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

Nuevo implante para la fijación rápida de colgajos óseos craneales

La empresa Neos Surgery SL, con el asesoramiento del Instituto de Biomecánica de Valencia (IBV) y la participación de la Fundación ASCAMM y la Fundación INASMET, ha desarrollado un nuevo implante que permite un anclaje más rápido y sencillo de los colgajos óseos resultado de las craneotomías. Para alcanzar este objetivo el diseño del nuevo implante aprovecha las propiedades mecánicas de biomateriales como la aleación Níquel Titanio (NiTinol) y el poliéter- éter-cetona (PEEK OPTIMA®) usados en su fabricación. El nuevo dispositivo ha mostrado un buen comportamiento biomecánico, simplifica la técnica quirúrgica al eliminar el uso de instrumentación específica para su implantación y, al mismo tiempo, consigue reducir el tiempo de la intervención

Nuevo implante para la fijación rápida de colgajos óseos craneales

La empresa Neos Surgery SL, con el asesoramiento del Instituto de Biomecánica de Valencia (IBV) y la participación de la Fundación ASCAMM y la Fundación INASMET, ha desarrollado un nuevo implante que permite un anclaje más rápido y sencillo de los colgajos óseos resultado de las craneotomías. Para alcanzar este objetivo el diseño del nuevo implante aprovecha las propiedades mecánicas de biomateriales como la aleación Níquel Titanio (NiTinol) y el poliéter- éter-cetona (PEEK OPTIMA®) usados en su fabricación. El nuevo dispositivo ha mostrado un buen comportamiento biomecánico, simplifica la técnica quirúrgica al eliminar el uso de instrumentación específica para su implantación y, al mismo tiempo, consigue reducir el tiempo de la intervención

Meeting on popular and traditional music in university education

"En mayo de 2018 se celebró en Bogotá el Encuentro sobre músicas populares y tradicionales en la educación universitaria, evento que contó con la participación de 20 ponentes, quienes presentaron los resultados de sus investigaciones e indagaciones alrededor del campo. Una muestra de esas ponencias constituye el conjunto de textos recogidos en esta publicación. Sin lugar a dudas, entre los temas más inquietantes de un evento de esta naturaleza resalta el que concierne a la definición de los términos. Las expresiones música popular y música tradicional son categorías plagadas de contradicciones y contra-ejemplos, lo que obliga a usarlas con mucha cautela. Detrás de ese problema está la dificultad de acotar con certeza qué significan tradicional y popular como adjetivos de sustantivos diversos. Reconociendo que el contexto artístico no ofrece mucha información al respecto, ya que categorías como popular y tradicional no aparecen en la arquitectura, el cine o las plásticas, el reto es abordar el debate desde lo musical.""In May 2018, the Meeting was held in Bogotá on popular and traditional music in university education, event with the participation of 20 speakers, who presented the results of their research and inquiries around the field. A A sample of these papers constitutes the set of texts collected in this publication. Undoubtedly, among the most disturbing subjects of a event of this nature highlights the one that concerns the definition of the terms. popular music expressions and traditional music are categories riddled with contradictions and counter-examples, which makes it necessary to use them with much caution. Behind that problem is the difficulty delimit with certainty what traditional and popular mean as adjectives of various nouns. acknowledging that the artistic context does not offer much information to the respect, since categories such as popular and traditional do not appear in architecture, cinema or plastic arts, the challenge is to approach the debate from the musical point of view."Bogot

Anales de Edafología y Agrobiología Tomo 26 Número 1-4

Semblanza, por el Excmo. Sr. Prof. Dr. M. Lora Tamayo.-- José María Albareda Herrera, por el Prof. Dr. A. Hoyos.-- Biografía y Bibliografía del Profesor Albareda.-- Ueber die Carotinkristalle in der Nebenkrone der Narzissenbluete, por A. Frey-Wyssling.-- Beiträge zur Kenntnis der Bodenentwicklung in NW-Spanien auf grund fossiler Biiden, por H. Franz.—La chenaie acidophile ibéro-atlantique (quercion occidentale) en Sologne, por J. Braun-Blanquet .-- Carbon and nitrogen transformations in world soils, por N. R. Dhar.-- Compounds isolated from woody cuttings of Platanus orientalis and their growth promoting activity, por E. Vieitez, E. Seoane, M. D. V. Gesto, A. Vázquez, M. C. Mato, J. Méndez and A. Carnicer.-- Der Boden als Wohnraum fiir Tardigraden, por F. Mihelcic.-- Physiographic systems in soil surveys, por A. P. A. Vink.-- The bulk volume of compacted soil as affected by water content and particle size, por Geoffrey B. Bodman über die Verwitterung der Sedimentgesteine por Carl W. Correns.-- Effects of heating on vermiculite saturated with different cations, por O. T. Rotini, G. Lotti and R. Riffaldi.-- La distribución de los vertebrados en el Alto Aragón, por E. Balcells R. y col.-- Nuevos sustratos con poder de orientación cristalina, por M. Morante, F. Arrende y J. Rodríguez.-- L'application de la méthode des variantes systématiques en recherche agronomique, por Marcel V. Homes et Germaine H. van Schoor .-- La podzolisation en climat atlantique, por Ph. Duchaufour .-- Ferredoxin and photosynthetic phosphorylation, por Daniel l. Arnon, Harry Y. Tsujimoto and Berah D. McSwain.-- Modificaciones de la lignina y formación de material húmico en el tracto digestivo de los rumiantes, por E. Zorita, A. Suárez y Mª L. Calvo.-- Las aguas subterráneas de Tenerife, por E. Fernández Caldas y V. Pérez García.-- Variedades anisoploides de remolacha azucarera (B. vulgaris L.) en España y sus problemas biológicos, por Antonio Silván y Mechtild Rommel.-- Conducción eléctrica de suelo y arcilla a bajas humedades, por R. Santamaría y M. Tschapek.-- Reducción de nitrato y nitrito por cloroplastos, por M. Losada. y A. Paneque.-- Ein Beitrag zur Kenntnis der MIikrostruktur von solifluidal bewegtem Bodenmaterial in der Sierra Nevada (Andalusien), por Walter Beckmann.-- El problema de los suelos in ter grados en España, por A. Guerra Delgado.-- Adsorption of calcium, magnesium, potassium and sodium as influenced by liming, por L. Wiklander and A. Lax.-- Tonverlagerung in Lössböden unter: Laubmischwald und Acker. por Heinz W. Zottl.-- Fertilidad de los suelos de cultivo de Pontevedra.: Estudio inicial, por B. Sánchez, A. García Sánchez y G. Dios.-- Pastúre science and the Spanish scene, por William Davies.-- Relaciones nutritivas y «grados» en los abonos compuestos, por . C. Tamés.-- The classification of soils under rice cultivation (Paddy soils), por Kazutake Kyuma and Keizaburo Kawaguchi.-- Milk production on a protein-free feed, using urea and ammonium salts as the sole source of nitrogen, por Artturi l. Virtanen.-- Evoluciones foliares de pares nutritivos en el género Citrus, por Octavio Carpena Artés.-- Estudio •del enzima ascórbico oxidasa aislado de diferentes materiales vegetales, por A. Carlos Blesa y Antonio Pretel.-- On the hypsometric change of morphology and micromorphology of terrestric soils, por W. L. Kubiena.-- The intensity and quantity aspects of soil phosphate status and laboratory exctraction values por E. G. Williams.-- Entstehung, Ursache und Wirkuhg von Schlieren in keramischen Giesschlickern, por Adolf Dietzel und Rolf Bruckner.-- Mountain rendzina soils in Israel, por S. Ravikovitch and F. Pines.-- Primeros estudios nematológicos en cultivos de la zona costera granadino-malagueña por Antonio Gómez Barcina y Fernando Jiménez-Millán.-- Influencia de diversos mineralizadores y .del óxido magnésico sobre la formación de forsterita a partir de serpentinas españolas, por V. Aleixandre Ferrandis y Julia Mª. González Peña.-- Nota preliminar sobRe la sedimentación en paleocanales terciarios de la zona de Caspe-Chiprana (provincia de Zaragoza), por Oriol Riba, Joaquín Villena y Jose Quirantes.-- The mineral nutrient relations of conifer seedlings with special reference to the phosphate relations of Pinus radiata, D. Don. por L. Leyton.-- Über die tirse Marokkos-schwarzerdeartige Böden unter subtropischem Klima, por F. Scheffer, U. Schoen und C. Hess.-- Geology, physiography relief and drainage of the Cauca Valley, Colombia, por Doeko Goosen.-- Die Bedeutung der Beschattung fuer unzureichend ernaehrte Nadelbaeume, por W. Laatsch.-- Die. Feinsuhstanz vulkanogener Edaphoide, por E. Mückenhausen.-- El espectro de las emulsioness foliares como índice de la nutrición del trigo, por L. Sánchez de la Puente y F. Lucena Conde.-- Estado de nutrición, equilibrio nutritivo y rendimiento en el olivar de la provincia de Sevilla, por F. González García, A. M•. García Gómez, M. Chaves Sánchez y C. Mazuelos Vela.-- Clasificación y distribución de Algunos virus de leguminosas en España, por M. Rubio-Huertos, M. Santaolalla y R. Moreno.-- Oligoelementos en árboles de bosques (Pinus), por M. Dean Guelbenzu y A. Santos Ruiz.-- Organische Verbindungen als Stickstoffquelle fur die Erniihrung der Ptlanzen, por W. Flaig und H. Söchtig.-- Centro de origen de las plantas cultivadas, por A. Cámara.-- Cassification pedologique, cartographie des sois et mise en valeur des terres, por G. Aubert.-- Interpretation de l'analyse granulometrique. Le concept de texture, por S. Hennin.-- Soil genesis in Southern Portugal, por J. Carvalho Cardoso .-- Soil resources appraisal for development, por Luis Bramao and J. Riquier.-- Almería en el Itinerarium Hispanicum de Jerónimo Münzer, por Manuel Mendizábal.-- Neueste Entwicklungen im Weltkampf gegen den Hunger, por Frita Baade.—On the importance of ion activity method for the theory of soil formation and soil fertility, por V. A. Kovda and D. S. Orlov.—Nuevo método para la determinación de la capacidad de cambio radicular de los vegetales, por J. Cardús y A . Pons.-- Ofrenda, por Gonzalo Bilbao.-- El suelo y la ganadería, por Gaspar González GonzálezPeer reviewe

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I 2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None