A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

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

Targeted Metagenomics: Finding Rare Tryptophan Dimer Natural Products in the Environment

Natural product discovery from environmental genomes (metagenomics) has largely been limited to the screening of existing environmental DNA (eDNA) libraries. Here, we have coupled a chemical-biogeographic survey of chromopyrrolic acid synthase (CPAS) gene diversity with targeted eDNA library production to more efficiently access rare tryptophan dimer (TD) biosynthetic gene clusters. A combination of traditional and synthetic biology-based heterologous expression efforts using eDNA-derived gene clusters led to the production of hydroxysporine (<b>1</b>) and reductasporine (<b>2</b>), two bioactive TDs. As suggested by our phylogenetic analysis of CPAS genes, identified in our survey of crude eDNA extracts, reductasporine (<b>2</b>) contains an unprecedented TD core structure: a pyrrolinium indolocarbazole core that is likely key to its unusual bioactivity profile. This work demonstrates the potential for the discovery of structurally rare and biologically interesting natural products using targeted metagenomics, where environmental samples are prescreened to identify the most phylogenetically unique gene sequences and molecules associated with these genes are accessed through targeted metagenomic library construction and heterologous expression

Discovery and Synthetic Refactoring of Tryptophan Dimer Gene Clusters from the Environment

Here we investigate bacterial tryptophan dimer (TD) biosynthesis by probing environmental DNA (eDNA) libraries for chromopyrrolic acid (CPA) synthase genes. Functional and bioinformatics analyses of TD clusters indicate that CPA synthase gene sequences diverge in concert with the functional output of their respective clusters, making this gene a powerful tool for guiding the discovery of novel TDs from the environment. Twelve unprecedented TD biosynthetic gene clusters that can be arranged into five groups (A–E) based on their ability to generate distinct TD core substructures were recovered from eDNA libraries. Four of these groups contain clusters from both cultured and culture independent studies, while the remaining group consists entirely of eDNA-derived clusters. The complete synthetic refactoring of a representative gene cluster from the latter eDNA specific group led to the characterization of the erdasporines, cytotoxins with a novel carboxy-indolocarbazole TD substructure. Analysis of CPA synthase genes in crude eDNA suggests the presence of additional TD gene clusters in soil environments

El gusto es mío : Programa de Alimentación, Nutrición y Gastronomía para Educación Infantil (PANGEI)

Resumen basado en la publicaciónEnseñar a los niños a comer bien y a disfrutar con ello es un objetivo prioritario con visión de futuro. Serán ellos quienes cuando crezcan enseñen a los hijos a alimentarse correctamente, a apreciar los sabores, texturas y olores de la comida. En definitiva, la educación pone las bases para construir un país de individuos saludables y con calidad de vida. El proyecto "Programa de alimentación, nutrición y gastronomía para la educación infantil" (PANGEI) tiene como principal objetivo la adquisición de hábitos saludables desde edades tempranas para asegurar una mejor calidad de vida durante etapas posteriores y en la edad adulta. PANGEI (Programa de alimentación, nutrición y gastronomía para la educación infantil) constituye un material innovador, renovado y con un enfoque gastronómico que mejorará la cultura alimentaria de España desde los más pequeños.ES

Transversal and complementary contents for the Food, Nutrition and Gastronomy Programmes for Infant and Primary School Education : it's my pleasure

En página de créditos: Centro Nacional de Innovación e Investigación Educativa (CNIIE) ; Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) ; Real Academia de Gastronomía ; Fundación Española de la NutriciónResumen basado en el de la publicaciónSe presentan los programas de alimentación, nutrición y gastronomía para las etapas de Educación Infantil y Primaria, que tienen como objetivo principal la adquisición de hábitos saludables por parte del alumnado desde la infancia para asegurar una mejor calidad de vida durante las etapas de desarrollo posteriores y afianzarlos para la edad adulta. Los contenidos transversales y complementarios a estos programas se articulan en cuatro unidades didácticas que refuerzan los objetivos comunes perseguidos en ambas etapas educativas. Si bien, ofrecen un nuevo matiz: la relación directa del escolar con lo que come y el ejercicio físico que realiza. Es decir, dónde come, qué debe comer para mantener un peso adecuado a la etapa de crecimiento y desarrollo, la importancia de practicar actividad física de forma regular, así como reforzar la información sobre los alimentos, las frecuencias de consumo o cómo alimentarse cuando se es alérgico o intolerante a alguno de ellos, potenciando, de forma conjunta, la adquisición de estilos de vida saludable. Las cuatro unidades en las que se articula la obra incluyen contenidos transversales y complementarios para la etapa de Educación Infantil y el primer ciclo de Educación Primaria, donde descubrirán nuevas formas de observar, saborear, oler y sentir los alimentos.ES

It's my pleasure : Food, Nutrition and Gastronomy Programme for Pre-schooll Education (PANGEI)

En página de créditos: Centro Nacional de Innovación e Investigación Educativa (CNIIE) ; Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) ; Real Academia de Gastronomía ; Fundación Española de la NutriciónResumen basado en el de la publicaciónEnseñar a los niños a comer bien y a disfrutar con ello es un objetivo prioritario con visión de futuro. Serán ellos quienes cuando crezcan enseñen a los hijos a alimentarse correctamente, a apreciar los sabores, texturas y olores de la comida. En definitiva, la educación pone las bases para construir un país de individuos saludables y con calidad de vida. El proyecto "Programa de alimentación, nutrición y gastronomía para la educación infantil" (PANGEI) tiene como principal objetivo la adquisición de hábitos saludables desde edades tempranas para asegurar una mejor calidad de vida durante etapas posteriores y en la edad adulta. PANGEI constituye un material innovador, renovado y con un enfoque gastronómico que mejorará la cultura alimentaria de España desde los más pequeños.ES