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. MethodsWe 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. FindingsWe 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•4...
Anastomotic leak (AL) is defined as communication between intra-and extraluminal compartments caused by a defect in intestinal wall integrity at the anastomosis [1]. AL after colorectal surgery is one of the most dreadful complications because it can cause septic complications due to intraabdominal contamination from fecal content and may require reoperation often followed by creating a stoma [2,3]. In addition, AL after cancer surgery is known to increase locoregional recurrence and decrease survival rate [4,5].Despite the development of novel surgical techniques and instruments, the incidence rate of AL has not declined in recent decades [6]. According to previous research that analyzed the results of rectal cancer surgeries from 1990 to 2008 in 84 prospective cohort studies, the AL rate was approximately 11% and remains considerably high [2]. Therefore, studies aimed at reducing AL are of ongoing interest, and the 2 most common
We developed a double-layer structured transparent electrode for use in flexible quantum-dot light-emitting diodes (QLEDs). Silver nanowires (AgNWs) and highly conductive poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate) (PEDOT:PSS) were coated on a transparent substrate to obtain a highly conductive and flexible transparent electrode. The highly conductive PEDOT:PSS improved the surface roughness of the AgNWs transparent electrode film as well as the surface coverage area of the film. The double-layer structured transparent electrode showed superior mechanical properties than conventional indium-tin oxide (ITO) and AgNWs transparent electrodes. QLEDs with the double-layer structured transparent electrode also showed good reliability under cyclic bending conditions. These results indicate that the double-layer structured AgNWs/ PEDOT:PSS transparent electrode described here is a feasible alternative to ITO transparent electrodes for flexible QLEDs.
The purpose of this study was to evaluate the effect of full-fat almonds (FFA) as an alternative protein and fat source for broiler feed on broiler productivity, nutrient digestibility, blood characteristics, cecal-fecal microflora, and foot-pad dermatitis (FPD). A total of 96, one-day-old broiler chickens (Arbor Acres) with initial body weight 41.61 ± 0.36 g were placed in 16 cages. In each trial, four treatments were set up: a basal diet partially replacing animal fat with FFA 0% (Control, CON), a basal diet partially replacing animal fat with FFA 1% (T1), a basal diet partial replacing animal fat with FFA 2% (T2), a basal diet partially replacing animal fat with FFA 4% (T3). The experiment was conducted for a total of 4 weeks. Feed conversion ratio (FCR) was higher (p < 0.05) in the T3 group of broilers at weeks 0 to 1 than in the CON group of broilers. From weeks 3 to 4, and for the entire experimental period, FCR was lower (p < 0.05) in the T3 group of broilers than in the CON and T1 groups of broilers. The apparent ileal digestibility (AID) of the ether extract (EE) was higher (p < 0.05) in the T3 group than in the other treatment groups, and AID of crude protein (CP) was higher (p < 0.05) in the T3 group than in the CON group. The apparent total tract digestibility (ATTD) of EE was lower (p < 0.05) in the CON group than in the other treatment groups, and the ATTD of CP and energy was higher (p < 0.05) in the T3 group of broilers than in the CON group of broilers. The AID and ATTD of total amino acids were higher (p < 0.05) in the T3 group than in the other treatment groups. Blood cholesterol levels were lower (p < 0.05) in the T3 group of broilers than in the CON and T1 groups of broilers, and higher (p < 0.05) in the CON group of broilers than in the T2 and T3 groups of broilers. The amount of E. coli in the cecal and fecal was lower (p < 0.05) in the T3 group than in CON and T1 groups. FPD score was higher (p < 0.05) in the T3 group of broilers than in the CON group of broilers. In conclusion, replacing a partial of animal fat with at least 4% FFA in broiler diets can increase growth performance and nutrient digestibility in broiler nutrition.
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