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

Relative toxicity of native Chilean Bacillus thuringiensis strains against Scrobipalpuloides absoluta (Lepidoptera: Gelechiidae)

Theoduloz, C.; Roman, P.; Bravo,J.; Padilla, C.; Vasquez, C.; Meza-Zepeda, L. and Meza-Basso, L. Programa de Biología Vegetal, Facultad de Recursos Naturales, Universidad de Talca, Casilla, Talca, Chile.The larva of Scrobipalpuloides absoluta, a South American moth, is the most devastating insect pest of tomato production in Chile. The potential for using bacterial insecticides was studied analysing the relative toxicity of native Bacillus thuringiensis (BT) isolates belonging to the Chilean collection. The polymerase chain reaction (PCR) technique was used in order to facilitate the prescreening. Mixtures of homologous specific primers to regions within genes encoding CryI, CryIII and CryIV crystal proteins were employed to generate a PCR product profile of each BT isolate. Four isolates were selected and further characterized by means of SDS-PAGE, Western blot and bioassays on fourth-instar S. absoluta larvae. Relative toxicities were evaluated by LD50 determinations. The entomocidal activity of isolate 121e, an autoagglutinating strain, was threefold higher than toxin synthesized by B. thuringiensis var. kurstaki. This native strain was also active against Culex pipiens larvae, although much less than towards S. absoluta

Effect of the antimicrobial peptide indolicidin on the green peach aphid Myzus persicae (Sulzer)

Le-Feuvre, R.R.; Ramirez, C. C.; Meza-Basso, L. Centro de Investigación en Biotecnología Silvoagrícola, Instituto de Biología Vegetal y Biotecnología, Universidad de Talca, Talca, Chile.The green-peach aphid, Myzus persicae (Sulzer) (Hem., Aphididae), is a major agricultural pest of a wide range of host plants, causing damage by feeding and indirectly by transmitting viruses. In this study we tested the effect of the antimicrobial peptide indolicidin on M. persicae survival and on its essential bacterial endosymbionts. Artificial diet bioassays showed a significant dose-dependent lethal response of indolicidin on M. persicae survival (LD50 of 209 ± 60 μg/ml). Histological analysis of indolicidin-treated aphids revealed a lower number of distorted mycetocytes, whereas control aphids showed abundant number of rounded and filled mycetocytes. These results suggest that aphid survival could be affected via reduction of its endosymbionts. Thus, aphid control based on antimicrobial substances against endosymbionts could be a promising strategy that needs to be further explored

Two related, low-temperature-induced genes from Brassica napus are homologous to the human tumour bbc1 (breast basic conserved) gene

Luis Meza-Basso. Departamento de Ciencias Biologicas, Programa de Biología vegetal, Universidad de Talca, 2 Norte 685, Casilla 747, Talca, Chile.In order to identify genes involved in cold acclimation, we have constructed a cDNA library from Brassica napus (cv. Samouraï) cold-acclimated etiolated seedlings. By differential screening, a cDNA clone named pBnC24 (Brassica napus Cold), corresponding to a new cold-inducible plant gene, was isolated. Northern blot hybridizations using total RNA from acclimated and unacclimated seedlings confirmed that BnC24 represents a cold-regulated gene. In contrast with a number of cold-inducible plant genes, BnC24 does not seem to be responsive to abscisic acid (ABA). In addition, further screening of the cold-acclimated cDNA library using pBnC24 cDNA as a probe, allowed the isolation of a second type of homologous cDNA. Sequence analysis showed that the two BnC24 genes encode basic 24 kDa proteins, which are highly hydrophilic and rich in alanine, lysine and arginine. The nucleotide and deduced amino acid sequences of these clones do not show any homology with other previously described cold-induced plants genes. However they have strong homology with a recently discovered human tumour gene, bbc1 (breast basic conserved), which seems to be highly conserved in eukaryotes

Expression of a Bacillus thuringiensisδ-endotoxin cry1Ab gene in Bacillus subtilis and Bacillus licheniformis strains that naturally colonize the phylloplane of tomato plants (Lycopersicon esculentum, Mills)

C. Theoduloz, A. Vega, M. Salazar, E. González and L. Meza-Basso. Instituto de Biología Vegetal y Biotecnología, Universidad de Talca, Casilla, Talca, Chile. L. Meza-Basso, Instituto de Biología Vegetal y Biotecnología, Universidad de Talca, Casilla 747, Talca, Chile (e-mail: [email protected]).Aims: To introduce a cry gene into microorganisms that naturally colonize the phylloplane of tomato plants to improve the persistence of the Cry proteins for controlling a South American tomato moth (Tuta absoluta, Meyrick, 1917). Methods and Results: A cry1Ab gene isolated from a native Bacillus thuringiensis strain (LM-466), showing a relevant activity against T. absoluta larvae, was cloned into the shuttle vector pHT315 (Arantes and Lereclus 1991). The construct was introduced by electroporation into native Bacillus subtilis and Bacillus licheniformis strains, both natural inhabitants of the tomato phylloplane. Western analysis and toxicity assays against the target larvae proved that the successful expression of the gene was accomplished in host bacteria. Recombinant toxin displayed a similar LC50 value in comparison to native donor strain LM-466. Both transformed Bacillus survived for at least 45 days on the tomato leaf surface. Conclusions: Plant-associated microorganisms that naturally colonize the phylloplane could be useful as recombinant microbial delivery systems of toxin genes of B. thuringiensis. Significance and Impact of the Study: Modified microorganisms capable of surviving on leaf surfaces for several weeks with insecticidal activity should allow for a reduction in pesticide application

Specificity and Insecticidal Activity of Chilean Strains of Bacillus thuringiensis

Marcela Vasquez, Carolina Parra, Elizabeth Hubert, Patricio Espinoza, Cristina Theoduloz and Luis Meza-Basso Programa de Biología Vegetal, Facultad de Recursos Naturales, Universidad de Talca, Casilla 747, Talca, ChileTwenty-eight samples containing Bacillus thuringiensis were obtained from 137 soil samples collected from the Maule Region of Chile. Two isolates were selected for evaluation of insecticidal activity against two agronomically important insects, according to the following criteria: colony and parasporal inclusion morphology, SDS-PAGE, Western blot, and flagellar serotypes. Results showed that strains indexed as 114 (var. kurstaki serotype H3a3b3c) and G11g (var. kenyae serotype H4a4C) synthesized entomocidal proteins of the Cry I group. The insecticidal activity of strain 114 was similar to control strain var. kurstaki HD-1 toward Scrobipalpula absoluta larvae and presented 30% of activity of control strain against Helicoverpa zea larvae. Isolate G11g was found to be approximately 20% less active than the other screened strains