bluuebunny/crossref_metadata_2025 huggingface dataset:
Alternate wetting and drying system (AWD) combined with farmyard manure to increase rice yield and reduce methane emission and water use
Authors: Viandari N Al , Adriany T A , Pramono A
Published: January 2021

Rice cultivation in flooded conditions is one of the methane emission sources. The objective of this study was to determine the effect of water management and farmyard manure application on grain yield, CH4 emissions, and water use efficiency. This study was conducted at the Indonesian Agricultural Environment Research Institute, Pati Central Java from November 2019 to March 2020. The treatments consisted of two factors, a) water management, namely 1) continuous flooding, at 5 cm (CF) and 2) Alternate Wetting-Drying, at 15 cm (AWD) system; and b) farmyard manure namely 1) farmyard manure application 2) without farmyard manure. The observed parameters were rainfall and air temperature, CH4 emissions, water level and milled dry grain. The measurement of CH4 gas emissions was conducted using a closed chamber method. The result of this study indicated that AWD management could increase grain yield by 3.3-8.5% and also reduce CH4 emissions by 12-14% compared to continuous flooding. AWD combined with organic fertilizer application produced the highest grain 7.27 tons ha-1 and emitted the lowest CH4. The AWD management also saved 32-38% of water compared to the continuous flooding.
Effectiveness of compost and vermicompost from market organic waste to improve soil chemical properties
Authors: Syarifinnur  , Nuraini Y , Prasetya B , Handayanto E
Published: January 2021

The purpose of this study is to evaluate the results of compost and vermicompost derived from market organic waste and its ability to improve soil chemical properties. Seven treatments consisted of treatments without organic matter (control), compost consisted of three treatments (2.5, 5, and 10 tons/ha), and vermicompost consisted of three treatments (2.5, 5, and 10 tons/ha). The treatments were arranged using a Completely Randomized Design with three replications. Each treatment was mixed with soil and incubated for eight weeks. After eight weeks the parameters observed consisted of total N, total P, available P, total K, Organic-C, and pH. The results showed a change in soil chemical content. The highest increase in soil chemical content was shown in the treatment of vermicompost. Application vermicompost 10 tons/ha had a significant influence on changes in soil pH, organic C, total P, available P, total K, and Compost 10 tons/ha increased total N. Vermicompost application of 10 tons/ha could increase total P (215.99%), available P (465.34%), total K (37.78%), pH (12.38%) and organic-C (40.34 %). Compost 10 tons/ha increases total N by (54%). Market organic waste effectively used as vermicompost and compost that could improve the soil’s chemical properties.
The utilization of agricultural waste for peatland management; in case chili cultivation
Authors: Fahmi A , Susilawati A
Published: January 2021

Peatland are known fragile and having a low bearing capacity for plant growth and production. One of the technologies that could be applied to improve peatland management is agricultural waste utilization. Agricultural waste such as ash and biochar from rice husk could be used as an ameliorant to improve the peatlands fertility. The objective of the experiment is to study peatland properties, carbon dioxide emission and yield of chili due to the application of ameliorant from agricultural waste. The experiment was conducted on the peatland that located around the farmer’s settlement. The treatment of experiment was set up with three treatments i.e.; rice husk biochar (RHB), rice husk ash (RHA) and without ameliorant. The results showed that the application of agricultural waste improved some peatland chemical properties, reduced carbon dioxide gas emission, and increased the yield of chili.
The potential of anaerobic-constructed wetland system for wastewater treatment of rice straw pulping
Authors: Setiawan Y , Hardiani H
Published: January 2021

Wastewater of cooking rice straw in the manufacture of pulp contains high levels of pollutants that must be treated first before being discharged into the environment. The purpose of this research is to study the potential of anaerobic and constructed wetland systems in treating pulp-making wastewater from rice straws. Anaerobic reactor with a volume of 30 L was filled with 5 L domestic sludge as sludge seed. Wastewater with COD of 762 - 17,900 mg/L, BOD5 of 354 – 8,000 mg/L, and TSS of 123 - 350 mg/L was fed into the anaerobic reactor. The organic loading rate was varied from 0.15 to 2.13 kg COD/m3 day, during the residence of wastewater for 5-8 days. Anaerobic reactor effluent was further processed in a constructed wetland reactor that varies in height from a mixture of sandy soil of 10-30 cm. The hydraulic residence time of wastewater in the constructed wetland reactor was 6.7 - 11.6 days. Influent and effluent of anaerobic and constructed wetland reactors were analysed for COD, BOD5, TSS, and pH parameters. The result indicated that wastewater treatment with anaerobic system could reduce COD of 63-72% and BOD5 of 65-75%, and the constructed wetland system could reduce COD and BOD5 of 96.5% and 96.1%, respectively.
Overcoming constraint of tidal swampland with water management with one-way flow system to increase of rice growth
Authors: Yusuf W A , Setiawati E
Published: January 2021

The paper addresses the issue whether water management is the key and the only practical way to reclaim and ameliorate a large area of tidal swampland. It reviews recent developments in water management practices with special emphasis on leaching acid sulphate soils are found throughout the length and breadth of the earth. Success in water management is the key for the reconciliation between agricultural yields and environmental sustainability. Water management of tidal swampland, which is dominated by acid sulphate soils, is a serious problem and challenges to reconcile agricultural practices and sustainable quality of ecosystem. Mismanagement of water dynamics may bring about catastrophic consequences instead of friendly environment. The local knowledge/wisdom in managing water supply and drainage to sustain rice yields with a two-way flow system of channels that allows a supply of fresh water during spring tide and drainage during tide has been introduced. The traditional system for reclaiming the tidal swampland by digging a drainage channel called handil. The experiment was carried out to investigate the effects of water management on soil chemistry of tidal swampland. Water management with a one-way flow system reduced of soil acidity, toxic elements and increased rice growth in tidal swampland.
Water quality assessment and a study of current palm oil mill effluent (POME) treatment by ponding system method
Authors: Jumadi J , Kamari A , Wong S T S
Published: January 2021

Palm oil is one of the main drivers of Malaysian economy that becomes major contributor to the Malaysian Gross Domestic Product (GDP) in the agriculture sector. The demand for palm oil-based product is expected to increase proportionally to the growing population, thus palm oil plantations have been growing rapidly to meet the global demand. Hence, to ensure sustainable management of palm oil production, avoid a significant effect to environmental pollution, the Roundtable on Sustainable Palm Oil (RSPO) and Malaysian Sustainable Palm Oil (MSPO) have been established to minimize environmental issues related to the palm oil industry in Malaysia. This paper provides the physicochemical characteristics and treatment techniques currently available for treating palm oil mill effluent (POME) nowadays. In addition, the correspondence between biological oxygen demand (BOD) and suspended solid (SS) of raw POME samples with the rainfall distribution pattern were also evaluated. The sampling took place at the cooling pond of a palm oil mill throughout 2019 and had been analyzed using water quality standard methods. The results indicated that the total monthly rainfall significantly influenced the concentration of BOD and SS parameters, of which in dry season (February) the highest BOD (36,200 mg/L) and lowest SS (10,522 mg/L) were recorded.
Comparing the effectiveness of chitosan and conventional coagulants for coal wastewater treatment
Authors: Maria A , Mayasari E , Irawati U , Zulfikurrahman
Published: January 2021

In this research, the potential of chitosan to be used as a coagulant to treat coal wastewater was investigated, in comparison to a conventional coagulant, i.e: Al2(SO4)3 or aluminum sulfate, and Poly Aluminium Chloride (PAC). The parameters being studied were turbidity, pH, TDS, and TSS. The result of this research showed that chitosan worked as a more efficient coagulant to treat coal wastewater compared to alum and PAC, in terms of the needed dose of application. The optimum dose of chitosan was 20 mg/L that gave a 100% decrease in turbidity and TSS. On the other hand, a dose of 120 mg/L of alum was needed to have an optimum result, where the turbidity and TSS were decreased up to 100%. When PAC was used as a coagulant, the optimum dose was 120 ppm that reduced turbidity and TSS to 99.50% and 99.58%, respectively. Coagulation by chitosan, alum, and PAC were all influenced by pH, where the optimum pH for all three coagulants was within a range of neutral pH.
Rapid start-up of expanded granular sludge bed (EGSB) reactor using granulated anaerobic bacteria in pharmaceutical wastewater treatment: pilot scale
Authors: Malik R A , Vistanty H , Mukimin A , Zen N
Published: January 2021

The start-up process is one of the most critical processes in wastewater treatment. The performance of a biological agent (bacteria) and/or the system can be predicted when the start-up process is carried out. The purpose of the start-up process is an adaptation of biological agent, and also as a granulation process for bacteria to form granule. The aim of this research was to study the effect of granular sludge in enhancing start-up time. The research was done using a 7 m tall stainless-steel reactor with 1,2 m x 1,2 m cubic shape-based and seeded with granulated anaerobic bacteria. The Reactor was operated continuously with configuration as follows: 4 h of HRT with up-flow velocity (Vup) of 1.75 m/h and recirculation ratio of 1:2. The main parameters observed were pH, alkalinity, and COD. The result showed that the effluent pH increased from 5,1 (inlet) to 6,9 on the first day of start-up and achieved pH 8,2 on the 4th day, the alkalinity also showed an increase from 219,05 CaCO3 mg/l to 470,3 CaCO3 mg/l. and the reduction of COD was 41,1% on the 4th day. It can be concluded that seeding the reactor with granulated anaerobic bacteria had successfully accelerated the start-up process.
Functional Assessment of Platelet Dense Granule ATP Release
Authors: Cho Joseph H , Wool Geoffrey D , Tjota Melissa Y , Gutierrez Jocelyn , Mikrut Krzysztof , Miller Jonathan L
Published: December 2020

Objectives

This study was undertaken to explore the feasibility of assessing platelet dense granule release in response to platelet stimuli, using less than 1 mL of whole blood (WB).

Methods

Optimization of the luciferin-luciferase (LL) assay for ATP release, together with additional modifications, was applied to 1:10 diluted WB.

Results

LL assay optimization using nonstirred 1:10 diluted WB resulted in dense granule ATP release in response to thrombin receptor-activating peptide (TRAP) of similar magnitude to that observed using stirred platelet-rich plasma. Stirring of the 1:10 diluted WB restored collagen-induced dense granule secretion. Addition of lyophilized, formalin-fixed platelets, together with stirring, restored dense granule secretion responsiveness to ADP. TRAP, ADP, and collagen all stimulated ATP release in 1:10 diluted WB under the optimized conditions of this study at levels close to those observed using platelet-rich plasma. Blood sample reconstitution experiments offer hope that this assay may prove robust down to WB platelet counts as low as 50 × 103/μL.

Conclusions

Platelet dense granule release in response to a number of classic stimuli, including ADP, was accomplished from less than 1 mL WB with minimal specimen processing, using widely available reagents and instrumentation.
Glue versus mechanical mesh fixation in laparoscopic inguinal hernia repair: meta-analysis and trial sequential analysis of randomized clinical trials
Authors: Habib Bedwani N A R , Kelada M , Smart N , Szydlo R , Patten D K , Bhargava A
Published: January 2021

Background

The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications.

Methods

A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model.

Results

Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88).

Conclusion

Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.
Artificial intelligence indocyanine green (ICG) perfusion for colorectal cancer intra-operative tissue classification
Authors: Cahill R A , O’Shea D F , Khan M F , Khokhar H A , Epperlein J P , Mac Aonghusa P G , Nair R , Zhuk S M
Published: January 2021

A new concept in intraoperative decision support for tumour delineation is proposed showing that artificial intelligence provides categorising information and interpretation from the images captured during fluorescence-guided colorectal cancer operations. This is potentially applicable to all cancer subtypes and is pertinent to new fluorophore development.A new concept in intraoperative decision support for tumour delineation is proposed showing that artificial intelligence provides categorising information and interpretation from the images captured during fluorescence-guided colorectal cancer operations. This is potentially applicable to all cancer subtypes and is pertinent to new fluorophore development. A new concept in intraoperative decision support for tumour delineation is proposed showing that artificial intelligence provides categorising information and interpretation from the images captured during fluorescence-guided colorectal cancer operations. This is potentially applicable to all cancer subtypes and is pertinent to new fluorophore development.

Shows promise
Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes
Authors: Schaap D P , Boogerd L S F , Konishi T , Cunningham C , Ogura A , Garcia-Aguilar J , Beets G L , Suzuki C , Toda S , Lee I K , Sammour T , Uehara K , Lee P , Tuynman J B , van de Velde C J H , Rutten H J T , Kusters M ,   the Lateral Node Study Consortium, Kusters M , Tuynman J , Hompes R , Akiyoshi T , Konishi T , Nieuwenhuijzen G A P , Rutten H J T , Schaap D P , Iversen H , Martling A , Suzuki C , Meershoek-Klein-Kranenbarg E , Ogura A , Putter H , van de Velde C J H , Garcia-Aguilar J , Gollub M J , Aiba T , Ogura A , Uehara K , Aalbers A G J , Beets G L , Beets-Tan R G H , Maas M , Betts M , Cunningham C , Lee H X , Moore J , Sammour T , Thomas M , Wells T , Lee P , Solomon M J , Choi M H , Kim M K , Lee I K , Oh S N , Won D D , Hanaoka Y , Kuroyanagi H , Toda S , Tomizawa K , Rutten H , Brown K G , Lee P , Solomon M J
Published: January 2021

Background

In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes.

Methods

Patients with low cT3–4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response.

Results

More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease.

Conclusion

Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes.

Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.
Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study
Authors: Fowler A J , Dobbs T D , Wan Y I , Laloo R , Hui S , Nepogodiev D , Bhangu A , Whitaker I S , Pearse R M , Abbott T E F
Published: January 2021

Background

The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled.

Methods

This was a modelling study using Hospital Episode Statistics data (2014–2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals.

Results

A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 – 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million.

Conclusion

As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
Comparison of multimodal analgesia with thoracic epidural after transthoracic oesophagectomy
Authors: Ng Cheong Chung J , Kamarajah S K , Mohammed A A , Sinclair R C F , Saunders D , Navidi M , Immanuel A , Phillips A W
Published: January 2021

Background

Thoracic epidural analgesia (TEA) has been regarded as the standard of care after oesophagectomy for pain control, but has several side-effects. Multimodal (intrathecal diamorphine, paravertebral and rectus sheath catheters) analgesia (MA) may facilitate postoperative mobilization by reducing hypotensive episodes and the need for vasopressors, but uncertainty exists about whether it provides comparable analgesia. This study aimed to determine whether MA provides comparable analgesia to TEA following transthoracic oesophagectomy.

Methods

Consecutive patients undergoing oesophagectomy for cancer between January 2015 and December 2018 were grouped according to postoperative analgesia regimen. Propensity score matching (PSM) was used to account for treatment selection bias. Pain scores at rest and on movement, graded from 0 to 10, were used. The incidence of hypotensive episodes and the requirement for vasopressors were evaluated.

Results

The study included 293 patients; 142 (48.5 per cent) received TEA and 151 (51.5 per cent) MA. After PSM, 100 patients remained in each group. Mean pain scores were significantly higher at rest in the MA group (day 1: 1.5 versus 0.8 in the TEA group, P = 0.017; day 2: 1.7 versus 0.9 respectively, P = 0.014; day 3: 1.2 versus 0.6, P = 0.047). Fewer patients receiving MA had a hypotensive episode (25 per cent versus 45 per cent in the TEA group; P = 0.003) and fewer required vasopressors (36 versus 53 per cent respectively; P = 0.016). There was no significant difference in the overall complication rate (71.0 versus 61.0 per cent; P = 0.136).

Conclusion

MA is less effective than TEA at controlling pain, but this difference may not be clinically significant. However, fewer patients experienced hypotension or required vasopressor support with MA; this may be beneficial within an enhanced recovery programme.
Understanding the benefits of botulinum toxin A: retrospective analysis of the Abdominal Core Health Quality Collaborative
Authors: Horne C M , Augenstein V , Malcher F , Yunis J , Huang L -C , Zolin S J , Fafaj A , Thomas J D , Krpata D M , Petro C C , Rosen M J , Prabhu A S
Published: January 2021

This was a retrospective analysis of a prospectively maintained database that objectively evaluated the benefit of preoperative chemical component separation with botulinum toxin A in complex hernia repairs.

Continued evaluation.
Safety and adverse events of urgent elective surgery during COVID-19 within three UK hospitals
Authors: Bertoncelli Tanaka M , St John E R , Exarchos G , Hogben K , Ahmed H U , Hrouda D ,   Imperial Breast and Urology Covid-19 Outcomes Group, Patrick J , Mundell A , Scrimgeour G , Abboudi H , Agarwal S , Al-Mufti R , Arya M , Dasgupta R , El-Husseiny T , Gibbons N , Hadjiminas D , Hellawell G , Karim O , Khoubehi B , Leff D R , Minhas S , Morley R , Rashid T , Thiruchelvam P , Urch C.E , Vyas L , Winkler M
Published: January 2021

This is a cohort study including 283 patients who underwent breast and urological procedures in three UK centres during the peak of COVID-19. COVID-related 30-day mortality was zero, as well as COVID-related admissions. Only 12 patients developed COVID-19 symptoms, although none had a positive COVID swab. Non-emergency surgery for breast and urological conditions was safe during the peak of the COVID-19 pandemic, provided contemporaneous safety measures were followed.
Genome sequencing of pancreatic cancer: differential expression by location
Authors: Bi F , Qian Y , Song L , Qu H , Zheng J , Fang X , He T , Yan H
Published: January 2021

The results demonstrated that pancreatic ductal carcinoma (PDAC) of the body/tail was associated with more transcriptional and genomic changes, and correlated with worse prognosis, than PDAC of the pancreatic head. The different mutation types and gene expression of tumour locations provide deep insight into the carcinogenesis or metastasis of PDAC, and suggest different early diagnostic and therapeutic strategies. SNV, single-nucleotide variations; NLS, Nuclear localization sequence; MB, million base-pairs; UTR, untranslated region.
Timing and clinical outcomes of tracheostomy in patients with COVID-19
Authors: Ahn D , Lee G J , Choi Y S , Park J W , Kim J K , Kim E J , Lee Y H
Published: January 2021

In this retrospective multicentre cohort study that included 27 COVID-19 patients who underwent tracheostomy, the mean time between intubation and tracheostomy was 15.8 days and the negative conversion time of COVID-19 was 43.1 days. Eleven patients (40.7%) died of COVID-19 and the use of percutaneous dilatation tracheostomy was significantly associated with in-hospital death. Timely tracheostomy could be performed in COVID-19 patients, regardless of duration of intubation or positivity of COVID-19 test, with an open surgical tracheostomy as a preferable technique.
Canaries in the mine
Authors: Dalli J , Khan M F , Nolan K , Cahill R A
Published: January 2021

Gas leaks occur frequently at laparoscopy and create jet-streams equivalent in velocity to human speaking. Focus on surgical smoke underestimates the issue and means any such guidance is incomplete.
Colorectal anastomotic leak: transcriptomic profile analysis
Authors: van Praagh J B , de Wit J G , Olinga P , de Haan J J , Nagengast W B , Fehrmann R S N , Havenga K
Published: January 2021

Background

Anastomotic leakage in patients undergoing colorectal surgery is associated with morbidity and mortality. Although multiple risk factors have been identified, the underlying mechanisms are mainly unknown. The aim of this study was to perform a transcriptome analysis of genes underlying the development of anastomotic leakage.

Methods

A set of human samples from the anastomotic site collected during stapled colorectal anastomosis were used in the study. Transcriptomic profiles were generated for patients who developing anastomotic leakage and case-matched controls with normal anastomotic healing to identify genes and biological processes associated with the development of anastomotic leakage.

Results

The analysis included 22 patients with and 69 without anastomotic leakage. Differential expression analysis showed that 44 genes had adjusted P < 0.050, consisting of two upregulated and 42 downregulated genes. Co-functionality analysis of the 150 most upregulated and 150 most downregulated genes using the GenetICA framework showed formation of clusters of genes with different enrichment for biological pathways. The enriched pathways for the downregulated genes are involved in immune response, angiogenesis, protein metabolism, and collagen cross-linking. The enriched pathways for upregulated genes are involved in cell division.

Conclusion

These data indicate that patients who develop anastomotic leakage start the healing process with an error at the level of gene regulation at the time of surgery. Despite normal macroscopic appearance during surgery, the transcriptome data identified several differences in gene expression between patients who developed anastomotic leakage and those who did not. The expressed genes and enriched processes are involved in the different stages of wound healing. These provide therapeutic and diagnostic targets for patients at risk of anastomotic leakage.
Postoperative infection and mortality following elective surgery in the International Surgical Outcomes Study (ISOS)
Authors: Wan Y I , Patel Akshaykumar , Achary C , Hewson R , Phull M , Pearse R M ,   the International Surgical Outcomes Study (ISOS) Group
Published: January 2021

Background

Postoperative infection is one of the most frequent and important complications after surgery. The epidemiology of infection following elective surgery remains poorly described.

Methods

This was a prospective analysis of the International Surgical Outcomes Study (ISOS) describing infection by 30 days after elective surgery. Associations between postoperative infection (primary outcome) and baseline demographic, surgical, and anaesthetic risk factors were assessed. Analyses were carried out using logistic and linear regression models. Secondary outcomes were 30-day mortality and duration of hospital stay. Treatments received by patients after different types of infection were evaluated.

Results

Some 44 814 patients were included in the analysis, with a total of 4032 infections occurring in 2927 patients (6.5 per cent). Overall, 206 patients died, of whom 99 of 2927 (3.4 per cent) had infection. Some 737 of 4032 infections (18.3 per cent) were severe; the most frequent types were superficial surgical-site infection (1320, 32.7 per cent), pneumonia (708, 17.6 per cent), and urinary tract infection (681, 16.9 per cent). Excluding missing data, antimicrobials were used in 2126 of 2749 infections (77.3 per cent), and 522 of 2164 patients (24.1 per cent) required admission to critical care. Factors associated with an increased incidence of infection in adjusted analyses were: age, male sex, ASA grade, co-morbid disease, preoperative anaemia, anaesthetic technique, surgical category, surgical severity, and cancer surgery. Infection significantly increased the risk of death (odds ratio 4.68, 95 per cent c.i. 3.39 to 6.47; P < 0.001), and duration of hospital stay by on average 6.45 (6.23 to 6.66) days (P < 0.001).

Conclusion

Infection is a common complication after elective surgery. Recognition of modifiable risk factors will help inform appropriate prevention strategies.
Publication trends and hotspots in enhanced recovery after surgery: 20-year bibliometric analysis
Authors: Zhang R , Qi S , Dai W , Chen S , Zhang Y , Tian W , Yan W , Kong M , Tian J , Su D
Published: January 2021

We evaluated enhanced recovery after surgery (ERAS) research and used bibliometric analysis to quantitatively and qualitatively predict research hotspots through extracting relevant publications from the core collection of the Web of Science database.
Prophylactic nipple-sparing mastectomy with immediate breast reconstruction: results of a French prospective trial
Authors: Houvenaeghel G , Cohen M , Dammacco M A , D’Halluin F , Regis C , Gutowski M , Acker O , Fournier M , Bannier M , Lusque A , Jouve E ,   the MAPAMc trial group, Bouteille C , Gertych W , Baron M , Leymarie N , Bertrand P
Published: January 2021

Background

Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is used increasingly when performing a prophylactic mastectomy. Few prospective studies have reported on complication rates. This complementary trial to the French prospective multicentre MAPAM trial aimed to evaluate the nipple–areola complex (NAC) necrosis rate in prophylactic NSM with IBR.

Methods

Patient characteristics and surgical data were recorded. Morbidity after prophylactic NSM with a focus on NAC necrosis was analysed.

Results

Among 59 women undergoing prophylactic NSM, 19 (32 per cent) of the incisions were partly on the NAC. Reconstructions were performed with 46 definitive implants and 13 expanders. The crude rate of postoperative complications was 25 per cent (15 patients). Complete NAC necrosis was reported in two women (3 per cent) and partial or total necrosis in nine (15 per cent). No NAC resection was necessary. Median BMI was lower in women with total or partial NAC necrosis compared with the others (20.0 versus 21.3 kg/m2 respectively; P = 0.034).

Conclusion

Results of this prospective study confirm that prophylactic NSM with IBR is associated with a low risk of total NAC necrosis.
Carbon tattooing for targeted lymph node biopsy after primary systemic therapy in breast cancer: prospective multicentre TATTOO trial
Authors: Hartmann S , Kühn T , de Boniface J , Stachs A , Winckelmann A , Frisell J , Wiklander-Bråkenhielm I , Stubert J , Gerber B , Reimer T
Published: January 2021

Background

Several techniques for targeted lymph node biopsy in patients with node-positive breast cancer receiving primary systemic therapy are in use, each with their inherent advantages and disadvantages. The aim of the TATTOO trial was to evaluate the feasibility and accuracy of carbon tattooing of positive lymph nodes as a method for targeted lymph node biopsy avoiding radiation exposure, high costs, and preoperative localization procedures.

Methods

Patients with initially cT1–4c cN1–3 cM0 invasive breast cancer were included in this prospective multicentre trial. Before initiation of primary systemic therapy, a carbon suspension was injected into the most suspicious axillary lymph node. Targeted lymph node biopsy was performed in all patients after completion of primary systemic therapy. Additional sentinel lymph node biopsy was done in those with axillary downstaging, and completion axillary lymph node dissection in patients still presenting with suspicious lymph nodes.

Results

A total of 118 patients were included and 110 were eligible for data analysis. The detection rate for the targeted lymph node was 93.6 per cent (103 of 110), and the sentinel lymph node was identical to the targeted lymph node in 60 per cent. The false-negative rate for the combination of targeted and sentinel node lymph node biopsy (targeted axillary dissection) was 9 per cent.

Conclusion

Targeted axillary dissection after carbon tattooing is associated with a high detection rate, an acceptable false-negative rate, and appears feasible for clinical use even in healthcare settings with limited resources.
Comment on: Use of an intraoperative wound protector to prevent surgical-site infection after pancreatoduodenectomy: randomized clinical trial
Authors: Chiu Chong-Chi , Lee Po-Huang , Lee Hui-Ming , Hung Chao-Ming
Published: January 2021

Our submission is the Correspondence to the text with the title of “Use of an intraoperative wound protector to prevent surgical-site infection after pancreatoduodenectomy: randomized clinical trial”. It was published in BJS 2020; 107: 1107–1113.
PAM-50 predicts local recurrence after breast cancer surgery in postmenopausal patients with ER+/HER2– disease: results from 1204 patients in the randomized ABCSG-8 trial
Authors: Fitzal F , Filipits M , Fesl C , Rudas M , Greil R , Balic M , Moinfar F , Herz W , Dubsky P , Bartsch R , Ferree S , Schaper C , Gnant M ,   the Austrian Breast and Colorectal Cancer Study Group (ABCSG)
Published: January 2021

Background

The aim of this study was to investigate whether the PAM-50-based 46-gene assay carries prognostic value for risk of local recurrence of breast cancer.

Methods

The Austrian Breast and Colorectal Cancer Study Group (ABCSG) 8 RCT compared 5 years of tamoxifen with tamoxifen for 2 years followed by anastrozole for 3 years in postmenopausal women with endocrine receptor-positive breast cancer. This study included patients from the trial who had breast-conserving surgery for whom tumour blocks were available for PAM-50 analysis.

Results

Tumour blocks from 1204 patients who had breast-conserving surgery were available for the PAM-50 analysis, and 1034 of these received radiotherapy. After a median follow-up of 10.8 years, 23 local events had been observed, corresponding to an overall local recurrence risk of 2.2 per cent. Univariable competing-risk analysis demonstrated that patients at low risk according to PAM-50 analysis (risk-of-recurrence (ROR) score less than 57) had a significantly lower incidence of local recurrence than those in the high-risk group at 5 years (0.1 (95 per cent c.i. 0 to 0.7) versus 2.2 (0.9 to 4.6) per cent respectively; subhazard ratio (SHR) 17.18, 95 per cent c.i. 2.06 to 142.88; P = 0.009) and 10 years (0.9 (0.4 to 2.0) versus 3.8 (1.9 to 6.6) per cent; SHR 4.76, 1.72 to 13.17; P = 0.003). Multivariable analyses that included ROR score, age, tumour size, nodal status, type of surgery, tumor grade, and trial-specific endocrine therapy confirmed that ROR score was an independent prognostic factor for risk of local recurrence. Analysis of the women randomized to radiotherapy or control after breast conservation showed that PAM-50 was not predictive of radiotherapy effect.

Conclusion

PAM-50 can be used as a prognostic tool for local recurrence risk in postmenopausal women with hormone receptor-positive breast cancer treated with endocrine therapy. The test was not predictive for the benefit of radiotherapy.
Airflow during clinical examinations with and without protective face masks
Authors: McInerney N , Gilligan C , Manojlovich L , Khan M F , Nolan K , Cahill R A
Published: January 2021

Close contact between the patient and physician markedly affects local airflow and their spared airspace, and this can be moderated by mask wearing. Understanding this is particularly relevant in the COVID-19 pandemic and for those new to clinical practice, in particular medical students.
Potential role for vascular surgeons during a COVID-19 outbreak: management, workload, and outcomes from the initiation of a central venous line service for patients with COVID-19 undergoing ventilation during the initial UK peak
Authors: Liu P , Lui D , Cheema S Mahmood , Hussain S Tahir , Husain T , Malina M
Published: January 2021

This is a report by a vascular unit in London on the initiation of a central venous line service for patients with COVID-19 undergoing ventilation during the initial UK peak. It includes views on management, workload, and overall outcomes.
Staging laparoscopy for pancreatic cancer using intraoperative ultrasonography and fluorescence imaging: the SLING trial
Authors: Oba A , Inoue Y , Ono Y , Ishizuka N , Arakaki M , Sato T , Mise Y , Ito H , Saiura A , Takahashi Y
Published: January 2021

This prospective trial revealed the additional diagnostic value of staging laparoscopy with contrast-enhanced intraoperative ultrasonography and indocyanine green-fluorescence imaging, detecting radiologically occult liver metastases and other occult metastases effectively for patients with high-risk resectable or borderline resectable pancreatic cancer. The 2-year survival rate of patients without occult metastasis was significantly better than that of patients with occult metastasis. These favourable results for patients without occult metastasis indicate that an enhanced screening strategy and modern multidisciplinary treatment may improve the outcome even of patients affected by high-risk advanced pancreatic cancer.

State-of-the-art staging worth the effort
Applying an intraoperative predictive indicator for postoperative pancreatic fistula: randomized preclinical trial
Authors: Pausch T M , Mitzscherling C , Aubert O , Liu X , Gesslein B , Bruckner T , Kommoss F K F , Golriz M , Mehrabi A , Hackert T
Published: January 2021

Leaking pancreatic fluid can contribute to postoperative pancreatic fistula (POPF), which can complicate pancreatic surgery. Surgeons lack reliable tools to identify pancreatic leaks, so a novel hydrogel indicator called SmartPAN was developed for intraoperative application. In this preclinical efficacy assessment study, SmartPAN was capable of detecting sites associated with biochemical leak and POPF-related symptoms, thereby guiding effective closure. Thus, SmartPAN may help to reduce POPF development in upcoming clinical trials.
Assessment of the introduction of semi-digital consent into surgical practice
Authors: St John E R , Bakri A C , Johanson E , Loughran D , Scott A , Chen S -T , Joshi S , Darzi A , Leff D R
Published: January 2021

In this study, paper-based surgical consent is demonstrated to have significant errors of omission and legibility. These errors were improved by the introduction of a procedure-specific, patient-bespoke, semi-digital consent form application. Patient-reported experience of their involvement in shared decision-making is described for paper-based consent and the implications of future digital consent are discussed.
Neoadjuvant chemoradiotherapy or chemotherapy alone for oesophageal cancer: population-based cohort study
Authors: Kamarajah S K , Phillips A W , Ferri L , Hofstetter W L , Markar S R
Published: January 2021

Background

Although both neoadjuvant chemoradiotherapy (nCRT) and chemotherapy (nCT) are used as neoadjuvant treatment for oesophageal cancer, it is unknown whether one provides a survival advantage over the other, particularly with respect to histological subtype. This study aimed to compare prognosis after nCRT and nCT in patients undergoing oesophagectomy for oesophageal adenocarcinoma (OAC) or squamous cell carcinoma (OSCC).

Methods

Data from the National Cancer Database (2006–2015) were used to identify patients with OAC and OSCC. Propensity score matching and Cox multivariable analyses were used to account for treatment selection biases.

Results

The study included 11 167 patients with OAC (nCRT 9972, 89.3 per cent; nCT 1195, 10.7 per cent) and 2367 with OSCC (nCRT 2155, 91.0 per cent; nCT 212, 9.0 per cent). In the matched OAC cohort, nCRT provided higher rates of complete pathological response (35.1 versus 21.0 per cent; P < 0.001) and margin-negative resections (90.1 versus 85.9 per cent; P < 0.001). However, patients who had nCRT had similar survival to those who received nCT (hazard ratio (HR) 1.04, 95 per cent c.i. 0.95 to 1.14). Five-year survival rates for patients who had nCRT and nCT were 36 and 37 per cent respectively (P = 0.123). For OSCC, nCRT had higher rates of complete pathological response (50.9 versus 30.4 per cent; P < 0.001) and margin-negative resections (92.8 versus 82.4 per cent; P < 0.001). A statistically significant overall survival benefit was evident for nCRT (HR 0.78, 0.62 to 0.97). Five-year survival rates for patients who had nCRT and nCT were 45.0 and 38.0 per cent respectively (P = 0.026).

Conclusion

Despite pathological benefits, including primary tumour response to nCRT, there was no prognostic benefit of nCRT compared with nCT for OAC suggesting that these two modalities are equally acceptable. However, for OSCC, nCRT followed by surgery appears to remain the optimal treatment approach.
Cribriform carcinoma in the lymph nodes is associated with distant metastasis, recurrence, and survival among patients with node-positive colorectal cancer
Authors: Yokoyama S , Fujita Y , Matsumura S , Yoshimura T , Kinoshita I , Watanabe T , Tabata H , Tsuji T , Ozawa S , Tamaki T , Nakatani Y , Oka M
Published: January 2021

Cribriform lymph node pattern is an independent risk factor for metachronous or synchronous distant metastasis in patients with stage III and IV node-positive colorectal cancer. Multivariable analysis in patients with stage III disease indicated that the cribriform pattern of carcinoma in the lymph nodes was an independent risk factor for recurrence and survival. Kaplan–Meier analysis demonstrated that the group with stage III cribriform-type lymph node carcinoma had shorter recurrence-free and overall survival times than the stage III group with the tubular type (P < 0.001).
Impact of COVID-19 on colorectal cancer presentation
Authors: Aguiar S , Riechelmann R Pimenta , de Mello C Abdon Lopes , da Silva J C Frazão , Diogenes I D Carrilho , Andrade M Silva , de Miranda Marques T M Duarte , Stevanato P R , Bezerra T Santoro , Silva M L Gobo , Lopes A , Curado M P
Published: January 2021

This was a cross-sectional and retrospective study of the short-term effects of the COVID-19 pandemic among patients with colorectal or anal cancer treated at AA Camargo Cancer Centre, a large and comprehensive cancer centre located in Sao Paulo, the epicentre of the pandemic in Brazil. The aim was to quantify the barriers to access to treatment and diagnosis of these tumours during the pandemic in comparison with the previous year. The results showed a significant decrease in newly diagnosed patients with colorectal or anal cancer, a significant increase in patients with locally advanced disease at presentation, and an increase in the proportion of patients without insurance for coverage of costs.
Systemic versus Oral and Systemic Antibiotic Prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial
Authors: Papp G , Saftics Gy , Szabó B E , Baracs J , Vereczkei A , Kollár D , Oláh A , Mészáros P , Dubóczki Zs , Bursics A
Published: January 2021

Background

There is no consensus regarding the role of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OABP) in reducing postoperative complications in colorectal surgery. The aim of this study was to examine the effect of OABP given in addition to MBP in the setting of a prospective randomized trial.

Methods

Patients awaiting elective colorectal surgery in four Hungarian colorectal centres were included in this multicentre, prospective, randomized, assessor-blinded study. Patients were randomized to receive MBP with or without OABP (OABP+ and OABP– groups respectively). The primary endpoints were surgical-site infection (SSI) and postoperative ileus. Secondary endpoints were anastomotic leak, mortality, and hospital readmission within 30 days.

Results

Of 839 patients assessed for eligibility between November 2016 and June 2018, 600 were randomized and 529 were analysed. Trial participation was discontinued owing to adverse events in seven patients in the OABP+ group (2.3 per cent). SSI occurred in eight patients (3.2 per cent) in the OABP+ and 27 (9.8 per cent) in the OABP– group (P = 0.001). The incidence of postoperative ileus did not differ between groups. Anastomotic leakage occurred in four patients (1.6 per cent) in the OABP+ and 13 (4.7 per cent) in the OABP– (P = 0.02) group. There were no differences in hospital readmission (12 (4.7 per cent) versus 10 (3.6 per cent); P = 0.25) or mortality (3 (1.2 per cent) versus 4 (1.4 per cent); P = 0.39).

Conclusion

OABP given with MBP reduced the rate of SSI and AL after colorectal surgery with anastomosis, therefore routine use of OABP is recommended.
Use of powered air-purifying respirators during surgical interventions
Authors: Hardy N , Dalli J , Khan M F , McCaul C , O’Keeffe D , Traynor O , Jerry J , Brady D , Cahill R A
Published: January 2021

This clinical study confirms user acceptability of PAPR during surgery both at operating room team level as well as by groups of surgeons, anaesthesiologists and nursing level. While some care is needed in the use of this equipment, surgery can be performed safely with satisfactory user experience.

Therefore PAPR is useable for surgery but scope exists for improvement.
Immune cell infiltration in colonic cancer: correlation between biopsy and surgical specimens
Authors: Bordry N , Germann M , Foukas P G , Sempoux C , Yan P , Dormond O , Speiser D E , Demartines N , Sauvain M -O
Published: January 2021

Infiltration of CD3+ and CD8+ T cells in tumour biopsies of patients with colonic cancer correlated positively with CD3+ and CD8+ T cell infiltration in matched tumour surgical specimens. This opens new perspectives in the potential of tumour biopsies for prognosis and treatment decisions.
Real postoperative complication rates: a key parameter that is not monitored
Authors: de la Plaza Llamas R
Published: January 2021

Postoperative complications represent a basic quality indicator of outcomes, but are not systematically measured. This situation has negative consequences that are ignored. An accurate assessment could help to evaluate the real morbidity, establish measures for improvement, increase efficiency and identify benchmark services. I present a personal review of the situation.