bluuebunny/crossref_metadata_2025 huggingface dataset:
Generativity, Ego Integrity, and the Achievement of Aging Well
Authors: Villar Feliciano , Zacarés Juan José
Published: May 2024

This chapter explores the different ways in which the psychosocial connection between generativity and ego integrity tasks occurs, and how they contribute to achieving successful aging. Firstly, it examines the expression of generativity in later life, highlighting that it cannot simply be seen as an extension of generativity during midlife. Next, it analyzes how the dynamic balance between ego integrity and despair is effectively achieved and resolved. Additionally, the chapter discusses the significance of engaging in life review activities to varying degrees, as well as the generative accomplishments made during the transitional adult period and throughout old age, which serve as fundamental pathways toward a fulfilling and integrated life. Lastly, it proposes a potential characterization of integrative generativity, one that reflects the unique development and expression of generative potential in late life, adapted to the opportunities and limitations of this particular phase in the life cycle.
Work, Retirement, and Generativity over the Lifespan
Authors: Krahn Harvey J , Galambos Nancy L , Johnson Matthew D
Published: May 2024

The chapter explores how engagement in paid work can be both a source and expression of generativity. It reviews the theoretical and empirical connections between aspects of job quality (particularly intrinsic work rewards and work-related satisfaction) and generativity, suggesting that paid work can satisfy and enhance the desire to be generative. The second part of the chapter explores to what extent leaving the world of work (i.e., retirement) may pose challenges or create opportunities for generative expression. The chapter ends with a brief discussion of our own program of research, the Edmonton Transitions Study, which, using longitudinal data, shed light on the relationships between early work experiences and later workplace and personal factors, including generativity.
Generativity and Leadership in Organizations
Authors: Zacher Hannes , Bordia Prashant
Published: May 2024

Generativity refers to people’s motives and behaviors associated with establishing and guiding members of future generations, including younger people at the workplace. Accordingly, there is conceptual overlap between generativity and leadership, which can be broadly defined as a process during which one person influences other people in order to achieve shared goals. This chapter first explores theoretical links between generativity and leadership in organizations. Second, it reviews empirical studies on associations between these constructs. It concludes with suggestions for future research on generativity and leadership and for organizational practice.
Parenting and Generativity
Authors: Peterson Bill E
Published: May 2024

After reviewing Erikson’s adult stages of development and the literature on generativity and positive parenting, this chapter focuses on what can happen when parenting efforts go awry. The psychological literature discussing generativity and the negative impact of parents on offspring is limited. In such cases where theory and research are not well developed, it may be useful to study literary works that thematically address important topics in psychology. Toward this end, this chapter examines Arthur Miller’s Death of a Salesman and to a lesser extent Charles Dickens’ A Christmas Carol as sources for psychological theory building and as inspiration for hypothesis generation on the concept of generativity.
Grandparenting and Generativity
Authors: Celdrán Montserrat
Published: May 2024

Being a grandparent is for many people a significant role in their lives. Elements of generativity aspects could be implicit in this role as regards caregiving tasks, transmitting knowledge, or having a symbolic value for older adults, but little research linking grandparenthood and generativity has been done previously. In that sense, this chapter analyses grandparenthood under the conceptual umbrella of generativity theory following different elements of the generativity model developed by McAdams and de St. Aubin: inner desire, generative concern, generative activities, and narrative. Finally, the chapter discusses the importance of observing the role of grandparenthood in its complexity, how cultural and social aspects could shape the link between grandparenthood and generativity, and how the concept of generativity can help promote intergenerational programs that value the relationship between grandparents and grandchildren.
Political Participation and Generativity across the Lifespan
Authors: Serrat Rodrigo
Published: May 2024

Political participation, which is broadly aimed at generating and improving social and cultural practices, institutions, and values for assuring the continuity and well-being of current and future generations, has been considered as one potential way of expressing generativity. Although research on the relationships between political participation and generativity has not been as extensive as in the case of other communal expressions, such as volunteering, the interest on the topic has grown steadily from Erikson’s seminal works. This chapter explores, from a developmental perspective, how political participation unfolds and changes across the life cycle, focusing on its links to Erikson’s developmental tasks, and particularly to generativity versus the stagnation crisis. It also addresses some of the challenges that political participation could bring to personal and community development, which are related to the reverse of generativity: stagnation.
Culture and Generativity
Authors: Hofer Jan , Busch Holger
Published: May 2024

This chapter reviews the empirical literature on generativity in various cultural contexts. It first defines culture and its relevance for research on developmental processes. Second, it describes methodological problems (e.g., measurement bias) that potentially challenge the meaningfulness of findings gained by research across cultures. Third, it presents some findings on generativity that were produced outside of Western cultural contexts. Fourth, it describes in detail a series of cross-cultural studies that focus on cross-culturally equivalent relationships of generativity with other variables, thus tentatively suggesting universality of these relationships. The fifth and final part of the chapter presents some conclusions and open questions for future culture-informed generativity research.
An Exploration of Generativity among Alaska Native Elders
Authors: Lewis Jordan P
Published: May 2024

Generativity is a stage of development in one’s life described by Erik Erikson as the desire to invest one’s knowledge, skills, and experiences into the future generations. The concept of generativity is important in Alaska Native and other Indigenous cultures, as well as for the survival of societies. Given the importance of generativity for Alaska Native communities, it is critical to locate generativity within the cultural contexts of how it is understood and practiced. Previous studies, including the author’s research, have demonstrated benefits of generativity both for Elders and for younger generations, but with changing community and family values, there are generativity threats including sociocultural changes. Historical and current sociopolitical events have changed the landscape of Alaska Native communities, adversely impacting the health and well-being of Alaska Native Elders, resulting in a breakdown of family systems and intergenerational connections. Despite these changes, Alaska Native Elders continue to exhibit hope for the future through their commitment and passion to pass on their knowledge and skills to benefit future generations, known as generativity.
Generativity and the Continuum of Suffering and Flourishing in Later Life
Authors: de Medeiros Kate , Ermoshkina Polina
Published: May 2024

Although much of the work on generativity has taken place in the context of a lifespan perspective, the authors focus their work on the idea that generativity in later life is a cultural construct deeply connected to the notions of suffering and flourishing. A lifetime of experiences and social marginalization in old age can contribute to the experience of suffering in later life through malignant social positioning, social death, loss of self, and loss of status. The ability to flourish, which includes purpose, meaningfulness, connectedness, and social belonging, is influenced by opportunities which may be limited as one ages. Rather than through a dichotomous lens of negative or positive states of being (suffering vs. not suffering, flourishing vs. non-flourishing), the authors view one’s position in later life as existing on a continuum influenced by generativity. This chapter explores the construct of later life in the context of suffering and flourishing, with generativity as a major influence. The authors have developed a conceptual diagram and examples to illustrate how generativity may operate to move one closer toward flourishing, or, through its absence, towards suffering. The importance is stressed of considering the multifaceted ways that experiences of individuals and groups are shaped.
Personal Reflections on Generativity across Adulthood
Authors: McAdams Dan P
Published: May 2024

Inspired by an overlooked passage in the writings of Erik Erikson, the author comments on the preceding chapters in this volume by considering the different ways generativity is wrapped up with love, necessity, and accident. Generativity springs from love, both literally and figuratively. Under the banner of love, young adults care for each other, which prepares them to care for the next generation. Yet, the author would argue that the full expression of generativity, including features fraught with ambivalence and psychological complexity, typically awaits the midlife years. Generativity springs from necessity, too, in the hard work of caring, in paid and unpaid work itself, in volunteer activities, through leadership, and in a host of other activities, opportunities, and burdens. And generativity sometimes simply happens, by accident, chance events, bad luck or good, and in situations that defy the best efforts of human agency. Accepting the limits of human agency, and the inevitable constraints on generativity, becomes an increasingly urgent task as adults move into their later years.
Group Evidence
Authors: Brown Jessica
Published: May 2024

I start by considering summative accounts of group evidence. On Pooled, p is part of the evidence of a group if and only if it is part of the evidence of some member of the group. On Shared, p is part of the evidence of a group if and only if it is part of the evidence of most members of the group. I argue that both face objections: 1) on a non-factive conception of evidence they result in groups having wildly inconsistent sets of evidence; 2) they intuitively count too much as group evidence; and 3) they are in tension with the doxastic constraint (p is part of S’s evidence if and only if S bears the relevant doxastic relation, D, to p). I then develop a non-summative account of group evidence by combining the doxastic constraint and a non-summative account of the relevant doxastic attitude, D.
Group Justified Belief and Knowledge
Authors: Brown Jessica
Published: May 2024

This chapter focuses on one distinctive way in which groups can form beliefs, namely by aggregating the opinions of their members. I defend a novel non-summative account of when such beliefs are justified/knowledge which treats such beliefs on the model of testimony. On a reliabilist approach to the epistemology of individual testimony, a hearer’s belief formed on the basis of a speaker’s testimony is justified/knowledge only if the hearer is a reliable consumer of testimony and the speaker is a reliable testifier. Applying this model to groups, a group belief formed by aggregating the opinions of its members is justified/knowledge only if the group is a reliable consumer of testimony and most of the members who input into the aggregation process are reliable testifiers. I argue that the model outperforms the existing inferential and perceptual models of group beliefs formed via aggregating member opinions.
Group Excuse from Blameless Ignorance
Authors: Brown Jessica
Published: May 2024

This chapter examines what it is for a group to have an excuse for its wrongdoing from blameless ignorance. I argue that one cannot identify group blameless ignorance with an already theorized group epistemic state (e.g. lack of knowledge or justified false belief). Nor is group blameless ignorance a function of member blameless ignorance. For group blameless ignorance can come apart from member blameless ignorance in both directions: the members of a group might be blamelessly ignorant that p even though the group is not, and vice versa. In the light of these results, I provide a new non-summative account of what it is for a group’s ignorance to be blameless and what it is for a group to act on that ignorance.
‘I secretly wish. . .’ Caregivers’ expression of wish for death of persons with severe dementia
Authors: Balasubramanian Ishwarya , Chaudhry Isha , Poco Louisa Camille , Malhotra Chetna ,   PISCES study group, Østbye Truls , Seow Dennis , Yap Phillip , Tan Lay Ling , Tham Weng Yew , Vaingankar Janhavi , Foo Jason , Yeow Tan Boon , Tong Kamun , Chong Ng Wai , Carson Allen Jr John , Malhotra Rahul , Mooi Tan Weng , Liang Wee Shiou , Ling Ng Li , Goveas Richard , Mok Vanessa , Sim Alisson , Fern Ng Wei , Khuan Wong Hon , Balasundaram Bharathi , Qi Tan Rui , Sim Ong Pui , Cheong Chin Yee , Chung Pheng Alethea Yee , Tiong Christina , Hum Allyn , Lee Angel , Finkelstein Eric A
Published: May 2024

Background

Qualitative evidence suggests that caregivers may express a wish for death of persons with severe dementia (PwSD). No study has assessed the extent to which it happens, stability of this wish over time and the factors associated with it.

Objectives

We examined caregivers’ wish for death of PwSDs overtime and the factors associated with this wish.

Methods

215 caregivers of community dwelling PwSDs were surveyed every 4 months for 2 years. Using the mixed-effects multinomial regression model, we assessed the PwSD and caregiver factors associated with caregivers’ wish for PwSDs’ death.

Results

At baseline, 27% caregivers expressed a wish for PwSDs’ life to end sooner. Overall, 43% of the caregivers expressed a wish for PwSDs’ death at least once during the study period and 11% expressed it consistently. Caregivers’ perception of PwSDs’ lower quality of life (RRR: 1.05, 95% CI: 1.00, 1.10), higher functional dependency (RRR: 1.1, 95% CI: 1.01, 1.21), eating difficulty (RRR: 2.25, 95% CI: 1.26, 4.04) and suffering (RRR: 1.92, 95% CI: 1.05, 3.52) were associated with this wish. Caregivers who were emotionally close to PwSDs were less likely (RRR: 0.25, 95% CI: 0.11, 0.55) while those who understood that dementia is a terminal illness were more likely (RRR: 2.01, 95% CI: 1.03, 3.92) to express this wish.

Conclusion

Caregivers’ wish for PwSDs’ death changed over time and was primarily driven by their perception of PwSDs’ poor well-being and awareness of their illness being terminal, indicating a need for increased support in this challenging caregiving context.
Self-Reported Executive Functioning in Young Adult Survivors of Childhood Bacterial Meningitis
Authors: El Tahir Omaima , Groenveld Julia , Jonge Rogier , Oostrom Kim , Goei Sui Lin , Pronk Jeroen , Furth Anne Marceline
Published: May 2024

Objective

This study investigated executive functions (EFs) in young adult survivors of childhood bacterial meningitis (BM). These skills are important for normal development, and their potential vulnerability in early years suggests that childhood BM could affect executive functions in the longer term.

Method

The adult self-report Behavior Rating Inventory of Executive Function was administered to 474 young adult survivors of childhood BM who participated in the 20|30 Dutch Postmeningitis study. Average scores were compared to population-norm group scores. Subgroup scores were compared according to causative pathogen and age at onset.

Results

Young adult survivors of childhood BM scored lower on overall metacognition than the age-matched population norm group. Young adult survivors of childhood BM caused by Streptococcus pneumoniae, S. agalactiae, or Escherichia coli had lower scores than cases caused by Neisseria meningitidis. Survivors with age-at-onset below 12 months had a higher (worse) overall EF score than survivors with age-at-onset above 12 months.

Conclusions

Young adult survivors of childhood BM experience difficulties in EF. However, most of the self-reported EF scores were within the norm. Future studies need to additionally assess EF in adult survivors of childhood BM using performance-based tests.
Examining the role of depression on the relationship between performance-based and self-reported cognitive functioning after sport-related concussion
Authors: Sakamoto McKenna S , Thomas Garrett A , Bradson Megan L , Arnett Peter A
Published: May 2024

Objective

Little is known about the relationship between neuropsychological test performance, cognitive symptom reporting, and depressive symptoms after sport-related concussion. Accordingly, this cross-sectional study examined these relationships in collegiate athletes. It was hypothesized that depressive symptoms would moderate and mediate the relationship between performance-based and self-reported cognitive functioning after concussion.

Methods

After sustaining a sport-related concussion, 110 collegiate athletes completed a neuropsychological battery, the Post-Concussion Symptoms Scale, and the Beck Depression Inventory-Fast Screen. Neuropsychological test performance, depressive symptoms, and their interactions were entered into distinct hierarchical linear regression analyses with self-reported cognition as the dependent variable to assess moderation. Mediation was analyzed using the PROCESS macro with 5000 bootstrap samples and a 95% confidence interval.

Results

There was a significant interaction between the mean memory composite and depressive symptoms when predicting cognitive symptom reporting, p = 0.047. Simple effects tests revealed that for athletes who had a lower memory composite score, an increase in depressive symptoms led to an increase in self-reported cognitive dysfunction, p < 0.001, ηp2 = 0.11. Depressive symptoms partially mediated the relationship between the memory composite and cognitive symptom reporting, indirect effect = −0.26, 95%CI[−0.58,0.001], but this relationship was not found for any other neurocognitive domain.

Conclusions

For tests of memory, depressive symptoms moderated and partially mediated the relationship between performance-based and self-reported cognitive functioning after sport-related concussion. Athletes reporting high depressive symptoms and cognitive dysfunction may need more comprehensive evaluations to inform return-to-play decisions, and depression could be a treatment target for athletes who report high levels of cognitive dysfunction after concussion.
Accurate prediction of antibody function and structure using bio-inspired antibody language model
Authors: Jing Hongtai , Gao Zhengtao , Xu Sheng , Shen Tao , Peng Zhangzhi , He Shwai , You Tao , Ye Shuang , Lin Wei , Sun Siqi
Published: May 2024

In recent decades, antibodies have emerged as indispensable therapeutics for combating diseases, particularly viral infections. However, their development has been hindered by limited structural information and labor-intensive engineering processes. Fortunately, significant advancements in deep learning methods have facilitated the precise prediction of protein structure and function by leveraging co-evolution information from homologous proteins. Despite these advances, predicting the conformation of antibodies remains challenging due to their unique evolution and the high flexibility of their antigen-binding regions. Here, to address this challenge, we present the Bio-inspired Antibody Language Model (BALM). This model is trained on a vast dataset comprising 336 million 40% nonredundant unlabeled antibody sequences, capturing both unique and conserved properties specific to antibodies. Notably, BALM showcases exceptional performance across four antigen-binding prediction tasks. Moreover, we introduce BALMFold, an end-to-end method derived from BALM, capable of swiftly predicting full atomic antibody structures from individual sequences. Remarkably, BALMFold outperforms those well-established methods like AlphaFold2, IgFold, ESMFold and OmegaFold in the antibody benchmark, demonstrating significant potential to advance innovative engineering and streamline therapeutic antibody development by reducing the need for unnecessary trials. The BALMFold structure prediction server is freely available at https://beamlab-sh.com/models/BALMFold.
IDMIR: identification of dysregulated miRNAs associated with disease based on a miRNA–miRNA interaction network constructed through gene expression data
Authors: Wu Jiashuo , Zhao Xilong , He Yalan , Pan Bingyue , Lai Jiyin , Ji Miao , Li Siyuan , Huang Junling , Han Junwei
Published: May 2024

Micro ribonucleic acids (miRNAs) play a pivotal role in governing the human transcriptome in various biological phenomena. Hence, the accumulation of miRNA expression dysregulation frequently assumes a noteworthy role in the initiation and progression of complex diseases. However, accurate identification of dysregulated miRNAs still faces challenges at the current stage. Several bioinformatics tools have recently emerged for forecasting the associations between miRNAs and diseases. Nonetheless, the existing reference tools mainly identify the miRNA-disease associations in a general state and fall short of pinpointing dysregulated miRNAs within a specific disease state. Additionally, no studies adequately consider miRNA–miRNA interactions (MMIs) when analyzing the miRNA-disease associations. Here, we introduced a systematic approach, called IDMIR, which enabled the identification of expression dysregulated miRNAs through an MMI network under the gene expression context, where the network’s architecture was designed to implicitly connect miRNAs based on their shared biological functions within a particular disease context. The advantage of IDMIR is that it uses gene expression data for the identification of dysregulated miRNAs by analyzing variations in MMIs. We illustrated the excellent predictive power for dysregulated miRNAs of the IDMIR approach through data analysis on breast cancer and bladder urothelial cancer. IDMIR could surpass several existing miRNA-disease association prediction approaches through comparison. We believe the approach complements the deficiencies in predicting miRNA-disease association and may provide new insights and possibilities for diagnosing and treating diseases. The IDMIR approach is now available as a free R package on CRAN (https://CRAN.R-project.org/package=IDMIR).
Sequential covariate-adjusted randomization via hierarchically minimizing Mahalanobis distance and marginal imbalance
Authors: Yang Haoyu , Qin Yichen , Li Yang , Hu Feifang
Published: May 2024

In comparative studies, covariate balance and sequential allocation schemes have attracted growing academic interest. Although many theoretically justified adaptive randomization methods achieve the covariate balance, they often allocate patients in pairs or groups. To better meet the practical requirements where the clinicians cannot wait for other participants to assign the current patient for some economic or ethical reasons, we propose a method that randomizes patients individually and sequentially. The proposed method conceptually separates the covariate imbalance, measured by the newly proposed modified Mahalanobis distance, and the marginal imbalance, that is the sample size difference between the 2 groups, and it minimizes them with an explicit priority order. Compared with the existing sequential randomization methods, the proposed method achieves the best possible covariate balance while maintaining the marginal balance directly, offering us more control of the randomization process. We demonstrate the superior performance of the proposed method through a wide range of simulation studies and real data analysis, and also establish theoretical guarantees for the proposed method in terms of both the convergence of the imbalance measure and the subsequent treatment effect estimation.
Dissecting the colocalized GWAS and eQTLs with mediation analysis for high-dimensional exposures and confounders
Authors: Zhang Qi , Yang Zhikai , Yang Jinliang
Published: May 2024

To leverage the advancements in genome-wide association studies (GWAS) and quantitative trait loci (QTL) mapping for traits and molecular phenotypes to gain mechanistic understanding of the genetic regulation, biological researchers often investigate the expression QTLs (eQTLs) that colocalize with QTL or GWAS peaks. Our research is inspired by 2 such studies. One aims to identify the causal single nucleotide polymorphisms that are responsible for the phenotypic variation and whose effects can be explained by their impacts at the transcriptomic level in maize. The other study in mouse focuses on uncovering the cis-driver genes that induce phenotypic changes by regulating trans-regulated genes. Both studies can be formulated as mediation problems with potentially high-dimensional exposures, confounders, and mediators that seek to estimate the overall indirect effect (IE) for each exposure. In this paper, we propose MedDiC, a novel procedure to estimate the overall IE based on difference-in-coefficients approach. Our simulation studies find that MedDiC offers valid inference for the IE with higher power, shorter confidence intervals, and faster computing time than competing methods. We apply MedDiC to the 2 aforementioned motivating datasets and find that MedDiC yields reproducible outputs across the analysis of closely related traits, with results supported by external biological evidence. The code and additional information are available on our GitHub page (https://github.com/QiZhangStat/MedDiC).
Living in my own skin: dermatological concerns and gender-affirming care as a trans person with neurofibromatosis type 1
Authors: Barbieri Alex , Orloff Jeremy , Gulati Nicholas , Brown Rebecca M
Published: May 2024

We provide patient and clinician perspectives on the dermatological outcomes of patients with neurofibromatosis type 1 (NF1) seeking gender-affirming hormone therapy. This perspectives article speaks to the psychosocial challenges that patients with NF1 may face due to the visible signs and symptoms of their disease. The theoretical role that hormones may play in the development of cutaneous neurofibromas is also addressed.
DOES THE USE OF POLYPROPYLENE INSTEAD OF STAINLESS-STEEL WIRE AFFECT THE SHORT-TERM RECURRENCE RATE AFTER SHOULDICE PRIMARY INGUINAL HERNIA REPAIR?
Authors: Paasch C , Mainprize M , Hunger R , Netto S
Published: May 2024

Background

Determine if polypropylene is noninferior to stainless-steel wire (SSW) after Shouldice Primary Inguinal Hernia Repair (SPIHR) regarding recurrence rate at ≥ 1-year after surgery.

Method

A prospective follow-up of SPIHR patients at Shouldice Hospital (SH) from 6/12/2021-1/09/2022, was conducted. Data collection included calls and chart review. Patients were asked about recurrence(s)/recurrent surgery and any observed groin swelling/protrusion. Recurrences were differentiated by confirmed (ultrasound report/documented examination) and not confirmed (report of bulging/swelling and examination outside SH).

Results

1120 patients underwent SPIHR (males: 1057; females: 63). The median age and body mass index were 62 years and 25.2 kg/m2. Hernias were more commonly repaired on the right (53.4%) and an indirect inguinal (56.5%). Most patients had American Society of Anesthesiologists (ASA) score II (39.7%, ASAI: 25.3%; ASAIII: 34.8%; ASAIV: 0.2%) and did not suffer from surgical site infection (98%), nor postoperative complications (98.4%). The median duration of surgery in patients with SSW and polypropylene were 47 and 49 minutes (p = .007), and median follow-up was 16- and 17-months (p < .001), respectively. Patients with polypropylene had more large hernias (47.1% vs. 25.4%), SSW had more medium (63.6% vs. 41.3%), and incidence of small hernias was comparable (p < .001). There were 18 recurrences (1.6%), 11 (0.98%) were confirmed, no difference between SSW and polypropylene (p > 0.9). The median month to noting a recurrence was 6, and only one patient underwent reoperation for recurrent hernia 9-months later.

Conclusion

The use of polypropylene is non-inferior to the use of SSW in terms of the recurrence rate at a median follow-up period of 16 months after elective unilateral SPIHR.
THE LOCAL PARASTOMAL (LOPA) REPAIR: A NOVEL APPROACH TO PARASTOMAL HERNIA REPAIR
Authors: Al Mukhtar A , Petersson U , Lydrup M L , Montgomery A
Published: May 2024

Background

Surgical repair of parastomal hernias (PH) is challenging due to high recurrence rates. This study describes and evaluates the short-term outcomes of the LoPa technique for local PH repair using a retromuscular synthetic mesh with an outward facing collar.

Methods

Patients who underwent LoPa repair at Skåne University Hospital, Malmö, Sweden, 2017–2022, were included. Medical history, operative details and 90-day complications, were collected retrospectively.

Results

Thirty-nine patients (twenty male) were included, with mean age 71 years and BMI 27 kg/m2. Twenty-five patients had a colostomy, 9 an ileal conduit and 5 an ileostomy. Eight patients had a prior retromuscular synthetic mesh: five with recurrence after earlier PH repair, and three with prophylactic mesh. Median (IQR) peroperative bleeding was 75 (20–120) ml. The median (IQR) operative time for those without prior mesh or undergoing concomitant procedures (n = 25) was 210 (144–296) minutes. Median length of stay (LOS) was 3 days. Two patients were readmitted and reoperated, one for bowel obstruction at the stoma site and the other for evacuation of fecal impaction, both were subsequently discharged without further complications. Four patients had surgical site infection, one classified as deep requiring radiology-assisted drainage.

Conclusions

Short-term outcomes of the LoPa technique for PH repair are promising with short LOS and few major complications. LoPa offers potential advantages such as avoiding midline laparotomy, minimizing adhesiolysis and reducing adhesion formation due to extraabdominal mesh placement. Upcoming studies will evaluate the long-term results of the LoPa technique including recurrence and potential benefits or drawbacks.
THE NEW ERA OF 3D-PRINTING TECHNIQUES IN A MEDICAL SETTING: EARLIER EXPERIENCE WITH THE USE OF BOTULINUM TOXIN FOR COMPLEX VENTRAL HERNIA
Authors: Caruso R , Ferri V , Vicente E , Quijano Y , Duran H , Diaz E , Fabra I , Malave L , Ruiz P
Published: May 2024

Background

In the last years 3D printing has progressively gained widespread interest for its several applications in many medical fields. Among the most common diagnostic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) allow only two-dimensional images to obtain information on different pathologies. This requires excellent visualization skills from not specialized medical doctors. The 3D printing has been developed to overcome the current disadvantages of conventional imaging techniques. The 3D models are created from the diagnostic studies of the patient (MRI, CT, PET or a combination of those) with a process that fuse advanced medical imaging algorithms and medical image processing, which are supervised by specialized radiologists.

Method

Hereby we describe the cases of two patients with giant incisional hernias. The patients underwent 3D study before botulinum toxin treatment and another 3D model a months after the botulin toxin. With the 3D model we calculated the abdominal cavity volume before and after the treatment with botulinum toxin. Six weeks after the toxin we planned the surgery.

Results

The operation time was 180 min and 150 min respectively. The patient’s diet was resumed on the first day postsurgery, and the postoperative hospital stay was five days.

Conclusion

Our experience gives an overview of the current use of 3D-techniques, more specifically in the field of abdominal wall defect.
DOCTORS’ ORDERS: A REVIEW ON POSTOPERATIVE INSTRUCTIONS PROVIDED TO PATIENTS AFTER ABDOMINAL WALL RECONSTRUCTION (AWR)
Authors: Holland A , Lorenz W , Mead B , Ayuso S , Scarola G , Kercher K , Augenstein V , Heniford B T
Published: May 2024

Background

Prescribed physical limitations following AWR primarily focus on weight lifting restrictions. The questions of how much and for how long are poorly understood. Neither a consensus, guidelines, nor definitive data exist to validate surgeon recommendations. We sought to assess the literature on postoperative instructions for patients after AWR.

Methods

A systematic review was performed of the Wake Forest Library and PubMed in January 2024 for literature on postoperative physical recommendations after AWR. Three separate searches concerning restrictions following hernia repair yielded 573 publications.

Results

Of the 573 publications reviewed, only eight articles were directly related to postoperative instructions after AWR. Four were surveys; one was an ongoing randomized controlled trial; one compared two postoperative lifting programs; two were systematic reviews. Three additional studies measured intraabdominal pressure and abdominal wall elasticity in healthy patients with intentions to apply this to AWR patients.

There was variation in the duration of convalescence and weight limitation. For laparoscopic VHR, convalescence recommendations ranged from 1 day to 6 weeks. For laparotomy, convalescence ranged from 1–12 weeks postoperatively. Actions such as coughing, vomiting, and jumping caused higher intraabdominal pressure than lifting. Only one study used recurrence as the primary outcome after comparing postoperative activity regimens.

Conclusion

Despite hernia repair being one of the most commonly performed operations globally, surgeons lack validated and uniform postoperative instructions. There remains a need for higher quality of evidence concerning AWR recovery to optimize patient quality of life while balancing safe return to normal activities.
UNPREPARED FOR THE EMERGENCE OF A PARASTOMAL BULGE – A QUALITATIVE STUDY INTO PATIENTS' PERSPECTIVES
Authors: Krogsgaard M , Dreyer P , Thomsen T
Published: May 2024

Aim

To investigate patients' experiences of being prepared for the emergence of a parastomal bulge in relation to a stoma.

Materials and Methods

Qualitative interviews with 20 patients participating in five focus groups. Two groups consisted of patients referred for repair of parastomal bulging and three groups were patients receiving non-surgical treatment.

Results

The unforeseen bulge gave rise to increasing concerns and worry about the cause and consequences of the bulging skin. Patients sought explanations in their own lives and suspected that their behaviour or previous illness such as influenza, coughing, and efforts to rehabilitate after surgery, induced the bulge. Missing or conflicting information led to counterproductive behaviour. Patients unknowingly carried on with hard and strenuous work after stoma surgery, a behaviour they would have refrained from had they known about the bulge. Patients found the bulge hard to live with and were disappointed with healthcare professionals due to lack of information on prevention and treatment strategies. When consulting surgeons for advice, patients realized that surgical treatment was a gamble. This helped some patients get on in life while others were left with little hope of change.

Conclusion

Lack of information may lead to mistrust and disappointment with healthcare professionals. Addressing patients’ individual support needs and information needs is important to preserve patient autonomy, satisfaction and well-being. Surgeons and stoma nurses should be aware of the impact of their approach to communicating with patients about parastomal bulging.
THE BENEFITS OF PREOPERATIVE SMOKING CESSATION ON ABDOMINAL WALL RECONSTRUCTION (AWR) OUTCOMES: AN EXAMINATION OF ABSTINENT VERSUS NEVER SMOKERS
Authors: Lorenz W , Holland A , Mead B , Scarola G , Colavita P , Kercher K , Augenstein V , Heniford B
Published: May 2024

Introduction

Wound complications are associated with recurrence and mesh infection. Following our data review and publication reporting smoking significantly increased the rate of complications, we implemented four-weeks of smoking cessation preoperatively. This study aimed to identify if there is an increased risk of wound complications in patients who are abstinent smokers (AS) versus never-smokers (NS).

Method

A prospectively maintained, institutional database was used to identify patients who underwent AWR with preperitoneal mesh. The groups were stratified by smoking status. AS quit at least four weeks prior to surgery. Descriptive statistics and univariate analyses were performed.

Results

Overall, 1,088 patients were evaluated, 305 AS and 783 NS. There were fewer female AS [144 (47.2%) vs. 446 (57%); P = 0.004]. Race, rate diabetes, cirrhosis, and coronary artery disease were similar (P > 0.05). AS were significantly more likely have COPD (8.9% vs. 4.0%, P = 0.001), ASA Class III (51.5% vs. 34.5%, P = 0.009), and more comorbidities (9.6 vs. 4.7, P < 0.0001). Average BMI was higher for NS (31.3 vs. 32.7; P = 0.004).

Operative times were equal. While defect size was different (229 vs. 209.1cm2; P = 0.023), mesh size was similar (850.2 vs. 836.3cm2; P = 0.410). AS had higher wound class (Class III/IV: 25.3% vs. 15.8%, P = 0.003) with more biologic mesh use (31.1% vs. 21.6%, P = 0.003), and more component separations (52.5% vs. 43.8%; P = 0.010).

Length-of-stay was longer in AS (6.6 vs. 6.2 days, P = 0.015). Follow-up time was similar (13.3 vs. 16.8 months; P = 0.218). Rates of post-operative wound outcomes including wound infection (5.2% vs. 7.4%) and mesh infection (1.6% vs. 0.6%) were similar (P = NS) between groups. The recurrence rates were 3% and 2.3% (P = 0.534).

Conclusion

Despite increased patient complexity, defect size, BMI, rate of component separation, and higher wound class, wound-related outcomes for patients AS and NS were equal. Preoperative smoking cessation appears to be an important part of prehabilitation for AWR.
VISCERAL SYMPTOMS IN ABDOMINAL WALL PAIN
Authors: Roumen R
Published: May 2024

Purpose

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is characterized by neuropathic pain in a predictable, circumscript abdominal area. The diagnostic delay is long, with half of ACNES-affected individuals reporting next to pain, also nausea, bloating, or loss of appetite mimicking some kind of visceral disease. The aim of this study was to describe these phenomena and to determine whether treatment could successfully reverse the visceral symptoms.

Methods

This was a prospective observational study. Adult patients who fulfilled published criteria for ACNES and reported at least one visceral symptom at intake were eligible for the study. A self-developed Visceral Complaints ACNES Score (VICAS) questionnaire that scores several visceral symptoms (minimum 1 point, maximum 9 points) was completed before and after therapy. The success of treatment was defined as at least 50% reduction in pain.

Results

Data from 100 selected (at least one visceral symptom) patients (86 females) aged 39 ± 5 years were available for analysis. Frequently reported symptoms were abdominal bloating (78%), nausea (66%) and altered defecation (50%). Successful pain treatment significantly reduced the number of visceral symptoms, with a VICAS before of 3 (range 1–8) and after of 1 (range: 0–6) (p < 0.001). A low baseline VICAS was associated with successful treatment outcome (OR: 0.738, 95% CI: 0.546–0.999).

Conclusion

Patients with ACNES may report a variety of visceral symptoms. Successful treatment substantially reduces these visceral symptoms in selected patients, indicating a segmental relation between the abdominal wall and the viscera.
SUTURE TECHNIQUES AND MATERIALS FOR FASCIAL CLOSURE OF ABDOMINAL WALL INCISIONS: HOW DO THEY COMPARE IN A SYSTEMATIC REVIEW AND META-ANALYSIS?
Authors: van den Berg R , Visscher L , Menon A G , Deerenberg E B , Tanis P J
Published: May 2024

Background

The aim of this meta-analysis was to evaluate closure of laparotomy using different suture-materials and techniques.

Methods

A literature search was conducted till 11 October 2023. All randomized controlled trials (RCTs) and prospective cohort studies (PCSs) on laparotomy closure were included. The study quality was evaluated using the ROB2 and ROBINS-I checklists. The primary outcome was incisional hernia (IH), and secondary outcomes were fascial dehiscence (FD), combined-FD+IH, and surgical site infection (SSI). Meta-analyses were performed using random-effects models.

Results

A total of 73 RCTs and 26 PCSs were included. Slowly-absorbable suture materials were associated with a lower risk of IH (OR: 0.64; 95%CI: 0.47–0.86) and combined-FD+IH (OR: 0.76; 95%CI: 0.58–0.99) when compared to fast-absorbable sutures (5 studies, 2,262 patients). Non-absorbable suture material was not superior to any other suture material. Continuous-suturing was not superior to interrupted-suturing, neither was mass-closure superior to layered-closure for any of the outcomes. Small-bites technique with a slowly-resorbable suture in the elective-setting resulted in significantly less IHs (OR 0.42; 95%CI: 0.28–0.62), combined-FD+IH (OR 0.39; 95%CI: 0.22–0.72) and SSIs (OR 0.67; 95%CI: 0.52–0.83) compared to a large-bites technique (8 studies, 1,168 patients). In the emergency setting, the continuous Smead-Jones suturing significantly reduced the risks of IH (OR 0.22; 95%CI: 0.08–0.59), FD (OR 0.20; 95%CI: 0.11–0.34), combined-FD+IH (OR 0.08; 95%CI: 0.03–0.19), and SSI (OR 0.45; 95%CI: 0.26–0.79) compared to continuous-suturing (6 studies, 265 patients).

Conclusions

Closure of laparotomies using the small-bites technique is superior to large-bites techniques. In the emergency setting, the Smead-Jones technique seems a valid alternative.
eTEP AND TRANSVERSUS ABDOMINIS RELEASE IN A M5W3 INCISIONAL HERNIA
Authors: Bellido-Luque J , Scammon Duran A , Alpizar-Rivas O , Sanchez Matamoros Marin I , Nogales Muñoz A , Morales-Conde S
Published: May 2024

A 59-year-old female who underwent hysterectomy and exploratory laparotomy secondary to seromucinous ovarian carcinoma presents with discomfort in a partially reducible M5W3 incisional hernia.

The patient is operated using a full endoscopic minimally invasive extraperitoneal approach (e-TEP + TAR). A 2 cm incision on the right subcostal region is made, exposing and opening the anterior rectal sheath (ARS), medializing the right rectus muscle. A dissection balloon is introduced to release the retromuscular space on the right side. A 10 mm trocar is placed in the right flank and a 5 mm trocar in the right iliac fossa.

First, we access the medial posterior rectus sheath (PRS) of the right side, which is then incised, and the preperitoneal dissection is performed doing the crossover above the umbilicus. Once the hernia is completely reduced we connect both the retrorectus space with the preperitoneal spaces on both sides of the hernia.

A modified posterior components separation (TAR) is performed on the left side, sectioning the aponeurosis of the transverse muscle (TM) and accessing the preperitoneal space laterally without sectioning the TM. The posterior and anterior defects are then closed separately using a barbed suture.

A wide pore mesh, covering both retrorectus and preperitoneal spaces is placed and fixated using glue. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after and no complications, where reported. In the CT scan 6 months after surgery the correction of the defects where confirmed.
MODIFIED LIRA+ AS A LAPAROSCOPIC COMPLEX LATERAL EVENTHROPLASTY
Authors: Font M , Díaz R , Farré R , Sánchez R , Guariglia C , Pardo S , Caraiman M , Valderrama S , Collera P
Published: May 2024

Background

We present a clinic case of a patient with a complex eventration with two anterior onlay repairs due to an open appendectomy years before.

Methods

A 74-year-old man with hypertension and surgical history of open appendectomy and 2 anterior onlay eventhroplasties was consulted for relapse and discomfort of the prior repair. Therefore, a TC was performed, and a large right flank eventration with a small intestine and colon inside and a left inguinal hernia was diagnosed; the patient is proposed for a laparoscopic joint repair.

Results

A posterior rectus sheet plasty was prepared, and a bottom-up closure of the defect was performed, and afterwards reinforced with the posterior rectus sheet plasty, trying to obtain the firmest possible base for the placement of the intraperitoneal mesh, given that the eventration was intermuscular and close to the iliac crest.

Then inguinal hernia repair was performed with TAPP technique, particularly laborious in this case due to the manipulation of the peritoneum.

The postoperative (OP) period occurred without complications and was discharged on the second post op day.

Conclusions

We present a specific case, favourable for a laparoscopic repair, with a repair inspired by a technique used for midline defects. Nevertheless, it is a difficult technique so the learning curve is expected to be longer, and experience is required.
TAPP APPROACH FOR INCISIONAL LUMBAR HERNIA. A VIDEO PRESENTATION
Authors: García Corona M , Sánchez Arteaga A , Moreno Suero F , Bustos Jiménez M , Martínez Nuñez S , Tallón Aguilar L
Published: May 2024

Introduction

Lumbar incisional hernias (LIH) constitute infrequent abdominal wall defects, typically arising as a consequence of traumatologic procedures. The surgical approach to LIH can be challenging due to the absence of specific recommendations for this particular condition.

Methods

This study presents a case report of a LIH resulting from lumbar arthroplasty in a 49-year-old female patient with no prior medical history. The patient reported back pain, and a CT scan revealed a lumbar hernia in close proximity to the iliac bone.

Results

A transabdominal preperitoneal approach (TAPP) was employed, uncovering a lumbar defect measuring 6 × 6 cm with a hernia sac containing the left colon. Procedures included peritoneal sac reduction, defect closure near the iliac bone, and placement of a polypropylene mesh in the preperitoneal position.

Conclusion

The TAPP approach proves to be a viable surgical technique for addressing LIH. It is crucial to acknowledge that closing the hernia defect may pose challenges when the hernia edges involve bony structures.