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

Functional responsive superparamagnetic core/ shell nanoparticles and their drug release properties

International audienceThe preparation of responsive superparamagnetic iron oxide (SPIO) nanoparticles (NPs), able to carry the anticancer drug doxorubicin (DOX) and to release it in physiological media at the physiological temperature, is one of the major challenges in nanomedicine. In this work, two families of NPs were synthesized. The first one consists of superparamagnetic Fe 3 O 4 NPs functionalized via covalent grafting by a biocompatible responsive copolymer based on 2-(2-methoxy)ethyl methacrylate (MEO 2 MA) and oligo(ethylene glycol) methacrylate (OEGMA). The second one consists of the same core/shell NPs but folic acid, a biological cancer targeting molecule, was grafted at the polymer chain end. The core/shell NPs were fully characterized by the combination of spectroscopic and microscopic techniques. The influence of the polymer chain structure in water and in physiological media was studied. We demonstrate that the magnetic properties of the NPs were only influenced by the amount of the grafted polymer and no influence of NP aggregation was evidenced. Indeed, the derived nanostructured materials displayed a combination of the physical properties of the core and the macromolecular behavior of the shell. The drug release experiments confirmed that DOX was largely released above the co-polymer LCST due to the presence of DOX. The nanomaterials developed in this work have high potential as multi-modal cancer therapy tools

Annealing effects on the structural, electrical and optical properties of ZnO thin films prepared by thermal evaporation technique

Zinc oxide (ZnO) thin films have been prepared on glass substrates at room temperature by thermal evaporation technique using ZnO powders and then are annealed at different temperatures ranging from 200 °C to 500 °C for 2 h in air. The effect of the annealing temperature (Tr) on the structural, optical and electrical properties of the ZnO thin films was studied. Experimental results show that annealing temperature has an important role in the changes observed in the structural, optical and electrical properties of the ZnO thin films. The XRD measurements confirm that the thin films grown by this technique have good crystalline hexagonal wurtzite structures. The optical transmittance spectra show transmittance higher about ∼90% within the visible wavelength region. Hence, the values of the gap are found to be between 3.13 and 3.25 eV. The resistivity values of the films have changed between 2.10−3 and 4.10−2 Ω cm with annealing temperature

Highly improved optical properties of silicon nanowires by deposition of Poly[2-methoxy-5-(2 '-ethylhexyloxy)-1,4-phenylene vinylene] polymer

International audienceThis paper reports on the effect of the Poly[2-methoxy-5-(2'-ethylhexyloxy)-1,4-phenylene vinylene] (MEH-PPV) deposition on the chemical composition and the optical properties of silicon nanowires (SiNWs). The SiNWs were obtained by a single-step Ag-assisted chemical etching method, and then coated by MEH-PPV polymer using the electroless dipping method. Scanning Electron Microscopy (SEM), X-Ray Diffraction (XRD) and Fourier Trans-formed Infra-Red (FTIR) spectroscopy were used to probe the deposition of the polymer on the SiNWs surface and its chemical interaction with them. The optical properties of the elaborated samples were investigated by pho-toluminescence (PL) spectroscopy. The PL spectra show that the PL emission range of the nanowires is practically the same as that of the MEH-PPV. We also get an enhancement of five orders of the integrated PL intensity of MEH-PPV/SiNWs sample compared to that of untreated SiNWs sample. The PL intensity enhancement is attributed to the luminescent centers of MEH-PPV molecules as well as the passivation of silicon nanowires surface. Interchain and intrachain transitions in the polymeric layer as well as the carriers transfer between SiNWs and MEH-PPV are the main sources of the multiband PL spectra

Efficient synthetic access to thermo-responsive core/shell nanoparticles

International audienceCore/shell nanostructures based on silica, fluorescent ZnO quantum dots (QDs) and superparamagnetic Fe3O4 nanoparticles (NPs) were prepared and fully characterized by the combination of different techniques and the physical properties of the nanostructures were studied. We demonstrate the efficiency of the Atom Transfer Radical Polymerization with activators Regenerated by electron Transfer (ARGET-ATRP) process to graft (co-)polymers of different structures and polarity at the surface of metal oxide NPs. The influence of the polymer chain configuration on the optical properties of the ZnO/polymer core/shell QDs was enlightened. Concerning the magnetic properties of the Fe3O4/polymer nanostructures, only the amount of the grafted polymer plays a role on the saturation magnetization of the NPs and no influence of the aggregation was evidenced. The simple and fast process described in this work is efficient for the grafting of copolymers from surfaces and the derived NPs display the combination of the physical properties of the core and the macromolecular behavior of the shel

Thermo-responsive magnetic Fe3O4@P(MEO2MAX-OEGMA100-X) NPs and their applications as drug delivery systems

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