Prenatal gunshot wound, a rare cause of maternal and fetus trauma, a case report

Background: Gunshot wounds in pregnant women, although rare, represent an important cause of fetal and maternal mortality. Understanding the mechanism of injury is essential to identify the possible injuries and to adequately manage the complexity of these emergency scenarios. Case presentation: We present a case of a 27-year-old woman and her 37 week fetus who were the victims of a gunshot wound. The trajectory of the bullet injured not only the mother but also the developing fetus. An emergency c-section was performed and the bullet was removed from the infant's abdomen. The two patients fully recovered and on follow up controls both patients are doing well. Conclusions: Trauma events, and particularly gunshot wounds in pregnant women requires promptly and adequate intervention. Coordinated efforts from multidisciplinary clinical teams are needed as well as the appropriate training in maternal and infant resuscitative measures and surgical techniques

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A contribution to the determination of polychlorobenzenes in sediments

A full analytical procedure involving extraction and clean-up is presented for the determination of the tri-, tetra-, penta- and hexa-chlorobenzenes in sediments. For this study, the gas chromatography coupled to electronic capture detection was used. The samples were dried with sodium sulphate and Soxhlet extracted for 16 hours with dichloromethane. Then this solvent was replaced by hexane and the resulting solution was concentrated in a rotary evaporator. The clean-up process consisted of elution through a mixed silica column followed by a treatment with activated copper turnings to remove the sulphur. The sample was then concentrated down to 2 mL by nitrogen stream. The internal standard, 1,4-dibromobenzene, was added to the sample prior to the extraction, whereas the injection standard, 1,3,5-tribromobenzene, was added right before the sample was injected through the chromatographic system. The limits of quantification ranged from 71 to 500 pg g -1 (dry weight). The reproducibility in the peak areas within a day was better for the compounds with increasing number of chlorines, whereas the reproducibility over time studies provided no significant differences in the peak areas in consecutive days. The method was successfully applied to the determination of polychlorobenzenes in a certified sediment and, finally, it was applied to the determination of these compounds in several sections of a sediment core from Esthwaite Water Lake (United Kingdom)

Molecular marker development and application for improving qualities in bread wheat

Molecular marker technology has provided a novel and efficient tool for improving qualities in bread wheat. This chapter summarizes progress in gene cloning, gene specific marker (functional marker) development and validation, establishment of high-throughput platform in genotyping, as well as integration of molecular marker technology with conventional quality testing and traditional breeding since 2000. Comparative genomic approach was used to discover more than 20 loci controlling important quality traits, and to develop and validate around 66 gene-specific markers for quality traits such as high- and low-molecular-weight glutenin subunits, color associated traits including polyphenol oxidase (PPO) and yellow pigment, as well as starch parameters. Now the availability of reference wheat genome sequence and on-going efforts to sequence diverse wheat cultivars would offer new opportunities to identify loci responsible for various quality traits through improved genome-wide association study (GWAS) and analytical approaches. Development of high-throughput genotyping platform such as SNP arrays, genotyping-by-sequencing (GBS) and Kompetitive Allele-specific PCR (KASP) have been well-established and will accelerate molecular breeding progress for quality improvement. New cultivars carrying excellent bread-making quality and outstanding agronomic performance such as Zhongmai 1062 and Jimai 23 were developed. Future strategies in using molecular markers in the context of gene-editing to fine tune allelic effects are also discussed

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Plant neighbour identity and invasive pathogen infection affect associational resistance to an invasive gall wasp

Theory predicts that mixed forests are more resistant to native pests than pure forests (i.e. associational resistance) because of reduced host accessibility and increased top-down control by natural enemies. Yet, whether the same mechanisms also apply to invasive pests remains to be verified. We tested the hypothesis of associational resistance against the invasive Asian chestnut gall wasp (ACGW, Dryocosmus kuriphilus) by comparing ACGW infestation rates on chestnuts (Castanea sativa) in stands varying in species composition (chestnut alone or associated with oaks, pines or ashes). We investigated the effects of reduced chestnut density and frequency in mixed stands, as well as the effect of biotic interactions between ACGW, its parasitoids and the chestnut blight disease (caused by Cryphonectria parasitica). ACGW infestation rates were significantly lower in chestnut-oak and chestnut-ash mixtures than in pure chestnut stands and chestnut-pine mixtures. Infestation rate decreased with decreasing chestnut relative proportion. The composition of native parasitoid communities emerged from galls significantly differed between pure and mixed chestnut stands, but not the species richness or abundance of parasitoids. The abundance of the introduced parasitoid Torymus sinensis was not correlated with ACGW infestation rates and was independent of stand composition. Blight symptoms modified ACGW infestation rates with taller trees being preferred when they were asymptomatic but avoided when they presented blight disease damage. Our results suggest that conservation biological control based on tree species mixtures could contribute to reducing the damage of invasive forest pests