bluuebunny/crossref_metadata_2025 huggingface dataset:
Promotion of angiogenesis toward transplanted ovaries using nitric oxide releasing nanoparticles in fibrin hydrogel
Authors: Yang Chungmo , Chung Nanum , Song Chaeyoung , Youm Hye Won , Lee Kangwon , Lee Jung Ryeol
Published: December 2021

Transplantation of ovary is one method of facilitating fertility preservation to increase the quality of life of cancer survivors. Immediately after transplantation, ovaries are under ischemic conditions owing to a lack of vascular anastomosis between the graft and host tissues. The transplanted ovaries can suffer damage because of lack of oxygen and nutrients, resulting in necrosis and dysfunction. In the technique proposed in this paper, the ovary is encapsulated with nitric oxide-releasing nanoparticles (NO-NPs) in fibrin hydrogels, which form a carrying matrix to prevent ischemic damage and accelerate angiogenesis. The low concentration of NO released from mPEG-PLGA nanoparticles elicits blood vessel formation, which allows transplanted ovaries in the subcutis to recover from the ischemic period. In experiments with mice, the NO-NPs/fibrin hydrogel improved the total number and quality of ovarian follicles after transplantation. The intra-ovarian vascular density was 4.78 folds higher for the NO-NPs/fibrin hydrogel groups compared to that for the nontreated groups. Finally, in vitro fertilization revealed a successful blastocyst formation rate for NO-NPs/fibrin hydrogel coated ovaries. Thus, NO-NPs/fibrin hydrogels can provide an appropriate milieu to promote angiogenesis and be considered as adjuvant surgery materials for fertility preservation.
Multilayer thin-film based nanophotonic windows: static versus electrotunable design
Authors: Chowdhary Ashish Kumar , Sikdar Debabrata
Published: December 2021

To meet the global energy demand, rapid growth in fossil fuel consumption has significantly contributed to global warming. Judicious utilization of renewable energy resources could help to combat this global challenge. Here, we present a comparative study on the designs of static and electro-tunable ‘smart’ windows that could help to reduce the energy need of typical air-conditioning systems deployed in buildings and motor vehicles. Our design comprises insulator–metal–insulator multi-layered thin-films deposited over a silica glass substrate to filter visible and infrared solar radiation selectively. For static windows, we optimize our design to operate in diverse climatic conditions by choosing different combinations and thicknesses of metal and insulator layers. Whereas for electro-tunable windows, we use an electro–optic polymer as the insulator layers to dynamically control portions of transmitted solar radiation over a voltage range of −12 to +12 V. Through size-dependence analysis, we could safely assume that the performance of smart windows is less likely to degrade during experimental realization. Our designs are lithography-free, large-area compatible, polarization-independent, angle-insensitive, and robust to fabrication imperfections. The analytical results show a near-perfect match with the simulation findings. The theoretically calculated figure of merit indicates that our proposed smart windows can outperform industry-standard commercial windows.
Effect of friction stir processing on microstructures and mechanical properties of TIG cladding layer on AA7075
Authors: Shi Chao , Liu Chao , Zhu Kaizhen
Published: December 2021

AA7075 is a precipitation strengthened Al-Zn-Mg-Cu alloy which has been widely used. As a common way to repair AA7075 components, tungsten inert gas (TIG) cladding generates coarse grains and defects. In addition, the use of other types of filler wires could lead to insufficient rigidity and strength of the cladding layer. In the present work, friction stir processing (FSP) has been applied to the TIG cladding layer on AA7075 to study the effect of process parameters on microstructures and mechanical properties. The macro/micro structural characteristics, elemental distribution, microhardness distribution and tensile properties have been investigated. The macroscopic defects in TIG cladding layer are eliminated and the size of grains is decreases to around 6 μm by FSP. FSP reduces the compositional difference between the stir zone and the base material. Higher rotational speed promotes the grain refinement while the lower traverse speed benefits the microstructural uniformity. FSP on the TIG weld bead brings improvement in tensile properties and hardness. All the fractures for TIG + FSP samples occur at thermo-mechanically affected zone of the advancing side. The tensile strength of the stir zone increases from 424.2 to 442.8 MPa with the increase in rotational speed and traverse speed.
Single-atom catalyst cathodes for lithium–oxygen batteries: a review
Authors: Lei Xin , Liu Bo , Koudakan Payam Ahmadian , Pan Hongge , Qian Yitai , Wang Gongming
Published: December 2021

Recently, single-atom catalysts (SACs) have been found to be promising candidates for oxygen electrocatalysis in rechargeable lithium–oxygen batteries (LOBs) owing to their high oxygen electrocatalytic activity and high stability, which originates from their unique coordination environments and electronic properties. As a new type of catalyst for LOBs, the advancements have never been reviewed and discussed comprehensively. Herein, breakthroughs in the design of various types of SACs as cathode catalysts for LOBs are summarized, including Co-based, Ru-based, and other types of SACs. Moreover, considerable emphasis is placed on the correlations between the structural feature of the SAC active sites and the electrocatalytic performance of LOBs. Finally, an overview and challenges of SACs for practical LOBs are also provided. This review provides an intensive understanding of SACs for designing efficient oxygen electrocatalysis and offers useful guidelines for the development of SACs in the field of LOBs.
A proof of Casselman’s comparison theorem
Authors: Li Ning , Liu Gang , Yu Jun
Published: December 2021

Let

G
G

be a real linear reductive group and

K
K

be a maximal compact subgroup. Let

P
P

be a minimal parabolic subgroup of

G
G

with complexified Lie algebra

p

\mathfrak {p}

, and

n

\mathfrak {n}

be its nilradical. In this paper we show that: for any admissible finitely generated moderate growth smooth Fréchet representation

V
V

of

G
G

, the inclusion

V

K

⊂
V

V_{K}\subset V

induces isomorphisms

H

i

(

n

,

V

K

)
≅

H

i

(

n

,
V
)

H_{i}(\mathfrak {n},V_{K})\cong H_{i}(\mathfrak {n},V)

(

i
≥
0

i\geq 0

), where

V

K

V_{K}

denotes the

(

g

,
K
)

(\mathfrak {g},K)

module of

K
K

finite vectors in

V
V

. This is called Casselman’s comparison theorem (see Henryk Hecht and Joseph L. Taylor [A remark on Casselman’s comparison theorem, Birkhäuser Boston, Boston, Ma, 1998, pp. 139–146]). As a consequence, we show that: for any

k
≥
1

k\geq 1

,

n

k

V

\mathfrak {n}^{k}V

is a closed subspace of

V
V

and the inclusion

V

K

⊂
V

V_{K}\subset V

induces an isomorphism

V

K

/

n

k

V

K

=
V

/

n

k

V

V_{K}/\mathfrak {n}^{k}V_{K}= V/\mathfrak {n}^{k}V

. This strengthens Casselman’s automatic continuity theorem (see W. Casselman [Canad. J. Math. 41 (1989), pp. 385–438] and Nolan R. Wallach [Real reductive groups, Academic Press, Boston, MA, 1992]).
Barriers and facilitators to nursing delirium screening in older emergency patients: a qualitative study using the theoretical domains framework
Authors: Eagles Debra , Cheung Warren J , Avlijas Tanja , Yadav Krishan , Ohle Robert , Taljaard Monica , Molnar Frank , Stiell Ian G
Published: December 2021

Background

delirium is common in older emergency department (ED) patients, but vastly under-recognised, in part due to lack of standardised screening processes. Understanding local context and barriers to delirium screening are integral for successful implementation of a delirium screening protocol.

Objectives

we sought to identify barriers and facilitators to delirium screening by nurses in older ED patients.

Methods

we conducted 15 semi-structured, face-to-face interviews based on the Theoretical Domains Framework with bedside nurses, nurse educators and managers at two academic EDs in 2017. Two research assistants independently coded transcripts. Relevant domains and themes were identified.

Results

a total of 717 utterances were coded into 14 domains. Three dominant themes emerged: (i) lack of clinical prioritisation because of competing demands, lack of time and heavy workload; (ii) discordance between perceived capabilities and knowledge and (iii) hospital culture.

Conclusion

this qualitative study explored nursing barriers and facilitators to delirium screening in older ED patients. We found that delirium was recognised as an important clinical problem; however, it was not clinically prioritised; there was a false self-perception of knowledge and ability to recognise delirium and hospital culture was a strong influencer of behaviour. Successful adoption of a delirium screening protocol will only be realised if these issues are addressed.
Development and evaluation of an evidence-based, theory-grounded online Clinical Frailty Scale tutorial
Authors: Haddad Taleen , Mulpuru Sunita , Salter Ivy , Hladkowicz Emily , Des Autels Kathryne , Gagne Sylvain , Bryson Gregory L , McCartney Colin J L , Huang Allen , Huang Shirley , Forster Alan , van Walraven Carl , Kyeremanteng Kwadwo , Fernando Shannon M , Nagpal Sudhir , Moloo Husein , Boet Sylvain , Le Blanc Vicki , Lalu Manoj M , McIsaac Daniel I
Published: December 2021

Introduction

Frailty is a robust predictor of adverse outcomes in older people. Practice guidelines recommend routine screening for frailty; however, this does not occur regularly. The Clinical Frailty Scale (CFS) is a validated, feasible instrument that can be used in a variety of clinical settings and is associated with many adverse outcomes. Our objective was to develop and evaluate an online training module to guide frailty assessment using the CFS.

Methods

A multidisciplinary team of clinical experts developed an evidence-based, theory-grounded online training module for users who wished to perform frailty assessment using the CFS. The module was prospectively evaluated for user satisfaction, effectiveness and feasibility using a standardised questionnaire. Qualitative feedback was analysed with thematic analysis.

Results

Version 1 of the CFS module was used 627 times from 21 October 2019 to 24 March 2020. Satisfaction, effectiveness and feasibility of the module were positively rated (≥4/5 on a 5-point Likert scale n = 582 [93%], n = 507, [81%], n = 575, [91%], respectively). Qualitative feedback highlighted ease of use, likelihood of users to share the module with others and opportunities to increase multimedia content.

Conclusion

An online tutorial, designed using evidence and theory to guide frailty assessment using the CFS, was positively rated by users. The module’s content and structure was rated effective and feasible, and users were satisfied with, and likely to share, the module. Research evaluating the module’s impact on the accuracy of frailty assessment is required.
Association between kidney function and incidence of dementia: 10-year follow-up of the Whitehall II cohort study
Authors: Singh-Manoux Archana , Oumarou-Ibrahim Amina , Machado-Fragua Marcos D , Dumurgier Julien , Brunner Erics J , Kivimaki Mika , Fayosse Aurore , Sabia Sèverine
Published: December 2021

Background

Cognitive dysfunction is common in haemodialysis patients but whether poor kidney function in the general population is also associated with higher risk of dementia remains unclear.

Objective

To examine the association of kidney function with incident dementia in community dwelling older adults.

Design

Whitehall II prospective study.

Setting

Population-based study on 6,050 adults, mean age 65.8 in 2007–2009.

Methods

Poor kidney function, defined as estimated Glomerular Filtration Rate (eGFR) <60 ml/min/1.73 m2 in 2007–2009, and adverse change in eGFR was defined as decrease ≥4 ml/min/1.73 m2 between 2007–2009 and 2012–2013.

Incident dementia was ascertained through linkage to electronic health records, and Cox regression was used to examine associations with dementia.

Results

A total of 306 cases of dementia were recorded over a mean follow-up of 10 years. Baseline eGFR <60 was associated with a hazard ratio (HR) for dementia of 1.37 (95% CI 1.02, 1.85) in analysis adjusted for sociodemographic factors, hypertension, obesity, stroke, diabetes and cardiovascular disease/medication. Removing stroke cases at baseline and censoring them over the follow-up yielded an HR of 1.42 (95% CI 1.00, 2.00) for the association between CKD and dementia. Decline of eGFR ≥4 between 2007–2009 and 2012–2013 was associated with incidence of dementia over a 6.3 year mean follow-up (HR: 1.37; 95% CI 1.02, 1.85), with somewhat stronger associations when analyses were restricted to those with eGFR ≥60 in 2007–2009 (1.56; 95% CI: 1.12, 2.19).

Conclusion

Poor and declining kidney function in older adults is associated with a higher risk of dementia that is not attributable to stroke and persists after accounting for major cardiometabolic conditions.
Chronic pain and circumstances of falls in community-living older adults: an exploratory study
Authors: Cai Yurun , Leveille Suzanne G , Shi Ling , Chen Ping , You Tongjian
Published: December 2021

Background

Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain.

Objective

To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults.

Design

Prospective cohort study.

Setting

Communities in/around Boston, Massachusetts.

Subjects

The MOBILIZE Boston Study enrolled 765 adults aged ≥70 years.

Methods

Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month.

Results

Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32–2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27–3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16–3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08–4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27–0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47–0.95) in the subsequent month.

Conclusions

Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.
Hepatitic Variant of Graft-vs-Host Disease
Authors: Liang Tom Z , Dong Stephen , Fang Mike , Gong Yuna , Yaghmour George , Chopra Shefali
Published: December 2021

Objectives

Graft-vs-host disease (GVHD) of the liver is a complication of allogeneic hematopoietic stem cell transplantation with hepatitic and classic variants. We determined the percentage of hepatitic variant cases, compared clinicopathologic features of the two groups, and assessed prognostic factors.

Methods

Fifty liver biopsy specimens from 40 patients with GVHD were studied.

Results

Fifteen (30%) cases had moderate to marked lobular inflammation and were classified as a hepatitic variant. Bile duct damage was present in all cases. Ductular reaction, apoptosis. and endotheliitis were more commonly seen in the hepatitic variant. Hepatocyte ballooning was an independent poor prognostic factor. The median aspartate aminotransferase and alanine aminotransferase were higher in the hepatitic variant while alkaline phosphatase and bilirubin were higher in the classic group. Forty (80%) GVHD cases were more than 100 days after transplant, correlating to immunosuppression taper. There was response to treatment with increased immunosuppression in both groups, but time to normalization of liver function tests was higher in the hepatitic variant.

Conclusions

Bile duct damage was the most consistent pathologic finding in our cohort and was present in all cases of GVHD. Moderate to marked lobular inflammation can be seen in GVHD in up to 30% of cases without any other coexisting cause. Hepatocyte ballooning is an independent poor prognostic factor.
Temperature Optimization Within 2 Uniquely Designed Courier Lockboxes During Extreme Summer Temperatures
Authors: Hart Stephanie , Wiencek Joesph R
Published: December 2021

Objectives

To determine optimal temperature profiles for 2 uniquely designed courier lockboxes (steel vs polymer) by standardizing daily ice (–20ºC) and cold (4-8ºC) pack placement.

Methods

Paired courier lockboxes were placed outside in direct sunlight. Ambient outdoor and lockbox temperatures were monitored during 2 4-day cycles, and temperature mean and range were determined daily (time frame, 4:00-10:00 pm). Control lockboxes without packs were compared with experimental paired lockboxes with either 2 cold packs placed at 4:00 pm or 4 ice packs placed at 8:00 am and replaced with 4 cold packs at 4:00 pm daily.

Results

Cycle 1 mean temperatures within control steel and polymer lockboxes were 31.8ºC (range, 18.4-44.1ºC) and 37.2ºC (range, 27.1-46.7ºC), respectively. The addition of 2 cold packs at 4:00 pm reduced mean temperatures to 29.1ºC (range, 19.1-37.2ºC) and 25.3ºC (range, 20.0-31.6ºC) in steel and polymer boxes, respectively. Cycle 2 mean temperatures within control steel and polymer lockboxes were 28.3ºC (range, 22.4-40.8ºC) and 31.6ºC (range, 23.8-41.0ºC), respectively. The addition of 4 ice packs at 8:00 am and replacement with 4 cold packs at 4:00 pm reduced mean temperatures to 24.3ºC (range, 17.4-27.9ºC) and 13.4ºC (range, 6.6-18.1ºC) in steel and polymer boxes, respectively.

Conclusions

Standardizing instructions for ice and cold packs can decrease internal courier lockbox temperatures.
From theory to bedside: Implementation of fluid stewardship in a medical ICU pharmacy practice
Authors: Hawkins W Anthony , Butler Sydney A , Poirier Nicole , Wilson Charles S , Long Michael K , Smith Susan E
Published: December 2021

Purpose

Intravenous fluids are the most commonly prescribed medication in the intensive care unit (ICU) and can have a negative impact on patient outcomes if not utilized properly. Fluid stewardship aims to heighten awareness and improve practice in fluid therapy. This report describes a practical construct for implementation of fluid stewardship services and characterizes the pharmacist’s role in fluid stewardship practice.

Fluid stewardship services were integrated into an adult medical ICU at a large community hospital. Data characterizing these services over a 2-year span are reported and categorized based on the 4 rights (right patient, right drug, right route, right dose) and the ROSE (rescue, optimization, stabilization, evacuation) model of fluid administration. The review encompassed 305 patients totaling 905 patient days for whom 2,597 pharmacist recommendations were made, 19% of which were related to fluid stewardship. This corresponded to an average of 1.52 fluid stewardship recommendations per patient. Within the construct of the 4 rights, 39% of recommendations were related to the right patient, 33% were related to the right route, 17% were related to the right drug, and 11% were related to the right dose. By the ROSE model, 1% of recommendations were related to the rescue phase, 3% were related to optimization, 79% were related to stabilization, and 17% were related to evacuation.

Conclusion

Implementation of fluid stewardship pharmacy services in a community hospital medical ICU is feasible. Integration of this practice contributed to 19% of pharmacy recommendations. The most common recommendations involved evaluation of the patient for the appropriateness of fluid therapy during the stabilization phase. The impact of fluid stewardship on patient outcomes needs to be explored.
I Can’t Breathe, 2020: The Arts and Sciences of Oxygen
Authors: Dimock Wai Chee
Published: December 2021

“I Can’t Breathe, 2020: The Arts and Sciences of Oxygen” proposes a literary criticism responsive to the existential crises of our time, working at the intersection of the linguistic, the physiological, and the atmospheric. Bringing together disciplines usually kept apart, this crisis-responsive genre remaps the input networks of literature, highlighting human agency on opposing ends of the spectrum. Both senses of the anthropogenic are at work here. Human causation is harm-mitigating as well as harm-bearing. Native American literature and pandemic responses provide a compelling archive for this approach. Often discussed only in terms of harm, this body of evidence in fact also shows harm partly alleviated, suggesting that reparative agency is possible, and that diversifying our investigative lens might be one way to begin. Joy Harjo—poet, musician, and former premed major—is a salient test case. “For Alva Benson” and “Ah, Ah,” like her blog posts, and like her saxophone playing, dwell on the respiratory chemistry of the human body as our precarious common ground. This chemistry integrates the arts and sciences of oxygen as physiological need, survival baseline, and expressive medium, speaking to the burden of the past, and holding out the perils and promise of the future.
Ligand-gated ion channels as targets of neuroactive insecticides
Authors: Ihara Makoto
Published: December 2021

The Cys-loop superfamily of ligand-gated ion channels (Cys-loop receptors) is one of the most ubiquitous ion channel families in vertebrates and invertebrates. Despite their ubiquity, they are targeted by several classes of pesticides, including neonicotinoids, phenylpyrazols, and macrolides such as ivermectins. The current commercialized compounds have high target site selectivity, which contributes to the safety of insecticide use. Structural analyses have accelerated progress in this field; notably, the X-ray crystal structures of acetylcholine binding protein and glutamate-gated Cl channels revealed the details of the molecular interactions between insecticides and their targets. Recently, the functional expression of the insect nicotinic acetylcholine receptor (nAChR) has been described, and detailed evaluations using the insect nAChR have emerged. This review discusses the basic concepts and the current insights into the molecular mechanisms of neuroactive insecticides targeting the ligand-gated ion channels, particularly Cys-loop receptors, and presents insights into target-based selectivity, resistance, and future drug design.
Critical assessment of computational tools for prokaryotic and eukaryotic promoter prediction
Authors: Zhang Meng , Jia Cangzhi , Li Fuyi , Li Chen , Zhu Yan , Akutsu Tatsuya , Webb Geoffrey I , Zou Quan , Coin Lachlan J M , Song Jiangning
Published: December 2021

Promoters are crucial regulatory DNA regions for gene transcriptional activation. Rapid advances in next-generation sequencing technologies have accelerated the accumulation of genome sequences, providing increased training data to inform computational approaches for both prokaryotic and eukaryotic promoter prediction. However, it remains a significant challenge to accurately identify species-specific promoter sequences using computational approaches. To advance computational support for promoter prediction, in this study, we curated 58 comprehensive, up-to-date, benchmark datasets for 7 different species (i.e. Escherichia coli, Bacillus subtilis, Homo sapiens, Mus musculus, Arabidopsis thaliana, Zea mays and Drosophila melanogaster) to assist the research community to assess the relative functionality of alternative approaches and support future research on both prokaryotic and eukaryotic promoters. We revisited 106 predictors published since 2000 for promoter identification (40 for prokaryotic promoter, 61 for eukaryotic promoter, and 5 for both). We systematically evaluated their training datasets, computational methodologies, calculated features, performance and software usability. On the basis of these benchmark datasets, we benchmarked 19 predictors with functioning webservers/local tools and assessed their prediction performance. We found that deep learning and traditional machine learning–based approaches generally outperformed scoring function–based approaches. Taken together, the curated benchmark dataset repository and the benchmarking analysis in this study serve to inform the design and implementation of computational approaches for promoter prediction and facilitate more rigorous comparison of new techniques in the future.
pSIR-bsr, a self-inactivating retrovirus vector expressing the blasticidin S-resistance gene
Authors: Fujii Hodaka
Published: December 2021

Self-inactivating retrovirus vectors are useful tools for generating stable cell lines harbouring designed exogenous sequences but lacking the constitutive transcriptional activity of the long terminal repeats that are usually retained by non-self-inactivating retrovirus vectors. Thus, self-inactivating retrovirus vectors are ideal vehicles for integrated transgenes comprising transcriptional regulatory sequences, and for the genes expressed by these regulatory sequences. This article describes the development of a self-inactivating retrovirus vector retaining a blasticidin S-resistance (bsr) gene. The vector, named pSIR-bsr, would be useful for transducing multiple expression vectors with different selection markers.
P002 POST-PARTUM ABDOMINAL WALL INSUFFICIENCY SYNDROME. LESSON LEARNED FROM THE SINGLE SURGEON'S EXPERIENCE BASED ON 200 CASES
Authors: Smietanski Maciej , Śmietańska Irmina
Published: December 2021

Aim

Post-partum abdominal wall insufficiency with rectus diastasis is present in over 30% of women after pregnancy. Little is known about how PPAWI affects the social, sexual life and self-esteem of patients. This study was designed to evaluate the safety of onlay mesh combined with abdominoplasty and its impact on the well-being of the patients.

Material and Methods

Two hundred patients with PPAWI underwent surgery with onlay mesh and abdominoplasty. The safety of the procedure was assessed by postoperative complications, time of hospitalization and time of drainage. Before the operation and 6 months later, a questionnaire asking about the patient’s sexual and social life and the presence of back pain was completed. The cosmetic effect was assessed separately.

Results

The onlay procedure with abdominoplasty was found to be safe and fast. The mean operation time was 82 min, and the drainage time was 2.1 days. In this group <2% postoperative complications were noted. There were no recurrences within the 6 month.p. Significant improvements in social and sexual life and the level of self-esteem were noted. Back pain was relieved or minimalized in all patients. The cosmetic effect was insufficient for 2 patients (1%).

Conclusions

PPAWI can be treated safely with onlay mesh and abdominoplasty. The patients’ symptoms were strongly correlated with the morphological status of the front abdominal wall and improved after the procedure. The authors are the first to propose PPAWI syndrome as a complex disorder with a disease classification, which can help patients with their choice of proper surgical intervention.
P008 SYNCHRONOUS SURGICAL TREATMENT OF MORBID OBESITY AND COMPLEX VENTRAL HERNIA AFTER PROGRESSIVE PNEUMOPERITONEUM AND BOTULINUM TOXIN A INJECTION
Authors: Bertoglio Camillo Leonardo , Morini Lorenzo , Barone Gisella , Maspero Marianna , Alampi Bruno , Girardi Valerio , Ferrari Giovanni
Published: December 2021

Aim

the worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing: synchronous bariatric and abdominal wall surgery versus delayed abdominal wall surgery. We report an innovative tailored surgical treatment carried out at our Institution.

Material and Methods

the approach provided the injection, six weeks before surgery, of 500 international units of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay.

Results

Postoperative superficial surgical site infection was successfully treated with negative pressure wound therapy. At one year follow up no hernia recurrence was recorded while total body weight loss was 31%.

Conclusions

a delay in ventral hernia repair could worsen quality of life of morbidly obese patients. In such high risk patients, the choice of the best surgical strategy remains controversial. There is great concern in performing bariatric surgery simultaneously to hernia repair, although there is lack of evidence on which is the ideal treatment modality. Synchronous bariatric surgery and complex ventral hernia repair should be approached in high volume centres where a consolidated experience of multidisciplinary team-work is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.
P055 THE USE OF ARTIFICIAL NEURAL NETWORK TO PREDICT THE RISK OF INCISIONAL HERNIA AFTER MIDLINE LAPAROTOMY
Authors: Hernandez Edgard Efren Lozada , Real Tania Aglae Ramírez del , Medina Dagoberto Armenta , Rodriguez Jose Francisco Molina , Reynoso Juan ramon Varela
Published: December 2021

Aim

“Incisional Hernia (IH) has an incidence of 10-23%, which can increase to 38% in specific risk groups. The objective of this study was developed and validated an artificial neural network (ANN) model for the prediction of IH after midline laparotomy (ML) and this model can be used by surgeons to help judge a patient’s risk for IH.”

Material and Methods

“A retrospective, single arm, observational cohort trial was conducted from January 2016 to December 2020. Study participants were recruited from patients undergoing ML for elective or urgent surgical indication. Using logistic regression and ANN models, we evaluated surgical treated IH, wound dehiscence, morbidity, readmission, and mortality using the area under the receiver operating characteristic curves, true-positive rate, true-negative rate, false-positive rate, and false-negative rates.”

Results

“There was no significant difference in the power of the ANN and logistic regression for predicting IH, wound dehiscence, mortality, readmission, and all morbidities after ML. The resulting model consisted of 4 variables: surgical site infection, emergency surgery, previous laparotomy, and BMI(Kg/m2) > 26. The patient with the four positive factors has a 73% risk of developing incisional hernia. The area under the curve was 0.82 (95% IC 0.76-0.87).

Conclusions

“ANNs perform comparably to logistic regression models in the prediction of IH. ANNs may be a useful tool in risk factor analysis of IH and clinical applications.”
P069 IMPLEMENTATION OF A TAP BLOCK PROTOCOL IN OUTPATIENT LAPAROSCOPIC HERNIA REPAIR DURING COVID PANDEMIC
Authors: Capinha Mariana , Gonçalves Mário Rui , Pereira Joaquim Costa , Antunes Conceição , Arantes Ana Rita , Almeida Paulo
Published: December 2021

Aim

“COVID has been a great challenge since its beginning. Hospitals had to change/create a lot of clinical pathways and protocols to fight it. As an adaptation to COVID pandemic, our surgical department decided to implement a protocol of Transversus Abdominis Plane Block (TAPB) in laparoscopic incisional ventral hernia repair to allow these patients to be shifted from elective to outpatient regime. This study aimed to analyze the implementation of this protocol during the covid era as a way to have more resources available for COVID patients.”

Material and Methods

“A retrospective observational study was conducted using data since the beginning of the implementation of the protocol, from July 2020 to May 2021. TAPB was performed in all patients, laparoscopically or ultrasound-guided. Patients and hernia variables were identified using the hospital database. Data was recorded in the recovery room, by a phone call 24h post-surgery and in postoperative consultations with the surgeon.”

Results

“A total of 18 patients with incisional ventral hernia was included in the study. All patients had laparoscopic incisional ventral hernia repair surgery with TAPB and in ambulatory regime, discharged before 24h, are very satisfied with the protocol in terms of post-operative pain and there are no complications related to the TAPB.”

Conclusions

“This study found that, despite of COVID Pandemic, implementing a TAP Block procedure during laparoscopic incisional ventral hernia repair, allows to shift these patients from elective to outpatient surgery without compromising the outcomes, pain management and patient security, and, finally, to increase availability of resources for COVID patients.”
P077 LONG-TERM CLINICAL OUTCOMES OF AN ANTIBIOTIC-COATED NON-CROSSLINKED PORCINE ACELLULAR DERMAL GRAFT IN HIGH-RISK ABDOMINAL WALL RECONSTRUCTION
Authors: Robinson Jordan , Sulzer Jesse , Baker Erin , Iannitti David
Published: December 2021

Aim

Abdominal wall reconstruction in high-risk and contaminated cases remains a challenging surgical dilemma. We report long-term clinical outcomes for a rifampin/minocycline-coated acellular dermal graft (XenMatrix™ AB) in complex abdominal wall reconstruction for patients with a prior open abdomen or contaminated wounds.

Material and Methods

Patients undergoing abdominal wall reconstruction at our institution at high risk for surgical site occurrence and reconstructed with XenMatrix™ AB with intent-to-treat between 2014 through 2017 were included. Demographics, operative characteristics, and outcomes were collected. Primary outcome was hernia recurrence. Secondary outcomes included length of stay, surgical site occurrence, readmission, morbidity, and mortality.

Results

Twenty-two patients underwent abdominal wall reconstruction using XenMatrix™ AB during the study period. Two patients died while inpatient from progression of their comorbid diseases and were excluded. Sixty percent of patients had an open abdomen at time of repair. All patients were Modified VHWG class 2 or 3.

There was a total of four 30-day infectious complications including superficial cellulitis/fat necrosis (15%) and one intraperitoneal abscess (5%). No patients required re-operation or graft excision.

Median clinical follow-up was 35.1 months with a mean of 32.2 +/- 16.5 months. Two asymptomatic recurrences and one symptomatic recurrence were noted during this period. Follow-up was extended by phone interview which identified no additional recurrences at a median of 45.5 and mean of 50.5 +/-12.7 months.

Conclusions

We present long-term outcomes for patients with high-risk and contaminated wounds who underwent abdominal wall reconstruction reinforced with XenMatrix™ AB to achieve early, permanent abdominal closure. Acceptable outcomes were noted.
P096 QUALITY OF LIFE FOLLOWING ROBOTIC-ASSISTED RETROMUSCULAR VENTRAL HERNIA REPAIR
Authors: Valsamidis Alexandros , Frederichsen Mathias , Nielsen Kristian Als , Harthimmer Mads , Helligsø Per , Nielsen Michael
Published: December 2021

Aim

Robotic-assisted ventral hernia repair (rVHR) has emerged as an alternative to current open and laparoscopic procedures. The present study aims to determine the effect of rVHR on postoperative quality of life.

Material and Methods

Patients undergoing elective rVHR from 01/01 2017 until 12/6 2020 were identified from the hospitaĺs electronic medical record system. Patient demographic, clinical presentation, location of the hernial defect and postoperative complications were obtained from the case notes. A phone interview was also conducted to assess postoperative life quality using the EuraHS-QoL questionnaire. The pre and postoperative life quality assessment was performed to determine the effect of robotic-assisted ventral hernia repair on 1. Pain at the site of the hernia, 2. Restrictions of activities due to pain or discomfort at the site of the hernia and 3. Esthetical discomfort. Moreover, patients were asked whether they felt their overall quality of life had improved, deteriorated or was unaltered after the procedure. A Wilcoxon signed rank test was conducted to determine the effect of the repair on postoperative life quality.

Results

85 out of 99 patients completed the interview and were included in this case series. The survey revealed a highly significant improvement of life quality in all categories (P < 0. 01). 86% of the participants reported that their overall quality of life had improved, 13% reported no change and 1% felt that it had deteriorated.

Conclusions

Robotic-assisted retromuscular ventral hernia repair is a safe procedure that is associated with a significant improvement of patient quality of life.
P154 DOES A PENO-SCROTAL APPROACH FOR PENILE PROSTHESIS IMPLANTATION INCREASE THE INCIDENCE OF INGUINAL HERNIAS POSTOPERATIVELY?
Authors: Al-Bahri Shadi , Taifour Hazem
Published: December 2021

Aim

The incidence of direct inguinal hernia and reservoir migration post-penile prosthesis implantation is extremely rare. We present a case series of patients presenting with direct inguinal hernia following three-piece penile prosthesis implantation.

Material and Methods

Three patients presented with direct inguinal hernia shortly following penile prosthesis implantation for treatment of refractory erectile dysfunction due to venous leak that was confirmed on ultrasound imaging. All patients underwent standard open Lichtenstein tension free repair.

Results

All patients underwent penile prosthesis Implantation through a peno-scrotal approach in which the reservoir was placed in the space of Retzius. The first patient had reservoir displacement one day post-operatively presenting as an inguinal bulge and discomfort, and repaired the same day. The other two patients presented with symptoms of inguinal swelling and pain at 40 days and 8 months respectively. None of our patients had signs and symptoms of intestinal obstruction. Identifiable risk factors included high BMI and a history of smoking, however dissection and placement of the reservoir may play a role in weakening the floor of the inguinal canal.

Conclusions

Despite the rare incidence of inguinal hernia post-penile prosthesis implantation, identification of patients with risk factors for inguinal hernia development should be done preoperatively. This may be evaluated through preoperative radiologic imaging with an abdominal wall ultrasound or clinical examination by a general surgeon.
O24 10 YEARS PARTICIPATING IN THE HERNIAMED-REGISTRY: REFLECTING ON RESULTS OF THE PAST HELPS US TO SHAPE THE FUTURE
Authors: Mayer Franz , Lechner Michael , Gabersek Ana , Bittner Reinhard , Emmanuel Klaus
Published: December 2021

Aim

Between 01/2011 and 12/2020 5,068 AWR-patients at our department (tertiary referral center) – 884 (17.4%) incisionals. Over this 10-years period considerable changes (patients characteristics, surgical techniques, results) were analyzed.

Material and Methods

Herniamed® offers an internet-based registry-platform to document all kinds of abdominal wall repairs on a voluntary basis since 2009. Demographic data, interventional details and outcomes are documented using the EHS-classification-system. Follow-up is standardized and sheduled for 10 years.

Results

Up to 54.7% of patients (in 2020) show at least one risk factor (diabetes, smoking ….), in contrast to the age pyramid patients >70 years are decreasing (47.2% in 2011 down to 29.3% in 2020), share of ASA III/IV is initially increasing (up to 42.9% in 2017) with a constant decrease after 2017 to 25.3% in 2020. Emergent cases are increasing (6.9% in 2011 up to 10.8% in 2019). Recurrent hernia repairs stays almost constant at median 21.7%. After 2015 we decided – for various reasons - not to routinely apply the laparoscopic IPOM-technique (with an interim ratio of up to 46.2%) – with a post-OP complication rate of median 23.3% anymore. From 2016 onwards we performed an increasing number of „other techniques“ (E-MILOS, E-TEP, ….) up to 36% in 2020 instead.

Conclusions

By analysing trends we recognized that patients show increasing numbers of risk factors and ASA-scores which led us to implement a prehabilitational strategy in clinical routine. However rate of post-OP complication is still high representing AWR as demanding in many aspects. A temporary cessation of MIS did not led to an extensive increase in post-OP wound complications.
O28 APPLICATION OF MICROPOROUS POLYSACCHARIDE HEMOSPHERES DURING TRANSVERSUS ABDOMINAL RELEASE TO REDUCE SEROMAS AND HEMATOMAS
Authors: Johannes Wegdam , de Jong Dite , Nienhuijs Simon , Schipper Ellis , Berkvens Elske , de Vries Reilingh Tammo
Published: December 2021

Aim

Wound complications, like seromas and hematomas, occur in 23% after transversus abdominis release (TAR). Hemostat agents like fibrin glue have potential to reduce this rate, by vessel sealing and tissue bonding. But these are expensive. A topical hemostatic, like microporous polysaccharide hemospheres (MPH), is much cheaper, but its potential to reduce seromas and hematomas has never been analyzed in ventral hernia surgery.

Material and Methods

After the first 25 consecutive TAR patients (Control group, 2016-2018), MPH was introduced as an adjunct in a consecutive group of 25 TAR patients (Intervention group, 2019-2020). MPH was sprinkled in the TAR planes and subcutaneous tissue. Groups were compared.

Results

Pre-operative base-line characteristics and the overall complexity of the hernia patients and operations did not differ between the two groups. Postoperatively, the overall rate of surgical site occurrences (SSO) differed (CG:60%;IG:32%), but not significantly. Seromas (CG:5%;IG: 3%) and hematomas (CG:28%;IG:8%) did not differ significantly between the two groups. Medical complications (CG:13%;IG:10%) and two-year recurrence rate (CG:12%;IG:16%) also did not differ.

Conclusions

This study did not demonstrate a clear effect of MPH on the incidence of SSO, seromas or hematomas after a transversus abdominis release, despite the high incidence of wound complications in the first group of TAR patients (presumably, reflecting the learning curve of TAR). The fact that MPH does not glue tissue layers and minimize dead space, may be causative. MPH is not advised as an adjunct to reduce SSO.
O34 AUTOLOGOUS FENESTRATED CUTIS GRAFTS FOR VENTRAL HERNIA REPAIR IN PATIENTS WITH OBESITY
Authors: Mansour Charles , Leonardi Claudia , McLaren Patrick , Cook Michael , Hodgdon Ian , Paige John
Published: December 2021

Aim

Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) > 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs.

Material and Methods

A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p < 0.05 considered significant.

Results

A total of 301 hernia repairs were performed (173 CGs, 54 SM, 59 PS, 15 BS). The groups had similar recurrence rates. A significant difference in complications rates did exist (37% CGs, 48.1% SMs, 15.3% PS, 66.7% BP, p < 0.001). Logistic regression revealed PS had fewer total complications than all other repairs. Compared to SM, CG had fewer seromas. Compared to BP, CG had fewer wound infections, systemic infections, renal complications, and additional procedures.

Conclusions

CG for abdominal wall hernia repair in patients with BMI ≥ 30 is an acceptable hernia repair in obese patients with similar recurrence rates and an acceptable complication profile compared to traditional repairs.
O41 PREDICTORS OF LOW QUALITY AFTER OPEN INGUINAL HERNIA REPAIR USING THE EURAHS-QOL SCORE: PROSPECTIVE MULTICENTRIC COHORT STUDY
Authors: Simoes Joana ,   PT Surg (Portuguese Collaborative Research Group)
Published: December 2021

Aim

Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to identify predictors of low Quality of Life (QoL) after open inguinal hernia repair, to guide practice and inform patients at high risk.

Material and Methods

Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors.

Results

893 patients were included from 33 hospitals. The majority were men (89.9% [800/891]), had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein’s repair (52.9% [472/893]). The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004).

Conclusions

This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.