Growth of radiata pine families in nursery and two years after field establishment

Pinus radiata D. Don is the most widely planted exotic species in Australia, Chile, New Zealand and Spain. In this study, growth and survival of P. radiata were compared in 30 open pollinated families grown under two contrasting watering regimes in nursery (well-watered cf. water-stress conditions) and planted on a drought-prone site with Mediterranean climate in central Chile. This study assessed phenotypic plasticity in growth and survival at nursery stage and two years after establishment in the field. Family plasticity at nursery stage was estimated by the angular phenotypic change index (APCI), while the relationship between nursery and field traits was estimated by genetic correlations (rg ) and the Pearson coefficient of correlation (rxy). Families presented high plasticity in diameter, height, and survival at nursery stage. Out of 30 families, eight exhibited over 80 % survival in the well-watered treatment, but less than 20 % survival in the water-stress treatment. As expected, growth traits and survival were positively correlated (rg and rxy > 0.65) between both nursery environments. However, for growth, most genetic and phenotypic correlations between combinations of nursery treatments versus the field test were negative or not significant. As there was no detectable pattern of nursery–field correlations regarding to combinations of nursery treatments and test site, the need to include more stable families and genotypes to an appropriate developmental stage at nursery is discussed

Growth of provenances of Cryptocarya alba during water stress and after re–watering in the nursery

Intensification of drought in Mediterranean–type climates has limited seedling establishment. The knowledge of the ecology of selected species and its intraspecific variation to water stress at the seedling stage should be considered in order to overcome limitations. We investigated variations in growth, survival, and leaf–level physiology in four provenances of the endemic Cryptocarya alba (Mol.) during water stress and after re–watering. Seedlings were cultured in the nursery during 23 months and then subjected to two watering treatments based on soil water content (well–watered and water restriction, 0.38 and 0.17 cm3 cm–3, respectively) for 45 days. At the end of the watering treatments, seedling growth, above– and belowground biomass, survival, and leaf gas exchange were measured. Right after the watering treatments, the surviving seedlings were submitted to a recovery period of 21 days, in which all seedlings were re–watered at 0.38 cm3 cm–3 of soil water content and measured for leaf gas exchange. Provenances differed in growth and biomass allocation. Unlike growth and biomass, interaction between provenance and watering treatments was found for photosynthesis, stomatal conductance, transpiration, and water use efficiency of northern provenances, exhibiting the highest performance under water restriction. However, most variations observed occurred before the re–watering period and only a few occurred after this period. The four provenances under study exhibited similar photosynthesis and stomatal conductance after re–watering. Our study demonstrated phenotypic variation of C. alba and the capability of the species to withstand and recover from water stress

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

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 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

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research