Upscaling of Apple By-Product by Utilising Apple Seed Protein as a Novel Wall Material for Encapsulation of Chlorogenic Acid as Model Bioactive Compound

Encapsulation is a versatile technique used to protect sensitive bioactive compounds under gastrointestinal conditions. In this study, nanoencapsulation of chlorogenic acid into the apple seed protein matrix was performed using the green technique ultrasonication to protect it from harsh gastric conditions and increase its biological activity and bioavailability upon digestion. Both nano (Nano-Chl) and native capsules (NT-Chl) were characterised by particle size, charge, structure, and morphology. The encapsulation efficiency, release behaviour, antioxidant and antidiabetic properties were also evaluated. The experimental results show that the particle size of the NT-Chl and Nano- Chl was found in the range of 1.4m to 708 nm. The encapsulation efficiency was found to be 69% and 80% for NT-Chl and Nano-Chl, respectively. Furthermore, an in vitro digestion study revealed that Nano-Chl showed controlled-release behaviour under simulated intestinal conditions in comparison to NT-Chl. Moreover, Nano-Chl showed enhanced antioxidant and antidiabetic activity in comparison to NT-Chl after simulated digestion. It was concluded that the protein from apple seeds could be utilised as a functional ingredient itself or as a wall material for the encapsulation of sensitive bioactive compounds. Furthermore, these encapsulated particles can be fortified into different food formulations for the development of functional food

Displaced calcaneal fractures, midterm results of the sinus tarsi approach and screw fixation

Background: We present the results of displaced intrarticular calcaneal fractures managed by limited sinus tarsi approach with good clinical and radiological outcome and less number of complications seen with conventional lateral approach.Methods: We operated 42 patients of displaced calcaneal fractures (Sanders type II and III) from April 2016 to March 2018 by open reduction and internal fixation with limited sinus tarsi approach by cannulated screws. All patients were evaluated clinically and radiologically before and after surgery. Final evaluation was done by Maryland Foot and Ankle score.Results: Patients were followed up for a mean period of 24 months. 30 patients returned to preinjury status activities while 12 patients confined themselves to sedentary schedule. The mean preoperative Bohler’s angle was 3.00 (range -30 to 20) while as mean postoperative Bohler’s angle was 26.4 (range 15 to 40). No wound dehiscence or skin necrosis was seen in our study. One patient developed superficial wound infection. Three patients reported prominent hardware related to screw heads. Four patients developed complex regional pain syndrome which was managed successfully at 6 month’s period.Conclusions: The limited sinus tarsi approach can be successfully used in displaced intra articular calcaneal fractures with good functional and radiological outcome. It allows good visualisation and reduction and can be used in patients with high risk. It is minimally invasive and undoubtly avoids the major soft tissue problems of extensile approach

Konservasi in Vitro Tanaman Jeruk Besar (Citrus Maxima (Burm.) Merr.) Kultivar Srinyonya Menggunakan Osmotikum Dan Retardan

In Vitro Conservation of Pomelo (Citrus maxima (Burm.)Merr.) cv Srinyonya Using Osmoticum and Retardant.Iswari S. Dewi, Gani Jawak, Ika Roostika, M. Sabda,Bambang S. Purwoko, and Widiati H. Adil. Pomelo is anunderutilized citrus fruit with a potential for commercialization.Only some cultivars have been conserved ex situ, suchas in home yards or in botanical gardens. Such collectionsare vulnerable to biotic and abiotic hazards. The goal of theexperiment was to study the effect of osmoticum (sorbitol)and retardant (ancymidol) on in vitro growth of pomelo.Four-leaf in vitro shoots of pomelo cultivar Srinyonya wereused as plant materials. Murashige-Skoog (MS) medium wasused as the basal medium for the culture. The trial wasarranged in a completely randomized design with threereplications. The treatments consisting of MS + sorbitol (0,20, 40, and 60 g/l) and MS + ancymidol (0, 1, 3, and 5 mg/l).The results indicated that based on plant height, number ofnew leaves, and visual plant architecture, sorbitol treatmentsfrom 20-60 g/l retard the growth of the pomelo plant significantly.On the other hand, ancymidol did not inhibit thepomelo growth significantly, but it was a suitable osmoticumfor improvement of in vitro plant vigor, increasing greencolor of leaf, and increasing root initiation. Leaf senescenceof in vitro plants cultured on media containing sorbitol 40and 60 g/l began 20 week after storage. The best medium forconservation of pomelo cv Srinyonya was MS + 20 gsorbitol/l

Konservasi In Vitro Tanaman Jeruk Besar (Citrus maxima (Burm.) Merr.) Kultivar Srinyonya Menggunakan Osmotikum dan Retardan

In Vitro Conservation of Pomelo (Citrus maxima (Burm.)Merr.) cv Srinyonya Using Osmoticum and Retardant.Iswari S. Dewi, Gani Jawak, Ika Roostika, M. Sabda,Bambang S. Purwoko, and Widiati H. Adil. Pomelo is anunderutilized citrus fruit with a potential for commercialization.Only some cultivars have been conserved ex situ, suchas in home yards or in botanical gardens. Such collectionsare vulnerable to biotic and abiotic hazards. The goal of theexperiment was to study the effect of osmoticum (sorbitol)and retardant (ancymidol) on in vitro growth of pomelo.Four-leaf in vitro shoots of pomelo cultivar Srinyonya wereused as plant materials. Murashige-Skoog (MS) medium wasused as the basal medium for the culture. The trial wasarranged in a completely randomized design with threereplications. The treatments consisting of MS + sorbitol (0,20, 40, and 60 g/l) and MS + ancymidol (0, 1, 3, and 5 mg/l).The results indicated that based on plant height, number ofnew leaves, and visual plant architecture, sorbitol treatmentsfrom 20-60 g/l retard the growth of the pomelo plant significantly.On the other hand, ancymidol did not inhibit thepomelo growth significantly, but it was a suitable osmoticumfor improvement of in vitro plant vigor, increasing greencolor of leaf, and increasing root initiation. Leaf senescenceof in vitro plants cultured on media containing sorbitol 40and 60 g/l began 20 week after storage. The best medium forconservation of pomelo cv Srinyonya was MS + 20 gsorbitol/l

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Time-dependent extraction kinetics of infused components of different Indian black tea types using UV spectroscopy

Time-dependent aqueous extraction of six tea types was carried out with leaf–water–ratio of 0.5 g/100 ml, temperature of extraction 90°C and time of extraction ranging from 1 to 10 min. UV–vis spectroscopic analysis in the range varying from 220 to 900 nm of the aqueous tea extracts showed a prominent peak at 273 nm in the ultraviolet region which can be associated with n → π* electronic transition of caffeine molecules. Parabolic diffusion, Power law, hyperbolic, Weibull’s and Elovich’s models were fitted to represent the aqueous soluble component extraction behaviour for time-dependent extraction of aqueous extractables. Parabolic diffusion model, Power law and Elovich’s model were a close fit to the experimental data for all the selected tea types with correlation coefficients (R2) ranging 0.8029–0.9953, whereas hyperbolic and Weibull’s models showed poor fitness to represent the extraction behaviour of fanning and AO leaf, LD, fanning and dust, respectively, with R2 < 0.8, for time-dependent aqueous soluble component extraction