Exotics-bearing layer in the Oligocene flysch of the Krosno Beds in the Fore-Dukla zone (Silesian Nappe, Outer Carpathians), Poland

A layer with exotic blocks has been found in the flysch of the Krosno Beds, in the Fore-Dukla Zone (the southernmost part of the Silesian Nappe in the Bieszczady Mts, Polish Outer Carpathians). It has been traced over a distance of 1 km near Wetlina (the Bieszczady Mts), in the southernmost exposed tectonic slice. The exotic blocks include crystalline schist (quartz-chlorite-muscovite-orthoclase schist with tourmaline and garnet) and three types of limestones: 1/ massive, sparitic, partly siliceous limestone, with numerous calcite veins; 2/ micritic limestone with rare planktic (Globigerina-like) foraminiferal tests; 3/ bioclastic limestone with numerous tests of small and large foraminifers, coralline algae (Rhodophyta), bivalves, bryozoans and rare echinoid spines. The exotics are embedded in light- and dark-grey argillaceous, partly sandy, calcareous matrix, together with a few small angular pebbles of grey mudstones and very fine-grained sandstones, which resemble lithological types of the Krosno Beds. The described rocks are similar to those found as exotic blocks in the Krosno Beds in neighbouring areas (Roztoki Dolne and Ustrzyki Górne) of the Central Carpathian Depression (Silesian Nappe). Calcareous nannoplankton from the exotic-bearing layer and neighbouring deposits show that they are not older than the NP24 Zone (late Kiscellian), below the isochronous marker horizon of the Jaslo Limestone. It may correspond to the Tenuitella munda Zone of Olszewska (1997, 1998), proposed for the Polish part of the Central Paratethys. The source area of the layer with exotics (islands with narrow shelf mafgins), probably lay to the south and south-east, was built mainly of crystalline rocks, and partly covered by various types of carbonate Eocene-Oligocene rocks. The deeper parts of the island slopes were covered with Cretaceous-Paleogene sediments, related to deep-water sedimentation in the marginal zone between the Dukla and Silesian subbasins. These deep-water deposits have been partly eroded during the submarine mass movements descending to the Silesian Subbasin

The efficacy of risk scores for predicting abdominal wound dehiscence : a case-controlled validation study

BACKGROUND: The medical literature includes two risk scores predicting the occurrence of abdominal wound dehiscence. These risk indices were validated by the authors on the populations studied. However, whether these scoring systems can accurately predict, abdominal wound dehiscence in other populations remains unclear. METHODS: A retrospective analysis was performed using the medical records of patients treated at a tertiary-care teaching hospital between 2008 and 2011. Patients that underwent laparotomy procedures complicated by the development of postoperative abdominal wound dehiscence were included into the study. For each of the cases, three controls were selected. RESULTS: Among the 1,879 patients undergoing intra-abdominal, 56 patients developed wound dehiscence and 168 patients included in the control group. Calculation of risk scores for all patients, revealed significantly higher scores in the abdominal wound dehiscence group (p < 0.001). The median score was 24 (range: 3–46) and 4.95 (range: 2.2-7.8) vs.10 (range:-3-45) and 3.1 (range:0.4-6.9), for the Veterans Affairs Medical Center (VAMC) and Rotterdam abdominal wound dehiscence risk score in the dehiscence and control groups, respectively. The area under the curve, on the ROC plot, was 0.84 and 0.76; this confirmed a good and moderate predictive value for the risk scores. The fit of the model was good in both cases, as shown by the Hosmer and Lemeshow test. CONCLUSIONS: Both the VAMC and Rotterdam scores can be used for the prediction of abdominal wound dehiscence. However, the VAMC prognostic score had better calibration and discriminative power when applied to the population in this study and taking into consideration our method of control selection

Porównanie operacji odbytnicy z pierwotnym zespoleniem wykonywanych laparoskopowo i z wykorzystaniem robota zabiegowego : przegląd systematyczny i metaanaliza

Cel: Rak odbytnicy jest jednym z najpowszechniejszych nowotworów przewodu pokarmowego. Złotym standardem pozostaje resekcja chirurgiczna, jednak jego leczenie wciąż budzi kontrowersje. Operacje z wykorzystaniem robota zabiegowego zyskują na popularności w porównaniu z technikami laparoskopowymi. Brakuje badań dotyczących resekcji odbytnicy z pierwotnym zespoleniem. Metody: Przeprowadzono przegląd systematyczny i metaanalizę zgodnie z wytycznymi PRISMA. Głównymi punktami końcowymi były: chorobowość i powikłania krótkoterminowe. Wyniki: Wstępnie przeszukano 1250 opublikowanych artykułów. Ostatecznie wybrano 6 badań przeprowadzonych na grupie 1580 chorych, które poddano analizie ilościowej. W naszym badaniu wykazaliśmy, że zarówno zabieg z wykorzystaniem robota chirurgicznego, jak i zabieg laparoskopowy, są równorzędne w odniesieniu do: zachorowalności (RR = 1,1; 95% CI: 0,89–1,39), liczby poważnych powikłań (RR = 1,01; 95% CI: 0,60–1,69) oraz długości hospitalizacji (MD = 0,15; 95% CI: -0,60–0,90). Wykazano również, że zabieg z wykorzystaniem robota chirurgicznego ma niewielką przewagę przy wycięciu mezorektum (RD = -0,19; 95% CI: -0,35–(-0,03). I2 = 69%) oraz wiąże się z mniejszą częstością nieszczelności zespolenia (OR = 2,25; 95% CI: 1,23–4,09; I2 = 0%). Wnioski: W niektórych przypadkach zabieg z użyciem robota chirurgicznego zapewnia radykalność resekcji oraz mniejsze prawdopodobieństwo nieszczelności zespolenia. Jednakże – ze względu na niejednorodność badań – otrzymane wyniki są niepewne. Potrzeba dalszych zrandomizowanych badań na dużych populacjach pacjentów.Purpose: Rectal cancer is one of the most common malignancies of the gastrointestinal tract. The gold standard method is surgical resection. The approach to rectal cancer is still controversial. Nowadays, robotic approach gains popularity in comparison to traditional laparoscopy. However, there is lack of studies assessing rectal resections with primary anastomosis. Methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications. Results: An initial reference search yielded 1250 articles. Finally, we chose six studies covering 1580 patients that we included in the quantitative analysis. In our study, we demonstrated that laparoscopic and robotic surgery are non-inferior to one another in terms of morbidity (RR=1.1 95% CI: 0.89-1.39), major complication rate (RR=1.01, 95% CI: 0.60-1.69) or in length of hospitalization (MD=0,15 95% CI: -0.60−0.90). The latter has slight advantage in quality of mesorectal excision (RD = -0.19, 95% CI: -0.35 − -0.03. I2=69%) and anastomotic leakage rate (OR=2.25, 95% CI: 1.23-4.09, I2=0%). Conclusion: In certain cases Robotic Surgery provide better quality of resected specimen and lower leakage ratio, nevertheless due to heterogeneity the results are uncertain. There is substantial need for large randomized controlled studies

Investigating Risk Factors for Complications after Ileostomy Reversal in Low Anterior Rectal Resection Patients : an Observational Study

: Introduction: Defunctioning ileostomy has been widely used in patients undergoing low anterior rectal resection to reduce the rate of postoperative leakage. It is still not clear whether interval between primary procedure and ileostomy reversal has an impact on treatment outcomes. Methods: In our prospective observational study we reviewed 164 consecutive cases of patients who underwent total mesorectal excision with primary anastomosis. Univariate and multivariate regression models were used to search for risk factors for prolonged length of stay and complications after defunctioning ileostomy reversal. Receiver operating characteristic curves were utilized to set cut-off points for prolonged length of stay and perioperative morbidity. Results: In total, 132 patients were included in the statistical analysis. The median interval between primary procedure and defunctioning ileostomy reversal was 134 (range: 17–754) days, while median length of stay was 5 days (4–6 interquartile range (IQR)). Prolonged length of stay cut-off was established at 6 days. Regression models revealed that interval between primary surgery and stoma closure as well as complications after primary procedure are risk factors for complications after defunctioning ileostomy reversal. Prolonged length of stay has been found to be related primarily to interval between primary surgery and stoma closure. Conclusions: In our study interval between primary surgery and stoma closure along with complication occurrence after primary procedure are risk factors for perioperative morbidity and prolonged length of stay (LOS) after ileostomy reversal. The effort should be made to minimize the interval to ileostomy reversal. However, randomized studies are necessary to avoid the bias which appears in this observational study and confirm our findings

Upper extremity surface electromyography signal changes after laparoscopic training

Introduction: Objective measures of laparoscopic skill in training are lacking. Aim: To evaluate the changes in the surface electromyography (sEMG) signal during laparoscopic training, and to link them to intracorporeal knot tying. Material and methods: Ten right-handed medical students (6 female), aged 25 ±0.98, without training in laparoscopy, were enrolled in the study. With no additional training, they tied intracorporeal single knots for 15 min. Then underwent laparoscopic training and redid the knot tying exercise. During both events, sEMG was recorded from 8 measurement points on the upper extremities and neck bilaterally. We analyzed changes in sEMG resulting from training and tried to find sEMG predictive parameters for higher technical competence defined by the number of knots tied after the training. Results: The average number of knots increased after the training. Significant decreases in activity after the training were visible for the non-dominant hand deltoid and trapezius muscles. Dominant and non-dominant hands had different activation patterns. Differences largely disappeared after the training. All muscles, except for the dominant forearm and non-dominant thenar, produced a negative correlation between their activities and the number of tied knots. The strongest anticorrelation occurred for the non-dominant deltoid (r = –0.863, p < 0.05). Relatively strong relationships were identified in the case of the non-dominant trapezius and forearm muscles (r = –0.587, r = –0.504). Conclusions: At least for some muscle groups there is a change in activation patterns after laparoscopic training. Proximal muscle groups tend to become more relaxed and the distal ones become more active. Changes in the non-dominant hand are more pronounced than in the dominant hand

Perioperacijske promjene subpopulacija limfocita u bolesnika operiranih zbog kolorektalnog karcinoma

Surgical procedure has immense impact on the immune balance. However, little is known about perioperative changes in T regulatory and Th17 lymphocyte subpopulations in patients undergoing colorectal resection. Patients with resectable colon cancer were enrolled in the study. Blood samples were obtained on two occasions, i.e. before the procedure and two days after the surgery. We also recruited a control group of young, healthy individuals. Lymphocyte subpopulations were analyzed with the use of flow cytometry. Investigated subpopulations consisted of total lymphocyte count, CD4+, CD8+, T regulatory Foxp3+ (Tregs), Th17 lymphocytes and white blood cell (WBC) count. There were significant differences in immune cell levels before and after the surgery. Reduction was recorded in the CD4+, CD8+, Tregs and total lymphocyte counts (p=0.002, p=0.01, p=0.008 and p=0.001, respectively). Increase was observed in total WBC and Th17 cells, however, Th17 lymphocytes did not reach statistical significance (p=0.01 and p=0.5, respectively). In conclusion, surgical intervention caused changes in all lymphocyte subpopulations investigated in patients undergoing surgery for colorectal cancer. However, it seemed to be an effect of perioperative trauma. Further studies are needed to investigate the impact of surgical intervention on lymphocyte subpopulations.Kirurški zahvat ima golem učinak na ravnotežu imunog sustava. Međutim, malo se zna o perioperacijskim promjenama u subpopulacijama T regulatornih i Th17 limfocita u bolesnika podvrgnutih resekciji kolorektuma. U istraživanje su bili uključeni bolesnici s resektabilnim karcinomom kolona. Uzorci krvi prikupljeni su dva puta: prije zahvata i dva dana nakon operacije. Uključena je bila i kontrolna skupina sastavljena od mladih i zdravih osoba. Subpopulacije limfocita analizirane su protočnom citometrijom. Istraživane su sljedeće subpopulacije: ukupan broj limfocita, CD4+, CD8+, T regulatorni Foxp3+ (Tregs), Th17 i bijela krvna slika. Utvrđene su značajne razlike u razinama imuno stanica prije i nakon operacije. Snižene razine zabilježene su za CD4+, CD8+, Tregs i ukupni broj limfocita (p=0,002, p=0,01, p=0,008 odnosno p=0,001). Povišenje je zapaženo za bijelu krvnu sliku i Th17 stanice, međutim, Th17 limfociti nisu postigli statističku značajnost (p=0,01 odnosno p=0,5). Zaključujemo da je kirurški zahvat uzrokovao promjene u svim istraživanim subpopulacijama limfocita kod bolesnika podvrgnutih operaciji kolorektalnog karcinoma. Međutim, čini se da je to bio učinak perioperacijske traume. Potrebna su daljnja istraživanja kako bi se ispitao utjecaj kirurškog zahvata na subpopulacije limfocita

Comparison of short-term clinical and pathological outcomes after transanal versus laparoscopic total mesorectal excision for low anterior rectal resection due to rectal cancer : a systematic review with meta-analysis

Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31&#8315;0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials