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

Dişeti ve dental folikül dokularında mezenkimal kök hücre araştırması ve plastisitelerinin karşılaştırılması

Mezenkimal kök hücreler, rejeneratif potansiyelleri, immünsupresif özelikleri ve destek doku olusturma potansiyelleri nedeniyle hücresel tedavi için ilgi çekmektedir. Kemik iliği, göbek kordonu, çevre kanı, amniotik sıvı, periost, yağ dokusu, sinovial membran ve kas gibi birçok kaynaktan elde edilebildiği gibi maksillofasiyal bölgede de MKH izolasyonu ile ilgili çalısmalar bulunmaktadır. Ağız ortamında en kolay ulasılan bölgelerden biri olan ve sürekli yenilenmekte olan disetinin MKH’ler için potansiyel bir kaynak olabileceğiyle ilgili bir çalısmaya literatürde rastlanmamıstır. Ayrıca dental folikül dokusundan MSC izolasyonu ile ilgili sınırlı sayıda çalısma mevcuttur. Çalısmada, çekim endikasyonu konulmus gömülü 20 yas disi olan 6 hastada insizyon esnasında çıkarılan disetinden ve dental folikül dokusundan alınan doku örneklerinden hücre kültürü yapılmıs ve tüm örneklerden adezyon özelliği gösteren MKH’lerin izolasyonu yapılmıs ve kültürde çoğaltılmıstır. Akım sitometri yöntemi ile hücrelerin immünfenotipleri tanımlanmıs ve adiposit, osteosit, kondrosit ve nöronal hücrelere farklılasabilme potansiyelleri arastırılmıstır. Her iki dokudan da gelistirilen MKH’lerin CD105, CD 73, CD 90 gibi stromal antijenleri yüksek oranda (%60-98) tasıdığı gösterilmistir. Hücreler kültürde 8. pasaja kadar ilerletilmis ve analizler 2, 5 ve 8. pasajlarda yapılmıstır. Pasajlar arasında yüzey antijen ekspresyonları yönünden farklılık saptanmamıstır. Kültürde çesitli uyaranlar kullanılarak yapılan farklılasma deneylerinde diseti ve folikülden elde edilen hücrelerin adipojenik ve osteojenik farklılasma kapasitelerinin bulunduğu gösterilmis, kondrojenik farklılasma elde edilmemistir. Ayrıca, uygun uyaranlar ile nöronal hücre morfolojisine değisme olduğu gözlenmistir. Bu çalısmalarda diseti ve dental folikül dokularından elde edilen MKH lere ait farklılık gözlenmemistir. Fibroblastlar ile birçok ortak özellik tasıyan MKH’lerin fibroblasttan ayrımı için, kültürde hücre yoğunluğunun, adezyon özelliklerinin, yüzey antijen ekspresyonlarının ve farklılasma özelliklerinin detaylı karsılastırması yapılmıstır. Baslangıç hücre yoğunluğu, erken veya geç adezyon göstermeleri ve yüzey antijenleri yönünden fibroblast ve MKH’lerin ayırt edilmesine katkıda bulunacak bir farklılık saptanmamıstır. Hücrelerin kök/projenitör özelliğini göstermesi açısından en önemli özellik olan çok yönlü farklılasma kapasiteleri test edildiğinde (8. pasaja kadar), ileri pasajlarda da farklılasma kapasitesinin korunmasının hücrelerin kök/projenitör özellikleri ile uyumlu olduğu, böylelikle genellikle 3.pasajdan sonra farklılasma özelliği bulunmayan fibroblastlardan ayırt edilebileceği düsünüldü. Elde edilen sonuçlar, diseti dokusunun noninvaziv metodla elde edilebilmesi ve defekt bölgesine yakın olması ile bilinen ağız içi kaynaklara ek bir MKH kaynağı olabileceğini düsündürmüstür. Mesenchymal stem cells draw attention for cell based therapy with their regenerative, and tissue supporting potential and immunosuppresive caharacteristics. MSCs can be isolated from several tissues such as bone marrow, umbilical cord, peripheral blood, amniotic fluid, periosteum, fat, synovial membrane and muscle. Like in different tissues, suitable MSC resources at the maxillofacial region have been investigated and related reports are published in the literature. No studies have been published in the literature about the gingival tissue which is the most easiest approachable site in the oral cavity with a high regeneration potential. Furthermore, isolation of MSCs from dental follicle tissues have been described in a few number of studies. In this study, impacted third molars of 6 patients were extracted in a routine surgical procedure and gingival/ dental follicle tissue samples was obtained during the incision and extraction period. Along all samples, MSCs with an adhesion property have been isolated and expanded in culture. Immunophenotyping was perfomed by flow cytometry and adipocyte, osteocyte, chondrocyte, and neuronal differentiation potential of these stem cells were tested and the characteristics of gingival and follicle stem cells were compared. It has been demonstrated that MSCs obtained from both tissues have a high frequency of specific stromal antigens (%60-98) such as CD105, CD 73, CD 90. Cells have been expanded through passage 8 and characterized at 2. 5. 8. passages. No differance have been determined about surface antigen expression speciality between the passages. Differantiation assays with various stimulants in the culture points out that dental follicle and gingiva derived cells have adipogenic and osteogenic differantiation capacity however there was no evidence of chondrogenic differantiation. Furthermore, with suitable stimulants alteration to neuronal cell morphology was observed. In this study there was no difference between the differantiation potentials of MSCs derived from gingival and dental follicle tissue. Because of their similarities, the detailed comparison of plating density, adhesion properties, surface antigen expressions and differantiation potentials have been performed to distinguish MSCs from fibroblasts. Initial plating density, early or late adhesion properties and surface antigen expressions did not contribute to distinguish MSCs from fibroblasts. Multilineage differantiation potential through the late passages is one of the most important criteria to distinguish MSCs from fibroblasts. The differantiation potential of gingiva and dental follicle derived cells through passage 8 denoted the MSC/progenitor specialities of these cells. Besides the differantiation potential of fibroblasts usually ends at the passage 3. In this study MSCs continuing differantiation through passage 8 was the most important criteria to separate these cells from fibroblasts which has a differantiation potential through passage 3. Obtained results suggest that the gingival tissue is considered as an alternative source of stem cells to the other intraoral stem cell sources with it is in close proximity to the recipient site and can be obtained easily by a non- invasiv method

Effects of humic acid on root development and nutrient uptake of Vicia faba L. (Broad Bean) seedlings grown under aluminum toxicity

Interactions of humic acid with development and uptake by seedlings of Vicia faba L., (cv. Eresen 87) grown in conditions of aluminium toxicity have been investigated in pot experiments in a controlled greenhouse environment. The objective of the study was to investigate whether humic acid moderates aluminum toxicity. The seedlings were treated with solutions of aluminum chloride (AlCl3) prepared in Hoagland control nutrient solution (HO) and 50 and100 μM and humic acid + Hoagland (HA) solutions, respectively. The 50 and100 μM HA solutions increased root fresh (RFW) and dry (RDW) weights, where the RFW differed significantly from controls (HO) after statistical evaluation by NCSS (NCSS, Kaysville, Utah) with two-sample T-test range at the 5% level. The results of the current experiment suggested that humic acid had suppressed or counteracted the toxic effect of aluminum (Al3+) on both main and lateral root growth. Humic acid seems to block the effect of Al3+ on nutrient uptake, as tested by atomic absorption spectrophotometry (AAS) and flame photometery (FP). Al3+ content in the roots was significantly decreased by 219% in 50-μM HA and by 49% in 100-μM HA treatments respectively. Potassium (K+), sodium (Na+), and iron (Fe3+) were recorded as the other elements taken up in the greatest amounts among the tested nutrients, in addition to Al3+. Humic acid increased the contents of Na+, K+, manganese (Mn2+), and zinc (Zn2+) significantly in both concentrations of HA treatment compared to controls. The Fe3+ content in the roots decreased, in both treatments of HA, application by 252% and 32% respectively. The reduction in the former was significant

Compransion Of The Clinical Outcomes Of Primary Closure And Patch Plasty Thecniques In Carotid Endarterectomy

Background: In this study, patients undergoing carotid endarterectomy with primary closure or patch angioplasty for carotid artery disease were evaluated retrospectively and our early results were presented. Methods: In our clinic, fifty-five patients who performed carotid endarterectomy for carotid artery disease between November 2013 and May 2017 were enrolled in the study. The files of patients were reviewed retrospectively. These patients were divided into two groups as Group 1 (primer closure group, n =32) and Group 2 (patch angioplasty group, n = 23). Both groups were compared in terms of demographic data, surgical technique, complications and early results. Results: There were no statistically significant differences in terms of intensive care unit stay and hospitalization, postoperative neck hematoma/exploration, postoperative renal failure and the other demographic data, symptomatology, surgical technique, ≥30-day stroke, ≥30-day restenosis, ≥30-day death between both groups. Conclusion: Our study results have shown that the closure of arteriotomy with primary or patch angioplasty after carotid endarterectomy is a safe method in terms of early results

Overview of Treatment Methods in Peripheral Major Vascular Injuries: A Retrospective Study

Objective: Vascular injuries are observed in 0.2-4% of all traumas and can be life-threatening or difficult when not properly treated. In this study, we aimed to present our experience in the treated vascular injury cases

Evoked and induced EEG oscillations to visual targets reveal a differential pattern of change along the spectrum of cognitive decline in Alzheimer's Disease

In recent years, quantitative variables derived from the electroencephalogram (EEG) attract an increasing interest for the evaluation of neurodegenerative diseases, as EEG registers the neuro-electric activity with a high temporal resolution and provides a cost-effective and easily accessible, non-invasive method. Event-related oscillations (EROs) as oscillatory responses in the EEG to specific events further provide the possibility to track the cognitive decline in a task-specific manner. Current study in search for potential ERO biomarkers to distinguish different stages of cognitive decline along the Alzheimer's Disease (AD) continuum re-analyzed a combined set of data collected and analyzed in previous studies by Basar and coworkers. Target responses of a visual oddball experiment recorded from 33 AD patients, 46 Mild Cognitive Impairment (MCI) patients and 48 age, gender, and education matched normal elderly controls were analyzed for both evoked (phase-locked) and total (phase-locked + non-phase-locked) ERO powers in delta, theta, alpha, beta and gamma bands by applying continuous wavelet transform (WT) on averaged and single trial data, respectively. The cluster-based non-parametric permutation test implemented in the FieldTrip toolbox revealed significant differences among the three groups. While the total delta and theta responses already significantly declined in the MCI stage with further spatial expansion of the decline in AD, the evoked delta response reached a statistically significant reduction level in the AD stage. We obtained no significant difference among groups for alpha, beta and gamma frequency bands. These results suggest that total delta and theta EROs to oddball targets may be useful for early detection of the disease in MCI stage, while the evoked delta response allows detecting the conversion to AD.Istanbul Universit