bluuebunny/crossref_metadata_2025 huggingface dataset:
Computed Tomography–Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility
Authors: Ravichandran Raj Chendur Abhishek , Amritanand Rohit , Moses Vinu , Kandagaddala Madhavi , Krishnan Venkatesh , David Kenny Samuel , Arockiaraj Justin , Kulasekaran Harini , Ganesan Maya Pavalasseril , Prabhu Anne Jennifer , Keshava Shyamkumar Nidugala
Published: May 2023

Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography–guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice.

Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis.

Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution.

Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%.

Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients.
Sinonasal Inflammation or Neoplasm: Raise the Red Flagsǃ—A Pictorial Review
Authors: Kumar Jyoti , Daga Radhika , Pradhan Gaurav , Meher Ravi
Published: May 2023

Inflammatory pathology remains the most common indication for sinonasal imaging. However, sinonasal region is also the epicenter of a variety of neoplasms. These are often missed both clinically and radiologically owing to nonspecific signs and symptoms and subtle imaging pointers. An early diagnosis of sinonasal neoplasms is critical for timely management and hence better prognosis and survival rate.

This pictorial review aims to acquaint the reader with the “red flag” signs on computed tomography that should raise suspicion for an underlying neoplastic pathology and also highlights the imaging features of common sinonasal neoplasms.
Piggyback Technique—A Safe Way of Performing Rib Biopsy
Authors: Botchu Rajesh , Nischal Neha , Botchu Bhuvan , Iyengar Karthikeyan P.
Published: May 2023

Rib biopsy can be challenging. A spectrum of bone biopsy techniques are available to undertake Rib Bone biopsy and yield a histological specimen. In this technical report, we described a new Piggyback technique of performing rib biopsy to decrease the incidence of pneumothorax and consolidate diagnostic accuracy.
The relationship between home-based physical activity and general well-being among Chinese university students during the COVID-19 pandemic: the mediation effect of self-esteem
Authors: Cao Mei , Teng Yongzhen , Shao Na , Wu Yijin
Published: May 2023

This study aimed to investigate the mediating effect of self-esteem on the relationship between home-based physical activity and the general well-being of university students. A web-based questionnaire survey was conducted on 311 Chinese university students using the Physical Activity Rating Scale, Rosenberg Self-Esteem Scale, and General Well-Being Scale. The influence of home-based physical activity on self-esteem and general well-being in Chinese university students was explored using a one-way ANOVA analysis of variance. The mediating model was tested with regression analysis to determine the mediating effects of self-esteem between home-based physical activity and general well-being among Chinese university students during COVID-19. The amount of home-based physical activity had a significant effect on the general well-being (F = 3.46, P < 0.05) and self-esteem (F = 6.99, P < 0.01) of university students. The study found that self-esteem had a full mediation (T = 4.445, P < 0.001) between medium and large amounts of home-based physical activity and general well-being among university students, accounting for 32.5% of the total effect. The study concluded that self-esteem mediated the relationship between home-based physical activity and general well-being in university students during the COVID-19 pandemic. The findings in this study highlight the importance of home-based physical activity in increasing the general well-being of university students during the pandemic.
Fictive questions in the Zhuangzi
Authors: Xiang Mingjian
Published: May 2023

Rhetoric is intimately related to interaction and cognition. This book explores the cognitive underpinnings of rhetoric by presenting a case study of the rhetorical use of interactional structures, namely expository questions and rhetorical questions, in the classical Chinese tradition. Such questions are generally meant to evoke silent answers in the addressee’s mind, thereby involving a fictive type of interaction. The book analyzes fictive questions as intersubjective mixed viewpoint constructions, involving a viewpoint blend of the perspectives of the writer, the assumed prospective readers, and possibly also that of the discourse characters. The analysis further shows that in addition to attention, other late developing human capacities such as mental simulation and perspective taking also have a pivotal role to play in rhetoric, on the basis of which a simulation-based rhetorical model of persuasion is proposed to account for meaning construction in rhetorical practices. The book will influence our understanding of rhetorical practices outside the Western tradition but within the framework of cognitive semantics.
Humor negotiation in interactional sequences in Spanish
Authors: Ruiz-Gurillo Leonor
Published: May 2023

This paper reports on the analysis of humor negotiation in
Spanish, using a database of 148 humorous sequences drawn from 67
colloquial conversations of the VALESCO.HUMOR corpus (accessible at
www.observahumor.com; cf. Ruiz-Gurillo, 2021; 2022). To this end, three variables were
addressed. First, following Martin et al. (2003), the style adopted by the speaker
in their turn was analyzed as affiliative,
aggressive, self-defeating or self-enhancing. Affiliative and aggressive styles
predominate in the data, whereas self-defeating and self-enhancing
styles are underrepresented. Second, we asked how participants are
seen to evaluate the verbal behavior within sequences in terms of
politeness, mock impoliteness, impoliteness and non-politeness
(Sinkeviciute, 2019).
Finally, an assessment was made of each sequence regarding how it
could be understood as creating intimacy (endogroup sequence) or as
a form of confrontation (confrontational sequence). Taken together,
these variables (style, evaluation of politeness, and the main
effect of the sequence) led to the identification of three main
trends: politeness with an affiliative style in endogroup sequences;
mock impoliteness with an aggressive style in endogroup sequences;
and mock politeness with an aggressive style in confrontational
sequences.
Hole density dependent magnetic structure and anisotropy in Fe-pnictide superconductor
Authors: Yue 岳 Yuan-Fang 远放 , Huang 黄 Zhong-Bing 忠兵 , Li 黎 Huan 欢 , Ming 明 Xing 星 , Zheng 郑 Xiao-Jun 晓军
Published: May 2023

The competition between different magnetic structures in hole-doped Fe-pnicitides is explored based on an extended five-orbital Hubbard model including long-range Coulomb interactions. Our results show that the stabilized magnetic structure evolves with increasing hole doping level. Namely, the stripe antiferromagnetic phase dominates at zero doping, while magnetic structures with more antiferromagnetic linking numbers such as the staggered tetramer, staggered trimer, and staggered dimer phases become energetically favorable as the hole density increases. At a certain doping level, energy degeneracy of different magnetic structures appears, indicating strong magnetic frustration and magnetic fluctuations in the system. We suggest that the magnetic competition induced by the hole doping may explain the fast decrease of the Neel temperature T
N and the moderately suppressed magnetic moment in the hole doped Fe-pnicitides. Moreover, our results show a sign reversal of the kinetic energy anisotropy as the magnetic ground state evolves, which may be the mechanism behind the puzzling sign reversal of the in-plane resistivity anisotropy in hole-doped Fe-pnicitides.
The response of growth and production in cauliflower with different doses of Paitan liquid organic fertilizer
Authors: Elinda F , Yora M , Renfiyeni  , Hendri J , Meyuliana A , Wulandari A
Published: May 2023

Organic fertilizers can be used in cauliflower cultivation as liquid organic fertilizer from Paitan. Paitan is a weed with organic matter and nutrients that can increase soil and plant fertility. The response of growth and production of cauliflower was examined with different doses of paitan liquid organic fertilizer. The randomized block design in this research is five groups with five treatments and then tested applying the Duncan New Multiple Range Test at a significance level of 5 % and 1 % utilizing SAS. Paitan liquid organic fertilizer doses given include treatment 20 ml, 40 ml, 60 ml, and 80 ml paitan/plants. Parameters observed on cauliflower were plant height, amount of leaf, leaf width, flower diameter, flower production weight, and flower weight. The findings of the research indicated no significant effect of liquid organic fertilizer on cauliflower plant height, the amount of leaf, leaf width, and flower diameter. The best impact of this research on cauliflower is the weight of flower production and flower weight treatment doses of 80 ml paitan liquid organic fertilizer.
Evaluation of nutrition content of six local job’s tears (Coix lacryma jobi-L.) accessions in West Sumatera, Indonesia
Authors: Ramadhan N , Hervani D , Martinsyah R H , Muhsanati  , Mutia Y D
Published: May 2023

This research is an advanced stage of exploration and characterization of job tears plants in West Sumatera Province. This study aimed to evaluate the nutrition content of six local job tears accessions of West Sumatra. The experiment used a completely randomized design (6 treatments and 4 replications) and was conducted from June until September 2022. The material was the seed from six accessions local job’s tears of West Sumatera, namely PTA- 1, KKD-3, PH-4, BTA-2, GT-2, and TJR-2. The data was analyzed using the F-test at 5%, and if there were significant differences, it was continued by analyzing DNMRT at 5%. Nutrition tests on ash and water content using the Gravimetric method, protein content using the Khjedal method, fat content using the Soxhlet method, and carbohydrate content using the by-difference method. The results showed that the PTA-1 accession had the highest percent ash content and the BTA-2 accession had the highest water content. The PTA-1, PH-4, BTA-2, GT-2, and TJR-2 accessions contained the best percentage of protein levels. In contrast, the PTA-1, KKD-3, PH-4, GT-2, and TJR-2 accessions have the highest rate of fat content, and the highest percentage of carbohydrate levels was found in the KKD-3 accession.
Study of surface charge and chemical properties of ex-gold mining soil ameliorated with Indonesian sub-bituminous coal
Authors: Prasetyo T B , Maulana A , Harianti M , Lita A L , Herviyanti H
Published: May 2023

Contamination of mercury (Hg) in ex-gold mining soil is the impetus for the development of amelioration technology that utilizes Indonesian sub-bituminous coal to study the soil surface charge and the chemical properties of ex-gold mining soil. This research was aimed to study surface charge and chemical properties of ex-gold mining soil ameliorated with Indonesian sub-bituminous coal. The experimental design used in this study was a Completely Randomized Design with three replications. The treatment was implemented in a pot with the equivalent dose: A = 0 (0.0g); B = 10 (0.5g); C = 20 (1.0g); D = 30 (1.5g), and (E) 40 t ha−1 (2g 100g−1 soil). The results showed amelioration technology with Indonesian sub-bituminous coal, at the application of 40 t ha-1 on ex-gold mining soils, could increase the soil surface charge (ΔpH) by 0.60 through changes in chemical properties of the ex-gold mining soil, where there was an increase in pH (H2O) EC, CEC, and SOM, respectively of 0.37; 0.04 dS m−1; 2.14 cmol kg−1 and 7.83% compared to the control. Soil surface charge was supported by soil minerals [Quartz (SiO2)] and an increase in the chemical properties of the ex-mining soil ameliorated with Indonesian sub-bituminous coal which caused Hg to decrease by 2.50 mg kg−1 compared to the control.
Golden apple snail management (Pomacea canaliculata Lamarck) using integrated pest management (IPM) and non-integrated pest management (non-IPM) on paddy cultivation
Authors: Rusli R , Hidrayani  , Putra R E
Published: May 2023

The golden apple snail (Pomacea canaliculata Lamarck) is one of the main pests of rice (Oryza sativa Linnaeus) that can be controlled by integrated pest management (IPM). This research aimed to compare the population and the attack rate of golden apple snails and rice production using IPM and non-IPM. This research was conducted from April to August 2021 in Nagari Koto Tuo Sijunjung Regency, West Sumatera. It used an experimental design that compares IPM and non-IPM treatments and analyzed with a t-test. The control techniques in the IPM were making trenches and maintaining the water level very low, using filters on water inlets and outlets, using ripe Artocarpus heterophyllus Lamark skin as bait, using botanical pesticides from Nothopanax scutellarium Merr leaves, and planting 21-day-old seedlings. The parameters observed were the attacked clumps (%), attacked tillers (%), golden apple snail population (individuals/m2), and rice production (kg/m2). The result showed that the percentage of rice clumps attacked in the IPM treatment was 11.33%, while the non-IPM treatment was 54.66%. The percentage of rice tillers attacked in the IPM treatment was 11.28%, while the non-IPM treatment was 32.51%. The population of golden apple snails in the IPM treatment was 0.19 individuals/m2, while in the non-IPM treatment was 2.04 individuals/m2. The production of rice plants under IPM treatment was 2,69 kg/m2, while the non-IPM treatment was 0,71 kg/m2. The implementation of IPM by combining various techniques effectively controlled golden apple snail attacks on clumps and tillers, and increased rice production compared to non-IPM.
Coffee berry borer population on the arabica coffee beans from three different cropping patterns in Karo, North Sumatera
Authors: Efrata E , Hidayat P , Harahap I S
Published: May 2023

The coffee berry borer or CBB (Hypothenemus hampei) is a critical pest overgrowing on coffee plants. This study was conducted to find out the intensity of CBB infestation. The method was based on the field primarily from direct observations of pest populations in coffee plants. The sampling method was used to systematically calculate the pest population in coffee plantations, with the sample of 50 coffee plants repeated three times for each type of cropping pattern. In each observation of the coffee plants, four samples of branches were taken according to the cardinal direction with the densest branches, and the infested berries were taken and separated according to the color of the berries to observe the population of CBB in it. Yield loss due to CBB infestation in Karo District was around 30-40%. Based on the observational data obtained up to the 10th observation, the highest CBB infestation was found in the coffee plant fields with a monoculture cropping pattern of 0.55%, polyculture (coffee - vegetable) of 0.43%, and the infestation was found in polyculture cropping pattern (coffee - citrus) by 0.24%. Plant spacing could affect the presence of CBB, and polyculture (coffee–citrus) in coffee cultivation is advised in Karo District since it has the lowest infestation rate of CBB.
Land optimization using tubers based agroforestry system in Semin, Gunung Kidul
Authors: Maharani D , Sudomo A , Swestiani D , Handayani W
Published: May 2023

Private forest farmers in Semin Village, Semin District, Gunung Kidul Regency transformed the cropping patterns from monoculture to polyculture to meet increasing needs. The farmers planted a variety of food crops to fulfill their short and medium-term needs, and woody plants to meet the long-term needs. Beside this, farmers have processed arrowroot tubers into flour, which can increase household income. The tuber plants apart from being able to live under the shade, have a low glycemic index value so they can be consumed by the diabetics. The method used randomized block design, trials were conducted by cultivating 3 species of tuber plants under the teak shade. Species of tuber plants were arrowroot, canna and yam. The treatments given were: 1) without shade, 2) under 5-year-old teak, 3) under 7-year-old teak. The aim was to understand the relationship between tuber plant growth variables and their environments. Tuber plant growth variables were height and diameter of plant, number of leaves and number of shoot. Environment variables were height and diameter of the teak trees, soil characteristic, and micro climate condition. The relationship was analyzed using linear regression. The results of regression analysis showed that there was a relationship between soil characteristics and plant height (R2=100%), stand height and number of leaves (R2=25.50%), air temperature and number of shoots (R2=22.60%), humidity and the number of shoots (R2=16.70%), light intensity and the number of shoots (R2=14.80%), as well as temperature, humidity, light intensity, percent canopy cover simultaneously and tuber weight/clump (R2=39.10%).
Developing a Real-time Luminous Facilities Management System in Residential Care Homes
Authors: Leung M Y , Wang C D
Published: May 2023

An integrated Real-time Luminous Facilities Management (Rt-LFM) system website has been developed, including hardware for data collection and software for data storage and download instantly. Two lighting sensors (illuminance, and color temperature) have been combined into a single device for measuring the continuous luminous data in the residential care homes. A wireless sensor network has been established through the combination and connection of lighting sensors to monitor the luminous conditions. The dynamic luminous environment data can then be saved and downloaded in the cloud-based system. By using the Rt-LFM system, the caregivers and managers in the residential care homes can promptly realize the luminous environment based on the instant data, while the construction professionals can then well design the building services for new homes or renovation. It is expected that the long-term health of our elderly will be improved finally. Furthermore, the subsequently improved elderly health conditioning will also relieve the medical burden of the government in central.
Delivery of healthcare facility management services: A literature review
Authors: Lavy Sarel , Terzioğlu Sinan
Published: May 2023

The delivery of healthcare services around the world has changed significantly over the past 25 years. Governments have realized that in order to achieve social and economic success in their countries, their health services should be improved, and these services should be sustainable. The World Health Organization (WHO) presents various approaches for people to access quality and adequate healthcare. Within this approach, the importance of hospitals in creating healthy societies is increasing. Healthcare facilities differ from any other facilities. These facilities, with their own characteristics, produce and offer complex and interdisciplinary services. Each country has its own unique and different approaches for its healthcare system, which are related to the level of development and to the cultural structure. Although there are different approaches to healthcare facility management (HFM) in various countries, it has been concluded that an HFM application model can emerge in all circumstances with a good understanding of the main components of HFM that this study describes. Today, the scope and service range of HFM in modern hospitals has expanded considerably, and the execution of these services depends on a wide variety of components, such as unique features, standards, codes, technological developments, planning of services, and operational management. In this study, the current components of HFM are explained by conducting a literature review of published studies on HFM. The main characterizing components of HFM are described in detail, and current trends are discussed within this framework.
Economic appraisal standards for planning earthquake early warning infrastructure acquisition
Authors: Wanigarathna N , Jones K , Mulder F , Borzi B , Bozzoni F , Festa E
Published: May 2023

Earthquake early warning systems can reduce potential economic losses caused by earthquakes. However, they are expensive to implement and maintain, as examples from around the word show. These examples also show the challenges in accurately estimating their costs during the acquisition phase and the consequences of poor cost estimating practices. Indeed, current approaches to early cost estimates lack consistency and a well thought out structure as there are currently no established standards to support cost planning for EEW systems. This paper argues that standards for estimating capital and maintenance costs are important during the infrastructure acquisition phase to ensure the financial viability and effective cost management of earthquake early warning systems. By comparing cost estimates of selected existing EEW systems against generic economic appraisal standards and using cost data from a research project which developed and tested a new EEW system, this paper provides insights into the factors that need to be considered when estimating the capital and maintenance costs of new EEW systems. As such, it provides the foundation for the development of economic appraisal standards for EEW systems. Standards for estimating costs could help decision makers develop well thought through estimates for capital and maintenance costs for major investments such as earthquake early warning systems and, assist subsequent cost controlling activities throughout the project life cycle.
Planned maintenance vs Unplanned maintenance and facility costs
Authors: Weidner Theodore J
Published: May 2023

Planned maintenance, preventive, predictive, or reliability-based, are assumed to minimize costs and ensure facility sustainment and provide for high customer satisfaction. Good facility management supports sustainability and occupant satisfaction. Planned maintenance is the most efficient means to serve a facility while unplanned maintenance, reactive response to service failures and interruptions, is costly. Customer survey results can be used to measure the effectiveness of preventive maintenance and identify alternative approaches. This research looks at maintenance records from several North American universities, focusing on planned and unplanned maintenance activities and occupant surveys. The ultimate goal is to find the appropriate mix of planning and unplanned maintenance and achieve occupant satisfaction.
The Role of Sustainable Project Management in Facilities Management
Authors: Zahid A , Klungseth N J , Andersen B
Published: May 2023

Growth in facilities management (FM) and project management (PM) have been remarkable over the last decade. Simultaneously, the adoption of sustainability principles among organisations has also increased. The purpose of this study was to determine the connection between sustainability in PM and FM. Specifically, this research study aimed at understanding the common principles involved in both PM and FM that allowed sustainable development goals (SDGs) to be achieved by the United Nations in 2015 and to be an integral part of the European Green Deal in 2019. A systematic literature review of more than 200 different resource materials was performed, 55 of which were finally selected as falling under the scope of the study. The chosen literature was published between 2001 and 2020, except for the Brundtland Commission Report, which was published in 1987. Based on the collected material, a simplified facility lifecycle model was produced to illustrate the connection between sustainability in FM and PM. Developing this model will help practitioners and researchers incorporate PM as a function of FM, including the application of sustainable activities in different phases of a facility’s lifecycle.
Air pollution and health impacts of oil & gas production in the United States
Authors: Buonocore Jonathan J , Reka Srinivas , Yang Dongmei , Chang Charles , Roy Ananya , Thompson Tammy , Lyon David , McVay Renee , Michanowicz Drew , Arunachalam Saravanan
Published: May 2023

Oil and gas production is one of the largest emitters of methane, a potent greenhouse gas and a significant contributor of air pollution emissions. While research on methane emissions from oil and gas production has grown rapidly, there is comparatively limited information on the distribution of impacts of this sector on air quality and associated health impacts. Understanding the contribution of air quality and health impacts of oil and gas can be useful for designing mitigation strategies. Here we assess air quality and human health impacts associated with ozone, fine particulate matter, and nitrogen dioxide from the oil and gas sector in the US in 2016, and compare this impact with that of the associated methane emissions. We find that air pollution in 2016 from the oil and gas sector in the US resulted in 410 000 asthma exacerbations, 2200 new cases of childhood asthma and 7500 excess deaths, with $77 billion in total health impacts. NO2 was the highest contributor to health impacts (37%) followed by ozone (35%), and then PM2.5 (28%). When monetized, these air quality health impacts of oil and gas production exceeded estimated climate impact costs from methane leakage by a factor of 3. These impacts add to the total life cycle impacts of oil and gas, and represent potential additional health benefits of strategies that reduce consumption of oil and gas. Policies to reduce oil and gas production emissions will lead to additional and significant health benefits from co-pollutant reductions that are not currently quantified or monetized.
Ecological and evolutionary drivers of phenotypic and genetic variation in the European crabapple [Malus sylvestris(L.) Mill.], a wild relative of the cultivated apple
Authors: Chen X , Avia K , Forler A , Remoué C , Venon A , Rousselet A , Lucas G , Kwarteng A O , Rover R , Le Guilloux M , Belcram H , Combes V , Corti H , Olverà-Vazquez S , Falque M , Alins G , Kirisits T , Ursu T M , Roman A , Volk G M , Bazot S , Cornille A
Published: May 2023

Background and Aims

Studying the relationship between phenotypic and genetic variation in populations distributed across environmental gradients can help us to understand the ecological and evolutionary processes involved in population divergence. We investigated the patterns of genetic and phenotypic diversity in the European crabapple, Malus sylvestris, a wild relative of the cultivated apple (Malus domestica) that occurs naturally across Europe in areas subjected to different climatic conditions, to test for divergence among populations.

Methods

Growth rates and traits related to carbon uptake in seedlings collected across Europe were measured in controlled conditions and associated with the genetic status of the seedlings, which was assessed using 13 microsatellite loci and the Bayesian clustering method. Isolation-by-distance, isolation-by-climate and isolation-by-adaptation patterns, which can explain genetic and phenotypic differentiation among M. sylvestris populations, were also tested.

Key Results

A total of 11.6 % of seedlings were introgressed by M. domestica, indicating that crop–wild gene flow is ongoing in Europe. The remaining seedlings (88.4 %) belonged to seven M. sylvestris populations. Significant phenotypic trait variation among M. sylvestris populations was observed. We did not observe significant isolation by adaptation; however, the significant association between genetic variation and the climate during the Last Glacial Maximum suggests that there has been local adaptation of M. sylvestris to past climates.

Conclusions

This study provides insight into the phenotypic and genetic differentiation among populations of a wild relative of the cultivated apple. This might help us to make better use of its diversity and provide options for mitigating the impact of climate change on the cultivated apple through breeding.
BJS-03 DEVELOPMENT AND IMPLANTATION OF 3D ANATOMICALLY TAILORED POLYPROPYLENE MESH FOR LAPAROSCOPIC INGUINAL HERNIA REPAIR DESIGNED ON THE BASIS OF CT IMAGES (THE ILAM STUDY)
Authors: Śmietański M , Zamkowski M , Karbowski K
Published: May 2023

Aim

The aim of the ILAM (Individualized Laparoscopic Anatomical Mesh) study was to create and implant a fully individualized mesh based on CT scans, taking into account the published body of knowledge about the material and mechanical behavior of the implant for laparoscopic inguinal hernia repair.

Material and Methods

The team creating and conducting this study consisted of surgeons and engineers. A specific project was made and divided into four phases. The process of development and implantation was divided into four milestones: CT scans and modeling based on predefined subgroups, mesh manufacture, certification and clinical evaluation.

Results

The result of study was first individually designed hernia mesh to have been implanted in a human subject. After 12-months of follow-up no recurrences or other complications were reported.

Conclusions

New mesh that provides a better anatomic fit to the patients’ inguinal region geometry. Mechanical stability is ensured by the multiple contact points between the implant and the tissues, which generate friction forces. Together with possibility of shape design (proper overlap) the authors believe that there is no need of mesh fixation. If so, the use of such design meshes can change the guidelines in laparo/endoscopic hernia repair in the future.
OC-002 CREATING THE INFRASTRUCTURE TO MAKE HERNIA RESEARCH A REALITY
Authors: Scarola G , Wilson H , Ku D , Brown K , Tawkaliyar R , Colavita P , Augenstein V , Heniford T
Published: May 2023

Background

Research at hernia surgery centers is growing around the United States but what does it takes to make this research possible? The aim of this study is to shed light on the process of creating and maintaining a hernia research program and addressing quality improvement initiatives.

Methods

To create a hernia research program certain pieces are required within an institution, an administration that supports research and phyisicians with research expertise and sufficient patient volume, research staff including: managers, fellows, research residents, advanced practice providers (APPs), nurses, statisticians, data abstractors, Instituitional Review Board (IRB), legal and contracting, and finance staff. Following IRB approval, data was collected in a prospective institutional outcomes database. The prospective database was designed longinatudally to track patient demographic, diagnosis, comorbidities, operative and patient outcomes from index procedure through 20+ years of follow-up. Data from the database can then be queried and analyzed to answer meaningful research and quality improvement questions.

Results

The results of of the aforementioned infrasctructure are more than 400 peer-reviewed publications accepted to more than 150 journals and over 900 abstract submissions accepted to more than 100 national and international conferences over a 22-year period from 2000–2022. The byproduct of data collection and manuscript writing results in constant quality improvement, academic advancement, teaching for residents and attendings, and driving national and international standards of care.

Conclusion

With thoughtful planning and correct implementation a hernia research program can be developed and produce decades of quality improvement and research to advance patient care.
OC-005 COMPARISON OF POSTOPERATIVE PAIN: BIOLOGICAL VERSUS SYNTHETIC MESH SIX MONTHS AFTER LAPAROENDOSCOPIC HERNIA REPAIR – RESULTS OF THE RANDOMIZED, MULTICENTER, SELF-CONTROLLED BIOLAP TRIAL
Authors: Seefeldt C S , Knievel J , Meyer-Zillekens J , Lange J , Lefering R , Heiss M
Published: May 2023

Aim

A remaining problem after hernia surgery is the occurrence of chronic pain. Up to now, the use of synthetic meshes is the standard procedure, but there is raising evidence that biological meshes could be advantageous concerning occurrence of chronic pain without the disadvantages of a life-long implant.

The BIOLAP trial compares synthetic and biological meshes in laparoendoscopic inguinal hernia repair. To test the hypothesis that the use of biological meshes results in significantly less pain postoperatively than the use of synthetic meshes, without an increased recurrence rate, patients with bilateral primary inguinal hernias were included. Patients received biological mesh on one side and synthetic mesh on the other.

Materials and Methods

In 21 German hernia centres, 982 hernias were treated using TEP or TAPP techniques. In addition to the study endpoints (recurrence rate within 2 years, pain intensity after 6 months), demographic and perioperative data as well as intraoperative and postoperative complications were recorded.

Results

Recruitment was successfully completed in February 2021. Six month after laparoendoscopic hernia repair there is no significant difference in pain occurrence comparing biological to synthetic mesh implants. Furthermore general demographics of the patients with bilateral primary inguinal hernias are evaluated.

Conclusion

The study provides data from 982 hernia operations dependent of the mesh material used. According to the study protocol, at the current time pain intensity after 6 months comparing both mesh materials has been evaluated as the first endpoint. Further study endpoints will be evaluated after completion of the two-year follow-up phase.
OC-010 5-YEAR ASSESSMENT OF RESORBABLE BIOSYNTHETIC MESH WITH TRANSVERSE ABDOMINIS RELEASE FOR LARGE VENTRAL HERNIA REPAIR: A LONG-TERM EVALUATION OF CLINICAL OUTCOMES AND QUALITY OF LIFE
Authors: Amro C , Messa Iv C A , Niu E F , Habarth-Morales T E , Talwar A A , Thrippleton S , Broach R B , Fischer J P
Published: May 2023

Aim

This study assesses long-term clinical and quality-of-life (QoL) outcomes following large ventral hernia repair (VHR) with transverse abdominis release (TAR) using resorbable biosynthetic mesh.

Methods

Retrospective review of clinical outcomes with prospective assessment of QoL was performed for patients undergoing VHR with Poly-4-hydroxybutyrate[P4HB]/Phasix mesh (C.R. Bard, Warwick, RI) and TAR from 2016–2021. Patients with less than 24 months of follow-up, defects smaller than 150cm2, and parastomal hernias were excluded.

Results

Sixty-nine patients were initially identified. Twenty-nine patients met inclusion criteria. Median age and BMI were 61 years (IQR 53.2–68.1 years) and 31.4 kg/m2(IQR 26.1–35.3kg/m2). Average hernia defect was 390cm2±152.4cm2. All patients underwent previous abdominal surgery and were primarily VHWG 2 (55.2%). Two hernia recurrences (6.9%) occurred over the median follow-up period of 63.1 months (IQR 43.7–71.3 months). Delayed healing and seroma occurred in 27% and 10.3% of patients, respectively. There were no cases of mesh infection or explantation. Cost analysis revealed no significant average margin loss(p>0.05) and risk-adjusted analysis demonstrated higher costs associated with ASA class and length of stay(p<0.05). Throughout the study period, patients demonstrated a significant improvement in long-term postoperative QoL(p<0.005). This was seen continuously throughout the 5-year follow up period (p>0.05), with an 80% response rate and overall average improvement of 41% compared to preoperative QoL.

Conclusion

Large VHR with resorbable biosynthetic mesh and TAR can be performed safely and effectively leading to an optimal ratio of recurrence and mesh infection at acceptable costs and with significant and sustained improvement in disease-specific QoL at long-term follow-up.
OC-031 TROCAR SITE INCISIONAL HERNIA PREVENTION BY ONLAY MESH PLACEMENT, NOT WHAT WAS EXPECTED
Authors: Ferreres Serafini J , Olona Casas C , Memba Ikuga R , Vives Abelló J P , Julià Verdaguer E , Casanova Marquès R , Varona Mancilla A , Rodrigo Rodrigo M , Jorba Martín R
Published: May 2023

Aim

The prevalence of Trocar site incisional hernia (TSIH) might be as high as 30%, due to this reason is paramount to find a better closure technique. Our aim is to test the TSIH preventive effect of the placement of an onlay mesh versus the standard fascial closure at the umbilical trocar site closure.

Material&Methods

We designed a Two-Center Randomized Controlled Trial where adult participants presenting for elective laparoscopic cholecystectomy, were allocated into 2 groups (Prosthesis and Control). The Hasson technique was the pneumoperitoneum creation technique. The procedure in the Prosthesis group consisted in the complete closure of the umbilical vertical section of the aponeurosis by single 0 Polydioxanone stitches, a 2cm onlay plane dissection, the placement of a lightweight, large-pore synthetic mesh and its fixation applying cyanoacrylate glue, subcutaneous stitches, and skin staplers. The Control group aponeurosis was closed by single stitches of Polydioxanone followed by skin staplers.

An ultrasound scan was performed at 12 postoperative months.

Results

At 12-month control, a 41.7% incidence of TSIH was recorded in the Prosthesis group while 28.5% in the control group. 6 patients developed a superficial wound infection at the umbilical port site in the Prosthesis group, and none in the Control group. 5 of the patients had to be operated for mesh removal as they developed 4 chronic infections and 1 seroma with bad wound pain control.

Conclusions

The preliminary results of the study show no benefit in the Prosthesis group for the prevention of TSIH and presented with a greater number of complications.
OC-044 MODIFIED CHEVREL TEHCNIQUE. A LIMITED OPTION FOR ABDOMINAL CLOSURE IN PATIENTS WITH ABDOMINAL HYPERTENSION
Authors: Vega V , Navarro D , Chitty M , Chacón F , Jiménez C , Loinaz C , Justo I
Published: May 2023

Abdominal compartment syndrome is a potentially life-threatening condition seen in critically ill patients. Several techniques have been described for abdominal wall closure after a damage control laparotomy to achieve static and dynamic support without leading to abdominal hypertension.

Aim

To describe short termn results after a modified Chevrel technique for midline incisional hernia repair in patients with abdominal hypertension.

Materials and Methods

We perfomed a modified Chevrel as an abdominal wall closure technique in 9 patients between January 2016 and January 2022. The inclusion criteria were patients surgical intervened from gastrointestinal diseases and postoperative complications who suffered from varying degrees of abdominal hypertension. We consider this surgical approach in symptomatic patients with intrabdominal pressures exceeding 20mmHg who were stable enough to undergo surgery.

Results

Nine patients were treated with this technique (6 male and 3 female). Their BMI ranged from morbidly obese to severe underweight. The main reasons why only one side of the fascia could be used were: The presence of a stoma, intrabdominal drains and inverted T-scars from previous surgeries. The use of mesh was dismissed in 6 of the patients (66.7%) because they required subsequent abdominal surgeries. None of the patients developed hernia recurrence, although we did have one case of bulging, one hematoma and one case of seroma. Our results are limited by a 33% mortality within the first two years.

Conclusions

The modified Chevrel technique can be used as an urgent surgical tool for closing midline defect in patients undergoing compartimental syndrome and abdominal hypertension.
OC-046 THE INGUINAL HERNIA OPERATION NOTES (GROIN) QUALITY IMPROVEMENT PROJECT
Authors: Kapsampelis P , Prce D , Saunders J , Bezzaa S , Gerogiannis I
Published: May 2023

Aim

Accurate and comprehensive operation notes are crucial for patient safety, quality assurance and medico-legal purposes. Inguinal hernia repair is one of the most common surgical procedures. Thus, operative documentation should be precise and standardised. The GROIN project aims to improve the quality of inguinal hernia operation notes using an evidence-based proforma and an operation note composition software.

Methods

We retrospectively reviewed operation notes of inguinal hernia repair performed at our institution between August and November 2022. Operation notes were assessed against the Royal College of Surgeons’ Good Surgical Practice standard, consisting of 18 items.

Results

The operation notes from 89 cases were reviewed. High-scoring items included: operation name (100%), operative findings (99%), surgeon's name (99%), closure technique (98%), operation date (90%) and signature (90%). Postoperative instructions were sufficiently detailed in 79% of cases. Regarding mesh placement, 63% of notes described mesh size and type, whereas 30% documented only the mesh type. The lowest-scoring items were: venous thromboembolism prophylaxis (31%), designation as elective or emergency (22%), operative diagnosis (6%), and estimated blood loss (2%).

Conclusions

We identified several areas for improvement in inguinal hernia operation notes based on our results. The next step of the GROIN project is to standardise operation note creation by implementing an evidence-based template, which will be delivered through a novel operation note composition software. This will allow accurate record-keeping and efficient operative data extraction analysis. Efforts to standardise operative notes and enhance their quality on a national and international level are imperative for patient safety.
OC-052 Study of incisional hernia as a result of patients with open abdomen management in a tertiary hospital
Authors: García Alonso L , Rodicio Miravalles J L , Cifrian Canales I , Lopez-Negrete Cueto E , Ramos Montes C , Amoza Pais S , Sanz Navarro S , Sanz Alvarez L
Published: May 2023

Aim

Open abdomen (OA) is a useful resource in critical situations, such as damage control surgery, abdominal sepsis, or compartment syndrome. However, it is not an innocuous technique with repercussions on the abdominal wall, for this reason, we have reviewed the results in our center.

Material and Methods

Retrospective descriptive study was carried out in a tertiary hospital between 2015–2022, all patients who required OA therapy were included.

Results

92 patients (68 men, 24 women) were operated, with a mean age of 65 years, 65.3% were ASA 3–4. The most frequently system used was negative pressure therapy (NPT) (81 patients). 45 patients were closed without need replacement and 14 died before being performed. In the rest, the first TPN change was performed in 48–72 h, requiring a mean of 3.5 changes.

Of the 78 patients underwent closure, 30 received primary fascial closure, 43 associated prophylactic mesh and other 5 only skin closure due to poor short-term prognosis. 24 patients died before discharge.

5 of the 30 patients with primary fascial closure had an incisional hernia. There were no hernias in the patients treated with prophylactic mesh but there was one case of chronic rejection.

Conclusions

OA is a useful resource; however, it is not exempt from short and long-term complications. At the time of definitive closure, it must be taken into account that these patients present multiple risk factors for the development of incisional hernias. For this reason, the use of prophylactic meshes in a protocolized manner is justified.
OC-063 REPAIR OF UMBILICAL HERNIAS ASSOCIATED TO DIASTASIS USING LAPAROSCOPIC ENDOSCOPIC EXTRAPERITONEAL STAPLE BASED SUBLAY MESH TECHNIQUE (LEESS)
Authors: Hashim D , Haso A , Meyer F , García-Ureña M A , Albyarak N
Published: May 2023

Aim

Patients with symptomatic umbilical hernia with associated rectus diastasis represent an increasing clinical problem. The objective was to analyze feasibility and safety using a novel surgical approach: laparoscopic extraperitoneal endoscopic staple-based sublay operation (LEESS).

Methods

Observational study with all patients for patients who underwent LEESS and a minimum follow-up of 1 year. Data was obtained from a prospective mantained database at Herniamed Registry

Results

81 patients were operated from January 1, 2016, to June 30, 2020. Mean operative time was 100 (range, 15–200) min and mean length of hospital stay was 5 (range, 1–9) days. The overall 30 days postoperative morbidity was 12.34%: 2 (2.4%) developed a symptomatic subfascial seroma (minor complication); 2 (2.4%), a postoperative bleeding; 2 (2.4%), mild wound infection without mesh infection; and 1 (1.23%) of internal herniation through a defect in the posterior rectus sheath suture line. There were no surgery-related deaths (in-hospital mortality, 0). After a total follow-up of 12 months, 54 patients out of 81 (rate, 69.3%) recorded their information in the registry; 9 (16.7%) reported pain. The ratio of “Pain at rest” (5.6%) was significantly less than preoperatively (58.8%; p<0.001). “Pain during exercise” (11.1%) is significantly less than preoperatively (58.8%; p<0.001).

Conclusion

The LEESS technique with mesh augmentation appears to be an innovative, minimally invasive, feasible and safe surgical procedure for treatment of patients with symptomatic ventral midline hernia