Does staged closure have a worse prognosis in gastroschisis?

INTRODUCTION: Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established. OBJECTIVE: To compare the outcome of primary and staged closure in newborns with gastroschisis using intravesical pressure (IVP) as the decision criterion. PATIENTS & METHODS: We prospectively analyzed 45 newborns with gastroschisis. An IVP with a threshold of 20 cm H2O was used to indicate primary or staged closure, and the outcomes between the two methods were compared. RESULTS AND DISCUSSION: Newborns in whom primary closure was feasible were born at a lower gestational age. There was no significant difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay. Compared with previous reports, our data showed higher rates of prenatal diagnosis and cesarean delivery, a lower average birth weight, a higher rate of small gestational age babies and a more frequent association with intestinal atresia. Conversely, our data showed a lower rate of postoperative necrotizing enterocolitis and a lower average length of hospital stay. CONCLUSION: No significant difference was observed in the outcome of newborns who underwent primary closure or staged closure of gastroschisis when using an IVP below 20 cm H2O as the criterion for primary closure

Evaluation of histological changes after tracheal occlusion at different gestational ages in a fetal rat model

OBJECTIVES: To evaluate the histological changes of tracheal cartilage and epithelium caused by tracheal occlusion at different gestational ages in a fetal rat model. METHODS: Rat fetuses were divided into two groups: a) External control, composed of non-operated rats, and b) Interventional group, composed of rats operated upon on gestational day 18.5 (term = 22 days), divided into triads: 1) Tracheal occlusion, 2) Internal control and 3) Sham (manipulated but not operated). Morphological data for body weight, total lung weight and total lung weight/body weight ratio were collected and measured on gestational days 19.5, 20.5 and 21.5. Tracheal samples were histologically processed, and epithelial, chondral and total tracheal thicknesses were measured on each gestational day. RESULTS: The tracheal occlusion group exhibited an increase in total lung weight/body weight ratio (

O papel das instituições subnacionais na aderência da agenda de integração hídrica

A escassez hídrica global tratada há décadas por documentos internacionais, é também reconhecida, ainda que com baixa aderência, nas agendas ambientais subnacionais. Conceitos como o Gerenciamento Integrado de Recursos Hídricos (GIRH) e Serviços Ecossistêmicos (SE) são relevantemente preconizados a nível internacional pela comunidade científica para serem aplicados pelas instituições no nível local. Este artigo propõe uma análise da adesão destes conceitos para a governança da água na Região Metropolitana de Curitiba (RMC). Primeiramente foram elencados os planos de maior relevância no gerenciamento da água na governança relativa ao Estado do Paraná e ao município de Curitiba, bem como fatores demográficos e suas respectivas atribuições com relação à manutenção desse recurso e suas escalas de atuação. Por meio de uma análise documental, relacionamos as medidas adotadas pelos diferentes atores de modo a subsidiar uma análise da inserção dos conceitos de GIRH e SE nas suas respectivas atuações. Com isto buscou-se entender as possíveis implicações para o gerenciamento da água dentro das especificidades de governança hídrica metropolitana paranaense e curitibana, e como as instituições e sua relação com o meio ambiente podem ter consequências sobre a disponibilidade de água com qualidade na RMC

Corticosteroid effect upon intestinal and hepatic interleukin profile in a gastroschisis rat model

PURPOSE: To evaluate the effect of corticosteroids on intestinal and liver interleukin profile in an experimental model of gastroschisis in fetal rats. METHODS: Sprague-Dawley rats at 19.5 days of gestation had its fetuses operated for the creation of gastroschisis. Two groups of fetuses were studied with and without maternal administration of dexamethasone. Each group was composed of fetuses who underwent gastroschisis (G), control fetuses without manipulation (C) and sham fetuses (S). A dosage of the following interleukins was carried out in fetal intestinal and liver tissues: IL-1, IL-6, IL-10, tumor necrosis factor-alpha (TNF-&#945;) and interferon-gamma (IFN-&#947;). The differences between the groups and subgroups were tested by ANOVA with Tukey post-test, with significant values of p<0.05. RESULTS: Dexamethasone led to an increase in intestinal and liver IL-6 (p<0.05) and a decrease in intestinal TNF-&#945; (p<0.001) in fetuses with gastroschisis. CONCLUSION: Corticosteroids had an effect on the intestinal interleukin profile and a small effect on the liver interleukin profile due to immunological immaturity of the fetus, and also of fetuses with gastroschisis. The steroid action may not be exclusively anti-inflammatory, but also pro-inflammatory, varying with time of pregnancy

ESTIMATIVA DE PREJUÍZOS ECONÔMICOS CAUSADOS POR CORPOS ESTRANHOS METÁLICOS EM BOVINOS LEITEIROS NO OESTE DE SANTA CATARINA

A espécie bovina tem a tendência de ingerir corpos estranhos por não possuir paladar seletivo. Os corpos estranhos metálicos perfurantes, como pregos, grampos, fios de arame, quando deglutidos, costumam alojar-se no retículo, pela gravidade, anatomia e movimentos ruminais. Quando ocorre perfuração deste órgão, o material pode atingir o coração (retículo-pericardite), ou alcançar a cavidade abdominal (peritonite). Eventualmente, o corpo estranho movimenta-se em outras direções, como ao baço (retículo-esplenite), fígado (retículo-hepatite) ou pode atingir somente o retículo. Todos estes quadros geram grandes prejuízos econômicos e frequentemente ocasionam o óbito do bovino. O objetivo deste projeto foi simular o prejuízo financeiro advindo da mortalidade de bovinos leiteiros no Oeste de Santa Catarina por essas patologias, utilizando um estudo retrospectivo dos casos diagnosticados no Laboratório de Patologia Veterinária (LPV). Dos 2.054 bovinos diagnosticados de 2013-2022 pelo LPV, 114 (5,5%) animais foram diagnosticados com enfermidades traumáticas advindas da ingestão de corpos estranhos metálicos. Os dados financeiros foram obtidos de veterinários que encaminham animais para diagnóstico. Para cada animal, considerou-se a idade no momento da morte e a perspectiva média de produção até o final da vida produtiva. A produção média de leite por animal até os oito anos de idade (tempo médio de descarte) é de 20 litros, com média de 305 dias de lactação, e o valor médio pago de R$2,28 por litro do leite; o valor médio de produção leiteira seria de 18.300,00 ± 9.544,46 litros, e consequentemente, a rentabilidade média bruta perdida de R$ 55.632,00 ± 26.071,39, dados por animal. Quanto ao valor referente a não produção de descendentes, usou-se a média de dias entre o parto e a nova gestação, 120 dias, na região. Foi calculado a quantidade de bezerros que cada animal iria gerar até seus oito anos de idade. Dos 114 animais necropsiados, descartou-se dois machos, e vacas necropsiadas com mais de oito anos de idade (22/114). Aos demais animais, o valor médio estimado foi de 3 ± 1,92 partos. No caso de nascimento de bezerros machos leiteiros (estimado 50% dos nascimentos), o valor médio da venda foi de R$150,00 ± R$ 0,00. No caso de nascimento de bezerras (estimado 50% dos nascimentos), o valor médio da venda foi de R$475,00 ± R$ 85,89 . Além disso, há que considerar o valor a ser recebido por esses animais na forma de descarte para abate frigorífico, R$3.000,00 cada. Ao final, o valor médio de prejuízo de um animal que veio a óbito foi de R$ 45.524,00 ± 27.854,32. A partir do valor bruto a ser descontado do fluxo financeiro da propriedade, deve-se comparar o custo do uso do dispositivo magnético intra-ruminal como medida preventiva, que custa apenas R$ 25,20. Conclui-se que, devido a alta casuística de mortalidade de bovinos por essas patologias, é urgente e imprescindível o convencimento dos produtores rurais a utilização do imã intra-ruminal em todos os bovinos leiteiros da região

Evolution of critically ill patients with gastroschisis from three tertiary centers

OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers. METHODS: From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables. RESULTS: 163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1%). The mean serum sodium level was 127.4¡6.7 mEq/L, and the mean serum albumin level was 2.35¡0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9%. CONCLUSION: In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome

The role of gut-liver axis in the restriction of intrauterine growth in a model of experimental gastroschisis

PURPOSE: To evaluate the intrauterine growth restriction (IUGR) by the expression of IR-&#946;, IRS-1, IRS-2, IGF-IR&#946; and Ikappa&#946; in experimental model of gastroschisis. METHODS: Pregnant rats at 18.5 days of gestation were submitted to surgery to create experimental fetal gastroschisis (term = 22 days) were divided in three groups: gastroschisis (G), control (C) and sham (S). Fetuses were evaluated for body weight (BW), intestinal (IW), liver (LW) and their relations IW/BW and LW/BW. IR-&#946; and IGF-IR&#946; receptors, IRS-1 and IRS-2 substrates and Ikappa&#946; protein were analyzed by western blotting. RESULTS: BW was lower in G, the IW and IW / BW were greater than C and S (p<0.05) groups. The liver showed no differences between groups. In fetuses with gastroschisis, compared with control fetuses, the expression of IGF-IR&#946; (p<0.001) and Ikappa&#946; (p<0.001) increased in the liver and intestine, as well as IR-&#946; (p<0.001) which decreased in both. In contrast to the intestine, IRS-1 (p<0.001) increased in the liver and IRS-2 decreased (p<0.01). CONCLUSION: The axis of the intestine liver has an important role in inflammation, with consequent changes in the metabolic pathway of glucose can contribute to the IUGR in fetuses with gastroschisis

Effect of nitrofen in the final stages of development of the diaphragm muscle in rats

PURPOSE: To evaluate the expression of myosin in muscle fibers of the diaphragm in experimental congenital diaphragmatic hernia (CDH). METHODS: Fetuses of pregnant rats were divided into four groups: External Control (EC), composed of non-manipulated rats; Nitrofen, composed of pregnant rats that received 100 mg of nitrofen (2,4-dichloro-4'nitrodiphenyl ether) diluted in olive oil on gestational day (GD) 9.5, whose fetuses developed CDH (N+) or not (N-), and Olive Oil Placebo (OO), composed of pregnant rats that received the oil on the same GD. The fetuses were collected on GD 18.5, 19.5, 20.5 and 21.5 (term = 22 days). We obtained body weight (BW) and photographed the diaphragm area (DA), hernia area (HA) and subsequent calculated the HA/DA ratio in N+ group. Samples of Diaphragm muscle were processed for histological staining with H/E and immunohistochemistry (IHQ) for myosin.} RESULTS: The fetuses of N- and N+ groups had decreased BW and DA compared to EC and OO groups (p <0.001). HA was decreased on GD 18.5 compared to 21.5 (p <0.001) and the HA/DA ratio showed no difference. IHQ showed decreased expression of myosin in nitrofen groups. CONCLUSION: CDH induced by nitrofen model contributes to the understanding of muscularization in the formation of the diaphragm where the myosin expression is decreased

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio