Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved

Synergistic effect of combined treatments of gamma radiation and ethyl methanesulfonate in barley

In these experiments 3H-labelled ethyl methanesulfonate (EMS) was used to study the effect of gamma rays on the uptake of EMS by barley seeds and the resultant alkylation of macro-molecules. In a parallel experiment the combined effect of gamma rays and EMS on mutation frequency and efficiency was investigated. Gamma irradiation (10, 20 and 30 kR) inhibited the uptake of [3H]-EMS, resulting in fewer alkylations in the macromolecular fraction. In the combined treatments with unlabelled EMS, seedling injury as well as frequency of mitotic and meiotic chromosomal aberrations were less than additive. However, a synergistic effect of combined treatment was observed for the induction of chlorophyll mutations in the M2 generation. The results rule out the increased uptake of the chemical mutagen as the cause of the observed synergism, and suggest the interaction of radiation- and chemically-induced lesions

Modification of mutagenic efficiency of ethyl methanesulfonate with ethidium bromide, iodoacetamide and sodium fluoride in barley

In order to modify the cellular sieves through which a pre-mutational lesion must pass before it can be realized as a phenotypic change, barley seeds were treated with ethyl methanesulfonate (EMS) in combination with non-toxic concentrations of ethidium bromide (EB), iodoacetamide (IA) and sodium fluoride (NaF). Treatments with EMS, EB, IA and NaF alone served as controls. Pre- and post-treatments with the modifying chemicals were also investigated. Seeds treated with EMS and three different modifiers served as the various controls. The parameters considered were germination, seedling injury, plants with chlorophyll chimeras, mitotic and meiotic aberrations, pollen sterility and seed set in M1 and the frequency of chlorophyll mutations in M2. None of the modifiers at the concentrations used, induced chlorophyll mutations in M2. However, the presence of EB, IA and NaF at the same concentration during treatments with EMS, significantly enhanced the mutagenic effect of the latter. Pre- and post-treatment with IA also significantly enhanced the mutation frequency in M2 seedlings. Pre- and post-treatments of EB and NaF did not bring about significant alterations in the mutation rates

Correlation between EMS uptake by barley embryos under different treatment conditions and mutation frequency

Uptake of ethyl methanesulphonate and its alkylation in the TCA-insoluble fraction of embryo cell lysates was followed after hull-less barley seeds (karyopses) had been treated with 3H-labelled EMS. The effects of modifying factors such as pre-soaking of seeds in water before mutagen treatment, post-soaking and drying back after treatment were investigated. The effects of the same factors on M1 parameters and chlorophyll mutation frequencies in the M2 were studied in parallel experiments with "cold" EMS. The uptake of EMS on the dry matter basis was greater in the embryo than in the rest of the karyopses. Movement of the mutagen or its hydrolytic products into the embryo from seed endosperm was noted during germination. Enhanced mutation frequencies in M2, when pre-soaked seeds were treated, was partly due to greater uptake of mutagen. The mutagen and its hydrolytic products were leached out of the treated seeds during the post-soaking. This leaching out decreased the effect on M1 parameters but had no significant effect on mutation frequencies in the M2. Drying of seeds after treatment with the mutagen and storage for seven days increased alkylation in the TCA-insoluble fraction and enhanced mutagenic and also the deleterious effects. It is concluded that at least some of th differences in mutation frequencies after various treatment procedures were due to variation in the actual dose of the mutagen ultimately received by the target cells

Modification of mutagenic efficiency of ethyl methanesulfonate

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