Thresholds of seascape fauna composition along gradients of human pressures and natural conditions to inform marine spatial planning.

Knowledge about the cumulative impacts of anthropogenic activities and environmental conditions on marine ecosystems is incomplete and details are lacking. Compositional community changes can occur along gradients, and community data can be used to assess the state of community resilience against combined impacts of variables representing human pressures and environmental conditions. Here we use a machine learning approach, i.e., Gradient Forest, to identify explanatory variable thresholds and select relevant epibenthic fauna and demersal fish species, which can be used to inform an integrated management of multiple human pressures and conservation planning in the southern North Sea. We show that a broad selection of anthropogenic and environmental variables, such as natural disturbance of the seafloor and euphotic depth, determined community composition thresholds of 67 epibenthic fauna and 39 demersal fish species along environmental conditions and human pressure gradients in the southern North Sea between 2010 and 2020. This has the potential to inform resilience assessments under the Marine Strategy Framework Directive to promote and retain a good environmental status of marine ecosystems.

Multimodal perioperative rehabilitation in elective conventional resection of colonic cancer: results from the German Multicenter Quality Assurance Program 'Fast-Track Colon II'.

AIM: Multimodal perioperative rehabilitation in patients undergoing curative conventional colonic resection for cancer has not yet been studied in a multicenter setting. In 2005, a nationwide quality assurance program was initiated in Germany in an unselected patient population. METHODS: The prospective multicenter data collection includes patients from 24 German hospitals. All hospitals had established 'fast-track' rehabilitation as the standard perioperative treatment in elective colonic resection, and all patients entered the registry. RESULTS: 748 of 2,047 fast-track patients (36.5%) underwent open resection of colonic cancer. The median age of the 380 female and 368 male patients was 71 (26-96) years. Compliance was high for epidural analgesia (89%), systemic basic nonopioid analgesia (93%), 'restrictive' intraoperative intravenous fluids (81%), oral feeding (73%) and enforced mobilization (84%) on the day of surgery. Surgical complications were diagnosed in 20%, general morbidity occurred in only 13% of all patients, and 3 patients (0.4%) died in the early postoperative period. Readmission within 30 days of discharge was necessary in 27 patients (4%). CONCLUSIONS: Compliance with fast-track measures was high, and general morbidity was low in a population of patients undergoing multimodal perioperative rehabilitation for conventional colonic cancer resection.

Effective prevention of adhesions with hyaluronate.

HYPOTHESIS: Hyaluronate sodium in the form of a bioresorbant membrane reduces the development of intra-abdominal adhesions frequently found after implantation of synthetic mesh in the context of surgical hernia repair. DESIGN: The effect of hyaluronate on the formation of adhesions was evaluated when applied laparoscopically as a bioresorbant membrane to protect the peritoneal surface of a synthetic mesh. SETTING: Experimental animal model. INTERVENTIONS: A peritoneal defect 5 cm in diameter was bilaterally created in the abdominal wall of each of 9 pigs by laparoscopy. A polypropylene mesh was fixed with clips onto these defects on both sides. In each of the animals, only on one side, the synthetic mesh was also covered by a hyaluronate membrane. MAIN OUTCOME MEASURES: The incidence and severity of adhesions (grade 0-4, where 0 indicates no adhesion; 1, filmy avascular adhesions; 2, vascular adhesions; 3, cordlike fibrous adhesions; and 4, plain fibrous adhesions) were determined after 45 days, comparing treated and untreated sides by autopsy results and histological features. RESULTS: Adhesions, mainly grades 3 and 4, occurred in 7 of the 9 animals in those meshes not covered by hyaluronate; 2 untreated animals did not develop adhesions. On the other hand, only 1 of the 9 animals developed adhesions (grade 2) at the mesh concealed by the hyaluronate membrane. CONCLUSIONS: The bioresorbant hyaluronate membrane significantly reduced the formation of peritoneal adhesions (1-sided sign test, P<.05) induced by the insertion of a polypropylene mesh, when compared with the contralateral implants not protected by hyaluronate. Thus, hyaluronate membranes are efficient for reducing the incidence of peritoneal adhesions.