Наукові праці. Кафедра хірургії № 2
Permanent URI for this collectionhttps://repo.knmu.edu.ua/handle/123456789/338
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Item The role of extracellular vesicles and genotypic characterization in antibiotic resistance formation of clinical Staphylococcus aureus isolates in causative flora of patients with diabetic foot syndrome(2024) Gramatiuk, Svetlana; Kryvoruchko, Igor; Криворучко, Ігор Андрійвоич; Sartelli, Massimo; Ivanova, Yuliya; Іванова, Юлія Володимирівна; Noebauer-Babenko, MariaIt has been suggested that defense against macroorganism immune factors is carried out by forming membrane vesicles with lytic action on Gram-positive bacteria, which in turn may cause antibiotic resistance in microorganisms. Staphylococcus aureus (S. aureus) is a common pathogen causing diabetic foot syndrome (DFS). We described antibiotic resistance and the role of lytic vesicles as antibiotic resistance factors in cultures of S. aureus isolates and S. aureus reference strains. Moreover, we used Bacillus subtilis (B. subtilis) to determine the lytic effect of vesicles in 36 patients of different ages with ischaemic and mixed forms of DFS. As a result of this study, we found that membrane vesicles have a lytic effect, with lysis zones forming both around vesicles of reference strains of S. aureus and their clinical isolates and around vesicles of reference strains of B. subtilis. Among genes encoding resistance to various antibiotics, blaCTX-M-2 were detected in 16.7% of clinical strains, Erm and Tet genes in 11.1%, Mec-1 in 5.5%, VanA and VanB genes in 5.5%. Plasmid-mediated quinoloneresistance genes qnrB were also detected in 5.5% of strains. Meanwhile, multiple resistance was detected in 11.1% of clinical strains of S. aureus. Further studies should analyze the contribution of the described genes to adhesion and membrane vesicle formation and their significance in the pathogenesis of wound healing in patients with DFS and wounds and infections of other origins.Item Diagnosis of intra-abdominal infections(2024) Kryvoruchko, Igor; Криворучко, Ігор Андрійвоич; Usenko, O.; Lurin, Igor; Ivanova, YuliyaItem The effect of pulsed photobiomodulation on proliferation and migration of human mesenchymal stem cells in vitro(2024) Ivanova, Yuliya; Gramatiuk, Svetlana; Kryvoruchko, Igor; Криворучко, Ігор Андрійвоич; Prasol, Vitalii; Pulyaeva, Inna; Miasoiedov, K.; Viun, SerhiiAim. To experimentally study the effect of light of different ranges on the proliferation and migration of mesenchymal stem cells of human MSCs and to select its optimal parameters for treatment. Materials and methods. The experiment was conducted in vitro on 260 cultures of human MSCs isolated from peripheral blood by magnetic separation. Cells were treated with pulsed LED light: 475 nm, 516 nm, 635 nm or left nstimulated. All LED devices had a peak radiation intensity of 80 mW/cm2. The average radiation intensity reached 40 mW/cm2. Irradiation was carried out at room temperature for 10 minutes at a distance of 2 cm from the cells. Cells embedded in a 2D fibrin gel matrix to study cell proliferation and a 3D fibrin gel matrix to study cell migration were studied. Hereby, cells used for 2D experiments were stimulated on day 0, while cells embedded in 3D arrays were stimulated on day 0 and then every 24 h until quantification. The effect of different wavelengths on both proliferation and cellular metabolic activity of MSCs from peripheral blood was evaluated after initial light treatment at 24 hours, 48 hours and 72 hours. Results. During the first 48 hours after stimulation, cells proliferated in all studied groups (stimulated and non-stimulated). At the same time, there were no significant differences between the groups at 24 hours and 48 hours. For 2D experiments, cells were stimulated only on day 0, whereas for 3D experiments, stimulation was performed every 24 h. Quantification of cells migrating into the surrounding fibrin gel matrix showed that red and green light stimulation significantly affected 3D migration after 4 days. Irradiation with blue light had no significant effect on migration. Conclusions. Thus, exposure of MSCs to red and green light increases cell proliferation in 2D and 3D environments, while exposure to blue light decreases their metabolic activity. In our opinion, this fact should be used to modernize laboratory equipment and improve treatment regimens for patients using MSCs. Further research on the influence of light on the differentiation of MSCs is promising.Item Pancreatic pseudocyst: The past, the present, and the future(2024) Koo, J.; Liau, M.; Kryvoruchko, Igor; Криворучко, Ігор Андрійвоич; Habeeb, T.; Chia, C.; Shelat, V.A pancreatic pseudocyst is defined as an encapsulated fluid collection with a welldefined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.Item Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper(2024) Coccolini, Federico; Shander, Aryeh; Ceresoli, Marco; Moore, Ernest E.; Tian, Brian; Parini, Dario; Kryvoruchko, Igor; Криворучко, Ігор АндрійовичEmergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.Item Knowledge, attitudes and practices of using Indocyanine Green (ICG) fluorescence in emergency surgery: an international web‑based survey in the ARtificial Intelligence in Emergency and trauma Surgery (ARIES)—WSES project(2024) De, Simone Belinda; Abu‑Zidan, Fikri M.; Saeidi, Sara; Deeken, Genevieve; Biffl, Walter L.; Moore, Ernest E.; Kryvoruchko, Igor; Криворучко, Ігор АндрійовичFluorescence imaging is a real-time intraoperative navigation modality to enhance surgical vision and it can guide emergency surgeons while performing difficult, high-risk surgical procedures. The aim of this study is to assess current knowledge, attitudes, and practices of emergency surgeons in the use of indocyanine green (ICG) in emergency settings. Between March 08, 2023 and April 10, 2023, a questionnaire composed of 27 multiple choice and open-ended questions was sent to 200 emergency surgeons who had previously joined the ARtificial Intelligence in Emergency and trauma Surgery (ARIES) project promoted by the WSES. The questionnaire was developed by an emergency surgeon with an interest in advanced technologies and artificial intelligence. The response rate was 96% (192/200). Responders affirmed that ICG fluorescence can support the performance of difficult surgical procedures in the emergency setting, particularly in the presence of severe inflammation and in evaluating bowel viability. Nevertheless, there were concerns regarding accessibility and availability of fluorescence imaging in emergency settings. Eighty-seven out of 192 (45.3%) respondents have a fluorescence imaging system of vision for both elective and emergency surgical procedures; 32.3% of respondents have this system solely for elective procedures; 21.4% of respondents do not have this system, 15% do not have experience with it, and 38% do not use this imaging in emergency surgery. Less than 1% (2/192) affirmed that ICG fluorescence changed always their intraoperative decision-making. Precision surgery effectively tailors surgical interventions to individual patient characteristics using advanced technology, data analysis and artificial intelligence. ICG fluorescence can serve as a valid and safe tool to guide emergency surgery in different scenarios, such as intestinal ischemia and severe acute cholecystitis. Due to the lack of highlevel evidence within this field, a consensus of expert emergency surgeons is needed to encourage stakeholders to increase the availability of fluorescence imaging systems and to support emergency surgeons in implementing ICG fluorescence in their daily practice.Item Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation(2024) Dal, Mas Francesca; Cobianch, Lorenzo; Piccolo, Daniele; Balch, Jeremy; Biancuzzi, Helena; Biffl, Walter L.; Kryvoruchko, Igor; Криворучко, Ігор АндрійовичBackground. The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision making. The study investigates trauma and emergency surgeons’ perception, acceptance, and employment of environmentally friendly habits. Methods. An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society’s website and Twitter/X profile. Results. 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care. Discussion. The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.Item Side‑specific factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study(2024) Tamer, A. A. M. Habeeb; Marta, Araujo‑Castro; Massimo, Chiaretti; Mauro, Podda; Alberto, Aiolfi; Kryvoruchko, I.; Криворучко, Ігор АндрійовичBackground. Adrenalectomy for pheochromocytoma (PHEO) is challenging because of the high risk of intraoperative hemodynamic instability (HDI). This study aimed to compare the incidence and risk factors of intraoperative HDI between laparoscopic left adrenalectomy (LLA) and laparoscopic right adrenalectomy (LRA). Methods. We retrospectively analyzed two hundred and seventy-one patients aged > 18 years with unilateral benign PHEO of any size who underwent transperitoneal laparoscopic adrenalectomy at our hospitals between September 2016 and September 2023. Patients were divided into LRA (N = 122) and LLA (N = 149) groups. Univariate and multivariate logistic regression analyses were used to predict intraoperative HDI. In multivariate analysis for the prediction of HDI, right-sided PHEO, PHEO size, preoperative comorbidities, and preoperative systolic blood pressure were included. Results. Intraoperative HDI was significantly higher in the LRA group than in the LLA (27% vs. 9.4%, p < 0.001). In the multivariate regression analysis, right-sided tumours showed a higher risk of intraoperative HDI (odds ratio [OR] 5.625, 95% confidence interval [CI], 1.147–27.577, p = 0.033). The tumor size (OR 11.019, 95% CI 3.996–30.38, p < 0.001), presence of preoperative comorbidities [diabetes mellitus, hypertension, and coronary heart disease] (OR 7.918, 95% CI 1.323–47.412, p = 0.023), and preoperative systolic blood pressure (OR 1.265, 95% CI 1.07–1.495, p = 0.006) were associated with a higher risk of HDI in both LRA and LLA, with no superiority of one side over the other. Conclusion. LRA was associated with a significantly higher intraoperative HDI than LLA. Right-sided PHEO was a risk factor for intraoperative HDI.Item Surgical antibiotic prophylaxis: a proposal for a global evidence-based bundle(2024) Sartelli, Massimo; Coccolini, Federico; Labricciosa, Francesco; Al Omari AbdelKarim; Bains, Lovenish; Kryvoruchko, Igor; Криворучко, Ігор АндрійовичIn the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean–contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.Item Side‑specifc factors for intraoperative hemodynamic instability in laparoscopic adrenalectomy for pheochromocytoma: a comparative study(2024-07-01) Habeeb Tamer, A. A. M.; Araujo-Castro, Marta; Chiaretti, Massimo; Podda, Mauro; Kryvoruchko, Igor