Pelvic exenteration and composite sacral resection in the surgical treatment of locally recurrent rectal cancer

AbstractBackgroundThe incidence of rectal cancer recurrence after surgery is 5–45%. Extended pelvic resection which entails En-bloc resection of the tumor and adjacent involved organs provides the only true possible curative option for patients with locally recurrent rectal cancer.AimTo evaluate the surgical and oncological outcome of such treatment.Patients and methodsBetween 2006 and 2012 a consecutive series of 40 patients with locally recurrent rectal cancer underwent abdominosacral resection (ASR) in 18 patients, total pelvic exenteration with sacral resection in 10 patients and extended pelvic exenteration in 12 patients. Patients with sacral resection were 28, with the level of sacral division at S2–3 interface in 10 patients, at S3–4 in 15 patients and S4–5 in 3 patients.ResultsForty patients, male to female ratio 1.7:1, median age 45years (range 25–65years) underwent extended pelvic resection in the form of pelvic exenteration and abdominosacral resection. Morbidity, re-admission and mortality rates were 55%, 37.5%, and 5%, respectively. Mortality occurred in 2 patients due to perineal flap sepsis and massive myocardial infarction. A R0 and R1 sacral resection were achieved in 62.5% and 37.5%, respectively. The 5-year overall survival rate was 22.6% and the 4-year recurrence free survival was 31.8%.ConclusionExtended pelvic resection as pelvic exenteration and sacral resection for locally recurrent rectal cancer are effective procedures with tolerable mortality rate and acceptable outcome. The associated morbidity remains high and deserves vigilant follow up

Global Forum of Cancer Surgeons: Position Statement to Promote Cancer Surgery Globally

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Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Whole ureteric course delineation assessment using non contrast curved sagittal oblique reformatted CT

Purpose: To develop a standardized technique to assess delineation of the whole ureter for the evaluation of symptomatizing urologic patients. Method and materials: 2500 patients are examined using 64-MDCT. Examinations were performed with oral hydration Group I (n = 834), Group II which received IV diuretics (n = 847), or Group III which received nothing (n = 819). Curved planar reformatted images were obtained manually to obtain the entire ureter in a single coronal oblique image. The ureter was divided into 3 anatomic segments for estimating the degree of its delineation where if the segment is assessed along its whole length it is graded as satisfactory delineation, otherwise it is graded as non-proper delineation. Delineation degrees for each ureteric segment were compared. Results: Satisfactory delineation obtained with group II (51.3%) was statistically higher than other groups with p value < 0.001, with a statistical significant result (p < 0.001) as regards the delineation of ureteric segments and patients’ sex; the middle and lower third segments show satisfactory delineation in group II with 86%, while the non-proper delineation is higher in females with percentage 66.1%, and the percentage of non-proper delineation among females is least recorded in group II. Conclusion: Curved sagittal oblique reformatted image with IV diuretics allows better tracing of the whole ureteric course

Biostimulant application of whey protein hydrolysates and potassium fertilization enhances the productivity and tuber quality of sweet potato

Utilizing biostimulants like protein hydrolysates is one of the most creative and promising approaches to improving nutritional efficiency, abiotic stress tolerance, or crop quality traits. In the present study, whey protein was hydrolysed with trypsin for 4 h at an enzyme/substrate ratio (1/300, w/w). The obtained whey protein hydrolysates (WPH) were chemically characterized, and their antioxidant activity was estimated. WPH, which was produced using trypsin for 4 hours and presented the highest antioxidant activity. Therefore, it was selected as a bio stimulant with potassium fertilization for enhancing the productivity and tuber quality of sweet potatoes. A field experiment was carried out during the two successive summer seasons, at a private vegetable farm in Faques City, Sharkia Governorate, Egypt, to study the effect of different potassium rates (50, 75, and 100 kg K2O/fad) and WPH at 0.10 and 0.20% as a foliar application compared to unsprayed plants (control). The interaction between K2O at 100 kg /fad and spraying with WPH at 0.15% increased shoot dry weight/ plant, N, P, and K uptake by shoots, yield/plant, marketable yield, and total yield/fad, as well as average tuber root weight. It was concluded that the most efficient bio-stimulating foliar spray treatment for increasing sweet potato productivity was WPH (0.20%)

Regulation of Agronomic Traits, Nutrient Uptake, Osmolytes and Antioxidants of Maize as Influenced by Exogenous Potassium Silicate under Deficit Irrigation and Semiarid Conditions

Understanding the link between the protective role of potassium silicate (K2SiO3) against water shortage and the eventual grain yield of maize plants is still limited under semiarid conditions. Therefore, in this study, we provide insights into the underlying metabolic responses, mineral nutrients uptake and some nonenzymatic and enzymatic antioxidants that may differ in maize plants as influenced by the foliar application of K2SiO3 (0, 1 and 2 mM) under three drip irrigation regimes (100, 75 and 50% of water requirements). Our results indicated that, generally, plants were affected by both moderate and severe deficit irrigation levels. Deficit irrigation decreased shoot dry weight, root dry weight, leaf area index (LAI), relative water content (RWC), N, P, K, Ca, Fe, Zn, carotenoids, grain yield and its parameters, while root/shoot ratio, malondialdehyde (MDA), proline, soluble sugars, ascorbic acid, soluble phenols, peroxidase (POD), catalase (CAT), polyphenol oxidase (PPO), and ascorbate peroxidase (APX) were improved. The foliar applications of K2SiO3 relatively alleviated water stress-induced damage. In this respect, the treatment of 2 mM K2SiO3 was more effective than others and could be recommended to mitigate the effect of deficit irrigation on maize plants. Moreover, correlation analysis revealed a close link between yield and the most studied traits

Is Gray Water the Key to Unlocking Water for Resource-Poor Areas of the Middle East, North Africa, and Other Arid Regions of the World?

Support for the use of treated gray water as an alternative water resource in the Middle East and North Africa is high, especially given the lack of religious restrictions against its use, but several obstacles have kept application of treated gray water near 1 % in some areas. The largest of obstacles include the cost of treatment and the ambiguity surrounding the health safety of gray water and treated gray water. This paper aims to provide an overview of current gray water practices globally, with specific focus on household-level gray water practices in the Middle East and North Africa region, and highlight the need for cost reduction strategies and epidemiological evidence on the use of household-level gray water and treated gray water. Such actions are likely to increase the application of treated gray water in water-deprived areas of the Middle East and North Africa