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.

BACKGROUND: is the commonly used marker of oxidative stress-derived DNA damage. 8-OxodG formation is regulated by local antioxidant capacity and DNA repair enzyme activity. Earlier studies have reported contradictory data on the function of 8-oxodG as a prognostic factor in different cancer types. METHODS: We assessed pre-operative serum 8-oxodG levels with an enzyme-linked immunosorbent assay in a well-defined series of 173 breast cancer patients. 8-OxodG expression in the nuclei of cancer cells from 150 of these patients was examined by immunohistochemistry. RESULTS: The serum 8-oxodG levels and immunohistochemical 8-oxodG expression were in concordance with each other (Po0.05). Negative 8-oxodG immunostaining was an independent prognostic factor for poor breast cancer-specific survival according to the multivariate analysis (Po0.01). This observation was even more remarkable when ductal carcinomas only (n ¼ 140) were considered (Po0.001). A low serum 8-oxodG level was associated statistically significantly with lymphatic vessel invasion and a positive lymph node status. CONCLUSIONS: Low serum 8-oxodG levels and a low immunohistochemical 8-oxodG expression were associated with an aggressive breast cancer phenotype. In addition, negative 8-oxodG immunostaining was a powerful prognostic factor for breast cancer-specific death in breast carcinoma patients.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

32Objectives 33 To evaluate serum AMH levels in polycystic ovary syndrome (PCOS) and in its different 34 phenotypes in relation to clinical, endocrine and metabolic parameters using a new automated 35 VIDAS® method and to compare it with the Gen II method. 36Study design 37 Multi-centre study including 319 PCOS women and 109 healthy controls. 38 Results 39Serum AMH levels measured using VIDAS® were significantly higher in PCOS women than 40 controls (p<0.001), and they correlated with those measured using the AMH Gen II method. 41 An AMH cut-off value of 42.1pmol/L distinguished PCOS women from controls with 67% 42 sensitivity and 83% specificity. The PCOS women with three Rotterdam criteria or 43 hyperandrogenism displayed significantly higher AMH levels compared with those with two 44 Rotterdam criteria or normoandrogenism. In PCOS, AMH levels correlated positively with 45 luteinizing hormone (LH), androgen and sex hormone-binding globulin (SHBG) levels and 46 negatively with BMI, abdominal obesity, follicle-stimulating hormone (FSH), fasting glucose 47 and insulin, and insulin resistance. 48 Conclusions 49 AMH evaluated using the VIDAS® method distinguished PCOS patients from healthy 50 controls relatively well, especially in those with more severe phenotypes. Further studies are 51 needed to establish whether AMH measurements can distinguish PCOS patients with different 52 metabolic risk factors.53 3 Phenotype of PCOS, Metabolic risks 55 56Polycystic ovary syndrome (PCOS) is characterized by oligoamenorrhoea (OA), 57 hyperandrogenism (HA) and polycystic ovary morphology (PCOM) on ultrasound (1,2). The 58 diagnosis of the syndrome requires the presence of at least two of the three aforementioned 59 criteria (3, 4). 60AMH is a member of the transforming growth factor-beta superfamily produced by the 61 ovarian granulosa cells (5). The main physiological roles of AMH in the ovary are the 62 prevention of primordial follicles recruitment and the modulation of FSH action in early 63 follicular development (6,7). Serum AMH levels are correlated with the ovarian antral follicle 64 count (AFC) in women with and without PCOS (8,9). As AMH levels are strongly correlated 65 with both biochemical HA and AFC, studies have suggested that AMH levels could be used 66 as a surrogate tool of PCOM in the diagnosis of PCOS (10,11). However, AMH assays lack 67 an international standard, and concentrations and cut-off values are method dependent. 68The presence of relatively high AMH levels in the peripheral circulation suggests that 69 circulating AMH may have also a function outside the reproductive system. Low AMH levels 70 could be associated with cardiovascular disease and metabolic disorders (12) whereas 71 elevated AMH levels seem to be related to PCOS severity (13,14,15,16,17,18). 72In a population study of Nordic Caucasian women, our first objective was to evaluate serum 73 AMH levels and their diagnostic value in PCOS using the VIDAS® (bioMérieux SA, Marcy-74 l'Etoile, France) kit. Our second aim was to exami...