Highlights d Gipr is expressed in the hypothalamus, as demonstrated using a new Gipr-Cre mouse model d Gipr cells included somatostatin-positive neurons, glia, and vascular cells d Gipr overlapped partially with Glp1r in human and mouse hypothalamus by RNAscope d Activation of Gipr neurons using local AAV-delivered G q-DREADDs reduced food intake

We read with great interest the study by Siyu Chen and colleagues. The authors evaluated the clinical features and outcomes of five pregnant patients with COVID-19 at term, whose delivery was uneventful and led to favorable perinatal outcomes for both mother and neonate. We would like to draw attention to a growing body of evidence that now points towards an under-addressed association between preterm maternal SARS-CoV-2 infection, preterm delivery and adverse neonatal outcomes, which is not reflected in Chen et al.'s small cohort. We also stress that vertical transmission, which was not tested for by Chen et al.,should not be excluded as a potential mechanism for viral spread. Centers should therefore be meticulous in their approach to a SARS-CoV-2+ pregnancy to optimize clinical outcomes for both mother and child.

Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.