bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the nonlinear behavior of EEG with advanced machine learning in artifact elimination
Authors: Sunny Md Samiul Haque , Hossain Shifat , Afroze Nashrah , Hasan Md Kamrul , Hossain Eklas , Rahman Mohammad H
Published: December 2021

Steady-state Visually Evoked Potential (SSVEP) based Electroencephalogram (EEG) signal is utilized in brain-computer interface paradigms, diagnosis of brain diseases, and measurement of the cognitive status of the human brain. However, various artifacts such as the Electrocardiogram (ECG), Electrooculogram (EOG), and Electromyogram (EMG) are present in the raw EEG signal, which adversely affect the EEG-based appliances. In this research, Adaptive Neuro-fuzzy Interface Systems (ANFIS) and Hilbert-Huang Transform (HHT) are primarily employed to remove the artifacts from EEG signals. This work proposes Adaptive Noise Cancellation (ANC) and ANFIS based methods for canceling EEG artifacts. A mathematical model of EEG with the aforementioned artifacts is determined to accomplish the research goal, and then those artifacts are eliminated based on their mathematical characteristics. ANC, ANFIS, and HHT algorithms are simulated on the MATLAB platform, and their performances are also justified by various error estimation criteria using hardware implementation.
Fully screen printed stretchable electrochromic displays
Authors: Linderhed Ulrika , Petsagkourakis Ioannis , Ersman Peter Andersson , Beni Valerio , Tybrandt Klas
Published: December 2021

The advent of the Internet of Things and the growing interest in continuous monitoring by wearables have created a need for conformable and stretchable displays. Electrochromic displays (ECDs) are receiving attention as a cost-effective solution for many simple applications. However, stretchable ECDs have yet to be produced in a robust, large scale and cost-efficient manner. Here we develop a process for making fully screen printed stretchable ECDs. By evaluating commercially available inks with respect to electromechanical properties, including electrochromic PEDOT:PSS inks, our process can be directly applied in the manufacturing of stretchable organic electronic devices. The manufactured ECDs retained colour contrast with useful switching times at static strains up to 50% and strain cycling up to 30% strain. To further demonstrate the applicability of the technology, double-digit 7-segment ECDs were produced, which could conform to curved surfaces and be mounted onto stretchable fabrics while remaining fully functional. Based on their simplicity, robustness and processability, we believe that low cost printed stretchable ECDs can be easily scaled up and will find many applications within the rapidly growing markets of wearable electronics and the Internet of Things.
Analogy between electro-magnetic waves in cold unmagnetized plasma and shallow water inertio-gravity waves in geophysical systems
Authors: Heifetz E , Maas L R M , Mak J , Pomerantz I
Published: December 2021

The fundamental dispersion relation of transverse electro-magnetic waves in a cold collisionless plasma is formally equivalent to the two-dimensional dispersion relation of inertio-gravity waves in a rotating shallow water system, where the Coriolis frequency can be identified with the plasma frequency, and the shallow water gravity wave phase speed plays the role of the speed of light. Here we examine this equivalence and compare between the propagation wave mechanisms in these seemingly unrelated physical systems.
Generating stable molecules using imitation and reinforcement learning
Authors: Ager Meldgaard Søren , Köhler Jonas , Lund Mortensen Henrik , Christiansen Mads-Peter V , Noé Frank , Hammer Bjørk
Published: December 2021

Chemical space is routinely explored by machine learning methods to discover interesting molecules, before time-consuming experimental synthesizing is attempted. However, these methods often rely on a graph representation, ignoring 3D information necessary for determining the stability of the molecules. We propose a reinforcement learning (RL) approach for generating molecules in Cartesian coordinates allowing for quantum chemical prediction of the stability. To improve sample-efficiency we learn basic chemical rules from imitation learning (IL) on the GDB-11 database to create an initial model applicable for all stoichiometries. We then deploy multiple copies of the model conditioned on a specific stoichiometry in a RL setting. The models correctly identify low energy molecules in the database and produce novel isomers not found in the training set. Finally, we apply the model to larger molecules to show how RL further refines the IL model in domains far from the training data.
A note on exhaustion of hyperbolic complex manifolds
Authors: Thu Ninh , Vu Trinh
Published: December 2021

The purpose of this article is to investigate a hyperbolic complex manifold

M
M

exhausted by a pseudoconvex domain

Ω
\Omega

in

C

n

\mathbb {C}^n

via an exhausting sequence

{

f
j

:
Ω
→
M
}

\{f_j\colon \Omega \to M\}

such that

f
j

−
1

(
a
)

f_j^{-1}(a)

converges to a boundary point

ξ
0

∈
∂
Ω

\xi _0 \in \partial \Omega

for some point

a
∈
M

a\in M

.
The Implications of Being “In it Together”: Relationship Satisfaction and Joint Health Behaviors Predict Better Health and Stronger Concordance Between Partners
Authors: Wilson Stephanie J , Novak Joshua R
Published: December 2021

Background

Extensive evidence shows that satisfying marriages boost physical health and longevity. A separate literature reveals strong concordance in couples’ health, but the relationship processes that contribute to health concordance remain poorly understood.

Purpose

The current study examined whether relationship satisfaction and joint health behaviors—the extent to which couples eat, sleep, and exercise together—are associated simultaneously with better health and greater health similarity between partners.

Methods

Heterogeneous variance multilevel models were applied to data from 234 married couples (Mage = 46, Range = 20–84) reporting on their relationship satisfaction, joint health behaviors, and four health indicators—health satisfaction, depressive symptoms, comorbidities, and medication use.

Results

More satisfied couples engaged in more joint health behaviors than less satisfied counterparts. When joint health behaviors and relationship satisfaction were examined as separate fixed effects, both predicted greater health satisfaction and fewer depressive symptoms. More joint health behaviors were also associated with less medication use. When both were modeled together, only relationship satisfaction predicted depressive symptoms. By contrast, in random effects, joint health behaviors predicted greater similarity in health satisfaction, depressive symptoms, and comorbidities. Relationship satisfaction only predicted more similar depressive symptoms.

Conclusions

Although more satisfied couples engaged in more joint health behaviors. relationship satisfaction and joint health behaviors uniquely predicted couples’ health quality and concordance, suggesting that distinct mechanisms may drive better health and stronger health resemblance.
An integrated approach to evaluate different tetracycline derivatives for formulary decisions
Authors: Zidaru Andrei , Phe Kady , Lasco Todd M , Tam Vincent H
Published: December 2021

Purpose

Stenotrophomonas maltophilia has emerged as a critical opportunistic pathogen associated with significant morbidity and mortality. Tetracycline derivatives have been recognized as alternative treatment options, but they have varied pharmacokinetic properties. An integrated approach to different tetracycline derivatives for formulary decisions is reported.

Methods

The minimum inhibitory concentration (MIC) data from clonally diverse bloodstream S. maltophilia isolates were examined, along with the pharmacokinetic profiles of 4 tetracycline derivatives, to predict achievable pharmacodynamic exposures with standard intravenous dosing regimens. Antimicrobial therapy was assessed using the ratio of daily drug acquisition cost relative to the ratio of the free-drug area under the time-concentration curve (fAUC) to minimum inhibitory concentration (MIC) for 90% of isolates (fAUC/MIC90).

Results

In our analysis, minocycline had the greatest fAUC/MIC90. Doxycycline was the most financially preferred agent, as calculated using 2020 average wholesale price for base-case estimates of drug acquisition cost.

Conclusion

An integrated evaluation for antimicrobial formulary decision-making addressed local susceptibility data, pharmacokinetics, pharmacodynamics, dosing regimens, and drug acquisition costs. This comprehensive method is more objective than the conventional approach and warrants validation.
The relationship of vancomycin 24-hour AUC and trough concentration
Authors: Nix David E , Davis Lisa E , Matthias Kathryn R
Published: December 2021

Purpose

Prior to the 2020 release of a joint consensus guideline on monitoring of vancomycin therapy for serious methicillin-resistant Staphylococcus aureus (MRSA) infections, clinicians had escalated vancomycin doses for 2 decades while targeting trough concentrations of 15 to 20 µg/mL, leading to an increased frequency of nephrotoxicity. For MRSA infections, the 2020 guideline recommends adjusting doses to achieve a 24-hour area under the concentration-time curve (AUC) of 400 to 600 µg · h/mL; however, monitoring of trough concentrations has been entrenched for 3 decades. Calculating dose regimens based on AUC will require obtaining an increased number of vancomycin serum concentrations and, possibly, advanced software. The aim of this investigation was to determine the relationship between AUC and trough concentration and the influence of dosing regimen on goal achievement.

Methods

The relationship between trough concentration and AUC was explored through derivation of an equation based on a 1-compartment model and simulations.

Results

24-hour AUC is related to dosing interval divided by half-life in a nonlinear fashion. The target trough concentration can be individualized to achieve a desired AUC range, and limiting use of large doses (>15-20 mg/kg) can protect against excessive 24-hour AUC with trough-only monitoring.

Conclusion

After initially determining pharmacokinetic parameters, subsequent monitoring of AUC can be accomplished using trough concentrations only. Trough concentration may be used as a surrogate for AUC, although the acceptable target trough concentration will vary depending on dosing interval and elimination rate constant. This work included development of an AUC-trough equation to establish a patient-specific target for steady-state trough concentration.
Amyloid β protein negatively regulates human platelet activation induced by thrombin receptor-activating protein
Authors: Mizutani Daisuke , Tokuda Haruhiko , Onuma Takashi , Uematsu Kodai , Nakashima Daiki , Ueda Kyohei , Doi Tomoaki , Enomoto Yukiko , Matsushima-Nishiwaki Rie , Ogura Shinji , Iida Hiroki , Kozawa Osamu , Iwama Toru
Published: December 2021

Amyloid β protein deposition in cerebral vessels, a characteristic of Alzheimer's disease, is a risk factor for intracerebral hemorrhage. Amyloid β protein directly modulates human platelet function; however, the exact mechanism of action is unclear. Therefore, we investigated the effects of amyloid β protein on human platelet activation using an aggregometer with laser scattering. Amyloid β protein decreased platelet aggregation induced by thrombin receptor-activating protein, but not by collagen and ADP. Amyloid β protein also suppressed platelet aggregation induced by SCP0237 and A3227. Platelet-derived growth factor-AB secretion and phosphorylated-heat shock protein 27 release by thrombin receptor-activating protein were inhibited by amyloid β protein. Additionally, thrombin receptor-activating protein-induced phosphorylation of JNK and p38 MAP kinase was reduced by amyloid β protein. Collectively, our results strongly suggest that amyloid β protein negatively regulates protease-activated receptor-elicited human platelet activation. These findings may indicate a cause of intracerebral hemorrhage due to amyloid β protein.
Overexpression of SRO_3163, a homolog of Streptomyces antibiotic regulatory protein, induces the production of novel cyclohexene-containing enamide in Streptomyces rochei
Authors: Misaki Yuya , Nindita Yosi , Fujita Kota , Fauzi Amirudin Akhmad , Arakawa Kenji
Published: December 2021

Streptomyces antibiotic regulatory proteins (SARPs) are well characterized as transcriptional activators for secondary metabolites in Streptomyces species. Streptomyces rochei 7434AN4 harbors 15 SARP genes, among which 3 were located on a giant linear plasmid pSLA2-L and others were on the chromosome. Some SARP genes were cloned into an integrative thiostrepton-inducible vector pIJ8600, and their recombinants were cultivated. The recombinant of SARP gene, SRO_3163, accumulated a UV-active compound YM3163-A, which was not detected in the parent strain and other SARP recombinants. Its molecular formula was established to be C8H11NO. Extensive NMR analysis revealed that YM3163-A is a novel enamide, 2-(cyclohex-2-en-1-ylidene)acetamide, and its structure was confirmed by chemical synthesis including Horner–Wadsworth–Emmons reaction and ammonolysis.
wTAM: a web server for annotation of weighted human microRNAs
Authors: Cui Chunmei , Fan Rui , Zhou Yuan , Cui Qinghua
Published: December 2021

It is well-known that some microRNAs (miRNAs) are more important than the others for life, hinting the wide range of miRNA in essentiality or importance. Functional enrichment analysis is a quite pervasive method to dig out the underlying biological pathway for a given gene list and several tools of miRNA set enrichment analysis have been developed. However, all those tools treat each miRNA equally and neglect the importance score of miRNA itself, which could be an obstacle to seek more insightful biological processes for researchers. Here, we developed wTAM, a tool for annotation of weighted human miRNAs, introducing the miRNA importance scores into enrichment analysis. In addition, the annotation repository has been enlarged comparing to TAM. Finally, the case study demonstrated the availability and flexibility of wTAM.

Availability and implementation

wTAM is freely available at http://www.cuilab.cn/wtam/.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
miRe2e: a full end-to-end deep model based on transformers for prediction of pre-miRNAs
Authors: Raad Jonathan , Bugnon Leandro A , Milone Diego H , Stegmayer Georgina
Published: December 2021

Motivation

MicroRNAs (miRNAs) are small RNA sequences with key roles in the regulation of gene expression at post-transcriptional level in different species. Accurate prediction of novel miRNAs is needed due to their importance in many biological processes and their associations with complicated diseases in humans. Many machine learning approaches were proposed in the last decade for this purpose, but requiring handcrafted features extraction to identify possible de novo miRNAs. More recently, the emergence of deep learning (DL) has allowed the automatic feature extraction, learning relevant representations by themselves. However, the state-of-art deep models require complex pre-processing of the input sequences and prediction of their secondary structure to reach an acceptable performance.

Results

In this work, we present miRe2e, the first full end-to-end DL model for pre-miRNA prediction. This model is based on Transformers, a neural architecture that uses attention mechanisms to infer global dependencies between inputs and outputs. It is capable of receiving the raw genome-wide data as input, without any pre-processing nor feature engineering. After a training stage with known pre-miRNAs, hairpin and non-harpin sequences, it can identify all the pre-miRNA sequences within a genome. The model has been validated through several experimental setups using the human genome, and it was compared with state-of-the-art algorithms obtaining 10 times better performance.

Availability and implementation

Webdemo available at https://sinc.unl.edu.ar/web-demo/miRe2e/ and source code available for download at https://github.com/sinc-lab/miRe2e.

Supplementary information

Supplementary data are available at Bioinformatics online.
SCRIP: an accurate simulator for single-cell RNA sequencing data
Authors: Qin Fei , Luo Xizhi , Xiao Feifei , Cai Guoshuai
Published: December 2021

Motivation

Recent advancements in single-cell RNA sequencing (scRNA-seq) have enabled time-efficient transcriptome profiling in individual cells. To optimize sequencing protocols and develop reliable analysis methods for various application scenarios, solid simulation methods for scRNA-seq data are required. However, due to the noisy nature of scRNA-seq data, currently available simulation methods cannot sufficiently capture and simulate important properties of real data, especially the biological variation. In this study, we developed scRNA-seq information producer (SCRIP), a novel simulator for scRNA-seq that is accurate and enables simulation of bursting kinetics.

Results

Compared to existing simulators, SCRIP showed a significantly higher accuracy of stimulating key data features, including mean–variance dependency in all experiments. SCRIP also outperformed other methods in recovering cell–cell distances. The application of SCRIP in evaluating differential expression analysis methods showed that edgeR outperformed other examined methods in differential expression analyses, and ZINB-WaVE improved the AUC at high dropout rates. Collectively, this study provides the research community with a rigorous tool for scRNA-seq data simulation.

Availability and implementation

https://CRAN.R-project.org/package=SCRIP.

Supplementary information

Supplementary data are available at Bioinformatics online.
P012 RISK FACTORS FOR INCISIONAL HERNIA AND ITS RECURRENCE: OBSERVATIONAL, AMBISPECTIVE STUDY
Authors: Jimenez Lia , Rojas Alexei , Merchan Angela , Velasquez Braulio , Fernandez Daniel , Bravo Andres
Published: December 2021

Aims

In patients with herniorrhaphy treated in a 3rd level hospital in the Southwestern of Colombia from January 2014 to March 2020, determine the frequency of incisional hernia recurrence and the risk factors related to.

Materials and methods

Observational, ambispective study that included patients older than 15 years with a history of incisional hernia that agreed to participate and signed a consent form. Patients with incomplete data or who underwent surgery in another institution were excluded. Follow-up appointments every 3 months were made to evaluate the incidence of hernia recurrence.

Results

112 patients were included, 64.3% female with a mean age of 58.6-year-old. The frequency of recurrence was 38.4% with a mean of appearance of 22.9 months; 44.2% were repaired with only one technique and 39.5% with non-mesh. Non-use of mesh increased the risk for recurrence (RR 2.02; CI95%: 1.17-3.48). Other risk factors were urgent surgery (RR 1.82; CI95%: 1.14-2.91), defect closure with multifilament suture (RR 1.61; CI95%: 1.15-2.25), not do adhesiolysis (RR 3.17; CI 95%; 0.85 – 11.76) and the no use of postoperative antibiotics (RR 1.67M CI95%: 0.97-2.89).

Conclusions

Incisional hernia recurrences increase with time. Therefore, a follow-up of at least for 3 years should be guaranteed to avoid undiagnosed cases. Risk factors identified like absorbable multifilament sutures and non-use of the mesh must be removed from the surgery plans. Furthermore, a specialized in-hospital group of the abdominal wall and an institutional protocol would help to diminish this complication.
P015 ABDOMINAL WALL PREPARATION PRECEDING COMPLEX ABDOMINAL WALL RECONSTRUCTION (CAWR) - SINGLE CENTER INITIAL EXPERIENCES UTILIZING BOTULINUM TOXIN A (BTA) ACCOMPANIED IN SELECTED PATIENTS BY PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM (PPP)
Authors: Husu Henrik , Valle Sanna , Scheinin Tom , Vironen Jaana
Published: December 2021

Aim

Complex ventral hernia (CVH) treatment due to large abdominal wall defects or loss of domain is challenging. BTA-injection in lateral abdominal wall causing flaccid paralysis and elongation, so called chemical component separation (CCS), might facilitate closure of large fascial defects. Combining preoperative progressive pneumoperitoneum might help restore abdominal content in severe loss of domain situations. We studied the results after CAWR following abdominal wall preparation with BTA and possible PPP. Primary aim was to report fascial defect closure rate without need for surgical component separation.

Material and Methods

All electively operated patients to date that were treated preoperatively with BTA, including all patients treated with PPP.

Results

Hospital index patient received preoperative BTA in January 2018. Since then, altogether 42 patients underwent CCS prior to CAWR. Average patient suffered from obesity (mean BMI 31), 30% had diabetes, and a third were active smokers. Mean hernia defect area exceeded 200 cm2. All operations were mesh repairs. Surgical approach was mostly (88%) open retromuscular. Abdominal wall reconstruction via fascial closure was achieved in 93% of cases with only 21% needing surgical component separation. Preoperative morbidity was common in patients undergoing PPP. Around 40% of all patients had postoperative complications, half of which were surgical complications. One patient died of a yet unknown cause on the third postoperative day. There were no recurrences within median 15 months follow-up.

Conclusions

Restoring abdominal wall continuity without frequent need for surgical component separation seems likely in CVH following CCS.
P022 OUTCOMES OF ABDOMINAL WALL REPAIR ASSOCIATED WITH INTESTINAL TRANSIT RECONSTRUCTION SURGERY
Authors: Munoz-Rodriguez Joaquin , Monclús Javier López , Lersundi Alvaro Robin Valle de , Hernando Luis Blázquez , Ureña Miguel Ángel García
Published: December 2021

Aim

Analyze and evaluate the results obtained in patients undergoing transit reconstruction surgery in which an abdominal wall reconstruction (AWR) is associated using a multidisciplinary approach.

Material and Methods

All patients who underwent an intestinal transit reconstruction associated with an AWR surgery were identified from a prospectively maintained multicenter database.

Short and long-term results have been analyzed, especially AWR outcomes.

Results

10 patients were identified. 60% were men. Mean time since previous surgery was 1.66 years.

8 cases (80%) associated a midline incisional hernia with the parastomal hernia.

3 (30%) bilateral posterior component separation (PCS) Madrid transverse abdominis muscle release (Madrid TAR) modification, 5 (50%) unilateral Madrid TAR, 1 (10%) PCS Carbonell, and 1 (10%) Rives-Stoppa techniques were performed.

A double mesh reconstruction technique was used in 60% of the patients, associating absorbable mesh with a permanent mesh.

One patient presented a paucisymptomatic colorectal anastomosis fistula, that could be managed conservatively. A case of postsurgical ileus was also evidenced.

Surgical site ocurrences (SSO) were recorded in 4 patients (40%), all of them related to surgical site infection that required a bedside wound opening.

During a mean follow-up of 24 (+/- 15) months, there was no evidence of hernia recurrence. No cases of bulging, chronic mesh infection or chronic pain were reported.

No case of mortality was recorded in the series.

Conclusions

Intestinal transit reconstruction surgery associated with an AWR, with a multidisciplinary team managed, presents acceptable long-term results, despite the high SSO associated.
P028 COMBINING SEVEN ITEMS OF THE TOOLBOX TO TREAT A LARGE INCISIONAL HERNIA WITH HETEROTOPIC OSSIFICATION: A CASE REPORT
Authors: Malaibari Zaid , Niebuhr Henning , Dag Halil
Published: December 2021

Aim

We present our approach of treating a W3 (EHS-Classification) incisional hernia with heterotopic ossification in the abdominal wall.

Material and Methods

a 62-years-old female patient presented with a hernia in her inverted-T incision (midline and transverse) after undergoing multiple laparotomies. The CT-scan showed calcified structures within the abdominal wall. We planned the extensive reconstruction after preoperative Botox injections.

Results

The 20x25 cm hernial sack contained parts of the stomach and colon. The dissection of the midline and transverse scars was challenging with the needed removal of scattered pieces of heterotopic bone tissues. After dissecting the retro-muscular space, the fascial edges were 25 cm apart. With bilateral transversus abdominis release (TAR), It was reduced to 20 cm. The posterior fascia was approximated, leaving a central 12 cm defect, and a smaller lateral defect, which we covered using open-IPOM and underlay techniques respectively. A 30x40 cm mesh in sublay position was placed and fascial traction was applied on the anterior fascia. With the resulting defect of 16 cm, a tension-free closure was still not possible, and we bridged the gap with a mesh in inlay position.

Conclusions

Despite combining pre-operative Botox injection and fascial traction with TAR, complete closure of the fascia was not possible. IPOM, sublay, underlay and inlay bridging were needed. Specialized hernia surgeons should be familiar with a wide range of different techniques to deal with such cases.
P029 HOW DOES THE MADRID APPROACH WORK
Authors: Blázquez Luis Alberto , Oto Diego , Porrero Belén , Molina José Manuel , Pastor Paula , Nieto María del Rocío
Published: December 2021

Aim

The Madrid APPROACH is the combination of an absorbable mesh and a permanent retromuscular mesh for the treatment of the complex abdominal wall problems. It has been controversial because of the need of two different meshes. We present a clinic case to show the utility of this technique and how it allows rebuilding the inguinal ligament.

Material and Methods

78 years old woman who underwent a right ilioinguinal and obturatriz lymphadenectomy due to a melanoma. Incisional hernia fixed in 2018 with a retromuscular polyester mesh. New incisional iliac hernia (L3) over the right iliac vessels, with an absence of inguinal ligament, right rectus atrophy, and the previous mesh being part of the sac.

Surgery: incision over the previous scar. Wide dissection of the preperitoneal space, Retzius space and lateral to the cuadratus lumborum, retrodiafragmatic dissection, lateral transverse abdominus release, and cross-over to the retrorectal left space. Preperitoneal BioA mesh and an upper 40x40cm medium weight polipropilene mesh set to both Cooper ligaments.

Results

After two and a half months, a PET-TC showed the BioA mesh perfectly adapted to the abdominal wall and rebuilt a new inguinal ligament. Also intense FDG capitation of the mesh due to the high cellular metabolism.

Two years later the patient has a continent abdominal wall, the follow up TC shows the disappearance of the absorbable mesh and the perfect abdominal wall rebuilt.

Conclusions

The BioA mesh acts like a tissue scaffold for new conjunctive tissue as we see the intense FDG captation. The Madrid APPROACH allows giving response to very complex abdominal wall problems.
P040 INFLAMMATORY REACTION TO ALD COATED POLYPROPYLENE MESHES USED FOR HERNIA REPIAR. AN EXPERIMENTAL STUDY IN ANIMALS
Authors: Khamidov Magomed , Razin Ragimov , Maksumova Abay , Abdullaeva Naida , Gasanbekova Zeinab , Abdulagatov Aziz
Published: December 2021

Aim

The main goal of the present work is to study and ability of Atomic Layer Depostion (ALD) ultra-thin (<100nm) ceramic films on polypropylene (PP) hernia meshes to prevent the mesh-associated infections (post-surgery complications).

Material and Methods

Three types of ALD nanofilms were examined: Al2O3, TiO2, or TixVyOz. 10 rats and 5 rabbits were used to evaluate the tissue reaction of surface modified PP meshes and for biomechanical (antibacterial, inflammation effect), biocompatibility, and barrier testing of the healed tissue. The ALD coated PP meshes were implanted into rabbits and rats together with uncoated ones. After 10, 20, 30 and 60 days, the hernia meshes with the surrounding soft tissues were removed and fixed for histological and cytological studies.

Results

The TixVyOz (28nm) film showed enhanced antibacterial activity compare to Al2O3 and TiO2 films. The histology was performed on coated and uncoated PP mesh samples.

Conclusions

The ALD TixVyOz film helped to avoids formation of rough scar tissue (microscale roughness, which prevents ability biofilm formation) and, reduction of eosinophilic-cell and lymphocytic-cell reactions of the tissues surrounding the mesh, illustrate good integration into the surrounding tissue with minimal inflammatory reaction and minimal adhesions to intra-abdominal structures. The ALD film was highly effective in inhibiting S. aureus and E. coli bacteria adhesion and exhibited excellent biological activity in promoting osteoblastic adhesion. Speculatively, presence of vanadyl (≡V=O:) chemical groups, either on the surface or in the bulk, believe to play a key role in high performance of the TixVyOz compare to TiO2.
P045 MEDIALIZATION AFTER COMBINED ANTERIOR AND POSTERIOR COMPONENT SEPARATION IN GIANT INCISIONAL HERNIA SURGERY, AN ANATOMICAL STUDY
Authors: Sneiders Dimitri , Smet Gijs de , Hartog Floris den , Verstoep Laura , Menon Anand , Muysoms Filip , Kleinrensink Gert-Jan , Lange Johan
Published: December 2021

Aim

To obtain tension-free closure for giant incisional hernia repair, anterior or posterior component separation (ACS, PCS) is often performed. In extreme patients, ACS and PCS may be combined. The aim of this study was to assess the additional medialization after simultaneous ACS and PCS.

Material and Methods

Fresh-frozen post mortem human specimens were used. Both sides of the abdominal wall were subjected to retro-rectus dissection (Rives-Stoppa), ACS and PCS, the order in which the component separation techniques (CST) were performed was reversed for the contralateral side. Medialization was measured at three reference points.

Results

ACS provided most medialization for the anterior rectus sheath, PCS provided most medialization for the posterior rectus sheath. After combined CST total median medialization ranged between 5.8 and 9.2 cm for the anterior rectus sheath, and between 10.1 and 14.2 cm for the posterior rectus sheath (depending on the level on the abdomen). For the anterior rectus sheath, additional PCS after ACS provided 15% to 16%, and additional ACS after PCS provided 32% to 38% of the total medialization after combined CST. For the posterior rectus sheath, additional PCS after ACS provided 50% to 59%, and additional ACS after PCS provided 11% to 17% of the total medialization after combined CST. Retro-rectus dissection alone contributed up to 41% of maximum obtainable medialization.

Conclusions

ACS provided most medialization of the anterior rectus sheath and PCS provided most medialization of the posterior rectus sheath. Combined CST provides marginal additional medialization, clinical use of this technique should be carefully balanced against additional risks.
P049 SAFETY AND EFFICACY OF ABSORBABLE AND NON-ABSORBABLE FIXATION SYSTEMS FOR INTRAPERITONEAL MESH FIXATION: AN EXPERIMENTAL STUDY IN SWINE
Authors: Kapoulas Spyridon , Papalois Apostolos , Papadakis Georgios , Tsoulfas Georgios , Christoforidis Emmanouil , Papaziogas Basileios , Schizas Dimitrios , Chatzimavroudis Grigorios
Published: December 2021

Aim

Choice of the best fixation system in terms of safety and effectiveness for intraperitoneal mesh placement in hernia surgery remains controversial. The aim of this study was to compare the performance of four fixation systems in a swine model of intraperitoneal mesh fixation.

Material and Methods

Fourteen Landrace swine were utilized and the experiment included two stages. Initially, four pieces of polypropylene mesh with hydrogel barrier coating1 were fixed intraperitoneally to reinforce 4 small full thickness abdominal wall defects created with diathermy. Each mesh was anchored with a different tack device between titanium2, steel3 or absorbable (4,5) fasteners. The second stage took place after 60 days and included euthanasia, laparoscopy, and laparotomy. The primary endpoint was to compare the peel strength of the compound tack/mesh from the abdominal wall. Secondary parameters were the extent and quality of visceral adhesions to the mesh, the degree of mesh shrinkage and the histological response around the tacks.

Results

Thirteen out of 14 animals survived the experiment and 10 were included in the final analysis. Steel tacks had higher peel strength when compared to titanium and absorbable fasteners. No significant differences were noted regarding the secondary endpoints.

Conclusions

Steel fasteners provided higher peel strength that the other devices in this swine model of intraperitoneal mesh fixation. Our findings generate the hypothesis that this type of fixation may be superior in a clinical setting. Clinical trials with long-term follow-up are required to assess the safety and efficacy of mesh fixation systems in hernia surgery.
P053 COMPARISON OF CLINICAL OUTCOMES BETWEEN INTRAPERITONEAL ONLAY MESH REPAIR (IPOM PLUS) AND ENHANCED-VIEW TOTALLY EXTRAPERITONEAL REPAIR (ETEP) FOR VENTRAL HERNIAS
Authors: Hirukawa Hiroshi
Published: December 2021

Aim

We have been performing intraperitoneal on lay mesh repair (IPOM plus) as the standard laparoscopic procedure for ventral hernia in our department. We introduced enhanced-view totally extraperitoneal repair (eTEP) for ventral hernia repair in 2018, and have performed 31 cases so far. We compared the outcomes of IPOM Plus and eTEP at our institution.

Material and Methods

Ventral hernia cases who underwent surgery at our department between 2018 and 2020 were included in the study. The postoperative outcomes and complications of the IPOM Plus and eTEP groups were evaluated retrospectively.

Results

There were 12 cases of IPOM plus, and all were incisional hernias. There were 31 cases of eTEP, including 7 cases of primary hernias and 24 cases of incisional hernias. Transversus abdominis muscle release (TAR) was added in 24 cases. The mean hernia size was 6.6 x 7.9 cm with IPOM Plus and 8.0 x 10.1 cm with eTEP, and the average meshes size was 15.5 x 22.0 cm and 20.3 x 23.6 cm, respectively. The mean postoperative hospital stay was 7.8 days and 5 days. Postoperative complications included 1 case of mesh bulging and 1 case of recurrence in the IPOM Plus group, 1 case of seroma and 1 case of intestinal obstruction in the eTEP.

Conclusions

The surgical outcomes for ventral hernias up to 8 cm wide were similar for IPOM Plus and eTEP. The eTEP can insert a larger mesh and may be useful for wider hernias (>8cm).
P072 ARTICULATED LAPAROSCOPIC INSTRUMENTS. BENEFITS ON LAPAROSCOPIC HERNIOPLASTY
Authors: Santilli Osvaldo , Santilli Hernán , Scaravonati Rodolfo , Nardelli Nicolás , Etchepare Hernán
Published: December 2021

Aim

To present initial experience using 5 mm articulated laparoscopic instruments in tapp laparoscopic hernioplasty that emulated the benefits attributed to robotic surgery.

Material and Methods

We report data from the first 42 procedures using 5 mm articulating instruments.

A retrospective analysis was performed in patients who underwent tapp laparoscopic hernioplasty using novel articulated graspers, needle holders, and scissors. The surgeons and surgical nurses were trained in the handling and operation of the articulating instruments, before the first surgical procedure. In all cases, articulating instruments were inserted through 5 mm trocars. Data collected included patient demographics, details related to the surgical procedure, postoperative outcomes, and complications.

Results

Over a period of one month, were repaired 78 inguinal hernias. 36 patients had a bilateral hernia, and the mean age was 45 years (SD 15.1), with a mean BMI of 28.6 (SD 6.1). 32 male and 4 female patients. The mean operative time was 90 min. The articulated head of the clamp allowed traction, dissection, and suture in different directions. In addition, was not detected a significant learning curve due to its intuitive applicability. Surgical complications included two serohematomas. All patients discharge during operation day. The procedures performing without intraoperative complications nor conversion to open surgery occurred.

Conclusions

The use of an articulated instrument has a promising future. It would meet some benefits of robotics without increasing costs. We need randomized comparative studies for a better conclusion.
P089 THE IMPACT OF VENTRAL HERNIA REPAIR ON PATIENT-REPORTED QUALITY OF LIFE: IDENTIFYING FACTORS ASSOCIATED WITH IMPROVEMENT
Authors: Morris Martin , Patel Viren , Christopher Adrienne , Broach Robyn , Fischer John
Published: December 2021

Aim

Assessing pre- and postoperative quality of life (QoL) is essential to quantify the magnitude of improvement in disease burden after ventral hernia repair (VHR). Here, we identify patient and operative factors associated with QoL improvement after VHR.

Material and Methods

Patients that underwent VHR by a single surgeon were retrospectively identified and included if they had minimum 1 year of follow-up, and completed pre- and postoperative Abdominal Hernia-Q (AHQ) questionnaires. Patients were divided into quintiles based on absolute pre- to postoperative improvement in AHQ score. Chi-squared and fisher’s exact tests were used for categorical data, and Student’s t-test for continuous data, as appropriate.

Results

Compared to the lowest quintile (n = 27, follow-up 32.6 months, mean improvement 3.24 [SD 10.4]), patients in the highest quintile (n = 26, follow up 23.9 months, mean improvement 66.3 [SD 12.1]) were female (76.9% vs 37.0%, p = 0.005) with a greater number of previous hernia repairs (mean 2.12 vs. 0.78, p < 0.005) and previous abdominal surgeries (mean 4.0 vs 2.0, p < 0.001). Patients with greater improvement also had higher incidences of delayed healing (42.3% vs 7.41%), required more office visits (5.54 vs 3.89), and had higher inpatient costs ($30,084 USD vs. $16,886, all p < 0.05). No significant differences were seen in terms of race, ethnicity, body mass index, age, length of stay, Clavien-Dindo scores, hernia recurrence, or other postoperative complications.

Conclusions

Despite increased preoperative risk and healthcare burden, some of the most significant QoL improvement after VHR is demonstrated in patients with complex repairs and recoveries. This indicates the global utility of VHR regardless of patient demographics and complicating perioperative factors.
P090 LONG-TERM OUTCOMES FOLLOWING HYBRID BIOMATERIAL REPAIR OF VENTRAL HERNIAS: A MULTICENTER, RETROSPECTIVE STUDY
Authors: Doerhoff Carl , Grantham David , Mallico Eric , Washington Raymond , Linn John
Published: December 2021

Aim

To analyze device safety and clinical outcomes of ventral hernia repair with a hybrid composite mesh

Material and Methods

This retrospective, multicenter, case review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥ 1 year from study enrollment.

Results

There were 459 patients with 469 ventral hernias with a mean age of 58 ±15 years and 77% Ventral Hernia Working Group 2 (VHWG2). Mean hernia size was 18.9 cm2. Laparoscopic or robotic approach were utilized in 95% of patients, incisional hernias accounted for 57%. Mesh location was 75% intraperitoneal and bridging repair was performed in 57%. Procedure related adverse events within 30-days occurred in 5%, including: surgical site infection (SSI), surgical site occurrence (SSO), ileus, readmission, and re-operation. Procedure-related SSI or SSO events were 3.75% through 12-months. SSO events requiring procedural intervention (SSOPI) were 2.57% through 24-months. An estimated 7% of subjects had hernia recurrence through the study with a mean follow-up of 32-months (14-53 months) using a patient-reported outcome measure. Subgroup comparison of fixation type (permanent vs absorbable, p = 0.93) and repair (bridging vs reinforcement, p = 0.99) were conducted for recurrence and were not statistically significant.

Conclusions

In this analysis, ventral hernia repair with hybrid, composite mesh results in successful outcomes in the majority of patients. This study represents a heterogeneous patient population undergoing repair using various approaches, mesh fixation, and mesh placement locations. These data appear to confirm long-term acceptable safety and device performance with a low rate of recurrence in a predominantly VHWG2 population.
P108 SARCOPENIA INCREASES THE RISK OF BURST ABDOMEN AFTER EMERGENCY MIDLINE LAPAROTOMY: A MATCHED CASE-CONTROL STUDY
Authors: Jensen Thomas Korgaard , Nielsen Yousef Jesper Wirenfeldt , Tolstrup Mai-Britt , Gögenur Ismail
Published: December 2021

Aim

The aim of this study was to investigate the association of sarcopenia with the risk of burst abdomen after midline laparotomy.

Material and Methods

A single-center, retrospective, 1:4 matched case-control study of patients suffering from burst abdomen (cases) and controls. Sarcopenia was defined as lowest sex-dependent quartile of total cross-sectional psoas area adjusted for body surface area. Primary outcome was to evaluate the rate of sarcopenic patients among cases and controls. Secondary, risk-factors for burst abdomen and postoperative death, were evaluated by multivariate regression analysis.

Results

67 patients suffering from burst abdomen were matched to 268 controls. Sarcopenia was associated with burst abdomen (OR 2.3, p = 0.006). Unadjusted analysis identified a higher 90-day mortality among sarcopenic patients compared to the non-sarcopenia group (32.9% vs. 21.1%, p = 0.029) but this association was not verified by the adjusted analysis.

Conclusions

Sarcopenia is an isolated risk-factor for burst abdomen after midline laparotomy.
P118 MORBIDITY, MORTALITY AND RECURRENCE FACTORS OF INCARCERATED FEMORAL HERNIA
Authors: Kalayci Tolga , Iliklerden Umit Haluk , Kotan Mehmet Çetin
Published: December 2021

Aim

Aimed to search the factors affecting morbidity, mortality, and recurrence in incarcerated femoral hernia cases.

Material and Methods

After ethical committee approval, patients operated due to incarcerated femoral hernia between 2010 and 2020 were included in the study. Patients in the pediatric age group (0-18 years), and pregnant patients were excluded from the study. Preoperative, intraoperative, and postoperative factors of the patients were gathered. Morbidity, mortality, and recurrence factors were evaluated with Mann-Whitney U test, χ² test, and Likelihood ratio test, p value lower than 0.05 as significant.

Results

The mean age of 50 patients was 54.56±19.34 years (19-91) and the female to male ratio was 33/17. Right-sided hernia was present in 27 (54%) patients and recurrent hernia in 5 (10%) patients. The most common surgery type was Mc Vay repair in 33 (66%) patients. Other surgery types were as follows: Lichtenstein procedure in 9 (18%) patients and Rutkow plug procedure in 8 (16%) patients. The morbidity and mortality rates of the study were 14% and 4%, respectively. Postoperative recurrence was seen in only 3 (6%) patients. Patients with preoperative nausea (p = 0.003), vomiting (p < 0.001), and tachycardia (p < 0.001), presence of recurrent hernia (p < 0.001), surgery under general anesthesia (p < 0.001), performing both laparotomy (p = 0.007) and organ resection during surgery (p < 0.001) had more morbidity. Also, patients with preoperative tachycardia (p = 0.005) and organ resection during surgery (p = 0.029) had more mortality. However, no factors affecting recurrence were found in the study.

Conclusions

Morbidity and mortality probability are higher in patients with preoperative septic and obstructive symptoms.
P124 RECURRENCE OF SPIEGEL'S HERNIA POST-IPOM IN AN ELDERLY PATIENT, HOW TO DEAL WITH IT?
Authors: Farré Roser , Gobbo Rafael Gerardo Díaz Del , Fructuoso Lorena Sanchon , Ramos Alexander Osorio , Guariglia Claudio Antonio , López Sara Pardo , Ormazabal Pablo Collera
Published: December 2021

Aim

To demonstrate how minimally invasive surgery of the abdominal wall allows us to rescue patients with recurrent hernias previously treated with other laparoscopic techniques.

Material and Methods

An 83-year-old woman with moderate comorbidities, ASA III and obese was operated for bilateral Spiegel’s hernia by laparoscopic IPOM. 21 months later, a symptomatic recurrence of the right hernia was diagnosed.

The physical examination was difficult due to obesity and the CT scan showed a right hernia recurrence. This CT scan was used for 3D Planning of the surgery, showing the right Spiegel’s hernia with 5-6 cm of diameter with a bowel loop inside.

Results

Given the age of the patient and comorbidities, it was decided to perform a laparoscopic repair using the IPOM + technique, closing the defect with barbed suture and placing a wide visceral contact mesh fixed with absorbable tackers.

She was discharged 24 hours after surgery without complications, providing the patient with the benefits of minimally invasive surgery.

Conclusions

Laparoscopic surgery allows us to treat hernia recurrences even in cases previously treated by minimally invasive approach.

An individualized treatment adjusted to the age and characteristics of each patient should be carried out.

3D Technology and reconstruction is very useful for pre-surgical Planning, allowing a personalized pre-operative assessment of each patient.

The use of 3D Technology is a great teaching tool with great potential for surgical planning.
P146 ROBOTIC REPAIR OF COMPLICATED INGUINAL HERNIAS
Authors: Avery Michael , Augenstein Vedra , Katzen Michael
Published: December 2021

Aim

In this video, the authors provide an educational demonstration on the use of robotic surgery in management of two patients with complicated and recurrent inguinal hernias. The two patients demonstrated in these videos show the benefits of use of robotics in the approach to a patient with a recurrent hernia after previous open repair with plug and patch method as well as repair in a very obese patient with large hernias causing obstruction of the left ureter.

Material and Methods

N/a

Results

N/a

Conclusions

Robotic surgery is an emerging technology in surgery and can be a useful modality in treating patients with complex and recurrent inguinal hernias. Furthermore, the visualization in these complex cases can be helpful in identifying the important structures during dissection. Regardless of technique, the two videos presented demonstrate a complex dissection which may be needed when repairing recurrent or very large inguinal hernias.