Pelvic Floor Peritoneum Closure Reduces Severe Postoperative Complications in Rectal Cancer Patients After Laparoscopic Anterior Rectal Resection.

BACKGROUND: Laparoscopic anterior rectal resection (LAR) is a commonly performed surgery for rectal cancer patients. Pelvic floor peritoneum closure (PC), a vital procedure in conventional anterior rectal resection, is not routinely performed in LAR. STUDY DESIGN: A total of 1118 consecutive patients with rectal cancer receiving LAR were included in this retrospective study. Patients were allocated into the PC group and the non-PC group. The occurrence of postoperative complications was compared between the 2 groups. Influential factors in anastomotic leakage (AL) were explored using univariate and multivariate logistic regression. RESULTS: There was no difference between the groups in terms of baseline characteristics. The occurrence of postoperative complications was similar between the groups. The PC group had significantly shorter postoperative hospitalization and longer operation duration compared with the non-PC group. The occurrences of Clavien-Dindo (CD) III-IV complications, CD III-IV AL, and reoperation were significantly lower in the PC group than the non-PC group. PC and a protective ileostomy were independent protective factors for CD III-IV AL. CONCLUSION: PC could reduce the occurrence of CD III-IV complications, especially CD III-IV AL, and the rate of secondary surgery, especially in patients with a lower body mass index and patients who did not receive protective ileostomies.

Long-term outcomes of single-incision plus one-port laparoscopic surgery versus conventional laparoscopic surgery for rectosigmoid cancer: a randomized controlled trial.

BACKGROUND: Though our previous study has demonstrated that the single-incision plus one-port laparoscopic surgery (SILS + 1) is safe and feasible for sigmoid colon and upper rectal cancer and has better short-term outcomes compared with conventional laparoscopic surgery (CLS), the long-term outcomes of SILS + 1 remains uncertain and are needed to evaluated by an RCT. METHODS: Patients with clinical stage T1-4aN0-2M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The 3-year DFS, 5-year OS, and recurrence patterns were analyzed. RESULTS: Between April 2014 and July 2016, 198 patients were randomly assigned to either the SILS + 1 group (n = 99) or CLS group (n = 99). The median follow-up in the SILS + 1 group was 64.0 months and in CLS group was 65.0 months. The 3-year DFS was 87.8% (95% CI, 81.6-94.8%) in SILS + 1 group and 86.9% (95% CI, 81.3-94.5%) in CLS group (hazard ratio: 1.09 (95% CI, 0.48-2.47; P = 0.84)). The 5-year OS was 86.7% (95% CI,79.6-93.8%) in the SILS + 1 group and 80.5% (95% CI,72.5-88.5%) in the CLS group (hazard ratio: 1.53 (95% CI, 0.74-3.18; P = 0.25)). There were no significant differences in the recurrence patterns between the two groups. CONCLUSIONS: We found no significant difference in 3-year DFS and 5-year OS of patients with sigmoid colon and upper rectal cancer treated with SILS + 1 vs. CLS. SILS + 1 is noninferior to CLS when performed by expert surgeons. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02117557 (registered on 21/04/2014).

Shifted-windows transformers for the detection of cerebral aneurysms in microsurgery.

PURPOSE: Microsurgical Aneurysm Clipping Surgery (MACS) carries a high risk for intraoperative aneurysm rupture. Automated recognition of instances when the aneurysm is exposed in the surgical video would be a valuable reference point for neuronavigation, indicating phase transitioning and more importantly designating moments of high risk for rupture. This article introduces the MACS dataset containing 16 surgical videos with frame-level expert annotations and proposes a learning methodology for surgical scene understanding identifying video frames with the aneurysm present in the operating microscope's field-of-view. METHODS: Despite the dataset imbalance (80% no presence, 20% presence) and developed without explicit annotations, we demonstrate the applicability of Transformer-based deep learning architectures (MACSSwin-T, vidMACSSwin-T) to detect the aneurysm and classify MACS frames accordingly. We evaluate the proposed models in multiple-fold cross-validation experiments with independent sets and in an unseen set of 15 images against 10 human experts (neurosurgeons). RESULTS: Average (across folds) accuracy of 80.8% (range 78.5-82.4%) and 87.1% (range 85.1-91.3%) is obtained for the image- and video-level approach, respectively, demonstrating that the models effectively learn the classification task. Qualitative evaluation of the models' class activation maps shows these to be localized on the aneurysm's actual location. Depending on the decision threshold, MACSWin-T achieves 66.7-86.7% accuracy in the unseen images, compared to 82% of human raters, with moderate to strong correlation. CONCLUSIONS: Proposed architectures show robust performance and with an adjusted threshold promoting detection of the underrepresented (aneurysm presence) class, comparable to human expert accuracy. Our work represents the first step towards landmark detection in MACS with the aim to inform surgical teams to attend to high-risk moments, taking precautionary measures to avoid rupturing.

A cognitive evaluation and equity-based perspective of pay for performance on job performance: A meta-analysis and path model.

Pay for performance, as one of the most important means of motivating employees, has attracted the attention of many scholars and managers. However, controversy has continued regarding whether it promotes or undermines job performance. Drawing on a meta-analysis of 108 independent samples (N = 71,438) from 100 articles, we found that pay for performance was positively related to job performance. That pay for performance had a more substantial positive effect on task performance than contextual performance in workplace settings. From the cognitive evaluation perspective, we found that pay for performance enhanced employees' task performance and contextual performance by enhancing intrinsic motivation and weakened task performance and contextual performance by increasing employee pressure. From the equity perspective, our results indicated that the relationship between pay for performance and task performance was partially mediated by employee perceptions of distributive justice and procedural justice, with distributive justice having a more substantial mediating effect than procedural justice. However, the relationship between pay for performance and contextual performance was only partially mediated by procedural justice. Further tests of moderating effects indicated that the varying impacts of pay for performance are contingent on measures of pay for performance and national culture. The findings contributed to understanding the complex mechanisms and boundary conditions of pay-for-performance's effects on job performance, which provided insights for organizations to maximize its positive effects.

Feeling Gratitude and Depletion: The Ambivalent Consequences of Receiving Help in the Workplace.

Drawing from social exchange theory, we developed a dual-path model of employees' reactions to episodic help received from colleagues. Through a diary study, using data collected from 127 full-time employees working in a large Chinese bank, we tested this model, revealing that receiving episodic help from colleagues is positively related to the help receivers' gratitude and ego depletion. Through these two ambivalent psychological states, help receivers were found to simultaneously engage in more organizational citizenship behaviors and deviance behaviors on a daily basis. These empirical findings contribute to research that adopts a target-centric perspective in examining the consequences of helping behavior in the workplace.

The Impact of Negative Informal Information Before a Change on Performance: A Within-Person Approach.

We live in a rapidly changing business environment where change has become the norm for organizations to maintain competitiveness. Although both scholars and practitioners agree that organizational change communication is important to help employees adjust to change, little is known about how negative informal information before the change affects employees' reaction to the change and occurrence of possible within-person dynamics of resistance intention over time. Based on the construal-level theory, we used SPSS 22, AMOS 20, and HLM 6.0 as tools to explore how negative informal information affects individual performance. We used a multilevel approach to probe within-person processes among 215 MBA students in China. The results show that (1) negative informal information provided before the organizational change is positively related to the resistance intention, (2) resistance intention decreases significantly over time, and (3) negative informal information is negatively related to individual performance during the organizational change. The results from this study extend the literature on informal communication before the change and provide a dynamic perspective on the occurrence of possible within-person dynamics of resistance intention over time.

Rapid removal of ultra-high-concentration p-nitrophenol in aqueous solution by microwave-enhanced Fe/Cu bimetallic particle (MW-Fe/Cu) system.

Ultra-high-concentration PNP-contained wastewaters are produced sometimes due to the wide application of this nitrophenolic compound in the chemical industry. However, there is a lack of appropriate technologies to rapidly pretreat the ultra-high-concentration wastewater. Therefore, a new microwave-enhanced Fe/Cu bimetallic particles (MW-Fe/Cu) system was developed to rapidly remove ultra-high-concentration PNP. First, the priority of the determinative parameters was obtained by orthogonal experiment. Based on this result, the effects of initial pH, microwave power, Fe/Cu dosage and initial PNP concentration on PNP removal were optimized thoroughly. Under the optimal conditions (i.e. initial pH = 1.0, MW power = 385 W, Fe/Cu dosage = 30 g/L and initial PNP concentration = 4000 mg/L), four control treatment systems (i.e. MW-Fe0, heating-Fe/Cu, MW alone and Fe/Cu alone system) were set up to compare with the MW-Fe/Cu system. The results suggest that high PNP removal (more than 99% with 2.5 min, k1/k2 = 1.18/6.91 min-1) and COD removal (26.6% with 5 min treatment) could be obtained by the MW-Fe/Cu system, which were much superior to those obtained using the MW-Fe0 (k1/k2 = 0.62/2.21 min-1) and the heating-Fe/Cu system (k1/k2 = 0.53/1.52 min-1). Finally, the determination of the intermediates of PNP degradation by HPLC indicated that the MW assistance process did not change the degradation pathway of PNP. This concludes that the new MW-Fe/Cu system was the promising technology for pretreatment of wastewater containing ultra-high-concentration toxic and refractory pollutants at a fairly short treatment time.

Determination of trace amounts of rare-earth elements in clean steel by inductively coupled plasma optical emission spectrometry after removal of iron matrix with anion-exchange resin.

Inductively coupled plasma optical emission spectrometry (ICP-OES) was applied to the determination of trace rare-earth elements in clean steel. The steel sample was dissolved with a mixture of hydrochloric acid (HCl), nitric acid (HNO(3)), and hydrogen peroxide (H(2)O(2)), with the solution passing through a column packed with the anion-exchange resin DOWEX 1 x 8-200. Iron was absorbed selectively on the resin column, and the analytes of interest passed through the column and were effectively separated from the iron matrix. Conditions of separation were optimized. When the sample solution was spiked with 10 microg of the analytes of interest, the recoveries ranged from 88% to 102%, and relative standard deviations were between 6% and 21% (n = 6). The method was successfully applied to the determination of trace amounts of targeted elements in clean steel.

Determination of trace amounts of lead, arsenic, nickel and cobalt in high-purity iron oxide pigment by inductively coupled plasma atomic emission spectrometry after iron matrix removal with extractant-contained resin.

Inductively coupled plasma atomic emission spectrometry (ICP-AES) was applied to the determination of lead, arsenic, nickel and cobalt in high-purity iron oxide pigment. Samples were dissolved with hydrochloric acid and hydrogen peroxide. The digest was passed through a column, which was packed with a polymer resin containing a neutral organophosphorus extractant, tri-n-butylphosphate. Iron was sorbed selectively on the resin and the analytes of interest passed through the column, allowing the effective separation of them from the iron matrix. Conditions of separation were optimized. The detection limits (3sigma) in solution were 10, 40, 7 and 5 microg L(-1), and in pigment were 0.2, 0.8, 0.14 and 0.1 mg kg(-1) for lead, arsenic, cobalt and nickel, respectively. The recoveries ranged from 95% to 107% when sample digests were spiked with 5 microg of the analytes of interest, and relative standard deviations (n=6) were 1.5-17.6% for the determination of the spiked samples. The method was successfully applied to the determination of trace amounts of these elements in high-purity iron oxide pigment samples.