Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Size and degeneration increase in herring bodies during aging in hamsters

The hypothalamo-neurohypophysial tract of young, adult and aged male hamsters was studied at lateral and ventral regions of hypothalamus by means of electron microscopy. Neurosecretory swelling axons (Herring bodies) were usually found as classically described containing abundant neurosecretory granules, mitochondria, few microtubules and profiles of smooth endoplasmic reticulum in al1 groups of age. However, in aged hamsters, starting at 18-month-old subjects, we observed that the size of some neurosecretory axons was highly increased. Autophagic and degenerative features were seen in the larger ones. These data could suggest abnormal axonal storage or axonal transport blocked during aging. The implications in the role of hypothalamus- neurohypophysial system during aging are discussed

Size and degeneration increase in herring bodies during aging in hamsters

The hypothalamo-neurohypophysial tract of young, adult and aged male hamsters was studied at lateral and ventral regions of hypothalamus by means of electron microscopy. Neurosecretory swelling axons (Herring bodies) were usually found as classically described containing abundant neurosecretory granules, mitochondria, few microtubules and profiles of smooth endoplasmic reticulum in al1 groups of age. However, in aged hamsters, starting at 18-month-old subjects, we observed that the size of some neurosecretory axons was highly increased. Autophagic and degenerative features were seen in the larger ones. These data could suggest abnormal axonal storage or axonal transport blocked during aging. The implications in the role of hypothalamus- neurohypophysial system during aging are discussed

Ultrastructural study of a special type of ependymal cell at paraventricular level of the golden hamster third ventricle

The present paper describes the presence of a special cell located in the ependymal wall at the level of the paraventricular nucleus. At this level, ultrastructural obsewation of these ependymal cells, unlike most other mammalian species, shows the presence of nucleoluslike bodies in their cytoplasm and occasionally basal processes. These processes appear perpendicular to the ependymal surface and end in contact with the basal membrane of hypothalamic capillaries. Mitochondria, endoplasmic reticulum and numerous filaments are present in the basal processes. Nucleolus-like bodies or nematosomes consist of round or ovoid unbound masses of granular appearing material of variable density located in the apical cytoplasm of the cells. Some of their ultrastructural characteristics are similar to other ependymal specialized cells which are classically termed tanycytes. These findings point out the possibility that those special cells may also be implicated in a ventricleblood vessel communication

Cell populations in the pineal gland of the viscacha (Lagostomus maximus). Seasonal variations

Pineal samples of the viscacha, which were taken in winter and in summer, were analysed using both light and electron microscopy. The differences found between the two seasons were few in number but significant. The parenchyma showed two main cell populations. Type I cells occupied the largest volume of the pineal and showed the characteristics of typical pinealocytes. Many processes, some of which were filled with vesicles, could be seen in intimate contact with the neighbouring cells. The presence in the winter samples of “synaptic” ribbons and spherules, which were almost absent in the summer pineals, suggests a seasonal rhythm. These synaptic-like structures, as well as the abundant subsurface cisterns present in type I cells, appeared as basic differential features which allowed these cells to be distinguished from type II cells. These latter cells, which can be classified as interstitial cells, showed some other distinguishing features, such as irregular-shaped nuclei, abundant deposits of glycogenlike particles and structures of unknown function consisting of concentric cisterns surrounding a dense body. In the summer, interstitial cells displayed numerous large round bodies, which contributed to increase the cellular volume slightly. Regarding other constituents, like glial cell processes, vessels of nonfenestrated endothelium and sympathetic innervation, no qualitative differences were observed between the two seasons studied. We have presented here some morphological evidences of the circannual rhythm of the viscacha pineal, as well as ultrastructural criteria for distinguishing the main cell populations of this organ, which could be useful for studies carried out in other mammals

New insights into the cytodynamics of the hamster Harderian gland as provided by the bromodeoxyuridine-labelling met hod

The fourth week of postnatal life is a critica1 point in the development of the hamster Harderian gland. During this week, cells with large lipid vacuoles (type-11 cells) appear in the male gland, marking a morphological sex difference that is notorius in adult animals. The origin and fate of type-11 cells are controversial. To gain insight into the mechanisms by which type-11 cells become a major cell type in the gland of adult male hamsters, bromodeoxyuridine (BrdU) labelling was used to assess the proliferative activity of both types of glandular cells in 28-day-old animals. To search for possible sex differences in the proliferative activity of this gland, female animals of the same age as the males were also studied. No difference was found in the overall labelling index (BrdU-labelled cells/100 cells) between males (1.8f 0.1%) and females (1.5+0.1%). In the gland of the males, the specific labelling index of type-11 cells (3.4+0.4%) was significantly higher than that of type-1 cells (0.9+0.2%). Interestingly, the proportion of type-11 cells present in the male glands at this age (36.6%) was significantly lower than that of type-1 cells. Our results strongly suggest that the proliferation of type-11 cells, rather than a continuous differentiation of these cells from preexisting type-1 cells, is a major event in the achievement of the mature form of this gland. The results reported here counsel a reappraisal of current theories about the cytodynamics of the hamster Harderian gland

Age-related morphometric changes in the pineal gland. A comparative study between C57BLI6J and CBA mice

Relatively little is known about the effects of melatonin on the aging of the pineal, the organ which is the main place for synthesis of this hormone. Using simple morphometric methods, some parameters of the pineal gland, such as total volume, number of pinealocytes and pinealocyte volume were estimated in two mice strains: normal CBA and melatonin-deficient C57BLl6J. Two age groups, 6 weeks and 10 months, were studied in order to evaluate possible differential age-related changes between both strains. Pineals of both strains have similar morphometric and morphological features at 6 weeks of age. This suggests that pineal development, which has already concluded at 6 weeks of age, is not affected by the absence of melatonin synthesis in the pinealocytes. Later on, CBA pineal showed an increase in size caused by cellular hypertrophy. In contrast, the C57BLl6J pineal volume decreased by loss of pinealocytes in the same period of time. Semithin sections analysed by light microscopy did not show that this cell death was evident in the C57BL16J strain at any of the ages studied. Thus, a gradual loss of pinealocytes could be hypothesised in these pineals. These results suggest that pineal melatonin could have a role in the maintenance of pinealocyte viability and the increase of pineal size which takes place after development. The abnormal pattern observed in the C57BL16J pineal should be taken into account in future studies on this gland