Modeling musculoskeletal kinematic and dynamic redundancy using null space projection

The coordination of the human musculoskeletal system is deeply influenced by its redundant structure, in both kinematic and dynamic terms. Noticing a lack of a relevant, thorough treatment in the literature, we formally address the issue in order to understand and quantify factors affecting the motor coordination. We employed well-established techniques from linear algebra and projection operators to extend the underlying kinematic and dynamic relations by modeling the redundancy effects in null space. We distinguish three types of operational spaces, namely task, joint and muscle space, which are directly associated with the physiological factors of the system. A method for consistently quantifying the redundancy on multiple levels in the entire space of feasible solutions is also presented. We evaluate the proposed muscle space projection on segmental level reflexes and the computation of the feasible muscle forces for arbitrary movements. The former proves to be a convenient representation for interfacing with segmental level models or implementing controllers for tendon driven robots, while the latter enables the identification of force variability and correlations between muscle groups, attributed to the system’s redundancy. Furthermore, the usefulness of the proposed framework is demonstrated in the context of estimating the bounds of the joint reaction loads, where we show that misinterpretation of the results is possible if the null space forces are ignored. This work presents a theoretical analysis of the redundancy problem, facilitating application in a broad range of fields related to motor coordination, as it provides the groundwork for null space characterization. The proposed framework rigorously accounts for the effects of kinematic and dynamic redundancy, incorporating it directly into the underlying equations using the notion of null space projection, leading to a complete description of the system.

Introduction of the trapezoidal thermodynamic technique method for measuring and mapping the efficiency of waste-to-energy plants: A potential replacement to the R1 formula

Waste-to-energy plants have the peculiarity of being considered both as energy production and as waste destruction facilities and this distinction is important for legislative reasons. The efficiency of waste-to-energy plants must be objective and consistent, independently if the focus is the production of energy, the destruction of waste or the recovery/upgrade of materials. With the introduction of polygeneration technologies, like gasification, the production of energy and the recovery/upgrade of materials, are interconnected. The existing methodology for assessing the efficiency of waste-to-energy plants is the R1 formula, which does not take into consideration the full spectrum of the operations that take place in waste-to-energy plants. This study introduces a novel methodology for assessing the efficiency of waste-to-energy plants and is defined as the 3T method, which stands for 'trapezoidal thermodynamic technique'. The 3T method is an integrated approach for assessing the efficiency of waste-to-energy plants, which takes into consideration not only the production of energy but also the quality of the products. The value that is returned from the 3T method can be placed in a tertiary diagram and the global efficiency map of waste-to-energy plants can be produced. The application of the 3T method showed that the waste-to-energy plants with high combined heat and power efficiency and high recovery of materials are favoured and these outcomes are in accordance with the cascade principle and with the high cogeneration standards that are set by the EU Energy Efficiency Directive.

Analysis of tar compounds and quantification of naphthalene from thermal treatment of household biowaste

Household biowaste represent the organic fraction of municipal solid waste and are an underutilized resource. Although previous studies have performed pyrolysis of organic waste, the vast majority has been on specific presorted feedstock or conventional lignocellulosic streams. Therefore, there is a lack of pyrolysis applications on representative food waste as retrieved from households and this can be attributed primarily to their high water content and their degradability. But via the intermediate step of drying, long-term storage and thermal treatment have become possible. In the framework of this study, household biowaste were pyrolyzed for the production of carbonaceous materials with a main focus on the analysis of produced tar compounds. Tars can be corrosive or cause clogging and disrupt the operation of pyrolysis and gasification plants. Their analysis has faced several difficulties due to inconsistency in the methodologies that have been applied by various groups. The tar protocol has provided a solid framework for consistent analysis of tars but until now has been solely used for the case of gasification. This study aimed to apply the tar protocol for pyrolysis and to enhance the detectability of the method for a wider range of tars by means of elemental analysis, attenuated total reflectance (ATR) and gas chromatography-mass spectrometry (GC-MS). GC- MS was performed by means of a specific column for PAHs identification and calibration methods were developed for the proper quantification of naphthalene which is the dominant tar compound. The results of the analysis showed that naphthalene concentration increased from torrefaction to carbonization but then decreased significantly for high temperature pyrolysis at 860 °C.

Thermodynamic modelling of an onsite methanation reactor for upgrading producer gas from commercial small scale biomass gasifiers

Small scale biomass gasifiers have the advantage of having higher electrical efficiency in comparison to other conventional small scale energy systems. Nonetheless, a major drawback of small scale biomass gasifiers is the relatively poor quality of the producer gas. In addition, several EU Member States are seeking ways to store the excess energy that is produced from renewables like wind power and hydropower. A recent development is the storage of energy by electrolysis of water and the production of hydrogen in a process that is commonly known as "power-to-gas". The present manuscript proposes an onsite secondary reactor for upgrading producer gas by mixing it with hydrogen in order to initiate methanation reactions. A thermodynamic model has been developed for assessing the potential of the proposed methanation process. The model utilized input parameters from a representative small scale biomass gasifier and molar ratios of hydrogen from 1:0 to 1:4.1. The Villar-Cruise-Smith algorithm was used for minimizing the Gibbs free energy. The model returned the molar fractions of the permanent gases, the heating values and the Wobbe Index. For mixtures of hydrogen and producer gas on a 1:0.9 ratio the increase of the heating value is maximized with an increase of 78%. For ratios higher than 1:3, the Wobbe index increases significantly and surpasses the value of 30 MJ/Nm³.

Integrating Brain and Biomechanical Models-A New Paradigm for Understanding Neuro-muscular Control

To date, realistic models of how the central nervous system governs behavior have been restricted in scope to the brain, brainstem or spinal column, as if these existed as disembodied organs. Further, the model is often exercised in relation to an in vivo physiological experiment with input comprising an impulse, a periodic signal or constant activation, and output as a pattern of neural activity in one or more neural populations. Any link to behavior is inferred only indirectly via these activity patterns. We argue that to discover the principles of operation of neural systems, it is necessary to express their behavior in terms of physical movements of a realistic motor system, and to supply inputs that mimic sensory experience. To do this with confidence, we must connect our brain models to neuro-muscular models and provide relevant visual and proprioceptive feedback signals, thereby closing the loop of the simulation. This paper describes an effort to develop just such an integrated brain and biomechanical system using a number of pre-existing models. It describes a model of the saccadic oculomotor system incorporating a neuromuscular model of the eye and its six extraocular muscles. The position of the eye determines how illumination of a retinotopic input population projects information about the location of a saccade target into the system. A pre-existing saccadic burst generator model was incorporated into the system, which generated motoneuron activity patterns suitable for driving the biomechanical eye. The model was demonstrated to make accurate saccades to a target luminance under a set of environmental constraints. Challenges encountered in the development of this model showed the importance of this integrated modeling approach. Thus, we exposed shortcomings in individual model components which were only apparent when these were supplied with the more plausible inputs available in a closed loop design. Consequently we were able to suggest missing functionality which the system would require to reproduce more realistic behavior. The construction of such closed-loop animal models constitutes a new paradigm of computational neurobehavior and promises a more thoroughgoing approach to our understanding of the brain's function as a controller for movement and behavior.

Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy in Recurrent Ovarian Cancer

Background and aims

Cytoreductive surgery with perioperative intraperitoneal chemotherapy is another approach for recurrent ovarian cancer. The purpose of the study was to assess the feasibility and the effect of cytoreduction and perioperative intraperitoneal chemotherapy in recurrent ovarian cancer.

Patients and methods

Twenty-nine women with recurrent ovarian cancer underwent cytoreductive surgery. Clinical variables were correlated to morbidity, hospital mortality, recurrences, and survival.

Results

Complete cytoreduction was possible in 58.6%. Extensive seeding of the small bowel and distant metastases excluded the possibility of performing complete cytoreduction. Perioperative intraperitoneal chemotherapy was given in 75.9%. Morbidity and hospital mortality rates were subsequently 24.1% and 3.4%. Recurrence was recorded in 48.3%. The extent of peritoneal dissemination was an independent variable of recurrence (P = 0.014). The 5-year survival rate was 30%. The extent of peritoneal dissemination and the completeness of cytoreduction were related to survival (P <05). The completeness of cytoreduction independently influenced survival (P = 0.013).

Conclusions

Secondary cytoreduction with intraperitoneal chemotherapy is feasible in most women with recurrent ovarian cancer with acceptable morbidity and mortality. Complete cytoreduction is not possible if distant and unresectable metastases are present or if the small bowel is extensively seeded. Long-term survivors are patients with limited peritoneal dissemination who may undergo complete cytoreduction.

Substance deposition assessment in obstructed pulmonary system through numerical characterization of airflow and inhaled particles attributes

BACKGROUND

Chronic obstructive pulmonary disease (COPD) and asthma are considered as the two most widespread obstructive lung diseases, whereas they affect more than 500 million people worldwide. Unfortunately, the requirement for detailed geometric models of the lungs in combination with the increased computational resources needed for the simulation of the breathing did not allow great progress to be made in the past for the better understanding of inflammatory diseases of the airways through detailed modelling approaches. In this context, computational fluid dynamics (CFD) simulations accompanied by fluid particle tracing (FPT) analysis of the inhaled ambient particles are deemed critical for lung function assessment. Also they enable the understanding of particle depositions on the airways of patients, since these accumulations may affect or lead to inflammations. In this direction, the current study conducts an initial investigation for the better comprehension of particle deposition within the lungs. More specifically, accurate models of the airways obstructions that relate to pulmonary disease are developed and a thorough assessment of the airflow behavior together with identification of the effects of inhaled particle properties, such as size and density, is conducted. Our approach presents a first step towards an effective personalization of pulmonary treatment in regards to the geometric characteristics of the lungs and the in depth understanding of airflows within the airways.

METHODS

A geometry processing technique involving contraction algorithms is established and used to employ the different respiratory arrangements associated with lung related diseases that exhibit airways obstructions. Apart from the normal lung case, two categories of obstructed cases are examined, i.e. models with obstructions in both lungs and models with narrowings in the right lung only. Precise assumptions regarding airflow and deposition fraction (DF) over various sections of the lungs are drawn by simulating these distinct incidents through the finite volume method (FVM) and particularly the CFD and FPT algorithms. Moreover, a detailed parametric analysis clarifies the effects of the particles size and density in terms of regional deposition upon several parts of the pulmonary system. In this manner, the deposition pattern of various substances can be assessed.

RESULTS

For the specific case of the unobstructed lung model most particles are detected on the right lung (48.56% of total, when the air flowrate is 12.6 L/min), a fact that is also true when obstructions arise symmetrically in both lungs (51.45% of total, when the air flowrate is 6.06 L/min and obstructions occur after the second generation). In contrast, when narrowings are developed on the right lung only, most particles are pushed on the left section (68.22% of total, when the air flowrate is 11.2 L/min) indicating that inhaled medication is generally deposited away from the areas of inflammation. This observation is useful when designing medical treatment of lung diseases. Furthermore, particles with diameters from 1 μm to 10 μm are shown to be mainly deposited on the lower airways, whereas particles with diameters of 20 μm and 30 μm are mostly accumulated in the upper airways. As a result, the current analysis indicates increased DF levels in the upper airways when the particle diameter is enlarged. Additionally, when the particles density increases from 1000 Kg/m³ to 2000 Kg/m³, the DF is enhanced on every generation and for all cases investigated herein. The results obtained by our simulations provide an accurate and quantitative estimation of all important parameters involved in lung modeling.

CONCLUSIONS

The treatment of respiratory diseases with inhaled medical substances can be advanced by the clinical use of accurate CFD and FPT simulations and specifically by evaluating the deposition of inhaled particles in a regional oriented perspective in regards to different particle sizes and particle densities. Since a drug with specific characteristics (i.e. particle size and density) exhibits maximum deposition on particular lung areas, the current study provides initial indications to a qualified physician for proper selection of medication.

Thermochemical valorization and characterization of household biowaste

Valorization of municipal solid waste (MSW), by means of energy and material recovery, is considered to be a crucial step for sustainable waste management. A significant fraction of MSW is comprised from food waste, the treatment of which is still a challenge. Therefore, the conventional disposal of food waste in landfills is being gradually replaced by recycling aerobic treatment, anaerobic digestion and waste-to-energy. In principle, thermal processes like combustion and gasification are preferred for the recovery of energy due to the higher electrical efficiency and the significantly less time required for the process to be completed when compared to biological process, i.e. composting, anaerobic digestion and transesterification. Nonetheless, the high water content and the molecular structure of biowaste are constraining factors in regard to the application of thermal conversion pathways. Investigating alternative solutions for the pre-treatment and more energy efficient handling of this waste fraction may provide pathways for the optimization of the whole process. In this study, by means of utilizing drying/milling as an intermediate step, thermal treatment of household biowaste has become possible. Household biowaste has been thermally processed in a bench scale reactor by means of torrefaction, carbonization and high temperature pyrolysis. According to the operational conditions, fluctuating fractions of biochar, bio-oil (tar) and syngas were recovered. The thermochemical properties of the feedstock and products were analyzed by means of Simultaneous Thermal Analysis (STA), Ultimate and Proximate analysis and Attenuated Total Reflectance (ATR). The analysis of the products shows that torrefaction of dried household biowaste produces an energy dense fuel and high temperature pyrolysis produces a graphite-like material with relatively high yield.

Study and assessment of segregated biowaste composting: The case study of Attica municipalities

This work aims to assess the operation of the first large scale segregated biowaste composting scheme in Greece to divert Household Food Waste (HFW) from landfill and produce a material which can be recovered and used as compost. The source separation and collection of HFW was deployed in selected areas in Attica Region serving about 3700 households. Sorted HFW is collected & transported to the Mechanical and Biological Treatment (MBT) plant in Attica Region that has been designed to produce Compost Like Output (CLO) from mixed MSW. The MBT facility has been adjusted in order to receive and treat aerobically HFW mixed with shredded green waste in a dedicated composting tunnel. The composting process was monitored against temperature, moisture and oxygen content indicating that the biological conditions are sufficiently developed. The product quality was examined and assessed against the quality specifications of EU End of Waste Criteria for biowaste subjected to composting aiming to specify whether the HFW that has undergone recovery ceases to be waste and can be classified as compost. More specifically, the heavy metals concentrations (Cr, Cu, Ni, Cd, Pb, Zn and Hg) are within the set limits and much lower compared to the CLO material that currently is being produced at the MBT plant. In regard to the hygienic requirements of the product it has been found that the process conditions result in a pathogen free material (i.e. E. Coli and Salmonella) which does not favor the growth of viable weeds and plant propagules, while it acquires sufficient organic matter content for soil fertilization. Noticeable physical impurities (mainly fractions of glass) have been detected exceeding the quality control threshold limit of 0.5% w/w (plastics, metals and glass). The latter is related to the missorted materials and to the limited pre-treatment configurations prior to composting. The above findings indicate that effective source separation of biowaste is prerequisite for good quality production and marketing of compost and special consideration should be made to minimize glass impurities prior composting (i.e. awareness raising and pretreatment stage). Therefore, it is feasible to gradually replace the production of questionable quality CLO in MBTs with biowaste compost which is in line with the required quality control standards especially when heavy metals concentrations is concerned.

Energy Efficient Monitoring of Metered Dose Inhaler Usage

Life-long chronic inflammatory diseases of the airways, such as asthma and Chronic Obstructive Pulmonary Disease, are very common worldwide, affecting people of all ages, race and gender. One of the most important aspects for the effective management of asthma is medication adherence which is defined as the extent to which patients follow their prescribed action plan and use their inhaler correctly. Wireless telemonitoring of the medication adherence can facilitate early diagnosis and management of these diseases through the use of an accurate and energy efficient mHealth system. Therefore, low complexity audio compression schemes need to be integrated with high accuracy classification approaches for the assessment of adherence of patients that use of pressurized Metered Dose Inhalers (pMDIs). To this end, we propose a novel solution that enables the energy efficient monitoring of metered dose inhaler usage, by exploiting the specific characteristics of the reconstructed audio features at the receiver. Simulation studies, carried out with a large dataset of indoor & outdoor measurements have led to high levels of accuracy (98 %) utilizing only 2 % of the recorded audio samples at the receiver, demonstrating the potential of this method for the development of novel energy efficient inhalers and medical devices in the area of respiratory medicine.

Combination of decentralized waste drying and SSF techniques for household biowaste minimization and ethanol production

The results of the demonstration of an innovative household biowaste management and treatment scheme established in two Greek Municipalities for the production of lignocellulosic ethanol using dehydrated household biowaste as a substrate, are presented within this research. This is the first time that biowaste drying was tested at a decentralized level for the production of ethanol using the Simultaneous Saccharification and Fermentation (SSF) process, at a pilot scale in Greece. The decentralized biowaste drying method proved that the household biowaste mass and volume reduction may reach 80% through the dehydration process used. The chemical characteristics related to lignocellulosic ethanol production have proved to differ substantially between seasons thus; special attention should be given to the process applied for ethanol production mainly regarding the enzyme quality and quantity used during the pretreatment stage. The maximum ethanol production achieved was 29.12g/L, approximately 60% of the maximum theoretical yield based on the substrate's sugar content. The use of the decentralized waste drying as an alternative approach for household biowaste minimization and the production of second generation ethanol is considered to be a promising approach for efficient biowaste management and treatment in the future.

Utilisation of biomass gasification by-products for onsite energy production

Small scale biomass gasification is a sector with growth and increasing applications owing to the environmental goals of the European Union and the incentivised policies of most European countries. This study addresses two aspects, which are at the centre of attention concerning the operation and development of small scale gasifiers; reuse of waste and increase of energy efficiency. Several authors have denoted that the low electrical efficiency of these systems is the main barrier for further commercial development. In addition, gasification has several by-products that have no further use and are discarded as waste. In the framework of this manuscript, a secondary reactor is introduced and modelled. The main operating principle is the utilisation of char and flue gases for further energy production. These by-products are reformed into secondary producer gas by means of a secondary reactor. In addition, a set of heat exchangers capture the waste heat and optimise the process. This case study is modelled in a MATLAB-Cantera environment. The model is non-stoichiometric and applies the Gibbs minimisation principle. The simulations show that some of the thermal energy is depleted during the process owing to the preheating of flue gases. Nonetheless, the addition of a secondary reactor results in an increase of the electrical power production efficiency and the combined heat and power (CHP) efficiency.

ACL Reconstruction Decision Support. Personalized Simulation of the Lachman Test and Custom Activities

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation".

OBJECTIVES

The objective of the proposed approach is to develop a clinical decision support system (DSS) that will help clinicians optimally plan the ACL reconstruction procedure in a patient specific manner.

METHODS

A full body model is developed in this study with 23 degrees of freedom and 93 muscles. The knee ligaments are modeled as non-linear spring-damper systems and a tibiofemoral contact model was utilized. The parameters of the ligaments were calibrated based on an optimization criterion. Forward dynamics were utilized during simulation for predicting the model's response to a given set of external forces, posture configuration and physiological parameters.

RESULTS

The proposed model is quantified using MRI scans and measurements of the well-known Lachman test, on several patients with a torn ACL. The clinical potential of the proposed framework is demonstrated in the context of flexion-extension, gait and jump actions. The clinician is able to modify and fine tune several parameters such as the number of bundles, insertion position on the tibia or femur and the resting length that correspond to the choices of the surgical procedure and study their effect on the biomechanical behavior of the knee.

CONCLUSION

Computational knee models can be used to predict the effect of surgical decisions and to give insight on how different parameters can affect the stability of the knee. Special focus has to be given in proper calibration and experimental validation.

Primary thyroid lymphoma: The two ends of the spectrum

We describe two different cases of prinary thyroid lymphoma (PTL). PTL is a rare malignancy. Nevertheless, it frequently presents diagnostic and therapeutic challenges. The first patient, a 79-year-old female, presented with a large, painless thyroid mass accompanied by severe obstructive symptoms of the upper respiratory and gastrointestinal track. The second patient (67-year-old female) presented with nodular goiter. Thyroidectomy - performed on the first patient for alleviation of obstructive symptoms - revealed the presence of a diffuse large B-cell lymphoma. Although she was administered standard chemotherapy she deceased four months later. In the second patient, primary thyroid lymphoma was an incidental finding following thyroidectomy performed for nodular goiter. These two cases illustrate the variable course of PTL, the possibility of which should be kept into consideration in clinical practice.

Design of an innovative, ecological portable waste compressor for in-house recycling of paper, plastic and metal packaging waste

Waste management in Greece relies heavily on unsustainable waste practices (mainly landfills and in certain cases uncontrolled dumping of untreated waste). Even though major improvements have been achieved in the recycling of municipal solid waste during recent years, there are some barriers that hinder the achievement of high recycling rates. Source separation of municipal solid waste has been recognised as a promising solution to produce high-quality recycled materials that can be easily directed to secondary materials markets. This article presents an innovative miniature waste separator/compressor that has been designed and developed for the source separation of municipal solid waste at a household level. The design of the system is in line with the Waste Framework Directive (2008/98/EC), since it allows for the separate collection (and compression) of municipal solid waste, namely: plastic (polyethylene terephthalate and high-density polyethylene), paper (cardboard and Tetrapak) and metal (aluminium and tin cans). It has been designed through the use of suitable software tools (LS-DYNA, INVENTROR and COMSOL). The results from the simulations, as well as the whole design process and philosophy, are discussed in this article.

The existing situation and challenges regarding the use of plastic carrier bags in Europe

Since day one, retailers and consumers have favoured plastic carrier bags. However, owing to the numerous environmental disadvantages, lightweight plastic carrier bags have been drawing the attention of the European Union competent authorities. Therefore, many European Union member states have taken action so as to reduce the use of plastic carrier bags. Based on the existing legislation and voluntary initiatives for the reduction of lightweight plastic carrier bags, the challenges and achieved outcomes from the implemented policy options in the various European Union member states are discussed and commented regarding the forthcoming transposition of the 'Directive 94/62/EC on packaging and packaging waste to reduce the consumption of lightweight plastic carrier bags' into the European Union member states' national law.

Household hazardous waste management: a review

This paper deals with the waste stream of household hazardous waste (HHW) presenting existing management systems, legislation overview and other relevant quantitative and qualitative information. European Union legislation and international management schemes are summarized and presented in a concise manner by the use of diagrams in order to provide crucial information on HHW. Furthermore, sources and types, numerical figures about generation, collection and relevant management costs are within the scope of the present paper. The review shows that the term used to refer to hazardous waste generated in households is not clearly defined in legislation, while there is absence of specific acts regulating the management of HHW. The lack of obligation to segregate HHW from the household waste and the different terminology used makes it difficult to determine the quantities and composition of this waste stream, while its generation amount is relatively small and, therefore, is commonly overlooked in waste statistics. The paper aims to cover the gap in the related literature on a subject that is included within the crucial waste management challenges at world level, considering that HHW can also have impact on other waste streams by altering the redox conditions or causing direct reactions with other non hazardous waste substances.

Leaching properties of slag generated by a gasification/vitrification unit: the role of pH, particle size, contact time and cooling method used

The environmental impact from the operation of thermal waste treatment facilities mainly originates from the air emissions, as well as the generated solid residues. The objective of this paper is to examine the slag residue generated by a demonstration plasma gasification/vitrification unit and investigate the composition, the leaching properties of the slag under different conditions, as well as the role of the cooling method used. The influence of pH, particle size and contact time on the leachability of heavy metals are discussed. The main outcome is that the vitrified slag is characterized as inert and stable and can be safely disposed at landfills or used in the construction sector. Finally, the water-cooled slag showed better resistance in relation to heavy metal leachability compared to the air-cooled slag.

Unobtrusive behavioral and activity-related multimodal biometrics: The ACTIBIO Authentication concept

Unobtrusive Authentication Using ACTIvity-Related and Soft BIOmetrics (ACTIBIO) is an EU Specific Targeted Research Project (STREP) where new types of biometrics are combined with state-of-the-art unobtrusive technologies in order to enhance security in a wide spectrum of applications. The project aims to develop a modular, robust, multimodal biometrics security authentication and monitoring system, which uses a biodynamic physiological profile, unique for each individual, and advancements of the state of the art in unobtrusive behavioral and other biometrics, such as face, gait recognition, and seat-based anthropometrics. Several shortcomings of existing biometric recognition systems are addressed within this project, which have helped in improving existing sensors, in developing new algorithms, and in designing applications, towards creating new, unobtrusive, biometric authentication procedures in security-sensitive, Ambient Intelligence environments. This paper presents the concept of the ACTIBIO project and describes its unobtrusive authentication demonstrator in a real scenario by focusing on the vision-based biometric recognition modalities.

The impact of total mesorectal excision in middle and low rectal carcinomas

PURPOSE

The incidence of locoregional recurrence in rectal cancer has declined since total mesorectal excision (TME) has been widely adopted. The purpose of this study was to investigate the long-term survival and the incidence of locoregional recurrences in patients with middle and low rectal carcinomas undergoing TME.

METHODS

The medical records of 126 patients with middle and low rectal carcinomas treated from 1987-2007 were retrospectively reviewed. Of them 80 had undergone total mesorectal excision (TME-group) and 46 surgery with conventional methods (CON-group). Clinical variables were correlated to morbidity, hospital mortality, recurrence, sites of recurrence, and survival.

RESULTS

The groups were comparable except for type of surgery and sites of recurrence. Five-year overall survival rate for TME group was 75% and for CON-group 47% (p=0.0346). Although the groups were not different for the total number of recurrences, the number of locoregional recurrences was significantly lower in TME group (p=0.004).

CONCLUSION

TME appears to improve long-term survival in patients with middle and low rectal carcinomas. The incidence of locoregional recurrence is also reduced by TME.