Antimicrobial Challenge in Acute Care Surgery

The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship

New perspectives in the prediction of postoperative complications for high-risk ulcerative colitis patients: machine learning preliminary approach

OBJECTIVE: Patients with acute severe and medical refractory ulcerative colitis have a high risk of postoperative complications after total abdominal colectomy (TAC). The objective of this retrospective study is to use machine learning to analyze and predict short-term outcomes. PATIENTS AND METHODS: 32 patients with ulcerative colitis were treated with total abdominal colectomy between 2011 and 2017. Biographical data, preoperative therapy, blood chemistry, nutritional status, surgical technique, blood transfusion and preoperative length of stay were the features selected for the statistical analyses and were used as input for the machine learning algorithms to predict the rate of complications. RESULTS: Traditional statistical analysis showed an overall postoperative morbidity rate of 34% and a mortality rate of 3%. Preoperative low serum albumin levels (4 days), blood transfusions (≥1 unit) and body temperature (≥37.5°C) demonstrated a major impact on infectious morbidity with statistical significance (p<0.05). Patients treated with steroids and rescue therapy presented a higher risk of minor infectious complications (p<0.05). Evaluating only preoperative features, machine learning algorithms were able to predict minor postoperative complications with a high strike rate (84.3%), high sensitivity (87.5%) and high specificity (83.3%) during the testing phase. CONCLUSIONS: Machine learning is demonstrated to be useful in predicting the rate of minor postoperative complications in high-risk ulcerative colitis patients, despite the small sample size. It represents a major step forward in data analysis by implementing a retrospective study from a prospective point of view

Cardiovascular and metabolic responses during indoor climbing and laboratory cycling exercise in advanced and &#233;lite climbers

Purpose. To validate heart rate (fH) as an effective indicator of the aerobic demands of climbing, the fH vs. oxygen uptake (VO2) relationship determined during cycling exercise and climbing on a circular climbing treadwall was compared. Possible differences in maximum aerobic characteristics between advanced and \ue9lite climbers were also assessed. Methods. Seven advanced and six \ue9lite climbers performed a discontinuous incremental test on a cycle ergometer and a similar test on a climbing treadwall. Cardiorespiratory and gas exchange parameters were collected at rest and during exercise. Results. The fH vs. VO2 relationship was steeper during cycling than climbing at submaximal exercise for both groups and during climbing in the \ue9lite climbers as compared to the advanced. At peak exercise, VO2 was similar during both cycling and climbing (3332\ub1115 and 3193\ub1129 ml/min, respectively). Despite similar VO2 peak, the \ue9lite climbers had a higher peak workload during climbing (11.8\ub10.8 vs. 9.2\ub10.3 m/min in \ue9lite and advanced climbers, respectively; P=.024) but not during cycling (282\ub113 vs. 268\ub112 W in \ue9lite and advanced climbers, respectively). Conclusions. Our findings indicate that care should be taken when energy expenditure during climbing is estimated from the fH vs VO2 relationship determined in the laboratory. The level of climbing experience significantly affects the energy cost of exercise. Lastly, the similar aerobic demands of cycling and climbing at peak exercise, suggest that maximum VO2 may play an important role in climbing performance. Specific training methodologies should be implemented to improve aerobic power in climbers

Pressurized intraperitoneal aerosol chemotherapy with cisplatin and doxorubicin or oxaliplatin for peritoneal metastasis from pancreatic adenocarcinoma and cholangiocarcinoma

Background: Systemic chemotherapy for pancreatic adenocarcinoma (PDAC) and cholangiocarcinoma (CC) with peritoneal metastases (PM) is affected by several pharmacological shortcomings and low clinical efficacy. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is expected to maximize exposure of peritoneal nodules to antiblastic agents. This study aims to evaluate safety and efficacy of PIPAC for PM of PDAC and CC origin. Methods: This is a retrospective analysis of consecutive PDAC and CC cases with PM treated with PIPAC at two European referral centers for peritoneal disease. We prospectively recorded from August 2016 to May 2019 demographic, clinical, surgical, and oncological data. We performed a feasibility and safety assessment and an efficacy analysis based on clinical and pathological regression. Results: Twenty patients with PM from PDAC (14) and CC (six) underwent 45 PIPAC administrations. Cisplatin–doxorubicin or oxaliplatin were administered to eight and 12 patients, respectively. We experienced one intraoperative complication (small bowel perforation) and 18 grade 1–2 postoperative adverse events according to Common Terminology Criteria for Adverse Events version 4.0. A pathological regression was recorded in 50% of patients (62% in the cisplatin–doxorubicin cohort and 42% in the oxaliplatin one). Median survival from the first PIPAC was 9.7 and 10.9 months for PDAC and CC, respectively. Conclusion: PIPAC resulted feasible and safe without relevant toxicity issues, with both cisplatin–doxorubicin and oxaliplatin. The pathological response observed supports the evidence of antitumoral activity. Despite the study limitations, these outcomes are encouraging, recommending PIPAC in prospective, controlled trials in the palliative setting or the first line chemotherapy for PM from PDAC and CC

A statistical method for revealing form-function relations in biological networks

Over the past decade, a number of researchers in systems biology have sought to relate the function of biological systems to their network-level descriptions -- lists of the most important players and the pairwise interactions between them. Both for large networks (in which statistical analysis is often framed in terms of the abundance of repeated small subgraphs) and for small networks which can be analyzed in greater detail (or even synthesized in vivo and subjected to experiment), revealing the relationship between the topology of small subgraphs and their biological function has been a central goal. We here seek to pose this revelation as a statistical task, illustrated using a particular setup which has been constructed experimentally and for which parameterized models of transcriptional regulation have been studied extensively. The question "how does function follow form" is here mathematized by identifying which topological attributes correlate with the diverse possible information-processing tasks which a transcriptional regulatory network can realize. The resulting method reveals one form-function relationship which had earlier been predicted based on analytic results, and reveals a second for which we can provide an analytic interpretation. Resulting source code is distributed via http://formfunction.sourceforge.net.Comment: To appear in Proc. Natl. Acad. Sci. USA. 17 pages, 9 figures, 2 table

Management of the mother-infant dyad with suspected or confirmed SARS-CoV-2 infection in a highly epidemic context

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards

Cardio-respiratory monitoring in archery using a smart textile based on flexible fiber bragg grating sensors

In precision sports, the control of breathing and heart rate is crucial to help the body to remain stable in the shooting position. To improve stability, archers try to adopt similar breathing patterns and to have a low heartbeat during each shot. We proposed an easy-to-use and unobtrusive smart textile (ST) which is able to detect chest wall excursions due to breathing and heart beating. The sensing part is based on two FBGs housed into a soft polymer matrix to optimize the adherence to the chest wall and the system robustness. The ST was assessed on volunteers to figure out its performance in the estimation of respiratory frequency (fR) and heart rate (HR). Then, the system was tested on two archers during four shooting sessions. This is the first study to monitor cardio-respiratory activity on archers during shooting. The good performance of the ST is supported by the low mean absolute percentage error for fR and HR estimation (≤1.97% and ≤5.74%, respectively), calculated with respect to reference signals (flow sensor for fR, photopletismography sensor for HR). Moreover, results showed the capability of the ST to estimate fR and HR during different phases of shooting action. The promising results motivate future investigations to speculate about the influence of fR and HR on archers’ performance

Efficacy and safety of intravenous paracetamol in comparison to ibuprofen for the treatment of patent ductus arteriosus in preterm infants: Study protocol for a randomized control trial

Background: Patent ductus arteriosus (PDA) is one of most common complications in preterm infants. Although ibuprofen represents the first choice for the closure of PDA, this treatment can cause severe gastrointestinal and adverse renal effects and worsen platelet function. The successful closure of the PDA with paracetamol has been recently reported in several preterm infants, and the safety of paracetamol for this use has been suggested by the available data. Methods/design: We present the design of a randomized, multicenter, controlled study, whose aim is to assess the effectiveness and safety of intravenous paracetamol in comparison to intravenous ibuprofen for the treatment of PDA in preterm infants. A total of 110 infants born at 25 +0 to 31 +6 weeks of gestational age will be enrolled and randomized to receive paracetamol or ibuprofen (55 patients per group) starting at 24-72h of life. The primary endpoint of the study is the comparison of the PDA closing rate observed after a 3-day course with paracetamol or ibuprofen. The secondary endpoints include the closure rate of PDA after the second course of treatment with ibuprofen, the re-opening rate of the PDA, the incidence of surgical ligation, and the occurrence of adverse effects. Discussion: The results of this study will provide new information about the possible use of paracetamol in the treatment of PDA. Paracetamol could offer several important therapeutic advantages over current treatment options, and it could become the treatment of choice for the management of PDA, mainly due to its more favorable side effect profile. Trial registration: Clinicaltrials.gov NCT02422966. Eudract no. 2013-003883-30

SIR-C/X-SAR data calibration and ground truth campaign over the NASA-CB1 test-site

During the Space Shuttle Endeavour mission in October 1994, a remote-sensing campaign was carried out with the objectives of both radiometric and polarimetric calibration and ground truth data acquisition of bare soils. This paper presents the results obtained in the experiment. Polarimetric cross-talk and channel imbalance values, as well as radiometric calibration parameters, have been found to be within the science requirements for SAR images. Regarding ground truth measurements, a wide spread in the height rms values and correlation lengths has been observed, which has motivated a critical revisiting of surface parameters descriptors