Anatomical, Histochemical and Cytogenetic Features of Doryopteris triphylla (Pteridaceae)

Doryopteris triphylla (Pteridaceae-Cheilanthoideae) grows in xeric habitats inBrazil, Paraguay, Uruguay and Argentina. The aim of this study was to characterizeD. triphylla anatomically, histochemically and cytogenetically. Foranatomical characterization, rhizomes, roots, petioles and leaves were madeand then stained using Safranine-Astra Blue for further observations. Leafblades were also cleared. For histochemical analysis, leaf cross sections werestained with different reagents to identify glandular trichomes compounds.For cytogenetic characterization, a karyogram was performed using laboratorycultivated roots. Results show a dictyostelic rhizome covered with scales withapical secreting gland; diarch roots; petiole cross-sections show thick cuticle,uniseriate epidermis, parenchymatic cortex cells with thick walls and a vascularbundle with two xylem groups; and hypostomatic fronds with glandulartrichomes. Histochemical studies of secretion products of the glandular trichomeswere positive for polysaccharides, pectins, lipids, acid lipids, dihydroxyphenols,phenols and flavonoids. Cytogenetically, D. triphylla is describedas a diploid species (2n = 60), with chromosomes gradually decreasingin size. The apical glands in scales of rhizomes, the presence of two xylemgroups in the vascular bundle in the petiole and the glandular trichomes onthe abaxial surface are new contributions to the species. The type of chemicalproducts secreted by glandular leaf trichomes and karyotype estimation isshown for the first time in this species.Fil: Neira, Diego Amando. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación Miguel Lillo; ArgentinaFil: Andrada, Aldo Rubén. Fundación Miguel Lillo; ArgentinaFil: Páez, Valeria de los Ángeles. Fundación Miguel Lillo; ArgentinaFil: Rodriguez, Ana María del Valle. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto de Química del Noroeste. Universidad Nacional de Tucumán. Facultad de Bioquímica, Química y Farmacia. Instituto de Química del Noroeste; ArgentinaFil: Ríos, Norma Fabiana. Fundación Miguel Lillo; ArgentinaFil: Martinez, Olga Gladys. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Bio y Geociencias del NOA. Universidad Nacional de Salta. Facultad de Ciencias Naturales. Museo de Ciencias Naturales. Instituto de Bio y Geociencias del NOA; ArgentinaFil: Hernández, Marcela Alicia. Fundación Miguel Lillo; Argentin

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)