Detaljna analiza istraživanja i prakse pedijatrijske kirurginje u istočnom dijelu Srednje Europe u XX. stoljeću – primjer profesorice Zofije Umiastowske-Sawicke

Professor Zofia Umiastowska Sawicka laid the foundations for modern pediatric surgery in Poland, first in Bialystok, and subsequently in Kielce. She was a student of Prof. Jan Kossakowski from Warsaw Medical University to be counted among his most talented and skilled disciples. Professor Umiastowska became the head of the first Department of Pediatric Surgery in Bialystok, which was later incorporated into the Medical Academy of Bialystok. In 1977 she moved to Kielce to run the Department of Pediatric Surgery until her retirement in 1991. In these locations she was the one who trained generations of pediatric surgeons with special emphasis on surgical management of exstrophy of the bladder, vaginal labial adhesion (synechia), injuries of the male urethra, liver and hepatic ligament. During her professional lifetime she focused on congenital diaphragmatic hernia, Meckel’s diverticulum, and some aspects of pediatric oncology as well. Every school she attended enriched her with the best of knowledge and skills that made her a perfect teacher for others. However, the Warsaw Medical University essentially played the main role at the core of her surgical training: here she was taught and she learnt how to be pediatric surgeon for good of public health of the society in concord with the motto of the Warsaw Medical University: Saluti publicae.Profesorica Zofia Umiastowska Sawicka postavila je temelje moderne pedijatrijske kirurgije u Poljskoj, najprije u Bialystoku, potom u Kielceu. Bila je jedna od najsposobnijih i najiskusnijih studentica profesora Jana Kossakowskog s Varšavskoga medicinskog sveučilišta. Profesorica Umiastowska postala je pročelnica prvog Odjela za pedijatrijsku kirurgiju u Bialystoku, koji je poslije pridružen Medicinskoj akademiji Bialystok. Godine 1977. preselila se u Kielce kako bi vodila Odjel pedijatrijske kirurgije sve do svoga umirovljenja 1991. godine. Obučavala je generacije pedijatrijskih kirurga, s posebnim naglaskom na kirurško liječenje ekstrofije mokraćnog mjehura, vaginalne labijalne adhezije (synechia), ozljede uretre u pacijenata muškog spola te jetre i jetrenih ligamenata. U svom se profesionalnom životu usredotočila na kongenitalnu dijafragmatsku herniju, Meckelov divertikul te na neka područja pedijatrijske onkologije. Svaka škola koju je pohađala obogatila ju je najboljim znanjem i vještinama koji su ju učinili savršenim učiteljem. Međutim, Varšavsko medicinsko sveučilište imalo je glavnu ulogu u njezinoj kirurškoj izobrazbi: ovdje je učila i naučila kako biti pedijatrijski kirurg za dobrobit javnog zdravlja društva u skladu s motom Varšavskoga medicinskog sveučilišta: Saluti publicae

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

Automation of the software production process for multiple cryogenic control applications

The development of process control systems for the cryogenic infrastructure at CERN is based on an automatic software generation approach. The overall complexity of the systems, their frequent evolution as well as the extensive use of databases, repositories, commercial engineering software and CERN frameworks have led to further efforts towards improving the existing automation based software production methodology. A large number of control system upgrades were successfully performed for the Cryogenics in the LHC accelerator, applying the Continuous Integration practice integrating all software production tasks, tools and technologies. The production and maintenance of the control software for multiple cryogenic applications have become more reliable while significantly reducing the required time and effort. This concept became a guideline for development of process control software for new cryogenic systems at CERN. This publication presents the software production methodology, as well as the summary of several years of experience with the enhanced automated control software production, already implemented for the Cryogenics of the LHC accelerator and the CERN cryogenic test facilities

Conventional colon adenomas harbor various disturbances in microsatellite stability and contain micro-serrated foci with microsatellite instability

<div><p>Introduction</p><p>Colorectal cancer belongs to the most frequent occurring malignancies. A prediction of the clinical outcome and appropriate choice of neoadjuvant chemotherapy needs personalized insight to the main driving pathways. Because most CRCs have polyps as progenitor lesions, studying the pathways driving to adenomagenesis is no less important.</p><p>Goals</p><p>Our purpose was the evaluation of microsatellite stability status within conventional colon adenomas and also β-catenin, BRAFV600E and p53 contribution.</p><p>Material and methods</p><p>The cohort included 101 cases of typical colon adenomas with high grade epithelial dysplasia according to WHO. An immunohistochemistry method was used for the depiction of the expression of targeted proteins, as also their heterogeneity.</p><p>Results</p><p>Generally, we noted a 10% frequency of MSI events where MSI-H reached a 5% share occurred within the left colon and rectal polyps. β-catenin nuclear overexpression was noted with a 70% frequency and p53 with close to a 24% frequency. In addition, we found a presence of micro-serration foci more often within tubular adenomas, where focal MSI took place more often. Our results indicate that MSI events occur more often than had been theorized earlier. It results in tumour heterogeneity, more complex underlying pathways and finally ontogenetic molecular-diversity of tumours besides similar occurring histopathological features.</p></div

The characteristics of used antibodies.

<p>The characteristics of used antibodies.</p