Superiority trial for the development of an ideal method for the closure of midline abdominal wall incisions to reduce the incidence of wound complications after elective gastroenterological surgery: study protocol for a randomized controlled trial.

BACKGROUND: The recent guidelines from the European and American Hernia Societies recommend a continuous small-bite suturing technique with slowly absorbable sutures for fascial closure of midline abdominal wall incisions to reduce the incidence of wound complications, especially for incisional hernia. However, this is based on low-certainty evidence. We could not find any recommendations for skin closure. The wound closure technique is an important determinant of the risk of wound complications, and a comprehensive approach to prevent wound complications should be developed. METHODS: We propose a single-institute, prospective, randomized, blinded-endpoint trial to assess the superiority of the combination of continuous suturing of the fascia without peritoneal closure and continuous suturing of the subcuticular tissue (study group) over that of interrupted suturing of the fascia together with the peritoneum and interrupted suturing of the subcuticular tissue (control group) for reducing the incidence of midline abdominal wall incision wound complications after elective gastroenterological surgery with a clean-contaminated wound. Permuted-block randomization with an allocation ratio of 1:1 and blocking will be used. We hypothesize that the study group will show a 50% reduction in the incidence of wound complications. The target number of cases is set at 284. The primary outcome is the incidence of wound complications, including incisional surgical site infection, hemorrhage, seroma, wound dehiscence within 30 days after surgery, and incisional hernia at approximately 1 year after surgery. DISCUSSION: This trial will provide initial evidence on the ideal combination of fascial and skin closure for midline abdominal wall incision to reduce the incidence of overall postoperative wound complications after gastroenterological surgery with a clean-contaminated wound. This trial is expected to generate high-quality evidence that supports the current guidelines for the closure of abdominal wall incisions from the European and American Hernia Societies and to contribute to their next updates. TRIAL REGISTRATION: UMIN-CTR UMIN000048442. Registered on 1 August 2022. https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055205.

Effects of daily management changes on behavioral patterns of a solitary female African elephant (Loxodonta africana) in a zoo.

This study investigated the effects of changes in daily management on behavior of a solitary female elephant in a zoo. The activity budget and space utilization of the subject and the management changes were recorded for 1 year after the conspecific male died. The observation days could be categorized into five clusters (C1-C5) by the characteristic behavioral pattern of each day. C1 had the highest percentage of resting of all clusters, and was observed after the loss of the conspecific and the beginning of use of the indoor exhibition room at night. C2, which had the highest percentage of stereotypy of any cluster, was observed after the beginning of habituation to the indoor exhibition room. Also, when the time schedule of management was changed irregularly, the subject frequently exhibited stereotypic pacing (C2, C4). The subject tended to rest when exhibiting lameness in the left hind limb (C3). In C5, activity reached a high level when she could utilize a familiar place under a stable management schedule. These results indicate that management changes affected the mental stability of an elephant in the early stage of social isolation.

Function of tongue-playing of cattle in association with other behavioral and physiological characteristics.

To study the function of tongue-playing of cattle, this study observed 71 Japanese Black x Holstein steers after feeding in 2 repetitive experiments. The number of steers who performed tongue-playing did not differ among the 3 levels of environmentally enriched pens. Most (90.6%) performances of tongue-playing terminated within 20 min. Frequency of tongue-playing positively correlated with the frequency of resting (r = 0.25, p < .05). Frequency of eating was lower in tongue-playing steers (n = 40) than in non-tongue-playing steers (n = 31; p < .05). Frequencies of self-grooming (p < .05), ruminating (p < .05), and lying ruminating (p < .01) were higher in tongue-playing steers. Plasma dopamine concentration was lower in tongue-playing steers (p < .05). In conclusion, tongue-playing that lasts only for a short time after feeding was induced by behavioral features of steers who rest more and eat hay less at the same time as they perform grooming and ruminating.

Oral behaviors of beef steers in pen and pasture environments.

This study observed the behavioral characteristics of 122 steers in eight pens and 1,136 steers at six pastures. Nonhuman animals kept in pens performed less nutritive oral behaviors and more nonnutritive oral behaviors than animals kept at pasture. Although these could not be described as stereotypies, they did represent a replacement of nutritive oral behaviors by nonnutritive oral behaviors, rather than simply an increase in resting time. This could be indicative of a level of oral frustration. At pasture, there was a greater proportion of oral behaviors in animals with low pasture availability as compared to high availability, but this was an increase in nutritive oral behaviors rather than nonnutritive oral behaviors. Factors other than oral frustration--for example, rumen fill--probably drove this increase.