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

Some experiments with high order compact methods using a computer algebra software - Part II (non-uniform grid)

We generalize a procedure proposed by Mancera and Hunt [P.F.A. Mancera, R. Hunt, Some experiments with high order compact methods using a computer algebra software-Part 1, Appl. Math. Comput., in press, doi: 10.1016/j.amc.2005.05.015] for obtaining a compact fourth-order method to the steady 2D Navier-Stokes equations in the streamfunction formulation-vorticity using the computer algebra system Maple, which includes conformal mappings and non-uniform grids. To analyse the procedure we have solved a constricted stepped channel problem, where a fine grid is placed near the re-entrant corner by transformation of the independent variables. (c) 2006 Elsevier B.V. All rights reserved

Dynamics of tumor growth: chemotherapy and integrative oncology

Cancer is still a disease with many unknowns. In this paper, we developed a study on the proliferation of tumor cells under chemotherapeutic treatment and the influence of integrative oncology on these results. Initially, we analyzed mathematically tumor behavior, using the Gompertz model, with and without chemotherapeutic treatment. We observed the variation of the immune system and tumor cell fighter cells directly associated with the integrative treatment through the noetic threshold. We analyzed tumor cell behavior, associated with the immune system, especially after treatment completion. The uncertainties under the parameters used led us to use the fuzzy theory and with that also define the fuzzy noetic threshold. We inserted the possibility of resistant cells to the chemotherapeutic treatment and studied the optimal control with this treatment. We also considered the values of the initial conditions, the node threshold, and the resistant cells by fuzzy numbers39

MODELAGEM MATEMÁTICA DE DORMÊNCIA TUMORAL VIA CÁLCULO FRACIONÁRIO

Neste trabalho resolvemos um modelo matemático de dormência tumoral usando um método numérico de diferenças finitas não–canônico para aproximação das derivadas de ordem não inteira, sendo que comparações são feitas com o modelo de derivada inteira resolvido via o método de Runge-Kutta de quarta ordem

Sliding mode control in a mathematical model to chemoimmunotherapy: the occurrence of typical singularities

The application of sliding mode control and piecewise smooth vector fields in cancer is an incipient research area. Here we propose a piecewise dynamics to explore chemoimmunotherapeutic strategies. We investigate the dynamic behavior of the discontinuous mathematical model and we observe the occurrence of typical singularities. The on-off treatment strategies are defined in terms of a time-dependent variable such as the number of cancer or immune cellsCONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP304809/2017-9Sem informação2017/00883-0; 2019/10450-

CÁLCULO FRACIONÁRIO APLICADO NUM PROBLEMA DE DINÂMICA TUMORAL

Este trabalho utiliza o Cálculo Fracionário para descrever o comportamento do número de células tumorais sob a ação do sistema imunológico e do tratamento quimioterápico. É&nbsp;observado que uma mudança na ordem da derivada fracionária resulta numa mudança no&nbsp;comportamento da dinâmica tumoral quando comparado com o modelo com derivada de ordem&nbsp;inteira

Tissue-Specific Oncogenic Activity of KRASA146T

KRAS is the most frequently mutated oncogene. The incidence of specific KRAS alleles varies between cancers from different sites, but it is unclear whether allelic selection results from biological selection for specific mutant KRAS proteins. We used a cross-disciplinary approach to compare KRASG12D, a common mutant form, and KRASA146T, a mutant that occurs only in selected cancers. Biochemical and structural studies demonstrated that KRASA146T exhibits a marked extension of switch 1 away from the protein body and nucleotide binding site, which activates KRAS by promoting a high rate of intrinsic and guanine nucleotide exchange factor– induced nucleotide exchange. Using mice genetically engineered to express either allele, we found that KRASG12D and KRASA146T exhibit distinct tissue-specific effects on homeostasis that mirror mutational frequencies in human cancers. These tissue-specific phenotypes result from allele-specific signaling properties, demonstrating that context-dependent variations in signaling downstream of different KRAS mutants drive the KRAS mutational pattern seen in cancer. SIGNIFICANCE: Although epidemiologic and clinical studies have suggested allele-specific behaviors for KRAS, experimental evidence for allele-specific biological properties is limited. We combined structural biology, mass spectrometry, and mouse modeling to demonstrate that the selection for specific KRAS mutants in human cancers from different tissues is due to their distinct signaling properties.National Institutes of Health (Grant U01CA215798