High Level Of Experience Research Articles

Selective resection of the medial wall of the cavernous sinus in pituitary surgery: results of a prospective single center analysis.

Pituitary adenomas, despite their histologically benign nature, can severely impact patients' quality of life due to hormone hypersecretion. Invasion of the medial wall of the cavernous sinus (MWCS) by these tumors complicates surgical outcomes, lowering biochemical remission rates and increasing recurrence. This study aims to share our institutional experience with the selective resection of the MWCS in endoscopic pituitary surgery. This prospective study included patients diagnosed with pituitary adenomas who underwent endoscopic endonasal surgery at Mayo Clinic, Jacksonville. Inclusion criteria encompassed confirmed pituitary adenomas, selective MWCS resection, and availability of histopathological data. Patient demographics, tumor characteristics, surgical outcomes, and postoperative complications were analyzed using descriptive statistics. Twenty-six cases met the inclusion criteria. Functional adenomas and macroadenomas constituted 80.8% of cases. Recurrent adenomas represented 19.2% of cases. Tumor invasion of the MWCS was confirmed in 76.9% of cases and patients with acromegaly had the highest rate of confirmed invasion of the MW (88.8%). Initial disease control was achieved in 88.5% of the patients, and disease remission at last follow up was observed in those with acromegaly, Cushing's disease and prolactinomas in 87.5%, 83.3% and 66.6% of cases, respectively. Complete resection was achieved in 5/5 nonfunctioning adenomas. There were no carotid injuries, cranial deficits or fatalities observed. Resection of the MWCS is an effective strategy for improving surgical outcomes in pituitary adenomas with potential invasion into this area, especially in patients with functional and/or recurrent adenomas. The procedure demonstrates a positive balance of efficacy and safety, when performed by teams with high level of experience in endoscopic skull base surgery and in selected patients.

중학생의 현실세계 학교폭력 피해 유형과 사이버폭력 피해 유형 간 전이 양상 및 심리적 특성

The purpose of this study is to analyze the cause and effect transition relationship between middle school students' experiences in school violence and cyber violence, and to identify differences in psychological characteristics by type of cyber violence victims. To this end, latent transition analysis was conducted with middle school students' data collected in 2018 from a survey on the status of children and youth human rights. According to the analysis, the types of school violence victims and cyber violence victims were classified into four groups each. Forty percent of students in groups experiencing different types of school violence at high-level experience similarly violence in cyberspace. Students who have experienced sexual harassment-oriented damage in cyberspace have the highest levels of drop-out impulse, suicide impulse, depression and anxiety, and the lowest level of self-esteem and satisfaction in life. Based on these findings, implications were derived and discussed.

Perceived prolonged stress leads to difficulties in recognizing sadness from voice cues in men but not women.

It has long been known that stress has detrimental effects on cognition (e.g., Alderson & Novack, 2002; Lupien & Lepage, 2001), most notably documented for memory functions (e.g., Schwabe & Wolf, 2013). Interestingly, less is known about the effects of stress on other cognitive functions including language processing. Here, we have examined the effects of self-reported prolonged stress on recognition of emotional language content with a particular emphasis on gender differences. We tested how well 399 participants with different perceived stress levels recognized emotional voice cues. Findings confirm previous results from the emotional prosody literature by demonstrating that women generally outperform men in the vocal emotion recognition task. Crucially, results also revealed that medium levels of perceived stress impair the ability to detect sadness from voice cues in men but not women. These findings were not modulated by task demands (e.g., speeded response) or better acoustic discrimination abilities in women. Results are in line with the idea that perceived stress has a different impact on men versus women and that women have a higher level of experience in voice sadness recognition, potentially due to their predominant role as primary caretakers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The role of sound-to-symbol literacy in phonological awareness: Evidence from Cantonese

Phonological awareness reflects linguistic knowledge related to the sound system of a language. Individual development of phonological awareness is known to progress from larger to smaller sized units and is promoted by the acquisition of literacy, especially in alphabet-based writing systems that are built around sound-to-symbol correspondences. The present study addressed the nature of phonological awareness in speakers of a logographically scripted language. It investigated phonological awareness in adult speakers of Cantonese hailing from Hong Kong who (compared to speakers of other logographically scripted languages) traditionally received little sound-based assistance from tools like Pinyin or Zhu-yin-Fu-Hao when they acquired orthography. The study adopted an individual difference approach, quantifying individually variable levels of experience with a sound-to-symbol writing system and their relationship to phonological awareness. Fifty-seven Hong-Kong speakers of Cantonese took part online, completing rhyme judgment and phoneme monitoring tasks, alongside an extensive background questionnaire. The main prediction that Cantonese speakers who had a relatively high level of experience with sound-to-symbol writing would show an advantage in phonological awareness at the subsyllabic level was largely borne out by the data. The findings of the present study suggest that phonological awareness is a complex set of dissociable skills, shaped by the linguistic and orthographic experience of individual speakers.

Experiences and Outcomes of the Society of Genitourinary Reconstructive Surgeons Fellowship Training: Growth in Fellowships Mirrors the Evolution of the Discipline

ObjectiveTo describe experiences and outcomes of the Society of Genitourinary Reconstructive Surgeons (GURS) fellowship match. In 2012, GURS developed a centralized fellowship match which has grown from 13 to 30 programs. MethodsGURS match statistics and case logs were reviewed from 2013-2024. Additionally, a 37 question survey evaluating satisfaction, procedural competency, fellowship experience, and employment opportunities were sent to graduates. Linear regression was performed to examine trends over time. ResultsOver the study period, program match success remained stable (94.7%;p=0.50) while applicant success (63.3%) increased over time (p=0.04). North American and female applicants experienced higher match success (72.8% and 73.6%) compared to their international (35.5%;p<0.0001) and male counterparts (60.0%;p=0.02). On case log analysis, mean surgical volumes per year increased in urethral reconstruction (mean=88.1;p=0.02), male sexual health (n=32.7;p=0.03), genital reconstruction (mean=16.4;p<0.01) and abdominal reconstruction (mean=24.5;p=0.03). Male incontinence surgeries remained stable (mean=30.5;p=0.21) while female reconstruction declined (mean=23.2;p=0.01). With a survey response rate of 54.5% (97/178), training satisfaction was 95.9% which did not differ by gender (p=0.54) or year of training (p=0.22). 97.9% felt competent to enter unsupervised reconstructive practice, 94.8% reported an understanding of the relevant literature and 96.9% were satisfied with their job as a reconstructive urologist. 49.5% identified a different case mix in practice compared to fellowship, most commonly related to abdominal (44.9%) or genital reconstruction (16.3%). ConclusionGURS fellowships have grown organically over the last decade and mirror the growth and evolution of the discipline with sustained high-levels of graduate satisfaction, surgical experience, competence, scholarly inquiry and employment.

An AI-Powered Product Identity Form Design Method Based on Shape Grammar and Kansei Engineering: Integrating Midjourney and Grey-AHP-QFD

Product Identity (PI) is a strategic instrument for enterprises to forge brand strength through New Product Development (NPD). Concurrently, facing increasingly fierce market competition, the NPD for consumer emotional requirements (CRs) has become a significant objective in enterprise research and development (R&amp;D). The design of new product forms must ensure the continuity of PI and concurrently address the emotional needs of users. It demands a high level of experience from designers and significant investment in R&amp;D. To solve this problem, a generative and quantitative design method powered by AI, based on Shape Grammar (SG) and Kansei Engineering (KE), is proposed. The specific method is as follows: Firstly, representative products for Morphological Analysis (MA) are selected, SG is applied to establish initial shapes and transformation rules, and prompts are input into Midjourney. This process generates conceptual sketches and iteratively refines them, resulting in a set of conceptual sketches that preserve the PI. Secondly, a web crawler mines online reviews to extract Kansei words. Factor Analysis (FA) clusters them into Kansei factors, and the Grey Analytic Hierarchy Process (G-AHP) calculates their grey weights. Thirdly, after analyzing the PI conceptual sketches for feature extraction, the features are integrated with CRs into the Quality Function Deployment (QFD) matrix. Experts evaluate the relationships using interval grey numbers, calculating the optimal ranking of PI Engineering Characteristics (PIECs). Finally, professional designers refine the selected sketches into 3D models and detailed designs. Using a Chinese brand as a case study, we have designed a female electric moped (E-moped) to fit the PI and users’ emotional needs. Through a questionnaire survey on the design scheme, we argue that the proposed innovative method is efficient, applicable, and effective in balancing the product form design of PI and user emotions.

The effect of promoting factors on learning by four different delivery modes

BackgroundIn the digital era, developing effective teaching methods is crucial due to the challenges of maintaining students’ concentration amidst distractions. This study assessed the effects of learning-promoting factors both across group boundaries and within RCT learning groups examined in our previous study on the effectiveness of online versus live teaching.MethodsThe participants’ experiences in the domains of Concentration, Anticipation, Liking and Desire to reuse were evaluated online immediately after a lesson on diagnosing pediatric respiratory issues implemented either in a Live, Live-stream, Vodcast or Podcast setting. The students rated their experiences on a scale of 1–10 with scores above a median of 8 indicating high experience levels in each factor. Learning was evaluated using a Webropol e-Test immediately and five weeks after the teaching session. The 15-minute test, comprised of 10 multiple-choice questions and real-life video scenarios, measured both theoretical and diagnostic skills. The test score scale ranged from − 26 to 28 points.ResultsHigh concentration was experienced by 70/72 (97.2%) students in the Live, 41/75 (54.7%) students in the Live-stream, 53/72 (73.6%) students in the Vodcast and 36/79 (45.6%) students in the Podcast teaching groups (P < 0.01). High concentration promoted learning the most, resulting in a 1.93 score improvement in the short-term test and a 1.65 score improvement in the long-term test. Among those with high concentration, the average test scores ranged from 21.9 to 23.4, while the range for low concentration was 18.3–20.0.ConclusionIn our study, good concentration promoted higher test scores in comparison with low concentration across all the learning modalities, both in digital and live settings. However, the live teaching modality resulted in the highest levels of concentration. Our results suggest that teachers should use various teaching modalities and utilize related special features to engage learners and maintain their concentration.

Surgeon's Experience and Accuracy of Preoperative Digital Templating in Primary Total Hip Arthroplasty.

Preoperative planning has become essential in performance of total hip arthroplasty (THA). However, data regarding the effect of the planner's experience on the accuracy of digital preoperative planning is limited. The objective of this study was to assess the accuracy of digital templating in THA based on the surgeon's experience. A retrospective study was conducted. An analysis of 98 anteroposterior pelvic radiographs, which were individually templated by four surgeons (two hip surgeons and two orthopaedic residents) using TraumaCad® digital planning, was performed. A comparison of preoperatively planned sizes with implanted sizes was performed to evaluate the accuracy of predicting component size. The results of preoperative planning performed by hip surgeons and orthopaedic residents were compared for testing of the planner's experience. Femoral stem was precisely predicted in 32.4% of cases, acetabular component in 40.3%, and femoral offset in 76.7%. Prediction of cup size showed greater accuracy than femoral size among all observers. No differences in any variable were observed among the four groups (acetabular cup P=0.07, femoral stem P=0.82, femoral offset P=0.06). All measurements showed good reliability (intraclass correlation coefficient [ICC] acetabular cup: 0.76, ICC femoral stem: 0.79). The results of this study might suggest that even though a surgeon's experience supports improved precision during the planning stage, it should not be restricted only to surgeons with a high level of experience. We consider preoperative planning an essential part of the surgery, which should be included in training for orthopaedics residents.

Glaucoma Filtration Surgery - Bleb-forming Procedures

Glaucoma filtration surgery has been a standard surgical therapy for decades. An increasing knowledge about wound healing processes in the eye, the introduction of antimetabolite treatment and continuous improvements of the surgical technique helped making trabeculectomy - the prototype filtration surgery - a very effective therapeutic tool. However, best results will only be regularly achieved with a high level of experience and time dedicated to postoperative follow-up. Furthermore, the potential for severe early and late complications still remains high. Thus, novel stent-based filtration surgery approaches, such as the Preserflo and the XEN shunt have been introduced. This review presents these three bleb-forming filtration procedures, covering the basic principles of surgical technique, data on effectivity as well as complications.

THE CURRENT SITUATION AND PROBLEMS OF THE DEVELOPMENT OF DAI NATIONALITY CULTURE THEME HOTELS IN XISHUANGBANNA REGION, YUNNAN, CHINA

The rise of minority culture-themed hotels in Yunnan Province is a new direction for the development of the hotel industry in Yunnan Province. At present, the scale of Dai Nationality (Acronyms: Dai) culture theme hotels in Xishuangbanna, Yunnan Province, varies in size and development. In this paper, we selected three five-star hotels in the Xishuangbanna area as research objects, and conducted interviews with tourists who have stayed there to understand the development status of Dai culture hotels in Yunnan Province. We discussed and summarized the problems in the development of ethnic minority hotels, particularly Dai theme hotels, which include: a lack of staff cognition of the ethnic minorities' culture; a lack of high-level experience with the cultural content; and a lack of marketing efforts in the development of this type of hotel. In order to improve the development of ethnic culture-themed hotels, the hotels should explore positive countermeasures in the design of Dai culture experience content, the improvement of marketing work, and human resources development.

‘A sense of the systemic’: the Bank of England and the language of inclusive capitalism

Successive crises – social, environmental and political – have led some in global governance circles to advocate a more ‘inclusive capitalism’. In this article, I show how this postcrisis language of inclusive capitalism was used by a specific subset of officials within the Bank of England: Those with high levels of experience in public sector and international official institutions. It is argued that these officials are ‘organic intellectuals’ who mobilise their experience of inter-institutional collaboration as a deliberative model for solving long-term social problems. The institutional experience of these officials and their concern with crises of trust in expertise facilitated the adoption of these models of communicative intervention. I draw on a novel dataset of Bank officials’ career data and speeches, as well as twelve interviews with current and former Bank staff, to show who used this language, in what settings and what motivated its adoption. The article makes a novel contribution to debates about the motivations of key figures in central banks, suggesting that their actions go beyond reputation defence to encompass an expansive worldview of how capitalism might solve its myriad crises.

Learning imaging in axial spondyloarthritis: more than just a matter of experience

ObjectiveReliable interpretation of imaging findings is essential for the diagnosis of axial spondyloarthritis (axSpA) and requires a high level of experience. We investigated experience-dependent differences in diagnostic accuracies using X-ray...

Long-term outcomes of pelvic exenterations for gynecological malignancies: a single-center retrospective cohort study

BackgroundRecently, with the advancement of medical technology, the postoperative morbidity of pelvic exenteration (PE) has gradually decreased, and it has become a curative treatment option for some patients with recurrent gynecological malignancies. However, more evidence is still needed to support its efficacy. This study aimed to explore the safety and long-term survival outcome of PE and the feasibility of umbilical single-port laparoscopic PE for gynecologic malignancies in a single medical center in China.Patients and methodsPE for gynecological cancers except for ovarian cancer conducted by a single surgical team in Sun Yat-sen University Cancer Center between July 2014 and December 2019 were included and the data were retrospectively analyzed.ResultsForty-one cases were included and median age at diagnosis was 53 years. Cervical cancer accounted for 87.8% of all cases, and most of them received prior treatment (95.1%). Sixteen procedures were performed in 2016 and before, and 25 after 2016. Three anterior PE were performed by umbilical single-site laparoscopy. The median operation time was 460 min, and the median estimated blood loss was 600 ml. There was no perioperative death. The years of the operations was significantly associated with the length of the operation time (P = 0.0018). The overall morbidity was 52.4%, while the severe complications rate was 19.0%. The most common complication was pelvic and abdominal infection. The years of surgery was also significantly associated with the occurrence of severe complication (P = 0.040). The median follow-up time was 55.8 months. The median disease-free survival (DFS) was 17.9 months, and the median overall survival (OS) was 25.3 months. The 5-year DFS was 28.5%, and the 5-year OS was 30.8%.ConclusionPE is safe for patient who is selected by a multi-disciplinary treatment, and can be a curative treatment for some patients. PE demands a high level of experience from the surgical team. Umbilical single-port laparoscopy was a technically feasible approach for APE, meriting further investigation.

Capacity and needs assessment of veterinary services in Vietnam in biosecurity, biosafety and One Health.

The Asia-Pacific region is recognised as an epicentre of emerging infectious diseases (EIDs), of which 75% are zoonotic in nature. Vietnam is recognised as a potential hotspot for zoonotic EIDs. There is a growing recognition that progress towards global health security requires greater focus on collaboration between the human health and animal health sectors to control diseases at their animal source and prevent against human health impacts. Assessment of veterinary epidemiology capacity in Vietnam is paramount to strengthening the health security of Asia-Pacific. This study aims to evaluate the national capacity and needs of veterinary services in Vietnam in biosecurity, biosafety and One Health. A cross-sectional, convergent mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government-employed field veterinarians. Descriptive analyses and logistic regression models were performed using survey responses to understand capacity in the field. Semi-structured interviews were also conducted with stakeholders in veterinary services including government, academia, research institutes, non-profit and international organisations. Coding and thematic analysis using a deductive approach was used for data collected from interviews to contextualise findings from the survey and understand institutional capacity. In total, 178 field veterinarians completed the online survey and 25 stakeholders were interviewed. The majority of participants had reported receiving training in biosecurity and biosafety, including use of personal protective equipment. Most respondents reported practicing good biosecurity measures (92%) and good biosafety measures (88%). Physical and socioeconomic barriers to practicing biosecurity were reported to be prevalent for smallholder farmers, which may suggest a gap in the capacity of veterinary services to provide cost-effective and practical biosecurity strategies. Seventy five percent of participants had never or rarely participated in One Health approaches in the field in the last 12 months and 69% reported further training as a high priority. There was a knowledge gap reported amongst district and commune-level veterinary staff about the need for, and awareness of multisectoral collaboration. Respondents that completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs (adjusted OR: 3.06; 95% CI: 1.01, 9.23, p = 0.046) and had longer job tenure between 10-12 years (OR: 10.38; 95% CI: 3.06, 35.15, p = <0.001) were more likely to have higher levels of experience in One Health. This study identified gaps in knowledge, attitudes and adoption of practices related to biosecurity, biosafety and One Health specifically in lower-level or less experienced veterinary staff without further training opportunities in epidemiology. These findings enable prioritisation of training, policy, and planning activities to further enhance the national capacity of veterinary services in Vietnam.

Investigating the workforce capacity and needs for animal disease surveillance and outbreak investigation: a mixed-methods study of veterinary services in Vietnam.

The need for strengthening national capacities for disease prevention, preparedness, and response is increasingly becoming urgent. Central to this is strengthening existing systems and workforce capacity for disease surveillance and disease outbreak response. This study aimed to evaluate the national capacity and needs of veterinary services in Vietnam in animal disease surveillance and outbreak investigation skills. A cross-sectional, convergent, mixed-methods study was conducted between November 2020 and April 2021. An online questionnaire was administered to government field veterinarians, followed by descriptive and multivariable analyses to understand field capacity, specifically levels of experience in outbreak investigation and animal health surveillance. Semi-structured interviews were conducted with various stakeholders in veterinary services and interview transcripts were coded and thematically analyzed. Qualitative results were used to contextualize quantitative findings from the survey. Overall, 178 field veterinary staff completed the online survey, and 25 stakeholders were interviewed. Eighty percent of respondents reported a high priority for further training in both animal disease surveillance and outbreak investigation. Training and competence were more limited at the district and commune levels, highlighting a gap in capacity at the subnational level. Reasons included a lack of in-depth training opportunities, limited access to resources and high staff turnover. Respondents who completed postgraduate qualifications in epidemiology or Field Epidemiology Training Programs were more likely to have higher levels of experience in animal health surveillance and outbreak investigation. This study identified gaps in knowledge and adoption of practices most often related to local-level or less experienced veterinary staff with limited training opportunities in epidemiology. Findings inform the prioritization of training and planning activities to further enhance the national capacity of veterinary services in Vietnam. Underlying explanations for existing gaps in capacity include inequities in skill development and training opportunities across levels of veterinary staff, gaps in the chain of command and unequal funding across provinces.

A New, Effective, Safe, and Accurate Method of Cervical Selective Nerve Root Block

Objective: Cervical selective nerve root block (SNRB) is an effective procedure that has long been performed for patients with radiating pain or paresthesia. However, there are several delicate structures around the cervical nerve root, damage to which could lead to irreversible neurovascular injury. Therefore, cervical SNRB requires a high skill level and extensive experience to execute it safely. To overcome these disadvantages, we used biplane computed tomography (CT)-guided fluoroscopy and a needle guidance program to achieve symptom improvement in a safer and shorter procedure. This study aimed to investigate the new method and report on its excellent clinical effects.Methods: A total of 57 patients who experienced radiating pain due to cervical spinal stenosis resulting from a herniated disc were enrolled. From September 2020 to September 2021 subjects underwent a biplane CT-guided fluoroscopic nerve block at an outpatient clinic. All procedures were performed by biplane CT-guided fluoroscopy. We analyzed treatment effects with a numerical rating scale (NRS) at 2 and 4 weeks after the procedure. Logistic regression was performed to reveal the significance of changes in NRS after the injection.Results: Pain improved in 56 of 57 patients (98%) after 2 and 4 weeks of follow-up compared to pre-injection pain. At the 2-week follow-up, the mean reduction based on NRS scores was 3.226 (2.782-3.674, 0; 95% confidence interval [CI], p &lt; 0.001) indicating a 48% decrease in pain scores compared with the initial NRS. The mean reduction in NRS 4 weeks after the procedure was 3.544 (3.090-3.998, 0; 95% CI, p &lt; 0.001) indicating a 52% reduction compared with the initial NRS. The average duration of the procedure was 4 minutes. Conclusion: We demonstrate a clinically effective, safe, and accurate method using a biplane CT-guided fluoroscopy and needle guide program. This new method can be an easy and relatively uncomplicated alternative to treatment for patients with cervical radiculopathy and provides safe and accurate targeting, making it easy for inexperienced surgeons.

Students’ Identification with Political and Ideological Theory Course at Chinese Universities: The Mediating Role of Emotional Experiences

This study aims to investigate the current status of college students’ identification with ideological and political theory courses (IPTC) in Chinese universities, as well as to explore the role of emotional experiences in the relationship between course cognition and course identification. Data were collected through the Curriculum Cognition Scale, the Positive-Negative Emotional Experiences Scale, and the Curriculum Identification Scale, and a total of 1,356 students from 10 different colleges and universities in China participated in the survey. Pearson correlation analysis, regression analysis and mediation effect analysis were used to analyze the data obtained. The results showed that the current Chinese university students’ identification with IPTC is at a moderately high level, both course cognition and emotional experiences have a significant positive effect on course identification, negative emotional experiences have a significant negative effect on course identification, and both positive and negative emotional experiences partially mediate between course cognition and course identification. The findings are discussed with the available relevant literature and suggestions were presented.

Mind ascribed to AI and the appreciation of AI-generated art

Creative artificial intelligence (AI) has received a lot of attention in recent years. Artworks that are introduced to be generated by AI (rather than a human artist) are, however, often evaluated negatively. Integrating extant research, we suggest that AI is ascribed less mind (i.e. agency and experience) which is responsible for this effect. In two experiments ( N = 176 and N = 381) we observed negative indirect effects of artist information (AI vs human artist) on the appreciation of visual artworks. The AI is consistently ascribed less agency and less experience than a human artist. Higher levels of experience and agency ascribed to an artist are, in turn, associated with higher appreciation of a piece of art. In both experiments the total effect of artist information on appreciation was not significant. Artist information did not predict whether the artwork deviated positively from viewers’ expectations developed before the actual artwork was encountered.

The dark side of travel: the effect of tourist harassment on destination image and destination revisit intent: a moderated mediation approach

PurposeThe authors’ examination aims to offer a quantitative perspective on the interrelationships between tourist harassment, the destination image, emotions and destination revisit intent. Furthermore, it explores the moderating role of travelers' experiences and tolerance in the link between tourist harassment, the destination image and revisit intentions.Design/methodology/approachThe authors’ examination seeks to fill this research gap by utilizing a combination of qualitative and quantitative methods to test eight hypotheses using AMOS 23 and PROCESS MARCO.FindingsThe findings showed that tourist harassment negatively impacts the destination image and revisit intentions. Moreover, it indicated that tourists' experiences and tolerance moderate the link between harassment, the destination image and revisit intentions for travelers with high levels of experience and tolerance compared to those with low levels.Originality/valueThis article contributes to travel research and service failure recovery research on tourist harassment and its consequences. To this end, it developed and validated a new tourist harassment scale. Moreover, it is the first study that examines the moderating role of visitors' experiences and tolerance on the link between tourist harassment, the destination image and revisit intentions. Finally, this article is the first to empirically offer destination harassment reduction techniques.

Pancreaticobiliary Diseases with Severe Complications as a Rare Indication for Emergency Pancreaticoduodenectomy: A Single-Center Experience and Review of the Literature.

The pancreaticobiliary system is a complex and vulnerable anatomic region. Small changes can lead to severe complications. Pancreaticobiliary disorders leading to severe complications include malignancies, pancreatitis, duodenal ulcer, duodenal diverticula, vascular malformations, and iatrogenic or traumatic injuries. Different therapeutic strategies, such as conservative, interventional (e.g., embolization, stent graft applications, or biliary interventions), or surgical therapy, are available in early disease stages. Therapeutic options in patients with severe complications such as duodenal perforation, acute bleeding, or sepsis are limited. If less invasive procedures are exhausted, an emergency pancreaticoduodenectomy (EPD) can be the only option left. The aim of this study was to analyze a single-center experience of EPD performed for benign non-trauma indications and to review the literature concerning EPD. Between January 2015 and January 2022, 11 patients received EPD due to benign non-trauma indications at our institution. Data were analyzed regarding sex, age, indication, operative parameters, length of hospital stay, postoperative morbidity, and mortality. Furthermore, we performed a literature survey using the PubMed database and reviewed reported cases of EPD. Eleven EPD cases due to benign non-trauma indications were analyzed. Indications included peptic duodenal ulcer with penetration into the hepatopancreatic duct and the pancreas, duodenal ulcer with acute uncontrollable bleeding, and penetration into the pancreas, and a massive perforated duodenal diverticulum with peritonitis and sepsis. The mean operative time was 369 min, and the median length of hospital stay was 35.8 days. Postoperative complications occurred in 4 out of 11 patients (36.4%). Total 90-day postoperative mortality was 9.1% (1 patient). We reviewed 17 studies and 22 case reports revealing 269 cases of EPD. Only 20 cases of EPD performed for benign non-trauma indications are reported in the literature. EPD performed for benign non-trauma indications remains a rare event, with only 31 reported cases. The data analysis of all available cases from the literature revealed an increased postoperative mortality rate of 25.8%. If less invasive approaches are exhausted, EPD is still a life-saving procedure with acceptable results. Performed by surgeons with a high level of experience in hepatobiliary and pancreatic surgery, mortality rates below 10% can be achieved.