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

Color Stable Deep Blue Multi‐Resonance Organic Emitters with Narrow Emission and High Efficiency

Abstract The development of highly efficient and deep blue emitters satisfying the color specification of the commercial products has been a challenging hurdle in the organic light‐emitting diodes (OLEDs). Here, deep blue OLEDs with a narrow emission spectrum with good color stability and spin‐vibronic coupling assisted thermally activated delayed fluorescence are reported using a novel multi‐resonance (MR) emitter built on a pure organic‐based molecular platform of fused indolo[3,2,1‐jk]carbazole structure. Two emitters derived from 2,5,11,14‐tetrakis(1,1‐dimethylethyl)indolo[3,2,1‐jk]indolo[1′,2′,3′:1,7]indolo[3,2‐b]carbazole (tBisICz) core are synthesized as the MR type thermally activated delayed fluorescence emitters realizing a very narrow emission spectrum with a full‐width‐at‐half‐maximum (FWHM) of 16 nm with suppressed broadening at high doping concentration. The tBisICz core is substituted with a diphenylamine or 9‐phenylcarbazole blocking group to manage the intermolecular interaction for high efficiency and narrow emission. The deep blue OLEDs achieve high external quantum efficiency (EQE) of 24.9%, small FWHM of 19 nm, and deep blue color coordinate of (0.16, 0.04) with good color stability with increase in doping concentration. To the authors’ knowledge, the EQE in this work is one of the highest values reported for the deep blue OLEDs that achieve the BT.2020 standard

Diversity and Communities of Fungal Endophytes from Four <i>Pinus</i> Species in Korea

Fungal endophytes are ubiquitous in nature. They are known as potential sources of natural products, and possible agents for biocontrol attributing to their ability to produce a repertoire of bioactive compounds. In this study, we isolated fungal endophytes from three different tissues (needle, stem and root) of four Pinus species (Pinus densiflora, Pinus koraiensis, Pnus rigida, and Pinus thunbergii) across 18 sampling sites in Korea. A total number of 5872 culturable fungal endophytes were isolated using standard culturing techniques. Molecular identification based on the sequence analyses of the internal transcribed spacer (ITS) or 28S ribosomal DNA revealed a total of 234 different fungal species. The isolated fungal endophytes belonged to Ascomycota (91.06%), Basidiomycota (5.95%) and Mucoromycota (2.97%), with 144 operational taxonomic units (OTUs) and 88 different genera. In all sampling sites, the highest species richness (S) was observed in site 1T (51 OTUs) while the lowest was observed in site 4T (27 OTUs). In terms of diversity, as measured by Shannon diversity index (H’), the sampling site 2D (H′ = 3.216) showed the highest while the lowest H’ was observed in site 2K (H’ = 2.232). Species richness (S) in three different tissues revealed that root and needle tissues are highly colonized with fungal endophytes compared to stem tissue. No significant difference was observed in the diversity of endophytes in three different tissues. Among the four Pinus species, P. thunbergii exhibited the highest species richness and diversity of fungal endophytes. Our findings also revealed that the environmental factors have no significant impact in shaping the composition of the fungal endophytes. Furthermore, FUNGuild analysis revealed three major classifications of fungal endophytes based on trophic modes namely saprotrophs, symbiotrophs, and pathotrophs in four Pinus species, with high proportions of saprotrophs and pathothrops

Genomic Insights into Nematicidal Activity of a Bacterial Endophyte, Raoultella ornithinolytica MG against Pine Wilt Nematode

Pine wilt disease, caused by the nematode Bursaphelenchus xylophilus, is one of the most devastating conifer diseases decimating several species of pine trees on a global scale. Here, we report the draft genome of Raoultella ornithinolytica MG, which is isolated from mountain-cultivated ginseng plant as an bacterial endophyte and shows nematicidal activity against B. xylophilus. Our analysis of R. ornithinolytica MG genome showed that it possesses many genes encoding potential nematicidal factors in addition to some secondary metabolite biosynthetic gene clusters that may contribute to the observed nematicidal activity of the strain. Furthermore, the genome was lacking key components of avermectin gene cluster, suggesting that nematicidal activity of the bacterium is not likely due to the famous anthelmintic agent of wide-spread use, avermectin. This genomic information of R. ornithinolytica will provide basis for identification and engineering of genes and their products toward control of pine wilt disease