Seroprevalence and risk factors of Toxoplasma gondii infection in goats from South Punjab Province, Pakistan.

Layyah District in South Punjab Province of Pakistan offers the most intensive caprine economy in the country; its Indus riverine and desert environment makes the area peculiar and worthy of specific investigations. This study aimed to investigate the prevalence of anti-Toxoplasma gondii (T. gondii) IgG-antibody in goats in serum samples and the potential risk factors. The prevalence of T. gondii infection was estimated using a two-stage sample design. All caprine farms in the study area were stratified by size, and from these 110 were randomly selected. Twelve goats (>1-year-old) were selected from each farm and a total of 1320 serum samples were collected and tested by ELISA. A questionnaire on the conditions and management practices of each farm was administered to 110 farmers. Four hundred and sixteen out of 1320 sera samples (31.5%) were found positive and 89% of the flock had at least one seropositive goat. The proportion of seropositive goats tested within each flock ranged from 8.3% to 83.3%. with several factors contributing to this heterogeneity. Goat age played a significant role in the presence of cats. Significant interactions were related to goat farms having floor of dirt and kitten presence. Moreover, age class, abortion history and water source supply were modulated by owner education levels. This is the first study to determine the prevalence of anti-T. gondii antibodies in goats sera in Layyah district and the largest carried out so far in Pakistan. The remarkable presence of T. gondii among goats in areas where goat farming plays a significant economic role may pose a production threat to the small-stock industry, as well as to public health and food safety. Therefore, investigations to identify high-risk goat populations are highly recommended in order to facilitate the implementation of local control strategies.

A key parametric study of ultrasonic exfoliation of 2D TiB2 using DI water as a unique medium.

Liquid Phase Exfoliation (LPE) is a very effective technique for the synthesis of few layered two dimensional (2D) nanosheets. There is a surge to find environment friendly solvents for efficient exfoliation of layered materials to produce 2D nanosheets. TiB2 is an important layered material with very little reported work on its 2D nanosheets. The present work is about successful LPE of TiB2 using deionized (DI) water as a clean, green and low cost dispersion medium to make TiB2 nanosheets. The impact of ultrasonication conditions i.e. input power and treatment duration for efficient synthesis of few layered 2D nanosheets in DI water is studied by Atomic Force Microscopy (AFM), X-Ray Diffraction (XRD) and Scanning Electron Microscopy (SEM). It is found that by increasing input power, the layer thickness is reduced from bulk to 34 nm with lateral dimensions as huge as up to 5 µm. The increased treatment duration has further reduced the layer thickness to 21 nm associated with a decrease in lateral dimensions to about 1 µm. The mechanism of variation in the aspect ratio of the 2D nanosheets with ultrasonication power and treatment duration is explained. The optimum conditions for the fabrication of high aspect ratio 2D nanosheets of TiB2 owe to a greater acoustic cavitation intensity, an optimum treatment duration and a homogenous distribution of the cavitation events while using an appropriate size of the sonotrode in the sonicated volume during ultrasonication.

Risk analysis and seroprevalence of bovine ephemeral fever virus in Punjab, Pakistan.

Bovine ephemeral fever (BEF) is a vector-borne viral disease caused by the RNA virus which belongs to the genus Ephemerovirus and the family Rhabdoviridae. To evaluate the effect of the risk factors like the breed of cattle and buffaloes, age, sex, lactation, housing and region on the bovine ephemeral fever virus (BEFV) prevalence, ELISA and virus neutralisation (VN) tests (n = 600) were performed for the BEFV prevalence. The seroprevalence in cattle was 45.6% and 42% by ELISA and VN, respectively (P = 0.001). The breed-wise seropositive ratio was (55-64%) in cattle and (22.5-18.3%) in buffaloes by VN and ELISA. The sex-wise prevalence was (40-49.4%) in females and (35.8-46%) in males by VN and ELISA in cattle and a similar prevalence was reported in buffaloes. The age-wise prevalence in bovines by ELISA was 5.33, 22.66 and 17.66% in the age group < 1 year, 1-3 years and > 3 years, respectively. The disease prevalence was higher in the age group of 1-3 years. The prevalence was higher during the 3rd lactation in bovines. The region-wise prevalence was higher in the 07 districts while lower (18-21%) in Rawalpindi District by VN and ELISA, respectively (P = 0.001). Commercial dairy farms of cattle showed a higher disease prevalence (52% and 44%) than non-commercial farms (38% and 36%) by ELISA and VN, respectively (P = 0.227). Exotic cows showed higher disease prevalence (76.67% and 70%) by ELISA and VN. The mortality in bovines was 5% (7.7% and 2.3%) in the cattle and buffaloes. The case fatality of BEFV in bovines was 12.25%. There was a significant effect of the risk factors like the breed, age, sex, lactation, housing and region on the BEFV prevalence. This is the first comprehensive study of BEFV in Pakistan.

Successful management of cervical tuberculosis and severe kyphosis using polyetheretherketone expandable cage and titanium plate: A case report.

Key Clinical Message: Successful management of cervical tuberculosis and severe kyphosis was achieved using a PEEK expandable cage and titanium plate, demonstrating favorable outcomes in restoring cervical alignment and stability. This approach represents a promising alternative for addressing complex cervical pathologies, highlighting the potential of PEEK-based interventions in surgical management. Abstract: Cervical tuberculosis can lead to severe vertebral destruction and kyphosis, posing challenges in surgical management. Recent advancements, including the use of polyetheretherketone (PEEK) expandable cages and titanium plates, show promise in addressing multilevel cervical pathologies. This report details the successful treatment of a 27-year-old male with cervical tuberculosis and severe kyphosis. Surgical intervention involved prevertebral abscess evacuation, C5-C7 corpectomy, and insertion of a PEEK expandable cage with an anterior titanium plate. Postoperative care included a Philadelphia collar, and follow-up demonstrated restored cervical alignment and stability. The use of PEEK-based surgical interventions, as demonstrated in this case, represents a significant evolution in managing complex cervical conditions. The successful outcome highlights the potential benefits of PEEK expandable cages in addressing cervical tuberculosis and kyphosis. Further research is needed to validate these findings and establish PEEK-based interventions as a viable alternative in such cases.

Green-fabricated silver nanoparticles from Quercus incana leaf extract to control the early blight of tomatoes caused by Alternaria solani.

BACKGROUND: Early blight (EB) of Tomatoes, caused by Alternaria solani, is a serious fungal disease that adversely affects tomato production. Infection is characterized by dark lesions on leaves, stems, and fruits. Several agrochemicals can be used to control infection, these chemicals may disrupt environmental equilibrium. An alternative technology is needed to address this significant fungal threat. This study was designed to control the growth of EB in tomatoes caused by A. solani, using green-fabricated silver nanoparticles (Ag-NPs). RESULTS: Ag-NPs were synthesized through an environmentally friendly and cost-effective approach using leaf extract of Quercus incana Roxb. (Fagaceae). The physico-chemical characterization of the Ag-NPs was conducted through UV-visible spectroscopy, scanning electron microscopy, X-ray diffraction analysis, and Fourier transform infrared spectrometry. The Ag-NPs produced were round with a mean diameter of 27 nm. The antifungal activity of these Ag-NPs was assessed through in vitro Petri plate and in vitro leaflet assays against A. solani. The green fabricated Ag-NPs exhibited excellent antifungal activity in vitro at a concentration of 100 mg/l against A. solani, inhibiting growth by 98.27 ± 1.58% and 92.79 ± 1.33% during Petri plate and leaflet assays, respectively. CONCLUSION: In conclusion, this study suggests the practical application of green-fabricated Ag-NPs from Q. incana leaf extract against A. solani to effectively control EB disease in tomatoes.

Offloading the computational complexity of transfer learning with generic features.

Deep learning approaches are generally complex, requiring extensive computational resources and having high time complexity. Transfer learning is a state-of-the-art approach to reducing the requirements of high computational resources by using pre-trained models without compromising accuracy and performance. In conventional studies, pre-trained models are trained on datasets from different but similar domains with many domain-specific features. The computational requirements of transfer learning are directly dependent on the number of features that include the domain-specific and the generic features. This article investigates the prospects of reducing the computational requirements of the transfer learning models by discarding domain-specific features from a pre-trained model. The approach is applied to breast cancer detection using the dataset curated breast imaging subset of the digital database for screening mammography and various performance metrics such as precision, accuracy, recall, F1-score, and computational requirements. It is seen that discarding the domain-specific features to a specific limit provides significant performance improvements as well as minimizes the computational requirements in terms of training time (reduced by approx. 12%), processor utilization (reduced approx. 25%), and memory usage (reduced approx. 22%). The proposed transfer learning strategy increases accuracy (approx. 7%) and offloads computational complexity expeditiously.

Fabrication of MoS2/rGO hybrids as electrocatalyst for water splitting applications.

Environmental degradation and energy constraint are important risks to long-term sustainability in the modern world. Water splitting is a vital approach for environmentally friendly and sustainable energy storage, providing a clean way to produce hydrogen without pollutants. Preparing a catalyst that is active, bifunctional, and durable for water splitting is a difficult task. We addressed the difficulty by creating a bifunctional heterogeneous catalyst, MoS2/rGO, with an ideal weight percentage of 5 wt% by a hydrothermal process. The optimized sample showed exceptional electrocatalytic activity, requiring an overpotential of 242 mV and 120 mV to achieve a current density of 10 mA cm-2 in the Hydrogen Evolution Reaction (HER) and Oxygen Evolution Reaction (OER). Furthermore, our synthesized catalyst was validated for its exceptional water-splitting capacity, with the optimized sample showing low Tafel slope values of 59 mV dec-1 for HER and 171 mV dec-1 for OER. The significant OER and HER activity seen in the 5 wt% MoS2/rGO hybrid, compared to other hybrids, is due to the many catalytic active sites that aid in charge and electron transport, as well as the synergistic interaction between MoS2 and rGO.

Examining the Efficacy of 38% Silver Diamine Fluoride in Halting Active Dental Caries Lesions Among Children: A Descriptive Study.

BACKGROUND/OBJECTIVES: Dental caries, a prevalent issue among children, often leads to discomfort and potential complications. Utilizing caries-arresting treatments to slow down its progression offers a practical alternative. Previous research indicates that topical fluorides can deactivate and remineralize enamel caries. This study aims to evaluate the efficacy of 38% silver diamine fluoride (SDF) in halting active dental caries lesions in children. MATERIALS AND METHODS: This descriptive case series was conducted at the Operative Dentistry Department of the Nishtar Institute of Dentistry in Multan, Pakistan. We enrolled 753 patients aged three to nine years, of both genders, each with at least one cavitated lesion graded 3-6 according to the International Caries Detection and Assessment System (ICDAS). SDF was directly applied to dried and isolated teeth using a micro brush and left to absorb for up to two minutes (adjusted based on the child's cooperation), and parents were instructed to ensure the child refrained from eating or drinking for an hour post-application. Baseline examinations were performed by consultant restorative dentists, and reexaminations were conducted after two to three weeks by a consultant unaware of the study. RESULTS: The study included children aged three to nine years, with a mean age of 6.02±1.35 years. The majority of patients (61.75%) were aged between three and six years. Among the 753 patients, 619 (82.20%) were male, and 134 (17.80%) were female, with a male-to-female ratio of 4.6:1. The efficacy of 38% SDF in arresting active dental caries lesions in children was observed in 720 (95.62%) patients. CONCLUSION: This study demonstrates that 38% SDF is highly effective in halting active dental caries lesions in children.

Studying Salt-Induced Shifts in Gene Expression Patterns of Glucosinolate Transporters and Glucosinolate Accumulation in Two Contrasting Brassica Species.

Brassica crops are well known for the accumulation of glucosinolates-secondary metabolites crucial for plants' adaptation to various stresses. Glucosinolates also functioning as defence compounds pose challenges to food quality due to their goitrogenic properties. Their disruption leaves plants susceptible to insect pests and diseases. Hence, a targeted reduction in seed glucosinolate content is of paramount importance to increase food acceptance. GLUCOSINOLATE TRANSPORTERS (GTRs) present a promising avenue for selectively reducing glucosinolate concentrations in seeds while preserving biosynthesis elsewhere. In this study, 54 putative GTR protein sequences found in Brassica were retrieved, employing Arabidopsis GTR1 and GTR2 templates. Comprehensive bioinformatics analyses, encompassing gene structure organization, domain analysis, motif assessments, promoter analysis, and cis-regulatory elements, affirmed the existence of transporter domains and stress-related regulatory elements. Phylogenetic analysis revealed patterns of conservation and divergence across species. Glucosinolates have been shown to increase under stress conditions, indicating a potential role in stress response. To elucidate the role of GTRs in glucosinolate transportation under NaCl stress in two distinct Brassica species, B. juncea and B. napus, plants were subjected to 0, 100, or 200 mM NaCl. Based on the literature, key GTR genes were chosen and their expression across various plant parts was assessed. Both species displayed divergent trends in their biochemical profiles as well as glucosinolate contents under elevated salt stress conditions. Statistical modelling identified significant contributors to glucosinolate variations, guiding the development of targeted breeding strategies for low-glucosinolate varieties. Notably, GTR2A2 exhibited pronounced expressions in stems, contributing approximately 52% to glucosinolate content variance, while GTR2B1/C2 displayed significant expression in flowers. Additionally, GTR2A1 and GTR1A2/B1 demonstrated noteworthy expression in roots. This study enhances our understanding of glucosinolate regulation under stress conditions, offering avenues to improve Brassica crop quality and resilience.

Prevalence of Aortic Root Pathologies in Platypnea-Orthodeoxia Syndrome Secondary to Intra-Cardiac Shunts.

Background: Atrial septal defects can allow right to left shunting of venous blood which presents clinically as platypnea-orthodeoxia syndrome. It is believed that concomitant presence of aortic root pathologies increases the likelihood of shunting. Methods: The study included a review of 510 articles listed in PubMed of patients with platypnea-orthodeoxia syndrome. Case reports of patients with extra-cardiac etiologies of platypnea-orthodeoxia were excluded. Results: We reviewed 191 case reports, and 98 cases (51.3%) had evidence of concomitant aortic root pathology. Furthermore, of the remaining 93 case reports, 69 ones excluded any mention of the nature of the aortic root altogether, further suggesting that this is an underreported number. Conclusions: There is a high prevalence of aortic root pathologies in patients with platypnea-orthodeoxia syndrome secondary to intra-cardiac shunts. In patients with unexplained hypoxemia and incidental finding of aortic root pathology, it may be worthwhile to obtain postural oxygen saturation measurements to exclude intra-cardiac shunts as the potential cause.

3D printing technology and its revolutionary role in stent implementation in cardiovascular disease.

Cardiovascular disease (CVD), exemplified by coronary artery disease (CAD), is a global health concern, escalating in prevalence and burden. The etiology of CAD is intricate, involving different risk factors. CVD remains a significant cause of mortality, driving the need for innovative interventions like percutaneous coronary intervention and vascular stents. These stents aim to minimize restenosis, thrombosis, and neointimal hyperplasia while providing mechanical support. Notably, the challenges of achieving ideal stent characteristics persist. An emerging avenue to address this involves enhancing the mechanical performance of polymeric bioresorbable stents using additive manufacturing techniques And Three-dimensional (3D) printing, encompassing various manufacturing technologies, has transcended its initial concept to become a tangible reality in the medical field. The technology's evolution presents a significant opportunity for pharmaceutical and medical industries, enabling the creation of targeted drugs and swift production of medical implants. It revolutionizes medical procedures, transforming the strategies of doctors and surgeons. Patient-specific 3D-printed anatomical models are now pivotal in precision medicine and personalized treatment approaches. Despite its ongoing development, additive manufacturing in healthcare is already integrated into various medical applications, offering substantial benefits to a sector under pressure for performance and cost reduction. In this review primarily emphasizes stent technology, different types of stents, highlighting its application with some potential complications. Here we also address their benefits, potential issues, effectiveness, indications, and contraindications. In future it can potentially reduce complications and help in improving patients' outcomes. 3DP technology offers the promise to customize solutions for complex CVD conditions and help or fostering a new era of precision medicine in cardiology.

Recent strategies to overcome breast cancer resistance.

Breast cancer is potentially a lethal disease and a leading cause of death in women. Chemotherapy and radiotherapy are the most frequently used treatment options. Drug resistance in advanced breast cancer limits the therapeutic output of treatment. The leading cause of resistance in breast cancer is endocrine and hormonal imbalance, particularly in triple negative and HER2 positive breast cancers. The efflux of drugs due to p-gp's activity is another leading cause of resistance. Breast cancer resistant protein also contributes significantly. Strategies used to combat resistance include the use of nanoparticles to target drug delivery by co-delivery of chemotherapeutic drugs and genes (siRNA and miRNA) that help to down-regulate genes causing resistance. The siRNA is specific and effectively silences p-gp and other proteins causing resistance. The use of chemosensitizers is also effective in overcoming resistance. Chemo-sensitizers sensitize cancer cells to the effects of chemotherapeutic drugs. Novel anti-neoplastic agents such as antibody-drug conjugates and mesenchymal stem cells are also effective tools used to improve the therapeutic response in breast cancer. Similarly, combination of photo/thermal ablation with chemotherapy can act to overcome breast cancer resistance. In this review, we focus on the mechanism of breast cancer resistance and the nanoparticle-based strategies used to combat resistance in breast cancer.

The effectiveness of emerging markets' legal structure in explaining financial development.

This article examines the role of legal structure in explaining financial development in twenty-three emerging markets, which has not been explored in institutional economics literature before. This study relied on Pedroni, and Kao cointegration tests, which is followed by the renowned panel cointegration technique. The results of the Pedroni and Kao cointegration tests show that the variables understudy is cointegrated in the long-run. These findings are confirmed by the panel cointegration showing that legal structure (LS) has positive impact on financial development (FIND) in long-run that support Law and Finance, and New Institutional Economics theories in emerging markets. This study is the first to directly examine the long-run impact of LS on FIND in emerging markets, and the result remains consistent across alternative measure of FIND. The findings of this study have important policy implications for emerging markets. Policymakers should focus on creating a legal environment that is conducive to financial development. This includes strengthening the legal framework, improving regulatory regimes, and promoting market autonomy. Additionally, policymakers should work to attract foreign investment, which can help spur economic growth and development in emerging markets. The findings of the study are consistent across battery of robustness testing.

Streptococcus agalactiae Infective Endocarditis in a Young Immunocompetent Male.

Group B Streptococcus endocarditis is a rare but serious condition, characterized by the infection of heart valves and associated with a high mortality rate. The emergence of antibiotic-resistant strains adds complexity to therapeutic strategies, emphasizing the importance of tailored antibiotic regimens and surgical interventions when indicated. Early diagnosis and multidisciplinary care are essential in improving patient outcomes. A 22-year-old male patient with no comorbidities was admitted with a thromboembolic stroke. MRI brain showed bilateral cerebral and cerebellar multifocal acute nonhemorrhagic infarcts. He was found to have Streptococcus agalactiae bacteremia, and infective mitral valve endocarditis. He underwent mitral valve replacement and IV antibiotic treatment with a successful outcome.

Hathewaya limosa Empyema: A Case Report.

Hathewaya limosa, an anaerobic bacterium, has been associated with various infections, including prosthetic valve endocarditis, although its role in empyema remains uncommon. This abstract presents a case report of a patient diagnosed with H. limosa empyema, highlighting the clinical presentation, diagnostic challenges, and successful treatment strategies. The case underscores the importance of considering unusual pathogens in the context of empyema. We discuss the clinical management, microbiological identification, and outcomes of this rare infection to contribute valuable insights for healthcare practitioners encountering similar cases.

Risk of candidiasis associated with interleukin-17 inhibitors: Implications and management.

The application of interleukin-17 (IL-17) inhibitors, including secukinumab, ixekizumab, brodalumab, and bimekizumab, are associated with elevated risk of candidiasis. These medications interfere with the IL-17 pathway, which is essential for maintaining mucosal barriers and coordinating the immune response against Candida species. The observational data and clinical trials demonstrate the increased incidence of candidiasis in individuals treated with IL-17 inhibitors. Brodalumab and bimekizumab pose a greater risk than secukinumab in eliciting candidiasis, whereas the data regarding ixekizumab are equivocal. Higher doses and prolonged treatment duration of IL-17 inhibitors increase the risk of candidiasis by compromising the immune response against Candida species. Prior to prescribing IL-17 inhibitors, healthcare professionals should comprehensively evaluate patients' medical histories and assess their risk factors. Patients should be educated on the signs and symptoms of candidiasis to facilitate early detection and intervention. Future research should focus on identifying the risk factors associated with candidiasis in patients receiving IL-17 inhibitors. Prospective studies and long-term surveillance are required to explore the impact of specific inhibitors on the incidence and severity of candidiasis and to evaluate the effectiveness of combination therapies, such as concurrent use of IL-17 inhibitors and prophylactic antifungal agents.

Surface-Functionalized Magnetic Silica-Malachite Tricomposite (Fe-M-Si tricomposite): A Promising Adsorbent for the Removal of Cypermethrin.

This study assessed the efficacy of adsorption for eliminating the agricultural pesticide cypermethrin (CP) from wastewater using various adsorbents: silica, malachite, and magnetite. Magnetic nanocomposites (NCs) (with varying amounts of Fe3O4 0.1, 0.25, 0.5, 1.0, and 1.5 wt/wt %) were synthesized, including Fe3O4 nanoparticles (NPs), bicomposites, and tricomposites, calcined at 300 and 500 °C, and then tested for CP removal. The study was conducted in two phases, with the objective of initially assessing how effectively each individual NP performed and then evaluating how effectively the NCs performed when used for the adsorption of CP. Notably, the Fe3O4-malachite combination exhibited superior CP removal, with the 0.25-Fe-M NC achieving the highest adsorption at 635.4 mg/g. This success was attributed to the large surface area, magnetic properties of Fe3O4, and adsorption capabilities of malachite. The Brunauer-Emmett-Teller (BET) isotherm analysis indicated that the NCs had potential applications in adsorption and separation processes. The scanning electron microscopy and transmission electron microscopy revealed the spherical, irregular shaped morphology of the synthesized NPs and NCs. However, the X-ray diffraction (XRD) pattern of surface functionalized materials such as surface functionalized malachite [Cu2CO3(OH)2] with Fe3O4 and SiO2 may be complicated by the specific functionalization method used and the relative amounts and crystallographic orientations of each component. Therefore, careful interpretation and analysis of the XRD pattern, along with other techniques, are necessary for accurate identification and characterization of the functionalized material. The originality of this study lies in its comprehensive investigation of several adsorbents and NCs for CP removal at neutral pH. The innovation stems from the synergistic action of Fe3O4 and malachite, which results in improved CP removal due to their combined surface properties and magnetic characteristics. The application of magnetic NCs in adsorption and separation, as validated by BET isotherm analysis, highlights the potential breakthrough in addressing pesticide contamination.

Anesthetic Challenges in a Patient With an Expanding Recurrent Mycotic Pseudoaneurysm of the Right Brachiocephalic Artery: A Case Report and Literature Review.

Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm's enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse. Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy. Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.

Care fragmentation in hepatopancreatic surgery and postoperative outcomes.

BACKGROUND: Practice fragmentation in surgery may be associated with poor quality of care. We sought to define the association between fragmented practice and outcomes in hepatopancreatic surgery relative to surgeon volume and sex. METHODS: Medicare beneficiaries who underwent hepatopancreatic surgery between 2016 and 2021 were identified. Multivariable analysis was performed to determine provider sex-based differences in the rate of fragmented practice relative to the achievement of a textbook outcome and health care expenditures after adjusting for procedure-specific case volume. RESULTS: Among 37,416 patients, almost one-half were female (n = 18,333, 49.0%) with the majority treated by male surgeons (n = 33,697, 90.8%). Female surgeons were more likely to have a greater rate of fragmented practice (females: n = 242, 84.9% vs males: n = 1,487, 78.4%, P = .003; odds ratio 2.66, 95% confidence interval 2.33-3.03, P < .001). Patients treated by high rate of fragmented practice surgeons had increased odds of postoperative complications (odds ratio 1.40, 95% confidence interval 1.28-1.54), extended length-of-stay (odds ratio 1.52, 95% confidence interval 1.38-1.68), 90-day-mortality (odds ratio 1.49, 95% confidence interval 1.28-1.72), and lower odds of achieving a textbook outcome (odds ratio 0.76, 95% confidence interval 0.71-0.83). This association persisted independent of surgeon-specific volume (textbook outcome, high vs low rate of fragmented practice: high-volume surgeon, odds ratio 0.53, 95% confidence interval 0.31-0.91, P = .021 vs. low-volume surgeon, odds ratio 0.76, 95% confidence interval 0.69-0.82, P < .001). Among patients treated by male surgeons, a high rate of fragmented practice was associated with reduced odds of achieving a textbook outcome (male surgeons: odds ratio 0.76, 95% confidence interval 0.70-0.82, P < .001; female surgeons: odds ratio 0.81, 95% confidence interval 0.63-1.05, P = .110). Treatment by surgeons with higher fragmented practice was associated with higher expenditures (index expenditure: percentage difference 9.87, 95% confidence interval, 7.42-12.36; P < .05). CONCLUSION: A high rate of fragmented practice adversely affected postoperative outcomes and healthcare expenditures even among high-volume surgeons with the impact varying based on surgeon sex.