Morfoanatomía, histoquímica y cristales del sistema subterráneo de Baccharis notosergila (Asteraceae)

Background and aims: Baccharis notosergila is presented as a productivity-reducing weed in the fields of the Salado river basin, Buenos Aires, Argentina. The aims of this work were: to describe the structure of the underground system, the origin of sprouts, locate the secretory structures and storage substance to understand the adaptation strategies of this species as well as its ability to withstand chemical and mechanical control. M&M: The collected material was examined with conventional optical microscopy techniques. Histochemical tests to identify secondary metabolites were performed, and crystals were analyzed by a scanning electron microscope. Results: The subterranean system found was a xylopodium which has high shoot bud-forming potential. Storage substance was found to be inulin. Test for starch was negative. Resins and lipids (oil drops) were identified in ducts of roots; tannins and crystals of calcium oxalate were also found in the xylopodium and roots. Conclusions: The presence of these characteristics on the underground systems could explain the frequency of this species in the floristic from Salado river basin in which alternate periods of 2 high humidity and drought. The belowground bud bank would be important to B. notosergila survival in this area with extreme climatic factors, and its resistance to mechanical and chemical control. Understanding the anatomical features of these plants is one of the steps to appropriate management of this species in the Salado river basin.Introducción y objetivos: Baccharis notosergila es una maleza de alta incidencia que reduce la productividad en campos de la Depresión del Salado, Buenos Aires, Argentina. Los objetivos de este trabajo fueron: describir la estructura del sistema subterráneo, el origen de los brotes y localizar las estructuras secretoras y la sustancia de almacenamiento, para comprender las estrategias de adaptación de esta especie, así como su capacidad para resistir el control químico y mecánico. M&M: El material recolectado fue analizado con técnicas convencionales de microscopía óptica; se realizaron pruebas histoquímicas para identificar los metabolitos secundarios y se analizaron los cristales con microscopio electrónico de barrido. Resultados: El sistema subterráneo encontrado fue del tipo xilopodio, el cual tiene un alto potencial de formación de brotes. Como sustancias carbonadas de almacenamiento se encontró inulina; no hallándose almidón. En los conductos secretores de las raíces se identificaron resinas y aceites; también se hallaron taninos y cristales de oxalato de calcio en el xilopodio y las raíces. Conclusiones: La presencia de estas características en los sistemas subterráneos podría explicar la elevada frecuencia de esta especie en la composición florística de la cuenca del río Salado, en la que alternan períodos de alta humedad y sequía. El banco de yemas subterráneas sería importante para la subsistencia de B. notosergila en esta área con condiciones climáticas extremas y también su tolerancia al control químico y mecánico. Comprender las características anatómicas de estas plantas es uno de los pasos para el manejo adecuado de esta especie en la cuenca del río Salado

Características morfo-anatómicas de las hojas y tallos de Baccharis notosergila (Asteraceae) y su relación con el ambiente y control químico

Background and aims: Baccharis notosergila is an aggressive weed inhabiting the Salado river basin, Buenos Aires province, Argentina. The aims were: to analyze the morpho-anatomy and histochemistry of aerial vegetative organs in order to understand the adaptation strategies that ensure its survival, as well as to expand knowledge on traits determining resistance to the control methods applied. M&M: The material collected was prepared and examined with conventional techniques of microscopy. Histochemical tests were performed. Results: The major features found were small and deciduous leaves; uniseriate epidermis with massive and striate cuticle; stomata at level or slightly above the other epidermal cells and glandular trichomes secreting oily substances; stomata on both surfaces and isobilateral mesophyll. Starch, phenolic and lipophilic substances, and resins were identified in leaves and stems, and calcium oxalate crystals in leaves, stems and capitate trichomes. Conclusions: The aerial vegetative organs features of B. notosergila explain its tolerance to the unfavorable conditions of the Salado river basin area, as well as its competitive ability over others species of the natural prairie. The reduced and deciduous leaves, the epidermal traits, and chemical substances found constitute a physical and chemical barrier reducing dehydration as well as the penetration of the herbicides applied for its control. Botanical knowledge of B. notosergila is the basis to develop new and appropiate management methods for this species.Introducción y objetivos: Baccharis notosergila es una maleza agresiva que habita la Depresión del Salado, provincia Buenos Aires, Argentina. Los objetivos de este trabajo fueron: analizar la morfo-anatomía e histoquímica de los órganos vegetativos aéreos para entender las estrategias de adaptación que aseguran su sobrevivencia, así como profundizar el conocimiento sobre los caracteres que determinan la resistencia a los métodos de control. M&M: El material recolectado fue preparado y analizado con técnicas convencionales para microscopía. Se realizaron pruebas histoquímicas para identificar almidón, resinas, polifenoles y sustancias lipofílicas. Resultados: Los principales caracteres encontrados fueron las hojas pequeñas y caedizas, anfistomáticas con mesofilo isobilateral; la epidermis uniseriada, cutícula masiva y estriada, estomas a nivel o ligeramente elevados y tricomas glandulares que secretan sustancias oleosas. Los tests histoquímicos dieron reacción positiva para almidón, taninos y sustancias lipofílicas en las hojas y tallos; polifenoles, resinas y aceites fueron identificados en los conductos y se hallaron cristales de oxalato de calcio en las hojas, tallos y tricomas capitados. Conclusiones: Las características de los órganos vegetativos aéreos de B. notosergila explican su tolerancia a las condiciones desfavorables del área de la Depresión del Salado, así como su alta habilidad competitiva y predominancia sobre otras especies de la pradera natural. Las hojas pequeñas y deciduas, sus características epidérmicas y sustancias químicas encontradas constituyen una barrera física y química para la deshidratación así como la penetración de los herbicidas aplicados para su control. El conocimiento botánico de B. notosergila es la base para el diseño y desarrollo de nuevos y apropiados métodos para el manejo de esta especie.Facultad de Ciencias Agrarias y ForestalesInstituto de Fisiología Vegeta

COBALT: A Confirmatory Trial of Obeticholic Acid in Primary Biliary Cholangitis With Placebo and External Controls.

ObjectivesObeticholic acid (OCA) treatment for primary biliary cholangitis (PBC) was conditionally approved in the phase 3 POISE trial. The COBALT confirmatory trial assessed whether clinical outcomes in PBC patients improve with OCA therapy.MethodsPatients randomized to OCA (5-10 mg) were compared with placebo (randomized controlled trial [RCT]) or external control (EC). The primary composite endpoint was time to death, liver transplant, model for end-stage liver disease score ≥15, uncontrolled ascites, or hospitalization for hepatic decompensation. A prespecified propensity score-weighted EC group was derived from a US healthcare claims database.ResultsIn the RCT, the primary endpoint occurred in 28.6% of OCA (n=168) and 28.9% of placebo patients (n=166; intent-to-treat [ITT] analysis hazard ratio [HR]=1.01, 95% CI=0.68-1.51), but functional unblinding and crossover to commercial therapy occurred, especially in the placebo arm. Correcting for these using inverse probability of censoring weighting (IPCW) and as-treated analyses shifted the HR to favor OCA. In the EC (n=1051), the weighted primary endpoint occurred in 10.1% of OCA and 21.5% of non-OCA patients (HR=0.39; 95% CI=0.22-0.69; P=0.001). No new safety signals were identified in the RCT.ConclusionsFunctional unblinding and treatment crossover, particularly in the placebo arm, confounded the ITT estimate of outcomes associated with OCA in the RCT. Comparison with the real-world EC showed that OCA treatment significantly reduced the risk of negative clinical outcomes. These analyses demonstrate the value of EC data in confirmatory trials and suggest that treatment with OCA improves clinical outcomes in patients with PBC

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)