New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery

PG - e3954 AB - BACKGROUND: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery. METHODOLOGY/PRINCIPAL FINDINGS: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively). CONCLUSIONS/SIGNIFICANCE: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier los

Environmental effects of underground freight transport: Inventory of current effects and study of developments for a medium long period

Dit rapport beschrijft de resultaten van een onderzoek naar de huidige en mogelijke toekomstige milieu-effecten van verschillende vormen van geautomatiseerd ondergronds goederentransport in Nederland. De beschouwde transportmethoden zijn: traditionele en extra-traditionele pijpleidingen, pneumatische en hydraulische capsule-pijpleidingen, en systemen die gebruik maken van railvoertuigen, automatische geleide voertuigen of dual-mode voertuigen. De meeste aandacht is uitgegaan naar de traditionele pijpleidingen en naar de ondergrondse logistieke systemen die gebruik maken van automatisch geleide voertuigen. De beschouwde milieu-effecten zijn de emissies van CO2, NOx, SO2, VOS en PM10, geluidshinder, visuele hinder en ruimtegebruik. Allereerst is een literatuuronderzoek uitgevoerd naar de state-of-the-art van de verschillende vormen van ondergronds goederentransport en van de methoden die gebruikt worden voor de aanleg van de ondergrondse infrastructuur. Vervolgens is de omvang van het huidige Nederlandse pijpleidingnetwerk bepaald en is een overzicht gegeven van mogelijke toekomstige toepassingen van de verschillende vormen van ondergronds goederentransport. Op basis van literatuur en van aanvullende berekeningen worden het directe en indirecte energiegebruik en de milieu-effecten van ondergronds goederentransport bestudeerd. Tenslotte is een case studie uitgevoerd om het totale effect te bepalen op het energiegebruik en de emissies van het ondergrondse logistieke systeem (OLS) Utrecht, een bestaand concept van een ondergronds netwerk voor stukgoederendistributie. Uit het onderzoek blijkt dat de meeste vormen van ondergronds goederentransport een lage directe energie-intensiteit hebben. Voor traditionele, extra-traditionele en capsule-pijpleidingen is het indirecte energiegebruik eveneens laag. OLS hebben daarentegen een zeer hoog indirect energiegebruik die naar verhouding toeneemt naarmate een grotere buisdiameter gebruikt wordt. Het OLS Utrecht leidt naar verwachting tot een toename van het totale energiegebruik en de totale emissies voor alle bekeken varianten.This report describes the results of a research on the current and possible future environmental effects of different forms of automated underground freight transport in the Netherlands. The transport methods that are examined are: traditional and extra-traditional pipelines, pneumatic and hydraulic capsule pipelines, and systems using rail-guided vehicles, automatic guided vehicles or dual mode vehicles. Most attention has been given to the traditional pipelines and to the underground logistic systems that make use of automatic guided vehicles. The environmental effects that have been determined are the emissions of CO2, NOx, SO2, VOC and PM10, noise nuisance, visual nuisance and the use of space. First of all a literature research is executed on the state-of-the-art of the diverse forms of underground freight transport and of the methods to build infrastructure underground. After that the extent of the existing Dutch pipeline network is determined and an overview is given of possible future applications of the different forms of underground freight transport. On the basis of literature and of supplementary calculations the direct and indirect energy use and the environmental effects of underground freight transport are being studied. Finally a case study is performed to determine the total effect on the energy use and the emissions of the underground logistic system (ULS) Utrecht, an existing network concept for underground freight transport. From the research most types of underground freight transport appear to have low direct energy intensities. For traditional, extra-traditional and capsule pipelines the indirect energy use is also low. ULS in contrary have a very high indirect energy use that increases for larger tube diameters. The ULS Utrecht is expected to result in an increase in the total energy use and emissions for all the alternatives under discussion.DG

Environmental effects of underground freight transport: Inventory of current effects and study of developments for a medium long period

This report describes the results of a research on the current and possible future environmental effects of different forms of automated underground freight transport in the Netherlands. The transport methods that are examined are: traditional and extra-traditional pipelines, pneumatic and hydraulic capsule pipelines, and systems using rail-guided vehicles, automatic guided vehicles or dual mode vehicles. Most attention has been given to the traditional pipelines and to the underground logistic systems that make use of automatic guided vehicles. The environmental effects that have been determined are the emissions of CO2, NOx, SO2, VOC and PM10, noise nuisance, visual nuisance and the use of space. First of all a literature research is executed on the state-of-the-art of the diverse forms of underground freight transport and of the methods to build infrastructure underground. After that the extent of the existing Dutch pipeline network is determined and an overview is given of possible future applications of the different forms of underground freight transport. On the basis of literature and of supplementary calculations the direct and indirect energy use and the environmental effects of underground freight transport are being studied. Finally a case study is performed to determine the total effect on the energy use and the emissions of the underground logistic system (ULS) Utrecht, an existing network concept for underground freight transport. From the research most types of underground freight transport appear to have low direct energy intensities. For traditional, extra-traditional and capsule pipelines the indirect energy use is also low. ULS in contrary have a very high indirect energy use that increases for larger tube diameters. The ULS Utrecht is expected to result in an increase in the total energy use and emissions for all the alternatives under discussion.Dit rapport beschrijft de resultaten van een onderzoek naar de huidige en mogelijke toekomstige milieu-effecten van verschillende vormen van geautomatiseerd ondergronds goederentransport in Nederland. De beschouwde transportmethoden zijn: traditionele en extra-traditionele pijpleidingen, pneumatische en hydraulische capsule-pijpleidingen, en systemen die gebruik maken van railvoertuigen, automatische geleide voertuigen of dual-mode voertuigen. De meeste aandacht is uitgegaan naar de traditionele pijpleidingen en naar de ondergrondse logistieke systemen die gebruik maken van automatisch geleide voertuigen. De beschouwde milieu-effecten zijn de emissies van CO2, NOx, SO2, VOS en PM10, geluidshinder, visuele hinder en ruimtegebruik. Allereerst is een literatuuronderzoek uitgevoerd naar de state-of-the-art van de verschillende vormen van ondergronds goederentransport en van de methoden die gebruikt worden voor de aanleg van de ondergrondse infrastructuur. Vervolgens is de omvang van het huidige Nederlandse pijpleidingnetwerk bepaald en is een overzicht gegeven van mogelijke toekomstige toepassingen van de verschillende vormen van ondergronds goederentransport. Op basis van literatuur en van aanvullende berekeningen worden het directe en indirecte energiegebruik en de milieu-effecten van ondergronds goederentransport bestudeerd. Tenslotte is een case studie uitgevoerd om het totale effect te bepalen op het energiegebruik en de emissies van het ondergrondse logistieke systeem (OLS) Utrecht, een bestaand concept van een ondergronds netwerk voor stukgoederendistributie. Uit het onderzoek blijkt dat de meeste vormen van ondergronds goederentransport een lage directe energie-intensiteit hebben. Voor traditionele, extra-traditionele en capsule-pijpleidingen is het indirecte energiegebruik eveneens laag. OLS hebben daarentegen een zeer hoog indirect energiegebruik die naar verhouding toeneemt naarmate een grotere buisdiameter gebruikt wordt. Het OLS Utrecht leidt naar verwachting tot een toename van het totale energiegebruik en de totale emissies voor alle bekeken varianten

Impact of high-speed railway accessibility on the location choices of office establishments

High-speed railways are becoming increasingly common in Europe. In the Netherlands soon the HSL-South will be opened. This high-speed railway line connects the Randstad to Brussels and Paris. A prominent aim of this new railway is to improve international competitiveness of the Netherlands. As a side effect it has also consequences for the distribution of offices within the Netherlands. Especially because also domestic high-speed train services will make use of the new infrastructure. Still, little research has addressed this issue of regional distributive effects. This thesis focuses on the topic how high-speed railway accessibility influences location attractiveness for offices within the Randstad. Telephone inquiries were hold among 297 decision makers of offices. Respondents were also asked to make hypothetical choices between fictitious locations (so-called ‘stated choices’). An analysis of the actual locations of offices in combination with stated choices yielded a model to determine location attractiveness. Within this model the concept of accessibility is central. A new high-speed railway, such as the HSL-South, can drastically reduce travel times between cities, at the expense of higher train fares. If the travel time advantage from an origin to a potential destination exceeds the fare supplement then these locations’ accessibility is improved. A higher accessibility makes a location more attractive. But other, more subjective factors are relevant as well. Regardless of travel times, proximity to a HST station can lead to the perception of a good accessibility. And also, evidence has been found that the availability of high-speed train services at a station can improve the image of this station and its immediate surroundings. But high-speed rail is not equally relevant to all offices. Spatial orientation is a determining factor: offices that have its business contacts distributed nationally or internationally are most influenced by high-speed rail. High-speed train accessibility is, however, rarely a decisive location factor for locating office establishments. Application of the model to different scenarios for the Randstad reveals that Rotterdam and especially Amsterdam (including Schiphol) benefit from the HSL-South. This comes at the cost of other cities in the Randstad. Particularly Utrecht suffers from the new line, because its urban region is traditionally strong in attracting the nationally oriented offices that are also sensitive to high-speed rail. Scenarios for the Zuiderzeelijn have little impact additional to the HSL-South. A specific focus on the Amsterdam urban region illustrates the dependence of the urban development on the specific outline of the high-speed train services. The choice between the South axis and the central station for HSL-South services influences the development potentials of these sites. The results confirm the usefulness of the policy of the Dutch government to support the urban redevelopment projects (‘new key projects’) around high-speed train stations. However, it is argued that policy makers should not have too high expectations for the impact of high-speed on economic development. New offices at a high-speed train station area come predominantly at the expense of a decline of office employment in other cities