Nutrition in the paediatric surgical patient

Nutritional care of surgical infants and children is of major importance. This is for several reasons: (i) body stores are often smaller and more precarious; (ii) infants and children not only require energy for maintenance, but also for growth; and (iii) as in adults, recovery from surgery is faster in those patients who are adequately nourished. Survival of infants with congenital anomalies dramatically improved following the introduction of parenteral nutrition. However, infection and cholestasis remain problematic for parenterally fed infants and children

Öffentliche Unterstützung für Demokratie und Autokratie in Russland

Putin genießt innerhalb der russischen Bevölkerung immer noch hohe Zustimmungswerte. Diese werden oftmals als öffentliche Akzeptanz gegenüber dem autoritären Kurs, der während Putins ersten beiden Amtszeiten als Präsident und seiner Zeit als Premierminister eingeschlagen wurde, interpretiert. Die Ergebnisse einiger Meinungsumfragen scheinen dieses Bild zu bestätigen. Allerdings könnte es auch sein, dass diese Befunde verzerrt sind und weniger Unterstützung für Demokratie anzeigen, als es tatsächlich der Fall ist. Die Herausforderung besteht nämlich darin, Zustimmung zu Demokratie in einem Land zu messen, in dem es gar keinen demokratischen Institutionen gibt. In Gesellschaften, die sich entweder auf dem Weg hin zu Demokratie oder weg von ihr bewegen, ist oft unklar, was »Demokratie« tatsächlich bedeutet. Institutionen und Praktiken, die das Label »Demokratie« tragen, handeln oft nicht so, wie es allgemeinen demokratischen Normen entsprechen würde. Interpretiert man die erwähnten Umfrageergebnisse unter diesem Gesichtspunkt, dann lassen sich Hinweise auf ein höheres Maß an passiver Unterstützung für Demokratie in Russland finden, als für gewöhnlich angenommen. Hingegen sind nur wenige bereit, sich aktiv politisch zu engagieren

А порядка в ней нет

Russian-language edition: One common explanation for the failure of democracy to take root in Russia more quickly and more thoroughly than it has points to inherited cultural values that predispose Russian citizens to favor an autocratic type of governance. Ellen Carnaghan takes aim at this cultural-determinist thesis in her study of Russian attitudes, based on intensive interviews with more than sixty citizens from all walks of life and a variety of political orientations. What she finds is that, rather than being influenced by an antidemocratic and anticapitalist ideology, these ordinary citizens view the economic and political system in Russia today very critically because it simply does not function well for them in meeting their everyday needs. They long for order not because they eschew democracy and free markets in any fundamental way, but because they experience them currently as chaotic and unpredictable, leading to constant frustration. As a result, there is reason to be optimistic about further progress in democratization: it depends on improving the functioning of existing institutions, not transforming deep-rooted cultural norms. In the Conclusion, Carnaghan applies her argument to elucidating the reasons why Russians have responded favorably to what Westerners see as moves in an antidemocratic direction by Vladimir Putin’s government

Investigation of the Pathophysiology and In-Utero Treatment of Gastroschisis-Related Intestinal Dysfunction

BACKGROUND: Gastroschisis is a paraumbilical abdominal wall defect through which the bowel herniates. The bowel is in direct contact with the amniotic fluid. At birth the bowel is often thickened and shortened. The main gastroschisis-related morbidity is that of intestinal dysmotility but the mechanism(s) underlying this are poorly understood and no treatment advances have occurred since the advent of parenteral nutrition. Human studies have shown that the third trimester amniotic fluid of gastroschisis pregnancies is proinflammatory. In addition, in animal models of gastroschisis and human pathological gut tissue interstitial cells of Cajal (ICC – pacemaker cells of the gut) have been found to be decreased in number and immature within gastroschisis bowel. HYPOTHESES: Gastroschisis-related intestinal dysfunction (GRID) is secondary to deficient, immature bowel wall ICC. AIMS: My primary aim in this thesis was to investigate the development of ICC in gastroschisis utilising genetic animal models and human pathological gut tissue. Additionally, I aimed to determine the overall morphology of gastroschisis bowel wall, the impact of inflammatory modulation on bowel wall development and the impact of clinical antenatal interventions on infant outcomes. METHODS: Quantitative analysis of bowel wall ICC, enteric neurons and architecture were performed utilising genetic animal gastroschisis models and human pathological tissue. Modulation of in-utero inflammation was performed through in-utero injections of IL-8 (pro-inflammatory protein) in a genetic animal gastroschisis model. Finally, retrospective clinical data on gastroschisis were collected from three paediatric surgical centres to determine whether early delivery or administration of maternal antenatal corticosteroids could improve infant morbidity. RESULTS: Phenotypic analysis of the Scribble knockout mouse model revealed the expressed abdominal wall defect (AWD) to be that of exomphalos rather than gastroschisis. Additionally, phenotypic analysis of the aortic carboxypeptidase-like protein (ACLP) knockout mouse showed the AWD was not characteristic of gastroschisis as the externalised bowel was free floating within exocoelomic fluid and not the amniotic fluid. Bowel wall ICC were architecturally normal but reduced in number in AWD fetuses compared to controls. In-utero injection of IL-8 further reduced ICC numbers. In contrast, analysis of human pathological gut tissue showed no difference in the number or architecture of bowel wall ICC between gastroschisis and control tissue. However, the gastroschisis bowel wall was significantly thicker than that of controls with evidence of smooth muscle hyperplasia and deficiency of α-smooth muscle actin within the longitudinal muscle layer. The clinical retrospective data showed that early delivery of gastroschisis fetuses did not improve bowel function and was associated with prolonged time to full enteral feeds and length of hospital stay. Additionally, there was no evidence that administration of maternal antenatal corticosteroids improved time to full enteral feeds or length of hospital stay in gastroschisis infants. CONCLUSION: Phenotypic analysis of abdominal wall defects in murine models is challenging. However, accurate delineation of the defect anatomy is essential to ensure appropriate result reporting and data analysis. The presented data suggests the ICC may be less important as the cause of GRID than originally expected. However, another potential cause for GRID is bowel wall thickening comprising of smooth muscle hyperplasia and possible bowel myopathy for which there are several hypothesised triggers. Additionally, the data presented in this thesis do not support early delivery of gastroschisis fetuses or the administration of maternal antenatal corticosteroids as methods to improve gastroschisis infant outcomes. The results of this thesis have generated some important findings and have highlighted a number of novel hypotheses for the trigger of GRID. Further research on the basis of these findings within an appropriate animal model and through prospective non-invasive human studies are required in order to develop a targeted antenatal therapy to improve gastroschisis infant bowel function and clinical outcomes

Effect of gestational age at birth on neonatal outcomes in gastroschisis.

Induced birth of fetuses with gastroschisis from 34weeks gestational age (GA) has been proposed to reduce bowel damage. We aimed to determine the effect of birth timing on time to full enteral feeds (ENT), length of hospital stay (LOS), and sepsis. A retrospective analysis (2000-2014) of gastroschisis born at ≥34weeks GA was performed. Associations between birth timing and outcomes were analyzed by Mann-Whitney test, Cox regression, and Fisher's exact test. 217 patients were analyzed. Although there was no difference in ENT between those born at 34-36+6weeks GA (median 28 range [6-639] days) compared with ≥37weeks GA (27 [8-349] days) when analyzed by Mann-Whitney test (p=0.5), Cox regression analysis revealed that lower birth GA significantly prolonged ENT (p=0.001). LOS was significantly longer in those born at 34-36+6weeks GA (42 [8-346] days) compared with ≥37weeks GA 34 [11-349] days by both Mann-Whitney (p=0.02) and Cox regression analysis (p<0.0005). Incidence of sepsis was higher in infants born at 34-36+6weeks (32%) vs. infants born at ≥37weeks (17%; p=0.02). Early birth of fetuses with gastroschisis was associated with delay in reaching full enteral feeds, prolonged hospitalization, and a higher incidence of sepsis

Novel exomphalos genetic mouse model: The importance of accurate phenotypic classification.

Rodent models of abdominal wall defects (AWD) may provide insight into the pathophysiology of these conditions including gut dysfunction in gastroschisis, or pulmonary hypoplasia in exomphalos. Previously, a Scribble mutant mouse model (circletail) was reported to exhibit gastroschisis. We further characterise this AWD in Scribble knockout mice

Epiboly generates the epidermal basal monolayer and spreads the nascent mammalian skin to enclose the embryonic body

© 2016. Published by The Company of Biologists Ltd This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution and reproduction in any medium provided that the original work is properly attributed.Epiboly is a morphogenetic process that is employed in the surface ectoderm of anamniotes during gastrulation to cover the entire embryo. We propose here that mammals also utilise this process to expand the epidermis and enclose the body cavity and spinal cord with a protective surface covering. Our data supports a model whereby epidermal spreading is driven by the primary establishment of the epidermal basal progenitor monolayer through radial cell intercalation of a multi-layered epithelium towards the basal lamina. By using a suspension organotypic culture strategy, we find that this process is fibronectin-dependent and autonomous to the skin. The radial cell rearrangements that drive epidermal spreading also require ROCK activity but are driven by cell protrusions and not myosin II contractility. Epidermal progenitor monolayer formation and epidermal spreading are delayed in Crash mice, which possess a dominant mutation in Celsr1, an orthologue of the core planar cell polarity (PCP) Drosophila protein Flamingo (also known as Stan). We observe a failure of ventral enclosure in Crash mutants suggesting that defective epidermal spreading might underlie some ventral wall birth defects.Peer reviewedFinal Published versio

End of organised atheism. The genealogy of the law on freedom of conscience and its conceptual effects in Russia

In the current climate of the perceived alliance between the Russian Orthodox Church and the state, atheist activists in Moscow share a sense of juridical marginality that they seek to mitigate through claims to equal rights between believers and atheists under the Russian law on freedom of conscience. In their demands for their constitutional rights, including the right to political critique, atheist activists come across as figures of dissent at risk of the state's persecution. Their experiences constitute a remarkable (and unexamined in anthropology) reversal of political and ideological primacy of state-sponsored atheism during the Soviet days. To illuminate the legal context of the atheists’ current predicament, the article traces an alternative genealogy of the Russian law on freedom of conscience from the inception of the Soviet state through the law's post-Soviet reforms. The article shows that the legal reforms have paved the way for practical changes to the privileged legal status of organized atheism and brought about implicit conceptual effects that sideline the Soviet meaning of freedom of conscience as freedom from religion and obscure historical references to conscience as an atheist tenet of Soviet ethics