Is surgical subspecialization associated with hand grip strength and manual dexterity?:A cross-sectional study

BACKGROUND: The aim of this study was to compare hand grip strength (HGS) and manual dexterity of academic, subspecialized surgeons. METHODS: A single-center cross-sectional study was performed among 61 surgeons. HGS was analysed with a hand dynamometer and manual dexterity was extensively analysed with a Purdue Pegboard Test. Correlations between HGS and manual dexterity and specific characteristics of the surgeons were analysed using Pearson's correlation coefficient (r). RESULTS: HGS and manual dexterity were comparable between surgeons from different specialities. HGS was positively correlated with male gender (r = 0.59, p < 0.001) and hand glove size (r = 0.61, p < 0.001), whereas manual dexterity was negatively correlated with male gender (r = −0.35, p = 0.006), age (r = −0.39, = 0.002), and hand glove size (r = −0.46, p < 0.001). CONCLUSIONS: Surgical subspecialization was not correlated with HGS or manual dexterity. Male surgeons have greater HGS, whereas female surgeons have better manual dexterity. Manual dexterity is also correlated with age, showing better scores for younger surgeons

Comparison of Methods for Modeling Fractional Cover Using Simulated Satellite Hyperspectral Imager Spectra

Remotely sensed data can be used to model the fractional cover of green vegetation (GV), non-photosynthetic vegetation (NPV), and soil in natural and agricultural ecosystems. NPV and soil cover are difficult to estimate accurately since absorption by lignin, cellulose, and other organic molecules cannot be resolved by broadband multispectral data. A new generation of satellite hyperspectral imagers will provide contiguous narrowband coverage, enabling new, more accurate, and potentially global fractional cover products. We used six field spectroscopy datasets collected in prior experiments from sites with partial crop, grass, shrub, and low-stature resprouting tree cover to simulate satellite hyperspectral data, including sensor noise and atmospheric correction artifacts. The combined dataset was used to compare hyperspectral index-based and spectroscopic methods for estimating GV, NPV, and soil fractional cover. GV fractional cover was estimated most accurately. NPV and soil fractions were more difficult to estimate, with spectroscopic methods like partial least squares (PLS) regression, spectral feature analysis (SFA), and multiple endmember spectral mixture analysis (MESMA) typically outperforming hyperspectral indices. Using an independent validation dataset, the lowest root mean squared error (RMSE) values were 0.115 for GV using either normalized difference vegetation index (NDVI) or SFA, 0.164 for NPV using PLS, and 0.126 for soil using PLS. PLS also had the lowest RMSE averaged across all three cover types. This work highlights the need for more extensive and diverse fine spatial scale measurements of fractional cover, to improve methodologies for estimating cover in preparation for future hyperspectral global monitoring missions

Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission Analysis of a Nationwide Audit:Analysis of a Nationwide Audit

OBJECTIVE: To quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy. SUMMARY OF BACKGROUND DATA: An initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives. METHODS: Data from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely. RESULTS: Overall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%. CONCLUSION: Interventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying

Biliary drainage prior to pancreatoduodenectomy with endoscopic ultrasound-guided choledochoduodenostomy versus conventional ERCP:Propensity score-matched study and surgeon survey

Background Preoperative endoscopic biliary drainage may lead to complications (16?%-24?%), potentially hampering surgical exploration. Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) may reduce drainage-related complications; however, in the absence of surgeon-reported outcomes, it is unknown whether EUS-CDS may hamper surgical exploration. This study assessed the impact of preoperative EUS-CDS on pancreatoduodenectomy. Method Consecutive patients who underwent pancreatoduodenectomy after preoperative biliary drainage were included in all eight centers performing EUS-CDS in the mandatory Dutch Pancreatic Cancer Audit (Jan 2020-Dec 2022). The primary outcome was major postoperative complications. Secondary outcomes included bile leak grade B/C, postoperative pancreatic fistula (POPF) grade B/C, and overall postoperative complications. A propensity score-matching (1:3) analysis was performed. Surgeons performing pancreatoduodenectomy after EUS-CDS completed a survey on surgical difficulty. Results 937 patients with pancreatoduodenectomy after preoperative biliary drainage were included (42 EUS-CDS, 895 endoscopic retrograde cholangiopancreatography [ERCP]). Major postoperative complications occurred in 8 patients (19.0?%) in the EUS-CDS group and 292 (32.6?%) in the ERCP group (relative risk [RR] 0.50; 95?%CI 0.23-1.07). No significant differences were observed in overall complications (RR 0.95; 95?%CI 0.51-1.76), bile leak (RR 1.25; 95?%CI 0.31-4.98), or POPF (RR 0.62; 95?%CI 0.25-1.56). Results were similar after matching. The survey was completed for 29 pancreatoduodenectomies; surgery was not (13, 45?%), slightly (9, 31?%), clearly (5,17?%), and severely (2, 7?%) more complex because of EUS-CDS. Conclusion This early experience suggests that preoperative biliary drainage with EUS-CDS does not increase the rate of complications after pancreatoduodenectomy and only infrequently hampers surgical exploration.</p

Early Diagnosis of Vegetation Health From High-Resolution Hyperspectral and Thermal Imagery: Lessons Learned From Empirical Relationships and Radiative Transfer Modelling

[Purpose of Review] We provide a comprehensive review of the empirical and modelling approaches used to quantify the radiation–vegetation interactions related to vegetation temperature, leaf optical properties linked to pigment absorption and chlorophyll fluorescence emission, and of their capability to monitor vegetation health. Part 1 provides an overview of the main physiological indicators (PIs) applied in remote sensing to detect alterations in plant functioning linked to vegetation diseases and decline processes. Part 2 reviews the recent advances in the development of quantitative methods to assess PI through hyperspectral and thermal images.[Recent Findings] In recent years, the availability of high-resolution hyperspectral and thermal images has increased due to the extraordinary progress made in sensor technology, including the miniaturization of advanced cameras designed for unmanned aerial vehicle (UAV) systems and lightweight aircrafts. This technological revolution has contributed to the wider use of hyperspectral imaging sensors by the scientific community and industry; it has led to better modelling and understanding of the sensitivity of different ranges of the electromagnetic spectrum to detect biophysical alterations used as early warning indicators of vegetation health.[Summary] The review deals with the capability of PIs such as vegetation temperature, chlorophyll fluorescence, photosynthetic energy downregulation and photosynthetic pigments detected through remote sensing to monitor the early responses of plants to different stressors. Various methods for the detection of PI alterations have recently been proposed and validated to monitor vegetation health. The greatest challenges for the remote sensing community today are (i) the availability of high spatial, spectral and temporal resolution image data; (ii) the empirical validation of radiation–vegetation interactions; (iii) the upscaling of physiological alterations from the leaf to the canopy, mainly in complex heterogeneous vegetation landscapes; and (iv) the temporal dynamics of the PIs and the interaction between physiological changes.The authors received funding provided by the FluorFLIGHT (GGR801) Marie Curie Fellowship, the QUERCUSAT and ESPECTRAMED projects (Spanish Ministry of Economy and Competitiveness), the Academy of Finland (grants 266152, 317387) and the European Research Council Synergy grant ERC-2013-SyG-610028 IMBALANCE-P.Peer reviewe

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

The effect of dipyridamole on transmural blood flow gradients

The effect of dipyridamole (DP) on subendocardial (ENDO) and subepicardial (EPI) blood flow in stenosed and normal regions was determined with radioactive microspheres before and after intravenous infusion of 0.08 mg/kg.min-1 of DP in two groups of dog hearts in situ. Group 1 (n = 6) had coronary stenoses that did not reduce distal perfusion at rest, but did attenuate hyperemic response, and group 2 (n = 6) had stenoses which reduced resting blood flow. In nonstenosed zones, a doubling in perfusion during DP infusion induced proportionate changes in ENDO and EPI flows (unchanged ENDO/EPI ratio) in group 1 hearts, but increased EPI more than ENDO flows in group 2 hearts (decreased ENDO/EPI ratio). In mildly stenosed regions, a 47 percent increase in perfusion during DP was associated with an increase in only EPI flow, which thereby reduced the ENDO/EPI ratio. In severely stenosed zones, the ENDO/EPI ratio was already significantly reduced at rest and a further reduction in ENDO flow during DP caused a significant decline in the ENDO/EPI ratio. Therefore, during pharmacologic vasodilation, a redistribution of coronary transmural flow occurs (relative ENDO to EPI steal) in non- and mildly stenosed regions while an absolute decrease or steal in ENDO flow was noted only in regions distal to more severe stenoses. These studies suggest that an interaction between the stenosis severity and vasodilation is a determining factor in ENDO/EPI ratios with dipyridamole