СОВРЕМЕННЫЙ ВЗГЛЯД НА ОПТИМАЛЬНЫЕ СПОСОБЫ ПОДГОТОВКИ ТОЛСТОЙ КИШКИ ПЕРЕД ПЛАНОВЫМИ КОЛОРЕКТАЛЬНЫМИ ОПЕРАЦИЯМИ

Purpose: to assess current data on the effect of different approaches to preoperative bowel preparation before elective colorectal surgery on short-term treatment outcomes.Material and Methods. Online system PubMed of U.S. National Library of Medicine was used to find articles with key words “mechanical bowel preparation”, “surgical site infection”, “oral antibiotics”. A total of 226 articles were reviewed. 31 articles were selected for final review. Furthermore, ClinicalTrials.gov site was used to find actual and recruiting trials.Results. Mechanical bowel preparation (MBP) used to be a standard procedure for a long time. Nowadays, routine use of MBP seems to be debatable. Alternative approaches, e.g. absolutely no preparation or the use of MBP in combination with oral antibiotics, are considered. Data on performing different kinds of bowel preparation is reviewed in this article.Conclusion. Optimal approach of preoperative bowel preparation is still questionable. Combination of mechanical bowel preparation and oral antibiotics seems to be a preferable method. However, there is not enough evidence to exclude anothertechniques. It’s required to conduct additional randomized controlled trials.Цель исследования – обобщение имеющихся данных по влиянию применения разных подходов предоперационной подготовки кишки на непосредственные результаты при плановых операциях на толстой кишке.Материал и методы. С помощью электронной системы американской национальной медицинской библиотеки PubMed проводился поиск статей по ключевым словам: mechanical bowel preparation, surgical site infection, oral antibiotics. В ходе анализа изучено 226 статей, 31 из которых отобрана для окончательного обзора. Также для поиска текущих исследований использовалась электронная база ClinicalTrials.gov.Результаты. Применение механической подготовки кишки при операциях на толстой кишке считалось стандартом в течение многих лет. В настоящее время целесообразность механической подготовки кишки подвергается сомнению, в связи с чем рассматривается возможность полного отказа от механической подготовки кишки либо, напротив, дополнение механической подготовки кишки пероральными антибиотиками. В обзоре представлены данные литературы по влиянию применения разных подходов предоперационной подготовки кишки на непосредственные результаты.Заключение. Оптимальный способ предоперационной подготовки кишки остается предметом дискуссии в хирургическом сообществе. В настоящее время наиболее предпочтительным способом следует считать комбинацию MBP и пероральных антибиотиков. Однако данная область изучена недостаточно и требует проведения дополнительных рандомизированных исследований

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Propaganda, survival, and living to tell the truth : an analysis of North Korean refugee memoirs

Recent international events have heightened global interest in the North Korean regime’s engagement with the world; however, information about North Korea remains largely nebulous, due to the continuing secrecy of the regime. This study provides a rich understating of North Korean refugee identity and gives voice to individuals who have experienced the oppressive conditions of North Korea, their often dangerous escapes via multiple countries, and nonlinear or frequently difficult times of readjustment. It takes as its focus the role and impact of deception in different stages of North Korean refugee life before, during, and after escape. Specifically, we examine how North Korean refugee memoirists discuss the topics of truthfulness and deception in their own words. Using thematic analysis, we discovered three primary themes, including discovering and dealing with propaganda, deceiving as a means of survival, and finding the truth and living to tell it. Lastly, we end with a call to action aimed at empowering survivor voices, utilizing information to create change in North Korea, and offering future directions for scholars, practitioners, and human rights advocates

Japanese source (Let's have the proper number of children and raise them well!): Family planning and nation-building in South Korea, 1961-1968

10.1007/s12280-008-9054-5East Asian Science, Technology and Society23361-37