Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

Biológiai terápiák psoriasis vulgarisban történő alkalmazása során szerzett tapasztalataink

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Hypoxia reshapes Arabidopsis root architecture by integrating ERF‐VII factor response and abscisic acid homoeostasis

Eysholdt‐Derzsó E, Hause B, Sauter M, Schmidt-Schippers R. Hypoxia reshapes Arabidopsis root architecture by integrating ERF‐VII factor response and abscisic acid homoeostasis. Plant, Cell & Environment. 2024.**Abstract** Oxygen limitation (hypoxia), arising as a key stress factor due to flooding, negatively affects plant development. Consequently, maintaining root growth under such stress is crucial for plant survival, yet we know little about the root system's adaptions to low‐oxygen conditions and its regulation by phytohormones. In this study, we examine the impact of hypoxia and, herein, the regulatory role of group VII ETHYLENE‐RESPONSE FACTOR (ERFVII) transcription factors on root growth in Arabidopsis. We found lateral root (LR) elongation to be actively maintained by hypoxia via ERFVII factors, aserfVIIseedlings possess hypersensitivity towards hypoxia regarding their LR growth. Pharmacological inhibition of abscisic acid (ABA) biosynthesis revealed ERFVII‐driven counteraction of hypoxia‐induced inhibition of LR formation in an ABA‐dependent manner. However, postemergence LR growth under hypoxia mediated by ERFVIIs was independent of ABA. In roots, ERFVIIs mediate, among others, the induction of ABA‐degrading ABA 8′‐hydroxylasesCYP707A1expression. RAP2.12 could activate thepCYC707A1:LUCreporter gene, indicating, combined with single mutant analyses, that this transcription factor regulates ABA levels through corresponding transcript upregulation. Collectively, hypoxia‐induced adaptation of the Arabidopsis root system is shaped by developmental reprogramming, whereby ERFVII‐dependent promotion of LR emergence, but not elongation, is partly executed through regulation of ABA degradation.**Summary Statement** ERFVII pathway actively maintains abscisic acid homoeostasis, enabling a partial control of lateral root development under hypoxic conditions

Az erythrodermáról és rühatkafertőzésről scabies norvegica két esete kapcsán = Report on erythroderma and scabies infection in connection with two cases of scabies norvegica

Az erythroderma a testfelszín csaknem egészét érintő bőrgyulladás, amelyet hyperaemia, bőrmegvastagodás, hámlás jellemez. A testfelület nagy részére lokalizálódó gyulladás az etiológiai tényezőtől függetlenül önmagában is előidézhet életveszélyes állapotot. Parazitafertőzés az erythroderma hátterében extrém ritka. A scabieses megbetegedésért (közismerten rühesség) egy, az atkák családjába tartozó élősködő, a Sarcoptes scabiei var. hominis tehető felelőssé. Míg a „klasszikus” scabies prevalenciája világviszonylatban magas, addig a súlyosabb, veszélyesebb formával – a scabies norvegicával, más néven crustosus scabiesszel – jóval ritkábban találkozhat a klinikus, felismerése és kezelése epidemiológiai szempontból kiemelkedően fontos. A szerzők scabies norvegica két esete kapcsán ismertetik az erythroderma és a scabies differenciáldiagnosztikai problémáit és a fertőzés epidemiológiai jelentőségét. | Erythroderma is an inflammation of almost the whole surface of the skin, characterized by erythema, skin infiltration and desquamation. Despite the etiological factors, the generalized inflammation of a large body surface can lead to a life-threatening condition in itself. Parasite infection lies rarely in the background of erythroderma. The Sarcoptes scabiei var. hominis belonging to the mite family is the cause of scabies disease. While the prevalence of „classic” scabies is high world-wide, the more severe and more dangerous form – scabies norvegica – is only seldomly observed. Diagnosis and treatment is highly important from an epidemiological aspect. The authors discuss the differential diagnostic problems and epidemiological significance of scabies infection and erythroderma through two cases

Kísérletes adatok az arteria renalis leszorítását követő érkontraktilitási változásokhoz

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