Who would benefit from open abdomen in severe acute pancreatitis?—a matched case-control study

Background Selection of patients for open abdomen (OA) treatment in severe acute pancreatitis (SAP) is challenging. Treatment related morbidity and risk of adverse events are high; however, refractory abdominal compartment syndrome (ACS) is potentially lethal. Factors influencing the decision to initiate OA treatment are clinically important. We aimed to study these factors to help understand what influences the selection of patients for OA treatment in SAP. Methods A single center study of patients with SAP that underwent OA treatment compared with conservatively treated matched controls. Results Within study period, 47 patients treated with OA were matched in a 1:1 fashion with conservatively treated control patients. Urinary output under 20 ml/h (OR 5.0 95% CI 1.8-13.7) and ACS (OR 4.6 95% CI 1.4-15.2) independently associated with OA treatment. Patients with OA treatment had significantly more often visceral ischemia (34%) than controls (6%), P = 0.002. Mortality among patients with visceral ischemia was 63%. Clinically meaningful parameters predicting developing ischemia were not found. OA treatment associated with higher overall 90-day mortality rate (43% vs 17%, P = 0.012) and increased need for necrosectomy (55% vs 21%, P = 0.001). Delayed primary fascial closure was achieved in 33 (97%) patients that survived past OA treatment. Conclusion Decreased urine output and ACS were independently associated with the choice of OA treatment in patients with SAP. Underlying visceral ischemia was strikingly common in patients undergoing OA treatment, but predicting ischemia in these patients seems difficult.

The globalization in highlights: achievements and genetic risks

Aim. A large-scale selection is based on the use of modern achievements of population genetics, creation of automatic informative systems with the help of electronic counting equipment, modelling and optimization of the selecting programs on EOM and modern biological technologies of recreation of animals. Centralization of selecting work enables to conduct genetic development of large number of dairy cattle within separate breeds with the effective use of achievements of practical selection in separate herds. Methods. In the conditions of large-scale selection the combination of pedigree, reproductive and marketable herds takes place in the only selective process. The aim of selective program is to transfer the selective achievements from the active part of the breed to the whole herd of the population. In terms of implementation of large-scale selection system there is a problem of optimal amount of lines in the population of separate breeds. There are three lines and three genealogical groups in the Holstein breed (more than 10 ml cows). Due to F.F. Eysner (1986), to conduct effective selective work in the breeds of narrow natural habitat of distribution it is necessary to have 6-8 lines and for wide natural habitat – not less than 15–20 lines. Results. Reduction of factory lines and genealogical groups in Holstein breed leads to reduction of genetic variety and unsystematic use of sperm of male-leaders results in the family mating. Moreover if males with their own genes and genes of their cubs in genotype are used, the frequency of genetic anomalies in pedigree population increases very fast. Conclusions. The work with the use of male-producers must be conducted under permanent genetic control. All males and their female cubs selected for the experiment must be identified according to the factors of blood types. Besides, male-producer leaders must be checked to determine if they have anomalies in chromosomes and lethal factors in perspective. Intensive use of male-improvers, estimated by their cubs is the base for effective large-scale selection of dairy cattle breed. Keywords: large-scale selection, breed, line, genotype, chromosome anomalies.

In vivo dynamics of active edema and lethal factors during anthrax

Lethal and edema toxins are critical virulence factors of Bacillus anthracis. However, little is known about their in vivo dynamics of production during anthrax. In this study, we unraveled for the first time the in vivo kinetics of production of the toxin components EF (edema factor) and LF (lethal factor) during cutaneous infection with a wild-type toxinogenic encapsulated strain in immuno-competent mice. We stratified the asynchronous infection process into defined stages through bioluminescence imaging (BLI), while exploiting sensitive quantitative methods by measuring the enzymatic activity of LF and EF. LF was produced in high amounts, while EF amounts steadily increased during the infectious process. This led to high LF/EF ratios throughout the infection, with variations between 50 to a few thousands. In the bloodstream, the early detection of active LF and EF despite the absence of bacteria suggests that they may exert long distance effects. Infection with a strain deficient in the protective antigen toxin component enabled to address its role in the diffusion of LF and EF within the host. Our data provide a picture of the in vivo complexity of the infectious process.