bluuebunny/crossref_metadata_2025_split huggingface dataset:
V-031 ETEP APPROACH FOR UMBILICAL HERNIA & GROIN HERNIA & RECTUS ABDOMINIS DIASTASIS: IS IT A GOOD OPTION?
Authors: Trujillo Díaz J , Gómez López J R , Concejo Cutoli P , Martinez Moreno C , Atienza Herrero J , Martin Del Olmo J C 
Published: May 2023

Abstract

Aims
Ventral hernias are a frequent pathology in general surgery.Its association with rectus abdominis diastasis and groin hernias is not uncommon. Currently, the minimally invasive approach of these pathologies is becoming more frequent.The retromuscular-preperitoneal approach is a good technique because of more anatomical position of the mesh, &lt;complications and recurrences.We present the usefulness of the e-TEP approach to treat different types of hernias (ventral and groin hernias)&rectus abdominis diastasis in the same surgical procedure.

Methods
Video-case.

Results
58-year-old man.Physical examination: umbilical hernia(4cm), rectus diastasis(4cm) and left groin-hernia.We decided to perform a laparoscopic-extraperitoneal technique(eTEP).
We use 4ports(2×12mm,2×5mm).The surgery begins dissecting the left retromuscular space using a dissector-balloon.We perform the supraumbilical cross-over transecting the left posterior sheath and then the right posterior sheath and complete the dissection of the other retromuscular space.
The dissection continues reducing the hernial content and after that dissecting down to the pubis, then dissecting the left groin space.After that we continue closing the anterior sheath using Stratafix (barbed suture) & posterior sheath using 2-0 V-lock suture.We placed a 3D-PVDF-mesh for left groin hernia and another 18×35cm PVDF-mesh fixed with fibrin and without drainage.
The patient presented a satisfactory evolution without complications and was discharged in 1°POD.

Conclusions
The minimally invasive eTEP-approach is an effective and good option in cases of ventral hernias associate with inguinal hernias and rectus abdominis diastasis,without increasing the incidence of postoperative complications and with better postoperative recovery,less postoperative pain,shorter LOS,lower rates of recurrence,faster return to routine activities and working life,and lower healthcare costs.
V-038 ENDOSCOPIC SPIEGEL'S HERNIA REPAIR BY TOTALLY EXTRAPERITONEAL EXTENDED ETEP APPROACH
Authors: Ye J , Gonzalo B , Norte A , Homs R , Vera C , Solans M , Gonzalez J A , Moral A , Lupu I 
Published: May 2023

Abstract

Background
Spiegel's hernia is a rare form of spontaneous abdominal anterolateral hernia (0.12–2% of abdominal hernias) seen in people between 40 and 70 years old. It is often found at the weak point located at the intersection between the semilunar line and the lateral end of the arched line. Traditionally, it was repaired with an open approach, currently we have multiple minimally invasive techniques (enhanced-view total extraperitoneal eTEP, transabdominal preperitoneal, intraperitoneal onlay mesh repair…) that offer less pain, faster recovery and shorter hospital stay as well as less complications risk and better cosmetic outcomes. None of these has proven superior to others but the eTEP approach requires an extensive learning curve.

Aim
To show a video of an eTEP approach to Spiegel's hernia.

Methods
We report the case of a 51 year old woman, without previous abdominal surgery, who consulted for a lump, manually reducible, in the right iliac fossa which appeared 2 years ago, and became progressively painful. She was diagnosed pre-surgically with abdominal tomography and was scheduled electively for an eTEP repair.

Results
After hernia sac reduction and tension-free closure of the defect with barbed suture 0, 15×15cm polypropylene mesh is placed.

Conclusion
Spiegel's hernia is an infrequent type of abdominal wall defect and several techniques have been developed. Adequate selection of patients is important to identify the most suitable approach for each one. The eTEP approach allows working in a large extraperitoneal space and has been demonstrated to be safe and effective although a demanding procedure.
V-046 LIRA (LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY) WITH A MANUAL ROBOTIC LAPAROSCOPIC ARM: TECHNICAL STEPS
Authors: Hoyuela C , Pierres M , Navarro J , Cubel M , Caballero D , Astete S , Muñoz C 
Published: May 2023

Abstract

Introduction
LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) is a minimally invasive technique for the tension-free repair of incisional hernias from M2 to M4, with low recurrence rate and less postoperative bulging and seroma formation than classic IPOM lap repair.

Objective
To describe the main steps of the LIRA focusing on the tension-free midline closure. The use of a robotic laparoscopic arm1 improved the surgeon's mobility range and ergonomy, facilitating the procedure.

Methods
A 42-year-old obese woman (BMI 34 Kg/m2), presented with a recurrent umbilical hernia M3W2, Hernia defect: 6cm.in width, (previous onlay repair with polypropylene mesh in 2020). Access: 3 Trocars at the midaxillary line. Posterior rectus sheaths were divided, and the defect was closed with a running 2/0 barbed suture. Then, the repair was reinforced with a tailored, round-shaped 15 cm. composite mesh2 fixed with a double crown of absorbable tacks3. No drain was used.

Results
Operating time: 85 minutes. The procedure was performed in an outpatient setting. The postoperative course was uneventful. Follow-up: 9 months. The patient remains asymptomatic and highly satisfied (9/10). No recurrence nor bulging has been observed.

Conclusions
The LIRA technique allowed a tension-free reconstruction of the abdominal midline when dealing with ventral hernias, without remarkable complications. LIRA provides the advantages of laparoscopic surgery in terms of less postoperative pain, morbidity (e.g. seroma, and less risk of infection), and no bulging. The use of robotized laparoscopic arms facilitates these quite complex procedures.
References:
1. Dex Surgical©
2. Symbotex® (composite mesh: polyester + collagen; Medtronic)
3. Reliatack DEEP® (Medtronic)
Quality of life in early-onset colorectal cancer patients: systematic review
Authors: Waddell Oliver , Mclauchlan Jared , McCombie Andrew , Glyn Tamara , Frizelle Frank 
Published: May 2023

Abstract

Background
There is an increasing incidence of early-onset colorectal cancer; however, the psychosocial impacts of this disease on younger adults have been seldom explored.

Methods
A systematic review was conducted according to the PRISMA guidelines. The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, PubMed, and Scopus were searched, and papers were included if published in English within the last 10 years and if they reported results separately by age (including early-onset colorectal cancer, defined as colorectal cancer diagnosed before the age of 50 years). Critical appraisal of all studies was done using the Joanna Briggs Institute tools. The primary outcome of interest was the global quality of life in patients with early-onset colorectal cancer. Secondary outcomes included the effect on sexual function, body image, finances, career, emotional distress, and social and family functioning.

Results
The search yielded 168 manuscripts and 15 papers were included in the review after screening. All studies were observational, and included a total of 18 146 patients, of which 5015 were patients with early-onset colorectal cancer. The studies included scored highly using Joanna Briggs Institute critical appraisal tools, indicating good quality and a low risk of bias, but data synthesis was not performed due to the wide range of scoring systems that were used across the studies. Six papers reported significant negative impacts on quality of life in patients with early-onset colorectal cancer. Three of the four studies that compared the quality of life in patients with early-onset colorectal cancer with older patients found that the younger group had worse mean quality-of-life scores (P ≤ 0.05). Secondary outcomes measured in five studies in relation to sexual dysfunction, body image, financial and career impacts, and social and family impacts and in eight studies in relation to emotional distress were found to be more severely impacted in those with early-onset colorectal cancer compared with those with late-onset colorectal cancer.

Conclusion
Whilst data are limited, the impact of colorectal cancer is different in patients with early-onset colorectal cancer compared with older patients in relation to several aspects of the quality of life. This is particularly prominent in areas of global quality of life, sexual functioning, family concerns, and financial impacts.
Development of metal-recycling technology in waste crystalline-silicon solar cells
Authors: Lin Dehai , Liu Zilin , Li Xiaoduan , Cao Zixiong , Xiong Rihua 
Published: May 2023

Abstract
Solar energy is currently one of the most promising clean energy sources and the use of solar energy has led to a rapid increase in the number of solar cells. As one of the fastest-growing electronic wastes, the resource treatment of solar cells at the end of their life should not be neglected. This review discusses the trend for the market development of crystalline-silicon solar cells and analyzes their physical structure and composition. It also discusses the current domestic and international recycling technologies for crystalline-silicon solar cells, including manual dismantling, inorganic acid dissolution, the combination of heat-treatment and chemical methods, and organic solvent dissolution. The shortcomings of the above treatment methods are discussed and some views on the recycling of waste crystalline-silicon solar cells are presented. Constructive suggestions for the green and sustainable development of crystalline-silicon solar cells are put forward by comparing different treatment-recycling processes.
Three-way gravity models with multiplicative unobserved effects
Authors: Yang Yimin , Zhang Huili 
Published: May 2023

SummaryThis paper investigates three-way gravity models with multiplicative unobserved effects, which are popular in bilateral trade analysis and many other contexts. Such models are usually estimated by the fixed effects Poisson pseudo maximum likelihood method. As an alternative, we extend the estimation strategy proposed by Jochmans (2017) to our new settings by constructing moment conditions that are independent of the unobserved effects. Our method entails estimation of the conditional mean of a variety of functional forms. The generalized method of moments (GMM) estimator based on these moment conditions is N-consistent and asymptotically normally distributed. We also discuss the estimation of dynamic models by extending the linear feedback models to our three-way settings. Through various simulation designs, we show that our GMM estimator outperforms the competing Poisson pseudo maximum likelihood estimator. As an empirical application, we estimate the effects of the currency unions on exports.
Danon disease in a Sardinian family: different aspects of the same mutation—a case report
Authors: Pasqualucci Daniele , Maiani Silvia , Perra Ferdinando , Cau Milena , Coiana Alessandra , Bianco Paola , Olivotto Iacopo , Corda Marco 
Published: May 2023

Abstract

Background
Danon disease (DD) is a rare X-linked disorder due to mutations in the lysosome-associated membrane protein 2 gene. It is characterized by a clinical triad of hypertrophic cardiomyopathy, skeletal myopathy, and a variable degree of intellectual disability.

Case summary
In this case series, we describe a mother and her son affected by DD, highlighting consistent clinical severity despite the expected variability related to gender. The mother (Case 1) presented isolated cardiac involvement, with an arrhythmogenic phenotype that evolved into severe heart failure requiring heart transplantation (HT). Danon disease was diagnosed 1 year after this event. Her son (Case 2) showed an earlier age onset of symptoms with complete atrioventricular block and fast progression of cardiac disease. Diagnosis was established 2 years after clinical presentation. He is currently listed for HT.

Discussion
In both of our patients, diagnostic delay was extremely long and could have been avoided by emphasizing the relevant clinical red flags. Patients affected by DD may present clinical heterogeneity in terms of natural history, age of onset, and cardiac and extracardiac involvement, even in the same family. Early diagnosis that phenotypic sex differences may impact is a crucial factor in managing patients with DD. Considering the rapid progression of cardiac disease and the poor prognosis, early diagnosis is important and close surveillance should be mandatory during follow-up.
The measurement of racism in health inequities research
Authors: Wizentier Marina Mautner , Stephenson Briana Joy K , Goodman Melody S 
Published: May 2023

Abstract
There is limited literature on the measures and metrics used to examine racism in the health inequities literature. Health inequities research is continuously evolving, with the number of publications increasing over time. However, there is limited knowledge on the best measures and methods to examine the impact of different levels of racism (institutionalized, personally mediated, and internalized) on health inequities. Advanced statistical methods have the potential to be used in new ways to examine the relationship between racism and health inequities. In this review, we conduct a descriptive examination of the measurement of racism in the health inequities epidemiologic literature. We examine the study design, methods used for analysis, types of measures used (e.g., composite, absolute, relative), number of measures used, phase of research (detect, understand, solutions), viewpoint (oppressor, oppressed), and components of structural racism measures (historical context, geographical context, multifaceted nature). We discuss methods (e.g., Peters–Belson, latent class analysis, difference in differences) that have demonstrated potential for future work. The articles reviewed were limited to the detect (25%) and understand (75%) phases, with no studies in the solutions phase. Although the majority (56%) of studies had cross-sectional designs, many authors pointed to the need for longitudinal and multilevel data for further exploration. We examined study design features as mutually exclusive elements. However, racism is a multifaceted system and the measurement of racism in many studies does not fit into a single category. As the literature grows, the significance of methodological and measurement triangulation to assess racism should be investigated.
Are insect bites responsible for the rise in summer flucloxacillin prescribing in United Kingdom general practices?
Authors: Wilcock Jane , Hawthorne Kamila , Reeve Joanne , Etherington Clare , Alsop Katharine , Bircher Joanna , McKechnie Douglas , Granier Stephen , Newport Daniel , Wright Simon , Larcombe James , Ndukauba Chinonso , Anastasius Nitharnie 
Published: May 2023

Abstract

Background
Insect bite inflammation may mimic cellulitis and promote unnecessary antibiotic usage, contributing to antimicrobial resistance in primary care. We wondered how general practice clinicians assess and manage insect bites, diagnose cellulitis, and prescribe antibiotics.

Method
This is a Quality Improvement study in which 10 general practices in England and Wales investigated patients attending for the first time with insect bites between April and September 2021 to their practices. Mode of consultation, presentation, management plan, and reattendance or referral were noted. Total practice flucloxacillin prescribing was compared to that for insect bites.

Results
A combined list size of 161,346 yielded 355 insect bite consultations. Nearly two-thirds were female, ages 3–89 years old, with July as the peak month and a mean weekly incidence of 8 per 100,000. GPs still undertook most consultations; most were phone consultations, with photo support for over half. Over 40% presented between days 1 and 3 and common symptoms were redness, itchness, pain, and heat. Vital sign recording was not common, and only 22% of patients were already taking an antihistamine despite 45% complaining of itch. Antibiotics were prescribed to nearly three-quarters of the patients, mainly orally and mostly as flucloxacillin. Reattendance occurred for 12% and referral to hospital for 2%. Flucloxacillin for insect bites contributed a mean of 5.1% of total practice flucloxacillin prescriptions, with a peak of 10.7% in July.

Conclusions
Antibiotics are likely to be overused in our insect bite practice and patients could make more use of antihistamines for itch before consulting.
Terminal Decline in Physical Function in Older Adults
Authors: Stolz Erwin , Mayerl Hannes , Muniz-Terrera Graciela , Gill Thomas M 
Published: May 2023

Abstract

Background
It is currently unclear whether (and when) physical function exhibits a terminal decline phase, that is, a substantial acceleration of decline in the very last years before death.

Methods
702 deceased adults aged 70 years and older from the Yale PEP Study provided 4 133 measurements of physical function (Short Physical Performance Battery, SPPB) up to 20 years before death. In addition, continuous gait and chair rise subtest scores (in seconds) were assessed. Generalized mixed regression models with random change points were used to estimate the onset and the steepness of terminal decline in physical function.

Results
Decline accelerated in the last years of life in all 3 measures of physical function. The onset of terminal decline occurred 1 year before death for the SPPB, and at 2.5 and 2.6 years before death for chair rise and gait speed test scores, respectively. Terminal declines in physical function were 6–8 times steeper than pre-terminal declines. Relative to those whose condition leading to death was frailty, participants who died from dementia and cancer had an up to 6 months earlier and 3 months later onset of terminal decline in SPPB, respectively.

Conclusions
Terminal decline in physical function among older adults is comparable to the more established terminal decline phenomenon in cognition. Our results provide additional evidence of late-life rapid decline in physical function due to impending death.
Senescence and Inflammation: Summary of a Gerontological Society of America and National Institute on Aging-Sponsored Symposium
Authors: Zhang Xu , Tyrrell Daniel J , Alliston Tamara , Schilling Birgit , Yousefzadeh Matthew J , Schafer Marissa J 
Published: May 2023

Abstract
The National Institute on Aging sponsored a symposium at the Gerontological Society of America (GSA) annual meeting in Indianapolis, Indiana, to discuss recent discoveries related to senescent and inflammatory mechanisms in aging and disease. Consistent with the 2022 Biological Sciences GSA program led by Dr. Rozalyn Anderson, the symposium featured early-stage investigators and a leader in the field of geroscience research. Cell senescence and immune interactions coordinate homeostatic and protective programming throughout the life span. Dysfunctional communication in this exchange eventuates in inflammation-related compositional changes in aged tissues, including propagation of the senescence-associated secretory phenotype and accumulation of senescent and exhausted immune cells. Presentations in this symposium explored senescent and immune-related dysfunction in aging from diverse viewpoints and featured emerging cellular and molecular methods. A central takeaway from the event was that the use of new models and approaches, including single-cell -omics, novel mouse models, and 3D culture systems, is revealing dynamic properties and interactions of senescent and immune cell fates. This knowledge is critical for devising new therapeutic approaches with important translational relevance.
A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy
Authors: Omuya Helen , Nickel Clara , Wilson Paije , Chewning Betty 
Published: May 2023

Abstract

Background
Mixed findings about deprescribing impact have emerged from varied study designs, interventions, outcome measures and targeting sub-categories of medications or morbidities. This systematic review controls for study design by reviewing randomised-controlled trials (RCTs) of deprescribing interventions using comprehensive medication profiles. The goal is to provide a synthesis of interventions and patient outcomes to inform healthcare providers and policy makers about deprescribing effectiveness.

Objectives
This systematic review aims to (1) review RCT deprescribing studies focusing on complete medication reviews of older adults with polypharmacy across all health settings, (2) map patients’ clinical and economic outcomes against intervention and implementation strategies and (3) inform research agendas based on observed benefits and best practices.

Methods
The PRISMA framework for systematic reviews was followed. Databases used were EBSCO Medline, PubMed, Cochrane Library, Scopus and Web of Science. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials.

Results
Fourteen articles were included. Interventions varied in setting, preparation, use of interdisciplinary teams, validated guidelines and tools, patient-centredness and implementation strategy. Thirteen studies (92.9%) found deprescribing interventions reduced the number of drugs and/or doses taken. No studies found threats to patient safety in terms of primary outcomes including morbidity, hospitalisations, emergency room use and falls. Four of five studies identifying health quality of life as a primary outcome found significant effects associated with deprescribing. Both studies with cost as their primary outcome found significant effects as did two with cost as a secondary outcome. Studies did not systematically study how intervention components influenced deprescribing impact. To explore this gap, this review mapped studies’ primary outcomes to deprescribing intervention components using the Consolidated Framework for Implementation Research. Five studies had significant, positive primary outcomes related to health-related quality of life (HRQOL), cost and/or hospitalisation, with four reporting patient-centred elements in their intervention.

Conclusions
RCT primary outcomes found deprescribing is safe and reduces drug number or dose. Five RCTs found a significant deprescribing impact on HRQOL, cost or hospitalisation. Important future research agendas include analysing (1) understudied outcomes like cost, and (2) intervention and implementation components that enhance effectiveness, such as patient-centred elements.
Stochastic zeroth-order gradient and Hessian estimators: variance reduction and refined bias bounds
Authors: Feng Yasong , Wang Tianyu 
Published: May 2023

Abstract
We study stochastic zeroth-order gradient and Hessian estimators for real-valued functions in $\mathbb{R}^n$. We show that, via taking finite difference along random orthogonal directions, the variance of the stochastic finite difference estimators can be significantly reduced. In particular, we design estimators for smooth functions such that, if one uses $ \varTheta \left ( k \right ) $ random directions sampled from the Stiefel manifold $ \text{St} (n,k) $ and finite-difference granularity $\delta $, the variance of the gradient estimator is bounded by $ \mathscr{O} \left ( \left ( \frac{n}{k} - 1 \right ) + \left ( \frac{n^2}{k} - n \right ) \delta ^2 + \frac{ n^2 \delta ^4} { k } \right ) $, and the variance of the Hessian estimator is bounded by $\mathscr{O} \left ( \left ( \frac{n^2}{k^2} - 1 \right ) + \left ( \frac{n^4}{k^2} - n^2 \right ) \delta ^2 + \frac{n^4 \delta ^4 }{k^2} \right ) $. When $k = n$, the variances become negligibly small. In addition, we provide improved bias bounds for the estimators. The bias of both gradient and Hessian estimators for smooth function $f$ is of order $\mathscr{O} \big( \delta ^2 \varGamma \big )$, where $\delta $ is the finite-difference granularity, and $ \varGamma $ depends on high-order derivatives of $f$. Our results are evidenced by empirical observations.