Functional and informatics analysis enables glycosyltransferase activity prediction

The elucidation and prediction of how changes in a protein result in altered activities and selectivities remain a major challenge in chemistry. Two hurdles have prevented accurate family-wide models: obtaining (i) diverse datasets and (ii) suitable parameter frameworks that encapsulate activities in large sets. Here, we show that a relatively small but broad activity dataset is sufficient to train algorithms for functional prediction over the entire glycosyltransferase superfamily 1 (GT1) of the plant Arabidopsis thaliana. Whereas sequence analysis alone failed for GT1 substrate utilization patterns, our chemical–bioinformatic model, GT-Predict, succeeded by coupling physicochemical features with isozyme-recognition patterns over the family. GT-Predict identified GT1 biocatalysts for novel substrates and enabled functional annotation of uncharacterized GT1s. Finally, analyses of GT-Predict decision pathways revealed structural modulators of substrate recognition, thus providing information on mechanisms. This multifaceted approach to enzyme prediction may guide the streamlined utilization (and design) of biocatalysts and the discovery of other family-wide protein functions

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 < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; 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

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. Funding DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

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

Tempo máximo fonatório de /e/ e /ė/ não-vozeado e sua relação com índice de massa corporal e sexo em crianças

RESUMO Objetivo: caracterizar e associar tempo máximo fonatório do /e/ vozeado e de /e/ não vozeado (/ė/), índice de massa corporal e sexo em crianças. Métodos: estudo transversal observacional analítico de campo e quantitativo do qual participaram 102 crianças com idades entre oito e 12 anos (média de 9,66 anos), sendo 53 (51,96%) meninas e 49 (48,04%) meninos. Os sujeitos passaram por triagem auditiva, avaliação antropométrica e coleta dos tempos máximos fonatórios de /e/ e /ė/. Os dados foram analisados por meio dos testes não-paramétricos Mann-Whitney e Correlação de Spearman, com nível de significância de 5%. Resultados: não houve diferença dos tempos máximos fonatórios de /e/, /ė/ e relação ė/e em função do índice de massa corporal e faixa etária, porém crianças do sexo masculino apresentaram tempo máximo fonatório de /e/ significantemente maior do que as meninas. Não foi encontrada correlação entre tempo máximo fonatório e índice de massa corporal. Conclusão: não houve diferença entre tempo máximo fonatório de /ė/, /e/ e relação ė/e, conforme faixa etária e índice de massa corporal, bem como o índice de massa corporal e os tempos máximos fonatórios não se correlacionaram, evidenciando homogeneidade entre as medidas dentro do grupo, sem influência do índice de massa corporal sobre os tempos máximos fonatórios. Em relação ao sexo, os meninos apresentaram tempo máximo fonatório de /e/ maior do que as meninas e apenas as crianças de oito anos apresentaram os TMF tempo máximo fonatório dentro do esperado

Seedling formation and field production of beetroot and lettuce in Aquidauana, Mato Grosso do Sul, Brazil Formação de mudas e produção a campo de beterraba e alface em Aquidauana-MS

In horticulture, the proper use of containers and substrates for the production of seedlings are important factors that affect crop productivity in the field. This study aimed to evaluate the effect of different containers and substrates in the production of lettuce (Lactuca sativa, cv Veneranda) and beetroot (Beta vulgaris, cv Top Tall Early Wonder) seedlings in nursery with monofilament screen, 50% of shading, and the productivity of these species when transplanted to field plots. In protected cultivation, a completely randomized experimental design, in a 3 x 3 factorial scheme (three polystyrene trays, R1= 72, R2= 128 and R3= 200 cells and three substrates, S1= 93% of soil + 7% of organic compost, S2= 86% of soil + 14% of organic compost and S3= 79% of soil + 21% of organic compost) was used, with 15 replications, where one plantlet was a replication. In the field, the nine treatments were evaluated in a completely randomized experimental design. The 72 cells tray with 7% commercial organic compost substrate promoted the best beetroot and lettuce seedlings. In the field, the plants from the 72 cell tray produced greater plants, independent of substrates type.<br>Na olericultura o uso adequado de recipientes e substratos para a produção de mudas são fatores importantes e que afetam a produtividade das culturas a campo. No presente trabalho objetivou-se avaliar, em viveiro de tela de monofilamento com 50% de sombreamento, o efeito de diferentes recipientes e substratos na produção de mudas de alface (Lactuca sativa, cv Veneranda) e beterraba (Beta vulgaris, cv Top Tall Early Wonder), bem como a produtividade dessas espécies quando transplantadas em canteiros a campo. No ambiente protegido utilizou-se o delineamento experimental inteiramente casualizado, em esquema fatorial 3 x 3, sendo os fatores 3 recipientes (R1= 72, R2= 128 e R3= 200 células de poliestireno) e 3 substratos (S1= 93% de solo + 7% de composto orgânico, S2= 86% de solo + 14% de composto orgânico e S3= 79% de solo + 21% de composto orgânico), totalizando nove tratamentos com quinze repetições, onde a plântula constituiu a repetição. A campo os nove tratamentos foram dispostos nos canteiros sob delineamento inteiramente casualizado. A bandeja de 72 células em conjunto com o substrato contendo 7% de composto orgânico propiciaram as melhores mudas de beterraba e alface. No campo as plantas provenientes dessa bandeja apresentaram os melhores resultados, independente do tipo de substrato