Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial.

BACKGROUND: There is no consensus regarding the role of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OABP) in reducing postoperative complications in colorectal surgery. The aim of this study was to examine the effect of OABP given in addition to MBP in the setting of a prospective randomized trial. METHODS: Patients awaiting elective colorectal surgery in four Hungarian colorectal centres were included in this multicentre, prospective, randomized, assessor-blinded study. Patients were randomized to receive MBP with or without OABP (OABP+ and OABP- groups respectively). The primary endpoints were surgical-site infection (SSI) and postoperative ileus. Secondary endpoints were anastomotic leak, mortality, and hospital readmission within 30 days. RESULTS: Of 839 patients assessed for eligibility between November 2016 and June 2018, 600 were randomized and 529 were analysed. Trial participation was discontinued owing to adverse events in seven patients in the OABP+ group (2.3 per cent). SSI occurred in eight patients (3.2 per cent) in the OABP+ and 27 (9.8 per cent) in the OABP- group (P = 0.001). The incidence of postoperative ileus did not differ between groups. Anastomotic leakage occurred in four patients (1.6 per cent) in the OABP+ and 13 (4.7 per cent) in the OABP- (P = 0.02) group. There were no differences in hospital readmission (12 (4.7 per cent) versus 10 (3.6 per cent); P = 0.25) or mortality (3 (1.2 per cent) versus 4 (1.4 per cent); P = 0.39). CONCLUSION: OABP given with MBP reduced the rate of SSI and AL after colorectal surgery with anastomosis, therefore routine use of OABP is recommended.

Staying with nursing: the impact of conflictual communication, stress and organizational problem-solving.

AIM: To predict nurses' intent to stay on the job as a function of organizational culture. BACKGROUND: Organizational climate significantly contributes to retention of nurses. Communication by conflict and organizational control over problem-solving has not thoroughly been studied. METHODS: A cross-sectional design was used with a randomly selected final sample of 367 nurses from regional hospitals in Hungary. Organizational climate, perceived stress, locus of control and self-esteem were assessed as main measures. Nurses indicated their intent to stay for the next 5 years. Spearman correlation coefficients were calculated to evaluate associations. Bivariate logistic regression was performed to predict intent to stay in nursing. FINDINGS: Organizational climate was negatively correlated with perceived stress and personal locus of control and positively with personal self-esteem. Organizational level internal locus of control (belief that employees have control over problem-solving) doubled the probability of staying on the job. Conflictual communication and perceived stress both decreased intent to stay by 50%. DISCUSSION AND CONCLUSIONS: Organizational internal locus of control, stress and conflictual communication were main predictors of intent to stay. The belief that nurses had collective control over problem-solving capabilities had a positive and greater impact on nurse retention compared to other measures. IMPLICATION FOR NURSING POLICY: Healthcare organizations should routinely scan workplace culture for conflictual communication, stress and organizational problem-solving capacities. Graduate nurse and nurse manager training should include practices that enable developing positive work atmospheres. Hospital managements should allocate training budget to stimulate and achieve cultural change. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers should promote internal trainings to help staff nurses adopt techniques that minimize conflict and emphasize positive impact of collaborative problem-solving.

Age-Related Changes in Serum Guanidinoacetic Acid in Women.

Guanidinoacetic acid (GAA) is a fundamental intermediate in cellular bioenergetics, with circulating levels of GAA often reflects disturbances in its conversion due to many intrinsic and extrinsic factors, including gender or age. Here, we evaluated serum GAA in 172 healthy women aged 18 to 65 years, with age found to significantly predict serum GAA concentrations (r=0.29; P=0.03). This perhaps nominates serum GAA as a novel gender-specific proxy of impaired bioenergetics with aging.

Expression of dihydropyrimidine dehydrogenase (DPD) and hENT1 predicts survival in pancreatic cancer.

BACKGROUND: Dihydropyrimidine dehydrogenase (DPD) tumour expression may provide added value to human equilibrative nucleoside transporter-1 (hENT1) tumour expression in predicting survival following pyrimidine-based adjuvant chemotherapy. METHODS: DPD and hENT1 immunohistochemistry and scoring was completed on tumour cores from 238 patients with pancreatic cancer in the ESPAC-3(v2) trial, randomised to either postoperative gemcitabine or 5-fluorouracil/folinic acid (5FU/FA). RESULTS: DPD tumour expression was associated with reduced overall survival (hazard ratio, HR = 1.73 [95% confidence interval, CI = 1.21-2.49], p = 0.003). This was significant in the 5FU/FA arm (HR = 2.07 [95% CI = 1.22-3.53], p = 0.007), but not in the gemcitabine arm (HR = 1.47 [0.91-3.37], p = 0.119). High hENT1 tumour expression was associated with increased survival in gemcitabine treated (HR = 0.56 [0.38-0.82], p = 0.003) but not in 5FU/FA treated patients (HR = 1.19 [0.80-1.78], p = 0.390). In patients with low hENT1 tumour expression, high DPD tumour expression was associated with a worse median [95% CI] survival in the 5FU/FA arm (9.7 [5.3-30.4] vs 29.2 [19.5-41.9] months, p = 0.002) but not in the gemcitabine arm (14.0 [9.1-15.7] vs. 18.0 [7.6-15.3] months, p = 1.000). The interaction of treatment arm and DPD expression was not significant (p = 0.303), but the interaction of treatment arm and hENT1 expression was (p = 0.009). CONCLUSION: DPD tumour expression was a negative prognostic biomarker. Together with tumour expression of hENT1, DPD tumour expression defined patient subgroups that might benefit from either postoperative 5FU/FA or gemcitabine.

Intratumoural expression of deoxycytidylate deaminase or ribonuceotide reductase subunit M1 expression are not related to survival in patients with resected pancreatic cancer given adjuvant chemotherapy.

BACKGROUND: Deoxycytidylate deaminase (DCTD) and ribonucleotide reductase subunit M1 (RRM1) are potential prognostic and predictive biomarkers for pyrimidine-based chemotherapy in pancreatic adenocarcinoma. METHODS: Immunohistochemical staining of DCTD and RRM1 was performed on tissue microarrays representing tumour samples from 303 patients in European Study Group for Pancreatic Cancer (ESPAC)-randomised adjuvant trials following pancreatic resection, 272 of whom had received gemcitabine or 5-fluorouracil with folinic acid in ESPAC-3(v2), and 31 patients from the combined ESPAC-3(v1) and ESPAC-1 post-operative pure observational groups. RESULTS: Neither log-rank testing on dichotomised strata or Cox proportional hazard regression showed any relationship of DCTD or RRM1 expression levels to survival overall or by treatment group. CONCLUSIONS: Expression of either DCTD or RRM1 was not prognostic or predictive in patients with pancreatic adenocarcinoma who had had post-operative chemotherapy with either gemcitabine or 5-fluorouracil with folinic acid.

Examination of the interaction of different lighting conditions and chronic mild stress in animal model.

We examined the effects of different shift work schedules and chronic mild stress (CMS) on mood using animal model. The most common international shift work schedules in nursing were applied by three groups of Wistar-rats and a control group with normal light-dark cycle. One subgroup from each group was subjected to CMS. Levels of anxiety and emotional life were evaluated in light-dark box. Differences between the groups according to independent and dependent variables were examined with one- and two-way analysis of variance, with a significance level defined at p < 0.05. Interaction of lighting regimen and CMS was proved to be significant according to time spent in the light compartment and the average number of changes between the light and dark compartments. Results of our examination confirm that the changes of lighting conditions evocate anxiety more prominently than CMS. No significant differences were found between the results of the low rotating group and the control group, supposing that this schedule is the least harmful to health. Our results on the association between the use of lighting regimens and the level of CMS provide evidence that the fast rotating shift work schedule puts the heaviest load on the organism of animals.

Surgical Aspects of Intraductal Papillary Mucinous Neoplasms of the Pancreas.

Intraductal papillary mucinous neoplasms (IPMN) play an important role mongst exocrine tumours of the pancreas due to several causes. Although they count for only 1% of all the tumours, they represent some 20-30% of all cystic neoplasms, a histologically defined group that has gained a lot of attention lately. IPMNs of the main or the secondary (branch) pancreatic ducts have remarkably different rates of malignant transformation, prognosis and thus indication for surgery. Prognosis of a ductal carcinoma developing from IPMN does not differ from classic ductal adenocarcinoma, with a very poor (10%) 5-year survival rate. However, prognosis of IPMN can still be regarded favourable, because the above rate can be as high as 70% if the tumour is non-invasive. This fact leads to the importance of diagnosing and resecting IPMN before its malignant transformation into an invasive carcinoma.

A comparative study on dyslipidaemia inducing diets in various rat strains.

In our experiments we compared the serum lipoprotein lipid composition of Fischer 344 (F344) and Long-Evans (LE) inbred rats as well as of their hybrid FLF(1) from both sexes after feeding them for 2, 4 and 8 weeks with different diets. The following diets were used: 1) standard diet marked as CRLT/N; 2) diet reach in butter marked as BR; 3) diet containing cholesterol, sodium cholate and methylthiouracil marked as CR; 4) diet marked as BRC, which is the Hartroft-Sós diet modified by our research group consisting of the diets BR and CR. The latter diet was the most effective, because within two weeks the level of serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triglyceride in the F344 female rats increased 8, 30, 4 and 8 times, respectively. The male rats of the Long-Evans strain showed moderately increased values while the FLF(1) female hybrids derived from the hybridization of LE males and F344 females had values closer to those of the mother strain. Despite the fact that during this time the LDL/HDL ratio increased from 0.06 to 2.97 and the PON-1 activity decreased to one-third, a significant lipid deposition could not be shown in the wall of the abdominal aorta even two months later. Our experimental model is suitable for the chemoprevention of dyslipidaemia or rapid testing of molecules chosen for its treatment.

Predicting acute viral hepatitis serum markers (A and E) in patients with suspected acute viral hepatitis attending primary health care centers in Baghdad: a one year cross-sectional study.

BACKGROUND: Viral hepatitis is an important preventable infectious disease with various rates of occurrence in different areas of the world. The main objective of the present study was to evaluate the role of some risk factors in predicting a positive acute viral hepatitis marker among patients with suspected acute viral hepatitis in a primary health care setting in Baghdad. Besides, finding out the occurrence of jaundice, contribution of viruses A and E to the cases that have occurred in Baghdad province was also searched for. METHODS: Over a period of 1 year a descriptive cross sectional study was carried out at the primary health care centers in Baghdad. A questionnaire form was used to collect data about demographic factors and the results of the investigations. Total serum bilirubin and bilirubin in urine were done at the primary health care center laboratory. The rest of the sera samples were sent to Hepatitis referral Lab at Central Public Health Laboratory (CPHL) to be tested for anti HAV IgM and anti HEV IgM using ELISA technique. RESULTS: A total of 7,576,372 consultations to primary health care centers were recorded in Baghdad. Among those a total of 2,692 cases (35.5 per 100,000 consultations) were labeled as acute viral hepatitis cases. A positive hepatitis viral marker (A, B, C and E) was found in 1,332 cases (17.6 per 100,000 consultations). More than two fifths (44.8%) of cases were positive for anti-HAV antibodies and another 1.6% had positive anti-HEV antibodies. CONCLUSION: During 1 year period, the rate of occurrence of suspected acute viral hepatitis cases was 35.5 per 100000 of consultations to the primary health care centers in Baghdad. Of the total suspected cases, only 17.6 per 100000 of the consultations were positive for one of the viral hepatitis markers. Those who tested positive for one of the viral hepatitis markers represent 49.5% of the suspected cases. Proportion of anti HAV IgM positive tests among suspected cases was 44.8%. Factors that were able to predict positive Anti HAV IgM were (younger age group, negative history of cupping or tattooing, negative past history of jaundice). Male gender was the least important predictor of a positive case for anti HAV IgM. Proportion of Anti HEV IgM positive tests among suspected cases was 1.6%. Of the factors studied, only age was able to predict a positive Anti HEV IgM in those more than 15 years. Further studies are recommended.