Abstract Objective Enhanced-recovery pathways aim to accelerate postoperative recovery and facilitate early hospital discharge. The aim of this systematic review was to summarize the evidence ...regarding the influence of this intervention in patients undergoing lung resection. Methods The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Eight bibliographic databases (Medline, Embase, BIOSIS, CINAHL, Web of Science, Scopus, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched for studies comparing postoperative outcomes in adult patients treated within an enhanced-recovery pathway or traditional care. Risk of bias was assessed using the Cochrane Collaboration risk of bias tool. Results Six studies fulfilled our selection criteria (1 randomized and 5 nonrandomized studies). All the nonrandomized studies reported shorter length of stay in the intervention group (difference, 1.2-9.1 days), but the randomized study reported no differences. There were no differences between groups in readmissions, overall complications, and mortality rates. Two nonrandomized studies reported reduction in hospital costs in the intervention group. Risk of bias favoring enhanced recovery pathways was high. Conclusions A small number of low-quality comparative studies have evaluated the influence of enhanced-recovery pathways in patients undergoing lung resection. Some studies suggest that this intervention may reduce length of stay and hospital costs, but they should be interpreted in light of several methodologic limitations. This review highlights the need for well-designed trials to provide conclusive evidence about the role of enhanced-recovery pathways in this patient population.
White root rot (WRR) disease caused by Rosellinia necatrix is one of the most important threats affecting avocado orchards in temperate regions. The eradication of WRR is a difficult task and ...environmentally friendly control methods are needed to lessen its impact. Priming plants with a stressor (biotic or abiotic) can be a strategy to enhance plant defense/tolerance against future stress episodes but, despite the known underlying common mechanisms, few studies use abiotic-priming for improving tolerance to forthcoming biotic-stress and vice versa ('cross-factor priming'). To assess whether cross-factor priming can be a potential method for enhancing avocado tolerance to WRR disease, 'Dusa' avocado rootstocks, susceptible to R. necatrix, were subjected to two levels of water stress (mild-WS and severe-WS) and, after drought-recovery, inoculated with R. necatrix. Physiological response and expression of plant defense related genes after drought-priming as well as the disease progression were evaluated.
Water-stressed avocado plants showed lower water potential and stomatal limitations of photosynthesis compared to control plants. In addition, NPQ and qN values increased, indicating the activation of energy dissipating mechanisms closely related to the relief of oxidative stress. This response was proportional to the severity of the water stress and was accompanied by the deregulation of pathogen defense-related genes in the roots. After re-watering, leaf photosynthesis and plant water status recovered rapidly in both treatments, but roots of mild-WS primed plants showed a higher number of overexpressed genes related with plant defense than severe-WS primed plants. Disease progression after inoculating primed plants with R. necatrix was significantly delayed in mild-WS primed plants.
These findings demonstrate that mild-WS can induce a primed state in the WRR susceptible avocado rootstock 'Dusa' and reveal that 'cross-factor priming' with water stress (abiotic stressor) is effective for increasing avocado tolerance against R. necatrix (biotic stressor), underpinning that plant responses against biotic and abiotic stress rely on common mechanisms. Potential applications of these results may involve an enhancement of WRR tolerance of current avocado groves and optimization of water use via low frequency deficit irrigation strategies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background Few studies have investigated the effectiveness of enhanced recovery pathways (ERP) for lung resection. This study estimates the impact of an ERP for lobectomy on duration of stay, ...complications, and readmissions. Methods Patients undergoing open lobectomy were identified from an OR database between 2011 and 2013. Beginning September 2012, all patients were managed according to a 4-day multidisciplinary ERP with written daily patient education treatment plans, multimodal analgesia, early diet, structured mobilization and standardized drain management. Pre-pathway (PRE) and post-pathway (POST) patients were compared in terms of duration of stay, complications, and readmissions. Results We identified 234 patients (PRE, 127; POST, 107). Groups were similar with respect to age, gender, American Society of Anesthesiologists score, and baseline pulmonary function. Compared with the PRE group, the POST group had decreased duration of stay (median, 6 interquartile range (IQR), 5–7 vs 7 6–10 days; P < .05), total complications (40 37% vs 64 50%; P < .05), urinary tract infections (3 3% vs 15 12%; P < .05), and chest tube duration (median, 4 IQR, 3–6 vs 5 4–7 days; P < .05), with no difference in readmissions (7 7% vs 6 5%; P < .05) or chest tube reinsertion (4 4% vs 6 5%; P < .05). Decreased duration of stay was driven by patients without complications (median, 5 IQR, 4–6 vs 6 5–7 days; P < .05). Conclusion Implementation of a multimodal ERP for lobectomy was associated with decreased duration of stay and complications with no difference in readmissions.
Objective
The objective of this study is to outline the evidence regarding the surgical management of esophageal cancer and provide a single institutional outline regarding its implementation.
...Background
Esophageal cancer is a major cause of cancer-related morbidity and mortality worldwide. Surgery continues to play an important role in its management and offers the best chance for cure in localized and locally advanced disease. However, considerable controversy exists regarding the optimum treatment strategy in this patient population. Furthermore, despite advances in operative and perioperative care and the advent of minimally invasive approaches, the majority of patients succumb to distant metastases after curative intent resection. This failure highlights the importance of multimodal, stage-directed therapy in the management of patients with newly diagnosed esophageal tumors.
Methods
Herein, we provide a comprehensive, evidence-based review of the diagnostic workup and locoregional and systemic treatment options available to esophageal cancer patients. The evidence supporting perioperative chemotherapy versus chemoradiotherapy is outlined and discussed. In addition, we highlight our institutional approach to the diagnostic evaluation, operative selection strategy, and perioperative treatment regimen selection based on the stage of presentation. Finally, we discuss the role of enhanced recovery in the postoperative management of this complex group of patients.
Conclusions
Esophageal cancer remains a devastating disease with high mortality. Favorable outcomes mandate a multimodal, stage-directed treatment approach.
Neutrophils promote tumor growth and metastasis at multiple stages of cancer progression. One mechanism through which this occurs is via release of neutrophil extracellular traps (NETs). We have ...previously shown that NETs trap tumor cells in both the liver and the lung, increasing their adhesion and metastasis following postoperative complications. Multiple studies have since shown that NETs play a role in tumor progression and metastasis. NETs are composed of nuclear DNA-derived web-like structures decorated with neutrophil-derived proteins. However, it is unknown which, if any, of these NET-affiliated proteins is responsible for inducing the metastatic phenotype. In this study, we identify the NET-associated carcinoembryonic Ag cell adhesion molecule 1 (CEACAM1) as an essential element for this interaction. Indeed, blocking CEACAM1 on NETs, or knocking it out in a murine model, leads to a significant decrease in colon carcinoma cell adhesion, migration and metastasis. Thus, this work identifies NET-associated CEACAM1 as a putative therapeutic target to prevent the metastatic progression of colon carcinoma.
Abstract
Index hopping is the main cause of incorrect sample assignment of sequencing reads in multiplexed pooled libraries. We introduce a statistical model for estimating the sample index-hopping ...rate in multiplexed droplet-based single-cell RNA-seq data and for probabilistic inference of the true sample of origin of hopped reads. We analyze several datasets and estimate the sample index hopping probability to range between 0.003–0.009, a small number that counter-intuitively gives rise to a large fraction of phantom molecules — the fraction of phantom molecules exceeds 8% in more than 25% of samples and reaches as high as 85% in low-complexity samples. Phantom molecules lead to widespread complications in downstream analyses, including transcriptome mixing across cells, emergence of phantom copies of cells from other samples, and misclassification of empty droplets as cells. We demonstrate that our approach can correct for these artifacts by accurately purging the majority of phantom molecules from the data.
Neutrophil Extracellular Traps (NETs) have been recently identified as part of the neutrophil's antimicrobial armamentarium. Apart from their role in fighting infections, recent research has ...demonstrated that they may be involved in many other disease processes, including cancer progression. Isolating purified NETs is a crucial element to allow the study of these functions. In this video, we demonstrate a simplified method of cell free NET isolation from human whole blood using readily available reagents. Isolated NETs can then be used for immunofluorescence staining, blotting or various functional assays. This enables an assessment of their biologic properties in the absence of the potential confounding effects of neutrophils themselves. A density gradient separation technique is employed to isolate neutrophils from healthy donor whole blood. Isolated neutrophils are then stimulated by phorbol 12-myristate 13-acetate (PMA) to induce NETosis. Activated neutrophils are then discarded, and a cell-free NET stock is obtained. We then demonstrate how isolated NETs can be used in an adhesion assay with A549 human lung cancer cells. The NET stock is used to coat the wells of a 96 well cell culture plate O/N, and after ensuring an adequate NET monolayer formation on the bottom of the wells, CFSE labeled A549 cells are added. Adherent cells are quantified using a Nikon TE300 fluorescent microscope. In some wells, 1000U DNAse1 is added 10 min before counting to degrade NETs.
White root rot disease caused by Rosellinia necatrix is one of the most important threats affecting avocado productivity in tropical and subtropical climates. Control of this disease is complex and ...nowadays, lies in the use of physical and chemical methods, although none have proven to be fully effective. Detailed understanding of the molecular mechanisms underlying white root rot disease has the potential of aiding future developments in disease resistance and management. In this regard, this study used RNA-Seq technology to compare the transcriptomic profiles of R. necatrix during infection of susceptible avocado 'Dusa' roots with that obtained from the fungus cultured in rich medium.
The transcriptomes from three biological replicates of R. necatrix colonizing avocado roots (RGA) and R. necatrix growing on potato dextrose agar media (RGPDA) were analyzed using Illumina sequencing. A total of 12,104 transcripts were obtained, among which 1937 were differentially expressed genes (DEG), 137 exclusively expressed in RGA and 160 in RGPDA. During the root infection process, genes involved in the production of fungal toxins, detoxification and transport of toxic compounds, hormone biosynthesis, gene silencing and plant cell wall degradation were overexpressed. Interestingly, 24 out of the 137 contigs expressed only during R. necatrix growth on avocado roots, were predicted as candidate effector proteins (CEP) with a probability above 60%. The PHI (Pathogen Host Interaction) database revealed that three of the R. necatrix CEP showed homology with previously annotated effectors, already proven experimentally via pathogen-host interaction.
The analysis of the full-length transcriptome of R. necatrix during the infection process is suggesting that the success of this fungus to infect roots of diverse crops might be attributed to the production of different compounds which, singly or in combination, interfere with defense or signaling mechanisms shared among distinct plant families. The transcriptome analysis of R. necatrix during the infection process provides useful information and facilitates further research to a more in -depth understanding of the biology and virulence of this emergent pathogen. In turn, this will make possible to evolve novel strategies for white root rot management in avocado.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•FAO estimations fit irrigation needs (IN) of Mediterranean avocados groves.•Over-irrigation of avocados does not involve better yields.•Leaf water potential is a good plant-based water stress ...indicator in avocado.•Water supply below IN negatively affects yield and fruit quality in avocado.
The subtropical Mediterranean climate of southeastern Andalusian coast allows Spain to be the largest European producer of subtropical fruit, with the avocado as the main representative. In this region, precipitations are scarce and erratic and limit water availability for irrigation. Under this climatic uncertainty, appropriate water use is required for assuring crop environmental sustainability and increasing water productivity (WP) of avocado orchards. For this purpose, it is necessary to evaluate if current water endowments in the region match crop water requirements and to what extent water use can be improved. In this study, water productivity was assessed in a mature avocado (cv. ‘Hass’) orchard along six consecutive seasons. The physiological and agronomical responses of avocado trees to five water treatments (T1-T5) were also evaluated during two consecutive seasons. Water amounts supplied by irrigation were compared with FAO’s estimations. For the six seasons, averaged FAO irrigation needs were 7916 ± 395 m3 ha−1 season−1 but averaged water supplied was 6503 ± 328 m3 ha−1 season−1 (˜18% below FAO’s) with yields 11 ± 2 t ha−1, meaning a WP of 1.7 kg m-3. FAO’s recommendations matched T2 and irrigation over or below T2 affected avocado yield, fruit quality (i.e. size) and WP. Water supplies 15% above FAO’s (T3) did not involve better yields but decreased WP. Conventional irrigation for mature orchards (T1) was ˜20% lower than FAO’s and entailed yield decreases (˜16%) but similar fruit sizes and WP. Water supplies 40% and 60% below FAO’s (T4 and T5, respectively) caused significant water stress and decreased yields and fruit quality of avocado trees but increased WP. These effects were more noticeable during the productive season, in which T5 trees showed weakening symptoms and marked fruit drop. Results are discussed in the context of viability of avocado cropping in the Mediterranean region under low water resource scenarios.
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