bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiation of
Plasmodium
male gametocytes is initiated by the recruitment of a chromatin remodeler to a male-specific cis-element
Authors: Kaneko Izumi , Nishi Tsubasa , Iwanaga Shiroh , Yuda Masao
Published: May 2023

Plasmodium
parasites, the causative agents of malaria, possess a complex lifecycle; however, the mechanisms of gene regulation involved in the cell-type changes remain unknown. Here, we report that gametocyte sucrose nonfermentable 2 (gSNF2), an SNF2-like chromatin remodeling ATPase, plays an essential role in the differentiation of male gametocytes. Upon disruption of
gSNF2
, male gametocytes lost the capacity to develop into gametes. ChIP-seq analyses revealed that gSNF2 is widely recruited upstream of male-specific genes through a five-base, male-specific cis-acting element. In
gSNF2
-disrupted parasites, expression of over a hundred target genes was significantly decreased. ATAC-seq analysis demonstrated that decreased expression of these genes correlated with a decrease of the nucleosome-free region upstream of these genes. These results suggest that global changes induced in the chromatin landscape by gSNF2 are the initial step in male differentiation from early gametocytes. This study provides the possibility that chromatin remodeling is responsible for cell-type changes in the
Plasmodium
lifecycle.
“The girl is on fire!”
Authors: Chovanec Jan , Tsakona Villy
Published: May 2023

The article deals with online interactional humour in user
comments on YouTube. Drawing on an extensive dataset of verbal
reactions to a video discussing the (in)appropriateness of joking
about the 2019 burning of the Notre Dame cathedral in Paris, the
analysis traces how online commenters recontextualise
the disaster and how they jointly produce humorous interaction on a
sensitive topic. The analysis focuses on the emergence of joking threads, which consist of jokes
shared by the commenters and additional (non-)humorous metapragmatic
comments that develop the interaction in various directions. The
data reveal that commenters cooperatively engage in a rich range of humour-related practices on a socially sensitive
topic, which oscillate between disaster humour and religious
humour.
Co-constructing humour and gender identity in live stand-up
comedy
Authors: Linares Bernabéu Esther
Published: May 2023

This chapter explores the role of kairos in female stand-up comedy, looking specifically
at the co-construction of humour between performer and audience.
Stand-up performers adapt their routines depending on their
audiences, trying to draw these into the performance through the use
of kairos, understood as the opportune
and unpredictable moments of persuasion in which comedians choose to
respond to and interact with their audience with the aim of
promoting a humorous effect (Greenbaum 1999; Medjesky 2017). In order to verify this
claim, the present study is an analysis of the FEMMES-UP corpus
(Linares Bernabéu,
2020), which comprises 15 humorous stand-up comedy
performances by 15 female Spanish comedians. The corpus has been
transcribed and segmented into 504 sequences, and we focus here on
113 of these, in all of which there is direct dialogue between the
comedian and one or more members of the audience. The findings show
that humour facilitates friendly interaction and helps comedians to
negotiate their identity. In fact, the stand-ups in these data use
kairos to adapt their speech in
light of how audiences respond. Overall, the research reported here
confirms that female stand-up comedy is a type of planned discourse,
and that it is used by comedians as a cultural and social tool in
terms of confrontation and resistance.
Fictional interaction in children’s humorous narratives
Authors: Timofeeva-Timofeev Larissa
Published: May 2023

This paper analyses the construction of fictional
interaction in humorous narratives written by children of 8, 10 and
12 years of age, as compiled in the CHILDHUM corpus. These
informants were asked to write a humorous story about an imaginary
school exchange program with Mars. The analysis will explore the
ways in which children shape their fictional conversational
interactions with Martians, and how the data that arise can be
correlated with the psychosocial and metalinguistic maturation of
the children. This preliminary qualitative study reveals that
children aged 8 demonstrate a certain degree of aggression towards
the image of Martians, whereas this tendency reduces in the
narratives of 10-year-olds. In regard to how they deal with the
orality vs. writing opposition, the 8-year-olds essentially write
like they speak, and once again it is by the age of 10 that a
turning point can be perceived towards a higher awareness of the
typographical conventions of the written representation of
orality.
Automated piezoresponse force microscopy domain tracking during fast thermally stimulated phase transition in CuInP2S6

*
Authors: Checa M , Kelley K P , Vasudevan R , Collins L , Jesse S
Published: May 2023

Real-time tracking of dynamic nanoscale processes such as phase transitions by scanning probe microscopy is a challenging task, typically requiring extensive and laborious human supervision. Smart strategies to track specific regions of interest (ROI) in the system during such transformations in a fast and automated manner are necessary to study the evolution of the microscopic changes in such dynamic systems. In this work, we realize automated ROI tracking in piezoresponse force microscopy during a fast (≈0.8 °C s−1) thermally stimulated ferroelectric-to-paraelectric phase transition in CuInP2S6. We use a combination of fast (1 frame per second) sparse scanning with compressed sensing image reconstruction and real-time offset correction via phase cross correlation. The applied methodology enables in situ fast and automated functional nanoscale characterization of a certain ROI during external stimulation that generates sample drift and changes local functionality.
All-printed multiplexed electrocatalytic biosensors with rationally designed nanoparticle inks
Authors: Li Xing , Yang Ming , Rao Ai , Su Yuming , Yang Taotao , Ye Yongqin , Wang Jiaxuan , Pan Shiyu , Chen Feng , Wang Bin , Luo Zhiqiang
Published: May 2023

Inkjet printing, capable of rapid and template-free fabrication with high resolution and low material waste, is a promising method to construct electrochemical biosensor devices. However, the construction of fully inkjet-printed electrochemical biosensor remains a challenge owing to the lack of appropriate inks, especially the sensing inks of bioactive materials. Herein, we demonstrate a fully inkjet-printed, integrated and multiplexed electrochemical biosensor by combining rationally designed nanoparticle Inks. The stable gold (Au) nanoparticles ink with lower sintering temperature is prepared by using L-cysteine as stabilizer, and it is used to print the interconnects, the counter electrodes, and the working electrodes. The SU-8 ink is used to serve as dielectric layer for the biosensor, whereas the silver electrode is printed on the Au electrode by using commercially silver nanoparticles ink before it is chlorinated to prepare Ag/AgCl reference electrode. Moreover, we synthesize an inkjet-printable and electroactive ink, by the ‘one-pot method’, which is composed of conductive poly 6-aminoindole (PIn-6-NH2) and gold–palladium (Au–Pd) alloy nanoparticle (Au–Pd@PIn-6-NH2) to enhance the sensing performance of gold electrode towards hydrogen peroxide (H2O2). Especially, the amino groups in PIn-6-NH2 can be further used to immobilizing glucose oxidase (GOx) and lactic acid oxidase (LOx) by glutaraldehyde to prepare printable sensing ink for the detection of glucose and lactate. The fully inkjet-printed electrochemical biosensor enabled by advanced inks can simultaneously detect glucose and lactate with good sensitivity and selectivity, as well as facile and scalable fabrication, showing great promise for metabolic monitoring.
Coupling conditions for linear hyperbolic relaxation systems in two-scale problems
Authors: Huang Juntao , Li Ruo , Zhou Yizhou
Published: May 2023

This work is concerned with coupling conditions for linear hyperbolic relaxation systems with multiple relaxation times. In the region with a small relaxation time, an equilibrium system can be used for computational efficiency. The key assumption is that the relaxation system satisfies Yong’s structural stability condition [J. Differential Equations, 155 (1999), pp. 89–132]. For the non-characteristic case, we derive a coupling condition at the interface to couple two systems in a domain decomposition setting. We prove the validity by the energy estimate and Laplace transform, which shows how the error of the domain decomposition method depends on the smaller relaxation time and the boundary-layer effects. In addition, we propose a discontinuous Galerkin (DG) numerical scheme for solving the interface problem with the derived coupling condition and prove the

L
2

L^2

stability. We validate our analysis on the linearized Carleman model and the linearized Grad’s moment system and show the effectiveness of the DG scheme.
Enhanced diagnosis and prognosis of severe alcoholic hepatitis using novel metabolomic biomarkers
Authors: Horhat Adelina , Fischer Petra , Nicoara-Farcau Oana , Rusu Ioana , Morar Corina , Bumbu Andreea , Ignat Mina , Procopet Bogdan , Socaciu Carmen , Sparchez Zeno , Stefanescu Horia
Published: May 2023

Aim: Differentiating alcoholic hepatitis (AH) from acute decompensation of alcoholic cirrhosis (DC) is challenging, as the presentation and biochemistry are similar. We aimed to identify potential metabolomic biomarkers to differentiate between AH and DC, and to predict short-term mortality. Methods: We included consecutive biopsy proven AH and DC patients, which were managed according to current guidelines and followed up until the end of the study. Untargeted metabolomics was assessed in all patients at baseline. Specific analyses were successively performed to identify potential biomarkers, which were further semi-quantitatively analysed against relevant clinical endpoints. Results: Thirty-four patients with AH and 37 with DC were included. UHPLC-MS analysis identified 83 molecules potentially differentiating between AH and DC. C16-Sphinganine-1P (S1P) was the most increased, whereas Prostaglandin E2 (PGE2) was the most decreased. The PGE2/S1P ratio < 1.03 excellently discriminates between AH and DC: AUC 0.965 (p < 0.001), Se 90%, Sp 100%, PPV 0.91, NPV 1, and diagnostic accuracy 95%. This ratio is not influenced by the presence of infection (AUC 0.967 vs. 0.962), correlates with the Lille score at 7 days (r = −0.60; P = 0.022) and tends to be lower in corticosteroid non-responders as compared with patients who responded [0.85(±0.02) vs. 0.89(±0.05), P = 0.069]. Additionally, decreased ursodeoxycholic acid levels are correlated with MELD and Maddrey scores and predict mortality with a 77.27% accuracy (NPV = 100%). Conclusion: This study suggests the PGE2 (decreased)/S1P (increased) ratio as a biomarker to differentiate AH from DC. The study also finds that low levels of ursodeoxycholic acid could predict increased mortality in AH.
Efficacy and safety of dupilumab in bullous pemphigoid: a retrospective multicentric study of 36 patients
Authors: Moghadam Parna , Tancrede Emmanuelle , Bouaziz Jean-David , Kallout Julien , Bedane Christophe , Begon Edouard , Bourgault-Villada Isabelle , Calugareanu Andreea , Dereure Olivier , Jendoubi Fatma , Pham-Ledard Anne , Ingen-Housz-Oro Saskia , Picard-Dahan Catherine , Viguier Manuelle , Mahevas Thibault , Jachiet Marie , Charvet Estelle , Cassius Charles , Alexandre Marina , Lepelletier Clémence
Published: May 2023

Bullous pemphigoid (BP) is the most common autoimmune blistering disease in Europe and its treatment can be challenging. Several published cases have reported dupilumab efficiency in treatment-refractory patients. We conducted a retrospective multicentric study of 36 patients to evaluate the real-life efficiency of dupilumab in BP. Our results suggest that dupilumab, in association with high-potency topical steroids, could be rapidly effective in various clinical forms of BP and seems to be well tolerated in the elderly.
OC-019 LEVERAGING NATURAL LANGUAGE PROCESSING AND ARTIFICIAL INTELLIGENCE TO LABEL UNSTRUCTURED DATA FOR RISK PREDICTION
Authors: Amro C , Desai A , Dattatri P , Liu T , Hsu J Y , Broach R B , Ungar L H , Fischer J P
Published: May 2023

Aim

Majority of clinical data is categorized into unstructured data, including operative notes containing unexplored key details yet to be incorporated into a surgical risk model. We sought to determine whether Natural Language Processing (NLP) methods could be implemented to systematically capture operative note features that can be considered for patient-specific risk modeling.

Methods

Operative notes describing abdominal wall closure for 8233 patients undergoing colorectal operations between 2013–2019 were obtained. A development dataset was manually generated for 600 patients including skin and fascia suture material, suture size, and closure pattern. These features were analyzed to train/test various NLP approaches and assess their corresponding accuracy.

Results

Of the remaining 7633 operative notes, assessment of suture type, size, and closure pattern for skin and fascia was analyzed by keyword search, regular expression, and RoBERTa 5-fold Cross Validation(CV). Overall, RoBERTa 5-fold CV demonstrated superiority in all feature extraction tasks. For fascial suture type, RoBERTa 5-fold CV achieved 92.1% accuracy, regular expression achieved 83.5%, and keyword search achieved 9.2%. For fascial suture size, RoBERTa 5-fold CV achieved 91.6% accuracy, regular expression achieved 89.4%, and keyword search achieved 81%. For fascial closure pattern, RoBERTa 5-fold CV achieved 91.4% accuracy, regular expression achieved 80.8%, and keyword search achieved 24.7%. Skin feature analysis also demonstrated superiority of RoBERTa 5-fold CV while assessing suture type, size, and closure pattern with 93.3%, 93.3%, and 84.9% accuracy, respectively.

Conclusions

NLP methods can be reliably used to label key features contained within unstructured datasets, enabling use in predictive modeling in medicine.
OC-034 SHORT- AND LONG-TERM OUTCOMES OF TEMPORISING ABDOMINAL CLOSURE WITH VICRYL MESH IN CONTAMINATED AND INFECTED FIELDS
Authors: Schembari E , Woyton M , Hendra L , Richardson C , King A , Layfield D
Published: May 2023

Aim

Abdominal wall reconstruction (AWR) in contaminated fields is associated with surgical site morbidity > 50% and high hernia recurrence rates. Patients undergoing surgery for intestinal failure are anatomically complex with fistulae+/-stomas within failed abdominal walls. Temporising the abdominal wall using vicryl mesh is an alternative to AWR. It avoids some of the morbidity of AWR however concern exists regarding persistent abdominal wall herniation longer-term. This study reports outcomes following temporising abdominal closure in contaminated fields.

Methods

Retrospective single-centre, observational study of all patients undergoing intestinal failure surgery in whom temporising abdominal closure was performed (2010–2019). Closure was achieved using 4-layers of vicryl mesh placed as an inlay, secured circumferentially using continuous absorbable suture.

Results

26 patients were included (VHWG Grade 3:n=23, VHWG 4:n=3). Indication for surgery was enterocutaneous fistulation (N=18), continuity restoration(n=6) and explantation of infected mesh(n=2). 15 had laparostomy wounds and 8 had surgical site herniation.

Median length of post-operative stay=31 days (range 11–161). Clavien Dindo>3 occurred in 9 cases (34%). Surgical site occurrences complicated 5/26 (20%) cases with zero 90-day mortalities.

Median follow-up=25 months (range 4–118);6 patients were lost to follow-up (including 5 deaths from unrelated causes). There were zero fistula recurrences. 13/20 (65%) of patients developed notable persistent abdominal wall herniation however just 5 (25%) reported symptoms.

Conclusions

Temporising vicryl mesh closure is a simple method associated with low surgical site morbidity in contaminated fields. Despite persistent herniation re-fistulation rates are low and the majority of patients are free of abdominal wall morbidity at follow up.
OC-059 PARAESOPHAGEAL HERNIA REPAIR (PEHR) IN OCTOGENARIANS: THE RISKS OF WATCHFUL WAITING VERSUS ELECTIVE REPAIR
Authors: Wilson H , Ayuso S , Rose M , Polcz M , Ku D , Scarola G , Augenstein V , Colavita P , Heniford B T
Published: May 2023

Introduction

With an aging population, the utility of surgery in elderly patients, particularly octogenarians, is of increasing interest. Our goal was to analyze outcomes of those over 80 versus younger patients.

Methods

The Nationwide Readmission Database was queried for patients who underwent PEHR from 2016–2018. Exclusions included diagnosis of gastrointestinal malignancy, concurrent bariatric procedure, or age <18. Patients 380 were compared to those 18–79 years old using standard statistical methods, with subgroup analysis of elective PEHR.

Results

From 2016–2018, 46,450 patients were identified: 5,425(11.7%) were 380 years old and 41,025(88.3%) were <80 years old. The median age of octogenarians was 84[81, 87] and of younger patients was 64[54, 71]. Octogenarians were more likely to have an emergency operation(46.3% vs 18.2%,p<0.001). Multivariable logistic regression revealed age380 was an independent predictor of readmissions at 30(OR=1.512[1.348–1.697],p<0.001), 90(OR=1.451[1.314–1.603],p<0.001), and 180(OR=1.471[1.341–1.613],p<0.001) days but not of perioperative mortality(OR=1.373[0.962–1.959],p=0.081). Emergency procedure was an independent predictor of mortality for all patients(OR=3.180[2.492–4.057],p<0.001). For only elective procedures, octogenarians had higher mortality(1.3% vs 0.2%,p<0.001), longer LOS (3[2, 5] vs 2[1, 3] days,p<0.001), and higher readmission rates at 30(11.1% vs 6.5%,p<0.001), 90(16.0% vs 9.4%,p<0.001), and 180(19.4% vs 11.5%,p<0.001) days.

Conclusions

Octogenarians represented a substantial proportion of patients undergoing PEHR and were more likely to undergo an emergent operation. Being an octogenarian was not an independent predictor of perioperative mortality, but emergency status was. Octogenarians’ perioperative mortality rate was reduced in elective procedures but was still higher than younger patients. The decision for elective repair should involve a thorough risk/benefit analysis in octogenarians.
OC-082 LAPAROSCOPIC VENTRAL HERNIA REPAIR WITH PHASIX ST, VENTRALIGHT, AND OMERA: 5 YEARS OUTCOME
Authors: Altowaijeri A , Aljomah N , Alshammari S , Binjaloud A , Aldohayan N , Aldohayan A
Published: May 2023

Background

Permanent synthetic mesh is the standard mesh used in repairing the ventral hernia. The complication of the synthetic mesh opens the door to assessing the place of resorbable mesh and allocating the exact position. This work is to evaluate the usage of Phasix ST, Ventralight, and omera in repairing Ventral Hernia.

Methods

A retrospective study of the patient undergoing laparoscopic using Phasix ST, Ventralight, and omera mesh was approved by Institutional research board.

Results

Seventy patients included in this study. 18 males and 52 females. Mean age is 54.1 with 33.2 kg/m2. All surgeries were done in a single Institution by one surgeon. The average age of the patient is 54.2, with a 33.2 BMI. The patients were followed in the clinic or via telephone for 60 months. Phasix ST was used for 26 patients, omera for 14 patients, and, Ventralight for 30 patients. There are three recurrences in the Phasix ST group. Recurrence occurred in the center of the mesh for all patient with adhesion to the mesh and capture tackers. One fistula and omera group, and one recurrence in the Ventralight group.

Post-operative pain is better in the Phasix ST group. However, it was not statistically significant. The cost of Phasix ST is higher than the two meshes.

Conclusion

Polypropylene composite mesh showed comparable results as Phasix ST in pain. Omera causes fistula and severe adhesions. Further work is needed to compare different mesh, and polypropylene composite mesh remains to be the first line in the management.
OC-086 THE NEW ERA OF 3D-PRINTING TECHNIQUES IN A MEDICAL SETTING: EARLIER EXPERIENCE WITH THE USE OF BOTULINUM TOXIN FOR COMPLEX VENTRAL INCISIONAL HERNIA
Authors: Caruso R , Vicente E , Quijano Y , Ferri V , Duran H , Diaz E , Fabra I , Malave L , Ruiz P , Pizzuti G , Naldini C
Published: May 2023

In the last years 3D printing has progressively gained widespread interest for its several applications in many medical fields. Among the most common diagnostic imaging techniques, computed tomography (CT) and magnetic resonance imaging (MRI) allow only two-dimensional images to obtain information on different pathologies. This requires excellent visualization skills from not specialized medical doctors. The 3D printing has been developed to overcome the current disadvantages of conventional imaging techniques.

The 3D models are created from the diagnostic studies of the patient (MRI, CT, PET or a combination of those) with a process that fuse advanced medical imaging algorithms and medical image processing, which are supervised by specialized radiologists. Hereby we describe the cases of two patients with giant incisional hernias. The patients underwent 3D study before botulinum toxin treatment and another 3D model a months after the botulin toxin. With the 3D model we calculated the abdominal cavity volume before and after the treatment with botulinum toxin. Six weeks after the toxin we planned the surgery.

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

Our experience gives an overview of the current use of 3D-techniques, more specifically in the field of abdominal wall defect.
OC-096 Short-Term Results of Transversus Abdominis Release in Patients under Immunosuppression
Authors: De Troyer A , Allaeys M , Molnar A , Berrevoet F , Hasan E
Published: May 2023

Aim

Immunosuppressive medication might increase the likelihood of wound morbidity, with possible higher rate of surgical site infections (SSIs). We aim to identify short-term outcomes and hospital stay after incisional hernia repair with transversus abdominis release (TAR) in patients with versus without immunosuppression.

Material & Methods

All patients undergoing open incisional abdominal wall hernia repair with uni-or bilateral TAR from January 2021 through November 2022 were identified using a prospectively maintained database. Minimum follow-up was 30 days. Outcomes included 30-day SSIs, seroma rate, hospital stay, and early recurrence.

Results

Twenty-seven patients with immunosuppressive medication were identified and 75 without (mean age 59.0 ± 13.9 vs. 65.1 ± 11.4, 74.1% vs. 46.7% male, respectively). Median hernia width was 7.7 ± 5.1 cm vs. 7.9 ± 4.3 cm respectively. At 30 days follow-up, SSI rate was 1/27 (3.7%) in the group under immunosuppression and 5/75 (6.7%) in the group without (p = 0.575). Seroma rate was 3/27 (11.1%) vs. 12/75 (16.0%), respectively (p = 0.539). Mean hospital stay was 6.0 ± 3.6 days in the immunosuppression group vs 8.1 ± 6.7 days in the group without (p = 0.052). No early recurrences were detected in either group.

Conclusion

Immunosuppression does not significantly increase the risk of short-term complications in incisional hernia repair with transversus abdominis release. There is a trend towards a shorter hospital stay in patients under immunosuppression, possibly related to a reduced inflammatory response.
OC-102 NUCK HYDROCELE DURING INGUINAL HERNIA REPAIR IN ADULT FEMALES. REPORT OF TWO CASES
Authors: Chamzin A , Galyfos G , Triantafyllou A , Theodoropoulos C , Toutouzas K , Theodorou D , Zografos G
Published: May 2023

Aim

To present both the open and laparoscopic technique when encountering a Nuck hydrocele during an inguinal hernia repair in females.

Methods

Two cases of incidentally encountered cysts of Nuck during elective inguinal hernia repair in females are presented.

Results

Hydrocele of Nuck is a type of primary idiopathic hydrocele. It can occur due to partial remaining of the physiologically obliterated Canal of Nuck. In females, cysts of Nuck are frequently clinically misdiagnosed as inguinal hernias. A 42-year-old woman was subjected to a left TAPP repair for a symptomatic inguinal bulge. Intraoperatively a cystic lesion was attached to the round ligament of the uterus. The cyst contained clear fluid and was progressively dissected from the round ligament, excised and sent for a pathological examination. A typical TAPP repair with mesh ensued. A second case of a 45-year-old woman was submitted to a laparoscopic exploration of an ultrasonographically identified cystic lesion inside the inguinal canal. Intraabdominal reduction of the cyst was not possible, so conversion to open surgery was decided. A clear-fluid cyst was then excised and a typical Lichtenstein repair was performed.

Conclusions

Symptomatic inguinal bulge especially in women may warrant ultrasound examination for preoperative clarification of the underlying pathology and intraoperative management. The surgeon should be aware of the existence and pathogenesis of this rare entity.
OC-123 COMPARISON OF COMPLICATION RATES BETWEEN INTRA- AND EXTRAPERITONEAL HERNIA REPAIRS
Authors: De Deken J , Stavrou G A
Published: May 2023

Aim

With the emergence of new laparoscopic techniques, Intra-Peritoneal-Onlay-Mesh (IPOM) has fallen out of favor for repairing abdominal wall hernias due to reported complications, including adhesions and bowel injury, our aim is to compare complication rates in our center between intra- and extraperitoneal techniques.

Material & Methods

A retrospective analysis was conducted on data from our certified hernia center from 2018 to 2021. All patients who underwent an umbilical, epigastric or incisional hernia-repair were included. The primary outcome measures were complications, including bowel injury and adhesions.

Results

A total of 188 patients underwent a hernia repair. 74 (39%) patients hat an umbilical hernia, 22 (12%) an epigastric hernia and 92 (49%) had an incisional hernia. Most patients (110–58%) were treated with laparoscopic IPOM, 14 (7,4%) of them underwent an open IPOM. 46 (25%) had hernias repaired with direct suture and the remaining patients were treated with other techniques, including open sublay and mini or less open sublay (MILOS). After an average follow-up of 36months, only two (1%) patients developed a mechanical ileus, one after laparoscopic and one after open IPOM surgery. Bowel lesions occurred in two (1%) patients who underwent open IPOM and direct suture hernia repairs. There was no difference in complications between the different surgical techniques.

Conclusion

Our study suggests that the different techniques for hernia repair have similar rates of complications. Further research is needed to determine the most effective and safe approach for hernia repair.
P-017 TROCAR SITE HERNIA: IS IT A MINOR PROBLEM ?
Authors: Zaragoza Zaragoza C , Duque Alvarez N X , Parra Chiclano J , Gomis Martin A , Rubio García J J , Viñas Martínez T , Ramia Ángel J M
Published: May 2023

Aim

Describe the characteristics of a trocar site hernia (TSH) in our center.

Materials and methods

Descriptive retrospective observational study. Tertiary hospital center. Period: July 2018 - November 2022. Inclusion criteria: Patients operated on for TSH. We analyzed patient characteristics, type of the primary procedure (appendectomy, cholecystectomy or other), TSH data and characteristics of TSH repair.

Results

150 patients were included. Patient data: 65.3% were women. Median age: 59.54 years. BMI <35 in 47%. BMI was higher in cholecystectomies than in appendectomies. 66% were ASA II. 31.3% were active smokers. Surgical primary procedures: 59.4% cholecystectomy, 17.3% appendectomy, 23.3% others. Surgical TSH time: 30–90 minutes (59.6%) and 36.7% were performed as an emergency procedure. TSH data: 85.3% were M3, mean size was 3.8 cm Time between primary surgery and TSH: 39.6 months. The size of the TSH only had a statistically relationship with the time between primary surgery and TSH diagnosis. Furthermore, 17.3% of the TSH were recurrences, of which 77% already had a mesh. 91% of the TSH were scheduled surgery, with a mean surgical time of 70 minutes. All were repaired with a mesh, 68.6% preperitoneal/medial retromuscular. Regarding complications, 7.4% presented after a month and 1.3% recurred after 6 months.

Conclusions

According to our data, the TSH is not a minor problem with high morbility and resource consumption. The rate of TSH is greater in obese women undergoing cholecystectomy. Perhaps a prophylactic mesh policy should consider in these cases.
P-038 BOTULINUM TOXIN IN THE TREATMENT OF COMPLEX ABDOMINAL HERNIAS: A REVIEW OF CLINICAL OUTCOMES
Authors: Oliveira A , Fonseca T , Barbosa E , Barbosa E
Published: May 2023

Aim

Adjuvant use of botulinum toxin (BTX), which causes temporary paralysis of the lateral abdominal wall muscles, may have a roll in achieving a functional abdominal wall reconstruction when treating complex hernias, without the need of component separation techniques (CST).

Methods

Retrospective analysis of all patients with complex hernia between April 2021 and October 2022 in which BTX was used. Patients that would have to go through CST regardless and patients with other adjuvant treatments were excluded.

Results

22 patients had BTX, with a total of 13 patients included in this study. The median age was 64 and BMI 30,7kg/m2. The average CT imaging measurement of the transverse defect was 13,7cm. The median of Cedar's calculation was 27%. 7 patients (54%) only needed a Rives Stoppa Wantz (RSW) for midline closure, but 6 patients still needed a CST. The median time of the surgery for the RSW was 233 min and for the CST 330 min. Of the patients submitted to RSW, 1 complicated with a deep incisional infection and 2 CST patients had surgical complications. No recurrences in the RSW group and one hernia persistence after a major complication on the CST group.

Conclusion

The BTX can have an important role as an adjuvant in the treatment of large incisional hernias and in some patients may allow its repair with a less invasive surgical technique, with less operative time and less complications. More studies are needed in this area.
P-042 SHORT-TERM RESULTS OF LAPAROSCOPIC TOTALLY EXTRAPERITONEAL (TEP) GROIN HERNIA REPAIR WITH LIGHTWEIGHT FLAT MESH WITHOUT FIXATION. AGAINST THE ESTABLISHED?
Authors: Marrero Marrero P , Delgado Plasencia L J , Lorenzo Rocha N , Rodríguez Castellano D , Fernández Hernández L , Bravo Gutiérrez A F
Published: May 2023

Aim

International guidelines concerning mesh and mesh fixation options in TEP and transabdominal preperitoneal (TAPP) groin hernia repair are based on studies focusing on either mesh or fixation. The value of such recommendations is limited by lacking knowledge on how mesh and fixation interact. The Swedish Hernia Registry Study published in 2022 a cohort study where it recommended in TEP and TAPP the use of lightweight flat mesh with fibrin glue fixation and the use of standar polypropylene flat mesh without fixation, as the two methods with the lowest rate of reoperations for recurrence (3,7%). We present the short-term results of TEP groin hernia repair with lightweight polypropylene flat mesh without fixation.

Material and Methods

In 2021, 32 TEP were electively performed in 27 adults with inguinal hernias L, M, F, P or R (EHS-Classification). The endpoint was reoperation due to recurrence at 1 year after surgery.

Results

32 hernias L1 P, 1 L2 P, 2 L2 R and 1 F1 P were operated as outpatient surgery. 24 males and 4 females. Average age 57,5; Average BMI 28; The most frecuent postoperative complication was mild self-limiting scrotal hematoma (10%; Clavien-Dindos-I). Recurrence rate of hernia was 3,7%.

Conclusions

The TEP groin hernia repair with lightweight flat mesh without fixation could be an option to consider. However, due to the small sample size used in this study, the results should be interpreted with caution and longer-term studies are needed.
P-045 OUR EXPERIENCE WITH THE PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM
Authors: Santidrián Zurbano M , Domínguez Bastante M , Salmerón Ruiz Á , Diaz Ríos P , Medina Benitez A , Mansilla Roselló A
Published: May 2023

Aim

Complex incisional hernias (IH) pose a surgical challenge. Prehabilitation of the abdominal wall favors surgery and improves outcomes. We present our results with the use of preoperative progressive pneumoperitoneum (PPP) in complex abdominal wall pathology.

Material and Methods

Single-centre, retrospective, observational study (March 2018-July 2022), including patients receiving PPP (Tanaka index >20% or <20% if facing a non-reducible or incarcerated IH). The insufflation catheter is placed under ultrasound control, initially administering 500 cc. The total volume of PPP to be administered is three times the volume of the hernia sac. Administration is effectuated on an outpatient basis, starting 15 days before surgery, administering 1000–1200 cc every 24–48 hours. Antithrombotic prophylaxis, incentive inspirrometry and prescribed analgesia are performed.

Results

68 patients were included, 39 females/29 males, age 63.3 years (24–85), body mass index 33.7 (20–48) and CeDAR 38.9% (11–92). Classification of IH (EHS): M 72% (49), L 15% (10), ML 6% (4), parastomal 4% (3), groin hernia 4% (3) and other primary hernia 3% (2). Mean Tanaka index is 26% (3–85), mean PPP insufflated 3395 cc (1800–15000 cc). Mean PPP time before surgery was 14 days (3–70).

Eight complications related with the procedure were observed: 3 subcutaneous emphysema (4.3%), 2 ineffective PPP (2.8%), 1 catheter exit (1.4%), 1 catheter infection (1.4%) and 1 laparoscopic approach (1.4%). In three cases it was not feasible to place the PPP catheter.

Conclusions

PPP is an effective and safe treatment to facilitate the repair of complex IH, with minimal morbidity and zero mortality.
P-082 THE EFFECT OF CLOSED DRAINAGE SYSTEM ON SEROMA IN LAPAROSCOPIC TOTAL EXTRAPERITONEAL INGUINAL HERNIA REPAIR
Authors: Agca B , Iscan Y , Ergin A , Bilgili A C , Topaloglu B , Fersahoglu M , Memisoglu K
Published: May 2023

Aim

Seroma that can be seen after endoscopic completely extraperitoneal inguinal hernioplasty (TEP) is a major problem in patients who are concerned about recurrence.In this study,a prospective study design was prepared in our clinic in order to see the incidence of seroma afterTEP and the effect of closed system negative pressure drainage, which is one of the methods thought to reduce it.

Methods

January2021-February2022patients who will undergo unilateral TEP were randomly selected and divided into two groups.Group I was the group where a drain would be placed after TEP,and Group II was the group where no drain was placed after TEP.A hemovac drain was placed behind the mesh, with the perforated end of the drain coming into the preperitoneal cavity,in the patients in Group I.All cases were anatomical 3Dmesh(3DMax™Mesh,BD,USA)was applied to all cases.

Results

There were 41patients in Group I and 39patients in Group II.73 of the patients were male and 8 were female.According to the EHS classification,47of the hernias wereL1 and 33 were M1 hernias.On the 7th postoperative day,seroma was observed in 5patients in Group I and13 patients in Group II (p<0.024).There was no difference between the groups in the seromas seen at the postoperative 3rd month.

Conclusion

The frequent occurrence of seroma after TEP is confused with recurrence, especially after hernia surgery.This may cause fear and panic in the patient.It is effective for the patients to come to the surgeon who performs the operation at regular intervals for control in order to eliminate the concerns of the patients.
P-097 FEMORAL AND OBTURATOR HERNIA INCARCERATED: A CASE REPORT
Authors: Lourenço R , Peixoto I , Santos A , Lopes A , Matos D , Pinto R , Alpoim C
Published: May 2023

Obturator hernia is a very rare type of abdominal wall hernia, accounting for less than 1% of all abdominal wall hernias. They can be confused with femoral hernias as well as they can arise simultaneously, just like in this clinical case.

A 82 year old female, with multiple comorbidities including a right inguinal hernioplasty, was brought to our emergency department complaining of abdominal pain, distension and vomiting in the last 24 hours.

On physical examination, there where abnormally active, high-pitched bowel sounds, abdominal distension and pain on left lower quadrant but no tenderness. Palpation of groin area showed an incarcerated left femoral hernia, apparently containing only omentum. As the patient maintained left lower abdominal pain, we proceed to a CT scan, which demonstrated small bowel dilation with air-fluid levels consistent with a small bowel obstruction originating from an obturator hernia.

Open tension-free mesh repair of femoral hernia was done and no need for ressection since it only contained omentum, without ischemic signs. Open transperitoneal nonmesh repair of obturator hernia was performed after hernia reduction. There was no irreversible ischemia. Evolution during hospitalization was uneventful.

Regarding obturator hernias, there is no optimal approach since it is a very rare type of hernia, so it probably depends on patient condition and surgeon experience. A transperitoneal approach is preferred when there's signs of bowel obstruction, as we proceed on this clinical case.
V-001 ROBOTIC E-TEP APPROACH FOR RECURRENT INCISIONAL HERNIA AFTER LAPAROSCOPIC IPOM REPAIR: HAZARD OR RIGHT CHOISE?
Authors: Cobuccio L , Tartaglia D , Coccolini F , Chiarugi M
Published: May 2023

The video shows the case of a 40-year-old male patient with a recurrent umbilical hernia after a laparoscopic IPOM repair. The preoperative CT scan with Valsalva shows a M3 defect with a width of 7 cm at the lower border of the intraperitoneal mesh, associated with upper midline diastasis. We decide to address the hernia repair with a robotic e-TEP approach and a lateral docking. Despite a difficult access and dissection of the retromuscular space due to the adhesions beetwen the rectus muscle and the non-absorbable tacks, the procedure was successful and the patient was discharged the day after the surgery. No complications or recurrence were detected at the 6-month follow-up.
V-018 PAULI REPAIR FOR THE COMBINATION OF MIDLINE INCISIONAL AND PARASTOMAL HERNIAS
Authors: García Ureña M Á , Medina M , Avilés A , Morejon S , Robin Valle De Lersundi A , Martínez J , Lopez Monclús J , Blazquez Hernando L A , Jiménez Ceinos C , Vaello V
Published: May 2023

Introduction

Parastomal hernias (PH) can be a complex surgical problem. When there is a combination of midline and parastomal hernias, an option could be using both posterior component separation technique and an intraparietal Sugarbaker as described by Pauli. We present a case with the combination of midline and parastomal hernias. The aim of this video is to offer the most relevant steps that should be followed for a Pauli repair.

Methods

This is a 75 years-old man,, that underwent abdominoperineal resection for rectal cancer T3N2 in 2018. He developed a very symptomatic incisional hernia + parastomal and repaired was offered. After adhesiolysis, a retromuscular Rives dissection and a left posterior component separation were made. A Pauli was planned lateralizing the bowel in the retromuscular plane (like an intraparietal Sugarbaker repair) and a biosynthetic mesh was used in the retromuscular preperitoneal plane, making an inner stoma site with the mesh and bringing the colon trough the previous stoma site. Finally, anterior abdominal wall was closed

Results

The patient was discharged uneventfully on the 6th postoperative day.

Discussion

Pauli described 3 patients in similar circumstances but leaving the new posterior ostomy site lateral to the mesh. This technique that we describe in this video could be particularly useful in patients in whom a simpler Sugarbaker laparoscopic repair is not adequate and in those cases with PH with concomitant midline defects.
V-019 Spiegel hernia repair using eTEP approach
Authors: Gómez López J R , Concejo Cutoli P , Trujillo Díaz J J , Martínez Moreno C M , Montenegro Martín M A , Atienza Herrero J , Martín Del Olmo J C
Published: May 2023

Objective

Spiegel hernia is a rare entity that accounts for less than 1% of operated hernias. Its clinical diagnosis is difficult and its treatment is varied.

The objective of this work was to show the eTEP approach for the treatment of this pathology.

Methods

Despite the fact that this entity accounts for less than 1% of all hernia outbreaks, we had three probable cases of Spigelian hernia in the last quarter. The last of them was resolved with Extended Totally Extraperitoneal (eTEP) Approach for Hernia Repair.

Results

We show a 62-year-old man, previously operated on for bilateral inguinal hernia and Spiegel hernia on the right side by TAPP laparoscopic approach. He presents a left Spiegel hernia now, for which a totally extraperitoneal approach is proposed. The surgery was uneventful and the patient was discharged the day after the intervention. At two months of follow-up, the patient is asymptomatic.

Conclusions

Spiegel hernia is a rare hernia, difficult to diagnose and can present itself as complicated. It can be treated with various approaches. Laparoscopic Spiegel hernia repair is gaining popularity for its safety and patient benefits. The eTEP approach is useful tool in the management of the abdominal wall and, as demonstrated in our case, for the treatment of Spiegel hernia.
V-022 POSTOPERATIVE INGUINODYNIA: LAPAROSCOPIC NEURECTOMY AND MESH REMOVAL
Authors: Olivero A A , Valinoti A C , Giacone J A , Sadava E E
Published: May 2023

Aim

Chronic groin pain following a hernioplasty is a complication with an incidence of 10–12%. A multidisciplinary approach, including pain management services, interventional radiology and surgery, has proven the best outcomes. Persistence of symptoms and lack of efficacy of non-surgical treatments make surgical treatment with prosthetic removal and neurectomies an appropriate alternative.

Material & Methods

We present the clinical case of a 35-year-old male with a history of bilateral laparoscopic groin hernioplasty performed at another institution 10 years ago. After the surgery, he developed chronic groin pain, predominantly on the left side, and underwent multiple interventions. He complained that the pain was severe and incapacitating, affecting his quality of life. Dermatome mapping evidenced compromise of the three inguinal nerves (ilioinguinal, iliohypogastric and inguinal branch of genitofemoral). A multidisciplinary approach including NSAIDs, pregabalin, tricyclic antidepressants and periradicular blocks followed by radiofrequency ablation was established, without success. A laparoscopic left inguinal exploration with mesh removal and triple neurectomy was then decided.

Results

The patient had an adequate postoperative course. He returned to daily activities including sports practice, and no recurrence was observed after 1 year of follow up.

Conclusions

A multidisciplinary approach is suggested for the treatment of postoperative inguinodynia. Neurectomy and mesh removal is a safe and effective strategy, and must be considered for the management of severe postoperative groin pain in which non-operative approaches failed. Surgery entails a great challenge and therefore should be performed in specialized centers.
V-052 Laparoscopic Treatmenf of Spiegel Strangulated Hernia by TAPP Approach
Authors: De Armas Conde M , Gianchandani Moorjani R , Reyes Correa B , Orti Rodríguez R , Díaz López C , Sánchez González J M , Moneva Arce E , Barrera Gómez M Á
Published: May 2023

Repair of hernia is a very common procedure performed by a general surgeon. Laparoscopic approach has demonstrated advantages over direct approach: less complications, faster recovery and less postoperative pain. In Spiegel hernias, if the ring is less than 2 cm, a simple laparoscopic suture can be performed; however, laparoscopic transabdominal preperitoneal (TAPP) hernioplasty has lower risk of recurrence.

We report the case of a woman with and strangulated Spiegel hernia which was attempted by TAPP hernioplastly.

63 year old woman consulted in emergency for a swelling of the left flank an occlusive syndrome. Physical examination found a distended abdomen with presence of a painful mass in the left flank, irreducible.

Radiological findings were inconclusive, so an ultrasound was performed which showed an abdominal wall defect of 15×15 mm with an ischemic small bowel loop herniation: strangulated Spiegel hernia.

A exploratory laparoscopy was attempted emergently. It found a 2 cm hole at the abdominal wall with 15 cm of ischemic small bowel. Ischemia was confirmed with indocyanine green (ICG).

Afterwards, TAPP herniopplasty was performed: peritoneal incision to create a peritoneal flap. The peritoneal sac was reduced and then, we closed the defect. After this, we placed a prosthesis covering the area of weakness in the pre-peritoneal space

and fixed with biological glue. At least, we covered the mesh with the peritoneal closure.

Finally, we performed a resection of ischemic bowel and isoperistaltic mechanical laterolateral extracorporeally anastomosis.

She had an unremarkable post-operative course, and she was discharge on the 4th postoperative day.
Impact of network treatment in patients with resected pancreatic cancer on use and timing of chemotherapy and survival
Authors: Hopstaken Jana S , Vissers Pauline A J , Quispel Rutger , de Vos-Geelen Judith , Brosens Lodewijk A A , de Hingh Ignace H J T , van der Geest Lydia G , Besselink Marc G , van Laarhoven Kees J H M , Stommel Martijn W J
Published: May 2023

Background

Centralization of pancreatic cancer surgery aims to improve postoperative outcomes. Consequently, patients with pancreatic cancer may undergo pancreatic surgery in an expert centre and adjuvant chemotherapy in a local hospital (network treatment). The aim of this study was to assess whether network treatment has an impact on time to chemotherapy, failure to complete adjuvant chemotherapy, and survival. Second, whether these parameters varied between pancreatic networks was studied.

Methods

This retrospective study included all patients diagnosed with non-metastatic pancreatic ductal adenocarcinoma who underwent pancreatic surgery and adjuvant chemotherapy, registered in the Netherlands Cancer Registry (2015–2020). Time to chemotherapy was defined as the time between surgery and the start of adjuvant chemotherapy. Completion of adjuvant chemotherapy was defined as the receipt of 12 cycles of FOLFIRINOX or six cycles of gemcitabine. Analysis was performed with linear mixed models and multilevel logistic regression models. Cox regression analyses were performed for survival.

Results

In total, 1074 patients were included. Network treatment was observed in 468 patients (43.6 per cent) and was not associated with longer time to chemotherapy (0.77 days, standard error (s.e.) 1.14, P = 0.501), failure to complete adjuvant chemotherapy (odds ratio (OR) = 1.140, 95 per cent c.i. 0.86 to 1.52, P = 0.349), and overall survival (hazards ratio (HR) = 1.04, 95 per cent c.i. 0.88 to 1.22, P = 0.640). Significant variation between the networks was observed for time to chemotherapy (range 40.5–63 days, P < 0.0001) and completion of adjuvant chemotherapy (range 19–52 per cent, P = 0.030). Adjusted for case mix, time to chemotherapy significantly differed between networks.

Conclusion

In this nationwide analysis, network treatment in patients with resected pancreatic cancer was not associated with longer time to chemotherapy, failure to complete adjuvant chemotherapy, and worse survival. Significant variation between pancreatic cancer networks was found for time to chemotherapy.
Rerum cognoscere causas
Authors: Wiest Gerald
Published: May 2023

Knowing the causes of things. In this Essay, Gerald Wiest considers the topic of causality in medical practice, and why finding the cause of symptoms—even if it does not always lead to their treatment—is of such fundamental importance to patients and physicians alike.