is suboptimal as a sole marker for predicting sudden cardiac death (SCD). Machine learning (ML) provides new opportunities for personalized predictions using complex, multimodal data. This study aimed to determine if risk stratification for implantable cardioverter-defibrillator (ICD) implantation can be improved by ML models that combine clinical variables with 12-lead electrocardiograms (ECG) time-series features. Methods and results A multicentre study of 1010 patients (64.9 ± 10.8 years, 26.8% female) with ischaemic, dilated, or non-ischaemic cardiomyopathy, and LVEF ≤ 35% implanted with an ICD between 2007 and 2021 for primary prevention of SCD in two academic hospitals was performed. For each patient, a raw 12-lead, 10-s ECG was obtained within 90 days before ICD implantation, and clinical details were collected. Supervised ML models were trained and validated on a development cohort (n = 550) from Hospital A to predict ICD non-arrhythmic mortality at three-year follow-up (i.e. mortality without prior appropriate ICD-therapy). Model performance was evaluated on an external patient cohort from Hospital B (n = 460). At three-year follow-up, 16.0% of patients had died, with 72.8% meeting criteria for non-arrhythmic mortality. Extreme gradient boosting models identified patients with non-arrhythmic mortality with an area under the receiver operating characteristic curve (AUROC) of 0.90 [95% confidence intervals (CI) 0.80–1.00] during internal validation. In the external cohort, the AUROC was 0.79 (95% CI 0.75–0.84). Conclusions ML models combining ECG time-series features and clinical variables were able to predict non-arrhythmic mortality within three years after device implantation in a primary prevention population, with robust performance in an independent cohort.
    Type of Medium: Online Resource
    ISSN: 1099-5129 , 1532-2092
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2002579-8
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