bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP2.4 The impact of preoperative American Society of Anesthesiologists grade on major pancreatoduodenectomy outcomes
Authors: Grayson Niamh , Ribaud Juliette , Mariathasan Michael , Nair Ashitha ,   RAW Study Collaborators, Srinivasan Parthi 
Published: August 2023

Abstract
American Society of Anesthesiologists (ASA) grade is often used as a crude assessment for grading patients prior to major surgery, such as pancreaticoduodenectomy (PD). Patients deemed to have a high ASA grade may not be offered resection. Increasing ASA grade is known to correlate with increasing morbidity and mortality rates. Prior authors have argued that caution should be used when offering PD to ASA grade &gt;II patients. This study aimed to compare the outcomes of PD patients with a low ASA grade (I-II) with high ASA grade (&gt;II).
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Patients were grouped by their ASA grade. The outcomes of interest were median length of stay (LoS), 30-day readmission, 90-day mortality and five-year survival. Comparisons were made using the Mann-Whitney U test and the Fisher exact test.
Out of 1484 cases, 1365 (92.0%) had information regarding their ASA grade available. Of these, 973 (71.3%) were ASA grade I-II and 392 (28.7%) were ASA grade &gt;II. Whilst those with a high ASA grade had significantly longer LoS (14 vs 13 days, p&lt;0.0001), 30-day readmission (8.5% vs 11.7% p=0.1), 90-day mortality (3.1% vs 4.6%, p=0.2) and five-year survival (32.5% vs 28.8%) rates were similar.
In our multicentre study of PD patients, high ASA grade correlated with increased LoS. However, a high ASA grade did not affect the other studied outcomes. Therefore, higher ASA grade alone should not be an absolute contraindication to PD.
ThTP1.9 The impact of patient gender on key outcomes of pancreatoduodenectomy: should gender influence patient selection?
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Patients with a suspected cancer affecting the pancreatic head or periampullary region may be offered curative-intent pancreatoduodenectomy providing they are fit enough. Due to the high-risk nature of the operation and high recurrence rates, outcomes are poor. This study aimed to investigate the impact of patient gender on key short- and long-term outcomes.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of pancreatoduodenectomy performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Patients were grouped by their gender and the following outcomes were compared: median length of stay (LoS), 30-day readmission, 90-day mortality, unplanned return to theatre rate, provision of nutritional support rate, five-year recurrence and five-year survival.

Results
Out of 1484 patients, 56% were male and 44% were female. Median LoS was thirteen days in both sexes (p=0.4). 30-day readmission (9% vs 8%, p=0.4), 90-day mortality (both 4%, p=1.0), unplanned return to theatre (both 5%, p=0.7), provision of nutritional support (42% vs 38%), five-year recurrence (60% vs 61%, p=0.8) and five-year survival (both 32%, p=0.9) rates were all similar.

Conclusions
In our multicentre study of patients who underwent PD for malignancy, gender did not affect the studied outcomes. Gender alone should not influence patient selection.
FTP7.4 Variations in the type of nutritional support provided after pancreatoduodenectomy: results from an international multicentre retrospective cohort study
Authors: Russell Thomas , Labib Peter , Murphy Paula ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
An early oral diet is recommended after pancreatoduodenectomy (PD), however, the nutritional management of PD patients is known to be highly variable, and some centres still provide postoperative parenteral nutrition (PN) routinely. A proportion of patients who receive PN experience clinically significant complications underscoring its judicious use. Using a multicentre cohort, this study aimed to determine the proportion of PD patients that received postoperative nutritional support (NS), describe the variations in this support, and investigate whether receiving PN correlated with morbidity.

Methods
Data was extracted from the Recurrence After Whipple’s (RAW) study database, a retrospective study of patients undergoing PD for histologically confirmed pancreatic, ampullary or distal bile duct malignancy.

Results
1323 patients (89.2%) had data on their postoperative NS status available. Of these, 45.4% received postoperative NS. This was “enteral only”, “parenteral only”, and “enteral and parenteral” in 44.3%, 35.2% and 20.5% of cases, respectively. Body mass index &lt;18.5 kg/m2 (p=0.03), an absence of preoperative biliary stenting (p=0.009) and preoperative serum albumin &lt;36 g/L (p=0.009) all correlated with receiving postoperative NS. Among those who did not develop a serious postoperative complication (Clavien-Dindo grade ≥IIIa), one-fifth received PN.

Conclusions
Being underweight, not undergoing preoperative biliary stenting and having a low preoperative serum albumin all correlated with receiving postoperative NS. A considerable number of patients who had an uneventful recovery received PN; this should be reserved for those who are unable to take an oral diet or those in whom an oral diet is contraindicated.
Surgical experience and identification of errors in laparoscopic cholecystectomy
Authors: Humm Gemma L , Peckham-Cooper Adam , Chang Jessica , Fernandes Roland , Gomez Naim Fakih , Mohan Helen , Nally Deirdre , Thaventhiran Anthony J , Zakeri Roxanna , Gupte Anaya , Crosbie James , Wood Christopher , Dawas Khaled , Stoyanov Danail , Lovat Laurence B 
Published: August 2023

Abstract

Background
Surgical errors are acts or omissions resulting in negative consequences and/or increased operating time. This study describes surgeon-reported errors in laparoscopic cholecystectomy.

Methods
Intraoperative videos were uploaded and annotated on Touch SurgeryTM Enterprise. Participants evaluated videos for severity using a 10-point intraoperative cholecystitis grading score, and errors using Observational Clinical Human Reliability Assessment, which includes skill, consequence, and mechanism classifications.

Results
Nine videos were assessed by 8 participants (3 junior (specialist trainee (ST) 3–5), 2 senior trainees (ST6–8), and 3 consultants). Participants identified 550 errors. Positive relationships were seen between total operating time and error count (r2 = 0.284, P &lt; 0.001), intraoperative grade score and error count (r2 = 0.578, P = 0.001), and intraoperative grade score and total operating time (r2 = 0.157, P &lt; 0.001). Error counts differed significantly across intraoperative phases (H(6) = 47.06, P &lt; 0.001), most frequently at dissection of the hepatocystic triangle (total 282; median 33.5 (i.q.r. 23.5–47.8, range 15–63)), ligation/division of cystic structures (total 124; median 13.5 (i.q.r. 12–19.3, range 10–26)), and gallbladder dissection (total 117; median 14.5 (i.q.r. 10.3–18.8, range 6–26)). There were no significant differences in error counts between juniors, seniors, and consultants (H(2) = 0.03, P = 0.987). Errors were classified differently. For dissection of the hepatocystic triangle, thermal injuries (50 in total) were frequently classified as executional, consequential errors; trainees classified thermal injuries as step done with excessive force, speed, depth, distance, time or rotation (29 out of 50), whereas consultants classified them as incorrect orientation (6 out of 50). For ligation/division of cystic structures, inappropriate clipping (60 errors in total), procedural errors were reported by junior trainees (6 out of 60), but not consultants. For gallbladder dissection, inappropriate dissection (20 errors in total) was reported in incorrect planes by consultants and seniors (6 out of 20), but not by juniors. Poor economy of movement (11 errors in total) was reported more by consultants (8 out of 11) than trainees (3 out of 11).

Conclusion
This study suggests that surgical experience influences error interpretation, but the benefits for surgical training are currently unclear.
Distribution and fixed-precision sampling plans for diamondback moth (Lepidoptera: Plutellidae), on winter–spring cabbage
Authors: Forbanka Derick Nomuh , Stemele Mxolisi Arnold , Heshula Lelethu Unathi-Nkosi Peter , Dzemo William Diymba , Kotey Daniel Ashie , Taruvinga Amon , Tshivhandekano Pfarelo Grace 
Published: August 2023

Abstract
The diamondback moth (Plutella xylostella L.) is the most destructive insect pest on cabbage (Brassica oleracea var. capitata L.). Infestation by this pest usually results in the indiscriminate use of insecticides by farmers due to a lack of sampling plans for this pest. Sampling plans for P. xylostella management decisions on winter–spring cabbage in the Eastern Cape Province of South Africa were developed, through population monitoring that comprised weekly counts of immature stages of P. xylostella on 60 plants for 11 wk each during the winter and spring seasons. The mean density–variance relationship was used to describe the distribution of the pest, and number of infested plants was used to develop a fixed-precision sampling plan. All plant growth stages preceding maturation were vulnerable to P. xylostella damage resulting in yield losses. A high aggregation of P. xylostella on cabbage was observed in spring than in winter. The average sample number to estimate P. xylostella density within a 15% standard error of the mean was 35 plants. Furthermore, the estimated plant proportion action threshold (AT) was 51% with density action thresholds of 0.50 and 0.80 for spring and winter, respectively. Fitting P. xylostella cumulative counts in the winter and spring sampling plans resulted in 100% and 45% reduction in insecticide treatments. The similarity of sample size and ATs between both seasons provides evidence that a single sampling plan is practical for all cabbage growing seasons. The similarity of the estimated ATs to those acceptable in established integrated pest management programs indicates reliability.
Systemic insecticides for control of stem gall wasp in highbush blueberry
Authors: DeVisser Amber K , Vandervoort Christine , Isaacs Rufus , Wise John 
Published: August 2023

Abstract
The gall wasp, Hemadas nubilipennis Ashmead, is a pest of highbush and lowbush blueberry and can pose a challenge to control with foliar sprays due to adult activity being during bloom and because larval development is within plant tissues. We hypothesized that systemic insecticides that move within the blueberry vascular system would reach areas where H. nubilipennis eggs are laid, causing larval mortality. Three application methods, crown injection, soil drench, and foliar spray were applied to potted ‘Jersey’ blueberry bushes at 50% and 100% rates to quantify systemic residue concentrations in shoots and leaves. Additionally, systemic insecticides were evaluated for control of gall wasps using single-shoot bioassays and measuring larval mortality at 0.01%, 0.1%, 1%, and 10% of field rate provided within a floral pick. Systemic insecticides tested in both studies included imidacloprid, flupyradifurone, and spirotetramat. The potted bush residue study determined that insecticides moved from three tested sites of entry: the roots, crown cavity, and foliage. Results from the shoot bioassays found that the mean percent larval survival of H. nubilipennis was negatively correlated with the concentration of AI detected in galls. Imidacloprid and spirotetramat were found to have the greatest potential for control of H. nubilipennis due to mortality in the shoot bioassays and similar residue concentrations in the potted bush studies to shoot bioassays. Future research should evaluate systemic insecticides applied in highbush blueberry plantings for control of H. nubilipennis using the bioassay mortality assessment method developed in this study.
The impact of functional teat number on reproductive throughput in swine
Authors: Obermier Dalton R , Howard Jeremy Thomas , Gray Kent A , Knauer Mark T 
Published: August 2023

AbstractThe objective was to evaluate the impact of functional teat number on reproductive throughput in swine. Data included 735 multiparous Landrace × Large White F1 females. Sow underlined traits consisted of total teat number (TT), functional teat number (FT), nonfunctional teat number (NFT), and number of functional mammary glands (FMG). Weaning traits were calculated for both the biological and the nurse dam. For the biological dam, litter size at weaning (LSW) included a sow’s biological piglets regardless of cross-fostering. For nurse dam, number weaned (NW) included the piglets a sow weaned. For the biological dam, piglet survival (PS) was calculated as litter size at weaning / (total number born × 100). Linear regression estimates were calculated in RStudio v. 1.1.456 and variance components were estimated using GIBBS3F90. Average total number born, number born alive, TT, FT, NFT, and FMG were 14.22, 13.12, 14.43, 13.96, 0.42, and 10.7, respectively. An increase in one FT enhanced (P &lt; 0.05) LSW by 0.32 piglets and NW by 0.33 piglets. Similarly, an increase in one FT improved (P &lt; 0.05) PS by 1.63% and reduced (P &lt; 0.05) preweaning mortality by 2.73%. However, an increase in one FT reduced (P &lt; 0.05) average piglet weaning weight (WW) for biological and nurse dams by 35 and 94 g, respectively. Yet an increase in one FT enhanced (P &lt; 0.05) litter weaning weight (LWW) for biological and nurse dams by 1.3 and 1.5 kg, respectively. Heritability estimates for TT, FT, NFT, FMG, WW, LWW, LSW, and PS were 0.25, 0.22, 0.53, 0.18, 0.21, 0.22, 0.16, and 0.18, respectively. Genetic correlation estimates between FT with TT, NFT, and FMG were 0.79, 0.09, and 0.28, respectively. Estimated genetic correlations between TT with WW, LWW, LSW, and PS were 0.37, 0.38, 0.11, and −0.19, respectively. Genetic correlation estimates between FT with WW, LWW, LSW, and PS were 0.44, 0.49, 0.39, and 0.35, respectively. Results suggest increasing functional teat number would enhance both piglet survival and reproductive throughput.
Reconstruction of a Spinal Accessory Nerve Defect Using Vascularized Vastus Lateralis Motor Nerve Graft
Authors: Yanagishita Shiori , Otani Naoya , Seike Shien , Tomita Koichi , Kubo Tateki 
Published: August 2023

Summary:
Massive resection of a malignant tumor of the head and neck region often requires loss of critical nerves, including the spinal accessory nerve. Recently, vascularized nerve grafts (VNGs) have been used to repair facial and other nerve defects with successful outcomes, even in cases involving factors that can inhibit nerve regeneration, such as radiotherapy. However, the effectiveness of these nerve grafts against postoperative radiotherapy has yet to be explored. We report the first successful case in reconstructing a spinal accessory nerve defect after total left parotidectomy with radical neck dissection, using a vascularized vastus lateralis motor nerve graft and an anterolateral thigh flap based on the lateral circumflex femoral system, with great shoulder function outcomes even after postoperative radiotherapy. A branch of vastus lateralis motor nerve perfused by the accompanying descending branch of lateral femoral circumflex vessel was used as a nerve graft, and was repaired in an end-to-end manner. The patient underwent postoperative radiotherapy to the area of operation. At 6-months follow-up, the patient was capable of 90 degrees lateral shoulder abduction, and at 18 months, achieved full-range shoulder abduction and reported neither functional limitations of the shoulder nor complaints of any shoulder pain (Disabilities of Arm, Shoulder, and Hand score 0). Although further study is necessary to fully understand the superiority of VNGs over postoperative radiotherapy, immediate nerve reconstruction using VNG for accessory nerve defects in patients scheduled for radiotherapy postoperation may be extremely beneficial for preserving shoulder motor function and sustaining the patient’s quality of life.
Effect of intraoperative noise on postoperative pain in surgery patients under general anesthesia: Evidence from a prospective study and mouse model
Authors: You Shuai , Xu Fang , Zhu Xiwen , Qin Siyu , Zheng Xuemei , Tao Chengkun , Wu Yingcai , Chen Yupei , Shu Bin , Huang He , Duan Guangyou 
Published: August 2023

Background:
Most patients are in a noisy environment during abdominal surgery under general anesthesia. This study included patients who underwent abdominal surgery under general anesthesia and established an animal model to determine whether intraoperative noise affects postoperative pain.

Materials and Methods:
This prospective study included 200 patients who underwent abdominal surgery under general anesthesia. Intraoperative noise and electroencephalograms were continuously recorded, and the mean level and time proportion of noise intensity of >70 dB were calculated. Maximum postoperative pain was assessed using a numerical rating scale (NRS) at 0–12 h and 12–24 h after surgery, and postoperative analgesia consumption in patients receiving patient-controlled intravenous analgesia was recorded. Postoperative pain intensity and electroencephalogram amplitude were compared between patients with high-noise exposure (time proportion of noise intensity greater than 70 dB ≥40%) and low-noise exposure (<40%). Mechanical pain sensitivity was tested in two groups of mice with plantar incisions exposed to 40 dB or 70–100 dB.

Results:
The time proportion of noise intensity >70 dB was identified as an independent risk factor for postoperative pain intensity (P<0.001). Pain NRS 0–12 h (4.5±1.5 vs. 3.7±1.3, P=0.001) and 12–24 h (3.9±1.5 vs. 3.2±1.1, P=0.004) after surgery in patients with high-noise exposure was significantly higher than in patients with low-noise exposure. The electroencephalogram amplitude of patients with high-noise exposure was significantly lower than that of patients with low-noise exposure (P<0.05). In the mouse model, mechanical hyperalgesia in the 70–100 dB group was significantly greater than that in the 40 dB group (P<0.001).

Conclusion:
High-level intraoperative noise exposure aggravates the degree of postoperative pain and analgesic needs of patients undergoing abdominal surgery, which may be related to the impact of noise on the neurophysiological activity of the brain and postoperative hyperalgesia.
Exploring the complex relationship between vitamin K, gut microbiota, and warfarin variability in cardiac surgery patients
Authors: Xue Ling , Singla Rajeev K. , Qin Qiong , Ding Yinglong , Liu Linsheng , Ding Xiaoliang , Qu Wenhao , Huang Chenrong , Shen Zhenya , Shen Bairong , Miao Liyan 
Published: August 2023

Background and Objectives:
Due to the high individual variability of anticoagulant warfarin, this study aimed to investigate the effects of vitamin K concentration and gut microbiota on individual variability of warfarin in 246 cardiac surgery patients.

Methods:
The pharmacokinetics and pharmacodynamics (PKPD) model predicted INR and warfarin concentration. Serum and fecal samples were collected to detect warfarin and vitamin K (VK1 and menaquinone-4 (MK4)) concentrations and gut microbiota diversity, respectively. In addition, the patient’s medical records were reviewed for demographic characteristics, drug history, and CYP2C9, VKORC1, and CYP4F2 genotypes.

Results:
The PKPD model predicted ideal values of 62.7% for S-warfarin, 70.4% for R-warfarin, and 76.4% for INR. The normal VK1 level was 1.34±1.12 nmol/mL (95% CI: 0.33-4.08 nmol/mL), and the normal MK4 level was 0.22±0.18 nmol/mL (95% CI: 0.07-0.63 nmol/mL). The MK4 to total vitamin K ratio was 16.5±9.8% (95% CI: 4.3-41.5%). The S-warfarin concentration of producing 50% of maximum anticoagulation and the half-life of prothrombin complex activity tended to increase with vitamin K. Further, Prevotella and Eubacterium of gut microbiota identified as the main bacteria associated with individual variability of warfarin. The results suggest that an increase in vitamin K concentration can decrease anticoagulation, and gut microbiota may influence warfarin anticoagulation through vitamin K2 synthesis.

Conclusion:
This study highlights the importance of considering vitamin K concentration and gut microbiota when prescribing warfarin. The findings may have significant implications for the personalized use of warfarin. Further research is needed to understand better the role of vitamin K and gut microbiota in warfarin anticoagulation.
Anticoagulation prescription among atrial fibrillation patients managed with and without an anticoagulant initiation pathway: a cohort study
Authors: Carter Jaimee , Kirwan Christopher , Niaz Saghar , Baweja Shriya , Al-Haimus Fayad , Hu Yang , Ramsden Sophie , Clayton Natasha , de Wit Kerstin 
Published: August 2023

Background and importance
The Canadian Association of Emergency Physicians atrial fibrillation (AF) checklist advises that emergency physicians initiate anticoagulation therapy for patients with AF or flutter who are CHADS65 positive.

Objectives
The aim was to compare anticoagulation initiation rates between patients treated with and without an anticoagulation assessment pathway (the SAFE pathway).

Design
This was a retrospective cohort study.

Settings and participants
All emergency department patients were discharged home with a diagnosis of AF between June 2018 and May 2020 at two Canadian emergency departments.

Intervention
The SAFE pathway is a hard copy form which allows emergency physicians to document contraindications to anticoagulation, the positive components of the CHADS65 score, and details how to prescribe anticoagulation.

Outcome measures and analysis
Trained researchers abstracted data on the use of the SAFE pathway by the presence or absence of the completed, scanned pathway in the electronic medical chart. The exposure of interest was use of this pathway. Patients were followed forward in time for 90 days by electronic medical record review to document stroke, transient ischemic attack, arterial embolism and major bleeding events. All events were independently adjudicated. Adjusted odds ratios were calculated to compare outcomes between those managed with and without the SAFE pathway.

Results
In total, 766 patients were included, of whom 264 were already taking anticoagulation, 166 were CHADS65 negative and 65 had a contraindication to anticoagulation, leaving 271 patients eligible for anticoagulation prescription. Among the 271 eligible patients, 137/166 managed with the SAFE pathway were initiated on anticoagulation and 24/105 managed without the SAFE pathway started anticoagulation (adjusted odds ratio 25.9; 13.1–51.2). There was no statistically significant difference in the 90-day rate of stroke or bleeding.

Conclusion
Use of the SAFE pathway was associated with a higher rate of anticoagulation prescription.