Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy

BACKGROUND At present,the enhanced recovery after surgery(ERAS)protocol is widely implemented in the field of gastric surgery.However,the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.AIM To compare the effects of ERAS and conventional protocols on short-term outcomes and long-term prognosis after laparoscopic gastrectomy.METHODS We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015.The patients were divided into either an ERAS group or a conventional group.The groups were matched in a 1:1 ratio using propensity scores based on covariates that affect cancer survival.The primary outcomes were the 5-year overall and cancer-specific survival rates.The secondary outcomes were the postoperative short-term outcomes and inflammatory indexes.RESULTS The patient demographics and baseline characteristics were similar between the two groups after matching.Compared to the conventional group,the ERAS group had a significantly shorter postoperative hospital day(7.09 d vs 8.67 d,P<0.001),shorter time to first flatus,liquid intake,and ambulation(2.50 d vs 3.40 d,P<0.001;1.02 d vs 3.64 d,P<0.001;1.47 d vs 2.99 d,P<0.001,respectively),and lower medical costs($7621.75 vs$7814.16,P=0.009).There was a significantly higher rate of postoperative complications among patients in the conventional group than among those in the ERAS group(18.1 vs 12.3,P=0.030).Regarding inflammatory indexes,the C-reactive protein and procalcitonin levels on postoperative day 3/4 were significantly different between the two groups(P<0.001 and P=0.025,respectively).The ERAS protocol was associated with significantly improved 5-year overall survival and cancer-specific survival rates compared with conventional protocol(P=0.013 and 0.032,respectively).When stratified by tumour stage,only the survival of patients with stage III disease was significantly different between the two groups(P=0.044).CONCLUSION Adherence to the ERAS protocol improves both the short-term outcomes and the 5-year overall survival and cancer-specific survival of patients after laparoscopic gastrectomy.

Effect of Management Practices on Seasonal Dynamics of Organic Carbon in Soils Under Bamboo Plantations

Soil samples for conventional management (CM) and intensive management (IM) practices were taken over a year at 2-month intervals to determine the effect of management practices on soil organic carbon (SOC) and to quantify seasonal dynamics in SOC for bamboo (Phyllostachys pubescens Mazel ex H. de Lehaie) stands. The results with IM compared to CM showed large decreases in total organic carbon (TOC), microbial biomass carbon (MBC), water-soluble organic carbon (WSOC), and the MBC/TOC ratio in the soils. With all IM plots in the 0-20 cm depth across sampling periods, average decreases compared with CM were: TOC, 12.1%; MBC, 26.1%; WSOC, 29.3%; the MBC/TOC ratio, 16.1%; and the WSOC/TOC ratio, 20.0%. Due to seasonal changes of climate, seasonal variations were observed in MBC and WSOC. Soil MBC in the 0-20 cm depth in September compared to May were 122.9% greater for CM and 57.6% greater for IM. However, due primarily to soil temperature, soil MBC was higher during the July to November period, whereas because of soil moisture, WSOC was lower in July and January. This study revealed that intensive management in bamboo plantations depleted the soil C pool; therefore, soil quality with IM should be improved through application of organic manures.

Evaluation of Environmental Impact Assessment Factors in Maritime Industry

The environmental impact of shipping sector includes the pollution caused by vessels to air and water environment.The water pollution is primarily caused by ship accidents and by untreated ballast water.To avoid maritime accidents,a complex system of regulations and safety management measures has been initiated to minimize and possibly avoid similar maritime disasters in the future.On the other hand,untreated ballast water,despite the ease of management by shipping companies,is regarded as one of the major maritime threats internationally and arguably a severe threat to biodiversity.The International Convention on the Control and Management of Ballast of Ships and Sediments,entered into force in September 2017,focusing on the prevention of the risk of importation and the proliferation of foreign species after the discharge of untreated ballast water from vessels.An option to reduce this risk is to install water treatment systems on the ballast tanks.Air pollution deriving from vessels is an additional issue that has great significance and impact on public health and the environment in general.Ships emit large amounts of air pollutants,mainly in the form of SO_(x)(Sulfur O_(x)ide),NO_(x)(Nitrogen O_(x)ide)and particulate matter,which are constantly growing and affecting humans.Vessels also produce nearly 3%of the world’s total greenhouse gas emissions,leading to rampant weather conditions.From 1 January 2020,the IMO(International Maritime Organization)imposed a new global sulfur emission ceiling of 0.5%on fuels,a reduction from the current limit of 3.5%,aiming at a gradual extinction of sulfur emissions in the near future.Pursuant to the previous analysis,three systems/indicators that are applied to vessels are going to be assessed,based on UNCTAD(United Nations Conference on Trade and Development)Report Data,to evaluate their impact in correlation to the measure of compliance to the relevant regulations so far:(i)the ship must have an equipped and installed ballast treatment system;(ii)the ship must be equipped and fitted with a special filter to eliminate sulfur emissions;(iii)the ship must comply with Tier III regulations to successfully reduce NO_(x)emissions.