bluuebunny/crossref_metadata_2025_split huggingface dataset:
V-020 LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY: FIRST EXPERIENCE AT HOSPITAL UNIVERSITARIO DE CANARIAS
Authors: Marrero Marrero P , Delgado Plasencia L J 
Published: October 2022

Abstract
We present the case of a 46-year-old-male patient, personal history: Chronic smoking; no previous abdominal surgeries. Height: 1,88 m. Weight: 100 Kg. BMI: 28. Clinical and ultrasound diagnosis of a painful and reducible ventral hernia M3 W1 (EHS Classification) associated with supraumbilical rectal diastasis (RD) of 4 cm transverse diameter T2 D2 H1 (EHS Classification). It is programmed for hernia and RD correction using de Laparoscopic Intracorporeal Rectus Aponeuroplasty (LIRA) technique. Access is laparoscopic at the left anterior axillary line level. Reduced umbilical hernia is identified and sickle cell ligament dissection is performed to identify and treat RD. The size of the umbilical defect and that of the supraumbilical RD are measured and, by means of a mathematical formula, the posterior aponeurosis of both rectal muscle is opened longitudinally parallel to both margins of the defect and the diastasis in order to suture the two flaps in the midline, allowing a tensión-free closure and also avoinding seroma formation and post-op bulging effect. We ended the procedure by placing an intraperitoneal mesh that we fixed covering the defect generated in the posterior aponeurosis. The LIRA technique could be considered an alternative to conventional defect closure (CD) or endoscopic component separation for midline defects smaller than 10 cm in transverse diameter. This is the first case of LIRA published in our latitude. It is a safe, effective and reproducible technique.
V-028 USE OF ARTICULATED INSTRUMENTS IN EXTRAPERITONEAL ABDOMINAL WALL SURGERY
Authors: Barranquero A G , Villalobos Mori R , Maestre González Y , Gutiérrez E , Olsina Kissler J 
Published: October 2022

Abstract

Introduction
One of the limitations in extraperitoneal abdominal wall surgery is the reduced range of movements of conventional instruments. The aim of this video was to show the advantages of articulated instruments.

Case presentation
The first case was a laparoscopic totally extraperitoneal (TEP) inguinal hernia repair of a direct bilateral hernia in a male patient. In this intervention the articulated grasper assisted with the isolation of the hernia sac and allowed to modify the direction of the traction during the dissection.
The second case was an extended totally extraperitoneal (eTEP) repair of a M3W2 incisional hernia associated to rectus diastasis in a female patient. The articulated instrument gave an increased traction adapted to the surface of the posterior rectus sheath and marked the limits for the section with the scissors.

Conclusion
The articulated instruments allowed an increased mobility in the extraperitoneal field.
Note: the articulated instruments were manufactured by IMM, Mannheim, Germany.
V-038 INGUINAL TEP WITH ARTICULATED INSTRUMENTS: BEYOND CONVENTIONAL LAPAROSCOPY, CLOSER TO ROBOTIC SURGERY
Authors: Villalobos R , Maestre Y , González Barranquero A , Olsina J 
Published: October 2022

Abstract

Introduction
Is known that laparoscopic inguinal hernia repair is well recommended in the guidelines. Despite that, in most cases the surgeon needs to do with the instruments manoeuvres that are not ergonomics. Robotic surgery has eliminated these problems but unfortunately this platform is not within reach of all. Articulated instruments appear as a forward stepwise to avoid these difficulties and allowing a better performance of the technique. We present a video that shows a case of an inguinal total extraperitoneal (TEP) performance with these instruments.

Material and methods
A 45-year-old man with a bilateral inguinal hernia underwent an inguinal TEP using 2 articulated grasper and Maryland instruments (IMM-Tontarra). An expander balloon was used to open the Retzius space, then a Hasson umbilical trocar and 2 (5mm) infraumbilical and suprapubic trocars were placed. All surgery was performed with these 2 instruments an only straight graspers were used when placing the mesh.

Results
The patient was discharged the same day of surgery with no complications. Our group made different kind of surgery and we observed that the learning curve to obtain an optimal performance of this instruments is short, lesser than 10 patients. We did eTEP procedure for ventral/incisional hernias, Cholecystectomies and hemicolectomies demonstrating the usefulness of these tools.

Conclusions
Inguinal TEP technique repair using articulated instruments is a very good option for a better dissection of the tissues, better triangulation of the graspers and more ergonomic for the surgeon.
V-053 USE OF HYBRID LAPAROSCOPIC INTRACORPOREAL RECTUS APONEUROPLASTY (LIRA-TECHNIQUE) IN COMPLEX VENTRAL HERNIAS
Authors: Licardie E , Eleuterio G , Navarro L , Bellido A , Suárez-Grau J , Morales-Conde S 
Published: October 2022

Abstract

Aim
The hybrid approach (HA) to ventral hernias (VH), combining the laparoscopic and open approaches, is not very common at present. The great contribution of this approach is that it combines the advantages of the minimally invasive approach with the advantages of the open approach, making it possible to correct aesthetic defects and major skin and subcutaneous problems.

Material & Methods
40-year-old-man with previous surgery for supraumbilical hernia, with placement of a supraaponeurotic mesh with hernia recurrence and chronic infection with a meshoma. Physical examination revealed VH of 5–8cm in transverse diameter and 10cm in vertical diameter. A CT-scan showed a 6.5cm transverse supraumbilical recurrent hernia with a fatty content.

Results
A laparoscopic approach was performed, revealing an 8×8cm supraumbilical defect in the abdominal cavity with no adhesions. A midline repair was performed according to the principles of the LIRA technique by performing a posterior fascial flap 2cm above the edges of the defect: the midline was reinforced with a loop-suture. An intra-abdominal mesh was placed and fixed with tackers and fibrin glue. In the open procedure, the chronic sinus, meshoma, excess skin and hernial sac were removed.

Conclusions
The treatment of complex abdominal hernias is a field in constant evolution. The HA aims to solve the skin problems associated with laparoscopic repairs alone. The use of intraperitoneal on-lay meshes combined with the use of open approach for excision of the sac and remaining skin tissue allows a complete and effective treatment of complex hernias.
Abnormal brain state distribution and network connectivity in aSYNGAP1rat model
Authors: Buller-Peralta Ingrid , Maicas-Royo Jorge , Lu Zhuoen , Till Sally M , Wood Emma R , Kind Peter C , Escudero Javier , Gonzalez-Sulser Alfredo 
Published: October 2022

AbstractMutations in the SYNGAP1 gene are one of the common predictors of neurodevelopmental disorders, commonly resulting in individuals developing autism, intellectual disability, epilepsy, and sleep deficits. EEG recordings in neurodevelopmental disorders show potential to identify clinically translatable biomarkers to both diagnose and track the progress of novel therapeutic strategies, as well as providing insight into underlying pathological mechanisms. In a rat model of SYNGAP1 haploinsufficiency in which the exons encoding the calcium/lipid binding and GTPase-activating protein domains have been deleted (Syngap+/Δ−GAP), we analysed the duration and occurrence of wake, non-rapid eye movement and rapid eye movement brain states during 6 h multi-electrode EEG recordings. We find that although Syngap+/Δ−GAP animals spend an equivalent percent time in wake and sleep states, they have an abnormal brain state distribution as the number of wake and non-rapid eye movement bouts are reduced and there is an increase in the average duration of both wake and non-rapid eye movement epochs. We perform connectivity analysis by calculating the average imaginary coherence between electrode pairs at varying distance thresholds during these states. In group averages from pairs of electrodes at short distances from each other, a clear reduction in connectivity during non-rapid eye movement is present between 11.5 Hz and 29.5 Hz, a frequency range that overlaps with sleep spindles, oscillatory phenomena thought to be important for normal brain function and memory consolidation. Sleep abnormalities were mostly uncorrelated to the electrophysiological signature of absence seizures, spike and wave discharges, as was the imaginary coherence deficit. Sleep spindles occurrence, amplitude, power and spread across multiple electrodes were not reduced in Syngap+/Δ−GAP rats, with only a small decrease in duration detected. Nonetheless, by analysing the dynamic imaginary coherence during sleep spindles, we found a reduction in high-connectivity instances between short-distance electrode pairs. Finally comparing the dynamic imaginary coherence during sleep spindles between individual electrode pairs, we identified a group of channels over the right somatosensory, association and visual cortices that have a significant reduction in connectivity during sleep spindles in mutant animals. This matched a significant reduction in connectivity during spindles when averaged regional comparisons were made. These data suggest that Syngap+/Δ−GAP rats have altered brain state dynamics and EEG connectivity, which may have clinical relevance for SYNGAP1 haploinsufficiency in humans.
Facial Metrics, Aggression, and the Use of Military Force
Authors: Miller Ross A 
Published: October 2022

Abstract
Presidents cite many reasons to justify their decisions to use military force. Regardless of the explanation provided, putting soldiers in harm's way entails a high degree of risk. Some presidents are more willing than others to undertake risky policies, and psychological dispositions help to account for their willingness. According to evolutionary psychology theories of conflict, facial characteristics serve as important cues of aggression, and a substantial body of empirical evidence supports the association between the facial width-to-height ratio (FWHR) and conflict behavior. All else equal, individuals with greater FWHRs are more likely to choose aggressive foreign policies. Empirical analyses of 1953–2000 show that US presidents with higher FWHRs are four times more likely than those with lower FWHRs to use military force. The results hold independent of traditional explanations such as power, ongoing war, elections, the misery index, and alternative measures of leader psychology.
Bacterial Hsp90 predominantly buffers but does not potentiate the phenotypic effects of deleterious mutations during fluorescent protein evolution
Authors: Iyengar Bharat Ravi , Wagner Andreas 
Published: October 2022

Abstract
Chaperones facilitate the folding of other (“client”) proteins and can thus affect the adaptive evolution of these clients. Specifically, chaperones affect the phenotype of proteins via two opposing mechanisms. On the one hand, they can buffer the effects of mutations in proteins and thus help preserve an ancestral, premutation phenotype. On the other hand, they can potentiate the effects of mutations and thus enhance the phenotypic changes caused by a mutation. We study that how the bacterial Hsp90 chaperone (HtpG) affects the evolution of green fluorescent protein. To this end, we performed directed evolution of green fluorescent protein under low and high cellular concentrations of Hsp90. Specifically, we evolved green fluorescent protein under both stabilizing selection for its ancestral (green) phenotype and directional selection toward a new (cyan) phenotype. While Hsp90 did only affect the rate of adaptive evolution transiently, it did affect the phenotypic effects of mutations that occurred during adaptive evolution. Specifically, Hsp90 allowed strongly deleterious mutations to accumulate in evolving populations by buffering their effects. Our observations show that the role of a chaperone for adaptive evolution depends on the organism and the trait being studied.
Frailty Transitions in Older Persons With Lung Function Impairment: A Population-Based Study
Authors: Wijnant Sara R A , Benz Elizabeth , Luik Annemarie I , Rivadeneira Fernando , Voortman Trudy , Brusselle Guy G , Lahousse Lies 
Published: October 2022

AbstractBackgroundThe aging population and its burden on health care systems warrant early detection of patients at risk of functional decline and mortality. We aimed to assess frailty transitions and its accuracy for mortality prediction in participants with impaired spirometry (Preserved Ratio Impaired Spirometry [PRISm] or chronic obstructive pulmonary disease [COPD]).MethodsIn participants from the population-based Rotterdam Study (mean age 69.1 ± 8.9 years), we examined whether PRISm (forced expiratory volume in 1 second [FEV1]/forced vital capacity [FVC] ≥ 70% and FEV1 &lt; 80%) or COPD (FEV1/FVC &lt; 70%) affected frailty transitions (progression/recovery between frailty states [robust, prefrailty, and frailty], lost to follow-up, or death) using age-, sex- and smoking state-adjusted multinomial regression models yielding odds ratios (OR). Second, we assessed the diagnostic accuracy of frailty score for predicting mortality in participants with COPD using c-statistics.ResultsCompared to participants with normal spirometry, participants with PRISm were more likely to transit from robust (OR 2.2 [1.2–4.2], p &lt; .05) or prefrailty (OR 2.6 [1.3–5.5], p &lt; .01) toward frailty. Participants with PRISm (OR 0.4 [0.2–0.8], p &lt; .05) and COPD (OR 0.6 [0.4–1.0], NS) were less likely to recover from their frail state, and were more likely to progress from any frailty state toward death (OR between 1.1 and 2.8, p &lt; .01). Accuracy for predicting mortality in participants with COPD significantly improved when adding frailty score to age, sex, and smoking status (90.5 [82.3–89.8] vs 77.9 [67.2–88.6], p &lt; .05).ConclusionParticipants with PRISm or COPD more often developed frailty with poor reversibility. Assessing physical frailty improved risk stratification for participants with impaired spirometry for predicting increased life years.
Minimal Volume Product of Convex Bodies with Certain Discrete Symmetries and its Applications
Authors: Iriyeh Hiroshi , Shibata Masataka 
Published: October 2022

Abstract
We give the sharp lower bound of the volume product of $n$-dimensional convex bodies that are invariant under the discrete subgroups $SO(K)=\{ g \in SO(n); g(K)=K \}$, where $K$ is an $n$-cube or $n$-simplex. This provides new partial results of Mahler’s conjecture and its nonsymmetric version. In addition, we give partial answers for Viterbo’s isoperimetric-type conjecture in symplectic geometry from the view point of Mahler’s conjecture.
Generating synthetic mixed discrete-continuous health records with mixed sum-product networks
Authors: Kroes Shannon K S , van Leeuwen Matthijs , Groenwold Rolf H H , Janssen Mart P 
Published: October 2022

Abstract

Objective
Privacy is a concern whenever individual patient health data is exchanged for scientific research. We propose using mixed sum-product networks (MSPNs) as private representations of data and take samples from the network to generate synthetic data that can be shared for subsequent statistical analysis. This anonymization method was evaluated with respect to privacy and information loss.

Materials and methods
Using a simulation study, information loss was quantified by assessing whether synthetic data could reproduce regression parameters obtained from the original data. Predictors variable types were varied between continuous, count, categorical, and mixed discrete-continuous. Additionally, we measured whether the MSPN approach successfully anonymizes the data by removing associations between background and sensitive information for these datasets.

Results
The synthetic data generated with MSPNs yielded regression results highly similar to those generated with original data, differing less than 5% in most simulation scenarios. Standard errors increased compared to the original data. Particularly for smaller datasets (1000 records), this resulted in a discrepancy between the estimated and empirical standard errors. Sensitive values could no longer be inferred from background information for at least 99% of tested individuals.

Discussion
The proposed anonymization approach yields very promising results. Further research is required to evaluate its performance with other types of data and analyses, and to predict how user parameter choices affect a bias-privacy trade-off.

Conclusion
Generating synthetic data from MSPNs is a promising, easy-to-use approach for anonymization of sensitive individual health data that yields informative and private data.
Engaging the next generation of physician–informaticians through early exposure to the field: successes and challenges associated with starting a novel clinical informatics interest group
Authors: Quach William T , Le Chi H , Clark Michael G , McArthur Evonne , Ancker Jessica S , Gadd Cynthia S , Johnson Kevin B 
Published: October 2022

Abstract
Clinical informatics remains underappreciated among medical students in part due to a lack of integration into undergraduate medical education (UME). New developments in the study and practice of medicine are traditionally introduced via formal integration into undergraduate medical curricula. While this path has certain advantages, curricular changes are slow and may fail to showcase the breadth of clinical informatics activities. Less formal and more flexible approaches can circumvent these drawbacks. Interest groups (IGs), which are organized through the Association of American Medical College Careers in Medicine (CiM) program, exemplify the informal approach. CiM IGs are student-led groups that provide exposure to different specialty options, acting as an adjunct to the traditional medical curriculum. While the primary purpose of these groups is to assist students applying to residency programs, we took a novel approach of using an IG to increase student exposure to an area of medicine that had not yet been formally integrated at our institution. IGs provide unique advantages to formal integration into a curriculum as they can be more easily setup and can quickly respond to student interests. Furthermore, IGs can act synergistically with UME, acting as proving grounds for ideas that can lead to new courses. We believe that the lessons and takeaways from our experience can act as a guide for those interested in starting similar organizations at their own schools.
Topical Liposomal Amphotericin (Ambisome®) for the Treatment of Cutaneous Fusarium in a Burn-Injured Patient
Authors: Louie Erin , Young Sierra , Virk Mehr , Barsun Alura , Sen Soman 
Published: October 2022

Abstract
Cutaneous Fusarium infections carry significant morbidity and mortality in burn-injured patients. Treatment involves surgical source control in combination of systemic and topical therapy. Given drug shortage constraints with conventional amphotericin deoxycholate, we describe the first case of successful treatment with adjunctive topical liposomal amphotericin in a critically ill burn-injured patient.
Bromelain ameliorates D-galactosamine-induced acute liver injury: role of SIRT1/LKB1/AMPK, GSK3β/Nrf2 and NF-κB p65/TNF-α/caspase-8, -9 signalling pathways
Authors: Didamoony Manar A , Atwa Ahmed M , Abd El-Haleim Enas A , Ahmed Lamiaa A 
Published: October 2022

Abstract

Objectives
The present research focused on estimating, for the first time, the potential protective effects of bromelain against D-galactosamine-induced acute liver injury in rats as well as identifying the possible underlying mechanisms.

Methods
Silymarin (100 mg/kg/day, p.o.) as a reference drug or bromelain (20 and 40 mg/kg/day, p.o.) were administered for 10 days, and on the 8th day of the experiment, a single dose of galactosamine (400 mg/kg/i.p.) induced acute liver injury.

Key findings
Pretreatment with bromelain improved liver functions and histopathological alterations induced by galactosamine. Bromelain ameliorated oxidative stress by inducing SIRT1 protein expression and increasing LKB1 content. This resulted in phosphorylating the AMPK/GSK3β axis, which stimulated Nrf2 activation in hepatic cells and thus increased the activity of its downstream antioxidant enzymes [HO-1 and NQO1]. Besides, bromelain exerted significant anti-apoptotic and anti-inflammatory effects by suppressing hepatic contents of TNF-α, NF-κB p65, as well as caspase-8 and caspase-9. The protective effects of bromelain40 were proved to be better than silymarin and bromelain20 in most of the assessed parameters.

Conclusions
Our results highlight the significant hepatoprotective effects of bromelain against acute liver injury through modulation of SIRT1/LKB1/AMPK, GSK3β/Nrf2 signalling in addition to NF-κB p65/TNF-α/ caspase-8 and -9 pathway.
Gossypiboma discovered 24 years after prostate surgery, a forgotten but never forgiven complication
Authors: Molina Gabriel A , Fuentes Germanico , Jimenez Andres , Proaño Estefany J , Chango Paulina E , Uzcategui Maria Isabel , Alvear Ronald S , Rubio Cristina B 
Published: October 2022

Abstract
Forgetting gauze or “a surgical drape” inside a patient after surgery is a rare medical error. It can lead to severe complications, high hospital costs and medico-legal implications. As a result, this complication is often not reported, mainly to avoid retaliation and because it can initiate extensive critical press coverage. This technical oversight may be just the tip of an iceberg concerning the reality of surgical errors; therefore, the entire surgical team must focus on prevention, continuing medical education and strict adherence to protocols and counting guidelines to minimize their incidence. We present the case of a 76-year-old patient with an acute abdomen; after an initial evaluation, a gossypiboma was discovered, which was forgotten 24 years after prostatectomy.
Trauma emergency thoracotomy for resuscitation in shock—a multi-centre evaluation of current UK practice of pre-hospital and emergency department resuscitative thoracotomy in trauma
Authors: Tucker Harriet , Ramage Lisa , Greenhalgh Rob , Griggs Jo , Lang Nigel , Marsden Max , Vulliamy Paul , Wohlgemut Jared M , Christian Mike , Davenport Ross 
Published: October 2022

Abstract

Background
Resuscitative thoracotomy (RT) in traumatic cardiac arrest, in particular for penetrating trauma features within several national guidelines. However, evidence surrounding its practice is poor, consisting of predominantly small-scale observational studies. Survival is generally poor, estimated at 3–13%, with better outcomes in penetrating trauma. There is no national RT database and the Trauma Audit Research Network data misses those who have died pre-hospital. It is important that a more in-depth and accurate national picture of thoracotomy practice is developed nationally to guide future practice. Traumatic emergency thoracotomy for resuscitation in shock (TETRiS) is a multi-centre, prospective and observational evaluation of current RT practice in the UK.

Aims and objectives
The aim of TETRiS is to evaluate the pathway of care for RT patients within the UK. This will be undertaken over a period of 12 months. This project will evaluate thoracotomies undertaken both pre-hospital and in emergency departments, examining various parameters including frequency, who performs the procedure, clinical indications, time from injury to initiation, mechanism of injury, injuries identified, interventions performed and patient outcomes.

Methods
This project is being conducted as a collaboration between the National Trauma Research and Innovation Collaborative, the Pre-Hospital Trainee Operated Research Network, the Trainee Emergency Research Network and the National HEMS Research and Audit Forum (NHRAF). All UK HEMS, helicopter emergency medicine services and major trauma centre (MTCs) nationally have been recruited, with site investigators identified within each participating unit. Inclusion criteria: All patients undergoing RT, pre-hospital or in an MTC emergency department will be included.