28 research outputs found
Laparoscopic repair of posttraumatic diaphragmatic rupture. Report of three cases
No full textAbstractINTRODUCTIONPosttraumatic diaphragmatic rupture (PTDR) is a rare complication of thoracoabdominal injuries. In the emergency phase, it is generally treated via wide laparotomy. The laparoscopic approach is controversial and it is reserved for the chronic type of PTDR. Herein we present three cases of laparoscopic treatment of PTDR, one of which was conducted early after the injury.PRESENTATION OF CASEThe patients’ age was 42, 66 and 53 years and the time from the injury until the operation 1 week, 2 months and 4 years, respectively. Hernia involved the left hemidiaphragm in two patients and the right hemidiaphragm in the second patient. Prolapsing viscera were the omentum/stomach/spleen, the small intestine and the omentum/large bowel, respectively. The PTDR was diagnosed right after the injury of the first patient but its treatment was postponed until the fourth day of hospitalization because of severe respiratory distress due to bilateral pneumothorax, flail chest and extended bilateral lung contusions. All patients underwent laparoscopic operation and correction of the hernia with the use of non-absorbable sutures or endoclips in two patients. There were no serious intra- or postoperative complications and the patients were discharged 30, 5, 6 days after the operation. After a period of 1, 8 and 9 years, respectively the patients remain without clinical evidence of recurrence.DISCUSSIONTrauma is the major cause of acquired diaphragmatic hernias.CONCLUSIONLaparoscopy is an attractive approach for the management of chronic PTDR. Moreover, it may offer the benefits of minimally invasive surgery during the acute phase of injury in highly selected patients
External Validation of the American College of Surgeons Surgical Risk Calculator in Elderly Patients Undergoing General Surgery Operations
No full textPreoperative risk stratification in the elderly surgical patient is an essential part of contemporary perioperative care and can be done with the use of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). However, data on the generalizability of the ACS-SRC in the elderly is scarce. In this study, we report an external validation of the ACS-RC in a geriatric cohort. A retrospective analysis of a prospectively maintained database was performed including patients aged > 65 who underwent general surgery procedures during 2012–2017 in a Greek academic centre. The predictive ability of the ACS-SRC for post-operative outcomes was tested with the use of Brier scores, discrimination, and calibration metrics. 471 patients were included in the analysis. 30-day postoperative mortality was 3.2%. Overall, Brier scores were lower than cut-off values for almost all outcomes. Discrimination was good for serious complications (c-statistic: 0.816; 95% CI: 0.762–0.869) and death (c-statistic: 0.824; 95% CI: 0.719–0.929). The Hosmer-Lemeshow test showed good calibration for all outcomes examined. Predicted and observed length of stay (LOS) presented significant differences for emergency and for elective cases. The ACS-SRC demonstrated good predictive performance in our sample and can aid preoperative estimation of multiple outcomes except for the prediction of post-operative LOS
Anakinra Efficacy in COVID-19 Pneumonia Guided by Soluble Urokinase Plasminogen Activator Receptor: Association With the Inflammatory Burden of the Host
No full textBackground: Anakinra was approved by the European Medicines Agency and received Emergency Use Authorization by the United States Food and Drug Administration for patients with COVID-19 pneumonia at risk for severe respiratory failure (SRF) with blood levels of soluble urokinase plasminogen activator receptor (suPAR) ≥ 6 ng/mL. We report the final results of the phase II open-label single-arm SAVE trial in a large population. Methods: Patients with COVID-19 pneumonia and suPAR levels ≥ 6 ng/mL received subcutaneous anakinra 100 mg once daily for 10 days. The primary outcome was the incidence of SRF by day 14. Secondary outcomes were 30-day mortality, incidence of SRF according to time delay for start of treatment, safety, and associations with the inflammatory burden of the host. Results: From March 2020 to March 2022, a total of 992 patients were enrolled. The incidence of SRF was 18.8%, similar to the results of the phase III pivotal SAVE-MOREtrial. The overall 30-day mortality was 9.5%. Participants were divided into 4 subgroups according to time delay between symptoms onset and start of anakinra. The incidence of SRF was similar for all subgroups. Serious adverse events were reported in 15.4%; only 3 were possibly related to anakinra. The most common adverse event was increased liver function tests. A post hoc comparison with the pivotal phase III trial showed similar anakinra outcomes among patient subgroups by levels of inflammatory mediators and D-dimers. Conclusions: Results support the efficacy of anakinra as being similar to that of the pivotal registrational trial for COVID-19 pneumonia. The lack of a comparator group is a limitation. Trial Registration: ClinicalTrials.gov, NCT04357366 © 2024 The Author(s
The potential of using dynamic information flow analysis in data value prediction
No full textValue prediction is a technique to increase parallelism by attempting to overcome serialization constraints caused by true data dependences. By predicting the outcome of an instruction before it executes, value prediction allows data dependent instructions to issue and execute speculatively, hence increasing parallelism when the prediction is correct. In case of a misprediction, the execution is redone with the corrected value. If the benefit from increased parallelism outweighs the misprediction recovery penalty, overall performance could be improved. Enhancing performance with value prediction therefore requires highly accurate prediction methods. Most existing general value prediction techniques are local and future outputs of an instruction are predicted based on outputs from previous executions of the same instruction. In this paper, we explore the possibility of introducing highly accurate general correlating value predictor using dynamic information flow analysis. We use information theory to mathematically prove the validity and benefits of correlating value predictors. We also introduce the concept of linear value predictors, a new technique that predicts a new value from another one using a linear relation. We then conduct empirical analysis using programs from SPECjvm2008 and Siemens benchmarks. Our empirical measurements support our mathematical theory and allow us to make important observations on the relation between predictability of data values and information flow. Furthermore, we provide a scheme to select highly predictable variables, and explain when a specific value predictor can perform well and even outperform other predictors. Using a dynamic information flow analysis tool called DynFlow, we show that the values of a set of selected variables can be predicted with very high accuracy, up to 100percent, from previous history of the same variables or other variables that have strong information flow into the predicted variable. © 2010 ACM.ACM SIGARCH;IEEE TCPP and TCCA;IFIP WG 10.3; Austrian Acad Sci ViennaAhuja P, 1998, P 12 INT C SUP JUL, P101, DOI 10.1145-277830.277854; AKKARY H, 1998, MICRO 31 NOV; AKKARY H, 2003, ICS 17, P12; AKKARY H, 2008, IFMT NOV; ALZAWAWI AS, 2007, ISCA 34 JUN; ASANOVI K, 2006, UCBEECS2006183; Austin T.M, 1992, P 19 ANN INT S COMP, V20, P342; BISHOP M, 2002, COMPUTER SECURITY AR, P2; BORKAR S, 2007, 44 ACM IEEE DES AUT, V4, P746; BURTSCHER M, 1999, INT C PAR ARCH COMP, P66; Butler M., 1991, P 18 INT S COMP ARCH, P276, DOI 10.1145-115952.115980; CHRYSOS G. Z, 1998, P 25 ANN INT S COMP; Cover TM, 1991, ELEMENTS INFORM THEO; Dalton M., 2007, P 34 INT S COMP ARCH; Denning D. 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Prospective multicenter external validation of postoperative mortality prediction tools in patients undergoing emergency laparotomy
No full textBACKGROUND
Accurate preoperative risk assessment in emergency laparotomy (EL) is valuable for informed decision-making and rational use of resources. Available risk prediction tools have not been validated adequately across diverse healthcare settings. Herein, we report a comparative external validation of 4 widely cited prognostic models.
METHODS
A multicenter cohort was prospectively composed of consecutive patients undergoing EL in 11 Greek hospitals from January 2020 to May 2021 using the National Emergency Laparotomy (NELA) audit inclusion criteria. 30-day mortality risk predictions were calculated using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), NELA, Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and Predictive Optimal Trees in Emergency Surgery Risk (POTTER) tools. Surgeons’ assessment of postoperative mortality using pre-defined cutoffs was recorded, and a surgeon-adjusted ACS-NSQIP prediction was calculated when the original model’s prediction was relatively low. Predictive performances were compared using scaled Brier scores, discrimination and calibration measures and plots, and decision curve analysis. Heterogeneity across hospitals was assessed by random-effects meta-analysis.
RESULTS
631 patients were included and 30-day mortality was 16.3%. The ACS-NSQIP and its surgeon-adjusted version had the highest scaled Brier scores. All models presented high discriminative ability, with concordance statistics ranging from 0.79 for P-POSSUM to 0.85 for NELA. However, except the surgeon-adjusted ACS-NSQIP (Hosmer-Lemeshow test p = 0.742), all other models were poorly calibrated (p < 0.001). Decision curve analysis revealed superior clinical utility of the ACS-NSQIP. Following recalibrations, predictive accuracy improved for all models but ACS-NSQIP retained the lead. Between-hospital heterogeneity was minimum for the ACS-NSQIP model and maximum for P-POSSUM.
CONCLUSION
The ACS-NSQIP tool was most accurate for mortality predictions after EL in a broad external validation cohort, demonstrating utility for facilitating preoperative risk management in the Greek healthcare system. Subjective surgeon assessments of patient prognosis may optimise ACS-NSQIP predictions.
Level of Evidence
Level II, Diagnostic test/criteri
Leveraging strength-based dynamic information flow analysis to enhance data value prediction
No full textValue prediction is a technique to increase parallelism by attempting to overcome serialization constraints caused by true data dependences. By predicting the outcome of an instruction before it executes, value prediction allows data dependent instructions to issue and execute speculatively, hence increasing parallelism when the prediction is correct. In case of a misprediction, the execution is redone with the corrected value. If the benefit from increased parallelism outweighs the misprediction recovery penalty, overall performance could be improved. Enhancing performance with value prediction therefore requires highly accurate prediction methods. Most existing general value prediction techniques are local, that is, future outputs of an instruction are predicted based on outputs from previous executions of the same instruction. In this article, we investigate leveraging strength-based dynamic information flow analysis to enhance data value prediction. We use dynamic information flow analysis (DIFA) to determine when a specific value predictor can perform well and even outperform other predictors. We apply information theory to mathematically prove the validity and benefits of correlating value predictors. We also introduce the concept of the linear value predictors, a new technique that predicts a new value from another one using a linear relation. We finally present a variant of stride predictor that we call update stride. We then conduct an empirical analysis using Pin, a dynamic binary instrumentation tool, and DynFlow, a dynamic information flow analysis tool, that we apply to programs from the SPECjvm2008 and Siemens benchmarks. Our empirical measurements support our mathematical theory and allow us to make important observations on the relation between predictability of data values and information flow. Our analysis and empirical results show that the values of a set of selected variables can be predicted with a very high accuracy, up to 100percent. Such prediction is based on the previous history and-or the values of one or more other source variables that have strong information flow into the predicted variable. Using our selection criteria, we show that a DIFA-directed predictor outperforms hardware value prediction for all subject programs, and sometimes by a significant margin. This was observed even when using an ideal tagged hardware value prediction table that does not suffer from aliasing or capacity misses. © 2012 ACM 1544-3566-2012-03-ART1 $10.00.Ahuja P, 1998, P 12 INT C SUP JUL, P101, DOI 10.1145-277830.277854; AKKARY H., 2003, P 17 ANN INT C SUP, P12; AKKARY H, 1998, P ANN ACM IEEE INT S; AKKARY H., 2008, P INT FOR NEXT GEN M; Allison P.D., 1998, MULTIPLE REGRESSION; AL-ZAWAWI A. S., 2007, P 34 ANN INT S COMP; AUSTIN T. 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The ChoCO-W prospective observational global study: Does COVID-19 increase gangrenous cholecystitis?
No full textBackground: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical abstract: [Figure not available: see fulltext.] © 2022, The Author(s)
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
No full textAIM: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.METHOD: This was an international cohort study of patients undergoing elective colon or rectal cancer resection, without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2, and a comparison with a pre-pandemic European Society of Coloproctology cohort data.RESULTS: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. 30-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073), and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV2 (14/1601, 0.9%), and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with an anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20), and advanced cancer stage (3.43, 1.16-10.21). Compared to pre-pandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%), an overall shorter length of stay (6 versus 7 days), but higher mortality (1.7% versus 1.1%).CONCLUSION: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative, and organisational risks
Pseudochromis chrysospilus Gill & Zajonz, 2011, sp. nov.
No full textPseudochromis chrysospilus sp. nov. Gold-spotted Dottyback Figures 4–5; Tables 1–2 Holotype. SMF 29234, 56.1 mm SL, Socotra Archipelago, SW coast of Socotra Island, Ras Qatanin Bay, 12 o 21 ' 17 "N 53 o 32 ' 39 "E, large boulder (biotope code S5.1.5), 8–11 m, U. Zajonz & F.N. Saeed, 9 April 2000 (ST- 726). Paratypes. AMS I. 45575 -001, 1: 40.0 mm SL (cleared and stained), Socotra Archipelago, W coast of Socotra Island, Shuab Bay, Ras Asfar, 12 ° 39 ’ 24 ”N 53 ° 24 ’07”E, bedrock with encrusting corals and filter feeders in front of cliff (biotope code S4.2.3), 8–10 m, U. Zajonz & M. Apel, 9 March 1999 (ST-017); SMF 29207, 4: 31.1–42.6 mm SL, collected with AMS I. 45575 -001; SMF 33400, 3: 34.1–42.5 mm SL, collected with holotype; NHCY-P 4, 4: 38.9–51.6 mm SL, collected with holotype; SMF 33552, 1: 39.5 mm SL, Socotra Archipelago, Socotra Island, Ras Qatanin, 12 ° 21 ’ 21 ”N 53 ° 32 ’ 44 ’E, T. Alpermann, 11 February 2011; SMF 33553, 1: 44.9 mm SL, Socotra Archipelago, Socotra Island, Ras Shuab, 12 ° 31 ’ 39 ”N 53 ° 18 ’ 27 ”E, T. Alpermann, 11 February 2011; SMF 33554, 1: 50 mm SL, Socotra Archipelago, Socotra Island, Steroh, 12 ° 19 ’00”N 53 ° 52 ’ 51 ”E, T. Alpermann, 11 February 2011; SMF 33555, 1: 56.9 mm SL, Socotra Archipelago, Socotra Island, Ras Bidou, 12 ° 39 ’ 15 ”N 53 ° 23 ’ 51 ”E, H. Pulch & F.N. Saeed, 2 December 2009 (ST 09- 14-20); SMF 33556, 1: 64.7 mm SL, Socotra Archipelago, Socotra Island, Ras Qatanin, 12 ° 21 ’09”N 53 ° 32 ’ 36 ’E, H. Pulch & F.N. Saeed, 9 December 2009 (ST 09- 19 -01); SMF 33557, 1: 55.6 mm SL, Socotra Archipelago, Socotra Island, Ras Qatanin, 12 ° 20 ’ 31 ”N 53 ° 32 ’ 36 ’E, H. Pulch & F.N. Saeed, 10 December 2009 (ST 09- 20 - 18). Diagnosis. A species of Pseudochromis with the following combination of characters: dorsal-fin rays III, 28– 31; anal-fin rays III, 18–19; scales in lateral series 47–52; scales below lateral-line 12–15, usually 13–14; scales on upper flank each with dark blue to dark purple basal spot; and scales on posterior part of body with gold basal spots. Description (based on 19 specimens, 31.1–64.7 mm SL; data for all types followed, where variation was noted, by data for holotype in parentheses). Dorsal-fin rays III, 28–31 (III, 29), all or all but first 1–3 segmented rays branched (all segmented rays branched); anal-fin rays III, 18–19 (III, 19), all segmented rays branched; pectoral-fin rays 17–19 (19 / 19); upper procurrent caudal-fin rays 7–9 (8); lower procurrent caudal-fin rays 7–8 (7); total caudal-fin rays 31–34 (32); scales in lateral series 47–52 (51 / 49); anterior lateral-line scales 36–43 (42 / 40); anterior lateral line terminating beneath segmented dorsal-fin ray 21–26 (24 / 23); posterior lateral-line scales 5–13 + 0–2 (10 + 1 / 8 + 1); scales between lateral lines 3–4 (3 / 3); horizontal scale rows above anal-fin origin 12–15 + 1 + 2–4 = 16–19 (14 + 1 + 3 / 14 + 1 + 3); circumpeduncular scales 19–22 (20); predorsal scales 19–24 (20); scales behind eye 3; scales to preopercular angle 5–6 (6); gill rakers 3–5 + 10–12 = 14–17 (4 + 11); pseudobranch filaments 8–11 (11); circumorbital pores 33–76 (54 / 53); preopercular pores 16–42 (25 / 24); dentary pores 3–5 (5 / 5); posterior interorbital pores 1–5 (2). Lower lip incomplete; dorsal and anal fins without distinct scale sheaths, although often with intermittent small scales overlapping fin bases; predorsal scales extending anteriorly to point ranging from posterior AIO to mid AIO pores; opercle with 3–5 relatively distinct serrations; teeth of outer ceratobranchial- 1 gill rakers varying from moderately developed and running most of raker length, to mostly weakly developed with well-developed teeth confined to raker tips; anterior dorsal-fin pterygiophore formula S/S/S + 3 / 1 + 1 / 1 / 1 / 1 + 1 */ 1 + 1 * or S/S/S + 3 / 1 + 1 / 1 / 1 / 1 / 1 / 1 + 1 (S/S/S + 3 / 1 + 1 / 1 / 1 / 1 / 1 + 1); dorsal-fin spines stout and pungent; anterior anal-fin pterygiophore formula 3 / 1 + 1 /1, 3/ 1 + 1 / 1 + 1 or 3 + 1 / 1 + 1 / 1 (3 + 1 / 1 + 1 / 1); anal-fin spines relatively stout and pungent, second spine much stouter than third; pelvic-fin spine moderately stout and pungent; second segmented pelvic-fin ray usually longest, sometimes subequal to third; caudal fin truncate to emarginate, often with only upper lobe produced; vertebrae 10 + 16; epineurals 15–18 (17); epurals 3. Upper jaw with 2–4 pairs of curved, enlarged caniniform teeth anteriorly, and 4–5 (at symphysis) to 1–2 (on sides of jaw) inner rows of small conical teeth, outermost of rows of conical teeth much larger and more curved than inner rows; lower jaw with 2–4 pairs of curved, enlarged caniniform teeth anteriorly, and 3–4 (at symphysis) to 1 (on sides of jaw) inner rows of small conical teeth, teeth on middle of jaw larger and curved; vomer with 1–2 rows of small conical teeth, forming chevron; palatine with 1–3 rows of small conical teeth arranged in elongate, suboval patch, anterior part of tooth patch more-or-less contiguous with posterolateral arm of vomerine tooth patch; ectopterygoid edentate; tongue moderately pointed and edentate. As percentage of SL (based on 10 specimens, 34.1–64.7 mm SL): Head length 20.4–24.9 (21.9); orbit diameter 6.8–9.4 (7.7); snout length 4.8–5.9 (5.5); fleshy interorbital width 3.6–4.7 (3.6); bony interorbital width 2.5–3.1 (2.5); body width 19.6 – 11.7 (10.0); snout tip to posterior tip of retroarticular bone 10.2–13.5 (10.2); predorsal length 27.4–32.3 (29.1); prepelvic length 27.2–31.6 (28.5); posterior tip of retroarticular bone to pelvic-fin origin 16.8–20.1 (17.6); dorsal-fin origin to pelvic-fin origin 22.4–25.4 (24.4); dorsal-fin origin to middle dorsal-fin ray 32.3–37.1 (35.7); dorsal-fin origin to anal-fin origin 35.9–39.4 (37.1); pelvic-fin origin to anal-fin origin 27.0– 31.4 (28.7); middle dorsal-fin ray to dorsal-fin termination 23.8–29.4 (26.7); middle dorsal-fin ray to anal-fin origin 22.1–24.2 (23.4); anal-fin origin to dorsal-fin termination 33.9–38.3 (37.4); anal-fin base length 29.0– 35.2 (33.2); dorsal-fin termination to anal-fin termination 12.5–14.1 (13.4); dorsal-fin termination to caudal peduncle dorsal edge 9.5–11.8 (11.2); dorsal-fin termination to caudal peduncle ventral edge 16.3 –18.0 (17.1); anal-fin termination to caudal peduncle dorsal edge 16.0– 18.4 (18.0); anal-fin termination to caudal peduncle ventral edge 9.9–12.1 (11.9); first dorsal-fin spine 1.8–3.1 (2.9); second dorsal-fin spine 4.2–6.4 (4.6); third dorsal-fin spine 6.6–9.1 (7.7); first segmented dorsal-fin ray 10.2–11.5 (10.9); fourth last segmented dorsal-fin ray 13.8–15.2 (15.2); first anal-fin spine 1.8–2.7 (2.5); second anal-fin spine 4.2–6.5 (5.2); third anal-fin spine 5.1–7.3 (5.7); first segmented anal-fin ray 8.0–10.0 (8.9); fourth last segmented anal-fin ray 11.1–13.4 (13.4); third pectoral-fin ray 12.7–15.4 (13.2); pelvic-fin spine 7.4 –10.0 (7.5); second segmented pelvic-fin ray 14.7–17.4 (16.2); caudal-fin length 22.1–23.8 (23.4). Live coloration (based on field observations and colour slide of 42.5 mm SL paratype from Socotra; Figure 5). Head and body yellowish to orangish brown, darker dorsally, becoming purplish blue behind anal-fin origin; upper part of operculum and head with dark purplish blue spots; two or three slightly oblique, dark blue stripes on cheeks beneath eye; snout and lips dark grey; iris bright red to brown with bright blue oblique line above and below pupil; scales of nape and upper flanks (immediately behind and above pectoral-fin base) each with dark blue to dark purple basal spot; scales of remainder of body each with orange-brown to bright golden yellow basal spot; dorsal fin yellowish to reddish brown, with three to six rows of elongate dark blue to purple spots, these curving proximally posteriorly to form broken oblique lines; anal fin blue to bluish hyaline, with several rows of yellow spots, these strongest on basal part of fin; caudal fin dark purplish grey, becoming greyish hyaline posteriorly; each scale of caudal-fin base with orange-brown basal spot; pectoral fins yellowish hyaline, brown basally; pelvic fins greyish hyaline to hyaline. Preserved coloration. Pattern similar to live coloration, head and body becoming brown, paler ventrally; dark purple to blue spots on head, nape, flanks and dorsal fin become dark brown to dark grey, these darkest on flanks; stripes on cheek become brown, though often indistinct; dark grey-brown to dark grey spot usually present on edge of opercle immediately behind upper tip of preopercle; dark grey-brown stripe extending from midside of upper lip to midanterior edge of eye; orange-brown and yellow spots on body and fins become pale brown; caudal fin brown basally and brownish hyaline distally, usually with indistinct to distinct narrow, dark grey stripe near upper border of fin, and another near lower border; border of fin above and below stripes noticeably paler; pectoral fins and pelvic fins pale brown to hyaline. Habitat and distribution. Collected from the south-west coast of Socotra Island at Ras Qatanin Bay, around a large boulder in 8–11 m from a macroalgae dominated biotope with large sponges and very sparse encrusting hard coral on rock platform with gravelly sand, and from the west coast of Socotra Island at Shuab Bay, Ras Asfar in 8– 10 m on a sparse hard coral and filter feeder community on rock outcrops. Additional visual records were made in 2000 from a Porites dominated community on rock platform from the west coast near Ras Bidou (ST- 736, biotope code 6.6.1). Recently (2009, 2011) the species has been recorded (by H. Pulch, F.N. Saeed and T. Alpermann) from Ras Qatanin, Shuab Bay and Ras Bidou again, and from the south of Socotra (off Steroh village). The species has not been collected at any of the relatively sheltered hard coral dominated biotopes at the north and north-east coast of Socotra, indicating tentatively a preference for the rather harsh, monsoon and upwelling impacted habitats in the south and west of Socotra Island. Two visual records from Hawlaf and Di Hamri at the north coast might represent misidentifications. The species has thus far only been recorded from the shallow depth range of 3– 11 m. It does also not seem to inhabit the other islands of the Archipelago. This apparent range restriction requires confirmation. Comparisons. Pseudochromis chrysospilus belongs to a species complex (hereafter termed the “ P. caudalis - complex”) that includes P. caudalis Boulenger (1898) from the Persian Gulf to South Asia, P. m o o i i Gill (2004) from Komodo Island, Indonesia, and P. natalensis Regan (1916) from south-eastern Africa. Pseudochromis caudalis -complex species are distinguished from congeners in having relatively high numbers of segmented dorsal- and anal-fin rays (modally 27–30 and 17–19, respectively), relatively small scales (scales in lateral series usually 43– 50), and usually a large dark grey to dark greyish brown (bright blue in life) spot on the anterior part of the opercle behind the upper tip of the preopercle. Meristic characters separating the four species are summarised in Table 2. Pseudochromis chrysospilus differs from P. caudalis in having more segmented anal-fin rays (18–19, usually 19, vs. 17–19, rarely 19), more segmented dorsal-fin rays (28–31 vs. 28–29), and fewer scales below anterior lateral line (12–15, usually 13–14 vs. 15–17). It differs from P. m oo ii in having more segmented anal-fin rays (18–19, usually 19 vs. 17), more scales in lateral series (47–52 vs. 46) and fewer scales below anterior lateral line (12–15, usually 13–14 vs. 15). It differs from P. natalensis in having more segmented dorsal-fin rays (28–31 vs. 26–28, modally 27); more segmented anal-fin rays (18–19, usually 19 vs. 16–18, modally 17); more total caudal-fin rays (31–34, modally 32 vs. 29–32, modally 30); and more scales in lateral series (47–52 vs. 41–50, usually 44–46). It further differs from these species in live coloration, particularly in having dark blue to dark purple basal spots on scales on the upper flanks and gold spots on the posterior part of the body. Remarks. Research on the niche ecology and conservation genetics of P. chrysospilus is currently underway as part of a joint project of the second author with H. Pulch of the BiK-F. Etymology. The specific epithet is from the Greek “chrysos,” gold, and “spilos,” spot, and alludes to the distinctive gold spots on the body. Material examined. See above type material.Published as part of Gill, Anthony C. & Zajonz, Uwe, 2011, Pseudochromine and pseudoplesiopine dottyback fishes from the Socotra Archipelago, Indian Ocean, with descriptions of two new species of Pseudochromis Rüppell (Perciformes: Pseudochromidae), pp. 1-23 in Zootaxa 3106 on pages 7-9, DOI: 10.5281/zenodo.20178
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
No full textAim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks
