bluuebunny/crossref_metadata_2025_split huggingface dataset:
O02 THE ROLE OF DEEP LEARNING IN PREDICTING COMPLEXITY AND COMPLICATIONS IN ABDOMINAL WALL RECONSTRUCTION
Authors: Elhage Sharbel , Ayuso Sullivan , Zhang Yizi , Deerenberg Eva , Augenstein Vedra , Colavita Paul , Todd Heniford B 
Published: December 2021

Abstract

Aim
The aim of our study was to evaluate the utility of image-based deep learning models (DLMs) to predict surgical complexity and postoperative outcomes in patients undergoing AWR.

Material and Methods
A prospective, tertiary center, hernia database was queried for open AWR patients with adequate pre-operative CT-scans. An 8-layer convolutional neural network (CNN) analyzed image characteristics in Python utilizing the open source Tensorflow© and OpenCV frameworks. Images were analyzed and batched into a training set (80%) and validation set (20%) used to analyze the model output, which was blinded to the CNN until testing. DLMs were run to assess surgical complexity based on need for component separation, surgical site infection (SSI), and pulmonary failure. The surgical complexity DLM was validated by comparison to 6 expert AWR surgeons.

Results
In total, 369 patient CT scans were utilized. The surgical complexity DLM performed well (ROC=0.744;p&lt;0.0001), and when compared to surgeon prediction on the validation set, performed better with an accuracy of 81.3% compared to 65.0% (p &lt; 0.0001). The SSI DLM was successful with an ROC of 0.898 (p &lt; 0.0001). The DLM for predicting pulmonary failure was less effective with an ROC of 0.545 (p = 0.03).

Conclusions
DLMs were able to successfully predict surgical complexity and were more accurate than expert surgeons using objective, pre-operative imaging. DLMs were also successful in predicting SSI. This breakthrough may allow for enhanced pre-operative planning, including resource utilization and possible need for tertiary center referral. AI appears to be an exciting new management tool in complex AWR.
O17 CHRONIC GROIN PAIN DUE TO OR DESPITE THE HERNIA REPAIR
Authors: Jasbon Fernando Ruiz , Ticehurst Kristina , Kroon Lovisa , Ahonen Jukka , Norrby Jonny 
Published: December 2021

Abstract

Aim
There is a discrepancy between the high frequency of chronic post-operative pain reported in questionnaire-based studies after groin hernia surgery and the clinical experience of many surgeons in which it is infrequent that patients return after surgery because of chronic post-operative pain. This is supported by the Swedish Hernia Registry, where the proportion of patients who are re-operated for chronic post-operative pain is 0.02-0.03% for open methods and less than 0,01% for laparo-endoscopic methods. The aim of this study is to find the incidence of non-surgical causes of chronic groin pain and other patient-reported outcomes after inguinal hernia surgery.

Material and Methods
Prospective cohort observation study of patients evaluated for suspected inguinal hernia-related symptoms at a hernia clinic in Sweden during 1 year. Patients completed validated pain forms before surgery and 6 and 12 months after surgery. Patients were assessed preoperatively about the possible causes of groin pain according to a checklist. For this purpose, a questionnaire of inguinal hernia-related symptoms was used. Patients with moderate or severe chronic groin pain after surgery were offered to participate in a clinical examination where the pain was evaluated for probable cause according to a checklist.

Results
574 patients were included in the study, of which 372 were operated on and answered the post-operative questionnaires. Preliminary results on surgical and non-surgical causes of chronic groin pain after hernioplasty and other patient-reported outcomes will be presented at Hernia 2021 EHS-AHS Joint Congress.

Conclusions
Proportion of patients with chronic groin pain related to groin hernia surgery and other non-surgical pathologies will be reported.
O30 THE INCIDENCE OF INCISIONAL HERNIA AT OSTOMY-REVERSAL SITE
Authors: Gorjanc Jurij , Edlinger Raphael , Rosenkranz Magdalena , Tschmelitsch Jörg 
Published: December 2021

Abstract

Aim
The purpose of this study was to evaluate the rate of incisional hernias at the ostomy site after reversal of the ostomy.

Material and Methods
We used retrospectively compiled database of patients who had undergone ostomy formation and ist reversal. All patients had their surgery performed between Jan. 2011 and December 2019. Patients history, added by clinical examination and CT-scan were performed in order to identify the incidence of incisional hernias. Different variables, like gender, surgical site infection (SSI) and BMI were evaluated as possible risk factors for hernia occurrence.

Results
Among totally included 224 patients in the study, 190 of all patients had reversal after loop-ileostomy (85%) and 34 patients had reversal after loop-colostomy (15%). Among all stoma reversal patients, 12,8 % developed incisional hernia at the stoma reversal site (n = 28). The incisional hernia occurrence at the ostomy reversal site was present in 20,0% in patients with clinically relevant SSI and only in 9,4% in patients where SSI was absent (p = 0,03). There was no statistical significance in hernia occurrence between both genders and among patients with low, normal and high BMI in our cohort of patients.

Conclusions
Incisional hernia after ostomy reversal is a common late surgical complication. All measurements that reduce SSI at the reversal site are important for lower hernia incidence. Prophylactic mesh implantation at stoma reversal sites may be considered in these patients.
O42 SURGICAL REPAIR OF DIASTASIS RECTI ABDOMINIS (DRA) PROVIDES LONG-TERM IMPROVEMENT OF ABDOMINAL CORE FUNCTION AND QUALITY OF LIFE: A THREE-YEAR FOLLOW-UP
Authors: Olsson Anders , Kiwanuka Olivia , Wilhelmsson Sofia , Sandblom Gabriel , Stackelberg Otto 
Published: December 2021

Abstract

Aim
Diastasis Recti Abdominis (DRA) is a condition affecting many post-partum women. The aim of this study was to evaluate long-term results of surgical repair of DRA in a cohort of post-partum women.

Material and Methods
Sixty post-partum women with DRA and training-resistant core dysfunctions were included. Surgical repair was performed with suture plication of the linea alba. Abdominal core function was evaluated with the Abdominal Trunk Function Protocol (ATFP) including a self-report questionnaire and seven functional tests. Urinary incontinence and Quality of Life was evaluated with the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the SF-36 questionnaire. Follow-up was performed at one year and three years’ post-operatively.

Results
Response rate at the three-year follow-up was 86.7 % for the DRI questionnaire; and 71.7% for ATFP, the UDI-6, IIQ-7, and SF-36 questionnaires. All DRI-parameters were improved (p &lt; 0,05) after three-years of follow-up compared to preoperative values. The functional tests in the ATFP showed an improvement (p &lt; 0.05) in core muscle strength and stability, persisting back and abdominal muscle strength compared to preoperative values as well as an improvement compared to the one-year follow-up values (p &lt; 0.05). UDI-6 and IIQ-7 results were improved (p &lt; 0.05) compared to preoperative values and showed consistent values compared to the one-year follow-up. Quality of life measured with SF-36 were improved compared to preoperative values and showed consistent values compared to the one-year follow-up (p &lt; 0.05).

Conclusions
The functional improvement of surgical reconstruction of the DRA persisted for three years in this series of post-partum women with DRA.
O44 ENHANCED RECOVERY AFTER SURGERY (ERAS) IN PATIENTS UNDERGOING COMPLEX ABDOMINAL WALL RECONSTRUCTION (AWR)
Authors: Katzen Michael , Ayuso Sullivan , Aladegbami Bola , Nayak Raageswari , Colavita Paul , Augenstein Vedra , Kercher Kent , Todd Heniford B 
Published: December 2021

Abstract

Aim
Enhanced Recovery After Surgery (ERAS) is often conceptually associated with hospital length of stay (LOS), but its true purpose is the application of best science to achieve best patient outcomes. We hypothesized that the implementation of the ERAS program would improve outcomes while possibly leading to a decreased LOS.

Material and Methods
Prospective institutional hernia database queried for patients who underwent open AWR between 2010–2014 (pre-ERAS) and 2016-2020 (ERAS). Demographics, operative characteristics and postoperative outcomes were compared between pre-ERAS and ERAS patients. Standard descriptive statistics and logistic regression were used.

Results
1713 patients were analyzed (ERAS-802, pre-ERAS-911). ERAS patients were similar in terms of age (58.9±12.1vs58.4±12.5;p=0.29) and diabetes (24.6%vs25.9%;p=0.53) compared to pre-ERAS patients, but ERAS patients had lower BMI (31.2±6.3vs33.3±8.1 kg/m2;p&lt;0.01) and increased smoking history (35.8%vs16.1%;p&lt;0.01). The percentage of ERAS patients with CDC 3 and 4 wound classes was higher (12.7%/11.9%vs10.4%/7.4%;p&lt;0.01) as was the use of biologic mesh (30.0% vs 17.4%; p &lt; 0.01). There were no significant differences in defect (208.3±165.4 cm2 vs 216.4 ±254.2cm2; p=0.16) or mesh size (824.1±477.7 cm2 vs 769.1±426.2cm2; p=0.99). ERAS patients had fewer panniculectomies (21.7%vs28.0%;p=0.02) and shorter operative time (176.3±81.6 vs 186.3±87.5min; p=0.01). Mean LOS shorter for ERAS patients (6.5±4.8vs7.2±7.1;p&lt;0.01). When transversus abdominis plane block was added (2018), LOS decreased further (6.0±6.0 days) and narcotic use decreased by 65.1% (each:p&lt;0.05). ERAS had fewer wound complications (14.1%vs32.3%;p&lt;0.01), mesh infections (0.6 %vs2.5%; p&lt;0.01), and 30-day readmissions (2.5%vs11.4%;p&lt;0.01). In logistic regression, BMI, operation time, and panniculectomy increased risk for wound complications.

Conclusions
ERAS measures improve multiple aspects of AWR patient outcomes including LOS, wound complications and readmissions.
OV04 MASSIVE INGUINAL-SCROTAL HERNIA WITH RETROPERITONEAL CONTENTS AND URETER: VIDEO CASE REPORT OF ROBOTIC REPAIR USING INTRAOPERATIVE FLUORESCENCE IMAGING
Authors: Atwood Rex , Tevar Rahul , Li Kai , Chen Gao 
Published: December 2021

Abstract

Aim
Inguinal hernias containing the ureter and retroperitoneal contents are uncommon. We present a robotic repair of a large inguinal-scrotal hernia containing the ureter as a video case presentation.

Material and Methods
A 66 year old male with no previous abdominal surgical history presents with a large left sided inguinal-scrotal hernia, as well as smaller ventral and right inguinal hernias. On CT imaging the patient was found to have an ectopic pelvic location of the left kidney with evidence of the left ureter coursing into the hernia with a significant amount of retroperitoneal fat. The patient was taken to the operating room for a robotic bilateral inguinal hernia repair and ventral hernia repair.

Results
A ureteral catheter was placed preoperatively and instilled with indocyanine green (ICG). The hernias were successfully repaired, and intraoperative fluorescence imaging was successfully used to visualize the ureter as it was reduced with the hernia sac. The robotic platform significantly aided in dissection of the large volume of retroperitoneal fat, while being able to quickly transition to intraoperative fluorescence to clearly visualize the course of the ureter. The patient did well post operatively with no complications.

Conclusions
We present a video case report of a large ureter-containing inguinoscrotal hernia that was successfully repaired using a robotic preperitoneal approach. Use of the robotic platform and indocyanine green/intraoperative fluorescence imaging were helpful adjuncts in aiding dissection by improving intraoperative visualization of the ureter.
OV07 LAPAROSCOPIC HIATAL HERNIA MESH-SUTURE REPAIR
Authors: Abolmasov Alexey 
Published: December 2021

Abstract

Aim
“A new original laparoscopic operative technique was used to suture paraesophageal hernia (PEH) with the strips of mesh.

Material and Methods
The Mercilen (MercilenTM) mesh suture was used to close large hiatal hernia. The strips of mesh, instead of normal thread, were applied to close the gap between diaphragm’s crura in 12 patients with hernia defect more than 5 cm. Mesh suture were tighten as a simple laparoscopic intracorporeal knot. The surgical technique and surgical outcomes are presented.

Results
12 patients underwent a laparoscopic PEH suturing with Mercilen strips of mesh. We recorded no recurrence or dysphagia at 6 and 12 months follow-up.

Conclusions
Mesh-sutured repairs of diaphragm’s hernia support the concepts of force distribution and resistance to suture pull through. The new original technique avoids using the sheet of mesh and enables to reduce the amount of dangerous complications connected with mesh and its fixation. Mesh-sutured closures of hiatal hernias seem to be safe and effective in tension closure of large hiatal defects. Further investigations are needed to evaluate the results.
Using the mesh suture technique for the closure of large PEH, we protect the cruras from being cutting through. Besides, the mesh stripes and its knots produce tissue scarring around the esophagus making the suture line stronger.
p62/SQSTM1 promotes mitophagy and activates the NRF2-mediated antioxidant and anti-inflammatory response restraining EBV-driven B lymphocyte proliferation
Authors: Gilardini Montani Maria Saveria , Tarquini Greta , Santarelli Roberta , Gonnella Roberta , Romeo Maria Anele , Benedetti Rossella , Arena Andrea , Faggioni Alberto , Cirone Mara 
Published: December 2021

Abstract
Reactive oxygen species (ROS) and DNA repair, respectively, promote and limit oncogenic transformation of B cells driven by Epstein-Barr virus (EBV). We have previously shown that EBV infection reduced autophagy in primary B lymphocytes and enhanced ROS and interleukin 6 (IL-6) release, promoting B-cell proliferation and immortalization. In this study, we explored the role of p62/SQSTM1, accumulated as a consequence of autophagy reduction in EBV-infected B lymphocytes, and found that it exerted a growth-suppressive effect in these cells. At the molecular level, we found that p62 counteracted IL-6 production and ROS increase by interacting with NRF2 and promoting mitophagy. Moreover, p62/NRF2 axis sustained the expression level of H2AX and ataxia-telangiectasia mutated (ATM), whose activation has been shown to have growth-suppressive effects during the first steps of EBV infection, before latency is established. In conclusion, this study shows for the first time that the accumulation of p62 and the activation of p62/axis counteracted EBV-driven proliferation of primary B lymphocytes.
A unique case report of mitral valve endocarditis associated with coronary stent infection
Authors: Doost Ata , Rankin James , Yong Gerald 
Published: December 2021

Abstract

Background
Despite increasing use of percutaneous coronary intervention and stenting, septic complications such as coronary stent infections are rare. We report a unique case of mitral valve infective endocarditis and associated coronary stent infection which emerged 6 months after index stent insertion.

Case summary
A 56-year-old previously healthy man underwent percutaneous coronary intervention and stenting of left circumflex (LCx) coronary artery in the setting of non-ST-segment elevation myocardial infarction. Six months later, he represented with inferior ST-segment elevation myocardial infarction and was found to have a coronary pseudoaneurysm of stented segment of LCx. The pseudoaneurysm was treated with insertion of a covered stent, and immediately following that he developed sepsis with methicillin-sensitive Staphylococcus aureus bacteraemia. Comprehensive work-up resulted in the diagnosis of mitral valve endocarditis complicated by coronary stent infection and myocardial abscess formation. He was managed with initial prolonged systemic antibiotic treatment followed by mitral valve replacement. Post-operative course was uneventful with a short duration of oral antibiotics. At 6-year follow-up, the patient was well with the satisfactory echocardiographic result.

Discussion
This is a very rare case of mitral valve endocarditis with extensive cardiac involvement including coronary stent infection and surrounding myocardial abscess. Stents can act as an ideal vector for bacterial adherence from which bacteria could spread to the arterial wall and adjacent myocardium. This case suggests a potential complication of delayed endothelialization and risk of infective complication due to bacterial seeding or embolization.
Peripartum management of patient with long QT3 after successful implantable cardioverter defibrillator device discharge resulting in device failure: a case report
Authors: Lee Melissa J , Monteil Danielle C , Spooner Michael T 
Published: December 2021

Abstract

Background
Long QT3 syndrome type 3 (LQT3) is a gain of function mutation of the SCN5A gene that is inherited in an autosomal dominant fashion. Long QT3 syndrome type 3 results in an increase in arrhythmic events during rest, sleep, and bradycardia by extending the QT interval and inducing Torsades de pointes and sudden cardiac death. Attempting to block the sodium channel with Class I anti-arrhythmics or blocking adrenergic tone with beta-blockers especially in women has shown to be beneficial. There have been few large-scale studies on treating patients with LQT3 due to its lethality and underreported number of cases. Specifically, the safety and efficacy of pharmacologic treatment in pregnant LQT3 patients are unknown.

Case summary
This case demonstrates the safe use of Mexiletine and Propranolol in a 3rd-trimester pregnant LQT3 patient after a presumed ventricular arrhythmia and device-lead electrical short from therapy rendered her implantable cardioverter defibrillator inoperable in a VVI mode (venticular demand pacing). With appropriate medications, the patient was safely monitored through the remainder of her pregnancy and safely delivered at 36 weeks of pregnancy a healthy baby girl. The daughter, heterozygous for LQT3, showed no evidence of intrauterine growth restriction or other side effects from the medications.

Discussion
There are many variants of the SCN5A gene mutations that can lead to different phenotypes and not all mutations are responsive to the same medications. In this case, Mexiletine and Propranolol, both of which have only recently shown to benefit certain variants or LQT3 respectively, were safely started during the 3rd trimester of pregnancy without harming the foetus.
Screening for subclinical rheumatic heart disease: addressing borderline disease in a real-world setting
Authors: Hunter Luke D , Pecoraro Alfonso J K , Doubell Anton F , Monaghan Mark J , Lloyd Guy W , Lombard Carl J , Herbst Philip G 
Published: December 2021

AbstractAimsThe World Heart Federation (WHF) criteria identify a large borderline rheumatic heart disease (RHD) category that has hampered the implementation of population-based screening. Inter-scallop separations (ISS) of the posterior mitral valve leaflet, a recently described normal variant of the mitral valve, appears to be an important cause of mild mitral regurgitation (MR) leading to misclassification of cases as WHF ‘borderline RHD’. This study aims to report the findings of the Echo in Africa project, a large-scale RHD screening project in South Africa and determine what proportion of borderline cases would be re-classified as normal if there were a systematic identification of ISS-related MR.Methods and resultsA prospective cross-sectional study of underserved secondary schools in the Western Cape was conducted. Participants underwent a screening study with a handheld (HH) ultrasound device. Children with an abnormal HH study were re-evaluated with a portable laptop echocardiography machine. A mechanistic evaluation was applied in cases with isolated WHF ‘pathological’ MR (WHF ‘borderline RHD’). A total of 5255 participants (mean age 15± years) were screened. A total of 3439 (65.8%) were female. Forty-nine cases of WHF ‘definite RHD’ [9.1 cases/1000 (95% confidence interval, CI, 6.8–12.1 cases/1000)] and 104 cases of WHF ‘borderline RHD’ [19.5 cases/1000 (95% CI, 16.0–23.7 cases/1000)] were identified. Inter-scallop separations-related MR was the underlying mechanism of MR in 48/68 cases classified as WHF ‘borderline RHD’ with isolated WHF ‘pathological’ MR (70.5%).ConclusionIn a real-world, large-scale screening project, the adoption of a mechanistic evaluation based on the systematic identification of ISS-related MR markedly reduced the number of WHF ‘screen-positive’ cases misclassified as WHF ‘borderline RHD’. Implementing strategies that reduce this misclassification could reduce the cost- and labour burden on large-scale RHD screening programmes.
Mourning sickness: the musical birth of ‘Barbara Allen’
Authors: Duffin Ross W 
Published: December 2021

Abstract
In his encyclopaedic 1966 study, The British broadside ballad and its music, Claude Simpson regretted the absence of tune directions for ‘such familiar traditional ballads as “Barbara Allen”’. Indeed, although it is by far the most collected traditional song in England, Scotland, Ireland and North America, and versions of its lyric date back to the 17th century, the tune most people know for ‘Barbara Allen’ was not notated until 1840. Using both verbal and melodic parallels from an earlier complex of ballads and tunes, this study proposes that ‘Barbara Allen’ had its origins in the early 17th century, if not the late 16th century, and that it was originally sung to one or more of three surviving tunes entitled ‘Sick, sick and very sick’. One of those is then linked to a 1740 tune called ‘Barbra Allan’, the earliest surviving melody to bear the name.
A novel transposable element-based authentication protocol for Drosophila cell lines
Authors: Mariyappa Daniel , Rusch Douglas B , Han Shunhua , Luhur Arthur , Overton Danielle , Miller David F B , Bergman Casey M , Zelhof Andrew C 
Published: December 2021

Abstract
Drosophila cell lines are used by researchers to investigate various cell biological phenomena. It is crucial to exercise good cell culture practice. Poor handling can lead to both inter- and intra-species cross-contamination. Prolonged culturing can lead to introduction of large- and small-scale genomic changes. These factors, therefore, make it imperative that methods to authenticate Drosophila cell lines are developed to ensure reproducibility. Mammalian cell line authentication is reliant on short tandem repeat (STR) profiling; however, the relatively low STR mutation rate in Drosophila melanogaster at the individual level is likely to preclude the value of this technique. In contrast, transposable elements (TEs) are highly polymorphic among individual flies and abundant in Drosophila cell lines. Therefore, we investigated the utility of TE insertions as markers to discriminate Drosophila cell lines derived from the same or different donor genotypes, divergent sub-lines of the same cell line, and from other insect cell lines. We developed a PCR-based next-generation sequencing protocol to cluster cell lines based on the genome-wide distribution of a limited number of diagnostic TE families. We determined the distribution of five TE families in S2R+, S2-DRSC, S2-DGRC, Kc167, ML-DmBG3-c2, mbn2, CME W1 Cl.8+, and ovarian somatic sheath Drosophila cell lines. Two independent downstream analyses of the next-generation sequencing data yielded similar clustering of these cell lines. Double-blind testing of the protocol reliably identified various Drosophila cell lines. In addition, our data indicate minimal changes with respect to the genome-wide distribution of these five TE families when cells are passaged for at least 50 times. The protocol developed can accurately identify and distinguish the numerous Drosophila cell lines available to the research community, thereby aiding reproducible Drosophila cell culture research.