Molecular detection of Trypanosoma spp. in Lipoptena cervi and Lipoptena fortisetosa (Diptera: Hippoboscidae) and their potential role in the transmission of pathogens.

The family Hippoboscidae is a less known group of blood-sucking flies. Deer ked are particularly important for animal health; they may act as potential vectors of disease to ungulates, and may transmit pathogens to animals and humans. The aim of this study was to investigate the presence of Trypanosoma (Megatrypanum) DNA in deer keds using molecular methods. Results prove the presence of Megatrypanum trypanosome DNA in the studied winged adult deer keds and this is the first detection of this pathogen in Lipoptena fortisetosa. In addition, this paper evidences the occurrence of L. fortisetosa in two new locations: one in the Bialowieza Primeval Forest, and another in the Strzalowo Forest Inspectorate (Piska Forest), both in north-eastern Poland.

Rickettsiales Occurrence and Co-occurrence in Ixodes ricinus Ticks in Natural and Urban Areas.

Bacteria of Rickettsiaceae and Anaplasmataceae families include disease agents spread by Ixodes ricinus ticks, the most common tick vector in Europe. The aim of the study was to compare the prevalence and co-infection prevalence of particular tick-transmitted Rickettsiales members: Rickettsia spp. (further referred as Rs), Anaplasma phagocytophilum (Ap), and "Candidatus Neoehrlichia mikurensis" (CNM) in I. ricinus ticks in two types of areas, different in terms of human impact: natural and urban. Using additional data, we aimed at investigating co-occurrence of these Rickettsiales with Borreliella spp. A total of 4189 tick specimens, 2363 from the urban area (Warsaw park and forests) and 1826 from the natural area (forests and park in the vicinity of National Parks), were tested for the presence of Rickettsiales DNA by PCRs. The prevalence of selected Rickettsiales was twice higher in urban than natural areas (13.2% vs. 6.9%, respectively). In total ticks, the prevalence of Rs, Ap, and CNM was 6.5%, 5.3%, and 3.6% in urban areas vs. 4.4%, 1.1%, and 2.1% in natural areas, respectively. Co-infections of Rickettsiales were also more prevalent in urban areas (2.6% vs. 0.3%, respectively). The most common Rs was R. helvetica; also R. monacensis and novel "Candidatus Rickettsia mendelii" were detected. Positive association between Ap and CNM infections was discovered. Rickettsiales bacteria occurrence was not associated with Borreliella occurrence, but co-infections with these two groups were more common in ticks in urban areas. In conclusion, three groups of Rickettsiales constituted the important part of the tick pathogen community in Poland, especially in the urbanized central Poland (Mazovia). In the Warsaw agglomeration, there is a greater risk of encountering the I. ricinus tick infected with Rickettsiales and co-infected with Lyme spirochaetes, in comparison to natural areas. This finding raises the question whether cities might in fact be the hot spots for TBDs.

Endoscopic treatment of leaks after laparoscopic sleeve gastrectomy using MEGA esophageal covered stents.

BACKGROUND: Sleeve gastrectomy has become one of the main bariatric procedures over the last few years. This can be explained by the relative simplicity and high effectiveness of this method. Yet, it causes complications as any other method. Staple line leaks are the most frequent ones. According to different sources, this complication may occur with 0-7% frequency. Until 2013, surgery was the only effective treatment method for this complication. However, reoperations considerably increased treatment cost and patient morbidity. The aim of this study is to present the possibilities of endoscopic treatment of leaks after laparoscopic sleeve gastrectomy. METHODS: From 2014 to 2016 14, cases of leaks following sleeve gastrectomy were diagnosed in our Department in Lódz. All of them were treated with MEGA stent in order to cover the leak site. Due to severe peritonitis, 3 patients had to undergo surgery prior to implantation of the prosthesis. Another patient underwent an unsuccessful attempt of leak closing via OTSC method prior to implantation of the prosthesis. Patients were nourished from the 3rd day after the surgery. On average, prostheses were removed on the 34th day after the implantation. RESULTS: The leak was fully sealed in 13 out of 14 cases. In 10 cases the leak was fully healed. There were 2 cases of patients' deaths: the result of a multi-organ failure in one case and early esophageal perforation in the other one. The overall success rate was 90.9%. CONCLUSION: Sealing leaks occurring after sleeve gastrectomy with MEGA stents represent an effective method and should become the technique of choice.

A comparison of performance of endotracheal intubation using the Levitan FPS optical stylet or Lary-Flex videolaryngoscope in morbidly obese patients.

INTRODUCTION: The use of videolaryngoscopes is recommended for morbidly obese patients. The aim of the study was to evaluate the Levitan FPS optical stylet (Levitan) vs Lafy-Flex videolaryngoscope (Lary-Flex) in a group of MO patients. METHODS: Seventy-nine MO (BMI > 40 kg m(-2)) patients scheduled for bariatric surgery were included in the study and randomly allocated to the Levitan FPS or Lary-Flex group. The primary endpoint was time to intubation and evaluation laryngoscopic of glottic view. Anesthesiologists were asked to evaluate the glottic view first under direct laryngoscopy using the videolaryngoscope as a standard laryngoscope (monitor display was excluded from use) and then using devices. The secondary endpoint was the cardiovascular response to intubation and the participant's evaluation of such devices. RESULTS: The time to intubation was 8.572.66 sec. versus 5.790.2 sec. for Levitan and Lary-Flex, respectively (P < 0.05). In all cases of CL grade >1 under direct laryngoscopy, the study devices improved CL grade to 1. The Levitan FPS produced a greater cardiovascular response than the Lary-Flex videolaryngoscope. CONCLUSION: The Lary-Flex videolaryngoscope and the Levitan FPS optical stylet improve the laryngeal visualization in morbidly obese patients, allowing for fast endotracheal intubation, but Lary-Flex produces less cardiovascular response to intubation attempt.

Selected factors affecting the rate of reduction of body weight components during the first six months after bariatric surgery: A cohort study.

<b><br>Aim:</b> To determine whether the rate of slimming following bariatric surgery depends on the sex, type of bariatric surgery, time elapsed since surgery or body weight components.</br> <b><br>Materials and methods:</b> The material is comprised of the results of three series of anthropometric measurements in 91 obese patients (before bariatric surgery, about 3 months after bariatric surgery and about 6 months afterwards). The inclusion criteria were patients of Polish origin admitted to the hospital from July 1, 2017 to January 31, 2019 for surgical treatment of obesity and written consent for the surgery and participation in the study. The measurements included body weight components assessed by bioelectrical impedance analysis.</br> <b><br>Results:</b> The reduction of all features was greater after SG than GB (p<0.0001), greater in the first quartile than in the second quartile after surgery (p<0.0001), and higher for fat mass than for other body weight components (p<0.0001). The sex of the patients, type of bariatric surgery, time elapsed since the operation, and type of body weight component constituted interactive modifiers of the rate of reduction.</br> <b><br>Conclusion:</b> After bariatric surgery, the reduction of fat mass was quicker in men than in women. SG and RYGB lead to a greater reduction of fat mass than GB. Among all three analyzed procedures, only for SG did the rate of body weight component reduction not decrease in the second quartile after surgery. This finding should be taken into account when creating an algorithm for treating a patient after bariatric surgery</br>.

The 2D:4D index is associated with the development of excess body weight in adults, but not with the rate of weight loss following bariatric surgery.

2D:4D finger length ratio is a proxy of prenatal sex hormone exposure. Prenatal testosterone decreases and prenatal estrogens increase this index. In the current study we investigated whether the 2D:4D index, as a marker of the prenatal hormonal environment, is associated with the development of overweight and obesity in adults, and whether is it correlated with the rate of weight loss in patients after bariatric surgery. We tested 125 adults with obesity (BMI ≥ 30.0 kg/m2), 125 adults with overweight (BMI 25.0-29.9 kg/m2) and 153 persons with normal body weight (BMI < 25 kg/m2) of both sexes. We have found that the development of excessive body weight in men and women, and fat accumulation in the upper arms, thighs and lower legs in women with obesity (but not men) are associated with increased prenatal estrogen exposure. This relationship indicates a new area of activity in the field of obesity prevention. Moreover, it seems that the 2D:4D index (especially of the right hand) may be a useful factor in early prediction of the risk of developing excessive body weight in humans. The rate of weight loss after bariatric surgery is independent of prenatal exposure to sex hormones.

The New Haplotypes of Bartonella spp. and Borrelia burgdorferi Sensu Lato Identified in Lipoptena spp. (Diptera: Hippoboscidae) Collected in the Areas of North-Eastern Poland.

Deer keds are hematophagous ectoparasites (Diptera: Hippoboscidae) that mainly parasitize Cervidae. These flies are particularly important for animal health due to the occurrence of numerous pathogenic microorganisms. They may also attack humans and their bites may cause allergenic symptoms. The aim of the study was to identify the molecular characteristics of Borrelia burgdorferi sensu lato and Bartonella spp. pathogens detected in Lipoptena spp. sampled both from the hosts and from the environment. For identification of Bartonella spp and B. burgdorferi s. l., the primers specific to the rpoB and flaB gene fragments were used, respectively. The overall prevalence of B. burgdorferi s.l. DNA in Lipoptena cervi was 14.04%, including 14.8% infection in the tested group of winged specimens. The overall prevalence of Bartonella spp. was 57.02%. The presence of these bacteria was detected in 53.5% of specimens of L. cervi and 75.7% of L. fortisetosa. The phylogenetic analysis showed five new haplotypes of the rpoB gene of Bartonella sp. isolated from L. cervi/Lipoptena fortisetosa. We also identified one new haplotype of B. afzelii and three haplotypes of B. burgdorferi isolated from winged specimens of L. cervi. This is the first study to detect the genetic material of B. burgdorferi s.l. in L. cervi in Poland and the first report on the identification of these bacteria in host-seeking specimens in the environment.

Molecular Detection of Bartonella spp. in Rodents in Chernobyl Exclusion Zone, Ukraine.

PURPOSE: Bacteria of the genus Bartonella are obligate parasites of vertebrates. Their distribution range covers almost the entire world, from the Americas to Europe and Asia. Many Bartonella species use rodents as reservoirs, and while much is known about Bartonella infection of rodents in central Europe, its extent is poorly understood in Eastern Europe. METHODS: The present study examines five rodent species (Apodemus flavicollis, Myodes glareolus, Microtus arvalis, Apodemus agrarius, Apodemus sylvaticus) in the Chernobyl Exclusion Zone in Ukraine. Total of 36 small mammals were captured in September 2017. RESULTS: The overall prevalence of Bartonella spp. was 38.9% (14/36) in rodents. Obtained four sequences from Apodemus flavicollis, were identical to Bartonella grahamii and B. taylorii. CONCLUSION: This is the first report to confirm the presence of Bartonella spp. in rodents in the Chernobyl Exclusion Zone, Ukraine by molecular methods. The sequences show similarity to Bartonella strains occurring in Europe.

Effect of Metal Lathe Waste Addition on the Mechanical and Thermal Properties of Concrete.

The amount of steel chips generated by lathes and CNC machines is 1200 million tons per year, and they are difficult to recycle. The effect of adding steel chips without pre-cleaning (covered with production lubricants and cooling oils) on the properties of concrete was investigated. Steel waste was added as a replacement for fine aggregate in the amounts of 5%, 10% and 15% of the cement weight, which correspond with 1.1%, 2.2% and 3.3% mass of all ingredients and 0.33%, 0.66% and 0.99% volume of concrete mix, respectively. The slump cone, air content, pH value, density, compressive strength, tensile strength, tensile splitting strength, elastic modulus, Poisson's ratio and thermal parameters were tested. It was observed that with the addition of lathe waste, the density decreased, but mechanical properties increased. With the addition of 5%, 10% and 15% metal chips, compressive strength increased by 13.9%, 20.8% and 36.3% respectively compared to plain concrete; flexural strength by 7.1%, 12.7% and 18.2%; and tensile splitting strength by 4.2%, 33.2% and 38.4%. Moreover, it was determined that with addition of steel chips, thermal diffusivity was reduced and specific heat capacity increased. With the addition of 15% metal chips, thermal diffusivity was 25.2% lower than in the reference sample, while specific heat was 23.0% higher. No effect was observed on thermal conductivity.

The role of sheep ked (Melophagus ovinus) as potential vector of protozoa and bacterial pathogens.

The sheep ked (Melophagus ovinus) hematophagous insect may act as a potential vector of vector-borne pathogens. The aim of this study was to detect the presence of Trypanosoma spp., Bartonella spp., Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato in sheep ked collected from sheep in Poland. In total, Trypanosoma spp. was detected in 58.91% of M. ovinus, whereas Bartonella spp. and B. burgdorferi s.l. were found in 86.82% and 1.55% of the studied insects, respectively. A. phagocytophilum was not detected in the studied material. In turn, co-infection by Trypanosoma spp. and Bartonella spp. was detected in 50.39%, while co-infection with Trypanosoma spp. and Bartonella spp. and B. burgdorferi s.l. was found in 1.55% of the studied insects. The conducted study showed for the first time the presence of B. burgdorferi s. l. in M. ovinus, as well as for the first time in Poland the presence of Trypanosoma spp. and Bartonella spp. The obtained results suggest that these insects may be a potential vector for these pathogens, but further-more detailed studies are required.

Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Bariatric and metabolic surgery care standards.

The Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons (Polish acronym: SCMiB TCHP) is a Polish specialist scientific society representing bariatric surgeons as well as specialists from other disciplines and professions cooperating with them during the provision of services in the field of bariatric and metabolic surgery, as well as the entire care process before and after surgery. The following standards constitute the minimum requirements set by the SCMiB TCHP for good practice of the basic process of bariatric care throughout its entire period, which ensure satisfactory safety and effectiveness of the obesity treatment and its metabolic complications.

Molecular detection of Anaplasma phagocytophilum in wild carnivores in north-eastern Poland.

BACKGROUND: Anaplasma phagocytophilum is an obligate parasitic intracellular bacterium. It is the causative agent of granulocytic anaplasmosis, with effects on human and animal health. In Europe, the pathogen is mainly transmitted among a wide range of vertebrate hosts by blood-sucking arthropods. The aim of this study was to determine the presence of A. phagocytophilum in wild carnivores, viz raccoon dogs (Nyctereutes procyonoides), badgers (Meles meles), foxes (Vulpes vulpes), martens (Martes sp.) and European polecats (Mustela putorius), using molecular methods. METHODS: In the present study, 174 spleen samples were collected from adult, wild carnivores hunted in the years 2013-2016. A short fragment (383 bp) of the 16S ribosomal RNA gene partial sequence was used as a marker to identify A. phagocytophilum in spleen samples collected from carnivores using nested PCR. RESULTS: The prevalence of A. phagocytophilum in wild carnivores was 31.61% (55/174). Seven sequences of A. phagocytophilum were generated from two raccoon dogs, two badgers, one marten, one red fox and one European polecat. Six identical nucleotide sequences were obtained from one raccoon dog, two badgers, one marten, one red fox and one European polecat (A. phagocytophilum sequences 1: MH328205-MH328209, MH328211), and these were identical to many A. phagocytophilum sequences in the GenBank database (100% similarity). The second sequence (A. phagocytophilum sequence 2: MH328210) obtained from the raccoon dog shared 99.74% identity with A. phagocytophilum sequence 1. CONCLUSIONS: To our knowledge, this is the first study to use molecular methods to determine the presence of A. phagocytophilum in wild carnivores, viz raccoon dog, badger, marten and European polecat, in Poland. The detected A. phagocytophilum sequences (1 and 2) were closely related with those of A. phagocytophilum occurring in a wide range of wild and domestic animals and vectors.

Molecular Detection of Anaplasma phagocytophilum in Blood-Sucking Flies (Diptera: Tabanidae) in Poland.

Anaplasma phagocytophilum is a pathogen of veterinary and medical importance. It is the causative agent of tick-borne fever (TBF) in ruminants (also known as bovine or ovine granulocytic anaplasmosis), and of human granulocytic anaplasmosis (HGA) in humans. In Europe, A. phagocytophilum is transmitted by Ixodes ricinus (Linnaeus 1758) ticks. The aim of this study was to confirm the presence of A. phagocytophilum DNA in blood-sucking flies belonging to the Tabanidae family using molecular methods. It represents the first detection of this pathogen in Haematopota pluvialis (Linnaeus 1758), Tabanus bromius (Linnaeus 1758), and Tabanus distinguendus (Verrall 1909) in Europe.

The Competition Between Immatures of Ixodes ricinus and Dermacentor reticulatus (Ixodida: Ixodidae) Ticks for Rodent Hosts.

The numbers of Ixodes ricinus (L.) and Dermacentor reticulatus (Fabricius) larvae and nymphs attached to small mammals are influenced by interspecific competition. The present study analyses data collected over several years in two study areas: Kosewo Górne (Mazurian District, N Poland; between July 1997 and July 2009) and Bialowieza Primeval Forest (E Poland; in July 2007). In total, 975 ticks were collected from striped field mice (Apodemus agrarius), yellow-necked mice (A. flavicollis), bank voles (Myodes glareolus), and root voles (Microtus oeconomus). In total, of the 203 investigated rodents, 137 were infested with ticks and 39 demonstrated mixed infection. The numbers of the two tick species found on Apodemus mice were significantly negatively correlated with those on root voles; similarly, although bank voles were significantly more frequently infested by I. ricinus than by D. reticulatus, the reverse was observed in root voles. In addition, among the voles, each tick species was found in different locations on the host body, which could also result from competitive interactions; furthermore, competitive release regarding microhabitat selection was observed on hosts infested with one tick species. This competition may be driven by the limited area of host body available for foraging by ticks, i.e., safe areas of high vascularization covered by thin skin. However, the mechanisms of such competition require further investigation.

The role of particular ticks developmental stages in the circulation of tick-borne pathogens in Central Europe. 5. Borreliaceae

The developmental cycles of all B. burgdorferi s.l. genospecies present typical, main pattern described in the 90thies. The simple scheme might be modified according to the biology of species and hosts preference. Central European genospecies of B. burgdorferi s.l. can be associated with four groups of hosts playing the role of animal reservoirs. The group 1 contains genospecies associated with rodents as primary animal reservoir ­ B. afzelii, B. garinii, B. burgdorferi sensu stricto, strains B. bavariensis (B. garinii OspA serotype 4). The group 2 involves B. valaisiana and most of B. garinii strains, associated with birds. The group 3 involves B. spielmanii, the reservoir hosts are Gliridae, and hedgehogs. The group 4 includes B. lusitaniae, the hosts are lizards. B. miyamotoi enzootic cycle seems to be similar to B. burgdorferi complex, however, differs by the transovarial transmission possibility. The divisions are not extreme; in the hosts group, infected with appropriate Borrelia genospecies, very often are found the specimens infected with other genospecies.

The role of particular ticks developmental stages in the circulation of tick-borne pathogens in Central Europe. 6. Babesia.

In the Central European conditions, three species of Babesia have epidemiological significance as human pathogens ­ Babesia divergens, B. microti and B. venatorum. Tick Ixodes ricinus is considered as their main vector, wild mammals as the animal reservoir. The zoonotic cycles of small and large Babesia differ in details. Due to the lack of transovarial mode transmission in small species B. microti, the circulation goes mainly between immature ticks and vertebrate hosts; pathogen circulates primarily in the cycle: infected rodent → the tick larva → the nymph → the mammal reservoir →the larva of the tick. The tick stages able to effectively infect human are nymphs and adult females, males do not participate in the follow transmission. For large Babesia ­ B. divergens and B. venatorum, the transovarial and transstadial transmission enable the presence of the agent in adult ticks, moreover, that larvae and nymphs feed on not-susceptible hosts. The tick stages able to effectively infect cattle and other ruminants are adult females. Resuming, pathogen circulates primarily in the cycle the ruminant host ­ adult female tick ­ the larva ­ the nymph ­ adult female of the next generation ­ the ruminant. Due to the compound developmental transmission has place after the outflow of a tick began feeding.

[Laparoscopic cholecystectomy for acute cholecystitis]. / Przydatnosc techniki laparoskopowej w leczeniu ostrego zapalenia pecherzyka zólciowego.

UNLABELLED: Laparoscopic cholecystectomy is considered the "gold standard" for the planned treatment of symptomatic cholecystolithiasis. Currently this method is used in 88% of cholecystectomy according to world database. There are evidences that laparoscopic cholecystectomy for acute cholecystitis is a quite safe method which is not connected with many complications. AIM OF THE STUDY: Assessment of the post-operative complication risk and hospitalization time in cases of acute cholecystitis had undergone laparoscopic cholecystectomy in comparison with classic cholecystectomy. Evaluation of non-specific inflammation process based on C-reactive protein (CRP) levels in patients' serum analysis. MATERIAL AND METHODS: Eighty patients (58 women and 22 men) aged 22-74 (mean 53.6) were included to the study. They were undergone cholecystectomy in the Department of Gastroenterological, Oncological and General Surgery because of acute cholecystitis. There were two groups of patients: 38 patients who underwent laparoscopic cholecystectomy (group I) and 42 patients who underwent "classic" cholecystectomy (group II). No statistical differences of clinical and demographic characteristics were found in the studied groups. There was also the third group of patients distinguished in the study - the control group of 42 patients who underwent "planned" laparoscopic cholecystectomy because of chronic cholecystolithiasis. The patients were qualified for the groups I and II in accordance with randomization rule. The CRP-level of the patients' serum was evaluated in the group I and II twice: before and in the 2nd day after cholecystectomy. RESULTS: The mean operating time was significantly shorter in the group I (laparoscopic cholecystectomy) compared with the group II ("open" cholecystectomy) 63.24 and 86.31 minutes respectively (p < 0.05) and 58 minutes in the control group. The mean period of hospital stay was also significantly shorter in the group I (4.12 day) compared with the group II (7.19), (p < 0.05), however there was no statistically significant difference between group I and the control group (3.1 day). The level of serum CRP measured before surgery was not significantly different in groups I and II although in the 2nd day after the operation statistically significant difference between studied groups was obtained: patients who were undergone laparoscopy (group I) had a lower level of serum CRP. CONCLUSIONS: Laparoscopic cholecystectomy is a safe method of treatment both acute cholecystitis and chronic cholecystolithiasis.

Slippage-a Significant Problem Following Gastric Banding-a Single Centre Experience.

BACKGROUND: Laparoscopic adjustable gastric banding is a well-established method of morbid obesity treatment. One of the complications is slippage. AIM: The aim of the study was to assess the prevalence, causes, and handling of slippage after LAGB in own material. MATERIAL AND METHODS: There were 740 procedures performed by one surgical team. The patients were selected according to the IFSO principles. The pars flaccida technique was applied and the position of the band was controlled. There was neither plication nor the bands were sutured to the stomach wall. Slippage was recognized during X-ray examination. With these patients, the band was emptied of liquid, gastric endoscopy was performed routinely, and patients were qualified for surgery. RESULTS: The patient group consisted of 500 women and 240 men. The average body weight was 128 kg and BMI 44.60 kg/m2. The slippage was observed in 8.1% cases in 7.03% patients. In 1.08%, slippage occurred twice. The main problems reported by patients were pain, a significant increase of disposable food intake, vomiting, and weight gain. In a small group of patients, these complications were detected incidentally. All patients were treated surgically. In 38.33%, the band repositioning was performed. In 33.33%, a different surgical approach was performed. In the group of reoperated patients, there were no fatal cases or any severe complications. CONCLUSIONS: In conclusion, we believe that slippage is and will continue to be a significant problem in patients with gastric banding. Patient education focused on dietary errors may reduce the incidence of this complication. The grace period between the primary surgery and the redo operation should be applied regarding reoperation.