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Background: Primary perineal wound closure after conventional abdominoperineal resection (cAPR) for rectal cancer has been the standard of care for many years. Since the introduction of neo-adjuvant radiotherapy and the extralevator APR (eAPR), oncological outcome has been improved, but at the cost of increased rates of perineal wound healing problems and perineal hernia. This has progressively increased the use of biological meshes, although not supported by sufficient evidence. The aim of this study is to determine the effectiveness of pelvic floor reconstruction using a biological mesh after standardized eAPR with neo-adjuvant (chemo) radiotherapy compared to primary perineal wound closure. Methods/Design: In this multicentre randomized controlled trial, patients with a clinical diagnosis of primary rectal cancer who are scheduled for eAPR after neo-adjuvant (chemo) radiotherapy will be considered eligible. Exclusion criteria are prior radiotherapy, sacral resection above S4/S5, allergy to pig products or polysorbate, collagen disorders, and severe systemic diseases affecting wound healing, except for diabetes. After informed consent, 104 patients will be randomized between standard care using primary wound closure of the perineum and the experimental arm consisting of suturing a biological mesh derived from porcine dermis in the pelvic floor defect, followed by perineal closure similar to the control arm. Patients will be followed for one year after the intervention and outcome assessors and patients will be blinded for the study treatment. The primary endpoint is the percentage of uncomplicated perineal wound healing, defined as a Southampton wound score of less than II on day 30. Secondary endpoints are hospital stay, incidence of perineal hernia, quality of life, and costs. Discussion: The BIOPEX-study is the first randomized controlled multicentre study to determine the additive value of using a biological mesh for perineal wound closure after eAPR with neo-adjuvant radiotherapy compared to primary perineal wound closure with regard to perineal wound healing and the occurrence of perineal hernia

Distribution and numbers of breeding ivory gulls Pagophila eburnea in Severnaja Zemlja, Russian Arctic

The ivory gullPagophila eburnea has a semi-circumpolar distribution with breeding sites in the High Arctic. Data about ivory gulls in the Severnaja Zemlja Archipelago (Siberia) were collected from 1991 to 1995. The numbers of breeding ivory gulls and their egg-laying period arc correlated with the sea ice situation and weather during the first part of the summer. We estimate that the total potential breeding population of Severnaja Zemlja is about 2000 pairs, which makes up approximately 20% of the Russian and 14% of the world ivory gull breeding population. The percentage of the total breeding population which actually breeds varies annually. The most important breeding area of the ivory gull in Severnaja Zemlja is the Sedov Archipelago (A. Sedova) where a large colony (from 410 to about 1100 pairs in different years) was found on flat ground on Domašmj Island. Colonies from 10 to 100 breeding pairs, mostly on steep cliff faces, occur on O. Oktjabr'skoj Revoljucii and O. Bo?ševik. The ivory gull is included in the Red Data Book of Russia. Parts of Severnaja Zemlja. with important breeding sites, have become a nature reserve