IMPACT OF MICROBIOME COMPOSITION ON QUALITY OF LIFE IN HEMODIALYSIS PATIENTS.

Accumulating evidence showed that chronic inflammation is a risk factor for increased cardiovascular mortality in the population with Kidney Failure (KF) remaining on Kidney Replacement Therapy (KRT). The gut microbiome is altered in patients with Chronic Kidney Disease (CKD) and is one of the major sources of chronic inflammation. Uremic gut microbiome may have serious effects on patients' quality of life (QoL) and, especially, on their psychological, social, and economic prosperity. Factors that influence health-related quality of life (HRQOL) in patients with ESRD have received little attention. Aim - this study aimed to investigate changes of QOL in HD patients by the correction of intestinal microflora. The sample study consisted of 33 HD patients (age 18-75) from "The clinical center for development of nephrology". Data was collected through the completion of a specially designed questionnaire. For assessment of Qo was used the "Missoula VITAS Quality of life index. Fecal samples were analyzed before and after treatment with probiotics. It was revealed alteration of the colonic microbial composition in the sample of the hemodialysis patients. Also, there was a strict correlation between gut dysbiosis and HD patients' QoL. Our study demonstrates important relationships between gut dysbiosis and QoL in HD patients. Correction of intestinal flora with probiotics-containing L. acidophilus, B. longum, and S. Thermophilus for a long period of at least 12 weeks improves the quality of their lives.

EVALUATION OF NOVEL PORCINE PERICARDIAL BIOMATERIAL FOR VENTRAL AND INGUINAL HERNIA REPAIR. THE RESULTS OF A NON-RANDOMIZED CLINICAL TRIAL.

Using the mesh for hernia repair is the most common type of hernia surgery. There are many types of meshes made of various synthetic materials, but all of these meshes have their own respective disadvantages. The aim of this study was to provide preliminary results of a non-randomized clinical trial evaluation of novel porcine grafts XI-S+® (Colorado Therapeutics LLC. USA) for ventral and inguinal hernia repair. All patients underwent a standardized surgical procedure. Onlay surgical repair technique has been performed in ten patients with ventral hernia and Lichtenstein tension-free method has been used for ten patients with inguinal hernia repair. The XI-S+® mesh fixation was performed with multiple simple interrupted sutures using prolene thread. The average age of the patients with ventral hernia was 54±14 years, and 30% of patients were female and 70% of patients were male. The average age of the patients with inguinal hernia was 62.5±9.4 years, and 10% of patients were female and 90% of patients were male. The average hospitalization length was 2 days. During three years of observation, no recurrence of hernia was observed in patients. The XI-S + ® mesh has anti-adhesive properties, is extremely resistant to infections, provides favorable conditions for engraftment, early activity and patient rehabilitation. The clinical studies of the patients that underwent ventral and inguinal hernia repair using XI-S+® mesh have shown that the post-operative pain was minimal and easily controlled by the use of analgesics. As for the sensation of the mesh, in some patients it has been present up until 1 month from surgery, but it fully disappeared by the end of the 3rd month.

RECONSTRUCTION OF THE ABDOMINAL WALL DEFECTS USING GELATIN-COATED DECELLULARIZED AND LYOPHILIZED HUMAN AMNIOTIC MEMBRANE.

Ventral hernias, with the incidence of reherniation nearly as high as 50%, still remain to be a real challenge for surgeons worldwide. The use of mesh in the repair of abdominal wall defects reduces the incidence of reherniation; however, using a prosthetic mesh can lead to complications like wound infection, hematoma, seroma, enterocutaneous fistula, small bowel obstruction, recurrent herniation and erosion into adjacent structures including the intestine. The aim of the study was to develop a method for producing gelatin-coated decellularized and lyophilized human amniotic membrane graft and to determine its effectiveness for the reconstruction of the anterior abdominal wall defects. Experiments were conducted on 40 Lewis white laboratory rats. Animals were divided into four equivalent groups. Abdominal wall defects were created in all rats and repaired using the ULTRAPROTM mesh (group I), ULTRAPROTM mesh which was covered by decellularized and lyophilized human amniotic membrane from both sides (group II), mesh from gelatin-coated decellularized and lyophilized human amniotic membrane (group III) and biological surgical mesh XI-S+® (group IV). Three months after implantation, meshes from gelatin-coated decellularized and lyophilized human amniotic membrane were integrated with host tissues so that it was difficult to distinguish it from the surrounding tissues. However, in the second group, ULTRAPROTM mesh was still detectable through the decellularized amniotic membrane. Encouraging results were also observed when using a XI-S+® graft. Three months after implantation, XI-S+® graft was surrounded by a well-defined connective tissue capsule and was tightly fixed to the host tissues. While using gelatin-coated decellularized and lyophilized human amniotic membrane grafts and XI-S+® grafts, all the defects were repaired successfully and none of the rats in these groups showed any evidence of bulging or herniation, development of wound rupture, wound infection or fistula formation in postoperative period. Gelatin-coated Decellularized human amniotic membrane can be used as anti-adhesive barrier in abdominal and pelvic surgery, as well as for the repair of the abdominal wall hernia.

[Clinical-epidemiological study of patients with toxic liver diseases].

To evaluate effects of potentially hepatotoxic factors on the body we have studied medical histories of 3382 patients hospitalized at the toxicoresuscitation unit of the TSU Clinical Hospital and at the University Therapy Clinic of the City Hospital N1 during 2000-2004. It was found out that the most common etiologic causes of intoxication are medicines and alcohol. The role of chemical substances is also significant. The number of effect of other etiologic factors is lower. Intoxications due to potentially hepatotoxic agents by years were observed in 68.25%; 68.18%; 80.35%; 75.31%; 64.42% of cases of accidental drug-induced intoxication and in 55.00%; 59.32%; 52.03%; 53.33%; 69.09% of drug-induced suicidal cases and these drugs represented various pharmacologic groups. Intoxication with combined drugs occurs mainly in cases of suicide. Effect of organic and non-organic substances in accidental intoxications and suicidal cases are similar. According to the data of the National Center for Diseases Control the number of patients with toxic liver injury during 2000 to 2004 yy. accounts for 0.42%, 014%, 0.06%, 0.89%, 1.17% of patients discharged from Tbilisi hospitals with diagnosis of chronic liver disease and 0.81%; 1.12%; 1.19%; 1.07%; 1.23% of patients being under the supervision of outpatient clinics at the end of the year respectively, this does not reflect actual state based on the observed effects of potentially hepatotoxic medicines and chemical substances and requires from clinicians to pay more attention to this problem.