Growth Assessment of Native Tree Species from the Southwestern Brazilian Amazonia by Post-AD 1950 14C Analysis: Implications for Tropical Dendroclimatology Studies and Atmospheric 14C Reconstructions

Tree-ring width chronologies of cedro (Cedrela fissilis Vell.) (1875 to 2018), jatobá (Hymenaea courbaril L.) (1840 to 2018) and roxinho Peltogyne paniculata Benth.) (1910 to 2018) were developed by dendrochronological techniques in the southern Amazon Basin. Acceptable statistics for the tree-ring chronologies were obtained, and annual calendar dates were assigned. Due to the lack of long-term chronologies for use in paleoclimate reconstructions in degraded forest areas, dendrochronological dating was validated by14C analysis. Tree-rings selected for analysis corresponded to 1957, 1958, 1962, 1963, 1965, 1971, and 1972. Those are critical calendar years in which atmospheric14C changes were the highest, and therefore their tree-ring cellulose extracts14C signatures when in alignment with existing post-AD 1950 atmospheric14C atmospheric curves would indicate annual periodicity. Throughout our correlated calendar years and post-AD 195014C signatures, we indicate that H. courbaril shows an erratic sequence of wood ages. The other two tree species, C. fissilis and P. paniculata, are annual in nature and can be used successfully as paleoclimate proxies. Moreover, due to the sampling site’s strategic location in relation to the Tropical Low-Pressure Belt over South America, these trees can be used to enhance the limited amount of observational data in Southern Hemisphere atmospheric14C calibration curves.Fil: Santos, Guaciara M.. University of California; Estados UnidosFil: Ortega Rodriguez, Daigard Ricardo. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; BrasilFil: Barreto, Nathan de Oliveira. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; BrasilFil: Assis Pereira, Gabriel. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; BrasilFil: Barbosa, Ana Carolina. Universidad Federal de Lavras.; BrasilFil: Roig Junent, Fidel Alejandro. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales; Argentina. Universidad Mayor; ChileFil: Tomazello Filho, Mário. Universidade do Sao Paulo. Escola Superior de Agricultura Luiz de Queiroz; Brasi

MANEJO DE CRANIECTOMIA DESCOMPRESSIVA EM NEUROCIRURGIA PEDIÁTRICA

The aim of this article is to provide a comprehensive overview of pediatric decompressive craniectomy, covering from surgical decision-making to post-operative care and reintegration. The multidisciplinary analysis emphasizes the importance of monitoring, pain management, psychosocial support, and continuous education, aiming not only for surgical effectiveness but also the overall well-being of the child for a successful recovery. Methodology: This involves an integrative review with literature search in specialized databases such as PubMed and Scopus, using relevant terms related to decompressive craniectomy and pediatric neurosurgery, descriptors: "Craniectomy," "Decompressive Craniectomy," "Child Health," "Pediatric Care." Results: In the development, the article explores the phases of pediatric decompressive craniectomy, encompassing surgical decision-making, post-operative care, and reintegration. It emphasizes the importance of aspects such as monitoring, pain management, psychosocial support, and continuous education to promote a complete recovery. The integrative approach seeks a holistic understanding, considering both medical and emotional-social aspects. Conclusion: Pediatric decompressive craniectomy requires comprehensive care, including monitoring and emotional support. Successful reintegration is promoted through continuous guidance, covering home care and school adaptations. This approach aims for surgical effectiveness and overall well-being in recovery.O objetivo deste artigo é oferecer uma visão abrangente sobre a craniectomia descompressiva em crianças, abordando desde a decisão cirúrgica até os cuidados pós-operatórios e reintegração. A análise multidisciplinar destaca a importância da monitorização, manejo da dor, apoio psicossocial e educação contínua, visando não apenas a eficácia cirúrgica, mas também o bem-estar global da criança para uma recuperação bem-sucedida. Metodologia: Trata-se de uma revisão integrativa com a busca de literatura em bases de dados especializadas, como PubMed e Scopus, utilizando termos relevantes relacionados à craniectomia descompressiva e neurocirurgia pediátrica, os descritores: “Craniectomia”, “Craniectomia Descompressiva”, “Saúde da Criança”, “Cuidado Infantil”. Resultados: No desenvolvimento, o artigo explora as fases da craniectomia descompressiva pediátrica, abrangendo a decisão cirúrgica, cuidados pós-operatórios e reintegração. Destaca a importância de aspectos como monitorização, manejo da dor, apoio psicossocial e educação contínua para promover uma recuperação completa. A abordagem integrativa busca uma compreensão holística, considerando tanto os aspectos médicos quanto os emocionais e sociais. Conclusão: A craniectomia descompressiva em crianças demanda cuidados abrangentes, incluindo monitorização e suporte emocional. A reintegração bem-sucedida é promovida por meio de orientações contínuas, abrangendo cuidados em casa e adaptações escolares. Essa abordagem visa eficácia cirúrgica e bem-estar total na recuperação

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030