Petrogenesis of arc-related peridotite hosted chromitite deposits in Sikhoran-Soghan mantle section, South Iran: evidence for proto-forearc spreading to boninitic stages

The Soghan-Sikhoran ophiolite in southeast Iran (Outer Zagros Ophiolite Belt) is a remnant of a series of Upper Triassic–Cretaceous supra-subduction zone (SSZ) ophiolites that formed along the Zagros suture zone, which is considered as the southern border of the Neo-Tethyan sea. These SSZ ophiolites are older than the Late Cretaceous Zagros ophiolites. The main part of the Soghan-Sikhoran ophiolite comprises layered ultramafic cumulates including dunites, wehrlites, and pyroxenites, and a tectonized mantle section including residual lherzolites, and depleted harzburgites with foliated/discordant dunite lenses. Podiform chromitites are common and are typically surrounded by thin dunitic haloes. Spinels in lherzolite–harzburgite are geochemically characterized by a low Cr# (42.0 to 52.6), and plot in an abyssal peridotite field on geochemical discrimination diagrams, whereas spinel in dunites and high-Cr chromitite spinels (Cr# = 52.4 to 76.4) show geochemical affinities to boninites. Lherzolites and harzburgites have low REE contents and experienced >17 vol% partial melting. The Soghan-Sikhoran ophiolite contains both high Cr# and low Cr# podiform chromitite types. Trace and REE element patterns of Soghan-Sikhoran rocks are similar to those in SSZ peridotites. The studied ophiolites show relatively moderate to high oxygen fugacities (ƒO2), with log units ranging from −0.4 to +0.4 for harzburgites, +0.2 for lherzolites, from − 0.7 to + 2.5 for pyroxenites, from +0.8 to +2.2 for dunites, and from + 0.6 to + 0.8 for chromitites. The moderate to high oxidation state of the studied upper-mantle ophiolitic complexes also suggests a boninitic source in the mantle wedge of the arc setting. The two-pyroxene thermometer yields mean equilibrium temperatures of 879 °C, 895 °C, 912 °C and 912 °C for harzburgites, lherzolites, dunites and pyroxenites, respectively. We therefore interpret that the spinels in the lherzolite-harzburgite crystallized from tholeiitic melt generated due to proto-forearc spreading and formation of the infant arc, whereas high-Cr# spinel in dunites and high-Cr# chromitite crystallized from boninitic melts during the mature arc stage, with an increasing contribution of slab-derived fluids at high ƒO2

Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin- (IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n=25), non-BA cholestasis group (n=30), and neglected BA group (n=20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin > 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and <0.0001, resp.) but comparable to that in the neglected BA group. Preoperative IL-12p40 levels in BA patients were significantly higher in successful Kasai compared with failed Kasai and a cutoff level of 547.47 pg/ml could predict the successful outcome with 87.5% sensitivity and 82.4% specificity. Three-month postoperative IL-12p40 tended to decrease in both the successful and failed groups. In conclusion, preoperative serum IL-12p40 is a potential predictor of Kasai outcome. Serial postoperative measurements may anticipate the failure of an initially successful operation, hence the need for liver transplantation

Remote sensing techniques and geochemical constraints on the formation of the Wadi El-Hima mineralized granites, Egypt: new insights into the genesis and accumulation of garnets

The Wadi El-Hima Neoproterozoic I- and A-type granites in the Southern Eastern Desert of Egypt are rich in garnets (up to 30 vol%) and are cut by NW–SE strike-slip faults, as confirmed from structure lineament extraction maps. These mineralized granites and garnet mineralization zones can be successfully discriminated using remote sensing techniques. Spectral angle mapper and matched filtering techniques are highly effective for mapping garnet-rich zones and show that the highest garnet concentrations occur along the intrusive contact zone of NW–SE striking faults. El-Hima granites have high SiO2 (73.5–75.1 wt%), Al2O3 (13.4–15.3 wt%) and total alkali (6.7–8.7 wt%) contents, suggesting that they were sourced from peraluminous (A/CNK > 1) parental magmas. Garnet-bearing trondhjemites are metasomatic in origin and formed after I-type tonalite-granodiorites, which originated in a volcanic arc tectonic setting. Garnet-rich syenogranites and alkali-feldspar granites are both post-collisional A-type granites: the syenogranites formed from peraluminous magmas generated by partial melting of lower crustal tonalite and metasedimentary protoliths during lithospheric delamination, and the alkali-feldspar granites crystallized from highly fractionated, felsic and alkali-rich peraluminous magmas in the upper crust. Garnets in El-Hima mineralized granites occur in three forms: (1) subhedral disseminated crystals, (2) vein-type crystals, and (3) aggregated subhedral crystals, reflecting different mechanisms of accumulation. All are dominantly almandine in composition (Alm76Sps10 Prp7Grs6Adr1) and have high average concentrations of heavy rare earth elements (HREE) (ΣHREE = 1636 ppm), Y = (3394 ppm), Zn (325 ppm), Li (39.17 ppm) and Ga (34.94 ppm). Garnet REE patterns show strong negative Eu anomalies with HREE enriched relative to LREE, indicating a magmatic origin. These magmatic garnets are late-stage crystallization products of Al-rich hydrous magmas, and formed at low temperature (680–730 °C) and pressure (2.1–2.93 kbar) conditions in the upper continental crust. Peculiar garnet concentrations in syenogranites near and along contact zones with alkali feldspar granites are related to peraluminous parent hydrous magma compositions. These garnets formed by in situ crystallization from A-type granite melts, alongside accumulation of residual garnets left behind after partial melting of the host garnet-rich granites along the intrusive contact. Magmatic-fluid flow along the NW–SE striking fault of Najd system enhanced garnet accumulation in melts, which formed clots and veins of garnet

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Petrology and chemistry of basal lherzolites above the metamorphic sole from wadi sarami central oman ophiolite

We studied basal lherzolites that are exposed along the metamorphic sole at the base of the central Oman ophiolite (Wadi Sarami). We recognized two types of lherzolites (Types I and II) based on field occurrences, textures, and mineral compositions. Type I lherzolites are massive and transition into harzburgites, whereas Type II lherzolites are strongly foliated with mylonitic to porphyroclastic textures. Type II lherzolites only crop out within a direct contact with the amphibolitic sole to few meters above this sole and are overlain and/or surrounded by Type I. The clinopyroxenes [Mg# = Mg/(Mg + Fe) = 0.89-0.94] of Type II lherzolites show higher contents of Al2O3 (4.5-7.3 wt%), Na2O (0.5-1.2 wt%), Cr2O3 (0.6-1.4 wt%), and TiO2 (0.2-0.4 wt%) than those of Type I lherzolites. Positive correlations among the Al2O3, Na2O, and TiO2 contents of clinopyroxenes show a pronounced residual trend from Type I lherzolites to depleted harzburgite, giving rise to chemical heterogeneities at the base of the mantle section. Clinopyroxenes in lherzolites and harzburgites show compositional trends that are similar to those in abyssal peridotites from normal ridge segments. Olivines (Fo89.4-Fo91.5) show a residual character of the Sarami peridotites. Primary spinels show a wide range of Cr# [= Cr/(Cr + Al) from 0.04 to 0.53] and low YFe [Fe3+/(Cr + Al + Fe3+), <0.046], similar to spinels in abyssal peridotites. The wide range of spinel Cr# is a result of a wide range of partial-melting degrees, which are up to 10% for lherzolites and ~ 10-25% for harzburgites. The Type II lherzolites, which occur near the paleo-fracture zone located to the east of Wadi Sarami, represent a remnant of asthenospheric materials trapped at the base of oceanic lithosphere mantle (Type I) during detachment and obduction. The Type I lherzolites experienced high-degree partial melting, resulting in the formation of harzburgites at the refractory end. The modal and compositional variations of Sarami pyroxenes and spinels indicate intrinsic mantle heterogeneity of Oman ophiolite formed as residues at an oceanic spreading center

Preoperative Serum IL-12p40 Is a Potential Predictor of Kasai Portoenterostomy Outcome in Infants with Biliary Atresia

The standard-of-care treatment for biliary atresia (BA) is surgical restoration of bile flow by Kasai portoenterostomy. We aimed to study serum interleukin-(IL-) 12p40, a natural antagonist for the proinflammatory IL-12p70, and its relation to surgical outcomes of BA. The study included 75 infants with neonatal cholestasis: BA group (n = 25), non-BA cholestasis group (n = 30), and neglected BA group (n = 20), in addition to thirty healthy neonates serving as controls. IL-12p40 was measured by ELISA in all individuals and a second assessment was performed 3 months postoperatively in the BA group. The surgical outcomes were classified as successful (bilirubin ≤ 2 mg/dl) or failed (bilirubin &gt; 2 mg/dl). IL-12p40 was higher in BA compared to that in the non-BA and control groups (P values were 0.036 and &lt;0.0001, resp.) but comparable to that in the neglected BA group. Preoperative IL-12p40 levels in BA patients were significantly higher in successful Kasai compared with failed Kasai and a cutoff level of 547.47 pg/ml could predict the successful outcome with 87.5% sensitivity and 82.4% specificity. Three-month postoperative IL-12p40 tended to decrease in both the successful and failed groups. In conclusion, preoperative serum IL-12p40 is a potential predictor of Kasai outcome. Serial postoperative measurements may anticipate the failure of an initially successful operation, hence the need for liver transplantation