rss_2.0Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. FeedSciendo RSS Feed for Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences. 's Cover UVB Therapy and Topical Calcineurin Inhibitors for the Treatment of Paediatric Vitiligo in Real Clinical Practice<abstract> <title style='display:none'>Abstract</title> <p>Vitiligo is an acquired chronic skin disease, characterised by progressing, usually symmetric, depigmented areas in human skin. Vitiligo affects 0.5% of the human population, however, optimal treatment combination real clinical practice has yet to be found. The aim of the study was to assess whether combined therapy with ultraviolet B (UVB) therapy and calcineurin inhibitors (CNI) provides superior response in vitiligo patients, compared with phototherapy or topical CNI monotherapy. We performed a retrospective cohort study of children treated for vitiligo from January 2016 to December 2019. Primary outcome measures include clinical efficacy defined by area of repigmentation — good clinical efficacy (re-pigmentation of ≥ 50% of lesion surface area), positive clinical efficacy and poor clinical efficacy (re-pigmentation of &lt; 15% of lesion surface area). Secondary outcome measures included reduction of lesion size and tolerability of therapy. A total of 114 patients were recruited in the study, 46 allocated to the topical CNI therapy group, 36 to the narrow band (Nb-UVB), and 32 to the combined therapy group. All treatments statistically significantly decreased lesion surface area compared to the baseline (mean, SD). Local therapy reduced lesions from 8.5 (5.7) to 5.3 (4.2) by 37.3% (p &lt; 0.0001), phototherapy reduced lesions from 9.8 (5.4) to 5.7 (3.92) by 42.3% (p &lt; 0.0001), and combined therapy reduced lesions from 14.2 (4.8) to 6.58 (3.5) by 53.6% (p &lt; 0.0001), with combined therapy showing superior numerical efficacy. Clinical efficacy for CNI monotherapy was 67.4%, for phototherapy — 80.5%, and for combined therapy 93.7%. The safety profile of therapies was consistent with other studies. Our results support the use of combined therapy in vitiligo patients.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Genetic Structure of Perch (L.) Populations in Latvian Rivers that are Fragmented (Daugava) and Non-Fragmented (Lielupe) By Hydroelectric Dams<abstract> <title style='display:none'>Abstract</title> <p>Water ecosystems have an important role in maintenance of biological diversity and environmental quality in Latvia. Fish resources are one of the most valuable biological resources in Latvia. To evaluate the influence of economic activity (anthropogenic influence of cities, hydroelectric power stations) on freshwater ecosystems, the genetic structure of perch Perca fluviatilis (L.) populations in Daugava River and Lielupe River was studied. The genetic structure of the perch populations from Daugava River and Lielupe River was investigated using 9 DNA microsatellites (Pfla L4, Pfla L10, Pfla L2, Pfla L6, YP111, YP78, YP60, Svi L10, Svi L7), and by genetic diversity, the level of polymorphism, means of alleles per locus, observed and expected heterozygosity, and population structuring. It was shown that the perch population in the Daugava River in the territory of Riga was significantly different from the other populations and there was a lower level of heterozygosity in this population. In the Daugava River, genetic differentiation was significant for fish populations between Ķegums Hydroelectric Power Plant (HPP) and Riga HPP reservoirs due to the fragmentation of population by HPP dams.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00“New Kids on the Block” — The Game Changers. The Role of Immune Check Point Blockade in Personalised Treatment of Prostate, Urinary Bladder and Kidney Cancer<abstract> <title style='display:none'>Abstract</title> <p>Early detection and diagnosis of cancer followed by a personalised approach to treatment is a key and can save lives. It has been an important issue in both the medical and social fields. The search for instruments and/or diagnostics tools able to detect cancers at an early stage has led to consideration of the usage of various approaches, such as exhaled air, biomarkers in blood, urine testing as well as imaging techniques. This actual time and everything that is happening around us could be characterised as a strange and very unpredictable time. This comparison could be made not only due to the actual coronavirus situation, but also the same can be noticed in the personalised medicine of the second decade of 21st century — by means of check point inhibitors. The old dogmas, for instance, chemotherapy and metastasis-surgery are being appended with new diagnostic and therapy use of checkpoint inhibitors. What exactly is the checkpoint blockade and how it is working in three tumour modalities: bladder cancer, prostate cancer and renal cancer. Our study group will provide a brief and detailed, guideline-compliant outline. The aim of this review was to provide a summary of the current state of the art of immune therapy as potential treatment of prostate, urinary bladder, and kidney cancer.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Homeostasis Regulating Factors, Innervation, Ischemia and Inflammatory Markers in the Right Atrial Tissue from Patients with Degenerative Aortic Valve Stenosis and Coronary Heart Disease<abstract> <title style='display:none'>Abstract</title> <p>Both coronary heart disease (CHD) and degenerative aortic valve (AoV) stenosis have common risk factors, such as age, high blood cholesterol, diabetes, smoking, high blood pressure, inflammation, and metabolic syndrome. However, these diseases are not always observed together, confirming the existence of risk and pathogenesis factors specific to each disease. The aim of this study was to identify presence and distribution of common and different homeostasis regulating factors, innervation, ischemia and inflammatory markers in the right atrial tissue from patients with degenerative AoV stenosis and CHD. During elective cardiac surgery, right atrial tissue fragments were taken from 20 patients with CHD and from 9 patients with degenerative AoV stenosis. All tissue fragments were stained for immunohistochemical detection of protein-gene peptide 9.5 (PGP 9.5), atrial natriuretic peptide (ANUP), vascular endothelial growth factor (VEGF), chromogranin A, endothelin, interleukin 1 and 10 (Il-1 and Il-10) and β defensins 2, and 3 (βD2 and βD3). For the quantification of structures, a semi-quantitative counting method was used. Mostly numerous Il-10 positive cardiomyocytes and epi-/endocardial endothelial cells were detected in all specimens taken from patients with CHD, and statistically more than in specimens taken from patients with degenerative AoV disease (p = 0.007 and p = 0.016). Also, the number of βD3 positive cardiomyocytes was higher in the coronary heart disease group (p = 0.026). All other tested markers such as PGP 9.5, ANUP, VEGF, endothelin, chromogranin A, Il-1 and βD2 showed similar expression in both groups. Increased production of ANUP in right atrial tissue characterises both CHD and degenerative AoV stenosis. Production of ChgA in right atrial endocardial endothelial cells might represent regulation of sympathetic activity as a compensatory homeostatic response. Increased PGP 9.5-containing innervation is characteristic in patients with degenerative AoV disease and secondary mitral insufficiency. A stable increase of VEGF and variations of endothelin without statistically significant difference suggest influence of ischemia on the local vascular blood supply. Decreased production of Il-1α together with moderate to rich production of Il-10, βD2, and βD3 indicates the dominance of the local immune system over inflammation.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Calculation of One-Electron Wave Functions and Energy Levels of N-Butane Molecule on the Basis of Slater Atomic Orbitals<abstract> <title style='display:none'>Abstract</title> <p>It is known that the application of the group theory greatly simplifies the problems of polyatomic systems possessing to any space symmetry. The symmetry properties of such systems are their most important characteristics. In such systems, the Hamilton operator is invariant under unitary symmetry transformations and rearrangements of identical particles in the coordinate system. This allows to obtain information about the character of one-electron wave functions — molecular orbitals — the considered system, i.e. to symmetrise the original wave functions without solving the Schrödinger equation.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Influence of Migraine on Axon Reflex-Mediated and Endothelial-Dependent Vasodilatation in the Skin<abstract> <title style='display:none'>Abstract</title> <p>The aim of the study was to evaluate the changes in skin blood flow as a result of local heating tests in migraine patients during the interictal period, measured by laser Doppler perfusion imaging (LDI). The aim of the study was also to estimate the correlations between the results of these tests and interleukin (IL)-8 levels. Twelve migraine patients during their interictal period were compared with twelve healthy control subjects. Only women were included in the study. Both groups were matched with regard of their age, body mass index and blood pressure. For the purpose of measuring cutaneous microvascular blood flow, heating (+44 °C) of the dorsal side of the palm as a response to the local LDI was used. IL-8 was measured in serum by ELISA method. The findings suggested that migraine patients have a cutaneous vasomotor dysfunction during the interictal period. The results showed a significant decrease in the initial peak of vasodilation and the second peak of vasodilation (plateau phase). Also there were significant changes observed in the length of the time interval required to reach the first and second vasodilation peak. It is known that migraine patients have a shorter time interval to reach the first perfusion peak (axonal reflex-mediated) and longer time interval to reach the second peak (endothelium-dependent). The results confirmed the correlation between proinflammatory chemokine IL-8 levels, and the time interval till the second peak of blood flow in all study subjects.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Comparative Analysis of Anthropometric Parameters and Body Composition of Patients with Breast Cancer and Healthy Women in the Postmenopausal Period<abstract> <title style='display:none'>Abstract</title> <p>According to a statistical review (2018) in Latvia, there are more than one thousand women (n = 1266) with the diagnosis of breast cancer. Assessments of anthropometrical parameters were made according to the World Health Organisation recommendations for morbidity risk analysis. The aim of the study was to determine the differences and changes of anthropometric parameters and indices in a control group and in a clinical group (initial oncological diagnosis without treatment intervention). We examined women in their postmenopausal period. The control group included apparently healthy women (n = 181) and the clinical group included women (n = 44) with initial oncological diagnosis (breast cancer 1<sup>st</sup> and 2<sup>nd</sup> stage). In order to assess body anthropometric characteristics we used the body mass index (BMI), waist circumference, waist/height ratio and skin fold thickness measurement. The study results were assessed using statistical analyses in the IBM SPSS Statistics for Windows, Version 22.0 software: Shapiro–Wilk and Mann–Whitney tests with a two-tailed p-value &lt; 0.05). The analysis of statistical data showed that, despite the low number of patients in the clinical group, we found a significantly lower waist-to-hip ratio, skinfold thickness above m. biceps brachii, skinfold thickness above m. triceps brachii, and subscapular and suprailiac skin fold thickness in this group.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Immunopathogenic Treatment Options for Psoriasis Patients Under a Restrictive Reimbursement Environment<abstract> <title style='display:none'>Abstract</title> <p>This article is aimed to provide an overview of psoriasis clinical aspects, available treatment options for moderate-to-severe psoriasis in Baltics and summarises recommendations of authors for use of different biologicals in psoriasis patients under a limited reimbursement environment.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Immediate Effects of Prescribed Burning on Soil Mite (Acari: Oribatida) Communities in a Scots Pine () Forest, Latvia<abstract> <title style='display:none'>Abstract</title> <p>Prescribed burning is used to maintain and restore habitats, to protect and increase species bio-diversity. Knowledge about soil fauna is limited, especially on community responses to fire disturbances. The aim of this study was to determine the immediate effects of prescribed burning on soil armoured mite (Acari: Oribatida) communities, vegetation cover and soil physiochemical properties in a boreal Scots pine forest in Latvia. Soil samples were collected on the day of the prescribed burning in the protected landscape area “Ādaži” and 16 days after. No significant changes in abiotic factors were found. Fire significantly decreased the vegetation cover. After the burning, the total number of oribatid mites decreased by 93%, and the number of species by 77%. Changes in oribatid mite communities were significantly influenced by fire severity. The number of individuals decreased among all taxa, except Brachychthonioidea spp. and Cosmochthonius lanathus. A significant decrease in abundance was observed in previously abundant species — Suctobelbella spp., Oppiella nova and Tectocepheus velatus. After the burning, Suctobelbella spp. was an eudominant and Tectocepheus spp. was a dominant genus.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Influence of Macro- and Micro-Element Content on Mycelial Growth of Sp.1<abstract> <title style='display:none'>Abstract</title> <p>Phoma blight of conifer seedlings is poorly studied. The main causal agent in Belarus differs in DNA sequence from other described Phoma species, and has not been fully taxonomically described, and therefore has been temporarily designated Phoma sp. 1. The basic morphological and growth culture characteristics of Phoma sp. 1 have recently been published. This report provides additional data about the influence of macro- and micro-elements on the growth of Phoma sp. 1 in vitro to complement the description of growth culture and morphological features. It was found that addition of tricalcium phosphate and potassium chloride to the media at concentrations of 1 g/l and 2 g/l slows the mycelial growth by an average of 30%. The micro-elements copper sulphate (at 50 mg/l and 100 mg/l) and zinc sulphate (at 100 mg/l) decreased growth by 50%, 63%, and 32%, respectively. Urea completely inhibited Ph. sp.1 growth at 0.5 g/l. Summarising previously published information, Phoma sp. 1 is a mesophilic acidophile, capable of forming chlamydospores in culture. Pycnidia form deep in the media only after prolonged low-temperature storage. The optimal pH for growth is 4.3–4.9. Constant medium aeration favours the formation of typical mycelium, proportional growth and stable biomass accumulation.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Tapetum Types and Forms in Angiosperms<abstract> <title style='display:none'>Abstract</title> <p>Based on the analysis of literature and our own data, we have suggested a new version of the typification of types and forms of the tapetum. It is proposed to distinguish two types of tapetum: parietal and periplasmodial. Parietal tapetum lines the locule of microsporangium and this position is maintained throughout the development. A periplasmodial tapetum is characterised by the formation of a coenocyte as a result of the fusion of protoplasts, while the cytoplasm and nucleus are located not only between the developing microspores and pollen grains, but also come into contact with the inner layers of the cavity. The differences between tapetum types relate to the peculiarities of structural and temporal reorganisation in anther development. The protoplasts that form after the disappearance of the cell walls (usually at the stage of microspore tetrad, or after their disaggregation), gradually break down (form 1 – typical parietal tapetum), or they form protrusions inside the microsporangium cavity (form 2 – amoeboid tapetum). The protoplasts in the periplasmodial tapetum are formed before or during meiosis. They fuse resulting in a symplast. It is possible to distinguish two forms of periplasmodial tapetum: combining and invasing of protoplasts into the locule of microsporangium (form 1 – typical periplasmodial tapetum), and almost or partly fusion of protoplasts, which do not organise the invasions and maintain the initial position (form 2 – bordering symplast). Data on the diversity and structure of the tapetum, like any other characters, are used to clarify the position of taxa on the phylogenetic tree.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00CD63 and Dna Mismatch Repair Protein Expression in Prostate Cancer<abstract> <title style='display:none'>Abstract</title> <p>Protein expression levels in immunohistochemistry and molecular biomarkers have been reported for their ability to predict recurrence, progression, development of metastases, and patient survival. The molecular features in low- and high-grade prostate cancer can differ and influence treatment decision and prognosis. The objective of the current study was to compare the expression of exosomal biomarkers CD63 and mismatch repair proteins (MSH2, MSH6, MLH1, and PMS2) by immunohistochemistry (IHC) in tissue of patients with prostate cancer and benign hyperplasia. Altogether, 62 patients with prostate acinar adenocarcinoma and 20 patients with prostate benign hyperplasia were enrolled in this retrospective study. CD63, MSH2, MSH6, MLH1, and PMS2 expression was analysed by immunohistochemistry. The obtained results showed that CD63 expression was significantly higher in patients with Grade III–V prostate cancer compared to Grade I–II, respectively; 2.23 (1–3) vs 0.92 (0–2) score, p = 0.001. In addition, a significant positive correlation between CD63 expression and grade groups was revealed (Rho = +0.54; p &lt; 0.0001). Furthermore, progression-free survival was significantly higher in patients with low CD63 expression, compared to high CD63 expression (p = 0.0007). MMR expression was absent in 14 patients (four patients with Grade I–II cancer and 10 patients with Grade III–cancer). MMR was present in all cases of benign prostate hyperplasia (mild to moderate staining). The conclusion was that high grade prostate cancer (Grade groups III–V) was characterised by increased CD63 expression, which correlated with progression-free survival.</p> </abstract>ARTICLE2021-07-22T00:00:00.000+00:00Erratum: Initiation of Vancomycin Therapy and the First Therapeutic Drug Monitoring of Hypouricaemia in the Development of Neurodegenerative Diseases<abstract><title style='display:none'>Abstract</title><p>Hypouricaemia has received relatively little attention in the literature. As a result, there is less awareness or understanding of the potential risks of low uric acid levels. Emerging research indicates that normal uric acid levels may have an antioxidative and neuroprotective effect. This study aims to investigate possible associations between hypouricaemia and neurodegenerative disease. Data was collected from seventy-seven outpatients and inpatients who underwent routine uric acid testing, who were then stratified into patients with and without neurodegenerative disease. Patients with renal pathologies and patients using uric acid altering medications were excluded from the study. There was a significant difference in the prevalence of Alzheimer’s disease between hypouricemic and normouricemic patients (p = 0.001), however there was no difference in the prevalence of vascular dementia (p = 0.45). This study provides evidence that hypouricaemia has potential effects on health, specifically on the rate of neurodegenerative diseases such as Alzheimer’s disease and gives weight to the potential neuroprotective role of uric acid.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00Does the Course of Disease Influence the Development of Fatigue in Rheumatoid Arthritis Patients?<abstract><title style='display:none'>Abstract</title><p>Patients with rheumatoid arthritis (RA) typically have many permanently inflamed joints. The inflammation inside the body can lead to general physical weakness, exhaustion, and drowsiness. This feeling of extreme tiredness is also called “fatigue”. Some people find this to be the worst symptom of the disease. However, the clinical significance of fatigue and its pathogenesis have not been recognised. This study aimed to determine the development of fatigue depending on activity and aggressiveness of RA. To achieve the goal, patients were interviewed and indicators of disease activity and aggressiveness were determined: rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), immunoglobulins IgA RF, IgM RF, IgG RF and anti-carbamylated protein antibodies (anti-CarP). Based on the results of the survey, RA patients were divided into two groups — with and without fatigue. In the group of RA patients with fatigue, statistically more often an increase in IgA RF, IgM RF, and IgG RF levels was observed in those with elevated RF level, higher IgM RF and IgG RF levels were associated with increase in IgA RF level, and increase in the IgG RF and anti-CarP levels with elevation in the IgM RF level. A higher IgG RF level contributed to a higher anti-CarP level increase. Significant differences in the levels of clinical and laboratory inflammatory markers were not observed between the RA patients with and without fatigue. The obtained data suggest that the aggressive course of RA, more than inflammation, may contribute to the development of fatigue in RA patients.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00Aqueous C60 Fullerene Solution Effects on Cell Viability<abstract><title style='display:none'>Abstract</title><p>Fullerenes are carbon nanoparticles with the ability to quench reactive oxygen species. The biomedical potential of fullerenes is diminished by their low solubility in water, but many approaches have been developed to bypass this problem, like chemical modification of the carbon cage and the use of the solvent exchange method to transfer fullerenes from one solvent to the other. These two approaches were used in this study. Carboxylated fullerene aqueous solution was acquired using solvent exchange method transferring fullerene nanoparticles (C60) from toluene to water. Effects of varying concentration (0.5, 1, 1.5, 2, 2.5, 3, 5, 10 µM) of aqueous fullerene solution on cell viability and their antioxidative capabilities were evaluated on PC-3 and on monocytes isolated from a blood donor using Resazurin Cell Viability Assay. PC-3 cell viability was drastically affected by the 10 µM fullerene solution but remained relatively stable when treated with other concentrations even after longer periods of incubation with resazurin dye. Elevated cell viability was observed in monocytes treated with various fullerene concentrations, possibly indicative of fullerene protective activity against oxidative stress.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00Do We Require to Use Antibacterial Prophylaxis in Hand Trauma? Results of a Randomised Prospective Case-Control Trial<abstract><title style='display:none'>Abstract</title><p>The proper management of traumatic hand injury is crucial for wound infection prevention. Antibiotics in various forms and conditions are prescribed to avoid this complication, but the effectiveness is unclear. Most forms used are intravenous solutions, topical ointments, and oral tablets. This prospective case-control trial was conducted in a tertiary care hospital. Healthy adult patients with simple, non-bite, surgically treated hand wounds were included. During the surgery, a proper debridement and irrigation with simple saline was consistently performed. Patients were randomly assigned to one of the eight groups. Seven groups received different antibacterial prophylaxis and one received none. At the two-week postoperative follow-up the wound site was assessed and any local infection was documented. Patients were excluded from the trial if they did not comply to treatment recommendations (i.e. commence antibiotics, applied solutions or ointments on the wound). Overall, 240 patients (80.2% male, mean age 38.7 years), 30 in each study group were included. 226 patients returned for the follow-up, and seven patients were excluded from the trial. Wound infection was observed in five patients from different groups. Thus, the rate of wound infection was 2.28%. A Chi-square test revealed no difference in infection incidence between the groups (p &gt; 0.05). In this study, antibiotics did not affect incidence of wound infection after hand trauma. Attention should be paid to proper debridement and irrigation of the wound as these interventions reduce the risk for wound infection and avoid unnecessary usage of antibiotics.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00What We Need to Learn When Exploring the Mixed Basal Cell Carcinoma of Head and Neck<abstract><title style='display:none'>Abstract</title><p>Coexistence of different histopathological types of basal cell carcinomas (BCC) in the same anatomical localisation is rare, and, therefore, is engaging for histopathologists and clinicians. In many cases, the determination of a neoplasm type remains difficult, since BCC may consist of more than one histopathological subtype. Mixed BCCs often present with an aggressive course and recurrence when compared to other subtypes of a tumour. Furthermore, tumours of this type are associated with time-consuming treatment and not a very satisfactory cosmetic result, thus worsening the quality of the patient’s life. Several clinical studies have been published regarding the histopathologically diverse tumours developed in the same anatomical region; however, largely peculiarities of mixed BCCs are not explored sufficiently. The purpose of this study was to substantiate the use of dermoscopy and morphology, assessing mixed type BCC of the head and neck. The tumours were removed with a surgical excision of 1 cm margins, and the tumour sites were assessed in a 24-month-long follow-up period. The dermoscopic characteristics of mixed and aggressive BCC are analysed in this study. Finally, to better estimate the invading cone of the tumour, a complex morphology, which included collagen type IV and podoplanin immunohistochemistry, and electron microscopy were used.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00Expression and Localisation of CD44 Antigen as a Prognostic Factor of Oral Leukoplakia<abstract><title style='display:none'>Abstract</title><p>It is essential to identify markers that could indicate the presence of early molecular changes in premalignant tissues like oral leukoplakia (OL). CD44 adhesion molecule is not only a stem cell marker, but also determines cell proliferation and migration in malignant processes. The aim of our study was to assess the amount and pattern of CD44 antigen expression by epithelial and mononuclear cells in the lamina propria under OL and their role in premalignant lesions. The current study included 102 cases of OL and ten biopsies from healthy oral mucosa. Immunohistochemical CD44 antigen expression was determined in 34 cases by a standard EnVision imaging system in three points of OL: both edges and centre. Statistical analysis was done using GraphPad Prism software version 8.4.0. In OL, statistically significant overexpression of membranous CD44 was demonstrated compared to healthy mucosa (p &lt; 0.0001). The intra-cytoplasmatic CD44 expression of epithelium together with characteristic nuclear changes may be used as a predictive factor for potential malignant transformation of non-homogenous leukoplakia. CD44 expression in mononuclear cells under the basal membrane in OL (p &lt; 0.05) possibly influences the process of premalignant lesion transformation into intraepithelial cancer. Further study of CD44 antigen expression in intra-cytoplasmatic structures is required for better explanation of the role of this glycoprotein.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00Vacuum-Assisted Abdominal Closure in Surgical Emergency: A Single Institution Experience Treating a Cohort with a Prevalence of Faecal Peritonitis<abstract><title style='display:none'>Abstract</title><p>Vacuum-assisted abdominal closure (VAAC) has evolved as a promising method for treatment of emergent surgical patients. The aim of the study was an assessment of the complication rate and outcomes following routine application of VAAC in a cohort of patients suffering predominantly with peritonitis of the lower gastrointestinal tract (GIT) origin. The prospectively collected data was analysed retrospectively, including demographic data, aetiological factors, comorbid conditions and severity of the disease. The indications for VAAC included complicated intra-abdominal infection, purulent peritonitis with sepsis and/or risk of increased intra-abdominal pressure. In total, 130 patients were managed with VAAC. The median age was 63.5 years, with a predominance of male patients (61.5%). Systemic inflammatory response was present in 68.5%, the median C-reactive protein (CRP) was 239.58 mg/l, Procalcitonin (PCT) level 7.02 ng/ml, and lactate 1.84 mmol/l before intervention. The median Sequential Organ Failure Assessment (SOFA) score was 4 and the Mannheim Peritonitis Index was 26. Sepsis developed in 87.0% of patients, and 43.8% had septic shock. VAAC was applied in 58.5% due to a perforation of the lower GIT, in 26.1% due to perforation of the upper GIT, and in 15.4% for other reasons. A median of two (interquartile range, IQR 1–3) VAAC system changes were performed in a period of 7 (IQR 4–11) days. In 88.6% of cases, multiple types of microorganisms were present. The application of VAAC resulted in a significant decrease of the postoperative SOFA score, and CRP, PCT and lactate levels (p &lt; 0.001). The complications included a “frozen abdomen”, enterocutaneous fistula, intraabdominal abscess and bleeding in 7.7%, 5.4% and 6.0% cases, respectively. Primary abdominal closure was accomplished in 76.2%, resulting in a 23.1% mortality rate. VAAC was found to be safe in the treatment of abdominal sepsis including in patients with faecal peritonitis. Complete abdominal closure can be achieved in the majority of patients resulting in a lower mortality rate.</p></abstract>ARTICLE2021-05-08T00:00:00.000+00:00en-us-1