Can Chronic Nitric Oxide Inhibition Improve Liver and Renal Dysfunction in Bile Duct Ligated Rats?

The aims of the present work were to study the effects of chronic NO inhibition on liver cirrhosis and to analyze its relationship with liver and kidney damage markers. Two inhibitors of NO synthesis (inducible NO synthase (iNOS) inhibitor, aminoguanidine (AG), and nonselective NOS inhibitor, L-nitroarginine methyl ester (L-NAME)) were administered for 6 weeks to bile duct ligated (BDL) rats 3 days after surgery. The present study showed that BDL was associated with liver injury and renal impairment. BDL increased liver NO content and myeloperoxidase (MPO) activity. This was corroborated by increased oxidative stress, TNF-α, TGF-1β, and MMP-13 genes overexpression. Although both drugs reduced NO synthesis and TNF-α gene overexpression, only AG improved renal dysfunction and liver damage and reduced liver oxidative stress. However, L-NAME exacerbated liver and renal dysfunction. Both drugs failed to modulate TGF-1β and MMP-13 genes overexpression. In conclusion, inhibition of NO production by constitutive nitric oxide synthase (cNOS) plays a crucial role in liver injury and renal dysfunction while inhibition of iNOS by AG has beneficial effect. TNF-α is not the main cytokine responsible for liver injury in BDL model. Nitric oxide inhibition did not stop the progression of cholestatic liver damage

Effect of a Self-Etch Adhesive Containing Nanobioglass on Postoperative Sensitivity of Posterior Composite Restorations - A Randomized Trial

BACKGROUND: Postoperative sensitivity is one of the major problems regarding posterior resin composite restorations that causes patient discomfort, maybe a reason for replacement of the restoration with an additional office time. AIM: To evaluate the effect of the addition of a Nanobioglass to a self-etch adhesive on the reduction of post-operative sensitivity following composite restorations versus a self-etch adhesive that is free of Nanobioglass agent. MATERIALS AND METHODS: Sixteen patients having class II carious lesions were included in the study. After cavity preparation, each tooth was randomised to one of the following restorative treatments. Teeth in the control group were restored using self-etch adhesive (OptiBond All-In-One, Kerr) that is free of nanobioglass agent, and nano-hybrid resin composite (Herculite Ultra, Kerr). Restoration of teeth in the experimental group was similar to the control except that a nanobioglass agent was added to the self-etch adhesive. Patients were contacted for evaluation of postoperative sensitivity at 1 day, 1 week, 1 month, and 3 months. Data were analyzed using friedmann test followed by fisher exact test. RESULTS: The experimental group (self-etch adhesive containing nanobioglass) showed a significantly less postoperative sensitivity compared with the control group (Self-etch adhesive free of nanobioglass) at 1 day, and 1-week evaluation periods. While both groups did not possess any significant difference at 1 month, and 3 months periods. CONCLUSION: The problem of postoperative sensitivity following resin composite restorations could be solved by the addition of bioglass nanoparticles into dental adhesives

L'impact de l'environnement sur la pratique du contrôle de gestion : Cas des hypermarchés marocains

  In an attempt to analyze the impact of contingency factors, specifically the "environment" determinant, on the practice of management control in large retail outlets, particularly Moroccan hypermarkets, an empirical study was carried out with a view to quantifying the impact of each item making up the "environment" explanatory variable on the "management control" response variable. To this end, a semi-structured interview was conducted with management control professionals and practitioners in Moroccan hypermarkets, providing significant results for these items on the practice of financial, commercial, managerial and organizational management control. However, this survey was carried out using the multiple linear regression method in order to measure the contribution of these items on the different angles of the practice of management control in this type of commercial structure.   Key words: Environment, management control, contingency, Morocco Classification JEL : C10, D01, D22 Paper type :  Empirical ResearchDans une tentative d’analyser l’incidence des facteurs de contingence, spécifiquement le déterminant « environnement » sur la pratique du contrôle de gestion dans les grandes surfaces commerciales, notamment les hypermarchés marocains, une étude empirique a été mise en œuvre dans un motif de quantifier l’impact de chaque item constituant la variable explicative « environnement » sur la variable réponse « contrôle de gestion ». Dans ce sillon, un entretien semi-directif a été entamé auprès des professionnels et praticiens de contrôle de gestion dans les hypermarchés au Maroc, permettant des résultats significatifs de ces items sur la pratique du contrôle de gestion dans le volet financier, commercial, managérial, et organisationnel. Toutefois, cette prospection a été réalisée à l’aide de la méthode de régression linéaire multiple afin de mesurer la contribution de ces items sur les différents angles de la pratique du contrôle de gestion dans ce type de structure commerciale.   Mots clés : Environnement, contrôle de gestion, contingence, Maroc JEL Classification : C10, D01, D22 Type du papier : Recherche empiriqu

Challenges of providing healthcare worker education and training in protracted conflict: a focus on non-government controlled areas in north west Syria

Without healthcare workers (HCWs), health and humanitarian provision in Syria cannot be sustained either now or in the post-conflict phase. The protracted conflict has led to the exodus of more than 70% of the healthcare workforce. Those remaining work in dangerous conditions with insufficient resources and a healthcare system that has been decimated by protracted conflict. For many HCWs, particularly those in non-government-controlled areas (NGCAs) of Syria, undergraduate education and postgraduate training has been interrupted with few opportunities to continue. In this manuscript, we explore initiatives present in north west Syria at both undergraduate and postgraduate level for physician and non-physician HCWs. Conclusion: Challenges to HCW education in north west Syria can be broadly divided into 1. Organisational (local healthcare leadership and governance, coordination and collaboration between stakeholders, competition between stakeholders and insufficient funding.) 2. Programmatic (lack of accreditation or recognition of qualifications, insufficient physical space for teaching, exodus of faculty affecting teaching and training, prioritisation of physicians over non-physicians, informally trained healthcare workers.) 3. Healthcare system related (politicisation of healthcare system, changing healthcare needs of the population, ongoing attacks on healthcare.) Locally implementable strategies including dedicated funding are key to supporting retention of HCWs and return during post-conflict reconstruction

Anti-uterine fibroid effect of standardized labisia pumila var. Alata extracts in vitro and in human uterine fibroid cancer xenograft model

Background: Uterine fibroids are a common type of solid tumor presenting in women of reproductive age. There are very few alternative treatment available from conventional treatment involving surgeries. Labisia pumila var. alata or locally known as ‘Kacip Fatimah’ was widely used as traditional medicine in Malaysia. This plant has been used to maintain a healthy female reproductive system. The present study aimed to evaluate anti fibroid potential of L. pumila extracts through in vitro apoptosis activity against uterine leiomyoma cells (SK-UT-1) and in uterine leiomyoma xenograft model. Evaluation of bioactive markers content were also carried out. Methods: Apoptotic induction of the extracts was determined by morphological examination of AO/PI dual staining assay by flourescent microscopy and flow cytometry analysis on Annexin V-FITC/PI stained cells. In vivo study was done in immune-compromised mouse xenograft model. HPLC analysis was employed to quantify marker compounds. Results: Morphological analysis showed L. pumila induced apoptosis in a dose dependent manner against SK-UT-1 cells. In vivo study indicated that L. pumila significantly suppressed the growth of uterine fibroid tumor. All tested extracts contain bioactive marker of gallic acid and cafeic acid. Conclusion: This work provide significant data of the potential of L. pumila in management of uterine fibroids

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

Volatile Compounds in Citrus Essential Oils: A Comprehensive Review

[EN] The essential oil fraction obtained from the rind of Citrus spp. is rich in chemical compounds of interest for the food and perfume industries, and therefore has been extensively studied during the last decades. In this manuscript, we provide a comprehensive review of the volatile composition of this oil fraction and rind extracts for the 10 most studied Citrus species: C. sinensis (sweet orange), C. reticulata (mandarin), C. paradisi (grapefruit), C. grandis (pummelo), C. limon (lemon), C. medica (citron), C. aurantifolia (lime), C. aurantium (bitter orange), C. bergamia (bergamot orange), and C. junos (yuzu). Forty-nine volatile organic compounds have been reported in all 10 species, most of them terpenoid (90%), although about half of the volatile compounds identified in Citrus peel are non-terpenoid. Over 400 volatiles of different chemical nature have been exclusively described in only one of these species and some of them could be useful as species biomarkers. A hierarchical cluster analysis based on volatile composition arranges these Citrus species in three clusters which essentially mirrors those obtained with genetic information. The first cluster is comprised by C. reticulata, C. grandis, C. sinensis, C. paradisi and C. aurantium, and is mainly characterized by the presence of a larger abundance of non-terpenoid ester and aldehyde compounds than in the other species reviewed. The second cluster is comprised by C. junos, C. medica, C. aurantifolia, and C. bergamia, and is characterized by the prevalence of mono- and sesquiterpene hydrocarbons. Finally, C. limon shows a particular volatile profile with some sulfur monoterpenoids and non-terpenoid esters and aldehydes as part of its main differential peculiarities. A systematic description of the rind volatile composition in each of the species is provided together with a general comparison with those in leaves and blossoms. Additionally, the most widely used techniques for the extraction and analysis of volatile Citrus compounds are also described.This work was supported in part by the European Commission Horizon 2020 program TRADITOM grant 634561 and TomGEM grant 679796 to JR and AG.González-Mas, M.; Rambla Nebot, JL.; López-Gresa, MP.; Blazquez, M.; Granell Richart, A. (2019). Volatile Compounds in Citrus Essential Oils: A Comprehensive Review. Frontiers in Plant Science. 10:1-18. https://doi.org/10.3389/fpls.2019.00012S11810Abreu, I., Da Costa, N. C., van Es, A., Kim, J.-A., Parasar, U., & Poulsen, M. L. (2017). Natural Occurrence of Aldol Condensation Products in Valencia Orange Oil. Journal of Food Science, 82(12), 2805-2815. doi:10.1111/1750-3841.13948Ahmed, M., Arpaia, M. L., & Scora, R. W. (2001). Seasonal Variation in Lemon (Citrus limonL. Burm. f) Leaf and Rind Oil Composition. Journal of Essential Oil Research, 13(3), 149-153. doi:10.1080/10412905.2001.9699646AKAKABE, Y., KUSUNOKI, A., TANAKA, R., & KANETSUNE, Y. (2010). A Comparison of Volatile Components of Setomi with Its Parent Cultivars. Bioscience, Biotechnology, and Biochemistry, 74(3), 659-662. doi:10.1271/bbb.90722AKAKABE, Y., SAKAMOTO, M., IKEDA, Y., & TANAKA, M. (2008). Identification and Characterization of Volatile Components of the Japanese Sour Citrus FruitCitrus nagato-yuzukichiTanaka. Bioscience, Biotechnology, and Biochemistry, 72(7), 1965-1968. doi:10.1271/bbb.80144Aliberti, L., Caputo, L., De Feo, V., De Martino, L., Nazzaro, F., & Souza, L. (2016). Chemical Composition and in Vitro Antimicrobial, Cytotoxic, and Central Nervous System Activities of the Essential Oils of Citrus medica L. cv. ‘Liscia’ and C. medica cv. ‘Rugosa’ Cultivated in Southern Italy. Molecules, 21(9), 1244. doi:10.3390/molecules21091244Alissandrakis, E. (2003). Ultrasound-assisted extraction of volatile compounds from citrus flowers and citrus honey. Food Chemistry, 82(4), 575-582. doi:10.1016/s0308-8146(03)00013-xAlonzo, G., Del Bosco, S. F., Palazzolo, E., Saiano, F., & Tusa, N. (2000). Citrus cybrid leaf essential oil. Flavour and Fragrance Journal, 15(2), 91-95. doi:10.1002/(sici)1099-1026(200003/04)15:23.0.co;2-xAsikin, Y., Maeda, G., Tamaki, H., Mizu, M., Oku, H., & Wada, K. (2015). Cultivation line and fruit ripening discriminations of Shiikuwasha (Citrus depressa Hayata) peel oils using aroma compositional, electronic nose, and antioxidant analyses. Food Research International, 67, 102-110. doi:10.1016/j.foodres.2014.11.015Asikin, Y., Taira, I., Inafuku-Teramoto, S., Sumi, H., Ohta, H., Takara, K., & Wada, K. (2012). The Composition of Volatile Aroma Components, Flavanones, and Polymethoxylated Flavones in Shiikuwasha (Citrus depressa Hayata) Peels of Different Cultivation Lines. Journal of Agricultural and Food Chemistry, 60(32), 7973-7980. doi:10.1021/jf301848sAsikin, Y., Taira, I., Inafuku, S., Sumi, H., Sawamura, M., Takara, K., & Wada, K. (2012). Volatile Aroma Components and Antioxidant Activities of the Flavedo Peel Extract of Unripe Shiikuwasha (Citrus depressa Hayata). Journal of Food Science, 77(4), C469-C475. doi:10.1111/j.1750-3841.2011.02604.xBelsito, E. L., Carbone, C., Di Gioia, M. L., Leggio, A., Liguori, A., Perri, F., … Viscomi, M. C. (2007). Comparison of the Volatile Constituents in Cold-Pressed Bergamot Oil and a Volatile Oil Isolated by Vacuum Distillation. Journal of Agricultural and Food Chemistry, 55(19), 7847-7851. doi:10.1021/jf070997qBen Hsouna, A., Ben Halima, N., Smaoui, S., & Hamdi, N. (2017). Citrus lemon essential oil: chemical composition, antioxidant and antimicrobial activities with its preservative effect against Listeria monocytogenes inoculated in minced beef meat. Lipids in Health and Disease, 16(1). doi:10.1186/s12944-017-0487-5Benelli, P., Riehl, C. A. S., Smânia, A., Smânia, E. F. A., & Ferreira, S. R. S. (2010). Bioactive extracts of orange (Citrus sinensis L. Osbeck) pomace obtained by SFE and low pressure techniques: Mathematical modeling and extract composition. The Journal of Supercritical Fluids, 55(1), 132-141. doi:10.1016/j.supflu.2010.08.015Benjamin, G., Tietel, Z., & Porat, R. (2013). Effects of Rootstock/Scion Combinations on the Flavor of Citrus Fruit. Journal of Agricultural and Food Chemistry, 61(47), 11286-11294. doi:10.1021/jf402892pBlanco Tirado, C., Stashenko, E. E., Combariza, M. Y., & Martinez, J. R. (1995). Comparative study of Colombian citrus oils by high-resolution gas chromatography and gas chromatography-mass spectrometry. Journal of Chromatography A, 697(1-2), 501-513. doi:10.1016/0021-9673(94)00955-9Blázquez, M. A., & Carbó, E. (2015). Control of Portulaca oleracea by boldo and lemon essential oils in different soils. Industrial Crops and Products, 76, 515-521. doi:10.1016/j.indcrop.2015.07.019Bonaccorsi, I. L., McNair, H. M., Brunner, L. A., Dugo, P., & Dugo, G. (1999). Fast HPLC for the Analysis of Oxygen Heterocyclic Compounds of Citrus Essential Oils†. Journal of Agricultural and Food Chemistry, 47(10), 4237-4239. doi:10.1021/jf990417sBoussaada, O., & Chemli, R. (2006). Chemical Composition of Essential Oils from Flowers, Leaves and Peel of Citrus aurantium L. var. amara from Tunisia. Journal of Essential Oil Bearing Plants, 9(2), 133-139. doi:10.1080/0972060x.2006.10643484Boussaada, O., Skoula, M., Kokkalou, E., & Chemli, R. (2007). Chemical Variability of Flowers, Leaves, and Peels Oils of Four Sour Orange Provenances. Journal of Essential Oil Bearing Plants, 10(6), 453-464. doi:10.1080/0972060x.2007.10643579Brophy, J. J., Goldsack, R. J., & Forster, P. I. (2001). The Leaf Oils of the Australian Species ofCitrus(Rutaceae). Journal of Essential Oil Research, 13(4), 264-268. doi:10.1080/10412905.2001.9699690Buettner, A., Mestres, M., Fischer, A., Guasch, J., & Schieberle, P. (2003). Evaluation of the most odour-active compounds in the peel oil of clementines (citrus reticulata blanco cv. clementine). European Food Research and Technology, 216(1), 11-14. doi:10.1007/s00217-002-0586-yCannon, R. J., Kazimierski, A., Curto, N. L., Li, J., Trinnaman, L., Jańczuk, A. J., … Chen, M. Z. (2015). Identification, Synthesis, and Characterization of Novel Sulfur-Containing Volatile Compounds from the In-Depth Analysis of Lisbon Lemon Peels (Citrus limonL. Burm. f. cv. Lisbon). Journal of Agricultural and Food Chemistry, 63(7), 1915-1931. doi:10.1021/jf505177rCarbonell-Caballero, J., Alonso, R., Ibañez, V., Terol, J., Talon, M., & Dopazo, J. (2015). A Phylogenetic Analysis of 34 Chloroplast Genomes Elucidates the Relationships between Wild and Domestic Species within the GenusCitrus. Molecular Biology and Evolution, 32(8), 2015-2035. doi:10.1093/molbev/msv082Casilli, A., Decorzant, E., Jaquier, A., & Delort, E. (2014). Multidimensional gas chromatography hyphenated to mass spectrometry and olfactometry for the volatile analysis of citrus hybrid peel extract. Journal of Chromatography A, 1373, 169-178. doi:10.1016/j.chroma.2014.11.023Chen, Y., Wu, J., Xu, Y., Fu, M., & Xiao, G. (2014). Effect of Second Cooling on the Chemical Components of Essential Oils from Orange Peel (Citrus sinensis). Journal of Agricultural and Food Chemistry, 62(35), 8786-8790. doi:10.1021/jf501079rCheong, M. W., Chong, Z. S., Liu, S. Q., Zhou, W., Curran, P., & Bin Yu. (2012). Characterisation of calamansi (Citrus microcarpa). Part I: Volatiles, aromatic profiles and phenolic acids in the peel. Food Chemistry, 134(2), 686-695. doi:10.1016/j.foodchem.2012.02.162Cheong, M.-W., Liu, S.-Q., Yeo, J., Chionh, H.-K., Pramudya, K., Curran, P., & Yu, B. (2011). Identification of Aroma-Active Compounds in Malaysian Pomelo (Citrus grandis(L.) Osbeck) Peel by Gas Chromatography-Olfactometry. Journal of Essential Oil Research, 23(6), 34-42. doi:10.1080/10412905.2011.9712279Cheong, M.-W., Loke, X.-Q., Liu, S.-Q., Pramudya, K., Curran, P., & Yu, B. (2011). Characterization of Volatile Compounds and Aroma Profiles of Malaysian Pomelo (Citrus grandis (L.) Osbeck) Blossom and Peel. Journal of Essential Oil Research, 23(2), 34-44. doi:10.1080/10412905.2011.9700445Chisholm, M. G., Jell, J. A., & Cass, D. M. (2003). Characterization of the major odorants found in the peel oil ofCitrus reticulata Blanco cv. Clementine using gas chromatography-olfactometry. Flavour and Fragrance Journal, 18(4), 275-281. doi:10.1002/ffj.1188Chisholm, M. G., Wilson, M. A., & Gaskey, G. M. (2003). Characterization of aroma volatiles in key lime essential oils (Citrus aurantifolia Swingle). Flavour and Fragrance Journal, 18(2), 106-115. doi:10.1002/ffj.1172Choi, H.-S. (2003). Characterization ofCitrus unshiu(C. unshiuMarcov. formaMiyagawa-wase) Blossom Aroma by Solid-Phase Microextraction in Conjunction with an Electronic Nose. Journal of Agricultural and Food Chemistry, 51(2), 418-423. doi:10.1021/jf0114280Choi, H.-S. (2003). Character Impact Odorants ofCitrusHallabong [(C. unshiuMarcov ×C. sinensisOsbeck) ×C. reticulataBlanco] Cold-Pressed Peel Oil. Journal of Agricultural and Food Chemistry, 51(9), 2687-2692. doi:10.1021/jf021069oChoi, H.-S. (2005). Characteristic Odor Components of Kumquat (Fortunella japonicaSwingle) Peel Oil. Journal of Agricultural and Food Chemistry, 53(5), 1642-1647. doi:10.1021/jf040324xChoi, H.-S. (2006). Lipolytic Effects of Citrus Peel Oils and Their Components. Journal of Agricultural and Food Chemistry, 54(9), 3254-3258. doi:10.1021/jf052409jChoi, H.-S., Kondo, Y., & Sawamura, M. (2001). Characterization of the Odor-Active Volatiles in Citrus Hyuganatsu (Citrus tamuranaHort. ex Tanaka). Journal of Agricultural and Food Chemistry, 49(5), 2404-2408. doi:10.1021/jf001467wChoi, H. S., Sawamura, M., & Kondo, Y. (2002). Characterization of the Key Aroma Compounds of Citrus flaviculpus Hort. ex Tanaka by Aroma Extraction Dilution Analysis. Journal of Food Science, 67(5), 1713-1718. doi:10.1111/j.1365-2621.2002.tb08711.xChung, H., Chung, W.-Y., Yoo, E.-S., Cho, S. K., Oh, S.-K., & Kim, Y.-S. (2012). Characterization of volatile aroma-active compounds in Dangyooja (Citrus grandis Osbeck). Journal of the Korean Society for Applied Biological Chemistry, 55(1), 133-136. doi:10.1007/s13765-012-0023-2Chung, M. S. (2012). Volatile compounds of the Hallabong (Citrus kiyomi × Citrus ponkan) blossom. Food Science and Biotechnology, 21(1), 285-290. doi:10.1007/s10068-012-0038-9Cosimi, S., Rossi, E., Cioni, P. L., & Canale, A. (2009). Bioactivity and qualitative analysis of some essential oils from Mediterranean plants against stored-product pests: Evaluation of repellency against Sitophilus zeamais Motschulsky, Cryptolestes ferrugineus (Stephens) and Tenebrio molitor (L.). Journal of Stored Products Research, 45(2), 125-132. doi:10.1016/j.jspr.2008.10.002Costa, R., Bisignano, C., Filocamo, A., Grasso, E., Occhiuto, F., & Spadaro, F. (2014). Antimicrobial activity and chemical composition ofCitrus aurantifolia(Christm.) Swingle essential oil from Italian organic crops. Journal of Essential Oil Research, 26(6), 400-408. doi:10.1080/10412905.2014.964428Costa, R., Dugo, P., Navarra, M., Raymo, V., Dugo, G., & Mondello, L. (2010). Study on the chemical composition variability of some processed bergamot (Citrus bergamia) essential oils. Flavour and Fragrance Journal, 25(1), 4-12. doi:10.1002/ffj.1949Craske, J. D., Suryadi, N., & Wootton, M. (2005). A comparison of the peel oil components of Australian native lime (Microcitrus australe) and Mexican lime (Citrus aurantifolia Swingle). Journal of the Science of Food and Agriculture, 85(3), 522-525. doi:10.1002/jsfa.2038Behzad, B. D. (2011). Comparison of volatile components of flower, leaf, peel and juice of Page mandarin [(Citrus reticulata var Dancy Citrus paradisi var Duncan) Citrus clementina]. African Journal of Biotechnology, 10(51), 10437-10446. doi:10.5897/ajb11.1069Delort, E., & Jaquier, A. (2009). Novel terpenyl esters from Australian finger lime (Citrus australasica) peel extract. Flavour and Fragrance Journal, 24(3), 123-132. doi:10.1002/ffj.1922Delort, E., Jaquier, A., Decorzant, E., Chapuis, C., Casilli, A., & Frérot, E. (2015). Comparative analysis of three Australian finger lime (Citrus australasica) cultivars: Identification of unique citrus chemotypes and new volatile molecules. Phytochemistry, 109, 111-124. doi:10.1016/j.phytochem.2014.10.023Dharmawan, J., Kasapis, S., Sriramula, P., Lear, M. J., & Curran, P. (2009). Evaluation of Aroma-Active Compounds in Pontianak Orange Peel Oil (Citrus nobilis Lour. Var.microcarpaHassk.) by Gas Chromatography−Olfactometry, Aroma Reconstitution, and Omission Test. Journal of Agricultural and Food Chemistry, 57(1), 239-244. doi:10.1021/jf801070rDong, Z. B., Shao, W. Y., & Liang, Y. R. (2014). Isolation and Characterization of Essential Oil Extracted from Tangerine Peel. Asian Journal of Chemistry, 26(16), 4975-4978. doi:10.14233/ajchem.2014.16277Družić, J., Jerković, I., Marijanović, Z., & Roje, M. (2016). Chemical biodiversity of the leaf and flower essential oils of Citrus aurantium L. from Dubrovnik area (Croatia) in comparison with Citrus sinensis L. Osbeck cv. Washington navel, Citrus sinensis L. Osbeck cv. Tarocco and Citrus sinensis L. Osbeck cv. Doppio Sanguigno. Journal of Essential Oil Research, 28(4), 283-291. doi:10.1080/10412905.2016.1159258Dugo, G., Bonaccorsi, I., Sciarrone, D., Costa, R., Dugo, P., Mondello, L., … Fakhry, H. A. (2011). Characterization of Oils from the Fruits, Leaves and Flowers of the Bitter Orange Tree. Journal of Essential Oil Research, 23(2), 45-59. doi:10.1080/10412905.2011.9700446Dugo, P., Mondello, L., Cogliandro, E., Verzera, A., & Dugo, G. (1996). On the Genuineness of Citrus Essential Oils. 51. Oxygen Heterocyclic Compounds of Bitter Orange Oil (Citrus aurantiumL.). Journal of Agricultural and Food Chemistry, 44(2), 544-549. doi:10.1021/jf950183mDugo, P., Mondello, L., Favoino, O., Cicero, L., Zenteno, N. A. R., & Dugo, G. (2004). Characterization of cold-pressed Mexican dancy tangerine oils. Flavour and Fragrance Journal, 20(1), 60-66. doi:10.1002/ffj.1367Elmaci, Y., & Onoğur, T. (2012). Mandarin peel aroma: Estimation by using headspace/GC/MS and descriptive analysis techniques. Acta Alimentaria, 41(1), 131-139. doi:10.1556/aalim.41.2012.1.15Fancello, F., Petretto, G. L., Zara, S., Sanna, M. L., Addis, R., Maldini, M., … Pintore, G. (2016). Chemical characterization, antioxidant capacity and antimicrobial activity against food related microorganisms of Citrus limon var. pompia leaf essential oil. LWT - Food Science and Technology, 69, 579-585. doi:10.1016/j.lwt.2016.02.018Fanciullino, A.-L., Gancel, A.-L., Froelicher, Y., Luro, F., Ollitrault, P., & Brillouet, J.-M. (2005). Effects of Nucleo-cytoplasmic Interactions on Leaf Volatile Compounds from Citrus Somatic Diploid Hybrids. Journal of Agricultural and Food Chemistry, 53(11), 4517-4523. doi:10.1021/jf0502855Fanciullino, A.-L., Tomi, F., Luro, F., Desjobert, J. M., & Casanova, J. (2006). Chemical variability of peel and leaf oils of mandarins. Flavour and Fragrance Journal, 21(2), 359-367. doi:10.1002/ffj.1658Feger, W., Brandauer, H., & Ziegler, H. (2000). Sesquiterpene hydrocarbons of cold-pressed lime oils. Flavour and Fragrance Journal, 15(4), 281-284. doi:10.1002/1099-1026(200007/08)15:43.0.co;2-wFeger, W., Brandauer, H., & Ziegler, H. (2001). Analytical Investigation of Sweetie Peel Oil. Journal of Essential Oil Research, 13(5), 309-313. doi:10.1080/10412905.2001.9712221Feger, W., Brandauer, H., & Ziegler, H. (2001). Germacrenes in Citrus Peel Oils. Journal of Essential Oil Research, 13(4), 274-277. doi:10.1080/10412905.2001.9699692Ferhat, M. A., Meklati, B. Y., & Chemat, F. (2007). Comparison of different isolation methods of essential oil fromCitrus fruits: cold pressing, hydrodistillation and microwave ‘dry’ distillation. Flavour and Fragrance Journal, 22(6), 494-504. doi:10.1002/ffj.1829Fischer, A., Grab, W., & Schieberle, P. (2007). Characterisation of the most odour-active compounds in a peel oil extract from Pontianak oranges (Citrus nobilis var. Lour. microcarpa Hassk.). European Food Research and Technology, 227(3), 735-744. doi:10.1007/s00217-007-0781-yFlamini, G., & Cioni, P. L. (2010). Odour gradients and patterns in volatile emission of different plant parts and developing fruits of grapefruit (Citrus paradisi L.). Food Chemistry, 120(4), 984-992. doi:10.1016/j.foodchem.2009.11.037Flamini, G., Tebano, M., & Cioni, P. L. (2007). Volatiles emission patterns of different plant organs and pollen of Citrus limon. Analytica Chimica Acta, 589(1), 120-124. doi:10.1016/j.aca.2007.02.053Fouad, H. A., & da Camara, C. A. G. (2017). Chemical composition and bioactivity of peel oils from Citrus aurantiifolia and Citrus reticulata and enantiomers of their major constituent against Sitophilus zeamais (Coleoptera: Curculionidae). Journal of Stored Products Research, 73, 30-36. doi:10.1016/j.jspr.2017.06.001Frizzo, C. D., Lorenzo, D., & Dellacassa, E. (2004). Composition and Seasonal Variation of the Essential Oils from Two Mandarin Cultivars of Southern Brazil. Journal of Agricultural and Food Chemistry, 52(10), 3036-3041. doi:10.1021/jf030685xFurneri, P. M., Mondello, L., Mandalari, G., Paolino, D., Dugo, P., Garozzo, A., & Bisignano, G. (2012). In vitro antimycoplasmal activity of citrus bergamia essential oil and its major components. European Journal of Medicinal Chemistry, 52, 66-69. doi:10.1016/j.ejmech.2012.03.005Gancel, A.-L., Ollé, D., Ollitrault, P., Luro, F., & Brillouet, J.-M. (2002). Leaf and peel volatile compounds of an interspecific citrus somatic hybrid [Citrus aurantifolia(Christm.) Swing. +Citrus paradisiMacfayden]. Flavour and Fragrance Journal, 17(6), 416-424. doi:10.1002/ffj.1119Gancel, A.-L., Ollitrault, P., Froelicher, Y., Tomi, F., Jacquemond, C., Luro, F., & Brillouet, J.-M. (2003). Leaf Volatile Compounds of Seven Citrus Somatic Tetraploid Hybrids Sharing Willow Leaf Mandarin (Citrus deliciosaTen.) as Their Common Parent. Journal of Agricultural and Food Chemistry, 51(20), 6006-6013. doi:10.1021/jf0345090Gancel, A.-L., Ollitrault, P., Froelicher, Y., Tomi, F., Jacquemond, C., Luro, F., & Brillouet, J.-M. (2005). Leaf Volatile Compounds of Six Citrus Somatic Allotetraploid Hybrids Originating from Various Combinations of Lime, Lemon, Citron, Sweet Orange, and Grapefruit. Journal of Agricultural and Food Chemistry, 53(6), 2224-2230. doi:10.1021/jf048315bGonzález-Mas, M. C., Rambla, J. L., Alamar, M. C., Gutiérrez, A., & Granell, A. (2011). Comparative Analysis of the Volatile Fraction of Fruit Juice from Different Citrus Species. PLoS ONE, 6(7), e22016. doi:10.1371/journal.pone.0022016Högnadóttir, Á., & Rouseff, R. L. (2003). Identification of aroma active compounds in orange essence oil using gas chromatography–olfactometry and gas chromatography–mass spectrometry. Journal of Chromatography A, 998(1-2), 201-211. doi:10.1016/s0021-9673(03)00524-7Hosni, K., Zahed, N., Chrif, R., Abid, I., Medfei, W., Kallel, M., … Sebei, H. (2010). Composition of peel essential oils from four selected Tunisian Citrus species: Evidence for the genotypic influence. Food Chemistry, 123(4), 1098-1104. doi:10.1016/j.foodchem.2010.05.068Huang, H.-H., Lin, L.-Y., Chiang, H.-M., Lay, S.-J., Wu, C.-S., & Chen, H.-C. (2017). Analysis of Volatile Compounds from Different Parts ofCitrus grandis(L.) Osbeck Flowers by Headspace Solid-Phase Microextraction-Gas Chromatography-Mass Spectrometry. Journal of Essential Oil Bearing Plants, 20(4), 1057-1065. doi:10.1080/0972060x.2017.1377112Inafuku-Teramoto, S., Suwa, R., Fukuzawa, Y., & Kawamitsu, Y. (2011). Polymethoxyflavones, Synephrine and Volatile Constitution of Peels of Citrus Fruit Grown in Okinawa. Journal of the Japanese Society for Horticultural Science, 80(2), 214-224. doi:10.2503/jjshs1.80.214Jabalpurwala, F. A., Smoot, J. M., & Rouseff, R. L. (2009). A comparison of citrus blossom volatiles. Phytochemistry, 70(11-12),

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

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&nbsp;years; 78.2% included were male with a median age of 37&nbsp;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

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