Fluorescent angiography in colorectal surgery, the influence of augmented reality in the operating room on the anastomotic leakage after low rectal resection.

INTRODUCTION: Near-infrared (NIR) fluorescence angiography (FA) is an augmented reality (AR) technique. When used in the operating room, it allows colorectal surgeons to visualize and evaluate intestinal blood flow in real time, identify lymph nodes, ureters, or peritoneal metastases. Evaluation of perfusion with FA in augmented reality mode has an impact on reducing the ALR (anastomotic leakage rate) in rectal resections. METHODS: Data analysis of patients after minimally invasive surgery (MIS) for middle and lower rectal adenocarcinoma with total mesorectal excision (TME) using fluorescent angiography (FA) with indocyanine green (ICG) (100 patients, 20152019) were subsequently compared with a historical control group (100 patients) operated on for the same diagnosis before the introduction of the FA-ICG method (20122015) using minimally invasive approach (MIS). The patients were operated on consequently at one workplace. RESULTS: In fifteen patients (15%), the resection line was shifted due to insufficient perfusion detected by FA-ICG. The incidence of AL was lower in the group with FA compared to the group without FA (9% vs. 19%, p=0.042, χ test). A retrospective analysis of the group revealed a significant risk factor (RF) for the anastomotic leak, namely diabetes (p=0.036) and, among others, a protective factor, application of the transanal drain (NoCoil) (p=0.032). CONCLUSION: The introduction of new procedures and the use of new technologies, such as the use of the FA method in the AR mode in resections of the rectum with TME for cancer can lead to a reduction in the incidence of anastomotic leakage.

Redox Status of Professional Soccer Players is Influenced by Training Load Throughout a Season.

The purpose of this study was to follow-up the variation of pro-/antioxidant status throughout a whole season in elite professional soccer players from the French league (n=19, 18.3±0.6 years) and to examine a possible link between these variations and training load. 5 time points (T1, T2, T3, T4, T5) were proposed to surround crucial periods of training during the whole season: the pre-season training/mid-season periods (T1-T2 and T3-T4), the championship or in-season periods (T2-T3 and T4-T5). At these times, blood samples were collected to measure pro-/antioxidant status (in erythrocytes: the ratio of reduced glutathione/oxidized glutathione, superoxide dismutase and glutathione peroxidase activities, in plasma: alpha-tocopherol, beta-carotene), and dietary intakes were also recorded. Training loads were quantified by the rating of perceived exertion method weekly throughout the season. Pro-/antioxidant-related measurements showed no modifications except for GSH/GSSG ratio, which evolved significantly between season periods: from 36.43±4.15 (T1) to 115.99±16.43 (T2) to 91.64±21.24 (T3) to 202.29±29.26 (T4) to 59.61±14.61 (T5). We observed a significant correlation (r(2)=0.84) between changes in GSH/GSSH ratio and cumulated mean training loads. In conclusion, these results suggest that the redox status of professional soccer players is altered according to training period (in-season periods) and that GSH/GSSH ratio variations are correlated with cumulated training loads.

Effect of fatigue on stride pattern continuously measured by an accelerometric gait recorder in middle distance runners.

AIM: The purpose of this study was to analyze the continuous changes in stride patterns of athletes running at speed elicited VO(2max). METHODS: Six male sub-elite middle-distance runners carried out a constant track running test to exhaustion (time to exhaustion: 409+/-71 s) at their maximal aerobic speed (17.4+/-1.1 km.h(-1)). The body accelerations were measured with a triaxial accelerometer fixed at the low back. A set of variables was computed from the accelerometer output: stride frequency, stride symmetry and regularity, signal energies and impulses in each axis and the integral of the total acceleration vector. An ANOVA with repeated measures was performed to test the changes of these variables during the three times: the onset point, midway point and end point of exercise. RESULTS: The following changes were observed: the regularity index which describes the similarity of crania-caudal movements over successive strides, decreased significantly between the start and the end of the test (309.9 to 274.5; P<0.05). During the same time, the media-lateral impulse (4.69%BW.s to 5.71%BW.s; P<0.001; BW: body weight) and signal energy (1.40 G(2).s to 2.06 G(2).s; P<0.001; G=9.81 m.s(-2)) increased significantly. CONCLUSIONS: The changes in medio-lateral axis (increase of energy expenditure which is not useful for propulsion) and in the regularity index (modifications in the temporal-spatial periodicity of the running cycle) could be considered as early alterations of running pattern when the athletes got fatigued.