The Long-Term Outcome of Abdominal Wall Defects Exomphalos & Gastroschisis Retrospective Single Centre Study Children Hospital at Westmead, Sydney, Australia

Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1st of October 1998 and the 1st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias

Bystander basic life support: An important link in the chain of survival for children suffering a drowning or near-drowning episode

Eight children suffered drowning or near-drowning in Sydney pools over an 11-day period in January 2007. Four received basic life support (BLS) within 5 minutes of immersion and survived with good functional neurological outcomes. The other four were not discovered for ≥ 5 minutes and all died. This cluster serves as a reminder that timely effective bystander BLS is crucial to survival and good clinical outcomes in near-drowning episodes

A large national comparative study of clinicopathological features and long-term survivals between esophageal gastrointestinal stromal tumor and leiomyosarcoma

Esophageal gastrointestinal stromal tumors (E-GIST) and leiomyosarcoma (E-LMS) are rare tumors. Previous studies are limited to small number of patients. We sought to study these two tumors using a large national database. The National Cancer Data Base 2004-2014 was queried for patients with E-GIST and E-LMS. The primary outcome was overall survival (OS). Univariate and multivariable Cox regression models were used to investigate OS predictors. We found 141 E-GIST and 38 E-LMS patients, with esophagectomy and systemic treatment rate of 55% and 49% for E-GIST and 50% and 26% for E-LMS. The 5-year OS of E-GIST and E-LMS were 62% and 23%, respectively, p < 0.001. In multivariable analysis, young age, tumor <10 cm, esophagectomy, and E-GIST were associated with superior OS. There was a higher median and mean OS with neoadjuvant vs. upfront surgery for E-GIST group (98 and 111 vs 79 and 80 months). E E-GIST has superior OS compared to E-LMS. Esophagectomy is the cornerstone treatment modality. Further studies are needed to evaluate the role of neoadjuvant therapy in E-GIST patients

Real-time continuous measurement of lactate through a minimally invasive microneedle patch: a phase I clinical study

IntroductionDetermination of blood lactate levels supports decision-making in a range of medical conditions. Invasive blood-sampling and laboratory access are often required, and measurements provide a static profile at each instance. We conducted a phase I clinical study validating performance of a microneedle patch for minimally invasive, continuous lactate measurement in healthy volunteers.MethodsFive healthy adult participants wore a solid microneedle biosensor patch on their forearms and undertook aerobic exercise for 30 min. The microneedle biosensor quantifies lactate concentrations in interstitial fluid within the dermis continuously and in real-time. Outputs were captured as sensor current and compared with lactate concentrations from venous blood and microdialysis.ResultsThe biosensor was well-tolerated. Participants generated a median peak venous lactate of 9.25 mmol/L (IQR 6.73–10.71). Microdialysate concentrations of lactate closely correlated with blood. Microneedle biosensor current followed venous lactate concentrations and dynamics, with good agreement seen in all participants. There was an estimated lag-time of 5 min (IQR −4 to 11 min) between microneedle and blood lactate measurements.ConclusionThis study provides first-in-human data on use of a minimally invasive microneedle patch for continuous lactate measurement, providing dynamic monitoring. This low-cost platform offers distinct advantages to frequent blood sampling in a wide range of clinical settings, especially where access to laboratory services is limited or blood sampling is infeasible. Implementation of this technology in healthcare settings could support personalised decision-making in a variety of hospital and community settings.Trial registration numberNCT04238611.</jats:sec

Continuous Measurement of Lactate Concentration in Human Subjects through Direct Electron Transfer from Enzymes to Microneedle Electrodes

Microneedle lactate sensors may be used to continuously measure lactate concentration in the interstitial fluid in a minimally invasive and pain-free manner. First- and second-generation enzymatic sensors produce a redox-active product that is electrochemically sensed at the electrode surface. Direct electron transfer enzymes produce electrons directly as the product of enzymatic action; in this study, a direct electron transfer enzyme specific to lactate has been immobilized onto a microneedle surface to create lactate-sensing devices that function at low applied voltages (0.2 V). These devices have been validated in a small study of human volunteers; lactate concentrations were raised and lowered through physical exercise and subsequent rest. Lactazyme microneedle devices show good agreement with concurrently obtained and analyzed serum lactate levels