Which trophic discrimination factors fit the best? A combined dietary study of a coastal seabird

The use of combined conventional and stable isotope analyses to study the diet of seabirds has become very frequent. Unfortunately species and tissue-specific Trophic Discrimination Factors (TDF), necessary to run stable isotope mixing models in the most performing way, are lacking for a wide number of seabird species. We assessed the process of inspecting and selecting the most adequate TDFs by running mixing region simulations with three different TDFs scenarios. This was carried out in a combined dietary study of a widespread but poorly studied seabird from the Americas: the Neotropic Cormorant (Phalacrocorax brasilianus), at a breeding colony from coastal Patagonia. The mixing models were run with the best fitting carbon and nitrogen TDFs (whole blood), which were those obtained with R package SIDER, a Bayesian inference-based model predicting the TDFs of consumers considering their ecology and phylogenetic relatedness. We found that cormorants fed on rather mobile fish of a fairly variable ecological spectrum, both benthic and pelagic, and showed low prey diversity. Our results coincide with the overall generalist and opportunistic piscivorous habit found at different coastal areas along its broad distribution range. Despite some differences found in the proportion estimates of the main prey between the two methods, their combination through the incorporation of prior information into the mixing models provides a comprehensive trophic profile. Finally, the use of SIDER, alongside the inspection and comparison of different potential TDF values, offered a simple and effective framework to calculate and select the most adequate specific TDFs to be employed in stable isotope mixing models.Bei Ernährungsuntersuchungen an Seevögeln wird immer häufger eine Kombination von konventionellen Analysen mit solchen mit Stabilen Isotopen angewandt. Leider aber fehlen uns für eine große Anzahl von Seevogelarten die art- und gewebespezifschen trophischen Unterscheidungsfaktoren (TDF), die notwendig sind, um Stabile Isotopenmischungs-Modelle mit höchstmöglicher Aussagekraft anzuwenden. Wir bewerteten das Verfahren zur Prüfung und Auswahl der bestgeeigneten TDFs, indem wir Simulationen von Mischregionen mit drei unterschiedlichen TDF-Szenarien laufen ließen. Diese Untersuchung wurde als kombinierte Ernährungsstudie an einer weitverbreiteten, aber nur wenig untersuchten amerikanischen Seevogelart, der neotropischen Humboldtscharbe (Phalacrocorax brasilianus) aus der Familie der Kormorane, in einer Brutkolonie an der Küste Patagoniens durchgeführt. Die Misch-Modelle wurden mit den am besten passenden Kohlenstofund Stickstof-TDFs (aus dem Blut) gerechnet, die wiederum mit SIDER (Stable Isotope Discrimination Estimation in R), einem Bayes’schen Inferenz-basierten Modell zur Vorhersage der TDFs von Konsumenten unter Berücksichtigung ihrer Ökologie und phylogenetischen Verwandtschaft, erstellt wurden. Wir fanden heraus, dass sich die Kormorane von Fischen aus einem breiten ökologischen Spektrum, benthisch und auch pelagisch, ernährten und eine geringe Beutevielfalt zeigten. Unsere Ergebnisse passen gut zu den an unterschiedlichen Küsten mit großen Verbreitungsgebieten gefundenen generellen Angewohnheiten von Fischfressern. Trotz einiger Unterschiede, die wir in den Schätzungen der Anteile der Hauptnahrung zwischen den beiden Methoden fanden, ergibt deren Kombination durch das Einbeziehen früher gewonnener Informationen in die Misch-Modelle doch ein umfassendes trophisches Profl. Schließlich bietet die Anwendung von SIDER zusammen mit der Prüfung und dem Vergleich unterschiedlicher potentieller TDF-Werte einen einfachen und efektiven Rahmen für die Berechnung und Auswahl der am besten passenden, spezifschen TDFs für die Anwendung in Modellen mit gemischten Stabilen Isotopen.Fil: Morgenthaler, Annick. Universidad Nacional de la Patagonia Austral. Unidad Académica Caleta Olivia. Centro de Investigaciones Puerto Deseado; ArgentinaFil: Millones, Ana. Universidad Nacional de la Patagonia Austral. Unidad Académica Caleta Olivia. Centro de Investigaciones Puerto Deseado; ArgentinaFil: Gandini, Patricia Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de la Patagonia Austral. Unidad Académica Caleta Olivia. Centro de Investigaciones Puerto Deseado; ArgentinaFil: Frere, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de la Patagonia Austral. Unidad Académica Caleta Olivia. Centro de Investigaciones Puerto Deseado; Argentin

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups

Brood Reduction in Neotropical Birds: Mechanisms, Patterns, and Insights from Studies in the Imperial Shag (Phalacrocorax atriceps)

Brood reduction is a within-brood partial mortality due to sibling rivalry and has been observed in a large number of bird species from diverse taxa. Here, I summarize several hypotheses accounting for the adaptive value of brood reduction and discuss different factors that modulate it. A description of different brood reduction systems is made with focus on Neotropical birds. Finally, an integrative approach analyzing brood reduction in Imperial Shags (Phalacrocorax atriceps) is presented to illustrate causes, consequences, and benefits of this breeding strategy.Fil: Svagelj, Walter Sergio. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentin

The impact of stapling technique and surgeon specialism on anastomotic failure after right?sided colorectal resection: an international multicentre, prospective audit

Aim There is little evidence to support choice of technique and configuration for stapled anastomoses after right hemicolectomy and ileocaecal resection. This study aimed to determine the relationship between stapling technique and anastomotic failure. Method Any unit performing gastrointestinal surgery was invited to contribute data on consecutive adult patients undergoing right hemicolectomy or ileocolic resection to this prospective, observational, international, multicentre study. Patients undergoing stapled, side?to?side ileocolic anastomoses were identified and multilevel, multivariable logistic regression analyses were performed to explore factors associated with anastomotic leak. Results One thousand three hundred and forty?seven patients were included from 200 centres in 32 countries. The overall anastomotic leak rate was 8.3%. Upon multivariate analysis there was no difference in leak rate with use of a cutting stapler for apical closure compared with a noncutting stapler (8.4% vs 8.0%, OR 0.91, 95% CI 0.54–1.53, P = 0.72). Oversewing of the apical staple line, whether in the cutting group (7.9% vs 9.7%, OR 0.87, 95% CI 0.52–1.46, P = 0.60) or noncutting group (8.9% vs 5.7%, OR 1.40, 95% CI 0.46–4.23, P = 0.55) also conferred no benefit in terms of reducing leak rates. Surgeons reporting to be general surgeons had a significantly higher leak rate than those reporting to be colorectal surgeons (12.1% vs 7.3%, OR 1.65, 95% CI 1.04–2.64, P = 0.04). Conclusion This study did not identify any difference in anastomotic leak rates according to the type of stapling device used to close the apical aspect. In addition, oversewing of the anastomotic staple lines appears to confer no benefit in terms of reducing leak rates. Although general surgeons operated on patients with more high?risk characteristics than colorectal surgeons, a higher leak rate for general surgeons which remained after risk adjustment needs further exploration

Relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit

Aim: The anastomosis technique used following right-sided colonic resection is widely variable and may affect patient outcome. This study aimed to assess the association between leak and anastomosis technique (stapled vs handsewn). Method: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a 2-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30\ua0days of surgery, determined using a prespecified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random-effect variable. Results: This study included 3208 patients, of whom 78.4% (n\ua0=\ua02515) underwent surgery for malignancy and 11.7% (n\ua0=\ua0375) underwent surgery for Crohn's disease. An anastomosis was performed in 94.8% (n\ua0=\ua03041) of patients, which was handsewn in 38.9% (n\ua0=\ua01183) and stapled in 61.1% (n\ua0=\ua01858). Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn vs 12.9% stapled) and to undergo open surgery (54.7% handsewn vs 36.6% stapled). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (P\ua0=\ua00.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted OR\ua0=\ua01.43; 95% CI: 1.04\u20131.95; P\ua0=\ua00.03). Conclusion: Despite being used in lower-risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe

The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileo-caecal resection: an international snapshot audit.

BACKGROUND: Anastomosis technique following right sided colonic resection is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn) METHODS: This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjusting for patient, disease and operative cofactors, with centre included as a random effect variable. RESULTS: This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in 38.9% (n=1183) and stapled in 61.1% (n=1858) cases. Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn versus 12.9% stapled) and to undergo open surgery (54.7% versus 36.6%). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (p=0.3). After adjustment for cofactors, the odds of a leak were higher for stapled anastomosis (adjusted odds ratio 1.43, 95% confidence interval 1.04-1.95, p=0.03). DISCUSSION: Despite being used in lower risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled anastomosis is safe. This article is protected by copyright. All rights reserve

Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection. An international audit by ESCP and S-ECCO

Aim: Patient- and disease-related factors, as well as operation technique, all have the potential to impact on postoperative outcome in Crohn's disease. The available evidence is based on small series and often displays conflicting results. The aim was to investigate the effect of preoperative and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. Method: This was an international prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. The study analysed a subset of patients who underwent surgery for Crohn's disease. The primary outcome measure was the overall Clavien\u2013Dindo postoperative complication rate. The key secondary outcomes were anastomotic leak, reoperation, surgical site infection and length of stay in hospital. Multivariable binary logistic regression analyses were used to produce odds ratios and 95% confidence intervals. Results: In all, 375 resections in 375 patients were included. The median age was 37 and 57.1% were women. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36, 95% CI 1.10\u20134.97), urgent/expedited surgical intervention (OR 2.00, 95% CI 1.13\u20133.55) and unplanned intra-operative adverse events (OR 2.30, 95% CI 1.20\u20134.45). The postoperative length of stay in hospital was prolonged in patients who received preoperative parenteral nutrition (OR 31, 95% CI 1.08\u20131.61) and those who had urgent/expedited operations (OR 1.21, 95% CI 1.07\u20131.37). Conclusion: Preoperative parenteral nutritional support, urgent/expedited operation and unplanned intra-operative adverse events were associated with unfavourable postoperative outcome. Enhanced preoperative optimization and improved planning of operation pathways and timings may improve outcomes for patients

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien\u2013Dindo Grades III\u2013V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49\u20132.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46\u20130.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease