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The healing process of telescopic anastomoses was found in an animal experiment with 12 mongrel dogs. After the division of vessels an ileal segment of different length was invaginated into the lumen of the colon using single-layer interrupted sutures. The following four groups were used: Group A (n = 3): end-to-side ileocolostomy, single-layer interrupted suture (invagination length: 0 mm), survival time: 21 days. Group B (n = 3): invagination length: 20 mm, survival time: 7 days. Group C (n = 3): invagination length: 10 mm, survival time: 21 days. Group D (n = 3): invagination length: 20 mm, survival time: 21 days. At the end of the above survival times the anastomosis area was removed. The bursting pressure was measured and morphological as well as histological examinations were performed. In each case the 0-day look-alikes of anastomoses were performed using the remnant bowels, and bursting pressure measurements were done on these models as well. Anastomosis leakage did not occur. The serosal layer of the intracolonic part of the ileum disappeared during the healing process. The free surface of the intracolonic ileal segment became covered by the sliding mucosa of the colon and the prolapsing mucosa of the ileum. The following could be concluded after the experiments: The inner pressure tolerance of a telescopic ileocolostomy promptly after preparation is better than in case of another single-layer anastomosis. This fact results in increased safety against leakage on the first postoperative days. The inner pressure tolerance of the telescopic ileocolostomy increases during the healing process and it does not depend on the length of the invaginated part (0 day-20 mm: 56 mmHg ± 6, Group A: 252 ± 39, Group B: 154 ± 19, Group C: 249 ± 20, Group D: 298 ± 2). There is no difference in pressure tolerance between the telescopic and the end-to-side single-layer interrupted anastomoses after the healing process. The invaginated section within the lumen of the large intestine does not suffer ischaemic or any other kind of damage. This inexpensive and simple anastomosis technique could be useful in the veterinary surgical practice as well.

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Cerebral state monitor (CSM) is a recently developed anaesthesia depth monitor based on EEG measurement. Medline search confirmed that the accuracy of this monitor has already been compared with BIS monitoring; however, we did not find any studies comparing CSM monitor with AEP monitoring. Therefore, the aim of our study was to investigate the correlation between AAI using AEP monitor and CSI (cerebral state index) using CSM monitor. Methods: Prospective, observational study involving 39 ASA I–III patients undergoing lumbar discus hernia operation. Simultaneous registration of CSI and AAI was performed during general anaesthesia. The identical values were off-line analysed. Additionally in 20 patients parallel registration of CSI and AAI was undertaken while anaesthesia was guided based on routine clinical signs. Results: While analysing the data in the superficial, ideal and deep anaesthesia zones, we found that a relationship between CSI and AAI is weak. Our patients spent roughly the half of the clinical anaesthesia in the ideal zone based on the AAI index and less than 50% based on CSI. Almost one fifth of clinical anaesthesia based on AAI and nearly 40% based on CSI was spent in the deep anaesthesia zones. A superficial anaesthesia has been detected in 27% of time based on AAI and 17% based on CSI. Conclusions: CSI and AAI weakly correlated to each other. Depth of anaesthesia monitors may be useful in detecting patients who spend valuable time within the deep anaesthetic zone.

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Physiology International
Authors: Zs. Sári, T. Kovács, T. Csonka, M. Török, É. Sebő, J. Toth, D. Tóth, E. Mikó, B. Kiss, D. Szeőcs, K. Uray, Zs. Karányi, I. Kovács, G. Méhes, P. Árkosy, and P. Bai


Breast cancer is characterized by oncobiosis, the abnormal composition of the microbiome in neoplastic diseases. The biosynthetic capacity of the oncobiotic flora in breast cancer is suppressed, as suggested by metagenomic studies. The microbiome synthesizes a set of cytostatic and antimetastatic metabolites that are downregulated in breast cancer, including cadaverine, a microbiome metabolite with cytostatic properties. We set out to assess how the protein expression of constitutive lysine decarboxylase (LdcC), a key enzyme for cadaverine production, changes in the feces of human breast cancer patients (n = 35). We found that the fecal expression of Escherichia coli LdcC is downregulated in lobular cases as compared to invasive carcinoma of no special type (NST) cases. Lobular breast carcinoma is characterized by low or absent expression of E-cadherin. Fecal E. coli LdcC protein expression is downregulated in E-cadherin negative breast cancer cases as compared to positive ones. Receiver operating characteristic (ROC) analysis of LdcC expression in lobular and NST cases revealed that fecal E. coli LdcC protein expression might have predictive values. These data suggest that the oncobiotic transformation of the microbiome indeed leads to the downregulation of the production of cytostatic and antimetastatic metabolites. In E-cadherin negative lobular carcinoma that has a higher potential for metastasis formation, the protein levels of enzymes producing antimetastatic metabolites are downregulated. This finding represents a new route that renders lobular cases permissive for metastasis formation. Furthermore, our findings underline the role of oncobiosis in regulating metastasis formation in breast cancer.

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