Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

The chemokine receptor CXCR3 and its ligands CXCL9, CXCL10 and CXCL11 in neuroimmunity - a tale of conflict and conundrum The chemokines CXCL9, CXCL10 and CXCL11 (also known as monokine induced by interferon-gamma, interferon-inducible protein-10 and interferon-inducible T cell alpha-chemoattractant, respectively) are structurally and functionally related molecules within the non-ELR CXC chemokine subgroup. These chemokines are generally not detectable in most non-lymphoid tissues under physiological conditions but are strongly induced by cytokines, particularly interferon-gamma, during infection, injury or immunoinflammatory responses. CXCL9, CXCL10 and CXCL11 each bind to a common primary receptor, CXCR3, and possibly to additional receptors. They are best known for their role in leucocyte trafficking, principally acting on activated CD4+ Th1 cells, CD8+ T cells and NK cells. An abundance of data demonstrates that CXCL9, CXCL10 and CXCL11 are produced in many diverse pathologic conditions of the central nervous system. More recent attention has focussed on the function of these chemokines in the central nervous system inflammation. The results of these studies have proven to be sometimes surprising and other times contradictory. Here we discuss the likely more subtle and perhaps divergent roles for these chemokines in the pathogenesis of neuroinflammatory diseases.

Knowing the travel-time distributions from infiltrating rivers to pumping wells is important in the management of alluvial aquifers. Commonly, travel-time distributions are determined by releasing a tracer pulse into the river and measuring the breakthrough curve in the wells. As an alternative, one may measure signals of a time-varying natural tracer in the river and in adjacent wells and infer the travel-time distributions by deconvolution. Traditionally this is done by fitting a parametric function such as the solution of the one-dimensional advection-dispersion equation to the data. By choosing a certain parameterization, it is impossible to determine features of the travel-time distribution that do not follow the general shape of the parameterization, i.e., multiple peaks. We present a method to determine travel-time distributions by nonparametric deconvolution of electric-conductivity time series. Smoothness of the inferred transfer function is achieved by a geostatistical approach, in which the transfer function is assumed as a second-order intrinsic random time variable. Nonnegativity is enforced by the method of Lagrange multipliers. We present an approach to directly compute the best nonnegative estimate and to generate sets of plausible solutions. We show how the smoothness of the transfer function can be estimated from the data. The approach is applied to electric-conductivity measurements taken at River Thur, Switzerland, and five wells in the adjacent aquifer, but the method can also be applied to other time-varying natural tracers such as temperature. At our field site, electric-conductivity fluctuations appear to be an excellent natural tracer.

The chemokine receptor CXCR3 promotes the trafficking of activated T and NK cells in response to three ligands, CXCL9, CXCL10, and CXCL11. Although these chemokines are produced in the CNS in multiple sclerosis and experimental autoimmune encephalomyelitis (EAE), their role in the pathogenesis of CNS autoimmunity is unresolved. We examined the function of CXCR3 signaling in EAE using mice that were deficient for CXCR3 (CXCR3−/−). The time to onset and peak disease severity were similar for CXCR3−/− and wild-type (WT) animals; however, CXCR3−/− mice had more severe chronic disease with increased demyelination and axonal damage. The inflammatory lesions in WT mice consisted of well-demarcated perivascular mononuclear cell infiltrates, mainly in the spinal cord and cerebellum. In CXCR3−/− mice, these lesions were more widespread throughout the CNS and were diffused and poorly organized, with T cells and highly activated microglia/macrophages scattered throughout the white matter. Although the number of CD4+ and CD8+ T cells infiltrating the CNS were similar in CXCR3−/− and WT mice, Foxp3+ regulatory T cells were significantly reduced in number and dispersed in CXCR3−/− mice. The expression of various chemokine and cytokine genes in the CNS was similar in CXCR3−/− and WT mice. The genes for the CXCR3 ligands were expressed predominantly in and/or immediately surrounding the mononuclear cell infiltrates. We conclude that in EAE, CXCR3 signaling constrains T cells to the perivascular space in the CNS and augments regulatory T cell recruitment and effector T cell interaction, thus limiting autoimmune-mediated tissue damage.

Persons with immune deficiency may present with atypical results in serological tests for hepatitis B virus (HBV). Frozen serum specimens that were sequentially obtained over time from a cohort of 57 HIV-infected patients, all of whom tested positive only for antibody to hepatitis B core antigen (anti-HBcAg), were therefore retested for HBV markers, including HBV DNA. The results were assessed for their time course and correlated with clinical data and alanine aminotransferase (ALT) values. Forty-eight patients were male; intravenous drug users constituted the principal risk group (n = 30), followed by homosexual men (n = 22). Thirty-three persons tested positive for antibody to hepatitis C virus (anti-HCV). During a median of 31 months from the first to the last serum, anti-HBcAg remained the sole marker of HBV infection in 98.2% of the patients. Polymerase chain reaction (PCR) to detect DNA for HBV core and HBV surface gene was positive in 126 (62.4%) and 121 (59.9%) of all 202 serum samples, respectively. Over time, HBV DNA was detected at least once in 51 (89.5%) patients. In contrast, decomplexed hepatitis B surface antigen (HBsAg) was detected at least once in 14 (24.6%) patients. Among patients positive for HBV DNA and negative for anti-HCV, eight (36.4%) of 22 had chronic hepatitis (ALT elevation > or = 6 months) that was attributable only to persisting HBV infection. Similarly, 12 (41.4%) of 29 patients positive for both HBV DNA and anti-HCV had chronic viral hepatitis, but their ALT values were significantly higher. In HIV-infected patients, anti-HBcAg as the sole serological HBV marker detected must be considered indicative of chronic HBV infection and is in part associated with chronic hepatitis and ALT elevation.

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The interferon (IFN) family of cytokines, in addition to their involvement in cell growth regulation and antitumor protection, are pivotal mediators in the innate and adaptive immune responses to microbial pathogens such as viruses and bacteria (reviewed in references 6 and 14). These cytokines fall into two distinct subgroups, type I (containing many members, including IFN-␣ and IFN-␤) and type II (containing a single member, IFN-␥). The type I IFNs are produced by a wide variety of cells in direct response to infection by viruses and bacteria, while type II IFN production is largely restricted to activated CD4-positive Th1 and CD8-positive T lymphocytes and natural killer cells.Type I and type II IFNs signal through separate unique cognate receptors, IFNAR (type I IFNs) and IFNGR (type II IFN), and activate signaling cascades primarily involving the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway (reviewed in references 29 and 36). The binding of the IFNs triggers receptor subunit heterodimerization, and the consequent activation of receptorassociated JAKs (type I IFN receptors, Jak1 and Tyk2; type II IFN receptors, Jak1 and Jak2). This leads to the recruitment of specific STAT molecules to the receptor and their subsequent phosphorylation by the JAKs. For the type I IFN-stimulated pathway, STAT1 and STAT2 molecules are recruited and activated by JAK-mediated tyrosine phosphorylation, before dissociating from the receptor complex and forming a heterodimer. This STAT1/STAT2 heterodimer then translocates to the nucleus and associates with a third molecule, IFN regulatory factor 9 (IRF-9). The heterotrimeric complex formed, IFN-stimulated gene factor 3 (ISGF3), binds to the cis-acting IFN-stimulated response element (ISRE), located upstream of most type I IFN-regulated genes. The type II IFN signaling pathway differs from the type I IFN pathway in that STAT1 molecules are recruited to the IFNGR and, after tyrosine phosphorylation, dissociate to form homodimers (gamma-activated factor [GAF]) that migrate to the nucleus and bind to a DNA recognition motif called the gamma activation sequence (GAS). In each case, the binding of ISGF3 to the ISRE or GAF to the GAS results in the altered transcription of a large number of overlapping as well as distinct genes (7).Gene expression profiling studies have found three genes within the extensive category of IFN-stimulated genes (ISGs) to be among the most responsive in a variety of both human

Infiltration of Ly6Chi monocytes from the blood is a hallmark of viral encephalitis. In mice with lethal encephalitis caused by West Nile virus (WNV), an emerging neurotropic flavivirus, inhibition of Ly6Chi monocyte trafficking into the brain by anti-very late antigen (VLA)-4 integrin antibody blockade at the time of first weight loss and leukocyte influx resulted in long-term survival of up to 60% of infected mice, with subsequent sterilizing immunity. This treatment had no effect on viral titers but appeared to be due to inhibition of Ly6Chi macrophage immigration. Although macrophages isolated from the infected brain induced WNV-specific CD4+ T-cell proliferation, T cells did not directly contribute to pathology, but are likely to be important in viral control, as antibody-mediated T-cell depletion could not reproduce the therapeutic benefit of anti-VLA-4. Instead, 70% of infiltrating inflammatory monocyte-derived macrophages were found to be making nitric oxide (NO). Furthermore, aminoguanidine-mediated inhibition of induced NO synthase activity in infiltrating macrophages significantly prolonged survival, indicating involvement of NO in the immunopathology. These data show for the first time the therapeutic effects of temporally targeting pathogenic NO-producing macrophages during neurotropic viral encephalitis.