Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P = 0.02) but MBP was not (OR 0.92, 0.63–1.36, P = 0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Evaluating the incidence of pathological complete response in current international rectal cancer practice

The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as 'fair' only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively).The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

Generative adversarial neural networks for face generation.

One of the most popular technologies today is artificial neural networks. This technology is widely used in medicine, policing and IT fields. The main idea behind neural networks is to train an algorithm on the basis of given data to perform certain tasks without programming specific actions, so that neural networks can be said to be able to come up with answers to certain given tasks. However, one of the unique human abilities that is more difficult to implement in computers is the ability to create something new and real. The human ability to imagine different worlds, environments, people, images, and to translate this into books, music, paintings, thus creating real new things. To replicate this ability using artificial intelligence in computers, various algorithms have been developed, including generative adversarial networks (GANs), which will be investigated in this thesis, as they are now one of the most popular algorithms used for photo generalization. In addition GANs can replicate the human ability to create new and realistic things such as photos of people, can merge two photos or generate a new unique photo, complete a part of a photo, generate a photo from text, increase the resolution of a photo, etc. This study will therefore look at where face generation is used, how the original GAN works, and what GANs are now developed to generate, merge or modify faces in videos. In addition, the performance of the GANs found will be reviewed and the results they generate will be compared between the intended categories

Analysis of the Reasons of the Suport for the Far-right Parties in Western Europe: Case of the Elections to the European Parliament

Darbo problema nusako tai, kas nulemia kraštutinių dešiniųjų partijų populiarumo augimą arba net tokių partijų atsiradimą. Taigi tyrimo objektas yra kraštutinių dešininųjų partijų populiarumo priežastis, kurias siekiama gerai įsivardinti ir stebėti bendrą ryšį. Šio tyrimo tikslas yra noras pastebėti, kaip Europos parlamento rinkimai ir vietinė rinkimų sistema galėjo padaryti įtaką kraštutinių dešiniųjų partijų populiarumo augimui. Kad būtų pasiektas šis tikslas yra iškelta keletas uždavinių: 1) Paaiškinti politinių partijų šeimų raidą socialinių takoskyrų teorijos kontekste įvertinant pasikeitimus tarp politinių partijų atstovaujančių joms įprastus interesus; 2) Įvardinti bei paaiškinti dažniausiai pateikiamas kraštutinių dešiniųjų partijų sėkmės priežastis; 3) Paaiškinti skirtingų rinkimų sistemų poveikį naujų politinių partijų atsiradimui valstybės valdyme; Atrinkti tyrimui tinkamus Vakarų Europos valstybių atvejus bei atlikti empirinį tyrimą; 4) Plačiau panagrinėti charakteringiausių tyrimo valstybių (Austrija, Prancūzija ir Belgija) atvejus; Interpretuojant tyrimo rezultatus patikrinti hipotezę ir taip įvertinti rinkimų institucijų poveikį kraštutinių dešiniųjų partijų sėkmei Europoje. Šio darbo metodologijoje vyrauja trys pagrindiniai metodai: deduckinės logikos metodas (aprašant teorijas, analizuojant kitų mokslininkų tekstus); lyginamosios analizės metodas (analizuojant teorijų ir tezių sąveikas bei sintetinant savarankiškus teiginius, taip pat empirinio tyrimo rezultatų interpretavimui lyginant atskirų šalių skirtingus atvejus); statistinės analizės metodas (naudojamas atliekant empirinį tyrimą su regresijos modeliu). Atlikus tyrimą paaiškėjo, kad nedarbo lygis nėra toks stiprus faktorius kraštutinių dešiniųjų partijų paramai. Hipotezėje buvo manoma, kad kuo mažesnė partinės sistemos fragmentacija, tuo labiau laikas praėjęs nuo pirmųjų rinkimų į Europos Parlamentą darys teigiamą įtaką naujų kraštutinių dešiniųjų partijų atsiradimui. Laiko kintamasis tokį poveikį, kaip ir tikėtasi turi, tačiau iškelta hipotezė iš dalies paneigiama, kadangi paaiškėjo, jog esant dideliam partinės sistemos fragmentacijos lygiui, begant laikui nuo pirmųjų rinkimų į Europos Parlamentą naujoms kraštutinėms dešiniosioms partijoms yra dar lengviau atsirasti ir veikti. Buvo prieita išvados, jog taip nutinka veikiausiai dėl to, kad didesnės fragmentacijos šalyse tokios partijos jau turi patirtį (įsikūrimo ir veiklos), o ten, kur dėl Europos Parlamento rinkimų fragmentacija padidėja, naujos kraštutinės dešiniosios partijos tik pradeda savo veiklą. Todėl jų sėkmė auga ne taip žymiai.Labour problem describes what determines the popularity of far-right parties in growth or even the appearance of such parties. Thus, the object of the study is far-rights‘ reasons of the popularity of parties, with the aim to identify them well and monitor the overall connection. The aim of this study is to see how the European Parliament elections and local elections in the system could cause the popularity growth of extreme right-wing parties. Few tasks are formed to achieve this goal: 1) Explain the development of political parties families’ in the context of social divides theory evaluating changes between the political parties representing their usual interests; 2) Identify and explain the most commonly presented reasons for the success of the far-right parties; 3) Explain the impact of different electoral systems on the emergence of new political parties in the government; select the adequate cases of Western European countries and study them empirically; 4) Analyse the cases of study’s characteristic countries (Austria, France and Belgium); according to the results of the study check the hypothesis and evaluate the impact of electoral authorities for the success of far-right parties in Europe. The methods used in this study are: deductive logic method; comparative analysis method; statistical analysis method. The research showed that the unemployment rate is not such strong factor in support of extreme right-wing parties. The hypothesis suggested that the smaller the fragmentation of the party system, the more positive impact the time that has passed since the first elections to the European Parliament will have on the emergence of new far-right parties. The time variable has such an effect as expected, but the hypothesis is partially denied as it turned out, that at high level of fragmentation of the party system, over time since the first elections to the European Parliament, new extreme right-wing parties emerge and act even easier. It was concluded that this happens probably due to the fact that countries of larger fragmentation such parties already have experience (installation and operation), and in countries where fragmentation increases because of the European Parliament elections new extreme-right parties are in their infancy. Therefore, their success is growing not so distinctly.Politikos mokslų ir diplomatijos fakult.Vytauto Didžiojo universiteta

Invoice data migration management system development

In this paper presents the process of designing an invoice data migration management system. The purpose of the study is to design an invoice data migration management system that allows to automate invoice submissions process from “B1” to “E. Sąskaita”. While designing the system was described the problematic and subject areas of the product being developed, and created a rich picture. In order to determine the functions provided by the system, a use case diagram has been drawn and by using use case diagram was created functional and non-functional requirements. Also a static image of the system was created and the systems architectural solution was described. A graphical user interface has been created, which is linked to target user. A dynamic view of the program is prepared, main operating algorithms are presented at several levels of detail using sequence and activity diagrams

Exploring generative adversarial networks: comparative analysis of facial image synthesis and the extension of creative capacities in artificial intelligence /

Neural networks have become foundational in modern technology, driving advancements across diverse domains such as medicine, law enforcement, and information technology. By enabling algorithms to learn from data and perform tasks autonomously, they eliminate the need for explicit programming. A significant challenge in this field is replicating the uniquely human capacity for creativity - envisioning and realizing novel concepts and tangible creations. Generative Adversarial Networks (GANs), a leading approach in this effort, are especially notable for synthesizing realistic human facial images. Despite the success of GANs, comprehensive comparative studies of face-generating GAN methodologies are limited. This paper addresses this gap by analyzing the scope and capabilities of facial generation, detailing the principles of the original GAN framework, and reviewing prominent GAN variants specifically designed for facial synthesis. Through performance evaluations and fidelity analysis of generated images, this study contributes to a deeper understanding of GAN potential in advancing artificial intelligence creativity through performance evaluations and fidelity analysis of generated images

Long-term Survival of Patient with Ampulla of Vater Metastasis of Renal Cell Carcinoma

Ampulla of Vater metastases from renal cell carcinoma are rare. The time between detection of the primary tumour and its metastasis may extend to years. Management should be aggressive, since the prognosis of renal cell carcinoma is unpredictable and curative surgery of metastases may extend patient survival and even lead to definite cure. Herein we report a case of long-term survival after successful surgical treatment of a renal cell carcinoma metastasis to the ampulla of Vater. A 62-year-old man with a history of renal cell carcinoma in the left kidney underwent a successful left nephrectomy. Eight months later duodenoscopy showed a tumour at the site of papilla of Vater. Biopsy confirmed the diagnosis of carcinoma. Contrast enhanced computer tomography scan verified the periampullary mass, dilatation of the pancreatic and the common bile duct. No radiological signs of either local advancement or distant metastases were present. Pylorus-preserving pancreatoduodenectomy with lymphadenectomy was performed. Pathology report disclosed metastatic lesions in the papilla of Vater from the clear cell carcinoma of the kidney. The postoperative course was uneventful, and the patient lived for 14 years after pancreatoduodenectomy and, following thorough investigations, was free from local and systemic recurrence. Pancreatoduodenectomy can provide long-term survival in selected cases with solitary papilla of Vater metastasis from renal cell carcinoma. Favourable long-term survival rates suggest that these patients should be considered candidates for pancreatoduodenectomy if experienced pancreatic surgeon is available and no other metastases are found