The spread of multi drug resistant infections is leading to an increase in the empirical antibiotic treatment failure in cirrhosis: a prospective survey

Background The spread of multi-resistant infections represents a continuously growing problem in cirrhosis,particularly in patients in contact with the healthcare environment. Aim Our prospective study aimed to analyze epidemiology, prevalence and risk factors of multiresistant infections, as well as the rate of failure of empirical antibiotic therapy in cirrhotic patients. Methods All consecutive cirrhotic patients hospitalized between 2008 and 2013 with a microbiologically-documented infection (MDI) were enrolled. Infections were classified as Community- Acquired (CA), Hospital-Acquired (HA) and Healthcare-Associated (HCA). Bacteria were classified as Multidrug-Resistant (MDR) if resistant to at least three antimicrobial classes, Extensively-Drug-Resistant (XDR) if only sensitive to one/two classes and Pandrug-Resistant (PDR) if resistant to all classes. Results One-hundred-twenty-four infections (15% CA, 52% HA, 33% HCA) were observed in 111 patients. Urinary tract infections, pneumonia and spontaneous bacterial peritonitis were the more frequent. Forty-seven percent of infections were caused by Gram-negative bacteria. Fifty-one percent of the isolates were multi-resistant to antibiotic therapy (76% MDR, 21% XDR, 3% PDR): the use of antibiotic prophylaxis (OR = 8.4; 95%CI = 1.03-76; P = 0,05) and current/recent contact with the healthcare-system (OR = 3.7; 95%CI = 1.05-13; P = 0.04) were selected as independent predictors. The failure of the empirical antibiotic therapy was progressively more frequent according to the degree of resistance. The therapy was inappropriate in the majority of HA and HCA infections. Conclusions Multi-resistant infections are increasing in hospitalized cirrhotic patients. A better knowledge of the epidemiological characteristics is important to improve the efficacy of empirical antibiotic therapy. The use of preventive measures aimed at reducing the spread of multi-resistant bacteria is also essential

Microalgae biomass concentration and reuse of water as new cultivation medium using ceramic membrane filtration

The aim of this study is to advance means for microalgae dewatering with the simultaneous reuse of water as new cultivation medium, specifically through ceramic membrane filtration. Three algae, namely, Spirulina platensis, Scenedesmus obliquus, and Chlorella sorokiniana were tested by filtering suspensions with four ceramic membranes having nominal pore sizes of 0.8 μm, 0.14 μm, 300 kDa, 15 kDa. The observed flux values and organic matter removal rates were related to the membrane pore size and cake layer properties, with some differences in productivity between algae types, likely due to cell size and shape. Interestingly, similar near steady-state fluxes (70-120 L m-2h-1) were measured using membranes with nominal pore size above 15 kDa, suggesting the dominance of cake layer filtration independently of the initial flux. Virtually complete algae cells rejections and high nutrient passage (>75%) were observed in all combinations. When the permeate streams were used as media for new growth cycles of the various algae, no or little growth was observed with Spirulina p., while Chlorella s. (permeate from 300 kDa membrane) and especially Scenedesmus o. (permeate from 0.14 μm membrane) showed the fastest growth rates, almost comparable to those observed with ideal fresh media

All-in-One Mesh Hernioplasty: A New Procedure for Inguinal Hernia Repair

Since the 1970s, when biocompatible meshes were introduced with the consequent decrease of recurrence, one of the priorities in inguinal hernia surgery was that of minimizing postoperative chronic pain. All technical variations, proposed during the past years in order to improve patient’s comfort, reported a variable incidence of chronic neuralgia. The procedure we describe, applicable to all cases of primary inguinal hernia, employs a smaller pre-cut single mesh that covers all weak areas of the inguinal canal and is enveloped in a fibro-cremasteric sheath, avoiding contact of the prosthesis with neural structures. The new procedure, already performed on 250 patients, aims to improve patients’ comfort and to reduce the incidence of chronic neuralgia

Despite association, the acute:chronic work load ratio does not predict non-contact injury in elite footballers

Purpose: To examine association and prediction of load-based markers (rate of perceived exertion) with non-contact injuries.Materials and methods: Thirty-four elite Italian football players (age 26 5 y, height 182 5 cm, body mass 78 +/- 4 kg) participated in a 3-seasons prospective study. Markers examined were: RPE, exposure, weekly load, week-to-week load change, cumulative 2, 3, 4 WL, acute:chronic 1:2 (acute:chronic2), 1:3 (acute:chronic3) and 1:4 (acute:chronic4) WL ratios. After checking multicollinearity between markers, a Generalized Estimating Equation analysis was used to examine association with a non-contact injury in the subsequent week. The associated markers were split into four groups based on 15th, 50th, 85th percentile to compare injury risk (IR) in different zones. Prediction was examined with receiver operating characteristic curve, area under the curve (AUC) and Youden index.Results: IR increased when acute:chronic2 of 1.00-1.20, >1.20 were compared to <0.81 (odds ratio (OR), 90% confidence interval (CI): 1.6, 0.79-3.29; 2.2, 1.03-4.74). IR increased when comparing acute:chronic3 of 1.01-1.23, >1.23 vs. <0.80 (OR, 90% CI: 1.9, 0.9-3.8; 2.5, 1.2-5.4). IR increased when comparing acute:chronic4 of 0.78-1.02, 1.02-1.26, >1.26 vs. <0.78 (OR, 90% CI: 2.4, 1.4-3.9; 3.3, 1.6-6.6; 3.5, 1.7-7.4). The AUC 0.60 for all markers and Youden Index (close to 0) showed poor prediction.Conclusion: Acute:chronic markers showed association however with poor prediction ability

Concentration of phycocyanin and coffee extracts in aqueous solutions with osmotically-assisted membrane distillation

Osmotic membrane distillation (OMD) is a dewatering process that exploits combined temperature and osmotic pressure gradients to drive water vapor fluxes under mild operation conditions. In this study, the feasibility of OMD is evaluated for the concentration of phycocyanin and coffee extract solutions, with the goal to safeguard the quality of the extracts. Different feed solution temperatures were studied, namely, 35 °C, 45 °C, 55 °C, while keeping a concentration of 4 M CaCl2 in the extraction solution. The target concentration factor was set to 4, equivalent to a water recovery rate of 75 %. The results suggest that a temperature equal to or below 45 °C should be chosen for the concentration of phycocyanin to prevent degradation and to minimize fouling, while higher temperatures may be used for the recovery of the coffee extract. The combined gradients provided water fluxes around or above 4 L m−2h−1 with both extracts under relatively mild conditions, even at high concentration factors. Qualitative membrane fouling inspection was corroborated by estimating the fraction of productivity lost due to fouling, which was larger for higher feed temperatures and for the phycocyanin extracts, and had values between roughly 20 and 70 %. Results also suggest that the quality of the extracts was maintained, based on the measured purity and content of the target compounds in the concentrated solutions. Specifically, no trace of extraneous compounds was found, and no salt passage was observed from the extraction solution to the feed solution, suggesting that OMD has the potential to concentrate sensitive components

ONIX: Open Radio Network Information eXchange

While video-on-demand still takes up the lion's share of Internet traffic, we are witnessing a significant increase in the adoption of mobile applications defined by tight bit rate and latency requirements (e.g., augmented/virtual reality). Supporting such applications over a mobile network is very challenging due to the unsteady nature of the network and the long distance between the users and the application back-end, which usually sits in the cloud. To address these and other challenges, like security, reliability, and scalability, a new paradigm termed multi-access edge computing (MEC) has emerged. MEC places computational resources closer to the end users, thus reducing the overall end-to-end latency and the utilization of the network backhaul. However, to adapt to the volatile nature of a mobile network, MEC applications need real-time information about the status of the radio channel. The ETSI-defined radio network information service (RNIS) is in charge of providing MEC applications with up-to-date information about the radio network. In this article, we first discuss three use cases that can benefit from the RNIS (collision avoidance, media streaming, and Industrial Internet of Things). Then we analyze the requirements and challenges underpinning the design of a scalable RNIS platform, and report on a prototype implementation and its evaluation. Finally, we provide a roadmap of future research challenges

Physiological indicators of acute and chronic stress in securely and insecurely attached dogs undergoing a strange situation procedure (SSP): Preliminary results

The quality of the attachment bond towards the caregiver may affect the dog’s physiological responses to stressful stimuli. This study aimed to measure chronic and acute physiological parameters of stress in ten securely and ten insecurely attached dogs. The twenty experimental subjects were selected from a sample of dogs that participated with their owners in the Strange Situation Procedure. Saliva samples were collected before (T0) and after (T1) the test. Blood pressure, heart rate, respiratory rate, and rectal temperature were measured after the test, only. At this time, a hair sample was also collected. RM ANOVA was used to analyse cortisol concentrations between secure and insecure dogs at T0 and T1. Mann–Whitney U test or T test were used for other physiological parameters. Insecure dogs had significant higher salivary cortisol concentrations than secure dogs at T1 (p = 0.024), but only a non-significant trend towards higher cortisol concentrations at T0 (p = 0.099). Post-test heart rate also tended to be higher in insecure compared to secure dogs (p = 0.077). No significant differences in hair cortisol concentration were found. The quality of attachment may affect the dog’s physiological response to acute stress, at least when related to separation from the caregiver. The effect of attachment on chronic stress requires further investigation

Detection of genomic regions underlying milk production traits in Valle del Belice dairy sheep using regional heritability mapping

The aim of this study was to identify genomic regions underlying milk production traits in the Valle del Belice dairy sheep using regional heritability mapping (RHM). Repeated measurements for milk yield (MY), fat percentage and yield (F% and FY) and protein percentage and yield (P% and PY), collected over a period of 6 years (2006-2012) on 481 Valle del Belice ewes, were used for the analysis. Animals were genotyped with the Illumina 50k SNP chip. Variance components, heritabilities and repeatabilities within and across lactations were estimated, fitting parity, litter size, season of lambing and fortnights in milk, as fixed; and additive genetic, permanent environment within and across lactations, flock by test-day interaction and residual as random effects. For the RHM analysis, the model included the same fixed and random effects as before, plus an additional regional genomic additive effect (specific for the region being tested) as random. While the whole genomic additive effect was estimated using the genomic relationship matrix (GRM) constructed from all SNPs, the regional genomic additive effect was estimated from a GRM matrix constructed from the SNPs within each region. Heritability estimates ranged between 0.06 and 0.15, with repeatabilities being between 0.14 and 0.24 across lactations and between 0.23 and 0.39 within lactation for all milk production traits. A substantial effect of flock-test-day on milk production traits was also estimated. Significant genomic regions at either genome-wide (p < .05) or suggestive (i.e., one false positive per genome scan) level were identified on chromosome (OAR) 2, 3 and 20 for F% and on OAR3 for P%, with the regions on OAR3 in common between the two traits. Our results confirmed the role of LALBA and AQP genes, on OAR3, as candidate genes for milk production traits in sheep

Head-to-head comparison of plasma cTnI concentration values measured with three high-sensitivity methods in a large Italian population of healthy volunteers and patients admitted to emergency department with acute coronary syndrome: A multi-center study

Abstract Background The study aim is to compare cTnI values measured with three high-sensitivity (hs) methods in apparently healthy volunteers and patients admitted to emergency department (ED) with acute coronary syndrome enrolled in a large multicentre study. Methods Heparinized plasma samples were collected from 1511 apparently healthy subjects from 8 Italian clinical institutions (mean age: 51.5 years, SD: 14.1 years, range: 18–65 years, F/M ratio:0.95). All volunteers denied chronic or acute diseases and had normal values of routine laboratory tests. Moreover, 1322 heparinized plasma sample were also collected by 9 Italian clinical institutions from patients admitted to ED with clinical symptoms typical of acute coronary syndrome. The reference study laboratory assayed all plasma samples with three hs-methods: Architect hs-cTnI, Access hs-cTnI and ADVIA Centaur XPT methods. Principal Component Analysis (PCA) was also used to analyze the between-method differences among hs-cTnI assays. Results On average, a between-method difference of 31.2% CV was found among the results of hs-cTnI immunoassays. ADVIA Centaur XPT method measured higher cTnI values than Architect and Access methods. Moreover, 99th percentile URL values depended not only on age and sex of reference population, but also on the statistical approach used for calculation (robust non-parametric vs bootstrap). Conclusions Due to differences in concentrations and reference values, clinicians should be advised that plasma samples of the same patient should be measured for cTnI assay in the same laboratory. Specific clinical studies are needed to establish the most appropriate statistical approach to calculate the 99th percentile URL values for hs-cTnI methods