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Herbaria are an important source of data and material useful in many fields, including plant conservation. Seeds preserved in herbarium specimens may have the potential to germinate, although few studies focused on this topic. Here, the first systematic assessment of six techniques, including priming techniques and melatonin application, aimed at improving the germination of seeds from herbarium specimens is presented. Seed germination of 26 species common in Europe, some of which congeneric to extinct species, collected in herbaria and in the wild (20,549 seeds in total, including 19,509 from 297 herbarium specimens from 8 different herbaria) was tested with the following treatments: exogenous melatonin addition to the germination medium, priming with melatonin, osmopriming, hydropriming for 24 and 48 hours, standard soil, heat sterilization and gibberellins addition. More than 85% of the fresh seeds and 1% of the seeds collected in herbaria germinated, including seeds older than 50 years. Data show that treatment with exogenous melatonin had a positive effect on the germination of fresh seeds, but a negative effect on the germination of herbarium‐derived seeds. Furthermore, osmopriming treatment had a slightly positive effect on the germination of herbarium‐derived seeds. Osmopriming and exogenous melatonin addition seem to be promising techniques that need further investigation and improvement and might be useful for the development of an optimal germination protocol for old and herbarium‐derived seeds. The germination of seeds from herbaria could be an important tool in plant conservation, with the aim of reversing the extinction trend of many species through de‐extinction, safeguarding biodiversity, and genetic variability. This study provides preliminary data for the development of germination protocols, especially for old seeds of species of conservation interest, to maximise the chance of recovering lost genetic diversity and leading to the first de‐extinction ever.

Herbaria may represent remarkable sources of viable diaspores for recovering lost genetic variation and extinct plant species, but the application of rewilding extinct species using these collections has not been explored in detail. De‐extinction in plants may be achieved by germinating viable diaspores or culturing tissues preserved in herbarium specimens. Germination of old diaspores (fruits, seeds, spores) preserved in sub‐optimal uncontrolled storage conditions demonstrates that the recovery of extinct plants from herbarium specimens may be possible. Plant de‐extinction via herbarium specimens relies on the availability of samples containing viable diaspores, and on the inclination of curators and the conservation community to use such material for this purpose. We developed an internet‐based survey to assess (i) whether the scientific community would consent to the use of herbarium specimens of extinct species to attempt de‐extinction, and (ii) the limitations of removing diaspores from specimens. Despite the risk of potential damages to valuable specimens from historical collections when harvesting diaspores, a consensus for using specimens of extinct plant species emerged. Most respondents would permit the collection of a low number of diaspores, preferably from duplicate specimens and only if the integrity of the specimen is preserved. These considerations would be more restrictive for type specimens and those of historical value. These results help to formalise a decision framework for the grant and use of material from natural history collections and a pragmatic approach to attempt to resurrect extinct species from herbarium specimens.

Resurrecting extinct species is a fascinating and challenging idea for scientists and the general public. Whereas some theoretical progress has been made for animals, the resurrection of extinct plants (de-extinction sensu lato) is a relatively recently discussed topic. In this context, the term ‘de-extinction’ is used sensu lato to refer to the resurrection of ‘extinct in the wild’ species from seeds or tissues preserved in herbaria, as we acknowledge the current impossibility of knowing a priori whether a herbarium seed is alive and can germinate. In plants, this could be achieved by germinating or in vitro tissue-culturing old diaspores such as seeds or spores available in herbarium specimens. This paper reports the first list of plant de-extinction candidates based on the actual availability of seeds in herbarium specimens of globally extinct plants. We reviewed globally extinct seed plants using online resources and additional literature on national red lists, resulting in a list of 361 extinct taxa. We then proposed a method of prioritizing candidates for seed-plant de-extinction from diaspores found in herbarium specimens and complemented this with a phylogenetic approach to identify species that may maximize evolutionarily distinct features. Finally, combining data on seed storage behaviour and longevity, as well as specimen age in the novel ‘best de-extinction candidate’ score (DEXSCO), we identified 556 herbarium specimens belonging to 161 extinct species with available seeds. We expect that this list of de-extinction candidates and the novel approach to rank them will boost research efforts towards the first-ever plant de-extinction.

Point‐of‐care lung sonography has theoretical usefulness in numerous diseases; however clinical indications and the impact of this technique have not been fully investigated. We aimed to describe the current use of point‐of‐care lung sonography. A 2‐year prospective observational study was performed by pulmonologists in an Italian university hospital. Techniques, indications, consequences of lung sonography, and barriers to the examination were analyzed. A total of 1150 lung sonographic examinations were performed on 951 patients. The most common indications were diagnosis and follow‐up of pleural effusion in 361 cases (31%), evaluation of lung consolidation (322 [28%]), acute heart failure (195 [17%]), guide to pleural procedures (117 [10%]), pneumothorax (54 [5%]) and acute exacerbations of chronic obstructive pulmonary disease (30 [3%]). The mean duration of the examination ± SD was 6 ± 4 minutes. The transducers most frequently used were convex (746 [65%]) and linear (161 [14%]), whereas in 205 examinations (18%), both transducers were used. According to the judgment of the caring clinician, 51% of the examinations were clinically relevant. Point‐of‐care lung sonography performed by pulmonologists is quick and feasible and could be widely used for different clinical indications with a potentially high clinical impact. The widespread use of this technique may have a relevant clinical impact in several indications.

IntroductionNon-compressible torso haemorrhage (NCTH) carries a high mortality in trauma as many patients exsanguinate prior to definitive haemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that has the potential to bridge patients to definitive haemostasis. However, the proportion of trauma patients in whom REBOA may be utilised is unknown.MethodsWe conducted a population based analysis of 2012–2013 Trauma Audit and Research Network (TARN) data. We identified the number of patients in whom REBOA may have been utilised, defined by an Abbreviated Injury Scale score ≥3 to abdominal solid organs, abdominal or pelvic vasculature, pelvic fracture with ring disruption or proximal traumatic lower limb amputation, together with a systolic blood pressure <90 mm Hg. Patients with non-compressible haemorrhage in the mediastinum, axilla, face or neck were excluded.ResultsDuring 2012–2013, 72 677 adult trauma patients admitted to hospitals in England and Wales were identified. 397 patients had an indication(s) and no contraindications for REBOA with evidence of haemorrhagic shock: 69% men, median age 43 years and median Injury Severity Score 32. Overall mortality was 32%. Major trauma centres (MTCs) received the highest concentration of potential REBOA patients, and would be anticipated to receive a patient in whom REBOA may be utilised every 95 days, increasing to every 46 days in the 10 MTCs with the highest attendance of this injury type.ConclusionsThis TARN database analysis has identified a small group of severely injured, resource intensive patients with a highly lethal injury that is theoretically amenable to REBOA. The highest density of these patients is seen at MTCs, and as such a planned evaluation of REBOA should be further considered in these hospitals.

Background. Continuous positive airway pressure (CPAP) can be beneficial in acute respiratory failure (ARF) due to coronavirus (COVID-19) pneumonia, but delaying endotracheal intubation (ETI) in nonresponders may increase mortality. We aimed at investigating the performance of composite respiratory indexes as possible predictors of CPAP failure in ARF due to COVID-19. Methods. This was a multicenter, prospective, observational, and cohort study conducted in the respiratory units of three University hospitals in Milan and in a secondary care hospital in Codogno (Italy), on consecutive adult patients with ARF due to COVID-19 pneumonia that underwent CPAP between March 2020 and March 2021. ETI transfer to the intensive care unit or death is defined CPAP failure. Predictors of CPAP failure were assessed before T0 and 1 hour after T1 CPAP initiation and included mROX index (ratio of PaO2/FiO2 to respiratory rate), alveolar-to-arterial (A-a) O2 gradient, and the HACOR (heart rate, acidosis, consciousness, oxygenation, and respiratory rate) score. Results. Three hundred and fifty four patients (mean age 64 years, 73% males) were included in the study; 136 (38.4%) satisfied criteria for CPAP failure. A-a O2 gradient, mROX, and HACOR scores were worse in patients who failed CPAP, both at T0 and T1 (p<0.001 for all parameters). The HACOR score was associated with CPAP failure (odds ratio—OR—for every unit increase in HACOR = 1.361; 95%CI: 1.103–1.680; p=0.004; AUROC = 0.742; p<0.001). CPAP failure was best predicted by a threshold of 4.50 (sensitivity = 53% and specificity = 87%). Conclusions. The HACOR score may be a reliable and early predictor of CPAP failure in patients treated for ARF in COVID-19 pneumonia.