Assessment of benzoquinones and mycotoxins in cereal flour samples from Portugal within SafeGrains project

One of the most relevant problems in stored grain is the contamination by insects and mycotoxin-producing fungi. The red flour beetle, Tribolium castaneum (Herbst) (Coleoptera, Tenebrionidae), one of the major key-pests of milled grain, is resistant to Beauveria bassiana infection, producing benzoquinone-containing defensive secretions, that reduce fungal germination and growth. It can be affirmed that the tenebrionid cuticular secretions have antifungal properties. For T. castaneum, p-benzoquinones such as methyl-1,4-benzoquinone (MBQ) and ethyl-1,4-benzoquinone (EBQ) are major components of defensive secretions used as repellents and irritants. SafeGrains project (PTDC/ASP‐PLA/28350/2017) intends to contribute to clarify the interaction among pest infestation and associated benzoquinones and fungus and produced mycotoxins. The present study aims to implement and validate two HPLC methodologies to determine benzoquinones and mycotoxins in cereal flour samples. In a first attempt, HPLC methods will be optimized and validated for cereal flour samples (linearity and working range, limits of detection (LOD) and quantification (LOQ) as well as recovery). Once attained the satisfactory analytical conditions for these determinations, the presence of both chemicals will be quantified in 5 flour samples from Portugal, contaminated with insects (T. castaneum) or fungi (mycotoxin producer as Aspergillus sp) or both. Results will be presented and discussed concerning its contents in benzoquinones and mycotoxins and possible interactive effects.Portuguese Foundation for Science and Technology (FCT), through the research unit ID/AGR/04129/2013-LEAF and by project PTDC/ASP-PLA/28350/2017 (SafeGrains) and FCT/MEC-FEDER, within the PT2020 Partnership Agreement and Compete 2020 through CESAM (UID/AMB/50017/2019).N/

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)