13 research outputs found
Laparoscopic splenectomy for solitary splenic hydatid cyst: Case report
No full textHydatid cyst disease is a parasitic disease caused by a type of tapeworm called Echinococcus. It is endemic to cattle-rearing regions of Africa, Asia, South Europe, the Mediterranean, the Middle East and Australia. The most common site of infection is the liver (75%). Involvement of the spleen is rare and occurs in 5% of the cases. Solitary splenic cysts are even rarer (0.5%–4%). We present a case of solitary hydatid cyst of the spleen in a 47-year-old woman. The cyst was asymptomatic and an accidental find on a full-body computed tomography after epileptic seizure and body trauma. The condition was treated successfully with albendazole, but the patient requested the cyst removed. Laparoscopic splenectomy was performed. The specimen was placed in an Endo-Bag and extracted. The patient recuperated well and was discharged on the post-operative day 5. Six months after the procedure, the patient has no complaints
Success rate and safety of totally implantable access ports placed by the cephalic vein cutdown technique in oncological patients – a single-center study
No full textIntroduction: Totally implantable access ports (TIAPs) are commonly used in oncologic patients undergoing ongoing chemotherapy. The methods of choice for implantation are the subclavian vein puncture approach and the cephalic vein cutdown technique, followed by internal jugular vein access and external jugular vein access. Materials and methods: We analyzed all patients who had a central venous access implanted by a single surgeon at the University Hospital in Pleven between October 2018 and January 2022, with the aim of determining the success rate and safety of the cephalic cutdown technique for placing totally implantable access ports. Results: 135 totally implantable access ports were inserted in the study period. Median age of patients was 69.2 years (range, 35-86 years). There were 71 (52.59%) women and 64 (47.41%) men. In 7 patients, the tip of the catheter was reported to go at the distal part of the subclavian vein and axillary vein on the ipsilateral side after initial placement and was repositioned under real-time fluoroscopic guidance. Successful placement of a totally implantable access port using the cephalic cutdown technique was reported in 127 patients (94.07%). No postoperative pneumothorax, hemothorax, or vessel injury were reported. One case of surgical site infection was seen on postoperative day (POD) 7. Late postoperative complications occurred in 3 patients with catheter-related bacteremia all after POD 30 (81, 95, and 172 days after the procedure). One patient died. Conclusions: Totally implantable access ports placed using the cephalic vein cutdown technique can be used safely and with high success rates in oncological patients
Complications in Transanal Total Mesorectal Excision (TATME) – Early Experience
No full textTransanal total mesorectal excision (TaTME) is a trending and promising surgical procedure to treat rectal cancer with oncologically oriented precision. Complication rates are promising after the learning curve is passed. A prospective study on the first 12 consecutive TaTME patients was done. The primary aim was the intraoperative and the early and late postoperative complications rate. Оne persisting failure as an intraoperative complication was reported: two anastomotic leaks and a ventral hernia as postoperative complications. TaTME is safe in terms of intra- and postoperative complications
Review on Anastomotic Leak Rate after ICG Angiography during Minimally Invasive Colorectal Surgery
No full textColorectal cancer is the 3rd most common type of cancer worldwide. The most devastating complication after colorectal surgery remains the anastomotic leak (AL). Many techniques have been developed to reduce its rate. One such new method is perfusion angiography using indocyanine green (ICG). A literary search in PUBMED on 1.03.2021 for full-text English articles published between 2014 and 2021 was performed. ICG, colorectal cancer, and angiography were the keywords we used. The review was performed following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search yielded 27 results when searching the database of PUBMED with the above keywords. Twenty-one out of 27 identified articles were included. Six were excluded from the analysis – four case reports, one review on the evolution of treating gastrointestinal cancers, and one containing no information on AL rate with ICG. One included article was RCT, sixteen were cohort studies, and four were meta-analyses or reviews. All articles reported a reduction in the anastomotic leak rate. However, the reduction was significant only in nine of them. Anastomotic leak is a severe complication and a subject of extensive research. Perfusion angiography with ICG is a step towards predicting and preventing AL, although it does not guarantee success in all cases
DATASET ABA INSENSITIVE 2 promotes flowering by inhibiting OST1/ABI5-dependent FLOWERING LOCUS C transcription in Arabidopsis
No full textFile List: Supplemental Figures 1-7. Supplemental Table 1.The plant hormone abscisic acid (ABA) is an important regulator of plant growth and development and plays a crucial role in both biotic and abiotic stress responses. ABA modulates flowering time, but the precise molecular mechanism remains poorly understood. Here we report that ABA INSENSITIVE 2 (ABI2) is the only phosphatase from the ABA-signaling core that positively regulates the transition to flowering in Arabidopsis. Loss-of-function abi2-2 mutant shows significantly delayed flowering both under long day and short day conditions. Expression of floral repressor genes such as FLOWERING LOCUS C (FLC) and CYCLING DOF FACTOR 1 (CDF1) was significantly up-regulated in abi2-2 plants while expression of the flowering promoting genes FLOWERING LOCUS T (FT) and SUPPRESSOR OF OVEREXPRESSION OF CONSTANS 1 (SOC1) was down-regulated. Through genetic interactions we further found that ost1-3 and abi5-1 mutations are epistatic to abi2-2, as both of them individually rescued the late flowering phenotype of abi2-2. Interestingly, phosphorylation and protein stability of ABA INSENSITIVE 5 (ABI5) were enhanced in abi2-2 plants suggesting that ABI2 dephosphorylates ABI5, thereby reducing protein stability and the capacity to induce FLC expression. Our findings uncovered the unexpected role of ABI2 in promoting flowering by inhibiting ABI5-mediated FLC expression in Arabidopsis. © 2024 The Author(s).Supported by grants from the National Research Foundation of Korea (NRF) funded by the Korean Government (2022R1A2C3004098 to DJY and RS-2023-00239735 to JP), and Bulgarian National Science Fund (project CAFTA, Grant No. КП06 ДВ/2 ЦС to AA and TG).Peer reviewe
Purse-string failure at the beginning of the learning curve in transanal total mesorectal excision
No full textNationwide analysis of the breast cancer guidelines adherence in Bulgaria
No full textIntroduction: The diagnosis and treatment of breast cancer have tremendously changed in the last decades improving the survival and quality of life of the patients. Adherence to clinical practice guidelines in oncology significantly improves patients’ recurrence-free and overall survival. Nowadays, no national registry/database for breast cancer patients is available. This study aims to perform a nationwide analysis of the breast cancer guidelines adherence in Bulgaria, in particular regarding the diagnostic methods for histological confirmation and the types of radical surgery performed using an artificial intelligence (AI) powered software. Materials and methods: We analyzed data from January 2019 to August 2023 nationwide using the platform with access to anonymized medical information from Bulgaria's leading territorial oncology hospitals. A total of 13,790 patients met the inclusion criteria. Results: The gold standard diagnostic tool, CNB, was done in 5427 patients (39.35%), an intraoperative frozen section was performed as a method for confirmation of breast cancer in 6257 patients (45.37%) and the standard technique for lymph node evaluation, sentinel lymph node biopsy, was done in 357 patients (2.99%). Conclusion: In Bulgaria, there are still difficulties in achieving comparable rates of core-needle biopsy for the diagnosis of breast cancer and we have demonstrated unacceptably high rates of frozen section use for intraoperative diagnosis of breast cancer. Breast-conserving surgery is widely accepted and available, but still, the rates are lower than usual for developed countries. The rates of sentinel lymph node biopsy, however, are unreasonably low
Piano Pieces of Transcarpathian Composers: Style Dimensions
No full textУ дисертації визначено, що фортепіанна творчість закарпатськихкомпозиторів (Зигмунд Лендєл, Дезидерій Задор, Емілій Кобулей, Іштван Мартон, Микола Попенко, Володимир Волонтир, Віктор Теличко, НаталіяМарченкова, Анатолій Затін, Роман Меденці, Василь Цанько) єунікальнимзразком історично визначеної логікистильового проєктування«змішаного»типу. Підставою тому було історично запізніле в рамках європейського та загальноукраїнського контекстів опанування стильовими інваріантами, що булихарактерними длякомпозиторської творчостіусього ХХ століття(постромантизм, модерн / сецесія, модернізм з його неостильовими формантамита епіцентром у вигляді авангардних технологій творення музичної матерії), що далося взнаки також у фазі постмодерну (початкуХХІ ст.). Встановлено, щоісторично складена на Закарпатті стилеутворююча ситуація мала характер«похапливого надолужування»(подібно до «стретного» характерустилеутворювального процесу в Галичині у першій третині ХХ ст.), що відбувалося такожв режимі «руху на випередження».Стверджено,отже, щовиявленіу зразках фортепіанної творчості закарпатських композиторів стильовівиміри свідчать про високу міру здобутків закарпатської композиторськоїтрадиції, які згідно із логікоюмікро-та макроіндивідуаційних процесів виводятьсяяк умовавходження до історичної системи «тотожності різних»(світова художня культура).The purpose of the dissertation is to reveal the character of the stylistic trends of the Transcarpathian music composition based on works of Transcarpathian composers. It is emphasized that in such a multiethnic region of modern Ukraine as Transcarpathia (with Ukrainian, Hungarian, Slovak, Czech, Romanian and German inhabiting or having inhabited the region) the professional tradition of music composition began to form quite late, in the 1940s; since the Transcarpathian region alternately was a part of the neighboring countries which leveled the "ethno-national form of identity" of the Transcarpathian culture. However, powerful "awakening" and "enlightenment" movements incessantly revived the forms of the ethnic identity and caused its transformation into a form of a national identity as a guarantee of entering the club of an "identity of the different", as a part of the world artistic culture. It has been established that the professionalization of the musical composition in Transcarpathia took place primarily in the sphere of compositions for piano: it provided an opportunity for an active approbation of stylistic invariants of the classical and modern musical traditions and their synthesis with the folklore fund of Transcarpathia in the spirit of Post-Romanticism and Modern / Secession. Moreover, the greatest effort was made in the sphere of the primary musical education: among its first founders was Sigmund Lendyel, who himself wrote piano compositions for his music school in order to stylize the ethnically characteristic abundance of the folk traditions of the region and introduce the academic norms of musical thinking. Noteworthy are the educational efforts of the next generations of Transcarpathian composers (Desiderius Zador, Emil Kobulei), who received professional education in prestigious institutions of music education (Budapest, Prague), and enriched the didactic potential of the piano material with examples of assimilation of the academic music with the folklore heritage of the Transcarpathian region. Soon these same founders of the Transcarpathian professional compositional tradition acquired their followers; for example, Istvan Marton.
The experience of studying the piano works of Transcarpathian composers has also been studied: it has been established that priority was given to the biographical and morphological approaches; that is, without taking into account the latest analytical algorithms and conceptual semantic values of the fundamental categories of modern systematic musicology. In this regard, the study of specific musical works of Transcarpathian composers took into account the aspects of intonation modeling, structural principles, dramatic relationships of concept segments and worldview specifics of the stylistic "image" of the author. Accordingly, conclusions have been made regarding the actualization of a certain stylistic invariant and its implementation. It is emphasized that the general "image" of the piano works of Transcarpathian composers has inherent communicative receptive (generative) aspects of Ukrainian musical modernism in the role of regionally characteristic artistic and stylistic model with its own cultural parameters – in order to comprehend the ethno-national identity. In such circumstances the spirit of assimilation is quite natural – a conscious assimilation with historically known but mentally different image systems. A special emphasis is placed on the process of macroindividuation as the basis for such a style-shaping model, when the systemic organization of musical resources outgrows the ethnic borders, which is ckarly seen in the didactic works of the mid-20th century. After "post-romantic" and "modern" visions, intentions of a purely modernist character became important (István Márton, Mykola Popenko, Volodymyr Volontyr, Viktor Telychko, Natalia Marchenkova, Anatoliy Zatin, Roman Medentsi, Vasyl Tsanko). The leading role was played by the idea of "global cultural synthesis" and reinterpretation of the cultural memory: these are conscious stylizations of the history based on the so-called "allusive" development with a certain "pole of stylistic attraction". In its turn, the post-modern intentions in the version of the so-called "eidetic" style have acquired a special stylistic significance – based on a certain original semantic image, on the basis of which a certain reality is perceived.
The conclusion is that for the stylistic trends of piano music by Transcarpathian composer’s characteristic is adaptation of the European academic experience, not only by the "hasty catch-up", but also by "movement in advance", when in addition to the increasingly obvious academization of style there was also a mixed build-up of stylistic initiatives
Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries
No full text© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
No full text© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research
