Meconium obstruction in absence of cystic fibrosis in low birth weight infants: an emerging challenge from increasing survival

<p>Abstract</p> <p>Background</p> <p>Meconium abnormalities are characterized by a wide spectrum of severity, from the meconium plug syndrome to the complicated meconium ileus associated with cystic fibrosis. Meconium Related Ileus in absence of Cystic Fibrosis includes a combination of highly viscid meconium and poor intestinal motility, low grade obstruction, benign systemic and abdominal examination, distended loops without air fluid levels. Associated risk factors are severe prematurity and low birth weight, Caesarean delivery, Maternal MgSO4 therapy, maternal diabetes. In the last 20 yrs a new specific type of these meconium related obstructions has been described in premature neonates with low birth weight. Its incidence has shown to increase while its management continues to be challenging and controversial for the risk of complicated obstruction and perforation.</p> <p>Materials and methods</p> <p>Among 55 newborns admitted between 1992-2008 with Meconium Related Ileus as final diagnosis, data about Low Birth Weight infants (LBW < 1500 g) were extracted and compared to those of patients ≥ 1500 g. Hischsprung's Diseases and Cystic Fibrosis were excluded by rectal biopsy and genetic probe before discharge. A softening enema with Gastrografin was the first option whenever overt perforation was not present. Temporary stoma or trans appendiceal bowel irrigation were elected after unsuccessful enema while prompt surgical exploration was performed in perforated cases. NEC was excluded in all operated cases. Data collected were perinatal history and neonatal clinical data, radiological signs, clinical course and complications, management and outcome.</p> <p>Results</p> <p>30 cases with BW ≥ 1500 g had an M/F ratio16/14, Mean B.W. 3052 g, Mean G.A. 37 w Caesarean section rate 40%. There were 10 meconium plug syndrome, 4 small left colon syndromes, and 16 meconium ileus without Cystic Fibrosis. Five cases were born at our institution (inborn) versus 25 referred after a mean of 2, 4 Days (1-7) after birth in another Hospital (outborn). They were managed, after a Gastrografin enema with 90% success rate, by 1 temporary Ileostomy and 2 trans appendiceal irrigation. 25 cases with BW< 1500 g (LBW) had M/F ratio 11/14, Mean B.W. 818 g, Mean G.A. 27 w, Caesarean section rate 70%, assisted ventilation 16/25. There were 8 inborn and 17 outborn. Gastrografin enema was successful in 6 out 8 inborn infants only, all referred within one week from birth. There were 12 perforations mainly among late referred LBW outborn.</p> <p>Conclusions</p> <p>Meconium Related Ileus without Cystic Fibrosis responds to conservative management and softening enema in most of mature infants. In LBW clinical course is initially benign but as any long standing bowel obstruction management may present particular challenges. Clinical and plain radiographic criteria are reliable for making diagnosis and testing for Cystic Fibrosis may not be indicated. Enema may be resolutive when performed in a proper environment. Perforated cases may be confused with NEC which is excluded by clinical history, no signs of sepsis, lab signs missing, abdominal signs missing, typical radiological signs missing. The higher complication rate is recorded among cases delivered and initially managed in Neonatal Units without co-located Surgical Facilities. Early diagnosis and aggressive medical therapy may lead to higher success rate and help avoiding surgical interventions. Surgical therapy in uncomplicated cases, unresponsive to medical management, should be minimally aggressive.</p

Functional connectivity modules in recurrent neural networks: function, origin and dynamics

Understanding the ubiquitous phenomenon of neural synchronization across species and organizational levels is crucial for decoding brain function. Despite its prevalence, the specific functional role, origin, and dynamical implication of modular structures in correlation-based networks remains ambiguous. Using recurrent neural networks trained on systems neuroscience tasks, this study investigates these important characteristics of modularity in correlation networks. We demonstrate that modules are functionally coherent units that contribute to specialized information processing. We show that modules form spontaneously from asymmetries in the sign and weight of projections from the input layer to the recurrent layer. Moreover, we show that modules define connections with similar roles in governing system behavior and dynamics. Collectively, our findings clarify the function, formation, and operational significance of functional connectivity modules, offering insights into cortical function and laying the groundwork for further studies on brain function, development, and dynamics

Solvent Dependency of the UV-Vis Spectrum of Indenoisoquinolines: Role of Keto-Oxygens as Polarity Interaction Probes.

Indenoisoquinolines are the most promising non-campthotecins topoisomerase IB inhibitors. We present an integrated experimental/computational investigation of the UV-Vis spectra of the IQNs parental compound (NSC314622) and two of its derivatives (NSC724998 and NSC725776) currently undergoing Phase I clinical trials. In all the three compounds a similar dependence of the relative absorption intensities at 270 nm and 290 nm on solvent polarity is found. The keto-oxygens in positions 5 and 11 of the molecular scaffold of the molecule are the principal chromophores involved in this dependence. Protic interactions on these sites are also found to give rise to absorptions at wavelengthsolution, due to the stabilization of highly polarized tautomers of the molecule. These results suggest that the keto-oxygens are important polarizable groups that can act as useful interactors with the molecular receptor, providing at the same time an useful fingerprint for the monitoring of the drug binding to topoisomerase IB

A technology evaluation method for assessing the potential contribution of energy technologies to decarbonisation of the Italian production system

A methodology focused on technology evaluation is proposed to give a footprint of the development potential of energy technologies in Italy. The approach focuses on the impact on climate, the potential in terms of R&amp;D, the competitiveness of Italian companies and their diffusion on the territory. A reference Catalogue was realised in the framework &nbsp;of the ‘Technical Board on Decarbonisation of the Economy’, established by the Italian Presidency of the Council of Ministers. 36 datasheets, containing quantitative and qualitative information on Technology Readiness Level (TRL), efficiency, environmental and economic impacts and policy aspects were filled by 70 experts for each technology. Some data were extracted from the Catalogue - TRL, CO2 emissions, developers, and centres of excellence - and further analysed with other information relating to the Italian production and innovation system collected from the National Enterprise Registry (ASIA). Companies and research centres&nbsp; are involved in development of technologies based on Renewable Energy Sources (RES) and Energy Storage (ES) with different levels of TRL and high potential for mitigating effects on climate. However, their distribution shows a rather inhomogeneous presence at territorial level. This evaluation provided useful elements to elaborate policy measures to support the diffusion of energy technologies

Pyrgi. Analysis of possible climatic effects on a coastal archaeological site

This work refers to an interdisciplinary study on the archaeological site of Pyrgi, an Etruscan harbour still under excavation, located on the Lazio’s coast in Santa Severa, in the province of Rome. The site in question is subject to frequent flooding which compromises its accessibility and delays the archaeological excavation operations. The study is based on the combined use of geomatic technologies, meteorological and climatic models, and hydrogeological knowledge of the examined site, to have a global view of the hazard to which it is exposed. Different geomatic techniques at different scales are used in the analysis. Large scale surveys are carried out to define the water networks and to monitor the site using satellite images. On a small scale, drone photogrammetry techniques are used to assess the morphology of the territory and eventual protection from natural hazards present in the site. Using these images, a detailed digital surface model (DSM) has been generated. The objective of the research is to assess the main cause of the floods and the time the water stays in the site and to determine if the floods are periodic phenomena over time or random events. The study was conducted using images captured by Sentinel 2 satellites processed at level 2-A. These images enabled the identification of the flooding periods of the site for the years of monitoring. The study was conducted by comparing the captured images with rainfall data, paying attention to extreme weather phenomena that occurred from 2012 to date. The rainfall data are provided by the National Department of Civil Protection to CNR-ISAC by an agreement between the two institutions. The same images have been compared with the wind data recorded by the anemometer located in the Civitavecchia harbour and the wave height data available from ERA5 reanalysis. Knowledge of the main cause of the floods and a possible periodicity will allow to plan correct conservation of the site through specific protection measures designed according to the hazards to which it is exposed

Chapter Pyrgi: analysis of possible climatic effects on a coastal archaeological site

This work refers to an interdisciplinary study on the archaeological site of Pyrgi, an Etruscan harbour still under excavation, located on the Lazio’s coast in Santa Severa, in the province of Rome. The objective of the research is to assess the main cause of the floods and the time the water stays in the site to determine if the floods are periodic phenomena over time or random events for guarantee a correct conservation of the site . The study is based on the combined use of geomatic technologies, meteorological and climatic models, and hydrogeological knowledge

Aspiration versus peritoneal lavage in appendicitis: a meta-analysis.

BACKGROUND: Acute appendicitis is one of the most frequent abdominal surgical emergencies. Intra-abdominal abscess is a frequent post-operative complication. The aim of this meta-analysis was to compare peritoneal irrigation and suction versus suction only when performing appendectomy for complicated appendicitis. METHODS: According to PRISMA guidelines, a systematic review was conducted and registered into the Prospero register (CRD42020186848). The risk of bias was defined to be from low to moderate. RESULTS: Seventeen studies (9 RCTs and 8 CCTs) were selected, including 5315 patients. There was no statistical significance in post-operative intra-abdominal abscess in open (RR 1.27, 95% CI 0.75-2.15; I2 = 74%) and laparoscopic group (RR 1.51, 95% CI 0.73-3.13; I2 = 83%). No statistical significance in reoperation rate in open (RR 1.27, 95% CI 0.04-2.49; I2 = 18%) and laparoscopic group (RR 1.42, 95% CI 0.64-2.49; I2 = 18%). In both open and laparoscopic groups, operative time was lower in the suction group (RR 7.13, 95% CI 3.14-11.12); no statistical significance was found for hospital stay (MD - 0.39, 95% CI - 1.07 to 0.30; I2 = 91%) and the rate of wound infection (MD 1.16, 95% CI 0.56-2.38; I2 = 71%). CONCLUSIONS: This systematic review has failed to demonstrate the statistical superiority of employing intra-operative peritoneal irrigation and suction over suction-only to reduce the rate of post-operative complications after appendectomy, but all the articles report clinical superiority in terms of post-operative abscess, wound infection and operative times in suction-only group

Rapid Damage Mapping for the 2015 M_w 7.8 Gorkha Earthquake Using Synthetic Aperture Radar Data from COSMO–SkyMed and ALOS-2 Satellites

The 25 April 2015 M_w 7.8 Gorkha earthquake caused more than 8000 fatalities and widespread building damage in central Nepal. The Italian Space Agency’s COSMO–SkyMed Synthetic Aperture Radar (SAR) satellite acquired data over Kathmandu area four days after the earthquake and the Japan Aerospace Exploration Agency’s Advanced Land Observing Satellite-2 SAR satellite for larger area nine days after the mainshock. We used these radar observations and rapidly produced damage proxy maps (DPMs) derived from temporal changes in Interferometric SAR coherence. Our DPMs were qualitatively validated through comparison with independent damage analyses by the National Geospatial-Intelligence Agency and the United Nations Institute for Training and Research’s United Nations Operational Satellite Applications Programme, and based on our own visual inspection of DigitalGlobe’s WorldView optical pre- versus postevent imagery. Our maps were quickly released to responding agencies and the public, and used for damage assessment, determining inspection/imaging priorities, and reconnaissance fieldwork

Cooperative Binding of the Cationic Porphyrin Tris-T4 Enhances Catalytic Activity of 20S Proteasome Unveiling a Complex Distribution of Functional States

The present study provides new evidence that cationic porphyrins may be considered as tunable platforms to interfere with the structural "key code" present on the 20S proteasome α-rings and, by consequence, with its catalytic activity. Here, we describe the functional and conformational effects on the 20S proteasome induced by the cooperative binding of the tri-cationic 5-(phenyl)-10,15,20-(tri N-methyl-4-pyridyl) porphyrin (Tris-T4). Our integrated kinetic, NMR, and in silico analysis allowed us to disclose a complex effect on the 20S catalytic activity depending on substrate/porphyrin concentration. The analysis of the kinetic data shows that Tris-T4 shifts the relative populations of the multiple interconverting 20S proteasome conformations leading to an increase in substrate hydrolysis by an allosteric pathway. Based on our Tris-T4/h20S interaction model, Tris-T4 is able to affect gating dynamics and substrate hydrolysis by binding to an array of negatively charged and hydrophobic residues present on the protein surface involved in the 20S molecular activation by the regulatory proteins (RPs). Accordingly, despite the fact that Tris-T4 also binds to the α3ΔN mutant, allosteric modulation is not observed since the molecular mechanism connecting gate dynamics with substrate hydrolysis is impaired. We envisage that the dynamic view of the 20S conformational equilibria, activated through cooperative Tris-T4 binding, may work as a simplified model for a better understanding of the intricate network of 20S conformational/functional states that may be mobilized by exogenous ligands, paving the way for the development of a new generation of proteasome allosteric modulators