The white test for intraoperative screening of bile leakage: a potential trigger factor for acute pancreatitis after liver resection—a case series

Background Acute pancreatitis after liver resection is a rare but serious complication, and few cases have been described in the literature. Extended lymphadenectomy, and long ischemia due to the Pringle maneuver could be responsible of post-liver resection acute pancreatitis, but the exact causes of AP after hepatectomy remain unclear. Cases presentation We report here three cases of AP after hepatectomy and we strongly hypothesize that this is due to the bile leakage white test. 502 hepatectomy were performed at our center and 3 patients (0.6%) experienced acute pancreatitis after LR and all of these three patients underwent the white test at the end of the liver resection. None underwent additionally lymphadenectomy to the liver resection. All patient had a white-test during the liver surgery. We identified distal implantation of the cystic duct in these three patients as a potential cause for acute pancreatitis. Conclusion The white test is useful for detection of bile leakage after liver resection, but we do not recommend a systematic use after LR, because severe acute pancreatitis can be lethal for the patient, especially in case of distal cystic implantation which may facilitate reflux in the main pancreatic duct.

Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant

Background Intra-operative bile leakage testing is very important in partial liver resection in living donor liver transplant as it allows detection of bile leaking points on the cut surface and decreases postoperative bile leak which is one of the most dreadful complication following liver transplant surgery. In this study we tried to assess the Effectiveness of White test versus conventional saline test in minimizing biliary leak in partial liver resection in living donor liver transplant. Objective In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of biliary leakage in patients who will undergo partial liver resection as living donor liver transplant. Methodology In this study, we assess whether the White test is better than the conventional saline test for the intraoperative detection of bile leakage in patients who underwent partial liver resection as a living donor liver transplant. This study included 60 patients who received partial liver resection as a living donor liver transplant. The conventional saline test (injecting an isotonic sodium chloride solution through the cystic duct) was carried out in 30 patients and the White test (injecting a fat emulsion solution through the cystic duct) was carried out in 30 patients Results Incidence of postoperative bile leakage was compared between the conventional method and the White test. Bile leakage occurred in 8 patients (26.7%) in the conventional method group and in 2 patients (6.7%) in the White test group. In addition, the White test detected intraoperative a significantly higher number of bile leakage sites compared with the conventional method. The White test is better than the conventional test for the intraoperative detection of bile leakage. Conclusion Based on our study, we recommend that surgeons investigating bile leakage sites during liver resections should use the White test instead of the conventional saline test.

White test versus conventional saline test in detecting intra-operative bile leakage in liver resection

Background Hepatic surgery will be always one of the most challenging surgical procedures due to its anatomical and pathophysiologic varieties. Various problems may complicate the post-operative course. Bile leak remains a serious complication after hepatectomy. Bile leaks can significantly impact morbidity, mortality, and cost of treatment. Bile leak increases risk of sepsis, need for further intervention, either radiological or return to theatre, prolongs duration of intensive care unit and hospital stay, and can precipitate liver failure and death. Objective To assess the post-operative bile leak complication after using white test versus conventional saline test Patients and Methods A prospective study on 50 Hepatectomy cases divided into two groups, the first group consist of 25 cases using white test and the second group consist of 25 cases using conventional saline test from January 2019 to January 2020, at Hepatobiliary unit of the general surgery department of Ain Shams university hospitals. Results The White test has clear advantages in comparison with other bile leakage tests: it precisely detects bile leakages, regardless of size; it does not stain the resection surface, allowing it to be washed off and repeated ad infinitum; and it is safe, quick, and inexpensive. The white test is a feasible and sensitive bile leakage test with no obvious disadvantages. It could be a possible standardized method to prevent bile leakage in major liver resection. Conclusion Now after we discussed our study and reviewed other opinions discussing the optimal methods for intraoperative bile leakage testing, we have now settled on White test using fat emulsion solution to be best of all tests.

The Effect of CEO on Bank Efficiency: Evidence From Private Commercial Banks

The main purpose of this study was to analyze the effects of Chief Executive Officer (CEO) Key attributes on the financial performance of banks. Current literature gives little attention to the important characteristics of CEOs, therefore, this paper investigates the effects of characteristics of CEOs, such as education, experience, nationality, military background (MTB), and political connectedness (PC), on the financial (return on assets) performance of listed private commercial banks in Pakistan. This research sample included 20 private commercial banks of Pakistan and used Secondary data that was derived from 2011 to 2020, which contained 200 sample observations. This paper used the Fixed effect model, Normality test, Breush–Pagan, white test, multi-collinearity, and Augmented Dickey–Fuller test to investigate the study hypotheses. The main results revealed that CEO MTB and PC significantly and positively affected the financial performance of the bank. It is also found that the CEO's education and Experience have a significant and positive relationships with bank profitability. In contrast, the nationality of the CEO has no significant relationship with the financial performance of the bank.

Impact of Inflation and Unemployment on Economic Growth of Pakistan

This paper aims to identify the influence of inflation and unemployment on the economic growth of the country. This study recommends some essential policies about unemployment and inflation in the economic growth of Pakistan. In this study, the “Ordinary Least Square (OLS)” method is used with different diagnostic tests for determining the fitness of data for the investigation; and the data is collected from 1980 to 2018. The econometric results suggest that the time series is stationary because the values of t-statistic are more than t-tab and sig value is also significant. The error term on ADF is significant and that ensures that there is long term association. The results of ECM indicate that inflation and unemployment are away from the value of equilibrium. The results of multiple linear regression models indicate that inflation and unemployment are statistically insignificant, and the overall model is also statistically insignificant. There is no multicollinearity and there is no heteroscedasticity as per White test. By running the Ramsay Reset test, the researcher concludes that the model is not specified because the sig value of the t-test and f-test is significant.

Diagnostic role of the ‘white test’ with lipidic solution in the early intraoperative identification of open bile ducts for the prevention of bile leakage after liver resection: study protocol for a randomised controlled multicentric superiority trial (BiLe-Trial)

IntroductionBile leakage is a frequent complication after liver resection associated with the need of interventional drainage, endoscopic retrograde cholangio pancreatography (ERCP) or reoperation. The intraoperative application of the white test could be a promising strategy to reduce the occurrence of bile leakages. Therefore, we propose to conduct the first multicentric randomised controlled trial with rate of postoperative bile leakage as primary endpoint with and without the white test.Methods and analysisThe Bile-Leakage Trial trial is an investigator-initiated randomised controlled, parallel group, double-blinded, multicentric, superiority trial in four Swiss centres. A total of 210 patients undergoing a resection of at least 2 liver segments will be randomly allocated intraoperatively to either the intervention (identification of open bile ducts with administration of 20–40 mL SMOFlipid5% in the bile tract) or the control group (identification with a white gauze on the liver resection surface).Primary outcome will be the comparison of the postoperative bile leakage rate in both groups within 30 days after liver resection, defined according to the classification of the International Study Group of Liver Surgery. Secondary outcomes will be operative and postoperative complication, including severity grade of the bile leakage, rate of ERCP, interventional drainage, morbidity, intensive care unit stay, and mortality.Ethics and disseminationThe cantonal ethics committees of all participating centres and Swissmedic approved the study. SMOFlipid20% consists of a mixture of oils, no side effects resulting from the intraoperative application of 20–40 mL in the biliary tract with consecutive enteral absorption are expected nor are side effects described in the literature. SMOFlipid20% will be diluted intraoperatively with isotonic saline solution to a concentration of 5%. The results of the BiLe-Trial will be submitted to a peer-reviewed journal regardless of the outcome. As this is an investigator-initiated trial, data are property of the sponsor investigator and can be obtained on request.Trial registration numberClinicaltrials.gov, ID: NCT04523701. Registered on 25 August 2020.Swiss National Clinical Trials Portal (SNCTP), ID: SNCTP000004200. Registered on 20 January 2021.Protocol versionV3.2_14-12-2020_clean.pdf

Paying for Whose Performance? Teacher Incentive Pay and the Black–White Test Score Gap

Teacher performance pay is often introduced with the goal of reducing gaps in test scores across groups, yet little is known about how well they achieve this aim. We ask, “Do test score-based teacher incentives impact the Black–White test score gap?” Using student–teacher matched data and a difference-in-differences approach in which the performance of a teacher’s students before and after the policy is compared, we find that performance pay increases the conditional Black–White gap. The effect is particularly evident when bonuses are large, consistent with a causal response to performance pay.

How Much Does the Cardinal Treatment of Ordinal Variables Matter? An Empirical Investigation

Many researchers use an ordinal scale to quantitatively measure and analyze concepts. Theoretically valid empirical estimates are robust in sign to any monotonic increasing transformation of the ordinal scale. This presents challenges for the point-identification of important parameters of interest. I develop a partial identification method for testing the robustness of empirical estimates to a range of plausible monotonic increasing transformations of the ordinal scale. This method allows for the calculation of plausible bounds around effect estimates. I illustrate this method by revisiting analysis by Nunn and Wantchekon (2011, American Economic Review, 101, 3221–3252) on the slave trade and trust in sub-Saharan Africa. Supplemental illustrations examine results from (i) Aghion et al. (2016, American Economic Review, 106, 3869–3897) on creative destruction and subjective well-being and (ii) Bond and Lang (2013, The Review of Economics and Statistics, 95, 1468–1479) on the fragility of the black–white test score gap.

PCA Forecast Averaging—Predicting Day-Ahead and Intraday Electricity Prices

Recently, the development in combining point forecasts of electricity prices obtained with different length of calibration windows have provided an extremely efficient and simple tool for improving predictive accuracy. However, the proposed methods are strongly dependent on expert knowledge and may not be directly transferred from one to another model or market. Hence, we consider a novel extension and propose to use principal component analysis (PCA) to automate the procedure of averaging over a rich pool of predictions. We apply PCA to a panel of over 650 point forecasts obtained for different calibration windows length. The robustness of the approach is evaluated with three different forecasting tasks, i.e., forecasting day-ahead prices, forecasting intraday ID3 prices one day in advance, and finally very short term forecasting of ID3 prices (i.e., six hours before delivery). The empirical results are compared using the Mean Absolute Error measure and Giacomini and White test for conditional predictive ability (CPA). The results indicate that PCA averaging not only yields significantly more accurate forecasts than individual predictions but also outperforms other forecast averaging schemes.