Pelvic Floor Peritoneum Closure Reduces Severe Postoperative Complications in Rectal Cancer Patients After Laparoscopic Anterior Rectal Resection.

BACKGROUND: Laparoscopic anterior rectal resection (LAR) is a commonly performed surgery for rectal cancer patients. Pelvic floor peritoneum closure (PC), a vital procedure in conventional anterior rectal resection, is not routinely performed in LAR. STUDY DESIGN: A total of 1118 consecutive patients with rectal cancer receiving LAR were included in this retrospective study. Patients were allocated into the PC group and the non-PC group. The occurrence of postoperative complications was compared between the 2 groups. Influential factors in anastomotic leakage (AL) were explored using univariate and multivariate logistic regression. RESULTS: There was no difference between the groups in terms of baseline characteristics. The occurrence of postoperative complications was similar between the groups. The PC group had significantly shorter postoperative hospitalization and longer operation duration compared with the non-PC group. The occurrences of Clavien-Dindo (CD) III-IV complications, CD III-IV AL, and reoperation were significantly lower in the PC group than the non-PC group. PC and a protective ileostomy were independent protective factors for CD III-IV AL. CONCLUSION: PC could reduce the occurrence of CD III-IV complications, especially CD III-IV AL, and the rate of secondary surgery, especially in patients with a lower body mass index and patients who did not receive protective ileostomies.

Exploring carbon sequestration in broad-leaved Korean pine forests: Insights into photosynthetic and respiratory processes.

A comprehensive understanding of carbon assimilation and sequestration in broad-leaved Korean pine forests is crucial for accurately estimating this significant aspect of temperate forests at a regional scale. In this study, we introduced a high-temporal resolution model designed for carbon assimilation insights at the plot scale, focusing on specific parameters such as leaf area dynamics, vertical leaf distribution, photosynthetically active radiation (PAR) fluctuations, and the photosynthetic traits of tree species. The findings reveal that most tree species in broad-leaved Korean pine forests exhibit an inverted U-shaped pattern in leaf area dynamics, with shorter leaf drop periods than leaf expansion events. Leaf distribution varies significantly among different canopy heights, with approximately 80 % of the leaves above 15 m. PAR decreases as canopy height decreases, with PAR at 25 m accounting for about 60 % of the PAR above the canopy. Our framework incorporates a leaf-scale light-response curve and empirical photosynthesis-temperature relationships to estimate forest carbon assimilation on daily and hourly scales accurately. Using the model, we assess the gross primary productivity (GPP), leaf net photosynthetic assimilation (LNPA), and carbon increment (ΔC) of broad-leaved Korean pine forests from 2017 to 2020. The results demonstrate GPP, LNPA, and ΔC values of 21.4 t·ha-1·a-1, 17.4 t·ha-1·a-1, and 4.0 t·ha-1·a-1, respectively. Regarding efficiency, GPP, LNPA, and ΔC per square meter of leaf per year are 179 g, 146 g, and 33 g, respectively. Notably, tree species in the canopy layer of the forest exhibit significantly higher efficiency than those in the understory layer. This research significantly contributes to our understanding of carbon cycling and the responses of forest ecosystems to climate change. Moreover, it provides a practical tool for forest management and the development of carbon sequestration strategies.

Long-term outcomes of single-incision plus one-port laparoscopic surgery versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial.

BACKGROUND: Though our previous study has demonstrated that the single-incision plus one-port laparoscopic surgery (SILS + 1) is safe and feasible for sigmoid colon and upper rectal cancer and has better short-term outcomes compared with conventional laparoscopic surgery (CLS), the long-term outcomes of SILS + 1 remains uncertain and are needed to evaluated by an RCT. METHODS: Patients with clinical stage T1-4aN0-2M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The 3-year DFS, 5-year OS, and recurrence patterns were analyzed. RESULTS: Between April 2014 and July 2016, 198 patients were randomly assigned to either the SILS + 1 group (n = 99) or CLS group (n = 99). The median follow-up in the SILS + 1 group was 64.0 months and in CLS group was 65.0 months. The 3-year DFS was 87.8% (95% CI, 81.6-94.8%) in SILS + 1 group and 86.9% (95% CI, 81.3-94.5%) in CLS group (hazard ratio: 1.09 (95% CI, 0.48-2.47; P = 0.84)). The 5-year OS was 86.7% (95% CI,79.6-93.8%) in the SILS + 1 group and 80.5% (95% CI,72.5-88.5%) in the CLS group (hazard ratio: 1.53 (95% CI, 0.74-3.18; P = 0.25)). There were no significant differences in the recurrence patterns between the two groups. CONCLUSIONS: We found no significant difference in 3-year DFS and 5-year OS of patients with sigmoid colon and upper rectal cancer treated with SILS + 1 vs. CLS. SILS + 1 is noninferior to CLS when performed by expert surgeons. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02117557 (registered on 21/04/2014).

Effect of single-incision plus one port laparoscopic surgery assisted with enhanced recovery after surgery on colorectal cancer: study protocol for a single-arm trial.

BACKGROUND: Studies have proved that the enhanced recovery after surgery (ERAS) protocol can significantly improve the recovery course of patients during the perioperative period. The application of minimally invasive surgery is a critical component of ERAS protocol. Single-incision plus one port laparoscopic surgery (SILS plus one) could achieve further minimally invasive surgical results than conventional laparoscopic surgery (CLS). The objective of this trial is to evaluate the safety and feasibility of SILS plus one with ERAS protocol in colorectal cancer. METHODS: This is a prospective, single-center, open-label, single-arm trial. A total of 120 eligible patients with colorectal cancer will receive SILS plus one followed by the ERAS management during the perioperative period. The primary endpoint is postoperative hospital stay. The secondary endpoints include rehabilitative rate of the fourth postoperative day, postoperative medical cost, postoperative pain score, postoperative recovery indexes, inflammatory immune response indexes, compliance with ERAS measures, 6 min postoperative walking test (6MWT), hospital readmissions, and early postoperative complications. DISCUSSION: This trial will be the first to evaluate the short-term outcomes of SILS plus one assisted with ERAS protocol for patients with colorectal cancer and will provide valuable clinical evidence on the benefit of the combination of these two techniques, hopefully, to provide patients with more safe, economic, feasible, and rapid surgery and perioperative strategies. TRIAL REGISTRATION: Clinical Trial Registry, NCT0426829. Registered February 15, 2020 (https://clinicaltrials.gov/ct2/show/NCT04268290).

[Nectar productivity of Tilia amurensis in a broadleaved-conifer mixed forest in Changbai Mountains, China]. / 长白山针阔混交林紫椴的泌蜜量.

Tilia amurensis is one of (co-)dominant species in the broadleaved-conifer mixed forest in Northeast China, with high commercial and nectariferous values. We estimated the quantity of nectar secretion from individual trees to population or stand levels based on observation and statistical analysis. An equation for individual-tree nectar secretion was established, which was used to estimate nectar quantity at the stand level. We analyzed the relationships between nectar secretion and basal area or stem volume. The booming time for single flower was in average 6-8 days, with a nectar secretion period of about five days. The quantity for the entire period was estimated at 8.58 mg per flower. Sugar contents in the nectar, average 37.7%, showed diurnal variations, being high in the mid-noon and low in the early morning and late afternoon. The average diameter (DBH) of the species was approximately 40 cm, which was estimated to possess as much as 18×104 single flowers and 1.56 kg (or pure sugar 0.588 kg) of nectar. At the stand level, the nectar production potential was 79-147 kg (or 0.0686-0.1285 m3, pure sugar 29.78-55.42 kg) per hectare. There was a close correlation between nectar quantity and basal area or timber volume at both individual and stand levels, which could be used to estimate the nectar quantity for macro-scale forest area based on inventory data.