Influência da técnica de quebra de dormência, substrato e tamanho da semente na germinação do taperebá procedentes de duas populações nativas da Amazônia Central

Spondias mombin (taperebá) é uma espécie frutífera da Amazônia, com grande potencial de uso agroindustrial e consumo “in natura”. No entanto, alguns problemas fitotécnicos persistem, dentre os quais a germinação irregular e sua má distribuição ao longo do tempo. Neste sentido, avaliamos a influência da técnica de quebra de dormência, substrato e tamanho da semente na germinação do taperebá procedentes de duas populações nativas da Amazônia Central. O estudo foi desenvolvido em casa de vegetação no Instituto de Ciências Exatas e Tecnologia (ICET) – UFAM, no município de Itacoatiara, Amazonas.  A amostragem dos frutos foi realizada em duas localidades distintas de populações nativas. De cada local de amostragem utilizamos 100 frutos, sendo divididos em quatro amostras para realizar a caracterização morfoagronômica, determinando o peso, diâmetro, comprimento do fruto, peso da casca sem polpa, porcentagem de polpa, teor de umidade, diâmetro da semente, comprimento e peso da semente. Foi utilizado o delineamento experimental em blocos casualizados em esquema fatorial 4x2x2, totalizando 16 tratamentos por local de coleta. Os fatores estudados foram, quebra de dormência (corte distal, temperatura à 100oC/5 minutos, temperatura à 50oC/5 minutos, testemunha), substrato (areia e terra da mata + esterco + cinza) e tamanho do endocarpo (grande e pequeno). Os resultados demonstraram que as sementes de taperebá podem ser influenciadas pelos locais de procedências, afetando as variáveis de emergência, velocidade e o tempo médio de emergência

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)

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Delaying surgery for patients with a previous SARS-CoV-2 infection

Not availabl