Žarnyno mikroorganizmų įtaka jungties nesandarumui po storosios žarnos operacijų

Introduction. One of the most common and serious complications of near-postoperative surgery after colon resection with anastomosis is intestinal leakage with a frequency of 1 to 24%. Therefore, it is very important to evaluate the factors that may determine the development of this complication. One of the etiological factors behind the development of this complication is the intestinal microbiota, which is playing an increasingly important role in this process. Nevertheless, there is still a lack of comprehensive clinical evidence on the influence of the intestinal microbiota on postoperative complications such as anastomotic leakage. Purpose. To evaluate the influence of intestinal microorganisms on anastomotic leakage after elective intestines surgery. Methods. A prospective study was performed at the Lithuanian University of Health Sciences Hospital, Kaunas Clinics, Clinic of Surgery. There were included patients who underwent colon surgery (right hemicolectomy, left hemicolectomy, sigmoid resection and closure of ileostomy). Intestinal mucosal biopsy performed before restoring intestinal integrity and sent for microbiological and antibiotic examination. Patients were also observed postoperatively for anastomotic leakage. Results. The majority of patients were treated for colon cancer – 46 (92.0%). In 19 patients crop (38.0%) grown one microorganism, in 12 (24.0%) – 2 microorganisms, in 5 (10.0%) – 3 microorganisms, in 1 (2.0%) – 4 types of bacteria. In the most of the crops were observed growth by E. coli – 30 (60.0%), Enterococcus spp. – 12 (24.0%), Bacteroides spp. – 4 (8.0%), Klebsiella oxytoca – 2 (4.0%), Beta hemolytic streptococcus – 2 (4.0%) patients. Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea grew only in 1 (2.0%) patients crop. Postoperative anastomotic leakage diagnosed in 2 (4.0%) patients. Conclusions. The major microorganisms that grown were E. coli. Due to the small sample, tendency can not be predicted, but microorganisms that promote small blood vessels thrombosis may be one of the factors that cause anastomotic leakage.Įžanga. Po rezekcinių storosios žarnos operacijų, kai formuojama jungtis, viena iš dažniausių ir pavojingiausių artimojo po­operacinio laikotarpio komplikacijų yra žarnų jungties nesandarumas (dažnis – 1–24 proc.), todėl labai svarbu įvertinti veiksnius, galinčius lemti šios komplikacijos vystymąsi. Vienas iš etiologinių veiksnių šiai komplikacijai išsivystyti yra žarnyno mikrobiota. Pastaraisiais metais jai skiriama vis daugiau dėmesio, tačiau vis dar trūksta išsamių klinikinių tyrimų apie žarnyno mikrobiotos įtaką pooperaciniam žarnų jungties nesandarumui. Tikslas. Įvertinti žarnyno mikroorganizmų įtaką jungčių nesandarumui po planinių žarnų operacijų. Metodika. Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikos (LSMUL KK) Chirurgijos klinikoje atliktas perspektyvusis tyrimas. Atrinkti pacientai, kuriems atliktos storosios žarnos operacijos: dešinioji hemikolektomija, kairioji hemikolektomija, riestinės žarnos rezekcija ir ileostomos uždarymas. Tyrimo dalyviams, prieš atkuriant žarnyno vientisumą, paimti žarnos gleivinės bioptatai, jie išsiųsti mikrobiologiniams tyrimams ir antibiotikogramai atlikti. Pacientai stebėti ir po operacijos, vertintas jungties nesandarumas. Rezultatai. Didžioji dalis pacientų stacionarizuoti ir operuoti dėl storosios žarnos vėžio (46 pacientai, 92,0 %). Devyniolikai pacientų (38,0 %) išauginta viena bakterija, dviem pacientams (24,0 %) – dvi, penkiems (10,0 %) – trys, vienam (2,0 %) – keturios skirtingos bakterijos. Didžiojoje dalyje išaugintų pasėlių rasta E. coli bakterija (30 pacientų, 60,0 %), dvylikai pacientų (24,0 %) – Enterococcus spp., 4 (8,0 %) – Bacteroides spp., dviem (4,0 %) – Klebsiella oxytoca, dviem (4,0 %) – Beta hemolitinis streptokokas. Vienam pacientui (2,0 %) išauginta: Citrobacter fundii, Citrobacter brakii, Parabacteroides distasonis, Proteus mirabilis, Klebsiella pneumoniae, Enterobacteriaceae daacea. Ankstyvasis jungties nesandarumas nustatytas dviem atvejais (4,0 %). Išvados. Dažniausiai nustatyta E. coli bakterija. Dėl nedidelės tyrimo apimties negalima numatyti tolesnių tendencijų, tačiau mikroorganizmai, skatinantys smulkiųjų kraujagyslių trombozę, gali būti vienas iš veiksnių, lemiančių jungties nesandarumą

Stuttering.

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Elucidating the mechanisms of anastomotic leakage:a new point of view

After surgical resection of a part of the colon an anastomosis is made to restore the continuity of the colon. Unfortunately, these anastomoses are often complicated by leakage. This thesis embarks on the quest to elucidate the mechanisms behind anastomotic leakage (AL). New techniques are used to study a long-ignored factor in AL: the intestinal microbiota. We demonstrate that the bacterial composition during the construction of the anastomosis plays a role in the subsequent development of anastomotic leakage. The lack of diversity in the microbial composition is associated with AL. Furthermore, the virulence factors (pathogenic molecules) of bacteria and other micro-organisms play an important role in the development of AL and the associated subsequent tumour recurrence. These virulence factors are a high expression of the collagen degrading GelE gene and the ability to activate the collagen degrading MMP9, together called the “leakage phenotype”. The Western diet causes a change in and reduction of the microbial diversity and a presence of micro-organisms with the “leakage phenotype”. Lastly, the expression of genes in the colon plays a role in AL, with a reduced expression of genes involved in the immune response, angiogenesis and collagen crosslinking. To conclude: the intestinal microbiota, partly influenced by the Western diet, and the colonic gene expression are important factors in the development of AL. In the nearby future, the results from this thesis can be used for therapeutic or preventive measures to prevent anastomotic leakage, partly focused on the manipulation of the intestinal microbiota

Religion, Custody, and a Child\u27s Identities

Custody decisionmaking in which religion plays a role is significant from the perspective of parents, children, religious communities, and the liberal diverse state. Neither a family law analysis based on best interests, nor a constitutional law analysis based on parental rights, provides a wholly satisfactory response to the task of delineating custody and access when religion is at issue. Instead, a child\u27s sense of identity, partly defined through membership in religious communities, must be considered; at the same time, the child\u27s integrity must be protected. By balancing a child\u27s interests of identity and integrity, courts respect religious freedoms and custodial authority, and acknowledge the realities of the lives of children of interfaith families. The complex and multiple affiliations of young individuals are thus recognized

Academic Concerns -Caring about Conversation in Canadian Common Law

The Supreme Court of Canada, in its 2001 decision in Cooper v Hobart, refined the test in Canadian common law for establishing a duty of care in the tort of negligence. Although aware of the complexities and ongoing challenges of the duty of care concept, the Supreme Court openly labelled these concerns as academic. This article confirms these concerns as academic, but insists that this label underlines their centrality not only to an understanding of the tort of negligence but to the nature and form of common law reasoning. By pointing to errors in the Supreme Court of Canada\u27s judgment-errors of using the wrong word, naming the wrong judge, confusing the structure of the duty of care inquiry, and omitting an important precedent case-the authors identify failures in the four principal activities of the common law: placing, naming, identifying, and remembering. They suggest that the image, sounds, and fluctuation of conversation capture the method of common law-its linking of past to future through imperfect yet evocative analogical reasoning-and affirm the importance of paying attention to the meaning of words, the names ofjudges, the structure of questions, and the importance of histor

Scanning & analysing individual bee (Apis mellifera L.) behavior using RFID

A complete system to make real-time flight entrance observations possible is described. The system consists of:RFID reader covering the flight entrance of a colony in a standard hive (25 cm wide). Each passing tagged bee is detected. ID, day, time is stored in the database and shown via the webinterface.ApiScan covering the same entrance width; giving in and out flight-activity on an individual basis.Camera allowing a permanent remote observation and registration of behavior at the flight entrance.Weather station registering air temperature, air humidity, wind velocity and direction, rain.The equipment and the data storage allows an in-depth analysis of the flight behavior of the worker bees during the measuring period or the lifespan of a worker bee.Keywords: honeybee, RFID tags, foraging behavior, automatic monitorin

Asia looks anxiously to China and Japan

French version available in IDRC Digital Library: Vedettes asiatiques : la Chine et le Japo

The Matriculation Course at Universiti Sains Malaysia

Pemerian mengenai Kursus Matrikulasi di daam rencana ini didahului dengan penjelasan terhadap masalah-masalah yang menimbulkannya dan juga usaha-usaha awalan untuk menyelesaikannya. Kursus Matrikulasi, Universiti Sains Malaysia dimulai awal tahun 1977 apabila perhubungan-perhubungan diadakan dengan Sekolah-Sekolah Menengah Sains di Sungei Patani dan di Bukit Mertajam. Pengambilan pelajar-pelajar yang pertama dilakukan pada bulan Julai 1977. Kakitangan sekolah dan universiti telah berusaha bersama-sama untuk membentuk sukatansukatan pelajaran, kaedah-kaedah mengajar dan peperiksaan-peperiksaan. Sekolah-sekolah ini diperbekalkan dengan buku-buku sains dan alatan-alatan tambahan. Pelajar-pelajar menjalani kursus tahun pertama di kedua-dua sekolah menengah sains tersebut. Selepas itu mereka mengambil peperiksaan (Matrikulasi I) sebelum memasuki universiti untuk mengikuti kursus tahun kedua. Oi akhir kursus ini, mereka harus mengambil peperiksaan Matrikulasi II. Kelulusan peperiksaan ini melayakkan kemasukan ke dalam tahun pertama Universiti Sains Malaysi

Kvalitet i nya deponiers lakvatten - resultat från Renovas deponi Fläskebo

The European landfill directive increases demands on landfills. The amount of organic matter being landfilled is restricted and landfills should be as dry as possible. The consequences of these changes are not yet fully understood. In this study the first landfill in Sweden to be constructed according to the directive, Fläskebo, has served as an example of future landfills. Its leachate has been studied with multivariate techniques (principal component analysis and canonical correlation analysis) and with the geochemical model PHREEQC. Several interesting correlations were found and the results clearly show that multivariate statistics can be of great use when studying landfill leachate. Their ability to extract the most important information is one thing that can be very useful. Combined with geochemical models they can provide an increased understanding of processes governing leachate quality. The next part of the study will be to use multivariate statistics to compare Fläskebo’s leachate with that from older landfills to find interesting differences and similarities