New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective.

Surgical site infections (SSIs) are among the most preventable health-care-associated infections and are a substantial burden to health-care systems and service payers worldwide in terms of patient morbidity, mortality, and additional costs. SSI prevention is complex and requires the integration of a range of measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations of national guidelines have been identified. Given the burden of SSIs worldwide, the numerous gaps in evidence-based guidance, and the need for standardisation and a global approach, WHO decided to prioritise the development of evidence-based recommendations for the prevention of SSIs. The guidelines take into account the balance between benefits and harms, the evidence quality, cost and resource use implications, and patient values and preferences. On the basis of systematic literature reviews and expert consensus, we present 13 recommendations on preoperative preventive measures.

New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective.

Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.

Restoration of stressor-induced calcium dysregulation and autophagy inhibition by polyphenol-rich açaí (Euterpe spp.) fruit pulp extracts in rodent brain cells in vitro.

OBJECTIVES: Oxidative damage to lipids, proteins, and nucleic acids in the brain often causes progressive neuronal degeneration and death that are the focal traits of chronic and acute pathologies, including those involving cognitive decline. The aim of this study was to investigate the specific effects of both Euterpe oleracea and Euterpe precatoria açaí fruit pulp on restoring stressor-induced calcium dysregulation, stunted growth of basal dendrites, and autophagy inhibition using embryonic hippocampal and HT22 hippocampal neurons. METHODS: Water-soluble whole fruit pulp extracts from two açaí species were applied to rat primary neurons and HT22 hippocampal neurons with varied time and concentrations. Recovery of neurons from dopamine-induced Ca(2+) dysregulation was measured by live cell imaging using fluorescent microscopy. The effect of açaí fruit pulp extracts on neurons following chemically-induced autophagy inhibition was measured using both immunofluorescence and immunohistochemical techniques. RESULTS: It has been postulated that at least part of the loss of cognitive function in aging may depend on a dysregulation in calcium ion (Ca(2+)) homeostasis and a loss of autophagy function in the brain, which affects numerous signaling pathways and alters protein homeostasis. In the present study, polyphenol-rich fruit pulp extracts from two species of açaí, Euterpe precatoria and Euterpe oleracea, when applied to rat hippocampal primary neuronal cells (E18), caused a significant (P < 0.05) recovery of depolarized brain cells from dopamine-induced Ca(2+) influx. Autophagy, a protein homeostasis mechanism in brain, when blocked by known inhibitors such as bafilomycin A1 or wortmannin, caused a significant reduction in the growth of primary basal dendrites in rodent primary hippocampal neurons and significant accumulation of polyubiquitinated proteins in mouse HT22 hippocampal neurons in culture. However, pretreatment with açaí extracts up to 1 mg/mL significantly increased the length of basal dendrites and attenuated the inhibitor-induced autophagy dysfunction. Açaí extracts activated the phosphorylation of mammalian target of rapamycin, increased the turnover of autophagosomes and MAP1 B LC3-II, and decreased accumulation of LC3-ubiquitin binding P62/SQSTM1. CONCLUSION: Although the polyphenol profile of Euterpe precatoria showed substantially higher concentrations of major flavonoids han Euterpe oleracea, the relative effects were essentially similar for both species. The study adds to growing evidence that supports the putative health effects of açaí fruit species on brain cells.

Stilbenes and anthocyanins reduce stress signaling in BV-2 mouse microglia.

Blueberries contain an array of phytochemicals that may decrease both inflammatory and oxidative stress. This study determined if pterostilbene, resveratrol, and two anthocyanins commonly found in blueberries, delphinidin-3-O-glucoside and malvidin-3-O-glucoside, would be efficacious in protecting microglia from inflammatory-induced stress signaling. Microglia that were pretreated with blueberry extract (0.25, 0.5, 1, 2 mg/mL) or its components (1, 10, 20, 30 µM pterostilbene, resveratrol, delphinidin-3-O-glucoside, or malvidin-3-O-glucoside) prior to exposure to lipopolysaccharide (100 ng/mL) demonstrated concentration-dependent reductions in nitric oxide and tumor necrosis factor-alpha release and decreased expression of inducible nitric oxide synthase and cyclooxygenase-2. However, much higher concentrations of the individual components than those found in blueberries were needed to demonstrate the effects. For example, 1 mg/mL blueberry extract significantly reduced LPS-induced nitric oxide release; this concentration of blueberry extract contains 2.6 µM malvidin-3-O-glucoside, but when malvidin-3-O-glucoside was tested individually, 20 µM was necessary to observe a significant reduction in nitric oxide release. Therefore the protective effects of blueberries may not be due to any one component, but rather a synergism of the activity of the compounds tested and/or other blueberry compounds not tested here. These results lend further support that blueberry and its active components are able to combat some of the inflammatory mediators of aging at the cellular level.