Oxygen Penetration Through Full-Thickness Skin by Oxygen-Releasing Sutures for Skin Graft Transplantation

The transplantation of full-thickness skin grafts(FTSGs)is important for reconstructing skin barrier and promoting wound healing.Sufficient oxygen supply is closely related to the success of skin grafting.However,full-thickness oxygen delivery is limited by the poor oxygen permeability of skin.Oxygen-releasing sutures(O_(2)sutures)were developed to facilitate oxygen penetration through full-thickness skin.The O_(2)sutures delivered 100 times more oxygen than topical gaseous oxygen therapy at a 15 mm depth in the skin model.Under extreme hypoxia(<0.5%O_(2),v/v),O_(2)sutures could also promote endothelial cell proliferation.After the transplantation of FTSGs in mice,O_(2)sutures accelerated blood re-perfusion and increased the survival area of the skin graft.It is expected that O_(2)sutures will be adopted in clinical applications to increase the success rate of full-thickness skin transplantation.

Use of an immunocapture device to detect cytokine release in discrete brain regions

Production of proinflammatory cytokines in the central nervous system is a key process in the neuroinflammatory response to trauma,infection,and neurodegenerative diseases(Kumar,2019).These intercellular signaling molecules play multiple roles in the immune response in the central nervous system including the orchestration of the sickness response to innate immune perturbations in the brain(Dantzer et al.,2008).

Early Triassic Volcanic Rocks in the Western Yarlung Zangbo Suture Zone:Implications for the Opening of the Neo-Tethys Ocean

In this study,zircon U-Pb dating of volcanic rocks from the Zhongba ophiolite of the Yarlung Zangbo Suture Zone(YZSZ)in southern Xizang(Tibet)yielded an age of 247±3 Ma.According to whole rock geochemical and Sr-NdPb isotopic data,the Early Triassic samples could be divided into two groups:Group 1 with P-MORB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70253–0.70602,ε_(Nd)(t)values of 4.2–5.3,(^(206)Pb/^(204)Pb)_(t)ratios of 16.353–18.222,(^(207)Pb/^(204)Pb)_(t)ratios of 15.454–15.564,and(^(208)Pb/^(204)Pb)_(t)ratios of 35.665–38.136;Group 2 with OIB affinity,showing initial^(87)Sr/^(86)Sr ratios of 0.70249–0.70513,ε_(Nd)(t)values of 4.4–4.9,(^(206)Pb/^(204)Pb)_(t)ratios of 17.140–18.328,(^(207)Pb/^(204)Pb)_(t)ratios of 15.491–15.575,and(^(208)Pb/^(204)Pb)_(t)ratios of 36.051–38.247.Group 2 rocks formed by partial melting of the mantle source enriched by a former plume,and assimilated continental crustal material during melt ascension.The formation of Group 1 rocks corresponds to the mixing of OIB melts,with the same components as Group 2 and N-MORBs.The Zhongba Early Triassic rocks belong to the continental margin type ophiolite and formed in the continental–oceanic transition zone during the initial opening of the Neo-Tethys in southern Xizang(Tibet).

Double-nylon purse-string suture in closing postoperative wounds following endoscopic resection of large(≥3 cm)gastric submucosal tumors

BACKGROUND Endoscopic full-thickness resection(EFTR)of gastric submucosal tumors(SMTs)is safe and effective;however,postoperative wound management is equally important.Literature on suturing following EFTR for large(≥3 cm)SMTs is scarce and limited.AIM To evaluate the efficacy and clinical value of double-nylon purse-string suture in closing postoperative wounds following EFTR of large(≥3 cm)SMTs.METHODS We retrospectively analyzed the data of 85 patients with gastric SMTs in the fundus of the stomach or in the lesser curvature of the gastric body whose wounds were treated with double-nylon purse-string sutures after successful tumor resection at the Endoscopy Center of Renmin Hospital of Wuhan University.The operative,postoperative,and follow-up conditions of the patients were evaluated.RESULTS All tumors were completely resected using EFTR.36(42.35%)patients had tumors located in the fundus of the stomach,and 49(57.65%)had tumors located in the body of the stomach.All patients underwent suturing with double-nylon sutures after EFTR without laparoscopic assistance or further surgical treatment.Postoperative fever and stomach pain were reported in 13(15.29%)and 14(16.47%)patients,respectively.No serious adverse events occurred during the intraoperative or postoperative periods.A postoperative review of all patients revealed no residual or recurrent lesions.CONCLUSION Double-nylon purse-string sutures can be used to successfully close wounds that cannot be completely closed with a single nylon suture,especially for large(≥3 cm)EFTR wounds in SMTs.

Intermittent sliding-lock-knot suture for limbal conjunctival autograft fixation in pterygium surgery:a technique note

AIM:To report a technique used with intermittent slidinglock-knot(ISLK)fixation for limbal conjunctival autografts in pterygium surgery and compared with those of routine intermittent(RI)fixation.METHODS:Consecutive patients with primary pterygium who had undergone pterygium excision combined with limbal conjunctival autograft transplantation between March 2021 and March 2022 at our institute were retrospectively analyzed.Primary outcome measures were mean duration of surgery and suture removal,degree of conjunctival hyperemia on postoperative day 1,pain score at suture removal,postoperative symptoms at 6mo,including conjunctival hyperemia,foreign body sensation,and graft stability.RESULTS:Ninety-eight patients underwent monocular surgery and were divided into ISLK(51 eyes)and RI(47 eyes)groups according to the type of conjunctiva autograft fixation method planned.There was no significant difference in mean duration of surgery between the two groups(18.59±2.39min vs 18.15±2.20min,P=0.417);however,compared to the RI group,shorter suture removal times were observed in the ISLK group[0.58min(0.42-0.87)vs 3.00min(2.21-4.15),P<0.001].The degree of conjunctival hyperemia on postoperative day 1 was milder in the ISLK group(P<0.001).Pain scores at suture removal were lower in the ISLK group than in RI group[1(0-3)vs 2(1-4),P<0.001].Postoperative symptoms at 6mo were comparable between the groups(P=0.487),with no recurrence.CONCLUSION:ISLK is an innovative method for limbal conjunctival autograft fixation after pterygium excision.Compared to RI fixation,ISLK facilitates suture removal and reduces discomfort,with comparable surgery duration and less conjunctival hyperemia.

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

The effect of Ti and Zr content on the structure,mechanics and energy-release characteristics of Ti—Zr—Ta alloys

Energetic structural materials(ESMs)are a new type of structural materials with bearing and damage characteristics.In this work the microstructure,mechanical properties and energy release characteristics of multi-element Ti-Zr-Ta alloys with good casting performance were studied.The microstructure of the Ti_(x)ZrTa alloys gradually change from BCC+HCP to single BCC structure with the increase of Ti.While the Ti_(2)Zr_(y)Ta alloys was still uniform and single BCC structure with the increase of Zr.The evolution of microstructure and composition then greatly affect the mechanical properties and energy-release characteristics of Ti-Zr-Ta alloys.The synergistic effect of dual phase structure increases the fracture strain of Ti_(x)ZrTa(x=0.2,0.5)with the Ti content decreases,while the fracture strain of Ti_(x)ZrTa(x=2.0,3.0,4.0)gradually increase with the Ti content increases caused by the annihilation of the obstacles for dislocation movement.And as Zr content increases,the fracture strain of Ti_(2)Zr_(y)Ta alloys decrease,then the oxidation reaction rate and fragmentation degree gradually increase.The higher oxidation rate and the lager exposed oxidation area jointly leads the higher releasing energy efficiency of Ti_(x)ZrTa alloys with low Ti content and Ti_(2)Zr_(y)Ta alloys with high Zr content.

Assessing the energy release characteristics during the middle detonation reaction stage of aluminized explosives

Afterburning behind the detonation front of an aluminized explosive releases energy on the millisecond timescale,which prolong the release of detonation energy and the energy release at different stages also shows significant differences.However,at present,there are few effective methods for evaluating the energy release characteristics of the middle reaction stage of such explosives,which can have a duration of tens to hundreds of microseconds.The present work demonstrates an approach to assessing the midstage of an aluminized explosive detonation based on a water push test employing a high degree of confinement.In this method,the explosive is contained in a steel cylinder having one end closed that is installed at the bottom of a transparent water tank.Upon detonation,the gaseous products expand in one direction while forcing water ahead of them.The resulting underwater shock wave and the interface between the gas phase products and the water are tracked using an ultra-high-speed framing and streak camera.The shock wave velocity in water and the expansion work performed by the gaseous detonation products were calculated to assess the energy release characteristics of aluminized explosives such as CL-20 and RDX in the middle stage of the detonation reaction.During the middle stage of the detonation process of these aluminized explosives,the aluminum reaction reduced the attenuation of shock waves and increased the work performed by gas phase products.A higher aluminum content increased the energy output while the presence of oxidants slowed the energy release rate.This work demonstrates an effective means of evaluating the performance of aluminized explosives.

Parent-offspring relationship recognition based on SSR and mtDNA confirmed resource supplement effect of Fenneropenaeus chinensis release

The resource of Fenneropenaeus chinensis has declined sharply due to excessive fishing intensity,ecological changes and diseases.In order to supplement the fishing yield and restore resources of F.chinensis,the relevant authorities have carried out the activities of stock enhancement and releasing.It can increase biomass and recover resources.However,compared with increasing biomass,there were still few reports on its effect on the recovery of resources.Resource recovery is a process related to whether the released individuals can form a reproductive population.Up to now,there has been a lack of evidence whether the released F.chinensis can complete the entire life history,and form reproduction population.In this study,gravid female shrimp after spawning migration were captured from coastal waters of Haiyang,Qingdao,and Yellow Sea.After identifying parentage relationships using simple sequence repeat(SSR)and mtDNA haplotype,it was finally confirmed that there were eight released individuals in the recapture samples.It was confirmed for the first time that at least part of the released F.chinensis can complete overwintering and reproductive migration,and maintain the migration habits as their wild counterparts.Therefore,we infered that the released shrimp can reproduce under natural conditions,these F.chinensis can form reproductive populations theoretically if without human intervention.These results indicated that enhancenment and release activities have a positive effect on resource recovery.

Evaluation of Interferon-Gamma Release Assay Testing and Tuberculin Skin Test for Early Diagnosis of Tuberculosis in Children and Adolescents

Background: This study aimed to evaluate the diagnostic value of interferon-γ release assay (IGRA), a sensitive microbiological diagnostic method, in children and adolescents with suspected tuberculosis in a country with a high burden of tuberculosis. Method: This study included 581 children and adolescents aged 4 - 19 years who were suspected of having tuberculosis, were latently infected with Mycobacterium tuberculosis, and had received at least one dose of BCG vaccine between April 17, 2019, and February 24, 2021. The study evaluated the TST results of 106 patients who had a positive Quantiferon test and were suspected of having tuberculosis. Results: The study included 581 patients aged between 4 and 19 years. Of these, 106 patients tested positive for the Quantiferon test, while 19 were indeterminate and 456 were negative. The Quantiferon test positivity rate was 18.24%. Among the 106 QFT-Plus-positive cases, 23 patients also tested positive for TST. The difference in distribution was found to be statistically significant. Conclusion: The QFT-Plus test is considered an alternative to TST and other microbiological diagnostic methods for early tuberculosis diagnosis, particularly in children and adolescents.

ISO releases a standard for a Chinese medicinal material

Rehmannia glutinosa root is one of the most commonly used herbs in traditional Chinese medicine. It has a long history in East and Southeast Asian countries for relieving heat and cooling the blood, nourishing yin and body fluid.

Controlled release of dexamethasone from fibrin sealant for intratympanic administration in inner ear therapy

The aim of the present work was to show the sustainability of fibrin sealant in releasing dexamethasone and adjust the protocol for clinical application of the novel method in the treatment of Meniere’s disease (MD) and sudden sensorineural hearing loss (SSHL).Gelation occurred shortly after mixing dexamethasone-containing fibrinogen with thrombin.Dexamethasone was constantly released for at least 16 d at a stable level after 7d in protocol 1 (low-dose),while it was robustly released within 4 d and slowed afterward until 10 d in protocol 2(high-dose).There were significant differences among the time points in Protocol 2 (p<0.01,ANOVA),and the exponential model with the formula y=15.299*e~(-0.483*t) fits the association.The estimated concentration of dexamethasone released on 7 d in protocol 2 was slightly lower than that observed in protocol 1.The fibrin sealant is capable of constantly releasing dexamethasone with adjustable dynamics.Targeted and minimally invasive administration of the material can be achieved in the clinic by sequential injections of the fluids using a soft-tipped catheter.

Translocation of telomerase reverse transcriptase coincided with ATP release in postnatal cochlear supporting cells

The spontaneous bursts of electrical activity in the developing auditory system are derived from the periodic release of adenosine triphosphate(ATP)by supporting cells in the Kölliker’s organ.However,the mechanisms responsible for initiating spontaneous ATP release have not been determined.Our previous study revealed that telomerase reverse transcriptase(TERT)is expressed in the basilar membrane during the first postnatal week.Its role in cochlear development remains unclear.In this study,we investigated the expression and role of TERT in postnatal cochlea supporting cells.Our results revealed that in postnatal cochlear Kölliker’s organ supporting cells,TERT shifts from the nucleus into the cytoplasm over time.We found that the TERT translocation tendency in postnatal cochlear supporting cells in vitro coincided with that observed in vivo.Further analysis showed that TERT in the cytoplasm was mainly located in mitochondria in the absence of oxidative stress or apoptosis,suggesting that TERT in mitochondria plays roles other than antioxidant or anti-apoptotic functions.We observed increased ATP synthesis,release and activation of purine signaling systems in supporting cells during the first 10 postnatal days.The phenomenon that TERT translocation coincided with changes in ATP synthesis,release and activation of the purine signaling system in postnatal cochlear supporting cells suggested that TERT may be involved in regulating ATP release and activation of the purine signaling system.Our study provides a new research direction for exploring the spontaneous electrical activity of the cochlea during the early postnatal period.

Cytokine release syndrome triggered by programmed death 1 blockade(sintilimab)therapy in a psoriasis patient:A case report

BACKGROUND In recent years,immune checkpoint inhibitors(ICIs)have demonstrated remarkable efficacy across diverse malignancies.Notably,in patients with advanced gastric cancer,the use of programmed death 1(PD-1)blockade has significantly prolonged overall survival,marking a pivotal advancement comparable to the impact of Herceptin over the past two decades.While the therapeutic benefits of ICIs are evident,the increasing use of immunotherapy has led to an increase in immune-related adverse events.CASE SUMMARY This article presents the case of a patient with advanced gastric cancer and chronic plaque psoriasis.Following sintilimab therapy,the patient developed severe rashes accompanied by cytokine release syndrome(CRS).Fortunately,effective management was achieved through the administration of glucocorticoid,tocilizumab,and acitretin,which resulted in favorable outcomes.CONCLUSION Glucocorticoid and tocilizumab therapy was effective in managing CRS after PD-1 blockade therapy for gastric cancer in a patient with chronic plaque psoriasis.

WDTA releases two standards for LLM security

The 27th Session of United Nations Commission on Science and Technology for Development(CSTD)was held on April 15-19.The side event“Shaping the Future of AI”on April 16 was hosted by the World Digital Technology Academy(WDTA),an NGO that promotes digital technologies and global cooperation,where breakthrough results including two standards were released.

A matrix metalloproteinase-responsive hydrogel system controls angiogenic peptide release for repair of cerebral ischemia/reperfusion injury

Vascular endothelial growth factor and its mimic peptide KLTWQELYQLKYKGI(QK)are widely used as the most potent angiogenic factors for the treatment of multiple ischemic diseases.However,conventional topical drug delivery often results in a burst release of the drug,leading to transient retention(inefficacy)and undesirable diffusion(toxicity)in vivo.Therefore,a drug delivery system that responds to changes in the microenvironment of tissue regeneration and controls vascular endothelial growth factor release is crucial to improve the treatment of ischemic stroke.Matrix metalloproteinase-2(MMP-2)is gradually upregulated after cerebral ischemia.Herein,vascular endothelial growth factor mimic peptide QK was self-assembled with MMP-2-cleaved peptide PLGLAG(TIMP)and customizable peptide amphiphilic(PA)molecules to construct nanofiber hydrogel PA-TIMP-QK.PA-TIMP-QK was found to control the delivery of QK by MMP-2 upregulation after cerebral ischemia/reperfusion and had a similar biological activity with vascular endothelial growth factor in vitro.The results indicated that PA-TIMP-QK promoted neuronal survival,restored local blood circulation,reduced blood-brain barrier permeability,and restored motor function.These findings suggest that the self-assembling nanofiber hydrogel PA-TIMP-QK may provide an intelligent drug delivery system that responds to the microenvironment and promotes regeneration and repair after cerebral ischemia/reperfusion injury.

关节镜辅助下Suture-button弹性固定治疗高位踝关节扭伤

背景:高位踝关节扭伤容易漏诊导致踝关节功能障碍,关节镜检查可发现隐匿性高位踝关节扭伤,采用Suture-button弹性固定能恢复远端胫腓联合的生物力学稳定性。目的:探讨踝关节镜辅助下采用Suture-button弹性固定治疗高位踝关节扭伤的临床疗效。方法:回顾性分析2019年8月至2021年8月武汉市第四医院足踝外科在踝关节镜辅助下进行Suture-button弹性固定治疗的40例高位踝关节扭伤患者的病历资料。所有患者均采用Suture-button弹性固定,记录患者术前及术后末次随访美国矫形外科足踝协会踝-后足功能评分、目测类比疼痛评分、踝关节活动度,将患者术前影像学数据与术中关节镜下分离程度进行相关性分析,按照Meislin标准进行疗效评估并记录术后并发症发生情况。结果与结论:①40例患者术后获16-48个月随访;②术后末次随访美国矫形外科足踝协会踝-后足功能评分为(88.95±6.64)分,目测类比评分为(1.78±1.23)分,踝背伸活动度为(33.50±5.79)°,踝跖屈活动度为(34.50±5.97)°,与术前相比差异均有显著性意义(P<0.05);③影像学分离指标与关节镜下分离程度存在低度正相关(r=0.612,P<0.01);④采用Meislin标准对疗效进行评估,优良率为95%(38/40);术后踝关节疼痛减轻,踝关节自主活动明显改善;⑤随访期间所有患者均未出现神经损伤及切口感染情况;1例患者因术后存在皮肤刺激、下蹲卡顿感取出内固定;⑥提示采取关节镜辅助Suture-button弹性固定治疗高位踝关节扭伤的临床疗效确切,能够更有效地恢复患肢足踝功能,恢复并维持关节稳定性且无需二次取出,值得临床应用。

V-Locsutures与普通可吸收线在后腹腔镜肾部分切除术中应用比较

目的:比较V-Loc sutures与普通可吸收线在后腹腔镜肾癌部分切除术中的应用价值。方法:2012年5月-2013年6月,本手术组共收治了25例确诊的病理分期为T1N0M0的肾癌患者,其中12例术中肾脏创面缝合均采用V-Loc sutures,其中男9例,女3例,年龄28-68岁,平均48.2岁;肿瘤大小为0.9-4.7cm,平均2.8cm;另13例术中采用普通可吸收线缝合创面,其中男8例,女5例,年龄34-74岁,平均45.5岁;肿瘤大小为1.2-4.5cm,平均2.6cm;比较两组患者手术中的手术时间、术中出血量、肾动脉阻断时间、创面缝合时间、各组手术前后测血肌酐、胱抑素C变化,术后并发症。结果:25例手术均在后腹腔镜下顺利完成。V-Loc sutures组和普通可吸收线组手术时间、术中出血、肾动脉阻断时间、肾创面缝合时间均有差异(P<0.05);V-Loc sutures组手术前后血肌酐、胱抑素C无明显差异(P>0.05),普通可吸收线组手术前后血肌酐、胱抑素C有差异(P<0.05);V-Loc sutures组出现1例血尿,普通可吸收线组出现1例漏尿。结论:V-Loc sutures较普通可吸收线可缩短手术时间及肾创面缝合时间,减少术中出血,更好的保护小肾癌患者的肾功能。

How many sutures in the southern Central Asian Orogenic Belt:Insights from East Xinjiang-West Gansu(NW China)?

How ophiolitic mèlanges can be defined as sutures is controversial with regard to accretionary orogenesis and continental growth.The Chinese Altay,East junggar,Tianshan,and Beishan belts of the southern Central Asian Orogenic Belt（CAOB） in Northwest China,offer a special natural laboratory to resolve this puzzle.In the Chinese Altay,the Erqis unit consists of ophiolitic melanges and coherent assemblages,forming a Paleozoic accretionary complex.At least two ophiolitic melanges（Armantai,and Kelameili） in East Junggar,characterized by imbricated ophiolitic melanges,Nb-enriched basalts,adakitic rocks and volcanic rocks,belong to a Devonian-Carboniferous intra-oceanic island arc with some Paleozoic ophiolites,superimposed by Permian arc volcanism.In the Tianshan,ophiolitic melanges like Kanggurtag,North Tianshan,and South Tianshan occur as part of some Paleozoic accretionary complexes related to amalgamation of arc terranes.In the Beishan there are also several ophiolitic melanges,including the Hongshishan,Xingxingxia-Shibangjing,Hongliuhe-Xichangjing,and Liuyuan ophiolitic units.Most ophiolitic melanges in the study area are characterized by ultramafic,mafic and other components,which are juxtaposed,or even emplaced as lenses and knockers in a matrix of some coherent units.The tectonic settings of various components are different,and some adjacent units in the same melange show contrasting different tectonic settings.The formation ages of these various components are in a wide spectrum,varying from Neoproterozoic to Permian.Therefore we cannot assume that these ophiolitic melanges always form in linear sutures as a result of the closure of specific oceans.Often the ophiolitic components formed either as the substrate of intra-oceanic arcs,or were accreted as lenses or knockers in subduction-accretion complexes.Using published age and paleogeographic constraints,we propose the presence of （1） a major early Paleozoic tectonic boundary that separates the Chinese Altay-East Junggar multiple subduction systems of the southern Siberian active margin from those of the northern Tarim;and （2） a major Permian suture zone that separates the Tianshan-Beishan from the northern active margin of the Tarim Craton.These new observations and interpretations have broad implications for the architecture and crustal growth of central Asia and other ancient orogens as well.

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.