ACE I/D Gene Polymorphism Can't Predict the Steroid Responsiveness in Asian Children with Idiopathic Nephrotic Syndrome: A Meta-Analysis

The results from the published studies on the association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and the treatment response to steroid in Asian children with idiopathic nephrotic syndrome (INS) is still conflicting. This meta-analysis was performed to evaluate the relation between ACE I/D gene polymorphism and treatment response to steroid in Asian children and to explore whether ACE D allele or DD genotype could become a predictive marker for steroid responsiveness. = 0.85; respectively), however, the result for the association of II genotype with SRNS risk was not stable.Our results indicate that D allele or DD homozygous can't become a significant genetic molecular marker to predict the treatment response to steroid in Asian children with INS

Review and analysis of fire and explosion accidents in maritime transportation

The globally expanding shipping industry has several hazards such as collision, capsizing, foundering, grounding, stranding, fire, and explosion. Accidents are often caused by more than one contributing factor through complex interaction. It is crucial to identify root causes and their interactions to prevent and understand such accidents. This study presents a detailed review and analysis of fire and explosion accidents that occurred in the maritimetransportation industry during 1990–2015. The underlying causes of fire and explosion accidents are identified and analysed. This study also reviewed potential preventative measures to prevent such accidents. Additionally, this study compares properties of alternative fuels and analyses their effectiveness in mitigating fire and explosionhazards. It is observed that Cryogenic Natural Gas (CrNG), Liquefied Natural Gas (LNG) and methanol have properties more suitable than traditional fuels in mitigating fire risk and appropriate management of their hazards could make them a safer option to traditional fuels. However, for commercial use at this stage, there exist several uncertainties due to inadequate studies, and technological immaturity. This study provides an insight into fire and explosion accident causation and prevention, including the prospect of using alternative fuels for mitigating fire and explosion risks in maritime transportation

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

Hepcidin, Serum Iron, and Transferrin Saturation in Full-Term and Premature Infants during the First Month of Life: A State-of-the-Art Review of Existing Evidence in Humans.

Neonates regulate iron at birth and in early postnatal life. We reviewed literature from PubMed and Ovid Medline containing data on umbilical cord and venous blood concentrations of hepcidin and iron, and transferrin saturation (TSAT), in human neonates from 0 to 1 mo of age. Data from 59 studies were used to create reference ranges for hepcidin, iron, and TSAT for full-term-birth (FTB) neonates over the first month of life. In FTB neonates, venous hepcidin increases 100% over the first month of life (to reach 61.1 ng/mL; 95% CI: 20.1, 102.0 ng/mL) compared with umbilical cord blood (29.7 ng/mL; 95% CI: 21.1, 38.3 ng/mL). Cord blood has a high concentration of serum iron (28.4 μmol/L; 95% CI: 26.0, 31.1 μmol/L) and levels of TSAT (51.7%; 95% CI: 46.5%, 56.9%). After a short-lived immediate postnatal hypoferremia, iron and TSAT rebounded to approximately half the levels in the cord by the end of the first month. There were insufficient data to formulate reference ranges for preterm neonates

Evaluation of air cavities on dose distributions with air-filled apparatuses having different volumes using Gafchromic EBT3 films in brachytherapy

WOS: 000450073600010Aim: The data used in brachytherapy planning are obtained from homogeneous mediums. In practice, the heterogeneous tissues and materials affect the dose distribution of brachytherapy. It is aimed to investigate the effect of air cavities on brachytherapy dose distribution using a specially designed device. Material and methods: In this study, the special device designed with different volumes of air and water to be irradiated and measured at different depths using EBT3 Gafchromic films. EBT3 Gafchromic films were preferred for this study because they can be cut to the shape of the experimental geometry, are water resistance and double directional usability. Results: In our study, sudden dose increases and decreases were observed at the water-air-water interfaces. Increases were 9, 11.8 and 15% in the 13, 18 and 22 mm apparatus, respectively. These effects were expected and the results were consistent with the literature and within the tolerance limits stated in the clinical dose guidelines. The most important result is that the percent depthdose curve of the radiation passing through the air to the water and only passing through the water medium is different The average differences were 1.97, 2.97 and /31% for the 13, 18 and 22 mm apparatus, respectively. Conclusion: Although the effect of heterogeneity may be neglected according to clinical guidelines, it is suggested that the dose effect of heterogeneity is taken into account so that the dose can be estimated sensitively. Brachytherapy plans using dose data without unisidering air gaps may cause erroneous dose distributions due to heterogeneity of tissue

oxygenation, hemodynamic and hematological adaptation of term infants

Objective: Although both delayed umbilical cord clamping and intact umbilical cord milking (I-UCM) provide the effective placental transfusion at birth, these procedures may not be used in neonates needing resuscitation. The aim of this study is to investigate the effect of cut umbilical cord milking (C-UCM), which permits resuscitation during an immediate transition period (ITP). Methods: Sixty-two healthy term infants were randomly divided into C-UCM and I-UCM groups at birth. Approximately 30-cm length of cord was milked towards the baby 2-4 times within 20 seconds after birth in both C-UCM and I-UCM groups while the umbilical cord was cut in the former, and intact in the latter. Heart rate, arterial oxygen saturation (SpO(2)), cerebral regional oxygen saturation (crSO(2)) (2nd-15th min), blood pressure (BP) (within 15-30 min), residual placental blood volume (RPBV), and hemoglobin levels (at the sixth hour) were monitored during ITP. Results: There were no significant differences in terms of mean gestational age (w) [(39.0 +/- 1.2) versus (38.8 +/- 1.1)], birth weight (g) [(3351.45 +/- 254.30) versus (3256.94 +/- 285.52)], Apgar scores at the 5th min (10 +/- 0 versus 10 +/- 0), first breathing time (sec) (5.4 +/- 3.8 versus 5.7 +/- 4.1), SpO(2), crSO(2), BP (mmHg) [(52.9 +/- 6.9) versus (51.8 +/- 5.7)], hemoglobin levels (g/dl) [(17.7 +/- 1.8) versus (18.4 +/- 1.4)], and RPBV (ml/kg) [(23.9 +/- 4.7) versus (22.9 +/- 5.4)] between C-UCM and I-UCM groups (p > .05). Conclusion: This study showed that C-UCM is as effective as I-UCM on cerebral oxygenation, hemodynamic and hematological adaptation of term infants in ITP. We suggest that C-UCM can provide additional placental transfusion in term neonates exposed to early cord clamping.C1 [Orpak, Ummuhan Seda; Ergin, Hacer; Cirali, Ceren; Ozdemir, Ozmert M. A.] Pamukkale Univ, Dept Pediat, Div Neonatol, Sch Med, Denizli, Turkey.[Can, Ozlem Kosar] Pamukkale Univ, Dept Obstet & Gynecol, Sch Med, Denizli, Turkey.[Celik, Ulker] Govt Hosp, Dept Pediat, Div Neonatol, Denizli, Turkey

Does colonization of Helicobacter pylori in the heterotopic gastric mucosa play a role in bleeding of Meckel's diverticulum?

WOS: 000179148900006PubMed ID: 12407535Background/Purpose: Helicobacter pylori is a microorganism known to colonize in gastric type of mucosa and is associated with gastritis and peptic ulceration. The aim of the study was to determine whether colonization of H pylori in heterotopic gastric mucosa plays a role in bleeding of Meckel's diverticulum. Methods: Histopathologic slides of patients who had undergone resection of Meckel's diverticulum in recent 5 years were reexamined for the presence of H pylori in heterotopic gastric mucosa. Polimerase chain reaction (PCR) test was used to trace the genetic material of urease gene and 16s rDNA amplifications for H pylori. Results: Thirteen of the 30 histopathologic slides of Meckel's patients presented with acute bleeding of the diverticula, whereas 3 of them were asymptomatic. None of the 13 gastric mucosa bearing diverticula were colonized with H pylori. PCR was unable to show any trace of genetic material for H pylori. Conclusion: Although the role of H pylori is well established in the gastric mucosal ulceration, its presence is not essentially required to induce "heterotopic gastritis" that may result in bleeding of the Meckel's diverticulum. Copyright 2002, Elsevier Science (USA). All rights reserved

Management of refractory hemorrhage in a kala-azar patient with thrombocytopenia and coagulopathy by using recombinant factor VIIa (rFVIIa)

47th Annual Meeting of the American-Society-of-Hematology -- DEC 10-13, 2005 -- Atlanta, GAWOS: 000233426100389…Amer Soc Hemato

Clinicopathological features of rapidly progressive hepatitis C virus infection in HCV antibody negative renal transplant recipients

WOS: 000077471200027PubMed ID: 9870473Background. Hepatitis C virus (HCV) infection acquired during dialysis treatment generally shows a relatively benign course after renal transplantation (RTx). However, less is known about the course of HCV infection acquired during or after RTx. Methods. Clinical and histopathological assessment of 15 renal transplant recipients who acquired HCV infection during or after RTx. Results. Alanine aminotransferase levels rose for the first time 1-19 weeks after RTx. HCV RNA was found positive in all patients, but anti-HCV became positive in only nine of them. During a mean follow-up of 21 +/- 12 months, jaundice appeared in 12 patients while ascites and/or hepatic encephalopathy occurred in six. Azathioprine was stopped in all patients. Cyclosporin was also stopped in four patients and in two of them prednisolone was also interrupted for a period of 3-7 weeks. Following this, ascites, hepatic encephalopathy and biochemical disturbances improved, while no deterioration was seen in graft function. Nine of the 15 patients had undergone two consecutive liver biopsies (LB). The first LB revealed cirrhosis in three and chronic hepatitis in six patients; the second LB showed cirrhosis in seven patients. The histological activity index (Knodell's score) progressed from 11.8 +/- 3.5 to 13.8 +/- 3.8. Conclusions. The results suggest that HCV infection acquired during or after RTx may run an unusual and rapidly progressive clinical and histopathological course at least in some of these patients. Decrease or withdrawal of immunosuppressive drugs may improve early hepatic failure without detrimental effect on graft function during that period