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Aim: It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo‐caecal resection with double‐barrelled ileo‐colostomy. We aimed to compare the results of these two strategies. Method: From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra‐operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo‐caecal resection with double‐end stoma (colon‐sparing group). Outcomes were compared retrospectively. Results: In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon‐sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double‐barrelled ileo‐colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon‐sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease‐free survival were similar between the two groups. Conclusion: The colon‐sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation. [ABSTRACT FROM AUTHOR] more...

Introduction: The management of hernias with loss of domain is a challenging problem. It has been shown that the volume of the incisional hernia/peritoneal volume ratio < 20% was a predictive factor for tension-free fascia closure, after pre-operative pneumoperitoneum preparation (Goni Moreno technique). In this study, we propose an easy, reliable and fast technique to perform volumetric calculation, by the surgeon alone.Materials and Methods: 3D slicer software (free open-source software) was used to calculate with precision the intra-peritoneal and intra-hernia volumes, and to create a 3D reconstruction of both volumes. The measurement technique is described step by step using detailed figures and videos.Results: The method was used to calculate the volumes for five consecutive patients, managed between January 2018 and March 2019. All the five patients had a ratio greater than 20% and, therefore, received a PPP program. The effectiveness of the procedure is objectified by the increase of the intraabdominal volume and the reduction of the incisional hernia/peritoneal volume ratio. The feasibility of a tension-free fascia closure was confirmed for the five patients.Conclusion: In addition to a standardized definition of "loss of domain", a standardized volumetric technique, easy to reproduce, needs to be adopted. Our method can be done by any surgeon with basic computer skills and radiological knowledge in an autonomous and a fast manner, thus helping to select the right technique for the right patient. [ABSTRACT FROM AUTHOR] more...

Purpose: At equal TNM stage, obstructing colon cancer (OCC) is associated with worse prognosis in comparison with uncomplicated cancer. Our aim was to identify prognostic factors of overall (OS) and disease-free survival (DFS) in patients treated for OCC. Methods: From 2000 to 2015, 2325 patients were treated for OCC in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management were excluded. The main endpoints were OS and DFS. A multivariate analysis, using Cox proportional hazards regression model, was performed to determine independent prognostic factors. Results: The cohort included 2120 patients. The median of follow-up was 13.2 months. In multivariate analysis, age > 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, presence of synchronous metastases, anastomotic leakage, and absence of adjuvant chemotherapy were independent OS factors. Age > 75 years, ASA score ≥ 3, right-sided colon cancer, presence of synchronous metastases, and absence of postoperative chemotherapy were independent factors of poor OS after exclusion of patients who died postoperatively. Age ≥ 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, lymph node involvement, presence of vascular, lymphatic or perineural invasion, less than 12 harvested lymph nodes, and absence of adjuvant chemotherapy were independent DFS factors. Conclusions: Management of OCC should take into account prognostic factors related to the patient (age, comorbidities), tumor location, and tumor stage. Adjuvant chemotherapy administration plays an important role. For patients undergoing initial defunctionning stoma, neoadjuvant chemotherapy could be an option to improve prognosis. [ABSTRACT FROM AUTHOR] more...

Aim: The aim was to define risk factors for postoperative mortality in patients undergoing emergency surgery for obstructing colon cancer (OCC) and to propose a dedicated score. Method: From 2000 to 2015, 2325 patients were treated for OCC in French surgical centres by members of the French National Surgical Association. A multivariate analysis was performed for variables with P value ≤ 0.20 in the univariate analysis for 30‐day mortality. Predictive performance was assessed by the area under the receiver operating characteristic curve. Results: A total of 1983 patients were included. Thirty‐day postoperative mortality was 7%. Multivariate analysis found five significant independent risk factors: age ≥ 75 (P = 0.013), American Society of Anesthesiologists (ASA) score ≥ III (P = 0.027), pulmonary comorbidity (P = 0.0002), right‐sided cancer (P = 0.047) and haemodynamic failure (P < 0.0001). The odds ratio for risk of postoperative death was 3.42 with one factor, 5.80 with two factors, 15.73 with three factors, 29.23 with four factors and 77.25 with five factors. The discriminating capacity in predicting 30‐day postoperative mortality was 0.80. Conclusion: Thirty‐day postoperative mortality after emergency surgery for OCC is correlated with age, ASA score, pulmonary comorbidity, site of tumour and haemodynamic failure, with a specific score ranging from 0 to 5. [ABSTRACT FROM AUTHOR] more...

Background and aim Dyspnea in patients with a para-esophageal hernia (PEH) occurs in 7 to 32% of cases and is very disabling, especially in the elderly and its origin is poorly defined. The present study aims to assess the impact of laparoscopic fundoplication (LF) on dyspnea and respiratory function. Methods Dyspnea assessment through dyspnea visual analogic scale (DVAS) and modified medical research council score and pulmonary function test (PFT) with plethysmography were performed before and 2 months after LF in all consecutive patients undergoing LF for PEH from January 2019 to May 2021. Results All 43 patients included had pre-and postoperative dyspnea assessments and pulmonary PFT. Patients' median age was 70 years (range 63–73.5 years), 37 (86%) were women, the median percentage of the intrathoracic stomach was 59.9% (range 44.2%–83.0%), the median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significantly (5.6 [4.7–6.7] vs 3.0 [2.3–4.4] P  < 0.001), and 37 (86%) patients had a clinically significant decrease inMMRC. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery respectively on average by +11.2% (SD 17.9), +5.0% (SD 13.9), and + 10.7% (SD 14.6). Subgroup analysis highlighted patients with low preoperative FEV1 were more susceptible to improve it. No correlation was identified between improvement in dyspnea and FEV1. Also, no correlation was identified between the percentage of intrathoracic stomach and dyspnea or PFT parameters improvement. Conclusion PEH repair improves dyspnea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnea. Patients with a low preoperative FEV1 are more likely to improve it after LF. [ABSTRACT FROM AUTHOR] more...

The war in Ukraine threatened to block 9% of global wheat exports, driving wheat prices to unprecedented heights. We advocate, that in the short term, compensating for such an export shortage will require a coordinated release of wheat stocks, while if the export block persists, other export countries will need to fill the gap by increasing wheat yields or by expanding wheat cropping areas by 8% in aggregate. We estimate that a production increase would require an extra half a million tons of nitrogen fertilizer, yet fertilizer prices are at record levels, driven by rising energy prices. Year-to-year variability plus more frequent climate change-induced crop failures could additionally reduce exports by another 5 to 7 million tons in any given year, further stressing global markets. Without stabilizing wheat supplies through judicious management of stocks and continuing yield improvements, food and national security are at risk across many nations in the world. • The war in Ukraine threatened to block 9% of global wheat exports. • Top export countries will need to increase wheat yields or cropping areas by 8% in aggregate. • A production increase would require an extra half a million tons of nitrogen fertilizer. • Climate induced crop failures could additionally reduce exports by 5–7 million tons. [ABSTRACT FROM AUTHOR] more...

The importance of aquaporins for root hydraulic conductance ( LP) was investigated along roots of the desert succulent Agave deserti in wet, dry and rewetted soil. Water channel activity was inferred from HgCl2-induced reductions of LP that were reversible by 2-mercaptoethanol. Under wet conditions, HgCl2 reduced LP for the distal root region by 50% and for the root region near the shoot base by 36% but did not affect LP for the mid-root region. For all root regions, LP decreased by 30–60% during 10 d in drying soil and was not further reduced by HgCl2. After soil rewetting, LP increased to pre-drying values and was again reduced by HgCl2 for the distal and the basal root regions but not the mid-root region. For the distal region, water channels in the epidermis/exodermis made a disproportionately large contribution to radial hydraulic conductance of the intact segment; for the basal region, water channel activity was highest in the cortex and endodermis. The role of water channels was greatest in tissues in which cells were metabolically active both in the distal root region, where new apical growth occurs in wet soil, and in the basal region, which is the most likely root region to intercept light rainfall. [ABSTRACT FROM AUTHOR] more...

ABSTRACT The water relations and hydraulic architecture of growing grass tillers (Festuca arundinacea Schreb.) are reported. Evaporative flux density, E (mmol s-1 m-2), of individual leaf blades was measured gravimetrically by covering or excision of entire leaf blades. Values of E were similar for mature and elongating leaf blades, averaging 2·4 mmol s-1 m-2. Measured axial hydraulic conductivity, Kh (mmol s-1 mm MPa-1), of excised leaf segments was three times lower than theoretical hydraulic conductivity (Kt) calculated using the Poiseuille equation and measurements of vessel number and diameter. Kt was corrected (Kt*) to account for the discrepancy between Kh and Kt and for immature xylem in the basal expanding region of elongating leaves. From base to tip of mature leaves the pattern of Kt* was bell-shaped with a maximum near the sheath–blade joint (≈ 19 mmol s-1 mm MPa-1). In elongating leaves, immature xylem in the basal growing region led to a much lower Kt*. As the first metaxylem matured, Kt* increased by 10-fold. The hydraulic conductances of the whole root system, &formmu1; (mmol s-1 MPa-1) and leaf blades, &formmu2; (mmol s-1 MPa-1) were measured by a vacuum induced water flow technique. &formmu1; and &formmu2; were linearly related to the leaf area downstream. Approximately 65% of the resistance to water flow within the plant resided in the leaf blade. An electric-analogue computer model was used to calculate the leaf blade area-specific radial hydraulic conductivity, &formmu3; (mmol s-1 m-2 MPa-1), using &formmu2;, Kt* and water flux values. &formmu3; values decreased with leaf age, from 21·2 mmol s-1 m-2 MPa-1 in rapidly elongating leaf to 7·2 mmol s-1 m-2 MPa-1 in mature leaf. Comparison of &formmu2; and &formmu3; values showed that ≈ 90% of the resistance to water flow within the blades resided in the liquid extra-vascular path. The same algorithm was then used to compute the xylem and extravascular water potential drop along the liquid water path in the plant under steady state conditions. Predicted and measured water potentials matched well. The hydraulic design of the mature leaf resulted in low and quite constant xylem water potential gradient (≈ 0·3 MPa m-1) throughout the plant. Much of the water potential drop within mature leaves occurred within a tenth of millimetre in the blade, between the xylem vessels and the site of water evaporation within the mesophyll. In elongating leaves, the low Kt* in the basal growth zone dramatically increased the local xylem water potential gradient (≈ 2·0 MPa m-1) there. In the leaf elongation zone the growth-induced water potential difference was ≈ 0·2 MPa. [ABSTRACT FROM AUTHOR] more...

Abstract: Nitrogen (N) fertilizer represents a significant cost for the grower and may also have environmental impacts through nitrate leaching and N2O (a greenhouse gas) emissions associated with denitrification. The objectives of this study were to analyze the genetic variability in N-use efficiency (grain dry matter (DM) yield per unit N available from soil and fertilizer; NUE) in winter wheat and identify traits for improved NUE for application in breeding. Fourteen UK and French cultivars and two French advanced breeding lines were tested in a 2 year/four site network comprising different locations in France and in the UK. Detailed growth analysis was conducted at anthesis and harvest in experiments including DM and N partitioning. Senescence of either the flag leaf or the whole leaf canopy was assessed from a visual score every 3–4 days from anthesis to complete canopy senescence. The senescence score was fitted against thermal time using a five parameters monomolecular-logistic equation allowing the estimation of the timing of the onset and the rate of post-anthesis senescence. In each experiment, grain yield was reduced under low N (LN), with an average reduction of 2.2tha−1 (29%). Significant N×genotype level interaction was observed for NUE. Crop N uptake at harvest on average was reduced from 227kgNha−1 under high N (HN) to 109kgNha−1 under LN conditions while N-utilization efficiency (grain DM yield per unit crop N uptake at harvest; NUtE) increased from 34.0 to 52.1kgDMkg−1 N. Overall genetic variability in NUE under LN related mainly to differences in NUtE rather than N-uptake efficiency (crop N uptake at harvest per unit N available from soil and fertilizer; NUpE). However, at one site there was also a positive correlation between NUpE and NUE at LN in both years. Moreover, across the 2 year/four site network, the N×genotype effect for NUpE partly explained the N×genotype effect for grain yield and NUE. Averaging across the 16 genotypes, the timing of onset of senescence explained 86% of the variation in NUtE amongst site-season-N treatment combinations. The linear regression of onset of senescence on NutE amongst genoytpes was not significant under HN, but at three of the four sites was significant under LN explaining 32–70% of the phenotypic variation amongst genotypes in NutE. Onset of senescence amongst genotypes was negatively correlated with the efficiency with which above-ground N at anthesis was remobilized to the grain under LN. It is concluded that delaying the onset of post-anthesis senescence may be an important trait for increasing grain yield of wheat grown under low N supply. [Copyright &y& Elsevier] more...