Drainage Management Research Articles

Surgical Management and Its Impact on Adjuvant Treatment in Recurrent Ipsilateral Breast Cancer: A Retrospective Cohort Study.

Background: Breast cancer (BC) recurrence, defined as the reappearance of cancer in the ipsilateral breast after primary treatment, poses significant challenges in clinical management. Despite advances in treatment, recurrence rates persist, ranging from 0.6 to 1.5% annually, reaching 10-15% at 20 years. This study aims to analyze the surgical and oncological characteristics of patients with BC recurrence. Methods: This retrospective study includes 56 patients diagnosed with recurrent BC between October 2018 and April 2022. Data were collected from a prospectively maintained surgical database. A descriptive analysis was performed on the initial BC, and the recurrence, including surgical complications, was classified using the Clavien-Dindo system. The success rates of selective sentinel lymph node (SLN) biopsies and aberrant drainages were assessed based on previous surgeries. Results: The cohort included 55 females and 1 male, with a median age of 65.3 years. The mean time to BC recurrence was 11.5 years. Among them, 26.8% underwent breast-conserving surgery, 41.1% had a mastectomy, 21.4% had a mastectomy with reconstruction, and 10.7% had an excision over a previous mastectomy. An SLN biopsy was performed in 78.6% of cases, with higher success rates in those without a previous axillary lymph node dissection (85.7% vs. 63.2%). Aberrant drainage was more frequent in patients with a previous ALND (44.4% vs. 20%). The median follow-up was 41.3 months, with 10.7% experiencing a second recurrence. Conclusions: Repeat breast-conserving surgery with re-irradiation for ipsilateral recurrence is feasible and does not significantly increase complications. SLN biopsy is valuable for restaging and tailoring adjuvant therapies, with ALND not being necessary if re-SLN biopsy shows no drainage. The management of aberrant drainage remains controversial.

Dynamic Assessment of Drain Fluid Amylase Estimates the Risk of CR-POPF Following Pancreatoduodenectomy.

To evaluate whether drain fluid amylase levels on day-1 (DFA1) and day-3 (DFA3) can reliably estimate the risk of clinically relevant-postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) compared to either value alone or in combination with clinicopathologic variables. CR-POPF is a major source of morbidity and mortality following PD. Current drain management algorithms are variable and are mostly dependent on DFA1, while the DFA3 is seldom utilized to guide clinical decision making. Between 2015-2020, patients who underwent PD at two high-volume pancreas centers and had intraoperative drain placement with measurement of DFA1 and DFA3 were retrospectively reviewed. Models to predict CR-POPF were constructed using DFA1, DFA3, fistula risk score (FRS) and other patient or treatment-related parameters. The fittest and more parsimonious model was used to construct a CR-POPF risk calculator. Nine-hundred-twenty-three patients were included in the analysis. The FRS was high in 100(10.9%), intermediate in 524(57.3%), low in 211(23.1%) and negligible in 79(8.6%) patients. The overall rate of CR-POPF was 9.2%. Five logistic regression models were constructed using variables known to be implicated in CR-POPF. A model based solely on DFA1 and DFA3 with a cross-validated area under the curve of 0.846 was selected. A calculator using DFA1 and DFA3 was created based on this model to estimate the risk of CR-POPF. Risk of CR-POPF following pancreatoduodenectomy can be accurately estimated based on measurement of DFA1 and DFA3. Our CR-POPF kinetics calculator can facilitate postoperative risk stratification and guide drain management algorithms.

Determination of Sustainable Factory Locations for the Lemon Agroindustry using AHP, Mapping and Water Management

This research was conducted in Suntenjaya Village, Lembang, and West Bandung Regency, focusing on lemon agro-industrial development. Research was conducted using the Analytical Hierarchy Process (AHP) approach, area mapping, and water management to determine a sustainable factory location. The main objective is the selection of factory sites by integrating lemon production, considering sustainable agriculture aspects, product aspects, and water conservation programs. The results of this study provide a strong foundation for sustainable agro-industrial development that will support sustainable agriculture, local economy, and environmental protection. The research also combined qualitative and quantitative elements with a mixed approach that included Focus Group Discussion (FGD) and AHP, and the results showed that integrated drainage management was the top priority, followed by sanitation, clean water, reforestation, and sustainable agriculture. Mapping of areas based on geographical characteristics, such as rainfall, slope, and soil type, provided a map of water infiltration rates, which became a key guide in planning water conservation programs. The ultimate location for the lemon agroindustry is half of Desa Suntenjaya, mostly from the center to the northern area, which needs to consider proximity to markets in Bandung Regency and City, easy access to sources of raw materials for lemons, water availability, adequate transportation infrastructure, access to energy sources, suitable climate for lemon growth, and the availability of adequate labor in the region.

Priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery.

Enhanced recovery after surgery (ERAS) is a perioperative care protocol, which was introduced several years ago and has gained increasing importance in thoracic surgery. The aim of this study was to provide guidance through clinical implementation and to identify factors for better compliance. This prospective cohort study collected data between July 2021 and June 2022 at the Department of Thoracic Surgery (University Hospital Regensburg, Germany). A modified enhanced recovery after thoracic surgery (ERATS) protocol with recommendations covering the pre-, intra- and postoperative phases was established and followed. The primary objective was to evaluate the implementation of the ERATS protocol. Secondary, specific and clinically relevant recommendations were analyzed regarding their compliance. The study included 139 patients undergoing elective lung resections. Many ERATS recommendations were already part of standard perioperative care, including perioperative antibiotics, venous thromboembolism prophylaxis and intraoperative warming. Other measures such as anemia management, carbohydrate loading or chest drain management were updated or newly established and standardized according to our ERATS protocol. The recommendations emphasizing early postoperative mobilization were found to be crucial. We identified three groups with significantly different compliance rates: (I) patient-dependent measures which require active participation (49.3%); (II) treatment measures requiring interdisciplinary consensus (85.8%); and (III) surgical measures (88%). The implementation and continuous evaluation of our perioperative ERATS protocol led to a new categorization of targeted measures into three groups with actors of different competencies. The new grouping enables gradual implementation and a step-by-step targeted approach in order to achieve a higher compliance of ERATS in the future as well as long-term sustainability.

Effects of Waterlogging on Rice Growth at Jointing–Booting Stage

The rice waterlogging stress test was conducted at the experimental base of the College of Agriculture, Yangtze University, using Yangxian You 418 as the test subject, in order to investigate the impact of waterlogging on rice growth during the period from July to August each year. Six waterlogging stress tests with different waterlogging depth (1/4 plant height (1/4PH), 2/4 PH, and 3/4 PH) and duration (5 d and 7 d) were set up at the jointing–booting stage of rice (T1: 1/4 PH, 7 d; T2: 2/4 PH, 7 d; T3: 3/4 PH, 7 d; T4: 1/4 PH, 5 d; T5: 2/4 PH, 5 d; T6: 3/4 PH, 5 d;) with shallow water irrigation (CK) as control. The plant height, population leaf area, above-ground dry matter, and the yield of rice were measured. The correlation between the waterlogging depth and rice yield reduction was analyzed, and the flood disaster threshold index of rice was established. The results showed that at the end of stress, the plant height of all waterlogged treatments exceeded CK, and the plant height of T3 and T6 treatments significantly increased by 31.90% and 15.93%, respectively. The leaf area of rice treated with T1, T3, T4, and T5 was higher than CK (p < 0.05), and the above-ground dry matter of rice treated with T2, T3, T4, T5, and T6 was higher than CK (p < 0.05). When normal irrigation was restored to the maturity stage, the plant height of all rice treated with waterlogging was still higher than CK (p < 0.05). However, as the degree of waterlogging increased, rice yield decreased significantly, with a notable reduction of 31.68% observed in the T3 treatment compared to CK. Assuming a drainage index based on a 20% decrease in rice yield, it is imperative that the ratio of flooded depth to plant height remains below 37% when waterlogging persists for 7 days in rice cultivation. These research findings offer crucial scientific insights for implementing effective drainage management measures during flood disasters in rice paddies.

Identification of illicit discharges in sewer networks by an SWMM-Bayesian coupled approach.

Illicit discharges into sewer systems are a widespread concern within China's urban drainage management. They can result in unforeseen environmental contamination and deterioration in the performance of wastewater treatment plants. Consequently, pinpointing the origin of unauthorized discharges in the sewer network is crucial. This study aims to evaluate an integrative method that employs numerical modeling and statistical analysis to determine the locations and characteristics of illicit discharges. The Storm Water Management Model (SWMM) was employed to track water quality variations within the sewer network and examine the concentration profiles of exogenous pollutants under a range of scenarios. The identification technique employed Bayesian inference fused with the Markov chain Monte Carlo sampling method, enabling the estimation of probability distributions for the position of the suspected source, the discharge magnitude, and the commencement of the event. Specifically, the cases involving continuous release and multiple sources were examined. For single-point source identification, where all three parameters are unknown, concentration profiles from two monitoring sites in the path of pollutant transport and dispersion are necessary and sufficient to characterize the pollution source. For the identification of multiple sources, the proposed SWMM-Bayesian strategy with improved sampling is applied, which significantly improves the accuracy.

Feasibility of implementing a remote system for lymphoedema conservative therapy: a case study.

Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination. The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management. The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B). The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management. The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment.

Management of external ventricular drain: to wean or not to wean?

PurposeExternal ventricular drain (EVD) is one of the most frequent procedures in neurosurgery and around 15 to 30% of these patients require a permanent cerebrospinal fluid (CSF) diversion. The optimal EVD weaning strategy is still unclear. Whether gradual weaning compared to rapid closure, reduces the rate of permanent CSF diversion remains controversial. The aim of this trial is to compare the rates of permanent CSF diversion between gradual weaning and rapid closure of an EVD.MethodsThis was a single-center, retrospective cohort study including patients between 2010 to 2020. Patients were divided into a weaning (WG) and non-weaning (NWG) group. The primary outcome was permanent CSF diversion rates, secondary outcomes included hospitalization time, EVD-related morbidity, and clinical outcome.ResultsOut of 412 patients, 123 (29.9%) patients were excluded due to early death or palliative treatment. We registered 178 (61.6%) patients in the WG and 111 (38.4%) in the NWG. Baseline characteristics were comparable between groups. The VPS rate was comparable in both groups (NWG 37.8%; WG 39.9%, p = 0.728). EVD related infection (13.5% vs 1.8%, p < 0.001), as well as non-EVD related infection rates (2.8% vs 0%, p < 0.001), were significantly higher in the WG. Hospitalization time was significantly shorter in the NWG (WG 24.93 ± 9.50 days; NWG 23.66 ± 14.51 days, p = 0.039).ConclusionGradual EVD weaning does not seem to reduce the need for permanent CSF diversion, while infection rates and hospitalization time were significantly higher/longer. Therefore, direct closure should be considered in the clinical setting.

Role of percutane peritoneal drainage in management of neonatal pneumoperitoneum: is surgery always necessary?

Aims: The standard procedure in the management of neonatal pneumoperitoneum (NP) cases is laparotomy. However, in some of the cases in which surgery is not a viable option, percutaneous peritoneal drainage (PD) can be performed in order to stabilize the patient prior laparotomy. This study reviews the role of PD in NP patients using previous studies in the literature. Methods: 26 neonates diagnosed with NP in Van Yüzüncü Yıl Faculty of Medicine, Van Training and Research Hospital neonatal ICU from April 2015 to January 2018 were retrospectively reviewed. In terms of surgical assessment, patients were divided into 2 groups according to their birth weight. Group A consisted of neonates with birth weight above 1000 grams whereas Group B consisted of neonates with birth weight above 1000 grams whereas Group B consisted of neonates with a birth weight of 1000 grams or below. Demographic values, diagnosis, and treatment methods were put on record in patient files. Results: 10 cases (7 male – 3 female) in Group A had a mean body weight of 1850 (Range: 1070 – 3400 gr) grams. In this patient group, NP developed as a result of pneumothorax, necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP). 3 (30%) of the patients who were treated with classical approaches were lost during the treatment period. Group B consisted of 16 (9 male – 7 female) patients with a mean body weight of 780 (Range 470 – 950) grams. In this case group, NP developed as a result of NEC. PD was performed prior to conventional treatment procedures and 5 (31%) of the patients were lost during the treatment period. Conclusion: Group B had similar mortality rates with Group A. result explains to us that PD is a viable option in stabilizing the patient prior to laparotomy as a starting procedure, especially in neonates below 1000 grams and deemed as surgically unstable.

Perioperative Patient-Initiated Communication in Gender-Affirming Mastectomy.

Background: Gender-affirming mastectomy (GAM) improves the psychosocial functioning and quality of life of transgender and non-binary (TGNB) individuals. However, the perioperative period is often marked by emotional stress, concerns about surgical outcomes, and physical discomfort. While inpatient procedures provide multiple opportunities to engage with and educate patients, outpatient surgeries, such as GAM, pose a unique challenge as patients are followed for <24 h postoperatively. Given the heightened emotional and psychological distress related to gender dysphoria TGNB individuals often experience, addressing these gaps can significantly improve outcomes. This study aims to characterize patient and surgical characteristics associated with patient-initiated communication (PIC) frequency in this population. Methods: A single-center retrospective review of TGNB patients undergoing GAM from February 2018 to November 2022 was conducted. Demographics, surgical characteristics, and frequency of and reasons for perioperative PIC (30 days before and after surgery) were recorded. The primary outcome was the incidence of perioperative PIC. The secondary outcomes included (1) the rationale for PIC and (2) patient and surgical characteristics associated with PIC. Results: A total of 352 patients were included. Of these, 285 (74.6%) initiated communication in the perioperative period, totaling 659 PICs. The median age was 25.0 (interquartile range [IQR]: 9.0) years. The median body mass index (BMI) was 28.5 (IQR: 8.5) kg/m2. The mean number of PICs was 0.7 ± 1.3 preoperatively and 1.3 ± 1.7 postoperatively (p < 0.001). The most frequent preoperative PIC subjects were administrative issues (AI; n = 66, 30.7%), preoperative requirements (n = 43, 20.0%), and cost and insurance (n = 33, 15.0%). The most frequent postoperative PIC subjects were wound care (n = 77, 17.3%), AI (n = 70, 15.0%), activity restrictions (n = 60, 13.5%), drainage (n = 56, 12.6%), and swelling (n = 37, 8.3%). Collectively, older patients (β = 0.234, p = 0.001), those with a history of major depressive disorder or generalized anxiety disorder (2.4 ± 3.0 vs. 1.7 ± 1.9; p = 0.019), and those without postoperative drains (n = 16/17, 94.1% vs. n = 236/334, 70.7%; p = 0.025) engaged in higher levels of PIC. There were no significant associations between other patient characteristics, perioperative details, or complications and PIC frequency. Conclusions: Perioperative PIC is prevalent among the majority of GAM patients at our institution, with age, psychiatric diagnosis, and postoperative drain use identified as significant predictors. To mitigate PIC frequency, it is crucial to ensure adequate support staffing and provide comprehensive postoperative instructions, particularly concerning activity restrictions and drainage management. These interventions may reduce PICs in high-volume centers. Further research should investigate targeted interventions to further support TGNB patients during the perioperative period.

Risk factors for enhanced recovery after surgery failure in patients undergoing lung cancer resection with concomitant cardiovascular disease: A single-center retrospective study

ObjectiveEnhanced recovery after surgery (ERAS) has been widely used in patients with lung cancer, and its effectiveness has been confirmed; however, some lung cancers with poor clinical outcomes lead to ERAS failure after radical resection. This study aimed to analyze risk factors associated with ERAS failure after radical resection in patients with lung cancer and concomitant cardiovascular disease. MethodsIn total, 198 patients who underwent ERAS following radical lung cancer surgery for concomitant cardiovascular disease between January 2022 and September 2023 were enrolled in this retrospective study. The patients were categorized into two groups based on the definition of ERAS failure: ERAS success group (n = 152) and ERAS failure group (n = 46). Univariate and multivariate analyses were performed to investigate the risk factors of ERAS failure. ResultsUnivariate analysis showed that gender, tumor location, operation time, estimated blood loss (EBL), suction drainage, and total cholesterol were associated with ERAS failure. Multivariate analysis showed that operation time (odds ratio [OR] = 1.015; P = 0.011) and suction drainage (OR = 3.343; P = 0.008) were independent risk factors for ERAS failure. ConclusionsOperation time and suction drainage were independent risk factors for ERAS failure after radical resection of combined cardiovascular lung cancer. Therefore, improving surgical efficiency and postoperative chest drain management are important for successful ERAS.

The ecological and sanitary-hygienic assessment of the river systems located in the technogenic polluted zone of the Caucasus

The Caucasus is characterized by the large and at the same time increasing load from exploited metal and non-metallic mines. The sanitary-hygienic and toxic danger to people and the environment is quite high. There are 44 metal ores in the Syunik Region, and more than 90 non-metal deposits. In 2018, 12 metal and 29 non-metallic deposits were granted with the use rights for the purpose of mineral extraction. Also, geological survey permission was granted for 12 metal deposits. Currently, there are 12 operating and conserved tailings filled with about 400 million m3 of tailings, which are equipped with many heavy metals and other dangerous substances, as the result of the exploitation of the metal mines in Syunik. The present study focuses on the ecological assessment of the waters of the Voghji and the Khalaj Rivers that are located in the technogenic polluted zone of the Caucasus. The research revealed that along with the increase of the volumes of the Kapan-Qajaran copper-molybdenum mines, as well as the increase of the rock dumps and tailings, the organoleptic-chemical indicators of the waters of the Voghji and the Khalaj Rivers had increased. The quantity of the suspended particles and the heavy metals in the waters of these rivers had increased 1.5 and 2.0 times or by 58–100 % and 19.5 − 29.8 %, respectively, in the last 10 years. The trends are also observed in the values of the sulfates, the total dissolved salts, and the electrical conductivity, which are due to the chemical composition of the ores and the improper management of the acid drainage. The content of the heavy metals in the waters of the mentioned rivers is 9 − 20 times higher than the permissible limit density, and the degree of the mineralization is above the permissible limit. Thus, the waters of these rivers, after mixing with the effluent from the mining industry, are not guaranteed to be used for irrigation. Considering that the mobility of the heavy metals decreases several times in the alkaline environment (pH 8.5 − 9.0), it is recommended that the mining industry constantly adds lime (CaO) to the acid drainage of the mines so that the pH of the water become lower: from acid to alkaline (pH 8.5 − 9.0) and only after that, the water could be used for irrigation of the agricultural crops. This is possible for many types of heavy metals, including when using other wastewater treatment measures: engineering, physicochemical and biological.

일개 대학의 핵심간호술 18종 프로토콜 개발 연구

Purpose : This study was conducted to establish a core nursing skills and evaluation protocols by modifying and supplementing Programme Outcome of nursing curiculum at a college. Methods : Through quantitative and qualitative surveys, expert consultation, and validity, 18 core nursing skills and evaluation protocols were finally derived. Results : The 18 core nursing skills include vital signs measurement, oral medication, intramuscular injection, subcutaneous injection, intradermal injection, intravenous fluid infusion, transfusion, intermittent gavage nutrition, simple catheterization, indwelling catheterization, enema, peripheral oxygen saturation measurement and electrocardiogram monitor, oxygen therapy using a nasal cannula, suction, basic CPR and defibrillator application, pain control, bedsore management and fall prevention nursing, and drainage management. Conclusion : It is expected that the final completed core nursing skills and evaluation protocols will contribute to improving nursing students’ core nursing skills competency and clinical adaptation ability.

Lessons from short chest drain management for primary spontaneous pneumothorax.

Video-assisted thoracic surgery (VATS) bullectomy is the mainstay treatment for primary spontaneous pneumothorax (PSP) but we encounter patients with pain due to chest tube. This study investigated the postoperative outcomes of shortened silicone drain as a chest tube after VATS bullectomy to reduce pain. The current study included patients aged < 30years who underwent VATS bullectomy for PSP. Patients with normal intrathoracic lengths of the silicone drain placed in a loop at the apex toward the diaphragm were categorized as Group L, whereas those with the silicone drain shortened to approximately 10cm and placed toward the apex were classified as Group S. Postoperative pain evaluated using a numerical rating scale (NRS) and other perioperative outcomes were compared between the groups. Altogether, 43 patients were included, with 22 in Group L and 21 in Group S, respectively. The NRS before chest tube removal was significantly lower in Group S (mean, 2.1) than in Group L (4.4; p = 0.001). In Group L, 4 patients (p = 0.017) required early chest tube removal than expected due to severe pain whereas none in Group S required this intervention; additionally, more patients needed additional analgesics than in Group S (p = 0.003). In VATS bullectomy for PSP, the pain intensity could be reduced by shortening the intrathoracic length of the silicone drain, compared to a longer intrathoracic length of the silicon drain. Our findings contribute to the establishment of optimal postoperative management of general thoracic surgery.

Training on Household Dirty Water Drainage Management

Training on Household Dirty Water Drainage Management

Comparing the effectiveness of full-vacuum and half-vacuum drainage in reducing seroma after modified radical mastectomy: a meta-analysis.

Owing to limited outpatient support for drain management, delayed discharge after mastectomy is more prevalent in developing countries. Utilising half-vacuum (HV) suction drains for routine drainage after mastectomy could lead to a reduced incidence of seroma and a shorter hospital stay. This systematic review and meta-analysis compared the outcomes of HV against full-vacuum (FV) suction drains in patients who underwent modified radical mastectomy for breast cancer. Differences between the two groups in length of hospital stay, total volume of drain effluent and incidence of seroma were assessed. RevMan 5.4 was used to calculate the odds ratio (OR) and relative risk (RR) for dichotomous data, and the mean difference (MD) for continuous data. Nine randomised controlled trials were included in this review. Using HV drains reduced both the mean length of hospital stay (MD: -2.30 days, 95% confidence interval [CI]: -4.10 to -0.49 days, I2=97%) and the mean total volume of effluent (MD: -132.61ml, 95% CI: -207.32ml to -57.91ml, I2=88%) compared with FV drains. However, there was no statistically significant difference in incidence of seroma between the two groups (RR: 0.67, 95% CI: 0.30 to 1.46, I2=65%). Likewise, there was no difference in rate of seroma occurrence on sensitivity analysis (OR: 1.29, 95% CI: 0.72 to 2.33, I2=74%). There was no difference in the incidence of seroma between HV and FV suction drainage. Conversely, a reduction in the length of hospital stay and the total volume of drain effluent was observed for mastectomy patients with a HV drain.

Development of a finite element groundwater flow model to test drainage management strategies for the expansion of the Dareh-Zar open pit mine, Iran

A finite-element groundwater flow model was developed for the expanding Dareh-Zar open pit mine in southern Iran, to simulate groundwater inflow into the excavation and mine wall pore pressure dynamics. The model was used to test the effectiveness of implementing different drainage management strategies to reduce groundwater inflow rates and mine wall pore pressures, including abstraction wells and horizontal drains. Model predictions suggest the implementation of abstraction wells will reduce groundwater inflow rates by 75% during the first 12 years of mining and 50% during the subsequent 5 years relative to a ‘no drainage’ management scenario, with further reductions in groundwater inflow achieved through horizontal drain installation. Furthermore, the installation of horizontal drains was found to be necessary to reduce mine-wall pore pressures from destabilizing the mine walls. Groundwater management of the decommissioned pit mine was also evaluated, with simulation results suggesting that backfilling the excavation would restore the groundwater level within the open pit mine region to ~2,442 m above sea level, representing a net restoration of ~204 m relative to the water table prior to mine closure.

Intraperitoneal prophylactic drain after pancreaticoduodenectomy: an Italian survey

Intraperitoneal prophylactic drain (IPD) use in pancreaticoduodenectomy (PD) is still controversial. A survey was designed to investigate surgeons’ use of IPD in PD patients through 23 questions and one clinical vignette. For the clinical scenario, respondents were asked to report their regret of omission and commission regarding the use of IPD elicited on a scale between 0 (no regret) and 100 (maximum regret). The threshold model and a multilevel mixed regression were applied. One hundred three (97.2%) respondents confirmed using at least two IPDs. The median regret due to the omission of IPD was 84 (67–100, IQR). The median regret due to the commission of IPD was 10 (3.5–20, IQR). The CR-POPF probability threshold at which drainage omission was the less regrettable choice was 3% (1–50, IQR). The threshold was lower for those surgeons who performed minimally invasive PD (P = 0.048), adopted late removal (P = 0.002), perceived FRS able to predict the risk (P = 0.006), and IPD able to avoid relaparotomy P = 0.036). Drain management policies after PD remain heterogeneous among surgeons. The regret model suggested that IPD omission could be performed in low-risk patients.

Difficult management of pancreatic pseudocyst drainage in a 4-year-old child.

Difficult management of pancreatic pseudocyst drainage in a 4-year-old child.

Agro-technologies for greenhouse gases mitigation in flooded rice fields for promoting climate smart agriculture

We investigated methane (CH4) and nitrous oxide (N2O), two important greenhouse gases (GHGs) emissions using the closed chamber method from a flooded rice field in Brahmaputra valley of Assam, northeast part of India. We tried to understand the factors responsible for the emission and identify appropriate agro-technologies for their mitigation. Various factors like water level, drainage management, soil organic carbon management, crop management, fertilizer amendment, cultivar type etc. affect the GHG production and emission from the flooded rice soil. In this study, six treatments were employed, namely, farmer's practice (FP), recommended fertilizer dosage (RDF), direct seeded rice (DSR), intermittent wetting drying (IWD), use of efficient methanotrophs (MTH), and use of ammonium sulfate as a nitrogen source for real-time nitrogen management using leaf color chart, (AS). GHG flux was measured through the static closed chamber technique. Soil temperature, pH, and redox potential (Eh) and other soil physico-chemical and biological properties that have a potential role in GHG emission were also assessed. The lowest CH4 flux was observed in IWD treatment. The highest CH4 but lowest N2O flux was observed in RDF thus portraying a tradeoff relationship among these two GHGs. The highest N2O flux was observed in AS. Changes in Eh strongly altered CH4 and N2O emissions. The CH4 flux for the growing season varied from 62.5 to 86.3 kg ha−1 with an average of 72.4 kg ha−1. The average N2O flux was 0.89 kg ha−1 with values fluctuating between 0.72 – and 1.08 kg ha−1. The findings of this study could assist in understanding the factors affecting the source, production, and sink of these two important GHGs. IWD, along with judicious N-based fertilizer use, could provide significant respite from GHG emissions in rice-based agriculture. These climate-smart strategies not only reduce emissions but also have the potential to improve yield.