Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Soybean Seed Amino Acid Content QTL Detected Using the Universal Soy Linkage Panel 1.0 with 1,536 SNPs

Soybean [Glycine max (L.) Merr.] is the primary source of meal used in animal feed in the U.S. However, few studies have been conducted to evaluate genomic regions controlling amino acid composition is soybean. Designing soybean seed compositions that will benefit animal production is essential. The objective of this study was to identify genomic regions controlling essential and non-essential amino acid composition in soybean seed proteins. To achieve this objective, 282 F5:9 recombinant inbred lines (RILs) developed from a cross of Essex × Williams 82 were used. Ground soybean seed samples were analyzed for amino acids and statistically significant differences (p \u3c 0.05) were found among genotypes in the population for all amino acid concentrations. The Universal Soy Linkage Panel (USLP) 1.0 of 1,536 single nucleotide polymorphism (SNP) DNA markers were used to genotype the 282 RILs and identify 480 useful genetic markers. The software R/qtl was used to identify candidate quantitative trait loci (QTL), which were validated using R/MQM. A total of ten QTL were detected on chromosomes 5, 7, 9, 10, 13 and 20 that explained 5 to 14% of the total phenotypic variation for a particular amino acid. Using SNPs from the USLP 1.0 to detect QTL for amino acids in soybean provides additional information to select genotypes with enhanced amino acid profiles that will benefit animal production

Selective Genotyping for Marker Assisted Selection Strategies for Soybean Yield Improvement

Using molecular markers in soybean [Glycine max (L.) Merr.] has lead to the identification of major loci controlling quantitative and qualitative traits that include: disease resistance, insect resistance and tolerance to abiotic stresses. Yield has been considered as one of the most important quantitative traits in soybean breeding. Unfortunately, yield is a very complex trait and most yield quantitative trait loci (QTL) that have been identified have had only limited success for marker assisted selection (MAS). The objective of this study was to identify QTL associated with soybean seed yield in preliminary yield trials grown in different environments and to evaluate their effective use for MAS using a yield prediction model (YPM), which included epistasis. To achieve this objective, 875 F5:9 recombinant inbred lines (RIL) from a population developed from a cross between two prominent ancestors of the North American soybean (Essex and Williams 82) were used. The 875 RIL and check cultivars were divided into four groups based on maturity and each group was grown in Knoxville, TN and one other location that had an environment in which the maturity group (MG) was adapted to be grown. Each RIL was genotyped with \u3e50,000 single nucleotide polymorphic markers (SNPs) of which 17,232 were This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. polymorphic across the population. Yield QTL were detected using a single factor (SF) analysis of variance (ANOVA) and composite interval mapping (CIM). Based on CIM, 23 yield QTL were identified. Twenty-one additional QTL were detected using SF ANOVA. Individually, these QTL explained from 4.5% to 11.9% of the phenotypic variation for yield. QTL were identified on all 20 chromosomes and five of the 46 QTL have not been previously reported. This study provides new information concerning yield QTL in soybean and may offer important insights into MAS strategies for soybean

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit