Surgical Disease Research Articles

An entropy-based membership approach on type-II fuzzy set (EMT2FCM) for biomedical image segmentation

Medical image segmentation is a challenging task owing to its aliasing artifacts, existence of mixed pixels, interference of noise and blurring effect, etc. The brain and the spinal cord together constitute the Central Nervous System (CNS), with the brain being the most complex component. Brain segmentation is crucial for surgical planning, disease detection, and therapeutic interventions. A unique entropy based soft clustering approach (EMT2FCM) for the brain MRI imaging on both real and simulated datasets is proposed in this paper. This paper presents a refined version of the type-2 Fuzzy C-Means (FCM) technique (EMT2FCM) for isolating diverse tissues in Magnetic Resonance (MR) brain images, achieved through an enhanced entropy-based membership function. Difficulty in edge detection occurs due to the vagueness caused by mixed pixels. To overcome the problem with mixed pixels a new membership function proposal has been given. EMT2FCM, i.e., fuzzy membership function with Shannon's entropy-based variation, is able to handle uncertainty and vagueness in images offered by mixed pixels, by implementing new distance criteria modification for the calculation of optimum cluster. The approach has been validated using datasets from BRAINWEB (simulated) and IBSR (real-life). Following the deployment of our new algorithm, we assessed its performance using six observation criteria. The results demonstrated significant improvements in clustering performance, as evidenced by enhanced Mean Squared Error (MSE), Dice Index, and Jaccard Index, Accuracy, Sensitivity and Partition Indices validation measures. The evaluation of EMT2FCM in comparison to other state-of-the-art methods is established to reduce segmentation errors significantly.

The impact of acquired immune deficiency syndrome on colorectal surgery

The patients infected with the human immunodeficiency virus are not a homogeneous group and are generally living longer on human active antiretroviral therapy. They are amenable to the colorectal diseases in the general population for which colorectal surgery is safe and effective. Surgical intervention is obligatory in life-threatening surgical correctable disease, but aggressive surgical intervention must be undertaken with caution and adequate perioperative care is required. A close liaison between the human immunodeficiency virus/acquired immune deficiency syndrome physician and the surgeon will decrease negative laparotomies and exclude preterminal cases. The knowledge of anorectal sexually transmitted diseases is important, and the symptomatic improvement of anorectal pathology in acquired immune deficiency syndrome may render delayed wound healing an acceptable complication.

Global Surgery Research: An Overview and the Role of Medical Students and Surgical Trainees in Advancing Global Surgery Research in LMICs

Global surgery research is a critical area of study aimed at enhancing access to safe and effective surgical care for patients in low- and middle-income countries (LMICs). It is essential to explore the significance of global surgery research and highlight the potential contributions of medical students and surgical trainees in addressing the pressing needs of LMIC populations. Global surgery research is pivotal in driving progress and fostering innovation by evaluating surgical disease burden, identifying access barriers, developing sustainable solutions, and strengthening health systems. Additionally, integrating sustainability principles into global surgery research endeavors ensures surgical interventions benefit patients while minimizing the environmental impact of surgical care delivery. Medical students and surgical trainees can engage in global surgery research, including collaborating with experienced researchers, developing research projects with local partners, conducting literature reviews, collecting and analyzing data, and disseminating research findings. Despite challenges faced in conducting research in LMIC, such as limited resources and sociopolitical instability, opportunities exist to nurture the interest of medical students and surgical trainees in global surgery research. By actively participating in global surgery research, medical students and surgical trainees can contribute to improving healthcare outcomes in LMICs while honing invaluable research skills for their future careers. Global surgery research is a critical area of study aimed at enhancing access to safe and effective surgical care for patients in low- and middle-income countries (LMICs). It is essential to explore the significance of global surgery research and highlight the potential contributions of medical students and surgical trainees in addressing the pressing needs of LMIC populations. Global surgery research is pivotal in driving progress and fostering innovation by evaluating surgical disease burden, identifying access barriers, developing sustainable solutions, and strengthening health systems. Additionally, integrating sustainability principles into global surgery research endeavors ensures surgical interventions benefit patients while minimizing the environmental impact of surgical care delivery. Medical students and surgical trainees can engage in global surgery research, including collaborating with experienced researchers, developing research projects with local partners, conducting literature reviews, collecting and analyzing data, and disseminating research findings. Despite challenges faced in conducting research in LMIC, such as limited resources and sociopolitical instability, opportunities exist to nurture the interest of medical students and surgical trainees in global surgery research. By actively participating in global surgery research, medical students and surgical trainees can contribute to improving healthcare outcomes in LMICs while honing invaluable research skills for their future careers. Global surgery research is a critical area of study aimed at enhancing access to safe and effective surgical care for patients in low- and middle-income countries (LMICs). It is essential to explore the significance of global surgery research and highlight the potential contributions of medical students and surgical trainees in addressing the pressing needs of LMIC populations. Global surgery research is pivotal in driving progress and fostering innovation by evaluating surgical disease burden, identifying access barriers, developing sustainable solutions, and strengthening health systems. Additionally, integrating sustainability principles into global surgery research endeavors ensures surgical interventions benefit patients while minimizing the environmental impact of surgical care delivery. Medical students and surgical trainees can engage in global surgery research, including collaborating with experienced researchers, developing research projects with local partners, conducting literature reviews, collecting and analyzing data, and disseminating research findings. Despite challenges faced in conducting research in LMIC, such as limited resources and sociopolitical instability, opportunities exist to nurture the interest of medical students and surgical trainees in global surgery research. By actively participating in global surgery research, medical students and surgical trainees can contribute to improving healthcare outcomes in LMICs while honing invaluable research skills for their future careers.

Optimal computed tomography-based biomarkers for prediction of incisional hernia formation.

Unstructured data are an untapped source for surgical prediction. Modern image analysis and machine learning (ML) can harness unstructured data in medical imaging. Incisional hernia (IH) is a pervasive surgical disease, well-suited for prediction using image analysis. Our objective was to identify optimal biomarkers (OBMs) from preoperative abdominopelvic computed tomography (CT) imaging which are most predictive of IH development. Two hundred and twelve rigorously matched colorectal surgery patients at our institution were included. Preoperative abdominopelvic CT scans were segmented to derive linear, volumetric, intensity-based, and textural features. These features were analyzed to find a small subset of OBMs, which are maximally predictive of IH. Three ML classifiers (Ensemble Boosting, Random Forest, SVM) trained on these OBMs were used for prediction of IH. Altogether, 279 features were extracted from each CT scan. The most predictive OBMs found were: (1) abdominopelvic visceral adipose tissue (VAT) volume, normalized for height; (2) abdominopelvic skeletal muscle tissue volume, normalized for height; and (3) pelvic VAT volume to pelvic outer aspect of body wall skeletal musculature (OAM) volume ratio. Among ML prediction models, Ensemble Boosting produced the best performance with an AUC of 0.85, accuracy of 0.83, sensitivity of 0.86, and specificity of 0.81. These OBMs suggest increased intra-abdominopelvic volume/pressure as the salient pathophysiologic driver and likely mechanism for IH formation. ML models using these OBMs are highly predictive for IH development. The next generation of surgical prediction will maximize the utility of unstructured data using advanced image analysis and ML.

Correlation between mortality and blood transfusion in patients with major surgery initially admitted to intensive care unit: a retrospective analysis

PurposeTransfusing red blood cells promptly corrects anemia and improves tissue oxygenation in around 40% of patients hospitalized in the intensive care unit (ICU) after major surgical operations. This study’s goal is to investigate how blood transfusions affect the mortality rates of patients after major surgery who are hospitalized in the ICU.MethodsRetrospective research was done on recently hospitalized patients who had major procedures in the ICU between October 2020 and February 2022 at the Huanggang Central Hospital of Yangtze University, China. The patients’ prognoses at three months were used to classify them as either survivors or deceased. Patient demographic information, laboratory results, and blood transfusion histories were acquired, and the outcomes of the two groups were compared based on the differences. Univariate and multivariate logistic regression analyses were used to examine the prognosis of surgical disease patients first admitted to the ICU. The receiver operating characteristic (ROC) curve was used to evaluate the predictive power of each risk factor. The relationship between transfusion frequency, transfusion modality, and patient outcome was examined using Spearman’s correlation analysis.ResultsData from 384 patients was included in the research; of them, 214 (or 55.7%) died within three months of their first stay in the ICU. The death group had higher scores on the Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Sequential Organ Failure Assessment (SOFA) than the survival group did (all P < 0.05); the death group also had lower scores on the Glasgow Coma Scale, systolic blood pressure, hemoglobin, platelet distribution width, and blood transfusion ratio. Multivariate logistic regression analysis revealed an odds ratio (OR) of 1.654 (1.281–1.989), a 95% confidence interval (CI) of 1.440 (1.207–1.701), and a P value of 0.05 for death in patients undergoing major surgery who were hospitalized to the intensive care unit (ICU). Areas under the ROC curve (AUC) of 0.836, 0.799, and 0.871, respectively, and 95% CIs of 0.796–0.875, 0.755–0.842, and 0.837–0.904, respectively, all P0.05, had significant predictive value for patients initially admitted to the ICU and for APACHE II score > = 12 points, SOFA score > = 6, and blood transfusion. When all three indicators were used jointly to predict a patient’s prognosis after major surgery, the accuracy increased to 86.4% (sensitivity) and 100% (specificity). There was a negative correlation between the number of blood transfusions a patient had and their outcome (r = 0.605, P < 0.001) and death (r = 0.698, P < 0.001).ConclusionA higher initial ICU APACHE II score, SOFA score, and a number of blood transfusions were associated with improved survival for patients undergoing major surgical operations. Patients’ death rates have increased with the increase in the frequency and variety of blood transfusions.

Scaling up essential surgery in rural Africa: outcomes of a novel regional initiative

Introduction: South Sudan, like most of rural Africa, has a high surgical disease burden and profound unmet surgical needs. This is against a background of weak surgical service delivery systems, especially in the harder-to-reach areas. Here it is further fueled by armed conflict and poverty. The surgical service delivery models applied so far have not adequately improved surgical care. Through the Intergovernmental Authority on Development Regional Initiative for Capacity Building, a surgical team was deployed to Kuajok Hospital in Warrap state. The team mentored South Sudanese health workers for 2 years while working together with other agencies operating in the locality to improve surgical services. This paper is an account of the capacity building process for surgical service improvement at this site, from 2015 to 2017. Methods: A descriptive study of activities and patients seen over a 2-year period at this centre. Quantitatively, statistics were extracted and compiled from all areas of surgical care, including profiles of the various surgical conditions. Qualitatively, information was gathered through unstructured interviews. Results: There was a drastic increase in surgical outpatient consultations, admissions, and operations. There was an improvement in the level of surgical care and patient care systems. New facilities like operating theaters, emergency rooms, surgical consultation rooms, and surgical wards were established. Community attitude and health-seeking behavior improved, leading to improved access to care. An indirect financial benefit was experienced due to improved patient care outcomes and reduced expenditure on referrals. Conclusion: Improvement of surgical services in Africa’s hard-to-reach areas is readily attainable through partnerships and mentoring of native medical workers by personnel from fellow African countries.

Pathogenic roles of microRNAs and competing endogenous RNAs in Hirschsprung disease (HSCR): Potential diagnostic markers for HSCR

AbstractMicroRNAs (miRNAs) are endogenous small non‐coding single‐stranded RNAs. They can bind to the 3′‐untranslated region (3′UTR) of mRNAs and regulate the expression of their target genes by inducing degradation or translation inhibition of the corresponding mRNAs. Competing endogenous RNAs (ceRNAs) can disable miRNAs by combining miRNAs response elements (MREs) with miRNAs. Hirschsprung disease (HSCR) is a common pediatric surgical disease in which cells derived from the enteric neural crest fail to colonize the distal colon, but its pathogenesis is not very clear. In recent years, with more and more studies on miRNAs in HSCR, miRNAs seem to be involved in the pathogenesis of HSCR. miRNAs in HSCR affect the proliferation and migration of enteric neural crest cells mainly through target genes, and ceRNAs inhibit miRNAs, thus participating in the pathogenesis of HSCR. It was reported that some miRNAs in the serum of children with HSCR were significantly higher than those in the control group. Therefore, miRNAs are expected to be a new noninvasive early screening biomarker and targeted therapy point for HSCR. Here, we provide a summary of the understanding of miRNAs and ceRNAs in regulating enteric nervous system proliferation and migration and their roles in the pathogenesis of HSCR.

Achushana (sucking of blood): An emergency management of snakebite

Snakebite has been considered as a burning and difficult situation not only for the affected individuals but also for the doctors. An individual, seeing the snake feels terrified. When there is bite by a snake one feels that the life is in danger now and death is unavoidable. This is, as evidence say, the main cause of death due to snakebite. So a patient with snakebite when comes to the physician shows the serious signs and symptoms and the physician also faces dilemma in diagnosis which is the prime important factor to become success. A patient of snakebite commonly visits the physician with a huge number of attendants with anxiety, fear and lots of questions. This makes the situation more confusing and even the physician has to take tension. Ayurveda is unanimously agreed to be the most ancient health science dealing with almost all unwanted states of health (disease). The great scholars and founders of Ayurveda, along with the medical and surgical disease conditions, also discuss poisoning with priority. Among all the poisonings snakebite is considered to be potent one which need prompt action of the physician in absence of which the life of the patient may be lost. The Ayurvedic scholars Charaka, Susruta and Bagbhata very nicely describe the seriousness of snakebite (SARPADANGSA) and advice to take step to prevent the spread of the bisha by following a number of procedures. Out of all one procedure is (ACHUSHANA) which is said to apply with the aim to expel out the poison contaminated blood by applying sucking. This procedure is not supported by the modern Toxicologists. Hence, a discussion on the topic is seemed to have importance. Hope this discussion will be able to convey information not only to the Ayurvedic fraternity but also to the Modern field with a message to re-evaluate the concept in modern scientific character.

Association between surgical disease burden and research productivity in surgery across the globe: a big data comparative analysis using artificial intelligence.

Association between surgical disease burden and research productivity in surgery across the globe: a big data comparative analysis using artificial intelligence.

What Proportion of East African Refugees Report Musculoskeletal Problems? A Cross-sectional Survey.

Musculoskeletal conditions are the leading cause of disability worldwide and disproportionally affect individuals in low-income and middle-income countries. There is a dearth of evidence on musculoskeletal problems among refugees, 74% of whom reside in low-income and middle-income countries. (1) What proportion of refugees in Nyarugusu Camp, Kigoma, western Tanzania, are affected by musculoskeletal problems and what are the characteristics of those individuals? (2) What are the characteristics of these musculoskeletal problems, including their causes, location, and duration? (3) What forms of healthcare do those with musculoskeletal problems seek, including those for both musculoskeletal and nonmusculoskeletal problems? We conducted a cross-sectional study among refugees in Nyarugusu Camp, using the Surgeons OverSeas Assessment of Surgical Need tool. The Surgeons OverSeas Assessment of Surgical Need tool is a validated population-based survey tool developed for use in limited-resource settings that is intended to determine the prevalence of surgical disease in a community. It uses a cluster random sampling methodology with house-to-house data collection in the form of a verbal head-to-toe examination that is performed by a trained community healthcare worker. A total of 99% responded, and 3574 records were analyzed. The mean age of respondents was 23 ± 18 years, with under 18 as the most-represented age group (44% [1563]). A total of 57% (2026) of respondents were women, 79% (2802 of 3536) were generally healthy, and 92% (3297 of 3570) had visited a camp medical facility. Only records endorsing musculoskeletal problems (extremity or back) were included in this analysis. Using all refugees surveyed as our denominator and refugees who endorsed a musculoskeletal problem (extremity or back) as the numerator, we calculated the proportion of refugees who endorsed a musculoskeletal problem. We then analyzed the characteristics of those endorsing musculoskeletal problems, including their healthcare-seeking behavior, and the characteristics of the musculoskeletal problems themselves. Among 3574 refugees interviewed, 22% (769) reported musculoskeletal problems, with 17% (609) reporting extremity problems and 7% (266) reporting back problems. Among all people surveyed, 8% (290) reported current extremity problems while 5% (188) reported current back problems. Among those reporting musculoskeletal problems, respondents younger than 18 years were the most-represented age group for extremity problems (28% [169 of 609]) whereas respondents between 30 and 44 years of age were the most-represented age group for back problems (29% [76 of 266]). Wounds from an injury or trauma (24% [133 of 557]) and acquired disability (24% [133 of 557]) were the most-common causes of extremity problems, whereas acquired disability (53% [97 of 184]) followed by a wound not from injury or trauma (25% [45 of 184]) were the most common causes of back problems. Fifty percent (303) of those with extremity problems characterized it as disabling, whereas 76% (203) of those with back problems did. Over one of five refugees endorsed musculoskeletal problems, which are most often caused by acquired disease and injury. These musculoskeletal problems are often characterized as disabling, yet only slightly more than half have sought treatment for problems. This warrants further research on care-seeking behavior in this setting, and emphasizes that investing in the spectrum of musculoskeletal health systems, including medical management and rehabilitation services, is critical to decreasing disability caused by musculoskeletal problems. Level IV, prognostic study.

Predicting Surgical Coronary Disease Prior to Invasive Coronary Angiography to Inform Selective Avoidance of Radial Artery Access and Preserve it for Use as a Bypass Graft

Predicting Surgical Coronary Disease Prior to Invasive Coronary Angiography to Inform Selective Avoidance of Radial Artery Access and Preserve it for Use as a Bypass Graft

Outcomes in Medically Managed Surgical Coronary Artery Disease Patients Deemed Inappropriate for Coronary Artery Bypass Surgery

Outcomes in Medically Managed Surgical Coronary Artery Disease Patients Deemed Inappropriate for Coronary Artery Bypass Surgery

Surgery in the Next Space Missions.

In the coming years, missions to the Moon and Mars shall be the new goals of space flight. The complexity of these missions due to the great distance from Earth and the unforeseen obstacles to settle on another planet have given rise to great concerns for crew health and survival. The need for advanced crew autonomy and a different approach to surgical emergency require new protocols and devices to help future crew medical officers and other crew members in a task of unprecedented difficulty. Hence, the increasing variety of schedules, devices, and protocols being developed. A serious health problem, such as an emerging surgical disease or severe trauma, can jeopardize the mission and survival of the entire crew. Many other difficulties are present in deep-space missions or settlements on other planets, such as communication and supply, also medical, delays, and shortage, and the presence of radiation. Progress in advanced technologies as well as the evolution of robotic surgery and the use of artificial intelligence are other topics of this review. In this particular area of research, even if we are still very far from an "intelligent robot", this evolution must be evaluated in the light of legislative and ethical considerations. This topic was presented at the annual meeting of the American College of Surgeons-Italy Chapter in 2021.

Long-term results of dearterialization and mucopexy for stage II–III hemorrhoids

BACKGROUND:Nowadays, minimally invasive procedures are mainly performed in the treatment of hemorrhoidal diseases. However, the feasibility of using ultrasound navigation for hemorrhoidal artery ligation-rectoanal repair (HAL-RAR) is still discussed because digital palpation of hemorrhoidal arteries for ligation is safe and easy to perform. AIM:To evaluate the long-term results of HAL with mucopexy by digital examination in comparison with traditional HAL-RAR in the surgical treatment stage II–III hemorrhoidal disease. MATERIALS AND METHODS:The controlled randomized trial included 150 patients with stage II–III hemorrhoidal disease. The study group (n=75) included patients who underwent surgery using digital palpation with mucopexy, and in the control group (n=75), the HAL-RAR was used. The primary endpoint was a recurrence of the main symptoms. Secondary endpoints included patient satisfaction and discomfort, pain intensity, prolapse of hemorrhoidal piles, and rectal bleeding. RESULTS:The groups did not differ in sex, age, body mass index, and stage, and symptoms of hemorrhoidal disease. During the 12-month follow-up, no difference in the prolapse of hemorrhoidal piles (p=0.49), patient satisfaction (p=0.95), and discomfort (p=0.67) was found. Periodic bleeding occurred in 5.3% and 17.3% of the patients in the study and control groups, respectively (p=0.037). After 2 months of follow-up, pain recurred in 8 (10.6%) patients in the study group and 22 (29.3%) in the control group (p=0.037). At 18 months follow-up, no difference in patient satisfaction (p=0.95) and discomfort (p=0.89) was noted; however, the rate of hemorrhoidal prolapse was significantly higher in the study group (16.3%) than in the control group (13.5%) (p=0.045), and bleeding was reported in 10.2% and 15.4% of the patients in these groups, respectively (p=0.86). Open hemorrhoidectomy for relapse of hemorrhoidal prolapse was performed in 2 (2.6%) patients in the study group and 4 (5.3%) patients in the control group (p=0.68). CONCLUSION:Ligation of hemorrhoidal arteries in combination with mucopexy without ultrasound guidance is a safe, easy, and reproducible technique, with comparable effectiveness, and long-term results to HAL-RAR. This procedure can be recommended for the surgical treatment of stage II–III hemorrhoids.

Operative experience on descending aorta with Takayasu Arteritis: a review.

Patients with Takayasu arteritis (TA) and descending aorta involvement often experience insidious onset and slow progression, leading to irreversible vascular lesions despite medication therapy. Surgical management plays a crucial role in resolving hemodynamic disturbances and has shown promise in improving the outcomes of this patient population, owing to significant advancements in surgical expertise. However, studies focusing on this rare disease are lacking. This review summarizes the characteristics of patients with stenosis in descending aorta, emphasizing surgical approaches, perioperative management, and disease outcomes. The operative approach depends on lesion location and extent. Existing studies have confirmed that the choice of surgical modality significantly influences postoperative complications and long-term prognosis in patients, highlighting the effectiveness of bypass surgery as a favorable option in clinical practice with a satisfactory long-term patency rate. To mitigate postoperative complications, it is advisable to conduct regular imaging follow-ups to prevent the deterioration of the condition. Notably, the occurrence of restenosis and pseudoaneurysm formation deserves particular attention due to their impact on patient survival. The use of perioperative medication remains a topic of debate, as previous studies have presented divergent perspectives. The primary objective of this review is to provide a comprehensive perspective on surgical treatment and offer customized surgical approaches for patients in this population.

Routine Pediatric Surgical Emergencies: Incidence, Morbidity, and Mortality During the 1st 8000 Days of Life—A Narrative Review

BackgroundMany potentially treatable non-congenital and non-traumatic surgical conditions can occur during the first 8000 days of life and an estimated 85% of children in low- and middle-income countries (LMICs) will develop one before 15 years old. This review summarizes the common routine surgical emergencies in children from LMICs and their effects on morbidity and mortality.MethodsA narrative review was undertaken to assess the epidemiology, treatment, and outcomes of common surgical emergencies that present within the first 8000 days (or 21.9 years) of life in LMICs. Available data on pediatric surgical emergency care in LMICs were aggregated.ResultsOutside of trauma, acute appendicitis, ileal perforation secondary to typhoid fever, and intestinal obstruction from intussusception and hernias continue to be the most common abdominal emergencies among children in LMICs. Musculoskeletal infections also contribute significantly to the surgical burden in children. These “neglected” conditions disproportionally affect children in LMICs and are due to delays in seeking care leading to late presentation and preventable complications. Pediatric surgical emergencies also necessitate heavy resource utilization in LMICs, where healthcare systems are already under strain.ConclusionsDelays in care and resource limitations in LMIC healthcare systems are key contributors to the complicated and emergent presentation of pediatric surgical disease. Timely access to surgery can not only prevent long-term impairments but also preserve the impact of public health interventions and decrease costs in the overall healthcare system.

Disease Recurrence and Long-term Outcomes Following the Development of Intestinal Failure in Crohn's Disease: Over 20 Years of Experience from a National Reference Centre.

Intestinal failure [IF] is a recognised complication of Crohn's disease [CD]. The aim of this study was to identify factors predicting the development and recurrence of CD in patients with IF [CD-IF], and their long-term outcomes. This was a cohort study of adults with CD-IF admitted to a national UK IF reference centre between 2000 and 2021. Patients were followed from discharge with home parenteral nutrition [HPN] until death or February 28, 2021. In all, 124 patients were included; 47 [37.9%] changed disease location and 55 [44.4%] changed disease behaviour between CD and CD-IF diagnosis, with increased upper gastrointestinal involvement [4.0% vs 22.6% patients], p <0.001. Following IF diagnosis, 29/124 [23.4%] patients commenced CD prophylactic medical therapy; 18 [62.1%] had a history of stricturing or penetrating small bowel disease; and nine [31.0%] had ileocolonic phenotype brought back into continuity. The cumulative incidence of disease recurrence was 2.4% at 1 year, 16.3% at 5 years and 27.2% at 10 years; colon-in-continuity and prophylactic treatment were associated with an increased likelihood of disease recurrence. Catheter-related bloodstream infection [CRBSI] rate was 0.32 episodes/1000 catheter days, with no association between medical therapy and CRBSI rate. This is the largest series reporting disease behaviour and long-term outcomes in CD-IF and the first describing prophylactic therapy use. The incidence of disease recurrence was low. Immunosuppressive therapy appears to be safe in HPN-dependent patients with no increased risk of CRBSI. The management of CD-IF needs to be tailored to the patient's surgical disease history alongside disease phenotype.

Nutritional status of patients with hepatobiliary-pancreatic surgical disease

Nutritional status of patients with hepatobiliary-pancreatic surgical disease

Alterations of gut microbiome following gastrointestinal surgical procedures and their potential complications.

Intestinal microorganisms play a crucial role in shaping the host immunity and maintaining homeostasis. Nevertheless, alterations in gut bacterial composition may occur and these alterations have been linked with the pathogenesis of several diseases. In surgical practice, studies revealed that the microbiome of patients undergoing surgery changes and several post-operative complications seem to be associated with the gut microbiota composition. In this review, we aim to provide an overview of gut microbiota (GM) in surgical disease. We refer to several studies which describe alterations of GM in patients undergoing different types of surgery, we focus on the impacts of peri-operative interventions on GM and the role of GM in development of post-operative complications, such as anastomotic leak. The review aims to enhance comprehension regarding the correlation between GM and surgical procedures based in the current knowledge. However, preoperative and postoperative synthesis of GM needs to be further examined in future studies, so that GM-targeted measures could be assessed and the different surgery complications could be reduced.

Immunological indicators of complications of surgical bowel disease in children

The article is devoted to the development of immunological indicators of intestinal inflammation in children, which is of great importance for health authorities when organizing specialized pediatric and surgical services. The proposed method contributes to the early diagnosis and prevention of complications of inflammatory surgical bowel diseases in children, which is of great practical importance. The purpose of the study: To develop immunological indicators of complications of surgical bowel diseases in children. A retrospective analysis of 867 case histories of children who received inpatient treatment at the Department of Pediatric Surgery of the Bukhara branch of the Republican Scientific Center of Emergency Medical Care from 2019 to 2022 for surgical diseases of the gastrointestinal tract was carried out. The authors conducted an immunological study of 91 pediatric patients. All children underwent immunological blood tests: cellular and humoral immunity, cytokines (TNFα, IFNα, IL-8, MCP-1 and vascular endothelial growth factor VEGF-A) were studied. For the prevention of postoperative complications of CKD in children, it is recommended to determine IFNα in the blood serum in the period before surgery to solve the indications for immunocorrection. A noticeable positive relationship was established between IFNα and CD8 – r = 0.34, between IFNα and CD23 – r = 0.38, between IFNα and IgA – r = 0.39, between IFNα and PCT – r = 0.36. At the same time, PCT has a noticeable negative relationship with CD16 – r = -0.31 and with CD8 – r = -0.31 against the background of a noticeable positive relationship with IgG – r = 0.32 and IFNα – r = 0.36. It was found that IFNα is a more informative indicator of the effectiveness of the immune response, and PCT is an indicator of the effectiveness of antibacterial therapy in surgical bowel diseases in children