Ethylene involvement in the regulation of the H\u3csup\u3e+\u3c/sup\u3e-ATPase \u3ci\u3eCsHA1\u3c/i\u3e gene and of the new isolated ferric reductase \u3ci\u3eCsFRO1\u3c/i\u3e and iron transporter \u3ci\u3eCsIRT1\u3c/i\u3e genes in cucumber plants

In previous works using ethylene inhibitors and precursors, it has been shown that ethylene participates in the regulation of several Fe-deficiency stress responses by Strategy I plants, such as enhanced ferric reductase activity, rhizosphere acidification, and subapical root hair development. Furthermore, recent evidence suggests that ethylene could regulate the expression of both the ferric reductase and the iron transporter genes of Strategy I plants by affecting the FER (or FER-like) transcription factor. Recently, two H+-ATPase genes have been isolated from cucumber roots, CsHA1 and CsHA2. CsHA1 is up-regulated under Fe deficiency while CsHA2 is constitutively expressed. In this work we have cloned and characterized the sequences of the ferric reductase (CsFRO1) and the iron transporter (CsIRT1) genes from cucumber (Cucumis sativus L. cv Ashley). Expression of CsHA1, CsFRO1, and CsIRT1 is diminished in Fe-deficient roots by treatment with ethylene inhibitors, such as Co (cobalt) or AOA (aminooxyacetic acid). Treatment with ethylene precursors, like ACC (1-aminocyclopropane-1-carboxylic acid) or Ethephon (2-chloroethylphosphonic acid), resulted in increased CsHA1, CsFRO1, and CsIRT1 transcript levels and increased ferric reductase activity during early stages of Fe deficiency. These results suggest that ethylene is involved in the regulation of CsHA1, CsFRO1, and CsIRT1 gene expression

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