bluuebunny/crossref_metadata_2025 huggingface dataset:
P-120 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA USING A NON-ABSORBABLE TRANSPARENT COMPOSITE PROSTHESIS TOTALLY IN POLYPROPYLENE - OUR EXPERIENCE
Authors: Pecic V , Pavlovic A , Todorovic A , Bogdanovic D , Dimitrijevic M , Bekic M , Rancic L , Rosati S , Balestra G , Jovanovic B
Published: October 2022

Introduction

Incisional ventral hernia is one of the most common surgical complications after laparotomy. The aim of this retrospective observational study is an evaluation of clinical outcomes after laparoscopic repair of incisional hernias with a non-absorbable and transparent composite prosthesis composed of a macro-porous monofilament polypropylene mesh and a transparent polypropylene film.

Materials and Methods

63 patients, from January 2016 to December 2021, were treated for incisional hernia at Center of minimal invasive surgery Nis, Serbia. The mesh was always positioned intraperitoneally after closing the defects and fixed with absorbable tacks and non-absorbable suture.

Results

In the considered cohort (54% female and 46% male) the median age and BMI were 54 years (range: 39–68) and 25,1 kg/m2 (range: 21.5–30.3), respectively. Concerning hernia position, 93.7% of the hernias were medial, 4.8% lumbar and 1.6% medio-lumbar. According to EHS classification, 58.7% of the hernias were W1, 36.5% W2 and 12.7% W3. The average duration of hospitalization was 2 days.

The rate of early post-operative complications was 6.3%, including 1 seroma (1.6%) and 3 patients reporting pain (4.8%). At a median follow up of 48 months (range: 6–60) we registered 2 cases of hernia recurrency (3.2%, both at 36 months follow-up) and 1 case of bowel obstruction (1.6%). All the considered variables did not result statistically significative in relation to post-operative complications.

Conclusion

Our clinical experience showed that intraperitoneal treatment of incisional hernia using a transparent composite prosthesis. The minimally invasive procedure allows a fast postoperative recovery and a consequent low economical cost.
P-144 THE ABDOMINAL BINDERS FOLLOWING ABDOMINAL WALL RECONSTRUCTIVE SURGERY: USEFUL OR USELESS? - A META-ANALYSIS
Authors: Zeb E , Pokusevski G , Sodde P , Sabri S , Ahmad S , Mihailescu A
Published: October 2022

Aim

Despite a recent meta-analysis published in SAGE in 2021 by a group of chinese researchers, which included 10 RCTs, the research committee for this study felt that a substantial volume of recent literature, including 7 RCTs and 3 high value non-RCT newly published articles have not been included in the latest meta-analysis and a new study is required, to understand the clinical usefulness of abdominal binders, following abdominal wall reconstructive surgery. Furthermore, no recent studies looked at the long-term impact of abdominal binders and whether their use prevent hernia recurrence, if applied from the immediate post-op period.

Material & Methods

A thorough review of all medical literature published in english language since year 2000 and to date was carried out, using the following keywords: “hernia”, “hernia repair”, “abdominal wall reconstruction” and “abdominal binder”. 17 randomised control trials and 3 non-RCT studies (systematic reviews and surveys) were included in the study. A total of 5216 patients were included in the 20 studies included. The databases searched were PubMed, Medbase, Jama and Embase.

Results/Conclusions

The use of abdominal binders following abdominal wall surgery suggests a better pain control when compared with non-users group. This contributes to earlier mobilisation and by this preventing secondary post-op complications. There is building evidence that in long term the use of abdominal binders reduces the risk of hernia recurrence and this could be in relation to decreased post-op pain and earlier return to a normal activities in the immediate post-op period.
P-149 FEASIBILITY AND SAFETY OF AMBULATORY ETEP RETRORECTUS RIVES-STOPPA REPAIR FOR VENTRAL HERNIA
Authors: Mok J , Markakis H
Published: October 2022

Introduction

Endoscopic totally extraperitoneal retromuscular repair (eTEP-RS) was recently introduced as a new technique for ventral hernia repair. It has been reported to have a significant reduction in analgesia need and reduce length of stay compared to laparoscopic intraperitoneal repair. We aim to evaluate the safety and feasibility of ambulatory primary ventral hernia and incisional hernia repair using eTEP technique.

Methods

Patients planned for ambulatory eTEP ventral hernia repair between October 2020 to April 2022 were retrospectively analyzed

Results

11 patients who were deemed suitable for day surgery preoperatively were included in the analysis. Median age was 48.3 years. Defect sizes ranged from 3–6 cm. 5 patients had more than 1 midline defect, 1 patient had a spigelian hernia and 1 patient had bilateral inguinal hernias which were repaired.

7 patients were successfully managed as day case eTEP-RS. 1 patient required a conversion to open RS due to additional, large defects found intraoperatively, 1 patient stayed for 1 night for urinary retention, 1 patient was drowsy and could not be discharged on the day of surgery and 1 patient was converted to IPOM repair. There were no postoperative complications or recurrences.

Conclusion

Ambulatory eTEP is feasible, safe and effective in selected patients.
P-153 COMPARING MESH RELATED SENSATION IN PATIENTS UNDERGOING AWR USING SYNTHETIC VERSUS BIOSYNTHETIC MESH USING STANDARDIZED PROMS
Authors: Kulkarni G , Elliott Z , Hammond T
Published: October 2022

Aim

To compare QualityOfLife (QoL) outcomes amongst patients undergoing elective Open abdominal wall reconstruction (AWR) with Synthetic Mesh versus Biosynthetic mesh, using Carolinas Comfort scale and EuraHS QOL questionnaires.

Material and Methods

This is a retrospective study with longitudinal prospective extension for serial administration of questionnaires at specific intervals, focusing on patients having undergone AWR within last 4 years by a two-operator team of same AWR surgeon and Plastic surgeon. 4 groups of patients compared based on less than / more than six months from time of surgery using either biosynthetic or synthetic mesh.

The rationale behind it is based on characteristics of the biosynthetic mesh data showing complete disappearance by 6 months time and replacement by a scaffolding tissue as a ingrown matrix and collagen. Decision of type of mesh was governed by patient characteristics.

Results

15 patients in each group (total 60 patients) included by consecutive retrospective enrollment. We excluded those who had further abdominal surgery since. Preliminary data showing reduced mesh related sensation in favour of patients with biosynthetic mesh repair more than six months ago. Since few of those patients have still not completed their six months post operative period yet, formal statistics are not included in abstract. They shall be available in time for EHS meeting, analysed to recognise differences if any regarding mesh related questions using variance, correlation and descriptive statistics.

Conclusions

This outcomes will provide a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions.
V-007 LESSONS LEARNED DURING THE ABDOMINAL WALL RECONSUTRCTION FOR A MULTIRECURRENT LUMBAR HERNIA AFTER BONE GRAFT HARVESTING
Authors: Garcia Urena M A , Medina M , Aviles A , Robin A , Martinez J , Muñoz J , Lopez-Monclus J , Morejon S , Blazquez-Hernando L A
Published: October 2022

The best approach for lateral incisional hernia is not known. Among these difficult hernias, those arising from iliac crest harvesting can be particularly challenging. The objective of this video is to illustrate the surgical approach of a multirecurrent case with the need of adding a posterior component separation

A 70 years old woman with 2 previous attempts of repair was referred to our center. With the patient in a 45 degrees lateral decubitus, a posterior lumbar approach was initiated through the previous scar. The retromuscular preperitoneal plane was accessed with difficulty due to previous meshes in the subdiaphragmatic, iliac and posterior areas. A big tear on the medial peritoneum changed our plan to add a posterior component separation. As we did not want to enlarge the lumbar incision to denervate more the lateral abdominal wall, we decided to make an accessory midline incision. Probably, an ETEP approach could have been better even before making the posterior incision. Once the retromuscular plane was dissected, the hole in the peritoneum could be closed. The reconstructive phase consisted in making a taco configuration using the combination of a permanent and absorbable mesh.

We have learned from this case, that an eTEP dissection of the retromuscular plane could have helped to avoid the accessory midline incision. It is also important to consider the potential iatrogenic denervation we could add in case of enlargement of the incision.
V-012 LAPAROENDOSCOPIC VENTRAL HERNIA SURGERY; ANIMAL MODEL AND PATIENTS
Authors: Otegi Altolagirre I , Arana Iñiguez I , Recreo Baquedano A , Ruiz Marzo R , Ariceta López A , Ramirez Cervera J L , Piñera Díaz A , Pérez Otermin I , Talavera Utrera G , San José Aranda L , Blázquez Lautre L
Published: October 2022

Aim

Show the possibility of training abdominal wall laparoendoscopic techniques in the animal model.

Material and Methods

The training consists of 3 phases; in a first phase, videos of laparoendoscopic ventral hernia surgeries are displayed. In the second phase, 3 sessions are carried out in a simulation box to practice the zenith suture with a 5 cm diameter defect.

For the third phase, each surgeon has four sessions of surgery with swine models; In the first three, a retromuscular dissection procedure was performed, creating and suturing a midline defect of 15×4 cm (long and transverse diameter), placement of mesh in a retromuscular position, and closure of the posterior sheath (laparoscopic RIVES). In the 4th animal model, an extraperitoneal procedure was performed (eTEP) without closure of the posterior rectus sheath.

After training, these surgical techniques have been performed on patients

Results

The video shows the similarity of the animal model with the patient to perform the following technical steps; opening of the posterior rectus sheath, left retrorectal space dissection, midline crossover, right retrorectal space dissection, zenith suture of the anterior rectus sheaths, retrorectal mesh positioning and posterior rectus sheath suture.

Conclusion

Simulation and training models of minimally invasive ventral hernia surgery are useful and necessary in the training of surgeons.
V-017 TOTALLY ENDOSCOPIC APPROACH TO MODIFIED SUGARBAKER PARASTOMAL HERNIA REPAIR BY TRANSVERSUS ABDOMINIS RELEASE (ETEP-PAULí). ADVANTAGES OF RETROMUSCULAR/PREPERITONEAL MESH PLACEMENT
Authors: Bellido-Luque J , Licardie E , Sanchez-Matamoros I , García Reyes A , Bellido Luque A , Nogales Muñoz A , Tejada Gomez A , Morales S
Published: October 2022

Several studies published have shown that TAR is an effective technique for reconstructing midline hernias and lateral hernias. In 2016, Pauli et al. described a novel technique for parastomal hernioplasty using open TAR combined with a modified Sugarbaker repair.A 56-year-old woman operated on 5 years earlier due to rectum adenocarcinoma by laparoscopic resection. A parastomal hernia was diagnosed. CT revealed a 5 cm wide parastomal hernia associated with an umbilical hernia.Patient is placed in the supine position. Identification by ultrasound of the lateral junction of right rectus sheaths. incision on subcostal region 1 cm medial to said juntion. An incision is made on the anterior lamina and retromuscular space is created with a dissection balloon. With the placement of two 11–5 trocars, the medial aspect of the posterior rectus sheath muscle is incised at the epigastric level and the Crossover is carried out. Left retromuscular dissection is performed. The hernia content is reduced. the left arcuate ligament is identified and the transverse abdominis muscle is released.

Anterior defect closure with barded suture. An horizontal peritoneal incision is performed with the aim of lateralizing the colonic stump, the peritoneum and posterior aspect of the rectum sheath are closed.Placement of PPL mesh of 25×30 cms covering the dissected space.Patient was discharged on postoperative day 2. No complications or hernia recurrence were identified.

Conclusions

This technique offers some advantages; Coated mesh is unnecessary,The retromuscular positioning permits the integration on both sides.However several drawbacks; lack of long-term outcomes and technically challenge.
V-020 LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY: FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS
Authors: Marrero Marrero P , Delgado Plasencia L J
Published: October 2022

We present the case of a 46-year-old-male patient, personal history: Chronic smoking; no previous abdominal surgeries. Height: 1,88 m. Weight: 100 Kg. BMI: 28. Clinical and ultrasound diagnosis of a painful and reducible ventral hernia M3 W1 (EHS Classification) associated with supraumbilical rectal diastasis (RD) of 4 cm transverse diameter T2 D2 H1 (EHS Classification). It is programmed for hernia and RD correction using de Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique. Access is laparoscopic at the left anterior axillary line level. Reduced umbilical hernia is identified and sickle cell ligament dissection is performed to identify and treat RD. The size of the umbilical defect and that of the supraumbilical RD are measured and, by means of a mathematical formula, the posterior aponeurosis of both rectal muscle is opened longitudinally parallel to both margins of the defect and the diastasis in order to suture the two flaps in the midline, allowing a tensión-free closure and also avoinding seroma formation and post-op bulging effect. We ended the procedure by placing an intraperitoneal mesh that we fixed covering the defect generated in the posterior aponeurosis. The LIRA technique could be considered an alternative to conventional defect closure (CD) or endoscopic component separation for midline defects smaller than 10 cm in transverse diameter. This is the first case of LIRA published in our latitude. It is a safe, effective and reproducible technique.
V-028 USE OF ARTICULATED INSTRUMENTS IN EXTRAPERITONEAL ABDOMINAL WALL SURGERY
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Gutiérrez E , Olsina Kissler J
Published: October 2022

Introduction

One of the limitations in extraperitoneal abdominal wall surgery is the reduced range of movements of conventional instruments. The aim of this video was to show the advantages of articulated instruments.

Case presentation

The first case was a laparoscopic totally extraperitoneal (TEP) inguinal hernia repair of a direct bilateral hernia in a male patient. In this intervention the articulated grasper assisted with the isolation of the hernia sac and allowed to modify the direction of the traction during the dissection.

The second case was an extended totally extraperitoneal (eTEP) repair of a M3W2 incisional hernia associated to rectus diastasis in a female patient. The articulated instrument gave an increased traction adapted to the surface of the posterior rectus sheath and marked the limits for the section with the scissors.

Conclusion

The articulated instruments allowed an increased mobility in the extraperitoneal field.

Note: the articulated instruments were manufactured by IMM, Mannheim, Germany.
V-038 INGUINAL TEP WITH ARTICULATED INSTRUMENTS: BEYOND CONVENTIONAL LAPAROSCOPY, CLOSER TO ROBOTIC SURGERY
Authors: Villalobos R , Maestre Y , González Barranquero A , Olsina J
Published: October 2022

Introduction

Is known that laparoscopic inguinal hernia repair is well recommended in the guidelines. Despite that, in most cases the surgeon needs to do with the instruments manoeuvres that are not ergonomics. Robotic surgery has eliminated these problems but unfortunately this platform is not within reach of all. Articulated instruments appear as a forward stepwise to avoid these difficulties and allowing a better performance of the technique. We present a video that shows a case of an inguinal total extraperitoneal (TEP) performance with these instruments.

Material and methods

A 45-year-old man with a bilateral inguinal hernia underwent an inguinal TEP using 2 articulated grasper and Maryland instruments (IMM-Tontarra). An expander balloon was used to open the Retzius space, then a Hasson umbilical trocar and 2 (5mm) infraumbilical and suprapubic trocars were placed. All surgery was performed with these 2 instruments an only straight graspers were used when placing the mesh.

Results

The patient was discharged the same day of surgery with no complications. Our group made different kind of surgery and we observed that the learning curve to obtain an optimal performance of this instruments is short, lesser than 10 patients. We did eTEP procedure for ventral/incisional hernias, Cholecystectomies and hemicolectomies demonstrating the usefulness of these tools.

Conclusions

Inguinal TEP technique repair using articulated instruments is a very good option for a better dissection of the tissues, better triangulation of the graspers and more ergonomic for the surgeon.
V-053 USE OF HYBRID LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA-TECHNIQUE) IN COMPLEX VENTRAL HERNIAS
Authors: Licardie E , Eleuterio G , Navarro L , Bellido A , Suárez-Grau J , Morales-Conde S
Published: October 2022

Aim

The hybrid approach (HA) to ventral hernias (VH), combining the laparoscopic and open approaches, is not very common at present. The great contribution of this approach is that it combines the advantages of the minimally invasive approach with the advantages of the open approach, making it possible to correct aesthetic defects and major skin and subcutaneous problems.

Material & Methods

40-year-old-man with previous surgery for supraumbilical hernia, with placement of a supraaponeurotic mesh with hernia recurrence and chronic infection with a meshoma. Physical examination revealed VH of 5–8cm in transverse diameter and 10cm in vertical diameter. A CT-scan showed a 6.5cm transverse supraumbilical recurrent hernia with a fatty content.

Results

A laparoscopic approach was performed, revealing an 8×8cm supraumbilical defect in the abdominal cavity with no adhesions. A midline repair was performed according to the principles of the LIRA technique by performing a posterior fascial flap 2cm above the edges of the defect: the midline was reinforced with a loop-suture. An intra-abdominal mesh was placed and fixed with tackers and fibrin glue. In the open procedure, the chronic sinus, meshoma, excess skin and hernial sac were removed.

Conclusions

The treatment of complex abdominal hernias is a field in constant evolution. The HA aims to solve the skin problems associated with laparoscopic repairs alone. The use of intraperitoneal on-lay meshes combined with the use of open approach for excision of the sac and remaining skin tissue allows a complete and effective treatment of complex hernias.
Abnormal brain state distribution and network connectivity in aSYNGAP1rat model
Authors: Buller-Peralta Ingrid , Maicas-Royo Jorge , Lu Zhuoen , Till Sally M , Wood Emma R , Kind Peter C , Escudero Javier , Gonzalez-Sulser Alfredo
Published: October 2022

Mutations in the SYNGAP1 gene are one of the common predictors of neurodevelopmental disorders, commonly resulting in individuals developing autism, intellectual disability, epilepsy, and sleep deficits. EEG recordings in neurodevelopmental disorders show potential to identify clinically translatable biomarkers to both diagnose and track the progress of novel therapeutic strategies, as well as providing insight into underlying pathological mechanisms. In a rat model of SYNGAP1 haploinsufficiency in which the exons encoding the calcium/lipid binding and GTPase-activating protein domains have been deleted (Syngap+/Δ−GAP), we analysed the duration and occurrence of wake, non-rapid eye movement and rapid eye movement brain states during 6 h multi-electrode EEG recordings. We find that although Syngap+/Δ−GAP animals spend an equivalent percent time in wake and sleep states, they have an abnormal brain state distribution as the number of wake and non-rapid eye movement bouts are reduced and there is an increase in the average duration of both wake and non-rapid eye movement epochs. We perform connectivity analysis by calculating the average imaginary coherence between electrode pairs at varying distance thresholds during these states. In group averages from pairs of electrodes at short distances from each other, a clear reduction in connectivity during non-rapid eye movement is present between 11.5 Hz and 29.5 Hz, a frequency range that overlaps with sleep spindles, oscillatory phenomena thought to be important for normal brain function and memory consolidation. Sleep abnormalities were mostly uncorrelated to the electrophysiological signature of absence seizures, spike and wave discharges, as was the imaginary coherence deficit. Sleep spindles occurrence, amplitude, power and spread across multiple electrodes were not reduced in Syngap+/Δ−GAP rats, with only a small decrease in duration detected. Nonetheless, by analysing the dynamic imaginary coherence during sleep spindles, we found a reduction in high-connectivity instances between short-distance electrode pairs. Finally comparing the dynamic imaginary coherence during sleep spindles between individual electrode pairs, we identified a group of channels over the right somatosensory, association and visual cortices that have a significant reduction in connectivity during sleep spindles in mutant animals. This matched a significant reduction in connectivity during spindles when averaged regional comparisons were made. These data suggest that Syngap+/Δ−GAP rats have altered brain state dynamics and EEG connectivity, which may have clinical relevance for SYNGAP1 haploinsufficiency in humans.
Facial Metrics, Aggression, and the Use of Military Force
Authors: Miller Ross A
Published: October 2022

Presidents cite many reasons to justify their decisions to use military force. Regardless of the explanation provided, putting soldiers in harm's way entails a high degree of risk. Some presidents are more willing than others to undertake risky policies, and psychological dispositions help to account for their willingness. According to evolutionary psychology theories of conflict, facial characteristics serve as important cues of aggression, and a substantial body of empirical evidence supports the association between the facial width-to-height ratio (FWHR) and conflict behavior. All else equal, individuals with greater FWHRs are more likely to choose aggressive foreign policies. Empirical analyses of 1953–2000 show that US presidents with higher FWHRs are four times more likely than those with lower FWHRs to use military force. The results hold independent of traditional explanations such as power, ongoing war, elections, the misery index, and alternative measures of leader psychology.
Bacterial Hsp90 predominantly buffers but does not potentiate the phenotypic effects of deleterious mutations during fluorescent protein evolution
Authors: Iyengar Bharat Ravi , Wagner Andreas
Published: October 2022

Chaperones facilitate the folding of other (“client”) proteins and can thus affect the adaptive evolution of these clients. Specifically, chaperones affect the phenotype of proteins via two opposing mechanisms. On the one hand, they can buffer the effects of mutations in proteins and thus help preserve an ancestral, premutation phenotype. On the other hand, they can potentiate the effects of mutations and thus enhance the phenotypic changes caused by a mutation. We study that how the bacterial Hsp90 chaperone (HtpG) affects the evolution of green fluorescent protein. To this end, we performed directed evolution of green fluorescent protein under low and high cellular concentrations of Hsp90. Specifically, we evolved green fluorescent protein under both stabilizing selection for its ancestral (green) phenotype and directional selection toward a new (cyan) phenotype. While Hsp90 did only affect the rate of adaptive evolution transiently, it did affect the phenotypic effects of mutations that occurred during adaptive evolution. Specifically, Hsp90 allowed strongly deleterious mutations to accumulate in evolving populations by buffering their effects. Our observations show that the role of a chaperone for adaptive evolution depends on the organism and the trait being studied.
Frailty Transitions in Older Persons With Lung Function Impairment: A Population-Based Study
Authors: Wijnant Sara R A , Benz Elizabeth , Luik Annemarie I , Rivadeneira Fernando , Voortman Trudy , Brusselle Guy G , Lahousse Lies
Published: October 2022

Background

The aging population and its burden on health care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in participants with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or chronic obstructive pulmonary disease [COPD]).

Methods

In participants from the population-based Rotterdam Study (mean age 69.1 ± 8.9 years), we examined whether PRISm (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≥ 70% and FEV1 < 80%) or COPD (FEV1/FVC < 70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty, and frailty], lost to follow-up, or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odds ratios (OR). Second, we assessed the diagnostic accuracy of frailty score for predicting mortality in participants with COPD using c-statistics.

Results

Compared to participants with normal spirometry, participants with PRISm were more likely to transit from robust (OR 2.2 [1.2–4.2], p < .05) or prefrailty (OR 2.6 [1.3–5.5], p < .01) toward frailty. Participants with PRISm (OR 0.4 [0.2–0.8], p < .05) and COPD (OR 0.6 [0.4–1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state toward death (OR between 1.1 and 2.8, p < .01). Accuracy for predicting mortality in participants with COPD significantly improved when adding frailty score to age, sex, and smoking status (90.5 [82.3–89.8] vs 77.9 [67.2–88.6], p < .05).

Conclusion

Participants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for participants with impaired spirometry for predicting increased life years.
Minimal Volume Product of Convex Bodies with Certain Discrete Symmetries and its Applications
Authors: Iriyeh Hiroshi , Shibata Masataka
Published: October 2022

We give the sharp lower bound of the volume product of $n$-dimensional convex bodies that are invariant under the discrete subgroups $SO(K)=\{ g \in SO(n); g(K)=K \}$, where $K$ is an $n$-cube or $n$-simplex. This provides new partial results of Mahler’s conjecture and its nonsymmetric version. In addition, we give partial answers for Viterbo’s isoperimetric-type conjecture in symplectic geometry from the view point of Mahler’s conjecture.
Generating synthetic mixed discrete-continuous health records with mixed sum-product networks
Authors: Kroes Shannon K S , van Leeuwen Matthijs , Groenwold Rolf H H , Janssen Mart P
Published: October 2022

Objective

Privacy is a concern whenever individual patient health data is exchanged for scientific research. We propose using mixed sum-product networks (MSPNs) as private representations of data and take samples from the network to generate synthetic data that can be shared for subsequent statistical analysis. This anonymization method was evaluated with respect to privacy and information loss.

Materials and methods

Using a simulation study, information loss was quantified by assessing whether synthetic data could reproduce regression parameters obtained from the original data. Predictors variable types were varied between continuous, count, categorical, and mixed discrete-continuous. Additionally, we measured whether the MSPN approach successfully anonymizes the data by removing associations between background and sensitive information for these datasets.

Results

The synthetic data generated with MSPNs yielded regression results highly similar to those generated with original data, differing less than 5% in most simulation scenarios. Standard errors increased compared to the original data. Particularly for smaller datasets (1000 records), this resulted in a discrepancy between the estimated and empirical standard errors. Sensitive values could no longer be inferred from background information for at least 99% of tested individuals.

Discussion

The proposed anonymization approach yields very promising results. Further research is required to evaluate its performance with other types of data and analyses, and to predict how user parameter choices affect a bias-privacy trade-off.

Conclusion

Generating synthetic data from MSPNs is a promising, easy-to-use approach for anonymization of sensitive individual health data that yields informative and private data.
Engaging the next generation of physician–informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group
Authors: Quach William T , Le Chi H , Clark Michael G , McArthur Evonne , Ancker Jessica S , Gadd Cynthia S , Johnson Kevin B
Published: October 2022

Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities. Less formal and more flexible approaches can circumvent these drawbacks. Interest groups (IGs), which are organized through the Association of American Medical College Careers in Medicine (CiM) program, exemplify the informal approach. CiM IGs are student-led groups that provide exposure to different specialty options, acting as an adjunct to the traditional medical curriculum. While the primary purpose of these groups is to assist students applying to residency programs, we took a novel approach of using an IG to increase student exposure to an area of medicine that had not yet been formally integrated at our institution. IGs provide unique advantages to formal integration into a curriculum as they can be more easily setup and can quickly respond to student interests. Furthermore, IGs can act synergistically with UME, acting as proving grounds for ideas that can lead to new courses. We believe that the lessons and takeaways from our experience can act as a guide for those interested in starting similar organizations at their own schools.
Topical Liposomal Amphotericin (Ambisome®) for the Treatment of Cutaneous Fusarium in a Burn-Injured Patient
Authors: Louie Erin , Young Sierra , Virk Mehr , Barsun Alura , Sen Soman
Published: October 2022

Cutaneous Fusarium infections carry significant morbidity and mortality in burn-injured patients. Treatment involves surgical source control in combination of systemic and topical therapy. Given drug shortage constraints with conventional amphotericin deoxycholate, we describe the first case of successful treatment with adjunctive topical liposomal amphotericin in a critically ill burn-injured patient.
Bromelain ameliorates D-galactosamine-induced acute liver injury: role of SIRT1/LKB1/AMPK, GSK3β/Nrf2 and NF-κB p65/TNF-α/caspase-8, -9 signalling pathways
Authors: Didamoony Manar A , Atwa Ahmed M , Abd El-Haleim Enas A , Ahmed Lamiaa A
Published: October 2022

Objectives

The present research focused on estimating, for the first time, the potential protective effects of bromelain against D-galactosamine-induced acute liver injury in rats as well as identifying the possible underlying mechanisms.

Methods

Silymarin (100 mg/kg/day, p.o.) as a reference drug or bromelain (20 and 40 mg/kg/day, p.o.) were administered for 10 days, and on the 8th day of the experiment, a single dose of galactosamine (400 mg/kg/i.p.) induced acute liver injury.

Key findings

Pretreatment with bromelain improved liver functions and histopathological alterations induced by galactosamine. Bromelain ameliorated oxidative stress by inducing SIRT1 protein expression and increasing LKB1 content. This resulted in phosphorylating the AMPK/GSK3β axis, which stimulated Nrf2 activation in hepatic cells and thus increased the activity of its downstream antioxidant enzymes [HO-1 and NQO1]. Besides, bromelain exerted significant anti-apoptotic and anti-inflammatory effects by suppressing hepatic contents of TNF-α, NF-κB p65, as well as caspase-8 and caspase-9. The protective effects of bromelain40 were proved to be better than silymarin and bromelain20 in most of the assessed parameters.

Conclusions

Our results highlight the significant hepatoprotective effects of bromelain against acute liver injury through modulation of SIRT1/LKB1/AMPK, GSK3β/Nrf2 signalling in addition to NF-κB p65/TNF-α/ caspase-8 and -9 pathway.
Gossypiboma discovered 24 years after prostate surgery, a forgotten but never forgiven complication
Authors: Molina Gabriel A , Fuentes Germanico , Jimenez Andres , Proaño Estefany J , Chango Paulina E , Uzcategui Maria Isabel , Alvear Ronald S , Rubio Cristina B
Published: October 2022

Forgetting gauze or “a surgical drape” inside a patient after surgery is a rare medical error. It can lead to severe complications, high hospital costs and medico-legal implications. As a result, this complication is often not reported, mainly to avoid retaliation and because it can initiate extensive critical press coverage. This technical oversight may be just the tip of an iceberg concerning the reality of surgical errors; therefore, the entire surgical team must focus on prevention, continuing medical education and strict adherence to protocols and counting guidelines to minimize their incidence. We present the case of a 76-year-old patient with an acute abdomen; after an initial evaluation, a gossypiboma was discovered, which was forgotten 24 years after prostatectomy.
Trauma emergency thoracotomy for resuscitation in shock—a multi-centre evaluation of current UK practice of pre-hospital and emergency department resuscitative thoracotomy in trauma
Authors: Tucker Harriet , Ramage Lisa , Greenhalgh Rob , Griggs Jo , Lang Nigel , Marsden Max , Vulliamy Paul , Wohlgemut Jared M , Christian Mike , Davenport Ross
Published: October 2022

Background

Resuscitative thoracotomy (RT) in traumatic cardiac arrest, in particular for penetrating trauma features within several national guidelines. However, evidence surrounding its practice is poor, consisting of predominantly small-scale observational studies. Survival is generally poor, estimated at 3–13%, with better outcomes in penetrating trauma. There is no national RT database and the Trauma Audit Research Network data misses those who have died pre-hospital. It is important that a more in-depth and accurate national picture of thoracotomy practice is developed nationally to guide future practice. Traumatic emergency thoracotomy for resuscitation in shock (TETRiS) is a multi-centre, prospective and observational evaluation of current RT practice in the UK.

Aims and objectives

The aim of TETRiS is to evaluate the pathway of care for RT patients within the UK. This will be undertaken over a period of 12 months. This project will evaluate thoracotomies undertaken both pre-hospital and in emergency departments, examining various parameters including frequency, who performs the procedure, clinical indications, time from injury to initiation, mechanism of injury, injuries identified, interventions performed and patient outcomes.

Methods

This project is being conducted as a collaboration between the National Trauma Research and Innovation Collaborative, the Pre-Hospital Trainee Operated Research Network, the Trainee Emergency Research Network and the National HEMS Research and Audit Forum (NHRAF). All UK HEMS, helicopter emergency medicine services and major trauma centre (MTCs) nationally have been recruited, with site investigators identified within each participating unit. Inclusion criteria: All patients undergoing RT, pre-hospital or in an MTC emergency department will be included.
Management and outcomes of sellar, suprasellar and parasellar masses in low- and middle-income countries: a scoping review protocol
Authors: Egiz Abdullah , Dalle David Ulrich , Ooi Setthasorn Zhi Yang , Dada Olaoluwa Ezekiel , Ikwuegbuenyi Chibuikem A , Gillespie Conor S , Tunde Olobatoke A , OuYong Brian Ming , Korch Moniba , Kesici Özgür , de Koning Rosaline , Takoutsing Berjo Dongmo , Bandyopadhyay Soham , Khan Mehdi , Erhabor Joshua , Kotecha Jay , Bocco Alberic Fabrice Sewa , Bankole Nourou Dine Adeniran
Published: October 2022

Sellar, suprasellar or parasellar masses refer to space-occupying lesions that arise from the area surrounding the pituitary gland and many other vital structures, which can impact quality of life if damaged. Therefore, optimal management by a multidisciplinary team, which includes neurosurgeons, would be required to ensure that patients receive timely intervention to prevent long-term co-morbidities. The landscape of management of these masses in high-income countries are well described in the literature, however, there is a lack of clarity in the counterpart low- and middle-income countries, thus necessitating an evaluation of the literature. This protocol outlines how we will conduct our scoping review on the topic of interest. MEDLINE, Embase, Global Index Medicus and African Journals Online will be searched from year 2000 to date in order to identify the relevant studies. Patients with a sellar, suprasellar or parasellar masses managed in an LMIC will be included. Surgical, medical and conservative management of the relevant masses will be considered. Articles in English and French will be included. Primary outcome will describe the management of sellar, suprasellar, or parasellar masses in LMICs. Secondary outcomes will include describing the epidemiology, presentation and outcomes of patients with sellar, suprasellar or parasellar masses. This scoping review will be the first to evaluate the current landscape of the management and outcomes of sellar, suprasellar and parasellar masses in LMICs, highlighting important themes that may be used to guide further research as well as health system strengthening efforts by policymakers, governments and stakeholders.
The Clinical Significance of Staphylococcus aureus Small Colony Variants
Authors: Keim Klara C , George Isaiah K , Reynolds Landrye , Smith Allie C
Published: October 2022

A burdensome, atypical phenotype of Staphylococcus aureus (SA) called S aureus small colony variant (SA-SCV) has been identified, which is induced as a result of a combination of environmental stressors, including polymicrobial interactions. The SA-SCVs exhibit altered phenotypes as a result of metabolic dormancy caused by electron transport deficiency, leading to increased biofilm production and alterations to antimicrobial susceptibility. The SA-SCVs typically exhibit altered colony morphology and biochemical reactions compared with wild-type SA, making them difficult to detect via routine diagnostics. The SA-SCVs have been found to contribute to chronic or recurrent infections, including skin and soft-tissue infections, foreign-body associated infection, cystic fibrosis, and sepsis. There is evidence that SA-SCVs contribute to patient morbidity and mortality as a result of diagnostic difficulties and limited treatment options. New detection methods may need to be developed that can be incorporated into routine diagnostics, which would allow for better assessment of specimens and introduce new considerations for treatment.
Finite shock model of density in supersonic turbulence
Authors: Rabatin Branislav , Collins David C
Published: October 2022

The probability distribution of density in isothermal, supersonic, turbulent gas is approximately lognormal. This behaviour can be traced back to the shock waves travelling through the medium, which randomly adjust the density by a random factor of the local sonic Mach number squared. Provided a certain parcel of gas experiences a large number of shocks, due to the central limit theorem, the resulting distribution for density is lognormal. We explore a model in which parcels of gas undergo finite number of shocks before relaxing to the ambient density, causing the distribution for density to deviate from a lognormal. We confront this model with numerical simulations with various rms Mach numbers ranging from subsonic as low as 0.1 to supersonic at 25. We find that the fits to the finite formula are an order of magnitude better than a lognormal. The model naturally extends even to subsonic flows, where no shocks exist.
Is polydopamine beneficial for cells on the modified surface?
Authors: Yu Yue , Wang Xiuli , Zhu Yi , He Yingning , Xue Hongrui , Ding Jiandong
Published: October 2022

Since the pioneering work of Messersmith’s group discovering that polydopamine (PDA) can serve to adhere to many types of materials, the PDA coating has, as a biomimetic approach, been widely used to enhance cell adhesion by surface modification to bind biologically active substances to a bioinert substrate. Nevertheless, it is unclear whether or not the PDA itself is beneficial for cells. Herein, we report that a PDA coating decreases viability of cells under normal culture and observation conditions. Such an inhibition effect was not caused by the free PDA or any inherent cytotoxicity of this chemical substance but a contact-dependent phenomenon. Human bone marrow mesenchymal stem cells were employed as the default cell type and tissue culture plates were used as the default substrate, although some other cell types and substrates were also examined to confirm the universality of such an ‘abnormal’ phenomenon of a superstar molecule. The viability of cells on the PDA coating exhibited time dependence, and the decreased cell viability during the normal observation time was found to come from the decrease of cell number instead of the decrease of average viability per cell. The PDA coating led to less cell global migration yet more local motility of cells. Based on the concept of ‘background adhesion’ of cells on a surface without significant motifs of specific cell adhesion, we supposed that cells adhered to the PDA coating better, which influenced mobility and eventually proliferation. Hence, the cell behaviors on the PDA coating are reasonable, albeit a bit complicated.
Enterobacter agglomerans, an uncommon cause of community-acquired bacterial infection in neonates
Authors: Mustapha Samaha S , Ibrahim Mohammed , Aliyu Shamsudin , Abdulkadir Isa
Published: October 2022

Enterobacter agglomerans formerly termed Erwina herbicola but now called Pantonea agglomerans is a ubiquitous gram-negative bacterium that rarely causes mild and opportunistic infection in humans. Sources of infection are myriad causing both local and systemic disease across all systems of the body. Infection is often fulminant and fatal in neonates. We aim to report another facet of the infection as seen in our centre. Of the 248 neonates recruited into the study, 94 had bacteria isolated from their blood, eight (8.5%) of whom had E. agglomerans sepsis. Infection was acquired from the community though its source could not be determined. The clinical features were non-specific running a mild course. Toxic granulation, elevated immature polymorph count and procalcitonin level was found in 50% and 75% of the neonates. Isolate was sensitive to most tested antibiotics, showing 100% sensitivity to gentamicin and ciprofloxacin and the survival rate was excellent (87.5%).
Development of Two Early Forecasting Models for Predicting Incidence of Rice Panicle Blast in China
Authors: Guo Fangfang , Liu Wan-Cai , Lu Ming-Hong , You Fengzhi , Wu B. M.
Published: October 2022

Early forecasting of rice panicle blast is critical to the management of rice blast. To develop early forecasting models for rice panicle blast, the relationship between the seasonal maximum incidence of rice panicle blast ( PBx) and the PBx in the preceding crop, weather conditions, location, and acreage of susceptible varieties was analyzed. Results revealed that PBx in the preceding crop, acreage of the susceptible varieties in class ( SVC), altitude, weather conditions 120 to 180 days before the PBx date (dbPBx) and 30 to 90 dbPBx were significantly correlated with the PBx. Subsequently, a logistic model and a two-step hurdle model were developed to predict rice panicle blast. The logistic model was developed to predict whether the PBx was 0 or not based on the preceding PBx, altitude, acreage of susceptible varieties, the longest stretch of days with soil temperatures between 16 and 24°C for the period 120 to 150 dbPBx, and the longest stretch of rainy days in the period 120 to 180 dbPBx. The hurdle model predicted if the PBx was greater than 0 at the first step, and if the prediction was greater than 0, then a regression model was developed for predicting PBx based on the preceding PBx, SVC, altitude, and weather data 180 to 30 dbPBx. Validation with the test datasets showed that the logistic model could correctly predict whether PBx was 0 at a mean test accuracy of 78.39% and that the absolute prediction error of PBx by the two-step hurdle model was smaller than 6.16% for 90% of the records. The model developed in this study will be helpful in management decisions for rice growers and policy makers and offer a useful basis for further studies on the epidemiology and forecasting of rice panicle blast.