Urban planning in Lahore:a confrontation with real development

Groningen: FRW-RU

Necrotising enterocolitis and mortality in preterm infants after introduction of probiotics: A quasi-experimental study

Evidence on the clinical effectiveness of probiotics in the prevention of necrotising enterocolitis (NEC) in preterm infants is conflicting and cohort studies lacked adjustment for time trend and feeding type. This study investigated the association between the introduction of routine probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum; Infloran ®) on the primary outcome 'NEC or death'. Preterm infants (gestational age <32 weeks or birth weight <1500 gram) admitted before (Jan 2008-Sep 2012; n = 1288) and after (Oct 2012-Dec 2014; n = 673) introduction of probiotics were compared. Interrupted time series logistic regression models were adjusted for confounders, effect modification by feeding type, seasonality and underlying temporal trends. Unadjusted and adjusted analyses showed no difference in 'NEC or death' between the two periods. The overall incidence of NEC declined from 7.8% to 5.1% (OR 0.63, 95% CI 0.42-0.93, p = 0.02), which was not statistically significant in the adjusted models. Introduction of probiotics was associated with a reduced adjusted odds for 'NEC or sepsis or death' in exclusively breastmilk-fed infants (OR 0.43, 95% CI 0.21-0.93, p = 0.03) only. We conclude that introduction of probiotics was not associated with a reduction in 'NEC or death' and that type of feeding seems to modify the effects of probiotics

Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

BACKGROUND: Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with h

Two versus five days of antibiotics after appendectomy for complex acute appendicitis (APPIC): Study protocol for a randomized controlled trial

Background: Acute appendicitis is one of the most common indications for emergency surgery. In patients with a complex appendicitis, prolonged antibiotic prophylaxis is recommended after appendectomy. There is no consensus regarding the optimum duration of antibiotics. Guidelines propose 3 to 7 days of treatment, but shorter courses may be as effective in the prevention of infectious complications. At the same time, the global issue of increasing antimicrobial resistance urges for optimization of antibiotic strategies. The aim of this study is to determine whether a short course (48 h) of postoperative antibiotics is non-inferior to current standard practice of 5 days. Methods: Patients of 8 years and older undergoing appendectomy for acute complex appendicitis - defined as a gangrenous and/or perforated appendicitis or appendicitis in presence of an abscess - are eligible for inclusion. Immunocompromised or pregnant patients are excluded, as well as patients with a contraindication to the study antibiotics. In total, 1066 patients will be randomly allocated in a 1:1 ratio to the experimental treatment arm (48 h of postoperative intravenously administered (IV) antibiotics) or the control arm (5 days of postoperative IV antibiotics). After discharge from the hospital, patients participate in a productivity-cost-questionnaire at 4 weeks and a standardized telephone follow-up at 90 days after appendectomy. The primary outcome is a composite endpoint of infectious complications, including intra-abdominal abscess (IAA) and surgical site infection (SSI), and mortality within 90 days after appendectomy. Secondary outcomes include IAA, SSI, restart of antibiotics, length of hospital stay (LOS), reoperation, percutaneous drainage, readmission rate, and cost-effectiveness. The non-inferiority margin for the difference in the primary endpoint rate is set at 7.5% (one-sided test at α 0.025). Both per-protocol and intention-to-treat analyses will be performed. Discussion: This trial will provide evidence on whether 48 h of postoperative antibiotics is non-inferior to a standard course of 5 days of antibiotics. If non-inferiority is established, longer intravenous administration following appendectomy for complex appendicitis can be abandoned, and guidelines need to be adjusted accordingly

Semiparametric Bernstein–von Mises for the error standard deviation

We study Bayes procedures for nonparametric regression problems with Gaussian errors, giving conditions under which a Bernstein–von Mises result holds for the marginal posterior distribution of the error standard deviation. We apply our general results to show that a single Bayes procedure using a hierarchical spline-based prior on the regression function and an independent prior on the error variance, can simultaneously achieve adaptive, rate-optimal estimation of a smooth, multivariate regression function and efficient, n-v-consistent estimation of the error standard deviation

Adaptive estimation of multivariate functions using conditionally Gaussian tensor-product spline priors

We investigate posterior contraction rates for priors on multivariate functions that are constructed using tensor-product B-spline expansions. We prove that using a hierarchical prior with an appropriate prior distribution on the partition size and Gaussian prior weights on the B-spline coefficients, procedures can be obtained that adapt to the degree of smoothness of the unknown function up to the order of the splines that are used. We take a unified approach including important nonparametric statistical settings like density estimation, regression, and classification

Interpretation of the giant magnetoresistance effect in Co/Cu(100) multilayers with the quantum model of giant magnetoresistance

\u3cp\u3eWe have measured the magnetoresistance of high-vacuum-sputtered Co/Cu(100) multilayers grown on Cu buffer layers. The magnetoresistance in the first antiferromagnetic- (AF-) coupling peak is very sensitive to the buffer layer thickness. We find a linear dependence between the actual measured magnetoresistance and the fraction of AF coupling, as determined by magnetization measurements. We compare our Co/Cu(100) magnetoresistance data at 4 K of completely antiparallel-aligned multilayers with the quantum model of giant magnetoresistance of Levy, Zhang, and Fert. This reveals evidence for strong spin-dependent interface scattering, whereas the spin dependence of the bulk scattering in Co is small.\u3c/p\u3

Neuropeptide Receptors in Intestinal Disease: Physiology and Therapeutic Potential

The autonomous nervous system of the gut is increasingly recognized as an important regulatory factor in intestinal permeability and immune cell activation. Neuropeptides released by neurons -or inflammatory cells-have emerged as neuro-immune modulators that can relay, for instance, stress-induced neuronal activity to immune processes. Such peptides can participate in processes reducing inflammatory responses, or augment resolution of inflammation. Neuropeptides and hormones such as vasoactive intestinal peptide, urocortin, ghrelin, and cortistatin have been shown to modulate the disease activity in a variety of experimental models of inflammatory and autoimmune disease via modulation of immune or neuronal cell activity. We review here the potential of neuropeptide receptor activation to modulate inflammatory diseases. We will highlight the role of neuropeptides in gastrointestinal (GI) physiology and immune regulation, and we will speculate on the therapeutic potential of peptides that bind G protein coupled receptors (GPCRs) in the management of inflammation in the GI trac