bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-071 GIANT INGUINOSCROTAL HERNIA ASSOCIATED WITH PENIS BASALOID CARCINOMA. A PURPOSE OF A CASE
Authors: Jaimes León E , Peña Soria M J , Buendia J , Galante I , García Romero E , López Antoñanzas L , Del Campo Martín M , De La Serna Esteban S , Torres García A J 
Published: May 2023

Abstract
We present a unique case of a patient with a giant bilateral inguinoscrotal hernia associated with a basaloid carcinoma in pennis. A 60 year old male with bilateral inguinoscrotal hernia came to our office because he had a suppurative ulcer around pennis and chronic hidradenitis in perineal and scrotum region. We presented the case in a multidisciplinary session composed by urologists, plastic surgeons and abdominal wall surgeons in order to plan the diagnosis and treatment.
The CT showed us a bilateral inguinoscrotal hernia with a large and small bowel inside them. The multidisciplinary team decided on toxin botulinum.
An infiltration previous hernia repair in order to avoid complications related to the huge volumen. During the infiltration we also scheduled cystoscopy and biopsy of the pennis injury. The cystoscopy showed a urethral fistula. The biopsy was informed as a basaloid invasive carcinoma.
Surgery was scheduled 4 weeks after toxin botulinum infiltration. Surgical team was composed of urologists, plastic surgeons and abdominal wall surgeons.
We performed a hypogastric transverse incision, then opened midline to reduce inguinal hernia contented by a combined maneuvers. Small bowel resection was performed because it was infiltrated by the tumor. Bilateral Liechtenstein repair was done with polypropylene mesh. The midline was closed with intra abdominal mesh and continuous suture. Partial penectomy was done. Scrotum skin was resected. Testicles are left in, in a crossing mode under skin flaps.
Anatomopatologic diagnosis was Pennis Epidermoid carcinoma pT3pN0 pM1. After 1 year follow up no recurrence of tumor or hernias.
V-010 ROBOTIC ASSISTED BILATERAL INGUINOSCROTAL HERNIA REPAIR: STEP BY STEP
Authors: Huerta M , Rodrígues V , Verdaguer M , Bergamini S , Martínez P , Herms D , López Cano M 
Published: May 2023

Abstract

Introduction
Robotic surgery in the field of abdominal wall surgery is exponentially growing. In this video we will present a step by step robotic approach for bilateral inguinoscrotal hernia repair.

Clinical case
A 79 year-old male with history of hypercholesterolemia was diagnosed of bilateral inguinal hernia. On physical examination, a right inguinoscrotal hernia (EHS classification L3P) and left inguinal hernia (EHS classification M1P) were diagnosed. Minimally invasive surgery assisted by DaVinci Xi robot is decided.
Under general anesthesia, a supraumbilical 8-mm trocar is located and 2 other trocars are positioned 8 cm laterally. Monopolar scissors and bipolar grasps are introduced. Laparoscopic examination confirmed the diagnosis.
First, peritoneum is dissected, allowing to access to the preperitoneal space, dissecting the medial and lateral compartiment, reaching the pectineal ligament. Identification and reduction of the hernia sac is performed, individualizing and preserving the inguinal structures. Critical view of the miopectineal orifice is ensured.
Contralateral procedure is performed. 15×15 cm Poplipropilene mesh are located at the preperitoneal space, fixated with 3/0 PDS stitches to the pectineal ligament. Fixation stitches are done at the superior section of the mesh. Peritoneal flaps are closed with V-lock suture.

Conclusion
Robotic surgery is a safe and feasible procedure for inguinal hernia repair in patients specially selected (BMI &lt;30, bilateral hernias). Further studies are needed in order to clarify its role in the field of minimally invasive surgery.
V-013 NEW TECHNIQUE FOR ABDOMINAL WALL GRAFT RETRIEVAL
Authors: Navarro Fajardo D , Jiménez Romero C , Vega Novillo V , Marcacuzco Quinto A , Caso Maestro O , Calvo Pulido J , Manrique Municio A , García Sesma Á , Loinaz Segurola C , Justo Alonso I 
Published: May 2023

Abstract

Aim
show our technique for abdominal wall graft retrieval minimizing warm ischemia time.

Material and methods
a video report of an abdominal wall graft retrieval (full-thickness) from a female brain death donor.

Results
better graft perfusion with a lower picnosis in the studied cells. Lower tissue damage in both full-thickness and isolated fascia grafts.
Surgical technique: An “house-flap” incision is done as opposed to a conventional cross-line laparotomy. The flap is extended until the inguinal ligament, divided afterwards to gain easier access to the femoral vessels. After abdominal organ dissection, the common iliac arteries are dissected from close to the aortic bifurcation up to the femoral vessels, beyond the origin of the inferior epigastric arteries. After cannulation of the aorta, cava vein and inferior mesenteric vein for the intraabdominal organs, both common iliac arteries are cannulated beyond the origin of external iliac artery. To achieve optimal perfusion of the rectus fascia we have to clamp the artery distal to the origin of the inferior epigastric artery (usually at the level of the femoral artery). The abdominal wall graft perfusion is done simultaneously with all the abdominal organs. Afterwards, we cover the graft with cold pads to avoid direct contact between the ice and the graft. A closure of the donor abdominal wall must be ensured after removing the wall graft.

Conclusions
our technique has showed better pathological outcomes than those previously published with a lower warm ischemia time of the abdominal wall graft.
V-020 Botulinum Toxin: not just aesthetics anymore
Authors: Barreira A L , Figueiredo J , Souto R , Branco A 
Published: May 2023

Abstract

Introduction
Surgical repair of recurrent abdominal incisional hernia can be challenging. ﻿The aim should be a tension-free, mesh reinforced midline fascial closure. Different methods have been described to achieve this primary fascial closure. Botulinum toxin (BT) is a neurotoxin that when injected into muscle tissue, causes a temporary flaccid muscle paralysis. This effect can be applied to the lateral abdominal wall muscles, thereby facilitating midline rectus muscles re-approximation and defect closure.

Clinical Case
We present a case of a 58 year old female, with a history of right hemicolectomy and ileostomy, that underwent subsequent stoma closure one year after. She presented with a 12 cm defect width incisional hernia and right rectus muscle atrophy. We demonstrate the preoperative injection of BT using the Zielinski technique in a consultation room with no need for patient monitoring or anesthesia. Four weeks later, the patient underwent open repair with bilateral transversus abdominis release and retromuscular mesh reinforcement. The defect was closed without tension and the postoperative period was uneventful. Patient was discharged on postoperative day 4.

Conclusion
Preoperative BT injection as a selective muscle chemical component paralysis is a safe, easy to perform and effective technique that aims to counteract the chronic muscle retraction observed in large ventral hernias.
BT in combination with advanced ventral hernia repair techniques, may help provide the crucial extra tissue mobility required to achieve primary closure, with the added advantage of less postoperative pain, thereby contributing to early patient discharge.
V-032 UMBILICAL ACCESS AND INFERIOR DOCKING FOR ROBOTIC EXTENDED TOTALLY EXTRAPERITONEAL REPAIR (ETEP) OF UPPER MIDLINE INCISIONAL HERNIA
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Sisó E , Codina L , Olsina Kissler J J 
Published: May 2023

Abstract

Aim
Inferior docking for extended totally extraperitoneal repair (eTEP) is the recommended access for the repair of upper midline defects (Belyansky et al. [2018]). However, this access can be challenging due to the proximity of the inferior epigastric vessels. The aim was to show the results of an infraumbilical access for inferior docking in a robotic eTEP.

Material & Methods
Video description of a case report.
The patient was a 59-year-old male who underwent an urgent splenectomy through an upper midline laparotomy and developed an M2 incisional hernia with a defect of 6 cm.

Results
An infraumbilical access was used to place a distension balloon and dissect the preperitoneal space. Then, a Hasson trocar was placed, followed by the first robotic trocar in the inferior midline. The space was dissected to place the other two robotic trocars laterally to the inferior epigastric vessels. After the inferior docking was completed, a sequential bilateral retrorectus dissection was performed, with hernia reduction and an extended dissection under the xiphoid process. Posteriorly, a bilateral partial transversus abdominis muscle release was made to allow a complete suture of the posterior rectus sheath. The image was inverted to perform the plication of the rectus muscle and the closure of the hernia defect. Finally, a polyvinylidene difluoride (PVDF) mesh was placed in the retromuscular space without additional fixation.

Conclusion
The umbilical access facilitates the inferior docking in robotic eTEP, providing an optimal vision of upper midline defects and allowing a symmetric transversus abdominis muscle release.
V-034 SPONTANEOUS EVISCERATION THROUGH AN UMBILICAL HERNIA
Authors: Tuñón-Féquant C , Rodríguez-González D , Casanova-Ramos R , Guil-Ortiz B , Montes-Montero A , Arteaga-González I 
Published: May 2023

Abstract

Aim
Umbilical hernia in the cirrhotic patient is frequently seen in the setting of refractory ascites. Nevertheless, spontaneous evisceration is an unusual and potentially life-threating event. This hernia rupture has a high mortality and morbidity and presents many challenges in medical and surgical management.

Material & Methods
We present a case of a 58 years-old man with personal history of alcoholic cirrhosis with multiple ascites drainages, portal hypertension and hepatic encephalopathy. The patient went to the emergency department suffering from an umbilical hernia with spontaneous rupture and evisceration.

Results
An urgent umbilical hernioplasty was conducted. We performed a hernia sac and suprafascial dissection. We verified that the vascularization of the hernia content was correct. We close peritoneum with double suture (transfixion ligature and continuous suture techniques) and fascia defect. We finally placed an onlay mesh. In the postoperative period, the patient had no complications related to dehiscence of suture or peritoneal fluid leakage, but stayed hospitalized for 25 days due to the decompensation of the cirrhosis. After six months of follow-up, there are no signs of recurrence.

Conclusions
Cirrhotic patients undergoing abdominal surgery are prone to complications, especially in hernias with spontaneous evisceration. One of de most frightening surgical complications in cirrhotic patients is the leakage of peritoneal fluid. In our case, this leakage could not have been produced because we used double suture and transfixion ligation to close peritoneum.
V-039 Combination of Botox & eTEP & hemi-TAR for giant hernia repair in an obese patient
Authors: Gómez López J R , Trujillo Díaz J J , Martínez Moreno C M , Concejo Cútoli P , Montenegro Martín M A , Atienza Herrero J , Martín Del Olmo J C 
Published: May 2023

Abstract

Objective
The possibility of new approaches allows dissecting wide retroperitoneal spaces with minimal tissue damage, make the laparoscopic approach a developing technique. Our purpose is to show how the extended-view totally extraperitoneal (eTEP) approach can be used for giant hernia repair in obese patients.

Material and Methods
34-year-old man, with a history of laparotomy due to traumatic perforation of the colon and BMI: 39.18, presented hernia M2–5W3. Preoperative botox is performed 1 month before.

Results
laparoscopic approach was performed: dissector balloon in the left hypochondrium, 5mm trocars in the right hypochondrium and flank. And 10mm trocar on the right flank. Dissection of the left retrorectal space. Crossover in upper third. Dissection of the right retrorectal space. Hernial sac opening during dissection. Section of the right transverse muscle is completed and that space is released. Plication of the anterior fascia and hernial sac. Closure of the posterior fascia. Measurement and placement of 37×25 cm CICAT mesh fixed with tissucol.

Conclusion
Minimally invasive surgery allows more and more extensive surgeries to be performed, with less aggression to patients and faster recovery. With the technical improvements and the combinations of different tools, we're capable of performing laparoscopic repair of giant hernias. In our case, the preoperative application of botox, eTEP technique, and the combination of one-sided TAR allowed safe and uncomplicated repair of an M2-5W3 hernia defect. eTEP is a safe and reproducible technique that can be used in association with hemi TAR or bilateral TAR for the solution of giant hernias.
Green and Sustainable Analytical Chemistry-Driven Chromatographic Method Development for Stability Study of Apixaban Using Box–Behnken Design and Principal Component Analysis
Authors: Prajapati Pintu , Rajpurohit Pooja , Pulusu Veera Shakar , Shah Shailesh 
Published: May 2023

Abstract
Apixaban (APX) is a novel anti-coagulant drug approved by USFDA. According to referred literature, numerous chromatographic methods such as RP-HPLC and high-performance thin-layer chromatography have been published for the stability study of APX. But these chromatographic methods have been developed using toxic organic solvents that are hazardous to the environment and unsafe for analysts. Hence, green and sustainable analytical chemistry-driven chromatographic method has been developed for the stability study of APX using safe organic solvents for the safety of analysts and the protection of the environment. APX was subjected to forced degradation for the development of a stability-indicating assay method. The method development was carried out by the implementation of chemometric and DoE approaches for minimizing solvent wastage. Principal component analysis was applied for the identification of critical method risk variables (MRVs) and method performance attributes. DoE-based response surface modelling was applied for the optimisation of critical MRVs. The greenness profile scales of published and developed chromatographic methods have been assessed by NEMI and AGREE methods for the estimation of APX. The developed method was found to be more eco-friendly and robust than the published chromatographic methods for the estimation of APX.
Venous excess ultrasound score and acute kidney injury in patients with acute coronary syndrome
Authors: Viana-Rojas Jesús Antonio , Argaiz Eduardo , Robles-Ledesma Mariana , Arias-Mendoza Alexandra , Nájera-Rojas Nitzha Andrea , Alonso-Bringas Alma Paola , De los Ríos-Arce Luis Fernando , Armenta-Rodriguez Jennifer , Gopar-Nieto Rodrigo , Briseño-De la Cruz Jose Luis , González-Pacheco Héctor , Sierra-Lara Martinez Daniel , Gonzalez-Salido Jimena , Lopez-Gil Salvador , Araiza-Garaygordobil Diego 
Published: May 2023

Abstract

Aims
Systemic venous congestion is associated with an increased risk of acute kidney injury (AKI) in critically ill patients. Venous Excess Ultrasound Score (VExUS) has been proposed as a non-invasive score to assess systemic venous congestion. We aimed to evaluate the association between VExUS and AKI in patients with acute coronary syndrome (ACS).

Methods and results
This is a prospective study including patients with the diagnosis of ACS (both ST elevation and non-ST elevation ACS). VExUS was performed during the first 24 h of hospital stay. Patients were classified according to the presence of systemic congestion (VExUS 0/≥1). The primary objective of the study was to determine the occurrence of AKI, defined by KDIGO criteria. A total of 77 patients were included. After ultrasound assessment, 31 (40.2%) patients were categorized as VExUS ≥1. VExUS ≥1 was more frequently found in inferior vs. anterior myocardial infarction/non-ST-segment elevation acute myocardial infarction (48.3 vs. 25.8 and 22.5%, P = 0.031). At each increasing degree of VExUS, a higher proportion of patients developed AKI: VExUS = 0 (10.8%), VExUS = 1 (23.8%), VExUS = 2 (75.0%), and VExUS = 3 (100%; P &lt; 0.001). A significant association between VExUS ≥1 and AKI was found [odds ratio (OR): 6.75, 95% confidence interval (CI): 2.21–23.7, P = 0.001]. After multivariable analysis, only VExUS ≥1 (OR: 6.15; 95% CI: 1.26–29.94, P = 0.02) remained significantly associated with AKI.

Conclusion
In patients hospitalized with ACS, VExUS is associated with the occurrence of AKI. Further studies are needed to clarify the role of VExUS assessment in patients with ACS.
Comparison of machine learning techniques in prediction of mortality following cardiac surgery: analysis of over 220 000 patients from a large national database
Authors: Sinha Shubhra , Dong Tim , Dimagli Arnaldo , Vohra Hunaid A , Holmes Chris , Benedetto Umberto , Angelini Gianni D 
Published: May 2023

Abstract

OBJECTIVES
To perform a systematic comparison of in-hospital mortality risk prediction post-cardiac surgery, between the predominant scoring system—European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, logistic regression (LR) retrained on the same variables and alternative machine learning techniques (ML)—random forest (RF), neural networks (NN), XGBoost and weighted support vector machine.

METHODS
Retrospective analyses of prospectively routinely collected data on adult patients undergoing cardiac surgery in the UK from January 2012 to March 2019. Data were temporally split 70:30 into training and validation subsets. Mortality prediction models were created using the 18 variables of EuroSCORE II. Comparisons of discrimination, calibration and clinical utility were then conducted. Changes in model performance, variable-importance over time and hospital/operation-based model performance were also reviewed.

RESULTS
Of the 227 087 adults who underwent cardiac surgery during the study period, there were 6258 deaths (2.76%). In the testing cohort, there was an improvement in discrimination [XGBoost (95% confidence interval (CI) area under the receiver operator curve (AUC), 0.834–0.834, F1 score, 0.276–0.280) and RF (95% CI AUC, 0.833–0.834, F1, 0.277–0.281)] compared with EuroSCORE II (95% CI AUC, 0.817–0.818, F1, 0.243–0.245). There was no significant improvement in calibration with ML and retrained-LR compared to EuroSCORE II. However, EuroSCORE II overestimated risk across all deciles of risk and over time. The calibration drift was lowest in NN, XGBoost and RF compared with EuroSCORE II. Decision curve analysis showed XGBoost and RF to have greater net benefit than EuroSCORE II.

CONCLUSIONS
ML techniques showed some statistical improvements over retrained-LR and EuroSCORE II. The clinical impact of this improvement is modest at present. However the incorporation of additional risk factors in future studies may improve upon these findings and warrants further study.
Transcriptional Misexpression in Hybrids between Species Linked by Gene Flow Is Associated With Patterns of Sequence Divergence
Authors: Díaz Fernando , Wolf Jason , de Brito Reinaldo A 
Published: May 2023

AbstractThe extent to which hybridization disrupts a gene's pattern of expression likely governs its propensity for introgression, whereas its extent of molecular divergence can itself underlie such disruption. Together, these phenomena shape the landscape of sequence and transcriptional divergence across the genome as species diverge. To understand this process, we characterize gene expression inheritance, regulatory divergence, and molecular divergence in the reproductive transcriptomes of species linked by gene flow: the fruit flies Anastrepha fraterculus and A. obliqua, which show evidence of gene flow despite clear evolutionary divergence. We find that their transcriptional patterns are a mosaic between those typically observed within and between allopatric species. Transcripts showing transgressive expression in hybrids or cis-regulatory divergence between species are associated with greater sequence divergence. This may reflect pleiotropic constraints that make them resistant to gene flow or they may be more likely to experience divergent selection. Although these more divergent gene classes are likely to be important contributors to species differences, they are relatively rare. Instead, most differentially regulated transcripts, including those linked to reproduction, show high degrees of dominance in hybrids and trans-regulated divergence between species, suggesting widespread genetic compatibility that potentially allowed for introgression. These findings provide insights into how postzygotic isolating mechanisms might evolve in the presence of gene flow: regions showing cis-regulatory divergence or transgressive expression contribute to reproductive isolation, whereas regions with dominant expression and trans-regulatory divergence allow for introgression. These patterns create a genomic mosaic of transcriptional regulation that is tied to sequence divergence.
Deficits in Accessibility across Field Research Stations for Scientists with Disabilities and/or Chronic Illness, and Proposed Solutions
Authors: Rudzki Elizabeth N , Kohl Kevin D 
Published: May 2023

Synopsis
Equity and inclusivity in STEM research has become a larger topic of discussion in recent years; however, researchers and scientists with disabilities and/or chronic illnesses are often missing from these conversations. Further, while field research is a major research component for some STEM disciplines, it is unclear what accessibility barriers or accommodations exist across the field sciences. Field research can sometimes involve harsh environments, topography, and weather that present challenges to those with disabilities and/or chronic illnesses. A large and coinciding obstacle standing in the way of field research accessibility is the ableism present across science and academia, resulting in and from a lack of prioritization of attention and funding from universities and institutions. Biological field stations have been shown to be valuable not only as infrastructure for field-based research, but also as providing resources toward the scientific education of students and scientific outreach initiatives for the general public. As such, biological field stations are perfectly positioned to reduce barriers in research inclusion and accessibility for students and scientists with disabilities and/or chronic illnesses. The current work presents the results of a survey meant to inventory the presence or absence of accessible infrastructure across field stations, with responses spanning six countries and 24 US states. Our results highlight a number of accessibility deficits in areas such as accessible entrances, kitchens, and bathrooms. Our results suggest that (1) biological field stations have significant variability in accessibility with significant deficits, especially in non-public-facing buildings used primarily by staff and researchers, and (2) field stations would benefit from an increase in federal funding opportunities to expedite their progress toward compliance with Americans with Disabilities Act (ADA) standards. We propose potential solutions to field work infrastructure spanning a range of financial costs, with emphasis on the point that efforts toward accessibility do not require an “all-or-nothing” approach, and that any step toward accessibility will make field stations more inclusive. Additionally, we further suggest that federal funding sources, such as the NSF and NIH, as well as university leadership, should consider broadening diversity initiatives to promote the continuation of, and increased accessibility of, university-affiliated field stations.