Transitional Care for Patients with Congenital Colorectal Diseases: An EUPSA Network Office, ERNICA, and eUROGEN Joint Venture

Background: Transition of care (TOC; from childhood into adulthood) of patients with anorectal malformations (ARM) and Hirschsprung disease (HD) ensures continuation of care for these patients. The aim of this international study was to assess the current status of TOC and adult care (AC) programs for patients with ARM and HD. Methods: A survey was developed by members of EUPSA, ERN eUROGEN, and ERNICA, including patient representatives (ePAGs), comprising of four domains: general information, general questions about transition to adulthood, and disease-specific questions regarding TOC and AC programs. Recruitment of centres was done by the ERNs and EUPSA, using mailing lists and social media accounts. Only descriptive statistics were reported. Results: In total, 82 centres from 21 different countries entered the survey. Approximately half of them were ERN network members. Seventy-two centres (87.8%) had a self-reported area of expertise for both ARM and HD. Specific TOC programs were installed in 44% of the centres and AC programs in 31% of these centres. When comparing centres, wide variation was observed in the content of the programs. Conclusion: Despite the awareness of the importance of TOC and AC programs, these programs were installed in less than 50% of the participating centres. Various transition and AC programs were applied, with considerable heterogeneity in implementation, content and responsible caregivers involved. Sharing best practice examples and taking into account local and National Health Care Programs might lead to a better continuation of care in the future. Level of Evidence: III

Effect of modified atmosphere packaging on microbiological quality of Manti

Manti, the traditional Turkish food, was subjected to modified atmosphere packaging (MAP) to extend its refrigerated storage time. Beef, which is one of the main raw ingredients in manti, is a highly perishable product. Therefore, it is essential that the microbiological effects of this product be analysed. The microbiological qualities of each manti package were assessed by analysing raw manti samples to determine the number of Lactobacillus spp. they contained, as well as the total anaerobic mesophilic microorganisms, the amounts of Staphylococcus spp., yeast and mould, the coliforms, Escherichia coli, Salmonella spp. and Clostridium perfringens and the total aerobic psychrophilic microorganisms. Salmonella spp. and C. perfringens were not detected in the raw materials or the packed samples, but the Lactobacillus spp. and total anaerobic mesophilic microorganism counts increased during cold storage. Growth of Enterobacteriaceae species in a modified atmosphere during the period in which the manti is being stored must also be taken into account. The compositions of the MAP samples lasted for the maximum storage time of 126 days as opposed to 20 days in normal atmospheric packaging. In conclusion, more than 40% carbon dioxide (CO2) with nitrogen (N2) should be used in the manti process. © 2016, Japanese Society for Food Science and Technology

Effect of FMD vaccination schedule of dams on the level and duration of maternally derived antibodies

Vaccination against Foot and Mouth Disease (FMD) in pregnant cows is crucial to produce greater immunity in new born calves, especially in late gestation, as this directly affects neonatal immunity. Therefore, we aimed to investigate how late gestation FMD vaccination of pregnant cows affects the maternally derived antibodies in their offspring. Pregnant cows were vaccinated with and without booster vaccination during the 3rd months (early gestation vaccination, EGV) or the 6.5th months (late gestation vaccination, LGV). Their offspring were investigated for passive immunity transfer, maternal antibody duration, and the first vaccination age of calves (when the maternal antibody has waned sufficiently to allow the first vaccination). Antibody titers were analyzed by a virus neutralization test (VNT). A digital Brix refractometer (% Brix) was used to estimate passive antibody transfer efficiency measuring total protein (TP) content of calf blood sera and also colostrum IgG content. Two linear mixed effects models were fitted: one for the antibody titer values of the dams, and the other for the antibody titer values of calves before the vaccination. A marginal fixed effects model was also fitted to explore the effects of the dam titers on the antibody titers of the calves after their vaccinations. As a result, the average neutralizing antibody titers did not differ between the EGV and LGV groups nor were any differences detected between dams that received a booster and those that were not boosted. However, the LGV calves' mean maternally derived antibody titers were significantly higher (p-values = 0.0001 for both groups) and the duration was longer than that of the EGV calves (120 days in LGV, 60 days in EGV, p 8.4% in both calf groups (9.3 +/- 0.33 in LGV and 8.6 +/- 0.40 in EGV, p > 0.05) indicating that passive immunity transfer had occurred for both groups. In addition, we found that the % Brix mean colostrum IgG content of the LGV (25.8 +/- 1.30) was higher than the EGV (21.8 +/- 0.58) dams (p < 0.01) and a significant positive correlation found between the colostrum density of LGV dams and TP (% Brix) value of their offspring (r = 0.73, p < 0.01). Our results show that vaccination during the late gestation period increased the colostrum IgG content of dams of LGV in addition to the maternally derived antibody duration and potentially provided greater protection of the offspring

The effect of azygos vein preservation on postoperative complications after esophageal atresia repair: Results from the Turkish Esophageal Atresia Registry

Aim: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. Methods: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fistula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. Results: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p 0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the requirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) Conclusion: The data in the TEAR demonstrated that preserving the AV during EA repair led to no significant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory complications. © 202

LID - 10.1016/j.jpedsurg.2020.12.008 [doi]

AIM: Preservation of the azygos vein (AV) maintains normal venous drainage of the mediastinum and decreases postoperative congestion. The modification of esophageal atresia (EA) repair by preserving AV may prevent postoperative complications and may lead to better outcomes. The data from the Turkish Esophageal Atresia Registry (TEAR) were evaluated to define the effect of AV preservation on postoperative complications of patients with EA. METHODS: Data from TEAR for a period of five years were evaluated. Patients were enrolled into two groups according to the preservation of AV. Patients with divided (DAV) and preserved AV (PAV) were evaluated for demographic and operative features and postoperative complications for the first year of life. The DAV and PAV groups were compared according to the postoperative complications, such as fistula recanalization, symptomatic strictures, anastomotic leaks, total number of esophageal dilatations, and anti-reflux surgery. In addition, respiratory problems, which required treatment, were compared between groups. RESULTS: Among 502 registered patients; the data from 315 patients with the information of AV ligation were included. The male female ratio of DAV (n = 271) and PAV (n = 44) groups were 150:121 and 21:23, respectively (p > 0.05). The mean body weight, height, gestational age, and associated anomalies were similar in both groups (p > 0.05). The esophageal repair with thoracotomy was significantly higher in DAV group, when compared to the PAV group (p  0.05). There was no difference between DAV and PAV groups for anastomotic leaks, symptomatic anastomotic strictures, fistula recanalization, and the requirement for anti-reflux surgery (p > 0.05). The rate of respiratory problems, which required treatment, was significantly higher in the DAV group (p < 0.05) CONCLUSION: The data in the TEAR demonstrated that preserving the AV during EA repair led to no significant advantage on postoperative complications, with exception of respiratory problems. AV should be preserved as much as possible to maintain a normal mediastinal anatomy and to avoid respiratory complications

Effect of FMD vaccination schedule of dams on the level and duration of maternally derived antibodies

Vaccination against Foot and Mouth Disease (FMD) in pregnant cows is crucial to produce greater immunity in new born calves, especially in late gestation, as this directly affects neonatal immunity. Therefore, we aimed to investigate how late gestation FMD vaccination of pregnant cows affects the maternally derived antibodies in their offspring. Pregnant cows were vaccinated with and without booster vaccination during the 3rd months (early gestation vaccination, EGV) or the 6.5th months (late gestation vaccination, LGV). Their offspring were investigated for passive immunity transfer, maternal antibody duration, and the first vaccination age of calves (when the maternal antibody has waned sufficiently to allow the first vaccination). Antibody titers were analyzed by a virus neutralization test (VNT). A digital Brix refractometer (% Brix) was used to estimate passive antibody transfer efficiency measuring total protein (TP) content of calf blood sera and also colostrum IgG content. Two linear mixed effects models were fitted: one for the antibody titer values of the dams, and the other for the antibody titer values of calves before the vaccination. A marginal fixed effects model was also fitted to explore the effects of the dam titers on the antibody titers of the calves after their vaccinations. As a result, the average neutralizing antibody titers did not differ between the EGV and LGV groups nor were any differences detected between dams that received a booster and those that were not boosted. However, the LGV calves' mean maternally derived antibody titers were significantly higher (p-values = 0.0001 for both groups) and the duration was longer than that of the EGV calves (120 days in LGV, 60 days in EGV, p 8.4% in both calf groups (9.3 +/- 0.33 in LGV and 8.6 +/- 0.40 in EGV, p > 0.05) indicating that passive immunity transfer had occurred for both groups. In addition, we found that the % Brix mean colostrum IgG content of the LGV (25.8 +/- 1.30) was higher than the EGV (21.8 +/- 0.58) dams (p < 0.01) and a significant positive correlation found between the colostrum density of LGV dams and TP (% Brix) value of their offspring (r = 0.73, p < 0.01). Our results show that vaccination during the late gestation period increased the colostrum IgG content of dams of LGV in addition to the maternally derived antibody duration and potentially provided greater protection of the offspring