In Vivo Assessment of Cold Adaptation in Insect Larvae by Magnetic Resonance Imaging and Magnetic Resonance Spectroscopy

Background Temperatures below the freezing point of water and the ensuing ice crystal formation pose serious challenges to cell structure and function. Consequently, species living in seasonally cold environments have evolved a multitude of strategies to reorganize their cellular architecture and metabolism, and the underlying mechanisms are crucial to our understanding of life. In multicellular organisms, and poikilotherm animals in particular, our knowledge about these processes is almost exclusively due to invasive studies, thereby limiting the range of conclusions that can be drawn about intact living systems. Methodology Given that non-destructive techniques like 1H Magnetic Resonance (MR) imaging and spectroscopy have proven useful for in vivo investigations of a wide range of biological systems, we aimed at evaluating their potential to observe cold adaptations in living insect larvae. Specifically, we chose two cold-hardy insect species that frequently serve as cryobiological model systems–the freeze-avoiding gall moth Epiblema scudderiana and the freeze-tolerant gall fly Eurosta solidaginis. Results In vivo MR images were acquired from autumn-collected larvae at temperatures between 0°C and about -70°C and at spatial resolutions down to 27 µm. These images revealed three-dimensional (3D) larval anatomy at a level of detail currently not in reach of other in vivo techniques. Furthermore, they allowed visualization of the 3D distribution of the remaining liquid water and of the endogenous cryoprotectants at subzero temperatures, and temperature-weighted images of these distributions could be derived. Finally, individual fat body cells and their nuclei could be identified in intact frozen Eurosta larvae. Conclusions These findings suggest that high resolution MR techniques provide for interesting methodological options in comparative cryobiological investigations, especially in vivo

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Karyotypic diversification due to Robertsonian rearrangements in Phyllodactylus lanei Smith, 1935 (Squamata, Gekkonidae) from Mexico

We analyzed chromosomes of male and female individuals of Phyllodactylus lanei Smith, 1935 (Squamata, Gekkonidae) from Chamela-Cuixmala Biosphere Reserve, Jalisco state, Mexico. The karyotype constructed for these specimens is composed of 19 pairs of telocentric chromosomes (2n = 38, FN = 38). This karyotype, due to Robertsonian fusions/fissions, differs from the one previously reported in samples from the State of Guerrero, which probably belonged to a different subspecies (2n = 33-34, FN = 40-41). Moreover, a presumed ZW sex chromosome system was not confirmed in the presently studied individuals

A CONCISE OVERVIEW OF MICRONUTRIENT DEFICIENCIES IN AFRICA AND FUTURE DIRECTIONS

Despite some encouraging progress, micronutrient malnutrition remains a public health problem affecting all countries in Africa. Estimates show that over 85 million people living on the African continent are iodine deficient. A further 180 million are at risk of iodine deficiency disorders. With iodized salt reaching about 70% of African households, these figures are presumably lower. Anemia is a major public health problem in Africa, affecting over 80% of women, infants and young children. Vitamin A deficiency is a public health problem in 64 countries. With a focus on the prevention and control of micronutrient deficiencies, supplementation with vitamin A capsules has been successfully integrated into the National Immunization Days in 43 of 64 vitamin A-deficient countries. Iron/folate supplementation of pregnant women is government policy in virtually all countries but has had very limited success. Multimicronutrient supplementation is another approach that is being explored. Food-based approaches such as dietary diversification are both sustainable and culturally well-accepted in the African context. Many countries in Africa are progressing with food fortification efforts including wheat flour fortification with iron in Zimbabwe and vitamin A fortification of sugar in Zambia. Ongoing complementary public health measures include breastfeeding, immunization, control of infectious diseases and poverty alleviation policies. Many existing challenges devalue the potential impact of nutrition programs on development and national progress. There exists however, a wealth of innovative promising experiences in Africa such as national micronutrient days and hammermill fortification. The major initiatives currently addressing malaria, tuberculosis, HIV/AIDS and infectious diseases will also contribute. Key words: micronutrient malnutrition, vitamin A, iron, iron deficiency anemia, Africa Rsum UNE VUE GLOBALE CONCISE DES INSUFFISANCES EN MICRONUTRIMENTS EN AFRIQUE ET ORIENTATIONS FUTURES RÉSUMÉ Malgré quelques progrès encourageants, la malnutrition en matière de micro-nutriments demeure un problème de santé publique qui affecte tous les pays en Afrique. Les estimations montrent que plus de 85 millions de personnes vivant sur le continent africain ont des insuffisances diode et que 180 millions dautres sont menacés davoir des perturbations causées par linsuffisance diode. Etant donné que le sel iodé atteint près de 70% de ménagers Africains, ces chiffres sont sans doute inférieurs à la réalité. Lanémie est un problème majeur de santé publique en Afrique ; elle affecte plus de 80% de femmes, de nourrissons et de petits enfants. Linsuffisance en Vitamine A est un problème de santé publique dans 64 pays. Laccent étant mis sur la prévention et la réduction des insuffisances en micro-nutriments, le supplément par des capsules de vitamine A a été efficacement intégré dans les Journées Nationales dImmunisation dans 43 sur 64 pays accusant une insuffisance en vitamine A. Un supplément de fer/folate chez les femmes enceintes est une politique gouvernementale dans pratiquement tous les pays, mais il a eu un succès très limité. Le supplément de multimicronutriments est une autre approche qui est explorée actuellement. Des approches basées sur les aliments, telles que la diversification du régime alimentaire, sont viables et culturellement bien acceptées dans le contexte africain. Plusieurs pays dAfrique progressent avec des efforts de fortification alimentaire, comme la fortification de la farine de blé avec du fer au Zimbabwe et la fortification de la vitamine A avec du sucre en Zambie. Les mesures en cours qui sont complémentaires de la santé publique sont notamment lallaitement, limmunisation, la lutte contre les maladies infectieuses et les politiques dallègement de la pauvreté. Beaucoup de défis actuels dévaluent limpact éventuel des programmes de nutrition sur le développement et le progrès national. Il existe, cependant, une richesse dexpériences novatrices prometteuses en Afrique, telles que les journées nationales des micro-nutriments et la fortification de hammermill. Les initiatives majeures de lutte contre la malaria, la tuberculose, les maladies infectieuses connexes du VIH/SIDA apporteront également des contributions. Mots clés: malnutrition par manque de micro-nutriments, vitamine A, le fer, lanémie causée par linsuffisance du fer, Afrique. (Af. J. Food and Nutritional Sciences: 2002 2 (2): 78-85

Transição alimentar por via oral em prematuros de um Hospital Amigo da Criança Transición de alimentación oral en bebés prematuros en un Hospital Amigo del Niño Oral feeding transition in preterm infants in a Child-Friendly Hospital

OBJETIVO: Caracterizar a transição da alimentação gástrica por via oral quanto à maturidade e peso do prematuro, vias e técnicas de administração e duração da transição até a alimentação oral exclusiva. MÉTODOS: Estudo retrospectivo com dados levantados em prontuários de 116 prematuros assistidos nas unidades de cuidados intensivos e intermediários neonatais de um hospital universitário do município de Ribeirão Preto - SP. RESULTADOS: A idade gestacional corrigida média foi de 36 semanas ao início da alimentação oral e de 37 semanas quando a alimentação ocorreu total por via oral. O peso médio foi de 1.743 gramas ao início da alimentação oral e peso médio de 1.934 gramas quando a alimentação ocorreu total por via oral. Durante o período de transição foram utilizadas uma ou mais técnicas de administração do leite. O uso da gavagem em conjunto com outras técnicas (89,5%) predominou em especial, complementada pelo seio materno e copo (56,9%) e a duração da transição alimentar variou de menos de 1 a 47 dias. CONCLUSÃO: A maturidade e o peso ao nascer, além das condições clínicas decorrentes dessas variáveis, podem interferir no processo de transição da alimentação láctea do prematuro. Considerando as vantagens da amamentação materna, sua prática deve ser iniciada o mais precocemente possível neste segmento populacional de risco.<br>OBJETIVO: Caracterizar la transición de la alimentación gástrica por vía oral en lo que se refiere a: madurez y peso del prematuro, vías y técnicas de administración y, duración de la transición hasta la alimentación oral exclusiva. MÉTODOS: Es un estudio retrospectivo con datos levantados en fichas de 116 prematuros asistidos en las unidades de cuidados intensivos e intermedios neonatales de un hospital universitario del municipio de Ribeirao Preto- SP. RESULTADOS: La edad de gestación corregida promedio fue de 36 semanas en el inicio de la alimentación oral y de 37 semanas cuando la alimentación ocurrió totalmente por la vía oral. El peso promedio fue de 1.743 gramos en el inicio de la alimentación oral y el peso promedio de 1.934 gramos cuando la alimentación ocurrió totalmente por la vía oral. Durante el período de transición fueron utilizadas una o más técnicas de administración de leche. El uso de alimentación forzada en conjunto con otras técnicas (89,5%) predominó, complementada por el seno materno y mamadera (56,9%); la duración de la transición alimentar varió de menos de 1 día a 47 días. CONCLUSIÓN: La madurez y el peso al nascer, además de las condiciones clínicas provenientes de esas variables, pueden interferir en el proceso de transición de la alimentación láctea del prematuro. Considerando las ventajas del amamantamiento materno, su práctica debe ser iniciada lo más precozmente posible en este segmento poblacional de riesgo.<br>OBJECTIVE: To characterize the transition from oral gastric feeding related to: maturity and weight of premature babies, methods and techniques of administration and, duration of the transition to only oral feeding. METHODS: This is a retrospective study of data gathered in records of 116 infants attended in intensive care units and neonatal intermediate in a university hospital in Ribeirao Preto-SP. RESULTS: The mean-corrected of gestational age was 36 weeks at the start of oral feeding and 37 weeks when the supply came entirely by the oral route. The average weight was 1,743 grams at the start of oral feeding and 1,934 grams when the food came entirely by the oral route. During the transition period were used one or more means of milk administration. The use of forced feeding in conjunction with other techniques (89.5%) predominated, this was complemented by breast feeding and milk bottle (56.9%); the duration of feeding transition ranged from less than 1 day to 47 days. CONCLUSION: The maturity and birth weight, in addition to the clinical conditions from these variables, can interfere in the process of milk feeding transition in preterm babies. Considering the advantages of breastfeeding, the practice should be initiated as early as possible in this risk population segment