Diagnostic Workup of Neonates With Esophageal Atresia : Results From the EUPSA Esophageal Atresia Registry

Aim:Controversies exist on the optimal diagnostic workup for neonates with esophageal atresia (EA) with/without tracheoesophageal fistula (TEF). Aim of this study was to describe the current diagnostic policies in EA/TEF patients enrolled in an International multicenter registry. Methods:All patients consecutively registered from July 2014 to December 2017 in the EUPSA Esophageal Atresia Registry (EUPSA-EAR) were included in the study. Data related to diagnostic investigations among Centers forming the EUPSA-EAR were analyzed. Main Results:During the study period, 374 consecutive patients were recorded by 23 Centers. The majority of patients underwent chest X-rays, echocardiography, abdominal ultrasound, and abdominal X-rays. Preoperative bronchoscopy and esophageal gap measurement were performed in one third of the patients. Conclusions:Present data from a large cohort of patients from the EUPSA-EAR show both inter-institutional and intra-institutional variability in diagnostic workup of patients with EA/TEF. Efforts should be made to develop guidelines on the diagnostic workup for EA/TEF patients.Peer reviewe

Birth-to-childhood tracking of linear growth and weight gain in the MINA-Brazil Study

OBJECTIVE: To investigate birth-to-childhood tracking of linear growth and weight gain across the distribution of length/height and weight for age z-scores and according to household wealth. METHODS: Data from 614 children from the MINA-Brazil Study with repeated anthropometric measurements at birth and up to age five years were used. Z-scores were calculated for length/height (HAZ) and weight (WAZ) according to international standards. Birth-to-childhood tracking was separately estimated using quantile regression models for HAZ and WAZ, extracting coefficients and 95% confidence intervals (95%CI) at the 25th, 50th, and 75th quantiles. In a subgroup analysis, we estimated tracking between birth and age two years, and between ages two and five years. To investigate disparities in tracking, interaction terms between household wealth indexes (at birth and age five years) and newborn size z-scores were included in the models. RESULTS: Tracking coefficients were significant and had similar magnitude across the distribution of anthropometric indices at age five years (HAZ, 50th quantile: 0.23, 95%CI: 0.11 to 0.35; WAZ, 50th quantile: 0.31, 95%CI: 0.19 –0.43). Greater tracking was observed between ages two and five years, with coefficients above 0.82. Significantly higher tracking of linear growth was observed among children from wealthier households, both at birth, at the lower bounds of HAZ distribution (25th quantile: 0.30, 95%CI: 0.13 – 0.56), a nd during childhood, in the entire HAZ distribution at five years. For weight gain, stronger tracking was observed at the upper bounds of WAZ distribution at age five years among children from wealthier households at birth (75th quantile: 0.59, 95%CI: 0.35–o 0.83) and during childhood (75th quantile: 0.54, 95%CI: 0.15 –0.93). CONCLUSION: There was significant tracking of HAZ and WAZ since birth, with indication of substantial stability of nutritional status between ages two and five years. Differential tracking according to household wealth should be considered for planning early interventions for preventing malnutrition

Risk Factors for Surgical Site Infection in Neonates: A Systematic Review of the Literature and Meta-Analysis

Purpose: Surgical site infections (SSI) contribute to postoperative morbidity and mortality in children. Our aim was to evaluate the prevalence and identify risk factors for SSI in neonates.Methods: Using a defined strategy, three investigators searched articles on neonatal SSI published since 2000. Studies on neonates and/or patients admitted to neonatal intensive care unit following cervical/thoracic/abdominal surgery were included. Risk factors were identified from comparative studies. Meta-analysis was conducted according to PRISMA guidelines using RevMan 5.3. Data are (mean ± SD) prevalence.Results: Systematic review—of 885 abstracts screened, 48 studies (27,760 neonates) were included. The incidence of SSI was 5.6% (1,564 patients). SSI was more frequent in males (61.8%), premature babies (77.4%), and following gastrointestinal surgery (95.4%). Meta-analysis—10 comparative studies (16,442 neonates; 946 SSI 5.7%) showed that predictive factors for SSI development were gestational age, birth weight, age at surgery, length of surgical procedure, number of procedure per patient, length of preoperative hospital stay, and preoperative sepsis. Conversely, preoperative antibiotic use was not significantly associated with development of SSI.Conclusions: Younger neonates and those undergoing abdominal procedures are at higher risk for SSI. Given the lack of evidence-based literature, prospective studies may help determine the risk factors for SSI in neonates

iPSC-derived healthy human astrocytes selectively load miRNAs targeting neuronal genes into extracellular vesicles

Astrocytes are in constant communication with neurons during the establishment and maturation of functional networks in the developing brain. Astrocytes release extracellular vesicles (EVs) containing microRNA (miRNA) cargo that regulates transcript stability in recipient cells. Astrocyte released factors are thought to be involved in neurodevelopmental disorders. Healthy astrocytes partially rescue Rett Syndrome (RTT) neuron function. EVs isolated from stem cell progeny also correct aspects of RTT. EVs cross the blood-brain barrier (BBB) and their cargo is found in peripheral blood which may allow non-invasive detection of EV cargo as biomarkers produced by healthy astrocytes. Here we characterize miRNA cargo and sequence motifs in healthy human astrocyte derived EVs (ADEVs). First, human induced Pluripotent Stem Cells (iPSC) were differentiated into Neural Progenitor Cells (NPCs) and subsequently into astrocytes using a rapid differentiation protocol. iPSC derived astrocytes expressed specific markers, displayed intracellular calcium transients and secreted ADEVs. miRNAs were identified by RNA-Seq on astrocytes and ADEVs and target gene pathway analysis detected brain and immune related terms. The miRNA profile was consistent with astrocyte identity, and included approximately 80 miRNAs found in astrocytes that were relatively depleted in ADEVs suggestive of passive loading. About 120 miRNAs were relatively enriched in ADEVs and motif analysis discovered binding sites for RNA binding proteins FUS, SRSF7 and CELF5. miR-483-5p was the most significantly enriched in ADEVs. This miRNA regulates MECP2 expression in neurons and has been found differentially expressed in blood samples from RTT patients. Our results identify potential miRNA biomarkers selectively sorted into ADEVs and implicate RNA binding protein sequence dependent mechanisms for miRNA cargo loading.</p

International survey on the management of esophageal atresia

IntroductionBecause many aspects of the management of esophageal atresia (EA) are still controversial, we evaluated the practice patterns of this condition across Europe. MethodsA survey was completed by 178 delegates (from 45 [27 European] countries; 88% senior respondents) at the EUPSA-BAPS 2012. ResultsApproximately 66% of respondents work in centers where more than five EA repairs are performed per year. Preoperatively, 81% of respondents request an echocardiogram, and only 43% of respondents routinely perform preoperative bronchoscopy. Approximately 94% of respondents prefer an open approach, which is extrapleural in 71% of respondents. There were no differences in use of thoracoscopy between Europeans (10%) and non-Europeans (11%, p=nonsignificant). Approximately 60% of respondents measure the gap intraoperatively. A transanastomotic tube (90%) and chest drain (69%) are left in situ. Elective paralysis is adopted by 56% of respondents mainly for anastomosis tension (65%). About 72% of respondents routinely request a contrast study on postoperative day 7 (2-14). Approximately 54% of respondents use parenteral nutrition, 40% of respondents start transanastomotic feeds on postoperative day 1, and 89% of respondents start oral feeds after postoperative day 5. Pure EA: 46% of respondents work in centers that repair two or more than two pure EA a year. About 60% of respondents opt for delayed primary anastomosis at 3 months (1-12 months) with gastrostomy formation without esophagostomy. Anastomosis is achieved with open approach by 85% of respondents. About 47% of respondents attempt elongation of esophageal ends via Foker technique (43%) or with serial dilations with bougies (41%). Approximately 67% of respondents always attempt an anastomosis. Gastric interposition is the commonest esophageal substitution. ConclusionMany aspects of EA management are lacking consensus. Minimally invasive repair is still sporadic. We recommend establishment of an EA registry

A relação entre a doença pulmonar obstrutiva crônica e a função muscular esquelética: revisão de literatura / The relationship between chronic obstructive pulmonary disease and skeletal muscle function: literature review

A Doença Pulmonar Obstrutiva Crônica (DPOC) possui várias consequências, sendo uma das mais importantes a depreciação da atividade muscular esquelética. O presente trabalho visa compreender então como a DPOC afeta essa musculatura e discorrer sobre algumas possíveis maneiras de minimizar esses efeitos. A metodologia utilizada foi a pesquisa nas bases de dados Scielo, PubMed e Google Acadêmico de artigos científicos originais e revisões de literatura elaborados entre os anos de 2014 e 2018. Os resultados indicam alto índice de atrofia, principalmente pela via miostatina, afetando expressivamente a morfologia das fibras, além de um notório estresse oxidativo e diâmetro reduzido das fibras, o que interfere em sua capacidade de contração. Com isso, conclui-se que a DPOC atua na disfunção do músculo esquelético através de vários mecanismos, os quais tem consequências severas que, possivelmente, podem ser tratadas com atividades físicas regulares e algumas substancias farmacológicas. 

A abordagem fisioterapêutica no tratamento de incontinência urinária em mulheres no período pós-parto

Sabe-se que disfunções na musculatura do assoalho pélvico podem ser um dos fatores causais de incontinência urinária, sobretudo, após alterações gestacionais. Por isso, o estudo objetivou verificar as principais características da incontinência urinária no período pós-parto e a abordagem fisioterápica no tratamento. Para isso, realizou-se uma revisão integrativa de literatura que selecionou, por meio de critérios de elegibilidade, 20 artigos base para compor a pesquisa, os quais foram encontrados nos bancos de dados Scientific Eletronic Library Online (Scielo), PubMed e Google Scholar. Após análise, evidencia-se que os efeitos da abordagem fisioterapêutica no tratamento de incontinência urinária no pós-parto são a estabilização, o aumento da sensibilidade e o fortalecimento dos músculos do assoalho pélvico, além da redução comprovada de queixas urinárias e melhora significativa da qualidade de vida. O tipo de exercício predominantemente abordado foi o treinamento dos músculos do assoalho pélvico, que, juntamente com exercícios de contração e relaxamento, se mostraram capazes de melhorar ou até mesmo curar a sintomatologia da incontinência urinária e reduzir o número e o volume dos vazamentos. Ademais, verificou-se maior frequência de incontinência urinária em mulheres com gestação anterior e parto vaginal. Houve divergência ao determinar o tipo de incontinência urinária mais prevalente (se mista ou de esforço). E, relativo ao conhecimento das mulheres sobre o assoalho pélvico e a função da fisioterapia, a maioria não tinha conhecimento prévio de sua importância e terapêutica. Conclui-se, portanto, que a intervenção fisioterapêutica para o tratamento de incontinência urinária em mulheres no pós-parto é resolutiva e eficaz, desde que haja a prática regular e adequada das sessões fisioterápicas, bem como, a presença do profissional fisioterapeuta com a seleção dos exercícios considerados efetivos