Can trans-anal reinforcing sutures after double stapling in lower anterior resection reduce the need for a temporary diverting ostomy?

AIM:To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution.METHODS:The data of patients who received transanal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection.Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January2008 and December 2011 were included in this study.Patients with no anastomosis,a hand-sewn anastomosis,high anterior resection,or preoperative chemoradiation were excluded.The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy.RESULTS:Among 110 patients,the rate of placement of a diverting ileostomy was significantly lower in the suture group(SG)compared with the non-suture control group(CG)[SG,n=6(12.8%);CG,n=19(30.2%),P=0.031].No significant difference was observed in the rate of anastomotic leakage[SG,n=3(6.4%);CG,n=5(7.9%)].CONCLUSION:Trans-anal reinforcing sutures may reduce the need for diverting ileostomy.A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.

Relationship between diversion colitis and quality of life in rectal cancer

AIM:To investigated the incidence of diversion colitis(DC) and impact of DC symptoms on quality of life(QoL) after ileostomy reversal in rectal cancer.METHODS:We performed a prospective study with 30 patients who underwent low anterior resection and the creation of a temporary ileostomy for the rectal cancer between January 2008 and July 2009 at the Department of Surgery,Korea University Anam Hospital.The participants totally underwent two rounds of the examinations.At first examination,endoscopies,tissue biopsies,and questionnaire survey about the symptom were performed 3-4 mo after the ileostomy creations.At second examination,endoscopies,tissue biopsies,and questionnaire survey about the symptom and QoL were performed 5-6 mo after the ileostomy reversals.Clinicopathological data were based on the histopathological reports and clinical records of the patients.RESULTS:At the first examination,all of the patients presented with inflammation,which was mild in 15(50%) patients,moderate in 11(36.7%) and severe in 4(13.3%) by endoscopy and mild in 14(46.7%) and moderate in 16(53.3%) by histology.At the second examination,only 11(36.7%) and 17(56.7%) patients had mild inflammation by endoscopy and histology,respectively.There was no significant difference in DC grade between the endoscopic and the histological findings at first or second examination.The symptoms detected on the first and second questionnaires were mucous discharge in 12(40%) and 5(17%) patients,bloody discharge in 5(17%) and 3(10%) patients,abdominal pain in 4(13%) and 2(7%) patients and tenesmus in 9(30%) and 5(17%) patients,respectively.We found no correlation between the endoscopic or histological findings and the symptoms such as mucous discharge,bleeding,abdominal pain and tenesmus in both time points.Diarrhea was detected in 9 patients at the second examination;this number correlated with the severity of DC(0%,0%,66.7%,33.3% vs 0%,71.4%,23.8%,4.8%,P = 0.001) and the symptom-related QoL(r =-0.791,P < 0.001).CONCLUSION:The severity of DC is related to diarrhea after an ileostomy reversal and may adversely affect QoL.

Risk factors causing structural sequelae after anastomotic leakage in mid to low rectal cancer

AIM: To investigate the risk factors causing structural sequelae after anastomotic leakage in patients with mid to low rectal cancer.METHODS: Prospectively collected data of consecutive subjects who had anastomotic leakage after surgical resection for rectal cancer from March 2006 to May 2013 at Korea University Anam Hospital were retrospectively analyzed. Two subgroup analyses were performed. The patients were initially divided into the sequelae(stricture, fistula, or sinus) and no sequelae groups and then divided into the permanent stoma(PS)and no PS groups. Univariate and multivariate analyses were performed to identify the risk factors of structural sequelae after anastomotic leakage.RESULTS: Structural sequelae after anastomotic leakage were identified in 29 patients(39.7%).Multivariate analysis revealed that diversion ileostomy at the first operation increases the risk of structural sequelae [odds ratio(OR) = 6.741; P = 0.017].Fourteen patients(17.7%) had permanent stoma during the follow-up period(median, 37 mo). Multivariate analysis showed that the tumor level from the dentate line was associated with the risk of permanent stoma(OR = 0.751; P = 0.045).CONCLUSION: Diversion ileostomy at the first operation increased the risk of structural sequelae of the anastomosis, while lower tumor location was associated with the risk of permanent stoma in the management of anastomotic leakage.

Anterograde jejunojejunal intussusception resulted in acute efferent loop syndrome after subtotal gastrectomy

Postoperative intussusception is an unusual clinical entity in adults,and is rarely encountered as a complication following gastric surgery.The most common type after gastric surgery is retrograde jejunogastric intussusception,and jejunojejunal intussusception has been rarely reported.We report a case of anterograde jejunojejunal intussusception after radical subtotal gastrectomy with Billroth Ⅱ anastomosis in a 38-year-old Korean woman with early gastric cancer,and include a review of the literature on this unusual complication.

Effect of Graphene Nanoribbons (TexasPEG) on locomotor function recovery in a rat model of lumbar spinal cord transection

A sharply transected spinal cord has been shown to be fused under the accelerating influence of membrane fusogens such as polyethylene glycol （PEG） （GEMINI protocol）. Previous work provided evidence that this is in fact possible. Other fusogens might improve current results. In this study, we aimed to assess the effects of PEGylated graphene nanoribons （PEG-GNR, and called ＂TexasPEG＂ when prepared as lwt% dispersion in PEG600） versus placebo （saline） on locomotor function recovery and cellular level in a rat model of spinal cord transection at lumbar segment 1 （L1） level. In vivo and in vitro experiments （n -- 10 per experiment） were designed. In the in vivo experiment, all rats were submitted to full spinal cord transection at L1 level. Five weeks later, behavioral assessment was performed using the Basso Beattie Bresnahan （BBB） locomotor rating scale. Immunohistochemical staining with neuron marker neurofilament 200 （NF200） antibody and astrocyt- ic scar marker glial fibrillary acidic protein （GFAP） was also performed in the injured spinal cord. In the in vitro experiment, the effects of TexasPEG application for 72 hours on the neurite outgrowth of SH-SYSY cells were observed under the inverted microscope. Results of both in vivo and in vitro experiments suggest that TexasPEG reduces the formation of glial scars, promotes the regeneration of neurites, and thereby contributes to the recovery of locomotor function of a rat model of spinal cord transfection.

Bowel function and quality of life after minimally invasive colectomy with D3 lymphadenectomy for right-sided colon adenocarcinoma

BACKGROUND Changes in bowel function after right-sided colectomy are not well understood compared to those associated with left-sided colectomy or rectal resection.In particular,there are concerns about bowel function after right-sided colectomy with complete mesocolic excision,which has become popular in the West.AIM To evaluate the functional outcomes of patients who underwent right-sided colectomy with D3 lymphadenectomy for colon cancer.METHODS Functional data from patients who underwent minimally invasive right-sided colectomy for colon cancer from October 2017 to September 2018 were prospectively collected.Functional outcomes were evaluated preoperatively and at 3,6,12,and 18 mo postoperatively.RESULTS Prior to surgery,57 patients answered the questionnaire,and 47 responded at three months,52 at 6 mo,52 at 12 mo,and 25 at 18 mo postoperatively.Most scales of quality of life and bowel function improved significantly over time.Urgency persisted to a high degree throughout the period without a significant change over time.The use of medications for defecation was about 10%over the entire period.Gas(P=0.023)and fecal frequency(P<0.001)increased,and bowel dysfunction group(P=0.028)was more common among patients taking medication.At six months,resected bowel and colon lengths were significantly different as a risk factor between the dysfunction group and the no dysfunction group[odd ratio(OR):1.095,P=0.026;OR:1.147,P=0.031,respectively]in univariate analysis,but not in multivariate analysis.CONCLUSION Despite D3 lymphadenectomy,most bowel symptoms improved over time after right-sided colectomy using a minimally invasive approach,and continuous medication was needed in only approximately 10%of patients.

Clinical characteristics of patients in their forties who underwent surgical resection for colorectal cancer in Korea

BACKGROUND The proportion of young patients with colorectal cancer(CRC),especially in their 40s,is increasing worldwide.AIM To confirm the clinical characteristics of such patients,we planned a study comparing them to patients in their 30s and 50s.METHODS Patients undergoing primary resection for CRC,patients in their 30s,40s and 50s were included in the study.Patient and tumor characteristics,and perioperative and oncologic outcomes were compared.RESULTS Most clinical characteristics of 451(10.5%)patients in their 40s were more similar to those of patients in their 30s than those in their 50s.On pathology data,there were more metastatic lesions(30s vs 40s vs 50s;17.5%vs 21.1%vs 14.9%,P=0.012)in patients in their 40s.There was a trend toward less frequent K-ras mutations among patients in their 40s(48.5%vs 33.3%vs 44.5%,P=0.064).The proportion of patients receiving postoperative chemotherapy was also significantly greater among patients in their 40s(58.3%vs 63.9%vs 56.3%,P=0.032).Five-year overall survival(OS)and disease-free survival(DFS)did not differ between the three groups(5-year OS,92.2%vs 89.8%vs 92.2%,P=0.804;5-year total DFS,98.6%vs 95.7%vs 96.1%,P=0.754;5-year local DFS,98.6%vs 94.3%vs 94.9%,P=0.579;5-year systemic DFS,86.4%vs 87.9%vs 86.4%,P=0.908).CONCLUSION Patients with CRC in their 40s showed significantly more numerous metastatic lesions.The oncologic outcome of stage 1-3 patients in their 40s was not inferior compared to that of those in their 30s and 50s.

Hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation

Here, we present the case of a 53-year-old man with a hepatothorax due to a right diaphragmatic rupture related to duodenal ulcer perforation. On admission, the patient complained of severe acute abdominal pain, with physical examination findings suspicious for a perforated peptic ulcer. Of note, the patient had no history of other medical conditions or recent trauma, and the initial chest radiography and laboratory findings were not specific. A subsequent abdominal computed tomography revealed intrathoracic displacement of the liver, gallbladder, transverse colon and omentum through a right diaphragmatic defect. The patient then underwent an explorative laparotomy that confirmed duodenal ulcer perforation. A primary repair of the duodenal perforation was performed, and the diaphrag-matic defect was repaired using a polytetrafluoroeth-ylene patch after the organs were reduced and the cavity irrigated. This particular case proves interesting as right-sided spontaneous diaphragmatic ruptures are very rare and difficult to diagnose. Additionally, the best treatment for such large diaphragmatic defects is still controversial, especially in cases of intrathoracic or intra-abdominal contamination.

A case study of customer satisfaction for information technology solutions

There are numerous information technology solutions including hardware and software. A company that provides the solution should have knowledge of the customer needs in the purpose of sailing strategy or upgrade policy. The needs are also directly connected to the user satisfaction. However, the users have respective points of view in the needs as well as they may not identify the requirements to improve the solution. SERVQUAL can be an appropriate method to define and measure the customer satisfaction for the information technology solutions. As a case study of the customer satisfaction, the modified SERVQUAL items and scoring method are applied to a cyber-infrastructure system named CyberL ab in Korea. The measurement results of user satisfaction for CyberL ab are provided to confirm that our proposed method performs as we intended. From the results, we can score the satisfaction level of users and identify their needs in the various aspects. The total user satisfaction level for CyberL ab is scored by 88.3.

Hepatic cyst misdiagnosed as a gastric submucosal tumor:A case report

We describe here a case of 51-year-old woman with a symptomatic hepatic cyst that was misdiagnosed as a gastric submucosal tumor (SMT) with endoscopic ultrasound (EUS) and CT scan. The patient presented with an epigastric pain for two months. On endoscopy, a submucosal tumor was found on the cardia of the stomach. Based on EUS and abdominal CT scan, the lesion was diagnosed as a gastric duplication cyst or a gastrointestinal stromal tumor (GIST). The operative plan was laparoscopic wedge resection for the GIST of the gastric cardia. A cystic mass arising from the left lateral segment of the liver was found at the laparoscopic examination. There was no abnormal finding at the gastric cardia. She was treated by laparoscopic hepatic wedge resection including the hepatic cyst using an endoscopic linear stapler.

Multi-redox phenazine/non-oxidized graphene/cellulose nanohybrids as ultrathick cathodes for high-energy organic batteries

Various redox-active organic molecules can serve as ideal electrode materials to realize sustainable energy storage systems. Yet, to be more appropriate for practical use, considerable architectural engineering of an ultrathick, high-loaded organic electrode with reliable electrochemical performance is of crucial importance. Here, by utilizing the synergetic effect of the non-covalent functionalization of highly conductive non-oxidized graphene flakes (NOGFs) and introduction of mechanically robust cellulose nanofiber (CNF)-intermingled structure, a very thick (≈ 1 mm), freestanding organic nanohybrid electrode which ensures the superiority in cycle stability and areal capacity is reported. The well-developed ion/electron pathways throughout the entire thickness and the enhanced kinetics of electrochemical reactions in the ultrathick 5,10-dihydro-5,10-dimethylphenazine/NOGF/CNF (DMPZ-NC) cathodes lead to the high areal energy of 9.4 mWh·cm−2 (= 864 Wh·kg−1 at 158 W·kg−1). This novel ultrathick electrode architecture provides a general platform for the development of the high-performance organic battery electrodes.