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

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Utilization of shellfish waste: Effects of Chitosan from shrimp shell waste on fatty acid profiles of European eel

The effects of chitosan extracted from shrimp (Metapenaeus stebbingi) shell waste and commercial chitosan on fatty acid profile of European eel (Anguilla anguilla) fillet pieces during refrigerated storage were investigated. Fish pieces samples were treated with aqueous solution of 0.1 and 1% extracted and commercial chitosan, and then stored at 4°C for 18 days. The fillet pieces samples were analyzed periodically for fatty acid analysis. No statistically significant change was detected in the total saturated fatty acid (SFA) contents of eel fillet pieces in the all groups at the end of storage (p>0.05). There were no significant difference in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) contents of the groups added 1% extracted and commercial chitosan (p>0.05), while a percentage decrease was determined in MUFA and PUFA contents of groups control, added 0.1% extracted and commercial chitosan at the end of storage (p<0.05). It was concluded appropriate to use chitosan obtained from shrimp shells not evaluated and discarded as waste products in Turkey during the storage of fatty fish like eel.This work was supported by Scientific Research Fund of Cukurova University in Turkey

Load distribution on the foot and lofstrand crutches of amputee football players

Background: Amputee football is a worldwide popular sport with positive physical and psychological effects on the disabled. Amputee players use their hands dominantly for locomotion. However, the effect of using upper extremity which is not accommodated to loading is not very well known. Research question: The objective of this study was to determine the load distribution of amputee football players during walking, running and kicking the ball. Methods: This study was conducted with 15 certified amputee football players (age 24.5 +/- 5.8 years, body weight 62.3 +/- 10.9 kg, height 171.6 +/- 7.7 cm). The loads on their non-amputated lower extremity were measured with F-Scan mobile system sensors inserted in their shoes, and the loads on their upper extremities were measured with F-Grip system sensors affixed to the gloves. The participants were asked to walk, run and kick the ball using Lofstrand Crutches. Results: The maximum loading on the upper extremities during walking, running and kicking the ball varied between 111% and 175% of the body weight. While loading during walking and running was similar, the loading on the upper extremity during kicking the ball exceeded that of walking by 58.1% and running by 47.4%. The maximum loading on the non-amputated lower extremity varied between 134% and 196% of the body weight. Loading during running was 46.2% higher than that of walking. The loading on the foot during kicking the ball was 45.7% higher than that of walking. The loading on the foot during running and kicking were similar. Significance: Walking-running-kicking the ball with LC resulted in unusual loading particularly on the upper extremity. During running, the increased loading was transferred to the foot rather than the hands. During kicking, the loading increased extremely and was mainly transferred to the hands. The frequent repetition of kicking during the game may therefore increase the incidence of upper extremity injuries