Pathways to wheat self-sufficiency in Africa

A growing urban population and dietary changes increased wheat import bills in Africa to 9% per year. Though wheat production in the continent has been increasing over the past decades, to varying degrees depending on regions, this has not been commensurate with the rapidly increasing demand for wheat. Analyses of wheat yield gaps show that there is ample opportunity to increase wheat production in Africa through improved genetics and agronomic practices. Doing so would reduce import dependency and increase wheat self-sufficiency at national level in many African countries. In view of the uncertainties revealed by the global COVID-19 pandemic, extreme weather events, and world security issues, national policies in Africa should re-consider the value of self-sufficiency in production of staple food crops, specifically wheat. This is particularly so for areas where water-limited wheat yield gaps can be narrowed through intensification on existing cropland and judicious expansion of rainfed and irrigated wheat areas. Increasing the production of other sources of calories (and proteins) should also be considered to reduce dependency on wheat imports

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of leukocytospermia on sperm dynamic motility parameters, DNA and chromosomal integrity

Introduction To characterize sperm dynamic motility patterns and chromatin integrity in infertile men with leukocytospermia. Material and methods Fifty patients with primary infertility and oligoasthenoteratozoospermia included in this prospective, controlled, blind study. All patients underwent clinical evaluation, semen peroxidase stain, computer aided semen analysis (CASA), sperm DNA integrity evaluation with acridine orange test (AOT) and fluorescence in situ hybridization (FISH) analysis of 18, X and Y chromosomes. Pregnancy outcomes were documented following antibiotic treatment of patients with leukocytospermia. Results Infertile men with leukocytospermia had significantly lower progressive and total sperm motility percentages compared to the control group. Sperm dynamic motility parameters by CASA including curvilinear, straight line and average pathway velocities, straightness and amplitude of lateral head displacement were significantly lower in leukocytospermia. Sperm DNA fragmentation index was significantly higher in leukocytospermia. Percentages of sperm with disomy XY and 18 were significantly higher. These changes in sperm motility parameters and DNA integrity correlated with the number of peroxidase positive leukocytes. Follow-up of 23 of the 25 patients with leukocytospermia after antibiotic treatment revealed significantly higher pregnancy rates in cured patients than in those with persistent leukocytospermia. Conclusions Leukocytospermia has a significant impact on sperm dynamic motility patterns, DNA and chromosomal integrity in infertile men which can adversely affect the likelihood of a successful pregnancy

Is LigaSure a safe cystic duct sealer? An ex vivo study

Background: To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC). Methods: During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed ex vivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated. Results: The mean CDBP was 329.7 ± 38.8 mmHg in the ligaclip group, 358.0 ± 33.1 mmHg in the HS group, and 219.7 ± 41.2 mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p 195 mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150–297 mmHg, indicating that it is not safe for sealing. Conclusion: HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing

Is LigaSure a safe cystic duct sealer? An ex vivo study

To compare the efficacy and safety of both mechanical methods (clips) and electrosurgical instruments, harmonic scalpel (HS) and LigaSure (LS), for securing the cystic duct during laparoscopic cholecystectomy (LC). During the study period from October 2010 to October 2012, 458 patients with gallbladder stones underwent LC. A total of 38 patients were excluded from the study for different reasons. The gallbladder was excised laparoscopically through the traditional method. The gallbladder specimens of the patients were divided into three equal groups randomly, and the distal part of the cystic duct was sealed ex vivo using ligaclips (Group A), HS (Group B), and LS (Group C). The gallbladders were then connected to a pneumatic tourniquet device and we very gradually increased the pressure with air. The bursting pressure of the cystic duct (CDBP) was measured and differences between the three groups were calculated. The mean CDBP was 329.7 ± 38.8 mmHg in the ligaclip group, 358.0 ± 33.1 mmHg in the HS group, and 219.7 ± 41.2 mmHg in the LS group. A comparison of the mean CDBP between the groups indicated the superiority of HS over ligaclip and LS. CDBP was significantly higher in the ligaclips group compared with the LS group (p 195 mmHg) than the maximum common bile duct pressure, whereas for LS the CDBP range was 150–297 mmHg, indicating that it is not safe for sealing. HS is a safe alternative to clips. In fact, it was even safer than clips. By contrast, LS is not safe for cystic duct sealing

Puzzling out the role of MIAT LncRNA in hepatocellular carcinoma

A non-negligible part of our DNA has been proven to be transcribed into non-protein coding RNA and its intricate involvement in several physiological processes has been highly evidenced. The significant biological role of non-coding RNAs (ncRNAs), including long non-coding RNAs (lncRNAs) has been variously reported. In the current review, the authors highlight the multifaceted role of myocardial infarction-associated transcript (MIAT), a well-known lncRNA, in hepatocellular carcinoma (HCC). Since its discovery, MIAT has been described as a regulator of carcinogenesis in several malignant tumors and its overexpression predicts poor prognosis in most of them. At the molecular level, MIAT is closely linked to the initiation of metastasis, invasion, cellular migration, and proliferation, as evidenced by several in-vitro and in-vivo models. Thus, MIAT is considered a possible theranostic agent and therapeutic target in several malignancies. In this review, the authors provide a comprehensive overview of the underlying molecular mechanisms of MIAT in terms of its downstream target genes, interaction with other classes of ncRNAs, and potential clinical implications as a diagnostic and/or prognostic biomarker in HCC

Improvement in Physiochemical Characteristics of ‘Prime Seedless’ Grapes by Basal Defoliation with Foliar-Sprayed Low-Biuret Urea and Cyanocobalamin under Mediterranean Climate

In viticulture, the main target is to achieve high yield and good fruit quality without compromising vine growth. Methods to achieve this balance will vary with regard to climate and cultivar. A two-year study was conducted on five-year-old ‘Prime Seedless’ grapevines to evaluate the effect of leaf defoliation and the foliar application of low-biuret urea (LBU) and cyanocobalamin (CCA) on berry set percentage, the compactness coefficient of the clusters and the overall quality of clusters and berries. The removal of the first four basal leaves was conducted at the full-bloom (FB) stage, while LBU (5 g·L−1) and CCA (40 mg·L−1) were sprayed at three phenological stages: (1) when the cluster length reached ~10 cm long, (2) at FB and (3) one week after the fruit set. The results demonstrated that the sole application of basal leaf removal (BLR) or in combination with LBU and/or CCA improved the vegetative growth, total yield and physiochemical characteristics of clusters and berries, whereas the same treatments decreased berry set and shot berry percentages and the compactness coefficient of the clusters, which in turn led to looser clusters compared to the control. The most pronounced effect was recorded for the combined application of BLR, LBU and CCA, which revealed the highest values of shoot length, leaf area and the contents of chlorophyll, proline, N, P, K, Ca, Mg, Fe and Zn. The same treatment recorded the lowest berry set and shot berry percentages, compactness coefficient of clusters and decay percentage. Overall, this treatment was the best in terms of total yield, cluster weight, berry firmness, soluble solid content (SSC), the SSC/acid ratio, total sugars, total carotenoids, total phenols, phenylalanine ammonialyase and polyphenol oxidase