Differences In Length Research Articles

A retrospective propensity-score-matched cohort study of the impact of procalcitonin testing on antibiotic use in hospitalized patients during the first wave of COVID-19.

Procalcitonin (PCT) is a blood marker used to help diagnose bacterial infections and guide antibiotic treatment. PCT testing was widely used/adopted during the COVID-19 pandemic in the UK. Primary: to measure the difference in length of early (during first 7 days) antibiotic prescribing between patients with COVID-19 who did/did not have baseline PCT testing during the first wave of the pandemic. Secondary: to measure differences in length of hospital/ICU stay, mortality, total days of antibiotic prescribing and resistant bacterial infections between these groups. Multi-centre, retrospective, observational, cohort study using patient-level clinical data from acute hospital Trusts/Health Boards in England/Wales. Inclusion: patients ≥16 years, admitted to participating Trusts/Health Boards and with a confirmed positive COVID-19 test between 1 February 2020 and 30 June 2020. Data from 5960 patients were analysed: 1548 (26.0%) had a baseline PCT test and 4412 (74.0%) did not. Using propensity-score matching, baseline PCT testing was associated with an average reduction in early antibiotic prescribing of 0.43 days [95% confidence interval (CI): 0.22-0.64 days, P < 0.001) and of 0.72 days (95% CI: 0.06-1.38 days, P = 0.03] in total antibiotic prescribing. Baseline PCT testing was not associated with increased mortality or hospital/ICU length of stay or with the rate of antimicrobial-resistant secondary bacterial infections. Baseline PCT testing appears to have been an effective antimicrobial stewardship tool early in the pandemic: it reduced antibiotic prescribing without evidence of harm. Our study highlights the need for embedded, rapid evaluations of infection diagnostics in the National Health Service so that even in challenging circumstances, introduction into clinical practice is supported by evidence for clinical utility. ISRCTN66682918.

SP7.5 - Time to CT for Acute General Surgery and Trauma in patients undergoing emergency laparotomy. A major trauma centre experience

Abstract Introduction In our institution separate care pathways exist for patients presenting with major trauma and acute abdomen (AA). Trauma patients activate a Consultant led trauma team attendance on arrival and CT imaging within 30 minutes where indicated. Our acute abdomen pathway attracts ST3+ general surgical review within 2 hours of emergency department referral and CT within a further 1 hour. We aimed to compare the two laparotomy cohorts with respect to clinical outcomes. Methods A retrospective analysis was performed on patients that underwent an emergency laparotomy following CT at our institution between December 2020 and February 2022. Patients were identified from the NELA and TARN databases. Results 66 trauma and 64 AA patients were identified. The mean time to CT in trauma was 56.1 minutes ± 24.8 and in AA 390.7 minutes ± 306.1 (p&amp;lt;0.001). There was no difference in length of ITU stay (mean days 3.1 ± 8.1 vs 4.2 ±9.8 p=0.260) or hospital stay (mean days 13.7 ± 19.2 vs 13.8 ±11.7 p=0.494). no correlation between time to CT and length of hospital stay (r=0.233 p=0.97) or ITU stay (r=0.224 p=0.964) in trauma patients or AA (r=0.217 p=0.58 and -0.001 p=0.562 respectively for hospital and ITU stays) was detected. However, there was a trend towards lower mortality in the trauma cohort (3% vs 7.8% p=0.227). Conclusion Trauma patients were scanned quicker than acute abdomen presentations likely due to greater personnel resource and better care pathways. This was associated with a trend towards lower mortality because of earlier pathology detection and Consultant directed care from hospital arrival.

ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis

Abstract Background Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. Methods A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model. Results Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%). Conclusion Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.

Invasive and conservative management of elderly patients presenting with acute coronary syndrome: A meta-analysis of randomized controlled trials and adjusted observational studies

BackgroundElderly patients are often under-represented in studies about coronary revascularization in acute coronary syndromes (ACS) and undertreated in clinical practice. We sought to evaluate differences in outcomes between an initial invasive or conservative strategy in this subset of patients, MethodsThe analysis was performed following PRISMA guidelines. Randomized controlled trials (RCTs) and adjusted observational studies comparing an invasive and conservative strategy in old patients with ACS were systematically identified. Random or fixed effect model was used accordingly to heterogeneity testing results. Short-term mortality was the primary outcome. 30-day and longer-term re-infarction, MACE and all-cause mortality were secondary endpoints. Sensitivity analysis including RCTs only were performed for the primary endpoint and 1 year mortality and another analysis, stratifying NSTEMI and STEMI studies, was performed for short-term mortality. ResultsInvasive management was associated with lower short and long-term mortality (30 days OR 0.64, 95 % CI 0.54–0.76, p < 0.001; 1 year HR 0.60, 95 % CI 0.52–0.78, p < 0.001; Long-term HR 0.62, 95 % CI 0.55–0.71, p < 0.001) compared to a conservative strategy. In the short-term follow-up, the benefit was preserved when differentiating for NSTEMI or STEMI studies but not when considering only RCTs. Major bleedings were more frequent in the invasive group (30 days OR 1.61, 95 % CI 1.39–1.87, p < 0.001). The mean difference in length of stay was not significantly different between the two strategies (mean difference in days 0.14, 95 % CI -0.79 to 1.06, p = 0.77). ConclusionAn initial invasive strategy might lead to reduced short and long-term mortality in elderly patients presenting with acute coronary syndrome but it is associated with increased bleeding events rate. No difference in hospital stay length was observed. Results were mainly driven by non-randomized studies.

Tree architecture and leaf morphometry of Qualea grandiflora Mart. (Vochysiaceae) in a fragment of dry forest and pasture in the State of Goiás, Brazil

Investigating the functional traits of plant communities is extremely important for conserving habitats and plant species. This study aimed to evaluate the tree architecture and leaf morphometry of Qualea grandiflora (Vochysiaceae) in a fragment of semideciduous dry forest and pasture in the Boa Esperança settlement, municipality of Piracanjuba, State of Goiás, Brazil. Environmental, tree architecture, and foliar morphometry data were collected for seven trees in the semideciduous dry forest and five in the pasture area. We used the Shapiro-Wilk test to assess the normality of the collected data. The student t-test was used to compare the means of the functional traits between the two environments (forest and pasture). The average value of canopy cover was 85% for the semideciduous dry forest and 0% for the pasture. The mean values for leaf length and width were lower in the pasture. There was no significant difference in the petiole length in the two evaluated environments and for none of the functional traits related to the tree architecture. However, individuals of Qualea grandiflora grow better in the seasonal semideciduous dry forest, probably as a response to less stressful environmental conditions for this species. Thus, for sustainable exploitation by the local community, it is recommended that the tree matrices be chosen within the semideciduous dry forest area.

Aesthetic Auricle Reconstruction with the Dieffenbach Flap: A Retrospective Case Review.

The Dieffenbach flap is often used for post-Mohs reconstruction of auricle defects, effectively restoring the auricle rim. However, its impact on auricle projection and length after division and inset is not well-documented. This study evaluates auricle projection and length following defect repair with the Dieffenbach flap, comparing results to the nonoperative ear. We conducted a retrospective review of patients who underwent a Dieffenbach flap repair surgery at a single institution from 2016 to 2023. Auricle projection and length of the reconstructed ear were measured within the first month following division and inset of the flap and compared with the contralateral ear. A subset of patients had additional measurements > 1 month following division and inset, and these measurements were compared with the contralateral ear. Our study included 23 patients with an average age 67.4 years and 78.3% male. Within 1 month following division and inset, the Dieffenbach flap resulted in a significant decrease in auricle projection (16.5 vs. 18.6 mm, p < 0.05) and length (67.0 vs. 69.7 mm, p < 0.05) compared with the contralateral ear. Subsequent follow-up showed no significant differences in projection (18.5 vs. 18.5 mm, p = 0.98) or length (68.0 vs. 68.7 mm, p = 0.54). Following division and inset of the Dieffenbach flap, auricle projection and length experience initial reduction but subsequently self-correct to match the contralateral ear.

Does PIC score pick correctly? Evaluation of a modified-PIC based admission a single institution retrospective cohort study

IntroductionThe Pain, Inspiratory effort, Cough score (PIC) has been developed and widely adopted to guide clinical prognostication for patients with chest wall injury. To date, the efficacy, accuracy, and safety of a PIC based triage system has not been validated. Therefore, this study sought to evaluate the use of a modified-PIC score to triage and down-grade trauma patients with chest wall injury at a single institution. MethodsA retrospective study was conducted at a large, Level I Trauma Center on patients with chest wall injuries admitted between 1/1/2018–10/31/20,222. On 12/1/2020, our institution implemented a modified-PIC triage tool including the PIC score, age, and severity of chest wall injury. The Pre-PIC (1/1/2018–11/20/2020) and Post-PIC (1/1/2021–10/31/2022) groups were composed based on admission date and outcomes between the two were compared. Results2,627 patients comprised the Pre-PIC group and 2,212 patients comprised Post-PIC. The groups didn't differ significantly in demographics or mechanisms of injury except for COVID status. Post-intervention, a greater proportion of patients were triaged to the intermediate care unit instead of the ICU or floor. There were no significant differences in hospital length of stay (LOS), ventilator days, unplanned ICU admission, or mortality in Pre-PIC vs Post-PIC. ICU LOS, rates of ARDS, and cardiac arrest with return of spontaneous circulation (ROSC) were significantly lower in Post-PIC. Multivariable models demonstrated significantly lower ARDS rates and ICU free days. ICU LOS trended towards significance as well. ConclusionsThis is the largest study, to date, evaluating the impact of a modified-PIC triage system on clinical outcomes. The results suggest a modified-PIC triage system may lead to decreased ICU days, ARDS rates, and rates of cardiac arrest w/ ROSC, potentially improving hospital resource allocation. Further prospective and multi-center studies are needed to validate our understanding on the impact of a chest wall scoring system on triage and outcomes.

Fetal Growth Following Electronic Cigarette Use in Pregnancy.

Electronic cigarette (e-cig) use in pregnancy is common, but potential effects on fetal development are largely unknown. This study's goal was to examine the association between e-cig exposure and fetal growth. Data were extracted from medical charts in this single-site retrospective study. The sample, excluding those with known tobacco, alcohol, illicit drug, opioid, and benzodiazepine use, contained women who used e-cigs throughout pregnancy and non-e-cig user controls. Fetal size measurements from second- and third-trimester ultrasounds and at birth were expressed as percentiles for gestational age. Following adjustment for confounding factors, in the second trimester, only femur length was significant, with an adjusted deficit of 11.5 percentile points for e-cig exposure compared to controls. By the third trimester, the femur length difference was 28.5 points, with the fetal weight difference also significant (17.2 points). At birth, all three size parameter differences between groups were significant. Significant size deficits were predicted by prenatal e-cig exposure, becoming larger and impacting more parameters with increasing gestation. While additional studies are warranted to confirm and expand upon these findings, this study adds to emerging data pointing to specific harms following e-cig exposure in pregnancy and suggests that e-cigs may not be a "safer" alternative to combustible cigarette smoking in pregnancy.

A New Precise Point Positioning with Ambiguity Resolution (PPP-AR) Approach for Ground Control Point Positioning for Photogrammetric Generation with Unmanned Aerial Vehicles

Unmanned aerial vehicles (UAVs) are now widely preferred systems that are capable of rapid mapping and generating topographic models with relatively high positional accuracy. Since the integrated GNSS receivers of UAVs do not allow for sufficiently accurate outcomes either horizontally or vertically, a conventional method is to use ground control points (GCPs) to perform bundle block adjustment (BBA) of the outcomes. Since the number of GCPs to be installed limits the process in UAV operations, there is an important research question whether the precise point positioning (PPP) method can be an alternative when the real-time kinematic (RTK), network RTK, and post-process kinematic (PPK) techniques cannot be used to measure GCPs. This study introduces a novel approach using precise point positioning with ambiguity resolution (PPP-AR) for ground control point (GCP) positioning in UAV photogrammetry. For this purpose, the results are evaluated by comparing the horizontal and vertical coordinates obtained from the 24 h GNSS sessions of six calibration pillars in the field and the horizontal length differences obtained by electronic distance measurement (EDM). Bartlett’s test is applied to statistically determine the accuracy of the results. The results indicate that the coordinates obtained from a two-hour PPP-AR session show no significant difference from those acquired in a 30 min session, demonstrating PPP-AR to be a viable alternative for GCP positioning. Therefore, the PPP technique can be used for the BBA of GCPs to be established for UAVs in large-scale map generation. However, the number of GCPs to be selected should be four or more, which should be homogeneously distributed over the study area.

Aortic Dissections in the Elderly: Older Age in Patients With Acute Aortic Syndromes Is Associated With Delayed Time to Surgery.

In the setting of acute aortic syndromes, timely access to definitive surgical repair is of paramount importance. Older patients, primarily septuagenarians and octogenarians, undergoing emergent ascending arch repair experience higher rates of mortality compared to younger patients. Despite this risk, studies show that surgical management is still superior to medical management for this patient population. The objective of this study is to determine if older age impacts the time from presentation to the start of surgery for patients with acute aortic syndromes undergoing surgical repair. This retrospective review included all patients with acute aortic syndromes who underwent emergent ascending aortic arch repair from January 2018 to May 2023 at a single academic institution. Our analysis compared outcomes for older patients (age 70 years and older) with younger patients (age less than 70 years). Primary outcomes included 30-day mortality, postoperative stay, time from emergency department presentation to the start of surgery, and time from diagnosis with computed tomography to the start of surgery. Secondary outcomes included postoperative complications. Outcomes were analyzed using chi-squared and Student's t-tests, with significance set at p<0.05. Of 107 patients included (male, N=57), 71 (66%) were under the age of 70 and 36 (34%) were 70 years of age or older. The younger cohort had more male and non-White patients, with no differences in rates of hypertension, dyslipidemia, and smoking history. With no difference in the rate of transfers from outside hospitals, we observed longer times from presentation to the start of surgery for older patients compared to younger patients (7 hours and 13 minutes vs. 6 hours 25 minutes; p=0.02) and also for time of diagnosis to the start of surgery (4 hours 22 minutes vs. 3 hours 54 minutes; p=0.006). Older patients had higher rates of intraoperative (0% vs. 17%, p<0.001) and 30-day (7% vs. 44%, p<0.001) mortality. There were no differences in length of stay or in rates of postoperative complications and surgery-related emergency department visits. Patients aged 70 and older experienced delays from the time of presentation to the start of surgery and from time of diagnosis to the start of surgery. Age should not delay an individual from receiving timely transfer to a tertiary center for a higher level of care to better assess the patient's operative candidacy and determine appropriate treatment.

Abstract P368: The Impact of Obesity on Patients Admitted for Hypertensive Emergency.

Objectives: Obesity is associated with a spectrum of metabolic and cardiovascular disorders, including hypertension. We will examine the hospital outcomes of hypertensive emergency in obese patients. Methods: Using the National Inpatient Sample Database (NIS) of 2020, patients admitted for hypertensive emergency as the principal diagnosis were identified using ICD-10 codes. The primary outcome was inpatient mortality with the secondary outcomes being acute kidney injury (AKI), cerebrovascular accident (CVA), myocardial infarction (MI), length of hospital stays, and charges between groups. (Patients with body mass index (BMI) greater than 30 and patients with body mass index lesser than 30). Results: A total of 59,690 patients were admitted for hypertensive emergency. Of those, 21% had a BMI&gt;30. Patients with BMI&gt; 30 were younger (53 years, 95% CI 53 – 54 VS 61 years, 95% CI 61 – 62). Patients with BMI &gt; 30 had reduced inpatient mortality (p=0.0420), CVA (p=0.0248), acute hypoxic respiratory failure (p=0.0033), and total hospital charges ($ 46,314, 95% CI $44,000.75 - $48,627.93 VS $47,248.7 95% CI $45,709.43 - $48,787.97). There was no difference in length of hospital stay between groups (4 days, 95% CI 3 – 4 VS 4 days, 95% CI 4 – 4). Patients with a BMI greater than 30 had increased acute kidney injury (p=0.0026). Conclusion: Per this study, obesity does not increase mortality in patients admitted for a hypertensive emergency.

The impact of liver cirrhosis on in-hospital outcomes among patients hospitalized for cardiogenic shock: A propensity score matched retrospective cohort study

BackgroundCardiogenic shock poses a critical challenge characterized by diminished cardiac output and organ perfusion. Timely recognition and risk stratification are essential for effective intervention. Liver cirrhosis adds complexity due to its diverse systemic manifestations. The effect of liver cirrhosis on in-hospital outcomes in cardiogenic shock remains underexplored. MethodsWe conducted a retrospective cohort study using the National Inpatient Sample database from 2016 to 2020, matching cirrhotic patients with non-cirrhotic counterparts using propensity scores. The Cochran-Mantel-Haenszel method was used to assess the impact of cirrhosis on in-hospital mortality and complications. Simple linear regression models were used to assess differences in length of stay and cost of hospitalization. ResultsThere were a total of 44,288 patients in the cohort, evenly distributed between the group with and without liver cirrhosis. Mean age of the cohort was 64 years (SD 12.5), 69.7 % were males, and 61.3 % were white. The overall in-hospital mortality rate in the cohort was 37.2 % with higher odds of in-hospital mortality in cirrhotic patients [OR = 1.3; 95 % CI (1.25, 1.35)]. Patients with cirrhosis exhibited increased risks of bowel ischemia, acute kidney injury, and sepsis compared to those without cirrhosis. Additionally, they had a heightened overall risk of major bleeding, particularly gastrointestinal bleeding, but a lower risk of intracranial hemorrhage and access site bleeding. Conversely, patients with cirrhosis had lower odds of deep vein thrombosis and pulmonary embolism, as well as arterial access site thrombosis and dissection, leading to reduced odds of peripheral angioplasty, thrombectomy, and amputation. Cirrhotic patients also had increased length of stay and cost of hospitalization. ConclusionLiver cirrhosis exacerbates outcomes in cardiogenic shock, necessitating tailored management strategies. Further research is warranted to optimize patient care and understand the underlying mechanisms.

Efficacy and safety of mesenchymal stem cell therapy for acute respiratory distress syndrome-a systematic review and meta-analysis.

Mesenchymal stem cells (MSC) therapy for acute respiratory distress syndrome (ARDS) represents a burgeoning treatment approach, supported by numerous preclinical studies confirming its efficacy. Our study aims to provide a comprehensive evaluation of both the safety and effectiveness of MSC. We conducted searches across three databases (PubMed, Embase, Cochrane) for randomized controlled studies up to June 23, 2024. A meta-analysis was performed on variables including adverse events, mortality, changes in the PaO2/FiO2 ratio, intensive care unit (ICU), length of stay, ventilation-free days, and changes in pro-inflammatory and anti-inflammatory cytokines. Relative risk (RR) values were employed for dichotomous variables, while mean difference (MD) and standard mean difference (SMD) were used for continuous variables. Risk bias was assessed using risk of bias 2 (ROB2). The meta-analysis encompassed 17 experiments involving 796 patients, with 410 undergoing MSC treatment and 386 in the control group. Primary outcomes indicated that MSC treatment did not escalate adverse events [RR =1.04; 95% confidence interval (CI): 0.90, 1.19; P=0.59; I2=0%]. On the contrary, it significantly diminishes the mortality (RR =0.79; 95% CI: 0.64, 0.97; P=0.02; I2=0%). Regarding secondary outcomes, MSCs led to a significant improvement in the PaO2/FiO2 ratio for ARDS patients (SMD =0.53; 95% CI: 0.15, 0.92; P=0.007; I2=0%). However, there were no significant differences in ICU length of stay (MD =-1.77; 95% CI: -6.97, 3.43; P=0.50; I2=63%) and ventilation-free days (MD =-1.29; 95% CI: -4.09, 1.51; P=0.37; I2=0%). MSCs significantly lowered C-reactive protein (CRP) (SMD =-0.65; 95% CI: -1.18, -0.13; P=0.01; I2=56%) and interleukin-6 (IL-6) levels compared to the control group (SMD =-0.76; 95% CI: -1.34, -0.17; P=0.01; I2=74%). However, changes in interleukin-10 (AIL-10) (SMD =-0.46; 95% CI: -1.51, 0.58; P=0.38; I2=77%), and changes in tumor necrosis factor-alpha (ATNF-α) (SMD =-1.5; 95% CI: -3.39, 0.40; P=0.12; I2=92%) levels showed no significant changes. MSC therapy demonstrates reliable safety, with a significant impact on reducing mortality and improving certain clinical symptoms. Moreover, in certain aspects, it may alleviate the inflammatory response in ARDS. Nonetheless, these findings necessitate validation through additional high-quality randomized controlled trials.

Structure of N-acetoxy-N-benzyloxyurea

The crystal structure of N-acetoxy-N-benzyloxyurea has been studied by single crystal X-ray diffraction study. It has demonstrated that this compound is a typical anomeric amide. ON(1)O nitrogen atom has a pyramidal configuration; the sum of the bond angles centered on N(1) atom is 335.20 and this atom is sp3 hybridized. The N(2) nitrogen atom of the carbamoyl moiety (H2NC=O) has planar configuration. The N–OAc bond is somewhat elongated and the N–OBn bond is shortened due to the action of nO(Bn)*N–OAc anomeric effect. In the molecule of N-acetoxy-N-benzyloxyurea, the N–C amide bonds are nonequivalent, and the (AcO)(BnO)N–C(O) bond is longer that the H2N–C(O) bond. Evidently, that this difference in bond lengths is caused by the stronger conjugation between lone pair (Lp) of the N(2) atom and the C=O carbonyl compared to conjugation between the lone pair of N(1) atom and the C=O carbonyl. The overall analysis of the structural parameters on all known N-acyloxy-N-alkoxyureas had been done. In addition, the structural parameters of N-acetoxy-N-benzyloxyurea have been compared with the same structural parameters of N-benzyloxyurea and N-benzyloxy-N-methoxyurea.

DETERMINING THE ASSOCIATIONS BETWEEN CROP PHENOLOGY, GROWTH, YIELD, AND YIELD-RELATED PARAMETERS OF MALT BARLEY (HORDEUM VULGARE)

The study was conducted at two locations, namely Holeta and Kulumsa Agricultural research centers of Ethiopia, for 2 consecutive years from 2019 to 2021 main cropping seasons. The objective of the experiment was to determine the association between crop phenology, growth, yield, and yield-related parameters. One variety of newly harvested pre-basic seed class of malt barley variety, namely IBON 174/03, was used for the experiment. Total number of treatment combinations was eighteen. The treatments were laid out in a randomized complete block design in two factorial arrangements with three replications. The factors are five deterioration/aging days 0 (control/un-aged), 2, 4, 6, 8, and 10 days and three seeding rates (75, 100, and 125 kg/ha). Before artificial deterioration, the seed moisture content for all treatments was 12.5%. Seeds were subjected to artificial deterioration treatments and placed in an incubator at 42°C for 0 (control), 2, 4, 6, 8, and 10 days at approximately 100% relative humidity. The result revealed that above-ground dry biomass (AGDBM) and grain yield (GYLD) per hectare were significantly affected both by deterioration days and seed rate. As deterioration day increased the mean value for AGDBM and GYLD per hectare was significantly reduced and as the seeding rate increased from 75 to 125 kg/ha AGDBM and GYLD per hectare increased by 30.53% and 21.01%, respectively. The main effect of deterioration days showed a significant difference (p&lt;0.05) for spike length (SL) as deterioration days increased from 2 to 10 days SL was reduced by 7.7–22.62% as compared to un-aged treatment but, the percentage reduction for barley seed deteriorated for 6 and 10 days recorded similar value which is 22.62% as compared to un-aged treatment. Seed per spike and thousand kernels weight were influenced by the main effect of seed rate but, not by deterioration days. As the seeding rate increased from 75 to 125 kg/ha, number of seeds per spike reduced by 4.75% whereas, seeds sown at a low seeding rate (75 kg/ha) recorded a higher thousand kernel weight (TKW) as compared to the seed sown at higher seed rate 100 and 125 kg/ha. Interaction effect of deterioration days and seed rate were only significant for TKW and it was non-significant for the rest of the evaluated crop phenology, growth, yield, and yield-related parameters. This study was only a field experiment result based on further conclusions on how aging can affect the genetic potential such as germination and viability; laboratory inclusive test will be required.

Effects of thrombus characteristics on clinical outcome and success of recanalization in acute ischemic stroke

Background: Despite current developments in mechanical thrombectomy (MT), successful recanalization cannot be achieved in all patients. One of the factors related to this is the characteristics of the thrombus. In this study, we aimed to evaluate the effects of thrombus length and permeability on procedural success and clinical outcome. Methods: Patients with intracranial ICA, middle cerebral artery M1, or M2 occlusions, who underwent MT between November 2019 and January 2022 were included in the study. Thrombus length, density and permeability were calculated and the relationship between recanalization success and modified Rankin Scores (mRS) at the 3rd month was evaluated. Good clinical outcome was defined as an mRS score of 2 or less. Results: Forty-six of the 79 patients included in the study had a good clinical outcome. Although thrombus length was shorter and permeability was higher in patients with good clinical outcome, statistical significance was not achieved. There was a positive correlation between thrombus density, thrombus length and the number of passes, and a negative correlation between permeability. There was no significant difference in thrombus length, density and permeability between patients with and without successful recanalisation. Thrombus length was found to be a predictor of clinical outcome at 3 months in univariate analysis, whereas only age was found to be an independent predictor in multivariate analysis. Conclusions: In conclusion, despite certain findings not achieving statistical significance, the observed trends offer valuable insights for future research. A comprehensive understanding of thrombus nature could guide personalized stroke treatment strategies in the future.

Black-throated blue warblers (Setophaga caerulescens) exhibit diet flexibility and track seasonal changes in insect availability.

Changes in leaf phenology from warming spring and autumn temperatures have lengthened the temperate zone growing "green" season and breeding window for migratory birds in North America. However, the fitness benefits of an extended breeding season will depend, in part, on whether species have sufficient dietary flexibility to accommodate seasonal changes in prey availability. We used fecal DNA metabarcoding to test the hypothesis that seasonal changes in the diets of the insectivorous, migratory black-throated blue warbler (Setophaga caerulescens) track changes in the availability of arthropod prey at the Hubbard Brook Experimental Forest, New Hampshire, USA. We examined changes across the breeding season and along an elevation gradient encompassing a 2-week difference in green season length. From 98 fecal samples, we identified 395 taxa from 17 arthropod orders; 242 were identified to species, with Cecrita guttivitta (saddled prominent moth), Theridion frondeum (eastern long-legged cobweaver), and Philodromus rufus (white-striped running crab spider) occurring at the highest frequency. We found significant differences in diet composition between survey periods and weak differences among elevation zones. Variance in diet composition was highest late in the season, and diet richness and diversity were highest early in the season. Diet composition was associated with changes in prey availability surveyed over the green season. However, several taxa occurred in diets more or less than expected relative to their frequency of occurrence from survey data, suggesting that prey selection or avoidance sometimes accompanies opportunistic foraging. This study demonstrates that black-throated blue warblers exhibit diet flexibility and track seasonal changes in prey availability, which has implications for migratory bird responses to climate-induced changes in insect communities with longer green seasons.

321. ANASTOMOTIC LEAK WITH ENHANCED RECOVERY PROTOCOL VERSUS CONVENTIONAL CARE AFTER ESOPHAGECTOMY FOR CANCER: CLINICAL CHARACTERISTICS AND OUTCOMES

Abstract Objective The anastomotic leak (AL) is greatly concerned in the clinical pathway of enhanced recovery after surgery (ERAS) with esophagectomy. This retrospective study was to compare the clinical characteristics and outcomes of AL between the ERAS protocol and conventional care in patients undergoing esophagectomy for cancer. The strategy for improving the safety of ERAS was explored. Methods The clinical data and outcomes were retrospectively analyzed in patients with thoracic esophageal carcinoma who received esophagectomy with esophagogastric anastomosis and experienced a postoperative AL from January 2018 to August 2023. The “Non Tube Non Fasting” edition was implemented in the ERAS group. Results 33 ERAS and 141 conventional patients experienced an AL in 489 ERAS and 1424 conventional patients with esophagectomy. The incidence of AL was significantly lower in the ERAS group (6.7%, 33/489) than in the conventional group (9.9%, 141/1424) (P&amp;lt;0.05). AL rate had no significant differences in the anastomotic sites between the two groups: cervical region (7.0%, 31/443 vs. 10.1%, 126/1250) and intrathoracic region (4.3%, 2/46 vs. 8.6%, 15/174) (P&amp;gt;0.05). There were no significant differences in the time-related AL between the two groups: delayed AL (39.4%, 13/33 vs. 54.6%, 77/141) and AL after planned discharge (24.2%, 8/33 vs. 23.4%, 33/141) (P&amp;gt;0.05). 164 patients received endoscopy and presented no significant differences in the average length of leakage between the two groups (5.7±3.8mm vs. 6.1±4.6mm, P&amp;gt;0.05). The comparison of the incidence of the most common early clinical manifestations showed no significant differences between the two groups: cervical wound infection (24.2%, 8/33 vs. 23.4%, 33/141), tachyarrhythmia (93.9%, 31/33 vs. 87.2%, 123/141), fever beyond 38°C (87.9%, 29/33 vs. 91.7%, 135/141), leukocytosis (81.8%, 27/33 vs. 89.4%, 126/141), cervical subcutaneous emphysema (42.4%, 14/33 vs. 41.1%, 58/141), purulent drainage (6.1%, 2/33 vs. 19.1%, 27/141), dyspnea (21.2%, 7/33 vs. 31.9%, 45/141), and right pneumothorax (54.5%, 18/33 vs. 50.4%, 71/141) (P&amp;gt;0.05). The incidences of the time-related early alarm signals were not significantly different between the two groups: within 3 days after surgery (100%, 33/33 vs. 95.7%, 135/141), during postoperative 4 days to 7 days (0%, 0/33 vs. 3.5%, 5/141), and after postoperative 7 days (0%, 0/33 vs. 0.7%, 1/141) (P&amp;gt;0.05). The 30-day mortality was significantly higher in the ERAS group than in the conventional group, and there were no differences in the other outcomes between the two groups (Table). Conclusion The ERAS protocol does not deteriorate the clinical characteristics and outcomes of AL compared with conventional care in patients undergoing esophagectomy for cancer. Improving the identification of delayed AL and the AL-associated mortality can enhance the safety of ERAS.

346. ESOPHAGOGASTRIC JUNCTION SIEWERT II TUMORS, A CHALLENGE FOR THE SURGEON: RESULTS OF TRANSHIATAL EXTENDED GASTRECTOMY VS. IVOR LEWIS ESOPHAGECTOMY

Abstract Background Esophagogastric junction (EGJ) Siewert type II tumors pose unique challenges in terms of adequate surgical treatment due to their anatomical location and potential for abdominal and mediastinal lymph node metastasis. The optimal surgical approach for these tumors remains a topic of debate, with options including transhiatal extended gastrectomy or transthoracic esophagectomy. Understanding the different outcomes associated with these surgical interventions is crucial for informed decision-making and patient-tailored management. The aim of this study was to compare the perioperative and oncological outcomes of these two surgical technique to access which could be the treatment of choice for Siewert II type tumours. Methods This study is a retrospective non-randomized cohort study from a single center. We reviewed the data of all the patients who underwent surgery for EGJ Siewert type II tumors between December 2014 and February 2023. The patients were divided into two groups: those who underwent transthoracic esophagectomy were assigned to “TE group” (72 patients) and those who underwent transhiatal extended gastrectomy were assigned to “TEG group” (21 patients). Results Patients in the TEG group were older (p=0.011) and in worst clinical condition (Charlson Comorbidity Index 4.15±1.78 vs. 4.95±1.46, p=0.064). The tumour stage at the diagnosis was more advanced in the TE group (p=0.004), and upfront surgery was infrequent in this group (p&amp;lt;0.001). The average duration of surgery was higher in the TE group (p&amp;lt;0.001). No difference was seen in the tumour length (p=0.924), implying a statistically significant difference in the proximal margin length (p&amp;lt;0.001), and distal margin length (p&amp;lt;0.001), with a R0 resection rate higher in the TE group (93.1% vs. 66.7%, p=0.002). The higher rate of R1 resection in the TEG group was mainly due to proximal margin infiltration. No difference was seen in the number of harvested lymph nodes (p=0.339). Overall postoperative complications rates were similar (p=0.144). No differences were found in the length of ICU stay (p=0.676) and in hospital stay (p=0.075). At a median follow up of 20 months, there were no statistical differences in Overall Survival and Disease-Free Survival at 5 years. Conclusion Our data suggests that transthoracic esophagectomy for EGJ Siewert type II tumors should be the treatment of choice for patients in good clinical condition, but transhiatal extended gastrectomy could be a good choice for patients presenting in worse clinical condition. A multidisciplinary approach is essential for optimal patient care, and the selection of the surgical technique should be based on a thorough evaluation of the patient's condition and tumor characteristics

759. P02.04 PARAVERTEBRAL VERSUS EPIDURAL ANALGESIA IN MINIMALLY INVASIVE ESOPHAGEAL RESECTION (PEPMEN): A RANDOMIZED CONTROLLED MULTICENTER TRIAL

Abstract Background Thoracic epidural analgesia has been the mainstay for pain control in esophageal cancer patients undergoing minimally invasive esophagectomy (MIE). Although effective epidural analgesia potentially contributes to achieving enhanced recovery after surgery (ERAS) goals in patients undergoing MIE, it can have counterproductive side effects such as hypotension, urinary retention and reduced mobility. Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery. Methods This open randomized controlled superiority trial was conducted across four Dutch centers. A total of 192 patients with esophageal cancer, scheduled for elective transthoracic MIE with intrathoracic anastomosis, were included and randomized to receive either epidural analgesia or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included the quality of life, postoperative pain, opioid consumption, need for inotropic/vasopressor medication, duration of admission, mobilization, complications, readmission, and mortality. Results From December 2019 to February 2023, 94 patients were assigned to epidural and 98 to paravertebral analgesia. QoR-40 score on POD3 did not differ between groups (mean difference 3.7; P=.268). The epidural group had higher QoR-40 scores on POD1 and 2 (mean difference 7.7; P=.018, mean difference 7.3; P=.020) and lower pain scores (1 versus 2; P=&amp;lt;.001, 1 versus 2; P=.033). More patients in the epidural group required vasopressor-medication on POD1 (38.3% versus 13.3%; P&amp;lt;.001). In the paravertebral group, the urinary catheter was removed one day earlier (P=&amp;lt;.001). No significant differences in complications or length of stay were observed. Conclusion This multicenter randomized controlled clinical trial did not show superiority of paravertebral analgesia over epidural analgesia in quality of recovery on the third day after minimally invasive esophagectomy. These results, however, support the safety of paravertebral analgesia as a viable alternative to epidural analgesia, enabling the provision of both techniques to patients in clinical practice.