International systems and regional subsystems theory: socioontological preconditions and a case study on the Middle East

The central aim of the thesis is to contribute to a deeper understanding of the complex reality of conflicts in the international system and more specifically in the region of the Middle East. Through the analysis of Regional Sub-systems theory, this study attempts to explain the role of power and interest, the centrality of the state in international affairs and the significance of self-preservation for the construction of identity of independent collective entities. The first part of the study is dedicated to the presentation of the continuous theoretical dialogue that takes place between various theorists and the delineation of the theoretical landscape of IR, with a special emphasis on the Realist approach. Furthermore, the core tenets of Realism are associated with the ideas of Panagiotis Kondylis who has developed a general theory on social ontology. The first part of the thesis forms the theoretical background that allows the development of the Regional Subsystems Theory. Based on the theoretical tools of this theory, the study sheds light on regional security dynamics in the Middle East region, throughout the period 1990-2009.Κεντρικός στόχος της διατριβής είναι η κατά το δυνατόν αντικειμενικότερη εξήγηση και βαθύτερη κατανόηση της πραγματικότητας των πολεμικών συγκρούσεων στο διεθνές σύστημα και ειδικότερα στην περιοχή της Μέσης Ανατολής. Μέσω της επεξεργασίας, ανάλυσης και εφαρμογής της θεωρίας περιφερειακών υποσυστημάτων εξετάζονται οι θεωρητικές υποθέσεις που διατυπώνονται στο εισαγωγικό μέρος της μελέτης και αφορούν, μεταξύ άλλων, στο ρόλο της ισχύος και του συμφέροντος, στην κεντρικότητα του κράτους και στη σημασία της έννοιας της αυτοσυντήρησης για τη δράση και την ταυτότητα των ανεξάρτητων συλλογικών οντοτήτων. Στην πρώτη ενότητα εξετάζονται διάφορες πλευρές ενός συνεχούς θεωρητικού διαλόγου που λαμβάνει χώρα μεταξύ διεθνολόγων και απεικονίζεται το θεωρητικό τοπίο των Διεθνών Σχέσεων προκειμένου να μεταβούμε στη συνέχεια σε μια βαθύτερη διερεύνηση της ρεαλιστικής προσέγγισης. Στη συνέχεια αναλύεται η διασύνδεση της κοινωνικής οντολογίας με τις κοινωνικές επιστήμες, παρουσιάζονται οι θέσεις του Παναγιώτη Κονδύλη και συσχετίζονται με βασικά αξιώματα του Ρεαλισμού. Αντικείμενο της δεύτερης ενότητας της διατριβής είναι η ανάλυση, διαμόρφωση και προσαρμογή των βασικών εννοιών της θεωρίας περιφερειακών υποσυστημάτων που αποτελεί τη βάση για την περιπτωσιολογική μελέτη. Η μελέτη ολοκληρώνεται με την εξέταση των περιφερειακών δυναμικών ασφάλειας στην περιοχή της Μέσης Ανατολής κατά την περίοδο 1990-2009

Stapler-assisted stoma prolapse repair with real-time fluorescent angiography using indocyanine green

<jats:title>Abstract</jats:title><jats:p>Stoma prolapse is an increase in the size of the stoma secondary to intussusception of the proximal bowel segment. Transverse loop colostomy is most commonly involved. Although ostomy function is rarely impaired, large prolapses may cause patients distress and impair stoma dressing. Strangulation and ischemia of the prolapsed segment have been reported as complications. Herein, we report a stapler-associated repair of a prolapsed transverse loop colostomy with real-time perfusion studies using indocyanine green.</jats:p&gt

The role of indocyanine green fluoroscopy for intraoperative bile duct visualization during laparoscopic cholecystectomy: an observational cohort study in 70 patients

Abstract Background Bile duct injury is the most feared complication during laparoscopic cholecystectomy. Real-time intraoperative imaging using indocyanine green (ICG) might reduce the risk of bile duct injury by improving visualization of the biliary tree during laparoscopic cholecystectomy. We compared the outcomes of laparoscopic cholecystectomy in patients with and without real-time ICG. Methods A retrospective analysis of the data of patients undergoing laparoscopic cholecystectomy with and without ICG in a referral centre for minimally invasive surgery was performed. We hypothesized that laparoscopic cholecystectomy with real-time ICG enables a better identification of the biliary tree and thus increases surgical safety. The outcomes of laparoscopic cholecystectomy with and without ICG were compared using the duration of surgery, the rate of bile duct injury, the rate of conversion, complications and the length of stay. Results Seventy patients including 29 with and 41 without ICG underwent laparoscopic cholecystectomy within the period of investigation. The median duration of surgery was 53.0 vs. 54.0 min while the median length of stay was 2.0 d in the group with and without ICG respectively. The rate of conversion was 2.4% in the group without ICG, while no conversion was performed in the group with ICG. NO bile duct injury occurred in both groups. These differences were not statistically significant. Conclusion Laparoscopic cholecystectomy with real-time indocyanine green fluorescence cholangiography enables a better visualization and identification of biliary tree and therefore should be considered as a means of increasing the safety of laparoscopic cholecystectomy

Changes in molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in the intensive care units of a Greek hospital, 2018-2021

The spread of multi-drug resistant (MDR) Gram-negative bacteria, including Klebsiella pneumoniae, constitutes a global threat. The most frequent mechanism of acquired carbapenem resistance is the production of carbapenemases, especially KPC, NDM, VIM, IMP and OXA-48. We analyzed the epidemiological trend of carbapenem resistance genes of carbapenem-resistant K. pneumoniae (CRKP) strains isolated from critically ill patients in a Greek tertiary hospital.The study included 150 CRKP isolates collected from 116 (77.4%) patients hospitalized in the adult ICU and 17 (11.3%) each in the pediatric and the two neonatal ICUs between March 2018 and March 2021. Identification and antimicrobial susceptibility testing were performed using VITEK-2. A multiplex lateral flow immunoassay was used for the detection of carbapenemases, while the detection of bla(VIM), bla(KPC), bla(NDM), bla(IMP) and bla(OXA-)(48)(-like) genes was achieved by multiplex PCR.The bla(NDM) was mainly detected in adults (54/116, 46.9%), while in children the most often detected gene was bla(KPC), (24/34, 70.6%). The predominant carbapenem resistance gene during 2018-2019 was bla(KPC) alone or in combination with bla(VIM), reaching 44.4% in 2019, while during 2020-2021 the detection of bla(NDM) prevailed significantly, reaching 45.5 and 60.7% for 2020 and 2021, respectively.A shift in the molecular epidemiology of CRKP was seen during 2018-2021, which is probably associated with the recent excessive empiric use of newer antimicrobials. Surveillance studies and proper and strict implementation of infection control measures are highly needed to decrease the spread of MDR bacteria, including CRKP

Routine preoperative mechanical bowel preparation with additive oral antibiotics is associated with a reduced risk of anastomotic leakage in patients undergoing elective oncologic resection for colorectal cancer

Abstract Background Anastomotic leakage (AL) following colorectal resection is a serious issue. AL in oncologic patients might negatively affect the overall survival. Recently, mechanical bowel preparation with additive oral antibiotics (MBP + AB) prior to surgery has been suggested as a means of reducing AL. However, it is unclear whether this positive effect is secondary to MBP alone or secondary to the additive oral antibiotic (MBP + AB). The aim of this study was to investigate the effect of mechanical bowel preparation with additive oral antibiotics (MBP + AB) and without additive oral antibiotics (MBP − AB) on the rate of AL following colorectal resection for cancer. Materials and methods Patients undergoing surgical management for colorectal cancer with anastomosis from January 2014 till September 2017 were included for analysis. Cases undergoing MBP + AB were included in the study group. Patients undergoing MBP − AB were included in the control group. Both groups were compared with regard to the rate of AL. Results Four hundred and ninety-six patients: 125 undergoing MBP + AB and 371 undergoing MBP – AB were included for analysis. Significantly, more male patients were included in the MBP – AB group compared to the MBP + AB group: 60.1% vs. 45.6% respectively (p = 0.03). Both groups were similar with regard to age distribution and clinicopathological findings (p > 0.05). The rate of AL was significantly higher in the control group (MBP − AB) compared to study group (MBP + AB) (9.1% vs. 4.0%, p = 0.03). Conclusion Mechanical bowel preparation with additive oral antibiotics prior to elective colorectal resection with anastomosis significantly reduces the risk of AL. Therefore, mechanical bowel preparation with additive non-absorbable oral antibiotics should be recommended in all cases prior to elective colorectal surgery

Intraoperative real-time fluorescence angiography with indocyanine green for evaluation of intestinal viability during surgery for an incarcerated obturator hernia: a case report

Abstract Background Bowel incarceration represents a dreaded complication amongst patients with hernias. The intraoperative evaluation of the bowel perfusion following hernia reduction with regard to the need for resection of ischaemic bowel can be challenging. In this case report we discuss intraoperative fluorescence angiography with indocyanine green (ICG) as an objective means of accessing bowel perfusion following hernia reduction. Case presentation The case of a 92-year-old, caucasian, female patient presenting with symptoms of small bowel obstruction secondary to an incarcerated left sided obturator hernia is presented. An incarcerated segment of the small bowel was reduced during emergency laparoscopy. Intraoperative ICG fluorescence angiography revealed ischaemic changes in the normal appearing bowel, so that the involved segment was resected. The postoperative course was uneventful and the patient was discharged home safely on postoperative day seven. Conclusion Intraoperative ICG fluorescence angiography provides an objective method of judging bowel perfusion and therefore represents a useful tool for assessing intestinal perfusion in patients with incarcerated hernia

Revisiting Java Bytecode Compression for Embedded and Mobile Computing Environments

Abstract — Pattern-based Java bytecode compression techniques rely on the identification of identical instruction sequences that occur more than once. Each occurrence of such a sequence is substituted by a single instruction. The sequence defines a pattern that is used for extending the standard bytecode instruction set with the instruction that substitutes the pattern occurrences in the original bytecode. Alternatively, the pattern may be stored in a dictionary that serves for the bytecode decompression. In this case, the instruction that substitutes the pattern in the original bytecode serves as an index to the dictionary. In this paper, we investigate a bytecode compression technique that considers a more general case of patterns. Specifically, we employ the use of an advanced pattern discovery technique that allows locating patterns of an arbitrary length, which may contain a variable number of wildcards in place of certain instruction opcodes or operands. We evaluate the benefits and the limitations of this technique in various scenarios that aim at compressing the reference implementation of MIDP, a standard Java environment for the development of applications for mobile devices. Index Terms — D.3.2.j Java, I.4.2 Compression (Coding). I

The role of saline irrigation prior to wound closure in the reduction of surgical site infection: protocol for a systematic review and meta-analysis

Abstract Background Surgical site infection describes an infectious complication of surgical wounds. This single complication is thought to occur in close to 20% of surgical cases. This complication has been described in all kinds of surgical procedure including minimally invasive procedures. Wound irrigation is frequently used as a means of reducing surgical site infection. However, there is lack of solid evidence to support routine wound irrigation. The aim of this review is to provide evidence for the efficacy of routine wound irrigation with normal saline in preventing surgical site infection. The rate of surgical site infection in cases with and without wound irrigation will be analyzed. Methods/design Systematic literature searches will be conducted to identify all published and unpublished studies. The following databases will be searched for citations from inception to present: MEDLINE (via PubMed), Embase (via Embase), and CENTRAL (via the Cochrane library). The search strategy will be developed by the research team in collaboration with an experienced librarian and checked by a referee according to the Peer Review of Electronic Search Strategies (PRESS) guideline. A draft of the PubMed search strategy could be (irrigation[tiab] OR “Therapeutic Irrigation”[mesh] OR lavage[tiab]) AND (saline[tiab] OR “Sodium Chloride”[mesh] OR sodium chloride[tiab]) NOT (“Comment” [Publication Type] OR “Letter” [Publication Type] OR “Editorial” [Publication Type]). No time limits will be set. The reference lists of eligible articles will be hand searched. Relevant data will be extracted from eligible studies using a previously designed data extraction sheet. Relative risks will be calculated for binary outcomes and mean differences or standardized mean differences, if necessary, for continuous outcomes. For all measures, 95% confidence levels will be calculated. Both arms would be compared with regard to the rate of surgical site infection within 30 days following surgery. We will report the review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Discussion This review aims at investigating the value of routine wound irrigation using normal saline in preventing surgical site infection. Systematic review registration PROSPERO: CRD4201808228