Esophageal atresia: data from a national cohort

PURPOSE: A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. METHODS: All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. RESULTS: Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. CONCLUSIONS: Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Le diagnostic anténatal modifie-t-il la prise en charge néonatale et le devenir à 1 an des enfants suivis pour atrésie de l’œsophage de type III ?

OBJECTIVE: Evaluate neonatal management and outcome of neonates with either a prenatal or a post-natal diagnosis of EA type III. STUDY DESIGN: Population-based study using data from the French National Register for EA from 2008 to 2010. We compared children with prenatal versus post-natal diagnosis in regards to prenatal, maternal and neonatal characteristics. We define a composite variable of morbidity (anastomotic esophageal leaks, recurrent fistula, stenosis) and mortality at 1 year. RESULTS: Four hundred and eight live births with EA type III were recorded with a prenatal diagnosis rate of 18.1%. Transfer after birth was lower in prenatal subset (32.4% versus 81.5%, P<0.001). Delay between birth and first intervention was not significantly different. Defect size (2cm vs 1.4cm, P<0.001), gastrostomy (21.6% versus 8.7%, P<0.001) and length in neonatal unit care were higher in prenatal subset (47.9 days versus 33.6 days, P<0.001). The composite variables were higher in prenatal diagnosis subset (38.7% vs 26.1%, P=0.044). CONCLUSION: Despite the excellent survival rate of EA, cases with antenatal detection have a higher morbidity related to the EA type (longer gap). Even if it does not modify neonatal management and 1-year outcome, prenatal diagnosis allows antenatal parental counseling and avoids post-natal transfer

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Transcranial Random Noise Stimulation-induced plasticity is NMDA-receptor independent but sodium-channel blocker and benzodiazepines sensitive

Background: Application of transcranial random noise stimulation (tRNS) between 0.1 and 640 Hz of the primary motor cortex (M1) for 10 minutes induces a persistent excitability increase lasting for at least 60 minutes. However, the mechanism of tRNS-induced cortical excitability alterations is not yet fully understood. Objective: The main aim of this study was to get first efficacy data with regard to the possible neuronal effect of tRNS. Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to measure levels of cortical excitability before and after combined application of tRNS at an intensity of 1mA for 10mins stimulation duration and a pharmacological agent (or sham) on 8 healthy male participants. Results: The sodium channel blocker carbamazepine showed a tendency towards inhibiting MEPs 5-60 mins poststimulation. The GABAA agonist lorazepam suppressed tRNS-induced cortical excitability increases at 0-20 and 60 min time points. The partial NMDA receptor agonist D-cycloserine, the NMDA receptor antagonist dextromethorphan and the D2/D3 receptor agonist ropinirole had no significant effects on the excitability increases seen with tRNS.Conclusions: In contrast to transcranial direct current stimulation (tDCS), aftereffects of tRNS are seem to be not NMDA receptor dependent and can be suppressed by benzodiazepines suggesting that tDCS and tRNS depend upon different mechanisms

Optimized micro-climate controller of a greenhouse powered by photovoltaic generator

Energy resources and food security are the most important issues for many countries around the world. Climatic conditions affect the agriculture production which is the backbone of the food security for all countries. Protected agriculture presents an effective solution to face this challenge. This paper aims to develop a high tech greenhouse with effective climatic control for greater yield. A fuzzy controller is used to manage the inside temperature and humidity of the greenhouse. Furthermore, based on the high level of solar radiation during summer and the high demand of power, the photovoltaic energy could be investigated to avoid burdening the utility grid by feeding different accessories of the greenhouse. This application is in accordance with the sustainable development and the environment protection where the classical energy resources are substituted with green energy form.Scopu

Neuroplastic effects of transcranial near-infrared stimulation (tNIRS) on the motor cortex

Near-infrared light stimulation of the brain has been claimed to improve deficits caused by traumatic brain injury and stroke. Here, we exploit the effect of transcranial near-infrared stimulation (tNIRS) as a tool to modulate cortical excitability in the healthy human brain. tNIRS was applied at a wavelength of 810 nm for 10 minutes over the hand area of the primary motor cortex (M1). Both single-pulse and paired-pulse measures of transcranial magnetic stimulation (TMS) were used to assess levels of cortical excitability in the corticospinal pathway and intracortical circuits. The serial reaction time task (SRTT) was used to investigate the possible effect of tNIRS on implicit learning.By evaluating the mean amplitude of single-pulse TMS elicited motor-evoked-potentials (MEPs) a significant decrease of the amplitude was observed up to 30 minutes post-stimulation, compared to baseline. Furthermore, the short interval cortical inhibition (SICI) was increased and facilitation (ICF) decreased significantly after tNIRS. The results from the SRTT experiment show that there was no net effect of stimulation on the performance of the participants. Results of a study questionnaire demonstrated that tNIRS did not induce serious side effects apart from light headache and fatigue. Nevertheless, 66% were able to detect the difference between active and sham stimulation conditions.In this study we provide further evidence that tNIRS is suitable as a tool for influencing cortical excitability and activity in the healthy human brain

An intelligent system for the climate control and energy savings in agricultural greenhouses

A greenhouse for crop production is a complex thermodynamic system where the indoor temperature and the humidity conditions have a great impact on the crop yields. This system can be considered a multivariable input output system MIMO. This paper aims at presenting a physical model of a greenhouse, experimentally validated, in order to propose a fuzzy-based controller to manage the indoor climate of a greenhouse using some actuators (induction motors, heating system etc.?) for ventilation, heating, humidifying, and dehumidifying purposes. In addition, a novel approach is presented for energy management by involving the photovoltaic energy in order to minimize the use of conventional electrical grid and to lower costs of agriculture production. The photovoltaic (PV) generator will serve to power a direct torque control (DTC) controlled induction motor which drive a variable speed fan. The validation of the physical model shows a high agreement with the experimental measurement. The simulation results show the effectiveness of the fuzzy controller as well as the PV generator for saving the energy and lowering the costs of crop production into greenhouses.Scopu

An intelligent system for the climate control and energy savings in agricultural greenhouses

A greenhouse for crop production is a complex thermodynamic system where the indoor temperature and the humidity conditions have a great impact on the crop yields. This system can be considered a multivariable input output system MIMO. This paper aims at presenting a physical model of a greenhouse, experimentally validated, in order to propose a fuzzy-based controller to manage the indoor climate of a greenhouse using some actuators (induction motors, heating system etc.…) for ventilation, heating, humidifying, and dehumidifying purposes. In addition, a novel approach is presented for energy management by involving the photovoltaic energy in order to minimize the use of conventional electrical grid and to lower costs of agriculture production. The photovoltaic (PV) generator will serve to power a direct torque control (DTC) controlled induction motor which drive a variable speed fan. The validation of the physical model shows a high agreement with the experimental measurement. The simulation results show the effectiveness of the fuzzy controller as well as the PV generator for saving the energy and lowering the costs of crop production into greenhouses

Auditory beat stimulation and its effects on cognition and mood states

Auditory beat stimulation may be a promising new tool for the manipulation of cognitive processes and the modulation of mood-states. Here we aim to review the literature examining the most current applications of auditory beat stimulation and its targets. We give a brief overview of research on auditory steady-state responses and its relationship to auditory beat stimulation. We have summarized relevant studies investigating the neurophysiological changes related to auditory beat stimulation and how they impact upon the design of appropriate stimulation protocols. Focusing on binaural beat stimulation, we then discuss the role of monaural and binaural beat frequencies in cognition and mood-states, in addition to their efficacy in targeting disease symptoms. We aim to highlight important points concerning stimulation parameters and try to address why there are often contradictory findings with regard to the outcomes of auditory beat stimulation