Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

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

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

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

Efecto de Pseudomonas syringae subsp. syringae en el rendimiento y distribución de biomasa en trigo

The effect of Pseudomonas syringae subsp. syringae on seed yield, aerial biomass production and partitioning in wheat (Triticum aestivum L.) is unknown. A field experiment was carried out in two locations of the Mexican Highlands (Montecillo and Chapingo) to evaluate the response of two wheat cultivars (‘Seri M82’ and ‘Rebeca F2000’) to four inoculum rates (106, 8, 10 cfu mL–1, plus a control without inoculum). Disease incidence and severity, seed yield, seed number and seed size were measured. At flowering and seed physiological maturity, aerial biomass production and distribution of main stem, secondary stems and total plant were recorded. Source-sink relationships during the grain filling period were estimated. Higher values of disease incidence and severity were observed at Chapingo; the same traits were also greater in ‘Seri’ than in ‘Rebeca’ at both sites (p < 0.05). Seed yield, seed number and seed size of ‘Rebeca’ were higher (p < 0.05) than that of ‘Seri’. The pathogen reduced (p < 0.05) plant height, seed yield, seed yield components, and biomass production of most organs of main and secondary stems. The magnitude of the reductions was similar in both cultivars at both sites. The effect of the bacteria at each location was higher (p < 0.05) at greater doses affecting seed number more than seed weight. Stems prevailed as sink organs, while laminae, sheaths, spikes, and other vegetative parts predominated as source organs. Plant disease records should complement crop physiological variables to evaluate and to explain bacterial disease effectsEl efecto de Pseudomonas syringae subsp. syringae en el rendimiento de semilla y en la producción y distribución de biomasa aérea en trigo (Triticum aestivum L.) es desconocido. Se sembró un experimento en dos localidades de los Valles Centrales de México (Montecillo y Chapingo) para evaluar la respuesta de dos cultivares de trigo (‘Seri M82’ y ‘Rebeca F2000’) a cuatro dosis de inóculo (106, 8, 10 cfu mL–1, más un testigo sin inóculo). Se registraron datos de incidencia y severidad, rendimiento de semilla y número y tamaño de semilla. En la floración y madurez fisiológica de semilla, se registró la producción y distribución de biomasa aérea de tallos, vainas, limbos y espigas de tallos principales, secundarios y total por planta. Se estimaron las relaciones fuente-demanda durante el periodo de llenado de grano. La incidencia y severidad de la enfermedad fueron mayores en Chapingo, y en ‘Seri’ respecto a ‘Rebeca’ en ambas localidades (p < 0,05). El rendimiento de semilla, así como el número y tamaño, fue mayor (p < 0,05) en ‘Rebeca’ que en ‘Seri’. El patógeno redujo (p < 0,05) la altura de la planta, el rendimiento y sus componentes, y la producción de biomasa de la mayoría de los órganos de los tallos principales y secundarios; sin embargo, la magnitud de las reducciones fue similar en ambos cultivares. El efecto de la bacteria en cada localidad fue mayor (p < 0,05) a dosis mayores al afectar al número de semillas más que al peso de las mismas. Los tallos prevalecieron como órganos de demanda, mientras que limbos, vainas, espigas, y otras partes vegetativas predominaron como órganos fuente. Los reportes de enfermedades de las plantas podrían complementarse con variables fisiológicas del cultivo para evaluar y explicar los efectos de las enfermedades bacteriana

Effect of pseudomonas syringae subsp. syringae on yield and biomass distribution in wheat [Efecto de pseudomonas syringae subsp. syringae en el rendimiento y distribución de biomasa en trigo]

The effect of Pseudomonas syringae subsp. syringae on seed yield, aerial biomass production and partitioning in wheat (Triticum aestivum L.) is unknown. A field experiment was carried out in two locations of the Mexican Highlands (Montecillo and Chapingo) to evaluate the response of two wheat cultivars ('Seri M82' and 'Rebeca F2000') to four inoculum rates (106,8,10 cfu mL-1, plus a control without inoculum). Disease incidence and severity, seed yield, seed number and seed size were measured. At flowering and seed physiological maturity, aerial biomass production and distribution of main stem, secondary stems and total plant were recorded. Source-sink relationships during the grain filling period were estimated. Higher values of disease incidence and severity were observed at Chapingo; the same traits were also greater in 'Seri' than in 'Rebeca' at both sites (p < 0.05). Seed yield, seed number and seed size of 'Rebeca' were higher (p < 0.05) than that of 'Seri'. The pathogen reduced (p < 0.05) plant height, seed yield, seed yield components, and biomass production of most organs of main and secondary stems. The magnitude of the reductions was similar in both cultivars at both sites. The effect of the bacteria at each location was higher (p < 0.05) at greater doses affecting seed number more than seed weight. Stems prevailed as sink organs, while laminae, sheaths, spikes, and other vegetative parts predominated as source organs. Plant disease records should complement crop physiological variables to evaluate and to explain bacterial disease effects

Effect of pseudomonas syringae subsp. syringae on yield and biomass distribution in wheat [Efecto de pseudomonas syringae subsp. syringae en el rendimiento y distribuci�n de biomasa en trigo]

The effect of Pseudomonas syringae subsp. syringae on seed yield, aerial biomass production and partitioning in wheat (Triticum aestivum L.) is unknown. A field experiment was carried out in two locations of the Mexican Highlands (Montecillo and Chapingo) to evaluate the response of two wheat cultivars ('Seri M82' and 'Rebeca F2000') to four inoculum rates (106,8,10 cfu mL-1, plus a control without inoculum). Disease incidence and severity, seed yield, seed number and seed size were measured. At flowering and seed physiological maturity, aerial biomass production and distribution of main stem, secondary stems and total plant were recorded. Source-sink relationships during the grain filling period were estimated. Higher values of disease incidence and severity were observed at Chapingo; the same traits were also greater in 'Seri' than in 'Rebeca' at both sites (p < 0.05). Seed yield, seed number and seed size of 'Rebeca' were higher (p < 0.05) than that of 'Seri'. The pathogen reduced (p < 0.05) plant height, seed yield, seed yield components, and biomass production of most organs of main and secondary stems. The magnitude of the reductions was similar in both cultivars at both sites. The effect of the bacteria at each location was higher (p < 0.05) at greater doses affecting seed number more than seed weight. Stems prevailed as sink organs, while laminae, sheaths, spikes, and other vegetative parts predominated as source organs. Plant disease records should complement crop physiological variables to evaluate and to explain bacterial disease effects

Physiological performance, yield, and quality of dry bean seeds under drought stress

Net photosynthesis (A), respiration (RE), stomatal conductance (gs), transpiration rate (E), yield, and its components, as well as physical and physiological quality of seeds were evaluated on dry bean (Phaseolus vulgaris L.) plants cv. 'Otomí', subjected to drought stress during the stages of flowering (F), pod formation (PF) and seed filling (SF). After 3 days under drought stress, gs, E and A decreased by more than 50% at F, PF and SF, respectively; after 10 days of stress, there was total inhibition of those processes, whereas the maximum reductions showed by RE were 42, 62, and 85% in F, PF and SF, respectively. Drought stress induced seed yield reductions of 10, 57, and 50% at F, PF and S F, respectively. High yield losses at PF and SF were caused by reductions in the number of seeds and pods per plant and seeds per pod. At the SF stage the loss in yield was moderate, because at this stage the plants were able to form new leaves and delay pod formation until water stress was over. The physiological quality was not affected by drought stress, even though the weight of 1000 seeds was reduced by about 10%

Changes in carbohydrate concentration in leaves, PODS and seeds of dry bean plants under drought stress

Changes in the concentration of sucrose, glucose, fructose and starch, in leaves, seeds and pods of Phaseolus vulgaris L. cv 'Otomí' of determinate growth habit, were evaluated under both drought stress and non stress (irrigated) conditions. Plants were submitted to drought stress during the flowering, pod formation and seed filling stages. The stress increased the concentrations of glucose from 18 up to 196% and of fructose from 20 up to 333% in mature leaves, likely due to starch hydrolysis, while showing starch reductions from 17 up to 46% and sucrose reductions from 41 up to 70%. These changes in leaves promoted the sugar exports toward pods and seeds, since their sucrose concentration increased. In the reproductive organs, the concentration of glucose and fructose of stressed plants increased 136 and 138% in pods and 83 and 73% in seeds, respectively. Contrary to the changes registered in leaves, in reproductive tissues the sucrose increased up to 238% in pods and up to 148% in seeds, while the starch became reduced down to 37% in pods and to 21% in seeds. The increase of hexoses in pods and seeds might be explained by in situ starch hydrolysis, whereas the increase in sucrose is probably due to an enhanced synthesis of this sugar for a higher osmotic adjustment

Changes in carbohydrate concentration in leaves, PODS and seeds of dry bean plants under drought stress

Changes in the concentration of sucrose, glucose, fructose and starch, in leaves, seeds and pods of Phaseolus vulgaris L. cv 'Otom�' of determinate growth habit, were evaluated under both drought stress and non stress (irrigated) conditions. Plants were submitted to drought stress during the flowering, pod formation and seed filling stages. The stress increased the concentrations of glucose from 18 up to 196% and of fructose from 20 up to 333% in mature leaves, likely due to starch hydrolysis, while showing starch reductions from 17 up to 46% and sucrose reductions from 41 up to 70%. These changes in leaves promoted the sugar exports toward pods and seeds, since their sucrose concentration increased. In the reproductive organs, the concentration of glucose and fructose of stressed plants increased 136 and 138% in pods and 83 and 73% in seeds, respectively. Contrary to the changes registered in leaves, in reproductive tissues the sucrose increased up to 238% in pods and up to 148% in seeds, while the starch became reduced down to 37% in pods and to 21% in seeds. The increase of hexoses in pods and seeds might be explained by in situ starch hydrolysis, whereas the increase in sucrose is probably due to an enhanced synthesis of this sugar for a higher osmotic adjustment