Laparoscopic rectal resections: practical aspects

Abordul laparoscopic in chirurgia cancerului de rect este o considerat standardul de aur ce ofera rezultate oncologice similar cu o recuperare postoperatorie imbunatatita, si o rata minimala de complicatii. Pe fondul complexitatii crescute, cu toate astea, abordul laparoscopic ar trebui efectuat in centre tertiare, fiind rezervat chirurgilor cu o curba de invatare adecvata. O selectie atenta a cazurilor si o planificare adecvata ar trebui luata in considerare in cadrul acestui abord. Prezentarea de fata surprinde aspectele practice de baza precum si variatii tatice in cadrul rezectiilor de rect laparoscopice, precum si pasii potentiali in atingerea curbei de invatare.Laparoscopic approach is an already established procedure in rectal cancer which offers a similar oncological outcome, with improved postoperative recovery and fewer complications. Due to its increased complexity, however, the laparoscopic approach should be reserved for high-volume centers and for experienced surgeons with an adequate learning curve. Appropriate patient selection and planning must be carefully considered when opting for this approach. In this presentation, the primary practical aspects as well as certain tactical approaches will be covered regarding the laparoscopic rectal resections as well as the potential steps in achieving the learning curve

An impulse response function for the "long tail" of excess atmospheric CO₂ in an Earth system model

The ultimate fate of (fossil fuel) CO emitted to the atmosphere is governed by a range of sedimentological and geological processes operating on timescales of up to the ca. hundred thousand year response of the silicate weathering feedback. However, how the various geological CO sinks might saturate and feedbacks weaken in response to increasing total emissions is poorly known. Here we explore the relative importance and timescales of these processes using a 3-D ocean-based Earth system model. We first generate an ensemble of 1 Myr duration CO decay curves spanning cumulative emissions of up to 20,000 Pg C. To aid characterization and understanding of the model response to increasing emission size, we then generate an impulse response function description for the long-term fate of CO in the model. In terms of the process of carbonate weathering and burial, our analysis is consistent with a progressively increasing fraction of total emissions that are removed from the atmosphere as emissions increase, due to the ocean carbon sink becoming saturated, together with a lengthening of the timescale of removal from the atmosphere. However, we find that in our model the ultimate CO sink - silicate weathering feedback - is approximately invariant with respect to cumulative emissions, both in terms of its importance (it removes the remaining excess ~7% of total emissions from the atmosphere) and timescale (~270 kyr). Because a simple pulse-response description leads to initially large predictive errors for a realistic time-varying carbon release, we also develop a convolution-based description of atmospheric CO decay which can be used as a simple and efficient means of making long-term carbon cycle perturbation projections. Key Points An ensemble of CO pulse emissions are modeled using an Earth system model Our impulse response function projects the atmospheric lifetime of emitted CO We characterize how the marine CO sinks tend to saturate at very high emissions. 2 2 2 2 2 2 2 2

Redox‐controlled preservation of organic matter during “OAE 3” within the Western Interior Seaway

During the Cretaceous, widespread black shale deposition occurred during a series of Oceanic Anoxic Events (OAEs). Multiple processes are known to control the deposition of marine black shales, including changes in primary productivity, organic matter preservation, and dilution. OAEs offer an opportunity to evaluate the relative roles of these forcing factors. The youngest of these events—the Coniacian to Santonian OAE 3—resulted in a prolonged organic carbon burial event in shallow and restricted marine environments including the Western Interior Seaway. New high‐resolution isotope, organic, and trace metal records from the latest Turonian to early Santonian Niobrara Formation are used to characterize the amount and composition of organic matter preserved, as well as the geochemical conditions under which it accumulated. Redox sensitive metals (Mo, Mn, and Re) indicate a gradual drawdown of oxygen leading into the abrupt onset of organic carbon‐rich (up to 8%) deposition. High Hydrogen Indices (HI) and organic carbon to total nitrogen ratios (C:N) demonstrate that the elemental composition of preserved marine organic matter is distinct under different redox conditions. Local changes in δ13C indicate that redox‐controlled early diagenesis can also significantly alter δ13Corg records. These results demonstrate that the development of anoxia is of primary importance in triggering the prolonged carbon burial in the Niobrara Formation. Sea level reconstructions, δ18O results, and Mo/total organic carbon ratios suggest that stratification and enhanced bottom water restriction caused the drawdown of bottom water oxygen. Increased nutrients from benthic regeneration and/or continental runoff may have sustained primary productivity.Key PointsBottom water redox changes triggered carbon burial within the WIS during OAE 3Anoxia developed due to O2 drawdown in a stratified water columnRedox‐controlled changes in OM preservation altered primary δ13Corg signalsPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112294/1/palo20210.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/112294/2/palo20210-sup-0001-SupportingInfo.pd

An extraterrestrial trigger for the Early Cretaceous massive volcanism? Evidence from the paleo-Tethys Ocean

The Early Cretaceous Greater Ontong Java Event in the Pacific Ocean may have covered ca. 1% of the Earth's surface with volcanism. It has puzzled scientists trying to explain its origin by several mechanisms possible on Earth, leading others to propose an extraterrestrial trigger to explain this event. A large oceanic extraterrestrial impact causing such voluminous volcanism may have traces of its distal ejecta in sedimentary rocks around the basin, including the paleo-Tethys Ocean which was then contiguous with the Pacific Ocean. The contemporaneous marine sequence at central Italy, containing the sedimentary expression of a global oceanic anoxic event (OAE1a), may have recorded such ocurrence as indicated by two stratigraphic intervals with 187Os/188Os indicative of meteoritic influence. Here we show, for the first time, that platinum group element abundances and inter-element ratios in this paleo-Tethyan marine sequence provide no evidence for an extraterrestrial trigger for the Early Cretaceous massive volcanism

The pathophysiology of fluid and electrolyte balance in the older adult surgical patient

Background & aims: Age-related physiological changes predispose even the healthy older adult to fluid and electrolyte abnormalities which can cause morbidity and mortality. The aim of this narrative review is to highlight key aspects of age-related pathophysiological changes that affect fluid and electrolyte balance in older adults and underpin their importance in the perioperative period. Methods: The Web of Science, MEDLINE, PubMed and Google Scholar databases were searched using key terms for relevant studies published in English on fluid balance in older adults during the 15 years preceding June 2013. Randomised controlled trials and large cohort studies were sought; other studieswere used when these were not available. The bibliographies of extracted papers were also searched for relevant articles. Results: Older adults are susceptible to dehydration and electrolyte abnormalities, with causes ranging from physical disability restricting access to fluid intake to iatrogenic causes including polypharmacy and unmonitored diuretic usage. Renal senescence, as well as physical and mental decline, increase this susceptibility. Older adults are also predisposed to water retention and related electrolyte abnormalities, exacerbated at times of physiological stress. Positive fluid balance has been shown to be an independent risk factor for morbidity and mortality in critically ill patients with acute kidney injury. Conclusions: Age-related pathophysiological changes in the handling of fluid and electrolytes make older adults undergoing surgery a high-risk group and an understanding of these changes will enable better management of fluid and electrolyte therapy in the older adult

Historicising Material Agency: from Relations to Relational Constellations

Relational approaches have gradually been changing the face of archaeology over the last decade: analytically, through formal network analysis; and interpretively, with various frameworks of human-thing relations. Their popularity has been such, however, that it threatens to undermine their relevance. If everyone agrees that we should understand past worlds by tracing relations, then ‘finding relations’ in the past becomes a self-fulfilling prophecy. Focusing primarily on the interpretive approaches of material culture studies, this article proposes to counter the threat of irrelevance by not just tracing human-thing relations, but characterising how sets of relations were ordered. Such ordered sets are termed ‘relational constellations’. The article describes three relational constellations and their consequences based on practices of fine ware production in the Western Roman provinces (first century BC – third century AD): the fluid, the categorical, and the rooted constellation. Specifying relational constellations allows reconnecting material culture to specific historical trajectories, and offers scope for meaningful cross-cultural comparisons. As such a small theoretical addition based on the existing toolbox of practice-based approaches and relational thought can impact on historical narratives, and can save relational frameworks from the danger of triviality.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s10816-015-9244-

Persistent Place-Making in Prehistory: the Creation, Maintenance, and Transformation of an Epipalaeolithic Landscape

Most archaeological projects today integrate, at least to some degree, how past people engaged with their surroundings, including both how they strategized resource use, organized technological production, or scheduled movements within a physical environment, as well as how they constructed cosmologies around or created symbolic connections to places in the landscape. However, there are a multitude of ways in which archaeologists approach the creation, maintenance, and transformation of human-landscape interrelationships. This paper explores some of these approaches for reconstructing the Epipalaeolithic (ca. 23,000–11,500 years BP) landscape of Southwest Asia, using macro- and microscale geoarchaeological approaches to examine how everyday practices leave traces of human-landscape interactions in northern and eastern Jordan. The case studies presented here demonstrate that these Epipalaeolithic groups engaged in complex and far-reaching social landscapes. Examination of the Early and Middle Epipalaeolithic (EP) highlights that the notion of “Neolithization” is somewhat misleading as many of the features we use to define this transition were already well-established patterns of behavior by the Neolithic. Instead, these features and practices were enacted within a hunter-gatherer world and worldview

Trophic State in Canterbury Waterways

Aquatic eutrophication is a serious global problem, associated with phytoplankton blooms, hypoxia, and loss of species. The objective of this thesis was to advance understanding of stream and lake eutrophication within Canterbury (South Island, New Zealand). I investigated three key questions: 1) How do riparian characteristics control stream trophic state, 2) how does stream trophic state in the Canterbury region compare to stream trophic state nationally and internationally, and 3) what factors control trophic state in Te Wairewa/Lake Forsyth. I measured rates of stream community metabolism in 21 Canterbury streams over a gradient of riparian canopy cover, and conducted a literature review of national and international studies of stream metabolism. I also examined the occurrence of cyanobacterial blooms in Te Wairewa in relation to water quality and weather from 17 years of measurements, and performed series of nutrient addition assays on the lake to assess nutrient limitation. I found that riparian characteristics strongly controlled stream trophic state by shading, thereby reducing photosynthetic productivity. This overwhelmed the effects of high nitrate concentrations, which increased primary production. Compared to national and international rates of stream metabolism, Canterbury streams were strongly heterotrophic, with low rates of autotrophic production. Catchment streams draining into Te Wairewa were unlikely to be the main source of nutrients supporting large cyanobacterial blooms. Instead, internal lake nutrient loading mechanisms associated with calm weather were likely to supply blooms. My results emphasize the importance of light limitation, nitrogen and heterotrophy in controlling stream trophic state, and nutrient supply and weather in controlling lake trophic state