Postoperative enteral feeding does not prevent intestinal bacterial translocation, but reduces the rate of pulmonary infections in pigs undergoing total orthotopic small bowel transplantation

OBJECTIVE: To assess the effects of a non-elemental liquid diet on nutritional state, composition of bowel flora, intestinal translocation, and pulmonary infections after small bowel transplantation in pigs. DESIGN: Prospective randomised experiment. SETTING: Teaching hospital, Italy. MATERIAL: 32 female Large White pigs. INTERVENTIONS: Group 1 (n = 6) underwent small bowel transplantation, were treated with immunosuppression, and fed on commercial chow. Group 2 (n = 6) were treated similarly except that they were fed with an enteral feed through a tube gastrostomy starting on day 4 postoperatively. Group 3 (n = 6) were treated similarly to group 1 except that they had no immunosuppression, and Group 4 (n = 6) underwent orthotopic small bowel autotransplantation; 8 further pigs underwent a sham operation only to act as controls. MAIN OUTCOME MEASURES: Signs of rejection, graft-versus-host-disease, luminal bacterial overgrowth, bacterial translocation, pneumonia, and the pigs' nutritional state. RESULTS: All animals in group 3 showed signs of acute rejection. There was appreciable overgrowth of aerobic and anaerobic bacteria in all three groups after allotransplantation compared with controls. The counts of anaerobic bacteria were significantly lower in group 2 (enterally fed animals) compared with those given free access to commercial chow [mean (SD) 2.81 (1.39) log CFU/cm2 compared with 4.80 (1.65), p = 0.047]. Bacterial translocation developed to a similar degree after autografts and allografts and pneumonia developed in fewer animals after enteral feeding (1/6) than after conventional feeding (5/6) but the difference was not significant (p = 0.08, odds ratio 25.0, 95% confidence interval of odds ratio 1.20 to 521.13). Enterally fed animals also lost less weight than conventionally fed animals [2.32 (1.23) kg compared with 4.53 (1.74), p = 0.016]. CONCLUSIONS: Enteral feeding for up to a month slightly reduced the rate of pneumonia and resulted in a better nutritional state in pigs after small bowel transplantation. It had no effect on luminal bacterial overgrowth or translocation.     

Kinematics of head-trunk movements while entering and exiting a car

The study of free and natural accessibility movements for a medium-sized car was carried out, recording the motor performances of ten participants by means of a motion analysis system. The experimental protocol used passive markers to implement a two-segment biomechanical model for the analysis of the head-trunk complex. The kinematic variables quantify the motor patterns, and showed specific features that can be related to the individual anthropometric characteristics and to the car geometry differences: tall participants used a neck flexion and a leftwards bending of the head, while short participants extended the neck and bent the head to the right. The different seat positions (short participants move forwards the seat) along with the principal need to avoid any body interference with the car, can explain the observed strategies. From the wider analysis of the movements in relation to the vehicle's features and to the anthropometric size of the participants, this approach could lead to an extension of the design criteria for those structural components of the car which have been demonstrated to significantly influence the human-machine interaction.     

The binding mode of progesterone to its receptor deduced from molecular dynamics simulations

An unambiguous understanding of the binding mode of human progesterone to its receptor still eludes experimental search. According to the X-ray structure of the ligand-binding domain, only one (O3) of the two keto groups at the ligand ends (O3 and O20) should play a role. This result is in conflict with chemical intuition and the results of site-directed mutagenesis experiments. Herein, we report classical molecular dynamics simulations that reveal the dynamic nature of the binding in solution, elucidate the reasons why X-ray studies failed to determine the role of O20, and clarify the effects of the mutations. The predictive power of the force field is ensured by the consistent introduction of a first-principles representation of the ligand.     

Feasibility of exeresis. Controversial aspects in the surgery of carcinoma of the pancreas

To establish a protocol for conscious sedation in microlaparoscopy, we conducted a prospective, observational study of 74 women undergoing the procedure under local anesthesia with conscious sedation for the evaluation and treatment of chronic pelvic pain. Our protocol for conscious sedation allowed us to perform diagnostic microlaparoscopy under local anesthesia in all 74 women and operative microlaparoscopy in 52 (70.2%). This procedure is a safe and effective alternative to general anesthesia during microlaparoscopy in selected patients.     

A new model to evaluate the dynamic adaptation of an electric distribution system

The main objective of this paper is to present a model developed to evaluate the Dynamic Adaptation of an Electric Energy Distribution System respecting its planning for a given period of Tariff Control. The model is based on a two-stage strategy that deals with the mid/short-term and long term planning, respectively. The starting point for modeling is brought about by the results from a multi-attribute method based on Fuzzy Dynamic Programming and on Analytic Hierarchy Processes for a mid/short-term horizon. Such a method produces a set of possible evolution trajectories which can be defined as satisfactory when they evolve above a given risk threshold that the planner is willing to accept. Then, the decision-making activities within the framework of the Analytic Hierarchy Processes are those tasks that allow defining a Vector for Dynamic Adaptation of the System, which is directly associated to an eventual series of imbalances that take place during its evolution.     

The recombinant Klebsiella pneumoniae outer membrane protein OmpA has carrier properties for conjugated antigenic peptides

Klebsiella pneumoniae OmpA, the 40-kDa major protein of the outer membrane, was cloned and expressed in Escherichia coli. The recombinant protein was produced intracellularly in E. coli as inclusion bodies. Fusion of a short peptide to the N-terminus of native P40 facilitated high-level expression of the recombinant protein. Purified recombinant P40 was analyzed to verify purity and structural integrity. The molecular mass of purified recombinant P40 determined by electrospray mass spectrometry was 37,061 Da, in agreement with the theoretical mass deduced from the DNA sequence. Specific proliferation of recombinant-P40-primed murine lymph node cells in response to recombinant P40 stimulation in vitro indicated the presence of a T-cell epitope on recombinant P40. The induction of high serum antibody titers to a synthetic peptide derived from the attachment protein G of the respiratory syncytial virus when chemically coupled to recombinant P40 indicated that the protein had potent carrier properties.     

Unraveling the Lagged Effect of Hydro-meteorological Conditions On the Trophic State of a Reservoir By Applying Dynamic Regression

In this study we develop a novel approach to quantify the relative importance of hydro-meteorological (HM) conditions on the trophic state index (TSI) of a water reservoir (San Roque, Córdoba, Argentina). Seven HM variables measured at four reservoir sites and different depths over a time period of near 2 decades are used. We propose a dynamic regression model to predict the TSI from these variables aggregated over a range of time lags, which has not been applied in such a complex setting so far. By performing coefficient analysis, we quantify the relative importance of these variables on the TSI, as well as the time duration over which they have significant impact (lagged effect). Additionally, the analysis of the autoregressive and moving average (ARIMA) terms reveals the impact of the residual effects of previous trophic states on the current trophic state. We find that surface temperature and precipitation have the largest direct relationship to the TSI in the short-term, while the reservoir water level is inversely related to the TSI in the short- to mid-term. Also, the residual effects of the trophic state impact from 1 month (generally) up to 2 years (exceptionally). This approach can be applied to other water bodies affected by similar eutrophication phenomena.

Graphical abstract

     

An elastic intrusion detection system for software networks

Internal users are the main causes of anomalous and suspicious behaviors in a communication network. Even when traditional security middleboxes are present, internal attacks may lead the network to outages or to leakage of sensitive information. In this article, we propose BroFlow, an Intrusion Detection and Prevention System based on Bro traffic analyzer and on the global network view of the software-defined networks (SDN) which is provided by the OpenFlow. BroFlow main contributions are (i) dynamic and elastic resource provision of traffic-analyzing machines under demand; (ii) real-time detection of DoS attacks through simple algorithms implemented in a policy language for network events; (iii) immediate reaction to DoS attacks, dropping malicious flows close of their sources, and (iv) near-optimal placement of sensors through a proposed heuristic for strategically positioning sensors in the network infrastructure, which is shared by multi-tenants, with a minimum number of sensors. We developed a prototype of the proposed system, and we evaluated it in a virtual environment of the Future Internet Testbed with Security (FITS). An evaluation of the system under attack shows that BroFlow guarantees the forwarding of legitimate packets at the maximal link rate, reducing up to 90 % of the maximal network delay caused by the attack. BroFlow reaches 50 % of bandwidth gain when compared with conventional firewalls approaches, even when the attackers are legitimate tenants acting in collusion. In addition, the system reduces the sensors number, while keeping full coverage of network flows.     

Ethane: a marker of lipid peroxidation during cardiopulmonary bypass in humans

The goals of this study were to (1) determine the utility of quantification of ethane as a marker of ischemia-reperfusion during human cardiopulmonary bypass (CPB); and (2) determine, using an animal model for this surgical procedure, whether the mode of surgical approach produced increases the quantity of exhaled ethane. Human CPB was initiated following standard anesthetic and monitoring regimens. Samples of gas were collected at baseline and at multiple defined time points throughout the studies. Ethane was determined using cryogenic concentration and gas chromatography. Sternotomy increased exhaled ethane compared to baseline (p < .007; 5.8 +/- 1.7 vs. 3.0 +/- 0.7 nmol/m2 x min); ethane returned to baseline levels prior to the initiation of CPB. Aortic unclamping produced ethane elevation (p < .05; 2.3 +/- 0.8 vs. 1.5 +/- 0.4 nmol/m2 x min) with the levels being related to a lower cardiac index and a higher systemic vascular resistance post aortic unclamping. Termination of CPB significantly increased ethane levels compared to baseline (p < .002; 4.8 +/- 1.7 vs. 3.0 +/- 0.7 nmol/m2 x min). Independent variables that correlated with increased ethane measurements included a higher arterial blood pH on bypass and the change in hemoglobin pre- and post-CPB. Electrocautery, but not scalpel, incision of the porcine abdominal wall increased ethane levels significantly (p < .02). These results indicate that exhaled ethane may be a valuable marker of lipid peroxidation during and following CPB.