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Background: Minimally invasive surgery in rectal cancer has gained prominence owing to its various advantages in surgical outcomes. Due to rapid adoption of robotics in rectal surgery, we intended to assess the pace in which surgeons gain proficiency using cumulative summation (CUSUM) technique in learning curve. Materials and Methods: This was a prospective study of 262 rectal cancer cases who underwent robotic-assisted low anterior resection and abdominoperineal resection (RA-LAR and RA-APR). Parameters considered for the study were console time, docking time, lymph nodal yield, total operative time and post-operative outcomes. We used Manipal technique of port placements and modified centroside docking for the procedure. Results: The mean age of our study was 46.62 ± 5.7 years, the mean body mass index (BMI) was 31.51 ± 3.2 kg/m2. 215 (82.06%) underwent RA-LAR and 47 (17.93%) underwent RA-APR. 2.67% of cases required to open during our initial period. We had three phases of learning curve, initial phase (11th case), plateau phase (29th case) and then phases of mastery (30th case onwards). Our mean total operative time reduced from 5.5 to 3.5 h (210 ± 8.2 min), console time from 4.5 to 2.9 h (174 ± 4.5 min) and docking time from 15 to 9 ± 1 min from 30th case onwards. Conclusion: RA surgeries for rectal cancer have got good oncological and functional outcomes in high BMI, male pelvis and low rectal cancers. Learning curve can be shortened with constant self-auditing of the surgeon and team with each surgeries performed, reviewing the steps and by improving techniques.

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Various decision contexts require the calculation of smaller recurring changes accumulated over time and their comparison to larger one-time changes (e.g., $100 periodic increase in monthly rent every year vs. a $1000 increase in rent at the end of 5 years). In both hypothetical and incentivized studies, we demonstrate an inaccuracy of estimations involving total cumulations of smaller recurring changes and single lump sums. We document this effect when individuals process increasing or decreasing changes in gains or losses (e.g., raises in wages or rent, discounts in membership fees). Importantly, these biases occur even when the changes are provided to the consumers as clear absolute dollar values as opposed to complex percentages. We discuss the theoretical contributions of our study as well as its implications for consumers, managers, and policy makers.

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The wish for rapid degradation of chlorinated organic pollutants along with the increase concern with respect to greenhouse effect and bioenergy methane production have created urgent needs to explore synchronous regulation approach. Microbial electrolysis cell was established under four degressive cathode potential settings (from -0.15V to -0.60V) to regulate γ-hexachlorocyclohexane (γ-HCH) reduction while CH4 cumulation in this study. The synchronous facilitation of γ-HCH reduction and CH4 cumulation was occurred in -0.15V treatment while the facilitation of γ-HCH reductive removal together with the inhibition of CH4 cumulation was showed in -0.30V treatment. Electrochemical patterns via cyclic voltammetry and morphological performances via scanning electron microscopy illustrated bioelectrostimulation promoted redox reactions and helped to construct mature biofilms located on bioelectrodes. Also, bioelectrostimulated regulation pronouncedly affected the bacteria and archaeal communities and subsequently assembled distinctly core sensitive responders across bioanode, biocathode and plankton. Clostridum, Longilinea and Methanothrix relatively accumulated in the plankton, and Cupriavidus and Methanospirillum, and Perimonas and Nonoarcheaum in biocathode and bioanode, respectively; while Pseudomonas, Stenotrophomonas, Methanoculleus and Methanosarcina were diffusely enriched. Microbial interactions in the ecological network were more complicated in -0.15V and -0.30V cathodic potential treatments, coincident with the increasement of γ-HCH reduction. The co-existence between putative dechlorinators and methanogens was less significant in -0.30V treatment when compared to that in -0.15V treatment, relevant with the variations of CH4 cumulation. In all, this study firstly corroborated the availability to synchronously regulate γ-HCH reductive removal and methanogenesis. Besides, it paves an advanced approach controlling γ-HCH reduction in cooperation with CH4 cumulation, of which to achieve γ-HCH degradation facilitation along with biogas (CH4) production promotion with -0.15V cathode potential during anaerobic γ-HCH contaminated wastewater digestion, or to realize γ-HCH degradation facilitation with the inhibition of CH4 emission with -0.30V cathode potential for an all-win remediation in γ-HCH polluted anaerobic environment such as paddy soil.

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Objective To explore the application of radiofrequency lipolysis combined with line-ar lifting in fine lipolysis ,facial rejuvenation and treatment of common complications .Methods From February 2016 to October 2018 ,237 patients were treated by radiofrequency lipolysis combined with linear lifting .According to the patient's face shape ,skin laxity and fat accumulation ,the thickness of fat was measured by B-mode ultrasonography before operation ,and the operative plan was formulated after sufficient communication with the patients .Then ,we marked the range of lipolysis ,the orienta-tion of serrated line and the position of puncture point ,followed by the adjustment of the treatment parameters .Subsequently ,we placed FaceTite handle after swelling anesthesia ,moving slowly and fixing the treatment point ,as well as monitoring the temperature and swelling status of the skin .Im-mediately after the completion of lipolysis ,the treatment area of skin was ice compressed ,with the trocar needles inserted and serrated lines introduced for linear lifting operation .Neck-jaw sleeves were put on after operation .Results 237 patients had different degrees of post-operative edema ,of which the period ranged from 2 to 7 days .168 patients were followed up for 6 to 24 months ,and 8 patients had subcutaneous sclerosis that then gradually disappeared within 2 months after operation .Folliculitis occurred in 5 cases of scalp puncture ,and recovered after topical antibiotics .Facial skin relaxation and sagging ,fat accumulation ,facial shape ,pouch and wrinkles of 160 patients were improved in varying degrees ,and the outcomes of facial rejuvenation were obvious .However ,the self-reported treatment outcomes of 7 patients were not obvious .One patient was reported that the sagging of the skin after sacrificial lipolysis was worse than before ;48 patients underwent autologous fat transplantation ,botu-linum toxin injection ,hot pull ,E-light ,and water-light injection during the follow-up period ,and were not included in the evaluation of efficacy ;21 patients were lost to follow-up .Conclusions Radio-frequency lipolysis combined with linear lifting is an effective method for facial rejuvenation ,and it has obvious effect in fining lipolysis and facial rejuvenation by avoiding the disadvantage of single approach . Post-operative edema should be controlled and avoided to improve patients'satisfaction .

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Visual inscriptions (e.g., graphs, illustrations) are a defining feature of scientific discovery to aid in data analysis, interpretation, and communication (e.g., Latour, 1990; Lynch, 1985). Our purpose was to examine how visual inscriptions are used to present data in gerontology journals. We compared 357 articles sampled from 24 peer-reviewed gerontology journals published between 1995 and 2009. Approximately 11 per cent of page space was dedicated to data presentation with more page space occupied by tables (9.13%) than graphs (2.32%). Graph use in gerontology was lower than in psychology (6.6% of page space) and higher than in criminology and criminal justice (1.7% of page space). Following Latour (1990), we argue that visualisations provide an understandable summary of complex data by effectively presenting multifaceted results. When inscriptions are used in dissemination, researchers become less reliant on complex statistical jargon and can communicate easily with a diverse audience (researchers, health care practitioners, clients).

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OBJECTIVE: To study the monthly dynamics of physical and chemical indexes in Achyranthis Bidentatae Radix(ABR, the dried root of Achyranthes bidentata Bl.) stored in simple and cool warehouses. METHODS: ABR was stored in simple and cool warehouses for 27 months. The color was observed. The water content was determined based on the drying method. The contents of β-ecdysone and 5-hydroxymethylfurfural (5-HMF) were determined by HPLC method. The accumulation of temperature difference between the simple and cool warehouses was evaluated with a relative temperature cumulation (RTC) method. The monthly dynamics of physical and chemical indexes of ABR was analyzed with RTC. RESULTS: As the extension of storage time, the ABR stored in the simple warehouse showed deeper color and harder texture, but the ABR stored in the cool warehouse still had soft texture without significant color change. The contents of β-ecdysone in ABR stored in the two warehouses both gradually decreased and dropped to lower than the limit of 0.030% ruled by China Pharmacopoeia when being stored for up to 27 months. The contents of 5-HMF of ABR stored in the two warehouses both increased and were higher for the sample in the simple warehouse than that in the cool warehouse. CONCLUSION: The concept of RTC is put forward and used to study the monthly dynamics of chemical constituents in traditional Chinese medicine during storage for the first time. The physical and chemical indexes of ABR varies during storage. Two years of storage time of ABR is suggested.

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We studied toxicity of a new Russian radiopharmaceutical Nanocolloid, (99m)Tc-Al2O3. Tests for acute toxicity showed that this agent belongs to a class of moderate-toxicity substances and does not have cumulative properties. The evaluation of subchronic toxicity after subcutaneous injection of this product to rats (0.04, 0.2, and 0.4 ml/kg) and rabbits (0.02 and 0.2 ml/kg) for 7 days did not reveal changes in the general state, temperature, body weight, indices of the peripheral blood and bone marrow, functions of the heart, liver, kidneys, and nervous system, and morphological characteristics of the internal organs in animals. The drug does not produce a local irritant effect.

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BACKGROUND: To prevent sudden unexpected movement of patients during surgery, muscle relaxants are used to maintain intense neuromuscular blockade.They are administered by intermittent bolus or continuous infusion.Rocuronium is often used for continuous infusion because it is known to lack cumulative effects. The purpose of this study was to compare recovery times from intense neuromuscular block to reappearance of muscle twitches after 0.1 Hz single twitch stimulation. MATERIALS AND METHODS: Seventy five patients were randomized to one of 3 groups.Patients in group 1 were administered a single bolus of rocuronium; groups 2 and 3 were given continuous infusion of rocuronium for 1 and 2 h, respectively.During anesthesia, neuromuscular blockade was monitored by TOF-watch(R) and regulated so as not to exceed more than 5 (PTC) during the infusion. After infusion, PTC was counted every 5 min until single twitch heights had reappeared and the time till the twitch reappeared was calculated. RESULTS: There was a good correlation between the time it took to observe a PTC and the first response of TOF time in each group.In a parallelism test, there were no significant differences. There were also no significant differences in recovery times from PTC to the reappearance of a single twitch between groups. CONCLUSIONS: There are no significant differences in recovery times-from deep neuromuscular blockade to reappearance of single twitch-regardless of the infusion time.When a PTC occurs during deep neuromuscular blockade, it may predict the remaining time of reappearance of a single twitch response.

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