Восстановление оттока желчи при повреждении гепатикохоледоха и несостоятельности билиобилиарного анастомоза после лапароскопической холецистэктомии

The aspect of injuring bile ducts during laparoscopic cholecystectomy is still of current concern. Causes of this complication include insufficient experience of surgical team, poor knowledge of topographic anatomy of subhepatic space, particularly when perivesical inflammatory infiltrate presents, inadequate approach conversion and so on. Most of patients with bile duct injuries undergo repeated operation in the same surgical unit where cholecystectomy was performed. In many cases, this results in a shortening of the segment of the common hepatic duct, which is favorable for restoration. Subsequent reconstructive surgery is usually performed in the worse conditions with a high risk of complications such as failure of sutures, biliary fistula, anastomotic stricture, etc. Most specialists recommend to abstain from primary reconstruction of the biliary tree in hospitals with no proper experience in hepatobiliary surgery and to perform only the external drainage of subhepatic space with subsequent admission of patient to a specialized clinic. We report a case of a young woman who suffered an excision of hepaticocholedochus fragment during laparoscopic cholecystectomy. A primary reconstructive surgery (hepatico-hepaticoanastomosis) was performed in the same clinic and resulted in external fistula of the common hepatic duct. The subsequent operation (hepaticoejunostomy) was performed in a specialized department of the regional clinical hospital. The woman underwent right-sided hypochondrium laparotomy with debridement of postoperative scar tissues. The stumps of common bile duct were mobilized in compact inflammatory infiltrate. The operation ended with distal stump closure and hepaticoenteroanastomosis formation. The patient was discharged with recovery. Six months later, her condition was satisfactory, and she was engaged in occupational activity.Проблема повреждений желчных протоков во время лапароскопической холецистэктомии не теряет свою актуальность. Причины осложнений: недостаточный опыт хирургической бригады, ограниченные знания топографической анатомии подпеченочного пространства, особенно в условиях перивезикального воспалительного инфильтрата, несвоевременная конверсия доступа и прочее.Большую часть больных с травмой желчных протоков повторно оперируют в хирургических отделениях, где выполняют холецистэктомию. Нередко это заканчивается несостоятельностью билиобилиарного анастомоза и приводит к укорочению перспективного для восстановления сегмента общего печеночного протока.Последующую реконструктивную операцию выполняют в худших условиях с высокой вероят­ностью различного рода осложнений (несостоятельность швов, желчный свищ, стриктура анастомоза и прочее). Большинство авторов рекомендуют воздержаться от первичных реконструкций билиарного дерева в стационарах без должного опыта гепатобилиарной хирургии и ограничиться санацией и наружным дренированием подпеченочного пространства с последующим направлением пациента в специализированные клиники. Представлено клиническое наблюдение лечения молодой женщины, которой во время лапароскопической холецистэктомии иссечен фрагмент гепатикохоледоха.В этой же клинике выполнена первичная реконструктивная операция (гепатикогепатикоанастомоз), после которой сформировался наружный свищ общего печеночного протока. Очередная операция проведена в специализированном отделении областной клинической больницы. Выполнена комбинированная правосторонняя подреберная лапаротомия с иссечением после­операционного рубца. В плотном воспалительном инфильтрате с напластованием фибрина мобилизованы культи общего печеночного протока. Дистальная культя ушита. Сформирован гепатикоэнтероанастомоз. Пациентка выписана с выздоровлением. При осмотре через 6 месяцев состояние удовлетворительное, работает по специальности

Hard Two-Photon Contribution to Elastic Lepton-Proton Scattering: Determined by the OLYMPUS Experiment

The OLYMPUS collaboration reports on a precision measurement of the positron-proton to electron-proton elastic cross section ratio, $R_{2\gamma}$, a direct measure of the contribution of hard two-photon exchange to the elastic cross section. In the OLYMPUS measurement, 2.01~GeV electron and positron beams were directed through a hydrogen gas target internal to the DORIS storage ring at DESY. A toroidal magnetic spectrometer instrumented with drift chambers and time-of-flight scintillators detected elastically scattered leptons in coincidence with recoiling protons over a scattering angle range of $\approx 20\degree$ to $80\degree$. The relative luminosity between the two beam species was monitored using tracking telescopes of interleaved GEM and MWPC detectors at $12\degree$, as well as symmetric M{\o}ller/Bhabha calorimeters at $1.29\degree$. A total integrated luminosity of 4.5~fb$^{-1}$ was collected. In the extraction of $R_{2\gamma}$, radiative effects were taken into account using a Monte Carlo generator to simulate the convolutions of internal bremsstrahlung with experiment-specific conditions such as detector acceptance and reconstruction efficiency. The resulting values of $R_{2\gamma}$, presented here for a wide range of virtual photon polarization $0.456<\epsilon<0.978$, are smaller than some hadronic two-photon exchange calculations predict, but are in reasonable agreement with a subtracted dispersion model and a phenomenological fit to the form factor data.Comment: 5 pages, 3 figures, 2 table

Induced polarization of {\Lambda}(1116) in kaon electroproduction

We have measured the induced polarization of the ${\Lambda}(1116)$ in the reaction $ep\rightarrow e'K^+{\Lambda}$, detecting the scattered $e'$ and $K^+$ in the final state along with the proton from the decay $\Lambda\rightarrow p\pi^-$.The present study used the CEBAF Large Acceptance Spectrometer (CLAS), which allowed for a large kinematic acceptance in invariant energy $W$ ($1.6\leq W \leq 2.7$ GeV) and covered the full range of the kaon production angle at an average momentum transfer $Q^2=1.90$ GeV$^2$.In this experiment a 5.50 GeV electron beam was incident upon an unpolarized liquid-hydrogen target. We have mapped out the $W$ and kaon production angle dependencies of the induced polarization and found striking differences from photoproduction data over most of the kinematic range studied. However, we also found that the induced polarization is essentially $Q^2$ independent in our kinematic domain, suggesting that somewhere below the $Q^2$ covered here there must be a strong $Q^2$ dependence. Along with previously published photo- and electroproduction cross sections and polarization observables, these data are needed for the development of models, such as effective field theories, and as input to coupled-channel analyses that can provide evidence of previously unobserved $s$-channel resonances.Comment: 13 figure

Towards a resolution of the proton form factor problem: new electron and positron scattering data

There is a significant discrepancy between the values of the proton electric form factor, $G_E^p$, extracted using unpolarized and polarized electron scattering. Calculations predict that small two-photon exchange (TPE) contributions can significantly affect the extraction of $G_E^p$ from the unpolarized electron-proton cross sections. We determined the TPE contribution by measuring the ratio of positron-proton to electron-proton elastic scattering cross sections using a simultaneous, tertiary electron-positron beam incident on a liquid hydrogen target and detecting the scattered particles in the Jefferson Lab CLAS detector. This novel technique allowed us to cover a wide range in virtual photon polarization ($\varepsilon$) and momentum transfer ($Q^2$) simultaneously, as well as to cancel luminosity-related systematic errors. The cross section ratio increases with decreasing $\varepsilon$ at $Q^2 = 1.45 \text{ GeV}^2$. This measurement is consistent with the size of the form factor discrepancy at $Q^2\approx 1.75$ GeV$^2$ and with hadronic calculations including nucleon and $\Delta$ intermediate states, which have been shown to resolve the discrepancy up to $2-3$ GeV$^2$.Comment: 6 pages, 4 figures, submitted to PR

Precision measurements of g1g_1 of the proton and the deuteron with 6 GeV electrons

The inclusive polarized structure functions of the proton and deuteron, g1p and g1d, were measured with high statistical precision using polarized 6 GeV electrons incident on a polarized ammonia target in Hall B at Jefferson Laboratory. Electrons scattered at lab angles between 18 and 45 degrees were detected using the CEBAF Large Acceptance Spectrometer (CLAS). For the usual DIS kinematics, Q^2>1 GeV^2 and the final-state invariant mass W>2 GeV, the ratio of polarized to unpolarized structure functions g1/F1 is found to be nearly independent of Q^2 at fixed x. Significant resonant structure is apparent at values of W up to 2.3 GeV. In the framework of perturbative QCD, the high-W results can be used to better constrain the polarization of quarks and gluons in the nucleon, as well as high-twist contributions

Beam-target helicity asymmetry for γ→n→→π−p in the N*resonance region

We report the first beam-target double-polarization asymmetries in the γ þ nðpÞ → π− þ pðpÞ reaction spanning the nucleon resonance region from invariant mass W ¼ 1500 to 2300 MeV. Circularly polarized photons and longitudinally polarized deuterons in solid hydrogen deuteride (HD) have been used with the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. The exclusive final state has been extracted using three very different analyses that show excellent agreement, and these have been used to deduce the E polarization observable for an effective neutron target. These results have been incorporated into new partial wave analyses and have led to significant revisions for several γnN* resonance photocouplings

Смешанная инвазия кур в Котайкской области Республики Армения

The purpose of the research is study of chicken parasitic associations in small farms of Kotayk region, and analysis of the determined factors. Materials and methods. Research was conducted in 2021 to 2022 in small poultry farms of Kotayk Marz. Poultry feces samples were examined at the Laboratory of Parasitology of the Research Center of Veterinary Medicine and Veterinary Sanitary Expertise, Armenian National Agrarian University. Totally 210 fecal samples were examined. Eimeria spp. oocysts and nematode eggs were detected by means of method after Darling. The results of the research were processed by statistical methods. Results and discussion. Results of the research have shown that poultry eimeriasis had a wide prevalence in Kotayk Region (52.86%). Three species of Eimeria spp. have been detected: E. acervulina, E. tenella, and E. necatrix. E. acervulina was the most prevalence species (34.29%). The highest intensity of the infection has been registered in Nairi and Kotayk Regions of the region. The above-mentioned species of Eimeria spp. have been occurred both in mono- and poly-infection, with various combinations of the species. E. acervulina + E. tenella combination was the most common. Poultry eimeriasis occurred as a mixed-infection with ascaridiasis, heterakiasis, and capillariasis. The highest extensiveness of the poultry infection has been registered in Kotayk and Hrazdan Regions of the region (65.71% in both cases). Geographical location, as well as natural and climatic conditions of the region promote the prevalence of the mixed infection of poultry.Цель исследований – изучение паразитарных ассоциаций кур в мелких подворных хозяйствах Котайкской области и анализ обусловливающих их факторов. Материалы и методы. Исследования проводили в 2021–2022 гг. в подсобных и фермерских птицеводческих хозяйствах Котайкской области. Материалом для исследования служили образцы помета. Исследования проб помета птиц проводили в лаборатории Исследовательского центра ветеринарии и ветеринарно-санитарной экспертизы Национального аграрного университета Армении. Было изучено 210 проб помета. Обнаружение ооцист эймерий и яиц нематод в пробах помета проводили флотационным методом Дарлинга. Полученные данные подвергали статистической обработке. Результаты и обсуждение. Установлено широкое распространение эймериоза у кур в Котайкской области (52,86%). У кур обнаружены три вида эймерий: Eimeria acervulina, E. tenella, E. necatrix. Наиболее распространен вид E. acervulina (34,29%). Наиболее высокую экстенсивность инвазии регистрировали в регионах Наири и Котайк. Вышеуказанные виды эймерий встречались в виде как моно-, так и полиинвазий с различными комбинациями. Чаще всего встречалась комбинация E. acervulina + E. tenella. Эймериоз кур протекал в виде смешанной инвазии с аскаридиозом, гетеракидозом и капилляриозом. Наиболее высокую экстенсивность инвазии кур нематодами отмечали в Котайкском и Разданском регионах (по 65,71%). Географическое расположение и природно-климатические особенности области способствуют распространению у кур смешанной инвазии

OLYMPUS: First measurement of the charge-averaged elastic lepton-proton scattering cross section

We report the first measurement of the average of the electron-proton and positron-proton elastic scattering cross sections. This lepton charge-averaged cross section is insensitive to the leading effects of hard two-photon exchange, giving more robust access to the proton's electromagnetic form factors. The cross section was extracted from data taken by the OLYMPUS experiment at DESY, in which alternating stored electron and positron beams were scattered from a windowless gaseous hydrogen target. Elastic scattering events were identified from the coincident detection of the scattered lepton and recoil proton in a large-acceptance toroidal spectrometer. The luminosity was determined from the rates of M{\o}ller, Bhabha and elastic scattering in forward electromagnetic calorimeters. The data provide some selectivity between existing form factor global fits and will provide valuable constraints to future fits.Comment: 6 pages, 3 figures, submitted to PR