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

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 middle-income 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 low-income 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 low-income, 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

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

SCHC su LoRaWAN, una struttura per reti interoperabili, efficienti dal punto di vista energetico e scalabili

International audienceLow Power Wide Area Networks, or simply LP- WANs, are expected to be among the main wireless technologies to connect the massive number of constrained devices with the Internet of Things. However, the limitation of the devices and the restrictive nature of LPWANs challenge the use of the Internet protocol, and thus sacrifice the network layer interoperability. To address this challenge, the IETF standardized Static Context Header compression and Fragmentation (SCHC) as an adaptation layer. SCHC compresses structured data, such as headers, and divides long messages over several fragments thus enabling IPv6 packets. In this paper, we evaluate the impact of using SCHC on the energy consumption of a LoRaWAN device and the capacity of a LoRaWAN network in terms of the number of served users. Results show that up to 81% of energy reduction can be achieved while increasing the capacity of the network more than 4 times

SCHC su LoRaWAN, una struttura per reti interoperabili, efficienti dal punto di vista energetico e scalabili

International audienceLow Power Wide Area Networks, or simply LP- WANs, are expected to be among the main wireless technologies to connect the massive number of constrained devices with the Internet of Things. However, the limitation of the devices and the restrictive nature of LPWANs challenge the use of the Internet protocol, and thus sacrifice the network layer interoperability. To address this challenge, the IETF standardized Static Context Header compression and Fragmentation (SCHC) as an adaptation layer. SCHC compresses structured data, such as headers, and divides long messages over several fragments thus enabling IPv6 packets. In this paper, we evaluate the impact of using SCHC on the energy consumption of a LoRaWAN device and the capacity of a LoRaWAN network in terms of the number of served users. Results show that up to 81% of energy reduction can be achieved while increasing the capacity of the network more than 4 times

SCHC su LoRaWAN, una struttura per reti interoperabili, efficienti dal punto di vista energetico e scalabili

International audienceLow Power Wide Area Networks, or simply LP- WANs, are expected to be among the main wireless technologies to connect the massive number of constrained devices with the Internet of Things. However, the limitation of the devices and the restrictive nature of LPWANs challenge the use of the Internet protocol, and thus sacrifice the network layer interoperability. To address this challenge, the IETF standardized Static Context Header compression and Fragmentation (SCHC) as an adaptation layer. SCHC compresses structured data, such as headers, and divides long messages over several fragments thus enabling IPv6 packets. In this paper, we evaluate the impact of using SCHC on the energy consumption of a LoRaWAN device and the capacity of a LoRaWAN network in terms of the number of served users. Results show that up to 81% of energy reduction can be achieved while increasing the capacity of the network more than 4 times

Unlocking the potential of keyword extraction: The need for access to high-quality datasets

Keyword extraction is a critical task that enables various applications, including text classification, sentiment analysis, and information retrieval. However, the lack of a suitable dataset for semantic analysis of keyword extraction remains a serious problem that hinders progress in this field. Although some datasets exist for this task, they may not be representative, diverse, or of high quality, leading to suboptimal performance, inaccurate results, and reduced efficiency. To address this issue, we conducted a study to identify a suitable dataset for keyword extraction based on three key factors: dataset structure, complexity, and quality. The structure of a dataset should contain real-time data that is easily accessible and readable. The complexity should also reflect the diversity of sentences and their distribution in real-world scenarios. Finally, the quality of the dataset is a crucial factor in selecting a suitable dataset for keyword extraction. The quality depends on its accuracy, consistency, and completeness. The dataset should be annotated with high-quality labels that accurately reflect the keywords in the text. It should also be complete, with enough examples to accurately evaluate the performance of keyword extraction algorithms. Consistency in annotations is also essential, ensuring that the dataset is reliable and useful for further research.[015PBC-005

Targeting prohibitin with small molecules to promote melanogenesis and apoptosis in melanoma cells.

Prohibitins 1 and 2 (PHB1/2) are scaffold proteins that are involved in both melanogenesis and oncogenic pathways. We hypothesized that a PHB1 ligand, melanogenin, may display anti-cancer effects in addition to its known melanogenic activity in melanocytes. Here, we disclose a convenient synthesis of melanogenin, and its analogs. We found that, among 57 new melanogenin analogs, two (Mel9 and Mel41) significantly promoted both melanogenesis in melanocytes by activating one of the PHB2-interacting proteins, microtubule-associated protein light chain 3 (LC3), and upregulating the expression of microphthalmia associated transcription factor (MITF). These analogs also activate ERK. Besides, in addition to their promelanogenic activities, we uncovered that melanogenin and its active analogs induce apoptosis in several cancer cell lines, including melanoma cells, and that this effect is caused by an inhibition of AKT survival pathway. Our findings present a new putative function for PHBs as regulators of LC3/ERK/MITF melanogenic signaling, and suggest that Mel9 and Mel41 may provide the basis for the development of new drugs candidates to treat melanoma and other types of cancers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Discovery of 3,3′-pyrrolidinyl-spirooxindoles as cardioprotectant prohibitin ligands

International audienc