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Purpose: Short-term effects of round ligament varicosity (RLV) in pregnancy have been investigated in small-scale studies. The long-term effects are unknown. This study aims to evaluate the risk of groin hernia manifestation after RLV in pregnancy, to delineate possible risk factors and to analyze the natural course of pregnancy and post-partum period with regard to RLV.Methods: In a prospective analysis 28 pregnant women with RLV presented to the hernia clinic over 9 years. After clinical and ultrasound examination during pregnancy and publication of early results in 2013 a second structured follow-up was conducted. Demographic data, hernia-specific risk factors, comorbidities, pregnancy and birth-related data as well as post-partum period were documented without loss of follow-up. In these women, all pregnancies that occurred, including the ones without RLV, were analyzed.Results: Median follow-up was 68 months (11.4-104.9). Only one groin hernia was found. No risk factors could be identified. After uncomplicated childbirth complaints subsided spontaneously in all but one patient within 4 weeks. Recurrence rates in subsequent pregnancies are up to 89%.Conclusion: Temporary RLV-induced dilation of the deep inguinal ring in pregnancy is not a common precursor for the development of inguinal hernias later in life. All findings support the theory that the hindrance of venous blood flow caused by the gravid uterus is an important contributing factor for RLV in pregnancy, which is self-limited but has a high risk of recurrence and is not an indication for surgery before or after delivery or for cesarean section. [ABSTRACT FROM AUTHOR]

Purpose: Knowledge of postoperative behavior of mesh implants used for hernia repair is generally limited to cases of recurrence, local complications or return to the previous operative field in other pathological conditions. Previous studies with MRI-visible mesh implants in different parts of the abdominal wall have led to variable findings with regard to mesh properties and mostly described a reduction in size over time with subsequently limited mesh overlap over hernia defects which could contribute to recurrence. We aimed to evaluate implant properties in a mechanically stable anatomical region after TAPP repair of primary unilateral inguinal hernias in men with clinical and MRI examinations 4 weeks and 1 year after surgery.Methods: From 11/2015 to 01/2019, 23 men with primary, unilateral, inguinal hernias underwent TAPP repair with iron particle-loaded, MRI-visible mesh implants in a prospective cohort study. In 16 patients the operative outcome could be evaluated 4 weeks and 12 months after surgery by clinical examination and MRI evaluation with regard to postoperative course, possible adverse outcomes and radiological findings related to implant behavior-namely MRI-identifiability, mesh dislocation or reduction in surface area.Results: All included patients had an uneventful postoperative clinical course. MRI after 4 weeks revealed one postoperative seroma, which resolved spontaneously. No recurrence was detected. Mesh implants could be accurately delineated in DIXON-IN studies and showed neither clinically nor statistically significant changes in size or position.Conclusion: 4 weeks and 1 year after a standardized TAPP procedure the mesh implant used in this study showed no tendency towards dislocation or reduction in size in this anatomical position. Its MRI visibility allows accurate delineation during the postoperative course by experienced radiologists in appropriate MRI protocols. Larger patient series are desirable to further support these findings. Shrinkage of implants in the groin as a reason for early recurrence may be overestimated. [ABSTRACT FROM AUTHOR]

Purpose: In open inguinal hernia repair self-gripping meshes are currently commonly employed. Assumed benefits are saving of time, ease of handling and omission of fixation. Self-gripping meshes are, however, not as easy to handle and position as commonly stated. We describe a newly developed way of intra-operative mesh preparation and implantation and compare it to the conventional technique of insertion of self-gripping meshes.Methods: A two-armed, randomized trial with 64 patients was performed. For implantation of the self-gripping, light weight and partially absorbable mesh we used either a newly described rolling technique (group 1: n = 32) or the conventional way of insertion (group 2: n = 32). Primary endpoints of the study were feasibility with regard to actual implantation time and surgeons' satisfaction with the methods. Secondary endpoints were total operating time, length of hospital stay, postoperative pain, duration of pain medication intake and postoperative morbidity. In addition all patients were prospectively followed up according to the Hernia Med® registry's standards.Results: Implantation time (seconds) 140 ± 74 vs. 187 ± 84, p = 0.008, duration of pain medication intake (days) 3.6 ± 2.8 vs. 4.8 ± 2.6; p = 0.046 and postoperative morbidity 2 (6%) vs. 8 (25%) was significantly beneficial in group 1 (rolling technique) compared to group 2 (conventional method). Blinded questionnaire revealed that rolling the mesh is generally easier with less repositioning maneuvers than conventional placement. Neither overall procedure time, length of stay nor postoperative pain scores differed significantly between groups.Conclusion: The newly introduced rolling technique for the actual placement of self-gripping meshes in open inguinal hernia repair is technically less demanding and therefore significantly faster when compared to the conventional way of insertion of the same product. In addition the rolling technique has shown to be safe for the patients and to also provide higher surgeons' satisfaction. [ABSTRACT FROM AUTHOR]

Economic and ecological demands like saving resources and improved material efficiency can be achieved by the application of process adapted semi-finished parts, so-called tailored blanks, for the manufacturing of for example gearings or synchronizer rings. Functional components require the locally restricted distribution of an adequate amount of material at defined positions in order to properly form functional elements like gearings or carriers. As these elements can be formed on one or both sides of the component, an appropriate material provision on one or both sides of the sheet metal is necessary. Having material thickenings on two sides lead to the interaction between both sides for example with regard to the maximum die filling. One process to produce tailored blanks is orbital forming. While manufacturing these tailored blanks with a local material thickening on one side of the sheet metal is state-of-the-art, the realization of these tailored blanks on both sides has not been investigated yet. In this paper, the results regarding the manufacturing of tailored blanks with a two-sided local material thickening will be presented for the first time. By analyzing three different tailored blank geometries, the influence of the interactions of two-sided material thickenings will be investigated. The results will be evaluated in terms of the resulting geometrical and mechanical properties. [ABSTRACT FROM AUTHOR]

Introduction: Several analyses of hernia registries have demonstrated that patients older than 65 years have significantly higher perioperative complication rates compared with patients up to the age of 65. To date, no special analyses of endoscopic/laparoscopic inguinal hernia surgery or of the relevant additional influence factors have been carried out. Besides, there is no definition to determine whether 65 years should really be considered to be the age limit.Methods: In the Herniamed Hernia Registry, it was possible to identify 24,571 patients with a primary inguinal hernia and aged at least 16 years who had been operated on between September 1, 2009, and April 15, 2013, using either the TAPP technique (n = 17,214) or TEP technique (n = 7,357). Patients in the age group up to and including 65 years (≤65 years) were compared with those older than 65 years (>65 years) in terms of their perioperative outcome. That was done first using unadjusted analysis and then multivariable analysis.Results: Unadjusted analysis revealed significantly different results for the intraoperative (1.19 vs 1.60%; p = 0,010), postoperative surgical (2.72 vs 4.59%; p < 0.001) and postoperative general complications (0.85 vs 1.98%; p < 0.001) as well as for complication-related reoperations (1.07 vs 1.37%; p = 0,044), which were more favorable in the ≤65 years age group. However, in multivariable analysis, it was not possible to confirm that for the intraoperative complications or the reoperations. Reoperations were needed more often for bilateral procedures (p < 0.001; OR 2.154 [1.699; 2.730]), higher ASA classification (IV vs I: p = 0.004; OR 6.001 [1.786; 20.167]), larger hernia defect and scrotal hernias. The impact of these factors, in addition to that of age >65 years, was also reflected in the postoperative complication rates. The age limit for increased onset of perioperative complication rates tends to be more than 80 rather than 65 years.Conclusion: The higher perioperative complication rate associated with endoscopic/laparoscopic inguinal hernia surgery in patients older than 65 years is of multifactorial genesis and is observed in particular as from the age of 80 years. [ABSTRACT FROM AUTHOR]

Purpose: With a newly described diagnostic pathway, we aim to avoid unnecessary surgical exploration for suspected symptomatic groin hernias in pregnancy. Methods: A consecutive series of eighteen pregnant women was referred to our department due to a gradual onset of inguinal swelling and groin ache. In a prospective clinical study, we evaluated these patients clinically and employed grey-scale and colour Doppler sonography (CDS) in all cases-following a newly described pathway. All patients were examined pre- and post-partum by two qualified surgeons. Median follow-up time was 11 months. Results: 4/18 of the suspected hernias first occurred towards the end of the first, the majority (12/18) in the second, 2/18 in the last trimester and all were suspected after clinical examination only. Most women were referred by their gynaecologists. We found no hernias in any of the women but always noted large varicose veins along the round ligament during CDS. All women gave uncomplicated birth to single children, one by caesarean section. Complaints subsided spontaneously within roughly 2 weeks after delivery. No patient developed a groin hernia until the end of the follow-up period. Conclusion: The diagnosis of an inguinal hernia with a first symptomatic onset during pregnancy may be wrong in most cases. Anamnesis and clinical examination must be backed by CDS and round ligament varicosity as an important differential diagnosis must always be considered. Our structured diagnostic pathway helps to easily make the correct diagnosis. Surgical exploration of the groin during pregnancy must be avoided. [ABSTRACT FROM AUTHOR]

Two data analysis programs of Sedfit and VelXLAI associated with analytical ultracentrifugation were compared with each other for the sedimentation analysis of a pure polystyrene polymer solution as well as solutions of polymer mixtures in organic solvent containing two components in different mixing ratios. Interference detection optics was used for the sedimentation analysis. The pure polymer showed concentration dependency of the sedimentation coefficient and the results were similar in both the programs. In the mixture samples, slight differences in the peak sedimentation coefficients of the two polymers fractions in the analysis programs were observed. However, VelXLAI program was observed to detect the relative fractions of the two mixture components more accurately than Sedfit. [ABSTRACT FROM AUTHOR]

Sedimentation analysis with interference detection optics was carried out for pure polymer as well as 1:1 polymer mixture samples as a function of polymer concentration in analytical ultracentrifuge. The data analysis was carried out using analysis programs of Sedfit and VelXLAI to elucidate the advantages and limitations of the analysis methods. The concentration dependency of the sedimentation coefficient was observed and the distributions became narrower on increasing the polymer concentration in both the methods. The peak sedimentation coefficients at different concentrations for both pure polymer as well as polymer mixture samples were same in both the methods though the sedimentation coefficients of the components in the mixture were slightly different from the sedimentation coefficient of the same component, when measured alone. The programs were observed to generate similar information in the case of pure polymer sample; however, in more complex polymer mixture sample, the Sedfit program was observed to have significant difference in the shape of the sedimentation coefficient distributions as well as in the amount of the components detected. [ABSTRACT FROM AUTHOR]

nalytical ultracentrifugation is one of the most powerful methods for the characterization of nanoparticles since the days of its invention due to its high resolution and statistical significance. Latexes with different sizes and their mixtures have been measured by sedimentation with the analytical ultracentrifuge (AUC) OPTIMA XL-I (Beckman Coulter, Palo Alto, CA, USA) with interference optics at λ = 675 nm and absorption optics at λ = 546 and 263 nm. Additionally, a blue pigment with high absorption characteristic at visible light has been investigated. A large influence of Mie scattering and Mie absorption on the particle size distribution with respect to absorption optics and samples with moderate or broad size distribution is observed. Therefore, the consideration of the Mie scattering effect is compulsory for most AUC measurements of nanoparticles with absorption optics. [ABSTRACT FROM AUTHOR]

Sedimentation velocity runs were carried out using both absorption and interference detectors in an analytical ultracentrifuge for a bi-component polymer mixture and using two different data analysis programs. The concentrations of polymer were chosen between 0.11 g/L and 3.43 g/L and were kept constant for both absorption and interference detection systems so as to generate comparisons between the two apart from comparisons between the data analysis programs. The comparisons were achieved through the differential and cumulative distributions of sedimentation coefficient. Though the peak sedimentation coefficient values in both analysis programs were same, the distributions differed in peak broadness and axis interception. The amount of detected components in the mixture also differed in the analysis programs, with VelXLAI exhibiting better performance than Sedfit analysis. Similar observations were made for absorption and interference optics, except for the inability of the absorption optics to measure correctly above polymer concentration of 1 g/L. [ABSTRACT FROM AUTHOR]

During continuous steel casting slag entrainment from the tundish into the mould has to be avoided. Since slag entrainment most likely occurs at low tundish levels, this paper focuses on the behaviour of the steel phase and the covering liquid slag during tundish draining. The process of slag entrainment is modelled both numerically by a volume of fluid (VOF) approach and physically by corresponding water-oil experiments. Thereby, the influence of a centric stopper and additional inserts on the critical suction level is studied. With help of the numerical model these results are subsequently extrapolated to real plant applications with steel and slag as liquid phases. The numerical simulations have been proven to reasonably depict the onset of slag entrainment during tundish draining and their results agree with corresponding experiments. [ABSTRACT FROM AUTHOR]

Abstract: Background:: The diagnosis of many gastro-intestinal diseases is difficult and can often be confirmed only by using invasive diagnostic means. In contrast, the headspace screening of fluid obtained from the gut during colonoscopy and the analysis of exhaled air may be a novel approach for the diagnosis of these diseases. Materials and methods:: The screening was performed by using proton transfer reaction-mass spectrometry (PTR-MS) which allows rapid and sensitive measurement. Fluid samples obtained from the gut during colonoscopy were collected from 76 and breath samples from 70 subjects. Mass spectra of healthy controls were created. Afterwards these spectra were compared with those of patients suffering from inflammatory bowel diseases (IBD; Crohn''s disease and ulcerative colitis; n =10) and irritable bowel syndrome (IBS; n =7). Results:: Significant differences in the mass spectra could be observed both in the headspace of the fluid and in the exhaled air comparing patients with healthy controls. Conclusions:: This study is the first describing headspace screening of fluid obtained from the gut during colonoscopy, possibly presenting a novel diagnostic tool in the differential diagnosis of gastro-intestinal diseases. [Copyright &y& Elsevier]

• Joining of similar and dissimilar materials in a sheet-bulk metal forming process. • Cold forming enables increased strength. • Significant reduction of required process force. • Enhanced lightweight potential by increased material flow control. Sheet-bulk metal forming is an expedient approach to efficiently manufacture functional components out of sheet metal. In order to reduce weight of the component manufactured, an application-adapted approach was developed to replace the conventional steel blank by a semi-finished product consisting of two blanks with half the thickness to enable the tailored combination of different materials in a combined deep drawing and upsetting process. To establish a basis for the application of these hybrid semi-finished products, first of all multilayer steel semi-finished products are drawn and upset in the process combination. Thereby, the upsetting process induces a three dimensional material flow and at the same time an interlocking connection of the two blanks. The gained results are the transferred onto the combination of steel and aluminium alloys within one semi-finished product. Fundamental dependencies as well as the influence of the application of different steel grades are investigated. [ABSTRACT FROM AUTHOR]

Objectives: The coronavirus disease 2019 pandemic has led to a need for alternative teaching methods in facial plastics. This systematic review aimed to identify facial plastics simulation models, and assess their validity and efficacy as training tools. Methods: Literature searches were performed. The Beckman scale was used for validity. The McGaghie Modified Translational Outcomes of Simulation-Based Mastery Learning score was used to evaluate effectiveness. Results: Overall, 29 studies were selected. These simulated local skin flaps (n = 9), microtia frameworks (n = 5), pinnaplasty (n = 1), facial nerve anastomosis (n = 1), oculoplastic procedures (n = 5), and endoscopic septoplasty and septorhinoplasty simulators (n = 10). Of these models, 14 were deemed to be high-fidelity, 13 low-fidelity and 2 mixed-fidelity. None of the studies published common outcome measures. Conclusion: Simulators in facial plastic surgical training are important. These models may have some training benefits, but most could benefit from further assessment of validity. [ABSTRACT FROM AUTHOR]

Purpose: Bochdalek hernia is a congenital diaphragmatic hernia. The incidence in adults is estimated around 0.17%. Right-sided hernias are much more seldom than left-sided ones because of faster closure of the right pleuroperitoneal canal and the protective effect of the liver. Due to its rarity, there have been no large prospective or retrospective studies following great need for evidence-based diagnostics and treatment strategies. In this systematic review, we evaluated the current evidence of diagnostics, treatment, and follow-up of adult right-sided Bochdalek hernias. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines a systematic literature review was conducted in PubMed and Cochrane library from 2004 to January 2021. The literature search included all studies with non-traumatic right-sided Bochdalek hernias. Literature on left- or both-sided, pregnancy-associated, pediatric, and other types of hernias were explicitly excluded. Quality assessment of the included studies was performed. Results: Database search identified 401 records. After eligibility screening 41 studies describing 44 cases of right-sided non-traumatic Bochdalek hernias in adulthood were included for final analysis. Based upon the systematic literature review, the current diagnostic, therapeutic, and follow-up management pathway for this rare surgical emergency is presented. Conclusion: This systematic review underlined that most studies investigating management of adult non-traumatic right-sided Bochdalek hernias are of moderate to low methodological quality. Hernias tend to occur more frequently in middle-aged and older women presenting with abdominal pain and dyspnea. A rapid and accurate diagnosis following surgical repair and regular follow-up is mandatory. High-quality studies focusing on the management of this rare entity are urgently needed. [ABSTRACT FROM AUTHOR]

Objectives: UK guidelines advocate 'one-stop' neck lump assessment for cancer referrals. This paper reports the pilot of a novel pre-clinic ultrasound pathway, presents outcomes, and discusses strengths and limitations in the context of the coronavirus disease 2019 pandemic. Methods: Two-week-wait cancer referral patients with a neck lump were allocated a pre-clinic ultrasound scan followed by a clinic appointment. Demographic, patient journey and outcome data were collected and analysed. Results: Ninety-nine patients underwent ultrasound assessment with or without biopsy on average 8 days following referral. Patients were followed up on average 14.1 days (range, 2–26 days) after initial referral. At the first clinic appointment, 45 patients were discharged, 10 were scheduled for surgery, 12 were diagnosed with cancer, 6 were referred to another specialty and cancer was excluded in 19 patients. Retrospectively, four ultrasounds were performed unnecessarily. Conclusion: Pre-clinic ultrasound scanning is an alternative to the one-stop neck lump pathway. This study demonstrates fewer clinic visits, faster diagnosis and a low proportion of unnecessary scans, whilst minimising face-to-face consultations and aerosol-generating procedures. [ABSTRACT FROM AUTHOR]

Whereas for TEP the guidelines do not recommend mesh fixation on the basis of meta-analyses regardless of the defect size, for TAPP mesh fixation can be omitted only up to a defect size of 3 cm because of the paucity of studies on this topic. Hence, this study now seeks to explore this subject on the basis of prospective data from the Herniamed Hernia Registry. In the period September 01, 2009, to January 31, 2014, 11,228 male patients were operated on with the TAPP technique for a primary unilateral inguinal hernia and were followed up for 1 year. Mesh fixation was used for 7422 (66.1 %) of these patients and no mesh fixation for 3806 patients (33.9 %). Unadjusted analysis did not find any significant difference in the recurrence rate (0.88 % with fixation vs. 1.1 % without fixation; p = 0.259). Multivariable analysis of all potential influence factors (age, ASA, BMI, risk factors, defect size, mesh fixation, localization of defect, mesh size) did not identify any factor that impacted recurrence on 1-year follow-up. Only for medial and combined defect localization versus lateral localization was a highly significant effect identified (p < 0.001). With mesh fixation and larger mesh size, it was possible to significantly reduce the recurrence rate for larger medial hernias in this series (p = 0.046). For TAPP repair of an inguinal hernia, mesh fixation is not necessary in a significant number of patients. Patients with a medial and combined hernia are at higher risk of recurrence. In the patient series analyzed, it was possible to significantly reduce the recurrence rate with mesh fixation and larger mesh size for medial defects. [ABSTRACT FROM AUTHOR]

Objectives: A broad range of factors is known to be associated with speech perception with cochlear implants (CI), such as age at implantation, deprivation of the implanted ear, the moment of deafness being pre or post lingual. Little research has studied the influence of person related factors, such as personal characteristics and optimism, to be associated with CI outcome. It is known from other rehabilitation processes that person related factors can be highly correlated with therapy adherence and rehabilitation outcome. The aim of our research is to study if an association between person-related factors and CI-outcome is likely to exist in adult CI-users. Our hypothesis is that higher positive scores on questionnaire items related to personal factors results in better speech perception with CI. Material: We conducted a retrospective study with post lingual deafened adult CI-users (N=45). We used the perceived pre implantation response to the CPHI35 consisting of the subscales Maladaptive Behavior, Verbal Strategies, Nonverbal Strategies, Acceptance of Loss, Self-Acceptance, and Stress and Withdrawal. As a measure for speech perception, we used the consonant-vowel-consonant (CVC) phoneme scores at 65 dB SPL in quiet prior to implantation and at 4, 6 and 12 months after rehabilitation onset. Methods: We performed correlations between the CPHI35 and the speech perception scores before and after implantation. After we identified cofounders and verified the assumptions for linear regression, we built a multivariate model. Results: Before implantation we found no correlations between the subscales of the CPHI35 and speech perception scores. However, post implantation we found significant correlations between the subscales Maladaptive Behavior and Self-Acceptance at 4 months after rehabilitation onset. Self- Acceptance was also associated with speech perception at 6 and 12 months. In a linear regression model including age at implantation and daily CI usage, the contribution of Selfacceptance to the speech perception at 6 months remained significant. The model explained 40.5% of the variance in the data. Conclusions: CI candidates scoring low on the subscale Self-Acceptance of the CPHI35 before implantation are at risk for lower speech perception with CI. Our findings show that person related factors should be taken into though when considering CI candidates. [ABSTRACT FROM AUTHOR]

Objectives To assess olfactory outcomes in patients undergoing septorhinoplasty surgery in our unit. Design Prospective cohort study. Setting The Royal National Throat Nose and Ear Hospital, London. Participants Forty-three patients undergoing functional septorhinoplasty (Males = 26; mean age = 34.1 ± 12.2) were recruited into the study. Main outcome measures The primary outcome of olfactory function was assessed using 'Sniffin sticks'. Our secondary outcomes were assessment of patient quality of life using the disease specific Sino-nasal Outcome Test-23 questionnaire ( SNOT-23) and a visual analogue scale for sense of smell. These measures were repeated at 12 weeks post operatively. Results There was a significant change in the Sniffin' sticks score post-operatively (8.3 versus 9.6; P < 0.001). The SNOT-23 score also showed a significant improvement post-operatively (53.5 versus 40.4; P < 0.001). A significant improvement was not found in the smell/taste question (question 21) of the SNOT-23 questionnaire as well as the visual analogue scale for sense of smell. A difference in olfactory outcome was not found between open versus closed approaches, primary versus revision surgery and traumatic versus non traumatic cases. Conclusions The results show a measured significant improvement in olfaction following functional Septorhinoplasty but not a subjective improvement in the patients perception of their sense of smell and hence not a clinically significant difference. The reasons for the measured improvement are not clear and are likely to be multifactorial. [ABSTRACT FROM AUTHOR]

Purpose: Mesh repair of large hiatal hernias has increasingly gained popularity to reduce recurrence rates. Integration of iron particles into the polyvinylidene fluoride mesh-based material allows for magnetic resonance visualisation (MR).Methods: In a pilot prospective case series eight patients underwent surgical repair of hiatal hernias repair with pre-shaped meshes, which were fixated with fibrin glue. An MR investigation with a qualified protocol was performed on postoperative day four and 3 months postoperatively to evaluate the correct position of the mesh by assessing mesh appearance and demarcation. The total MR-visible mesh surface area of each implant was calculated and compared with the original physical mesh size to evaluate potential reduction of the functional mesh surfaces.Results: We documented no mesh migrations or dislocations but we found a significant decrease of MR-visualised total mesh surface area after release of the pneumoperitoneum compared to the original mesh size (mean 78.9 vs 84 cm(2); mean reduction of mesh area = 5.1 cm(2), p < 0.001). At 3 months postoperatively, a further reduction of the mesh surface area could be observed (mean 78.5 vs 78.9 cm(2); mean reduction of mesh area = 0.4 cm(2), p < 0.037).Conclusion: Detailed mesh depiction and accurate assessment of the surrounding anatomy could be successfully achieved in all cases. Fibrin glue seems to provide effective mesh fixation. In addition to a significant early postoperative decrease in effective mesh surface area a further reduction in size occurred within 3 months after implantation. [ABSTRACT FROM AUTHOR]

Introduction: Transabdominal preperitoneal hernioplasty (TAPP) is a common procedure for groin hernia repair in adults. The peritoneal closure after mesh placement can be performed in various ways. In any case, thorough closure is recommended to avoid mesh exposure to the viscera with the risk of adhesions and bowel incarceration into peritoneal defects. Postoperative intestinal obstructions can mainly occur due to adhesions or bowel herniation through peritoneal defects into the dissected preperitoneal space. Incarcerations can also occur as a consequence of trocar site herniation. Results and conclusion: Recently barbed self-anchoring knotless suturing devices are frequently used for peritoneal closure. The correct handling of such sutures is crucial to avoid potential complications. Despite of accurate management, bowel adherence and injuries or volvulus can occur. Methods: We present an unusual case of a postoperative small bowel obstruction owing to strained adhesions and ingrowth between a small bowel segment and a polyglyconate unidirectional self-anchoring barbed suture device. Medline and PudMed databases were searched using the below-mentioned keywords and the literature on efficacy and safety of barbed sutures for peritoneal closure is reviewed as well as the usage of such devices in other fields of surgery. [ABSTRACT FROM AUTHOR]

The objective was to analyse outcome and advisability of ossiculoplasty after modified radical mastoidectomy using Kurz Titannium prosthesis. Analysis of ossiculoplasties with partial ossicle replacement prosthesis (PORP) and total replacement prosthesis (TORP) operated between 2012 and 2016 was performed. Mean preoperative and postoperative airbone gaps (ABG) and the changes in mean hearing loss were analysed using a four frequency (500, 1000, 2000 and 4000 Hz) pure tone average. Success rate was defined as postoperative air-bone gap closed to within 20 dB. Radical mastoidectomy is performed in substantially damaged ear, and yet, it is worth to perform reconstruction of the ossicular chain to improve hearing. [ABSTRACT FROM AUTHOR]

The retinoblastoma protein (pRb) and the pRb-related proteins, p130 and p107, form the 'pocket protein' family of cell cycle regulatory factors. A well characterized function of these proteins is the cell cycle-dependent regulation of E2F-responsive genes. The biological activity of pocket proteins is regulated by phosphorylation and for the founding member pRb it has been shown that acetylation also has an important role in modulating its function during the cell cycle. Here, we show that hyperphosphorylated retinoblastoma 2 (Rb2)/p130 also exists in an acetylated form in NIH3T3 cells. Acetylated p130 is present in the nucleus but not in the cytoplasm. Acetylation is cell cycle dependent, starting in S-phase and persisting until late G2-period. Using recombinant p130 and truncated forms for in vitro acetylation by the acetyltransferase p300, we could identify K1079 in the C-terminal part as the major acetylation site by mass spectrometry. Minor acetylation sites were pinpointed to K1068 and K1111 in the C-terminus, and K128 and K130 in the N-terminus. The human papilloma virus 16 protein-E7 preferentially binds to acetylated p130 and significantly increases in vitro p130 acetylation by p300. [ABSTRACT FROM AUTHOR]

Homalodisca vitripennis (Germar) (Hemiptera: Cicadellidae), glassy-winged sharpshooter, was collected in California and several states in the southeastern United States in 2002 and 2003 and analyzed for endosymbiotic bacteria. Hemolymph, eggs, and bacteriomes were examined for the presence of bacteria by polymerase chain reaction. A subset of hemolymph and egg samples had their 16S rRNA gene amplicons cloned and sequenced or analyzed by restriction digest patterns of samples compared with known bacterial DNA. Baumannia cicadellinicola, one of the primary symbionts of glassy-winged sharpshooter, was found in the majority of hemolymph samples, although it has been considered until now to reside primarily inside the specialized host bacteriocytes. Wolbachia sp., a common secondary symbiont in many insect taxa investigated to date, was the second most frequently detected bacterium in hemolymph samples. In addition, we detected bacteria that were most closely related (by 16S rRNA gene sequence) to Pseudomonas, Stenotrophomonas, and Acinetobacter in hemolymph samples of one and/or two glassy-winged sharpshooters, but their origin is uncertain. [ABSTRACT FROM AUTHOR]

Describes the polymorphism of turnip yellow mosaic virus empty shells. Attainment of similar empty shells by submitting the virions to various treatments; Thermodenaturation of natural empty shells present in purified virus suspensions; Types of artificial top component.

Introduction: Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date.Methods: In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques.Results: The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs).Conclusion: In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications. [ABSTRACT FROM AUTHOR]

Introduction: Inguinal hernias are among the most common surgical diseases in Africa. The current International HerniaSurge Guidelines recommend mesh-based surgical techniques in Low Resource Settings (LRS). This recommendation is currently unachievable in large parts of Africa due to the unaffordability of mesh and lack of appropriate training of the few available surgeons. There is, therefore, a need for formal training in mesh surgery. There is an experience in Hernia Repair for the Underserved in Central and South America, however, inadequate evidence of structured training in Africa. Material and methods: Since 2016, the aid Organizations, Surgeons for Africa and Operation Hernia have developed and employed a structured hernia surgical training program for postgraduate surgical trainees and medical doctors in Rwanda. This course consists of lectures on relevant aspects of hernia surgery and hands-on training in operating theatres. The lectures emphasize anatomy and surgical technique. All parts of the training were evaluated. Formal pre-course evaluation was conducted to assess the personal surgical experience of the trainees. Results: Over a 3-year period, a structured hernia training programme was employed to train a total of 36 surgical trainees in both mesh and also non mesh hernia surgery. The key principle in this course is the continuous competence assessment and feedback. Evidence is provided to demonstrate improvement in surgical skills as well as knowledge of surgical anatomy which is essential to acquiring surgical competency. With self-assessment, expressed on a Likert scale, the participants could improve the theoretical knowledge about hernias from median 4.4 (on a scale of 1–10) before training to 8.4 after the training. The specific knowledge about anatomy could be improved in the same assessment from 4.8 before training to 8.1. after the training. After training course 12 of the 36 participants (33.33%) were able to carry out both suture- and mesh-based operations of simple inguinal hernias completely and independently. 20 of the 36 participants (55.55%) required only minimal supervision and only four participants (11.11%) required surgical supervision even after the completion of the course. Conclusion: We have demonstrated that, medical personnel in Africa can be trained in mesh and non-mesh hernia surgery using a structured training programme. [ABSTRACT FROM AUTHOR]

Purpose: Retromuscular mesh augmentation is generally considered to be the ideal technique for repairing ventral hernias and can be performed laparoscopically by 'enhanced view totally extraperitoneal plasty' (eTEP)-a technically complex procedure that requires a high level of surgical expertise. We aimed to develop a simplified technical modification.Methods: Thirty-one patients with ventral hernias were operated with a modified precostal, top-down eTEP approach, and prospectively recorded in our hernia registry. We describe this novel standardized precostal access and the bilateral development of both retromuscular compartments with a cylindrical dilating balloon port. Demographic-, hernia-specific-, and perioperative data were analyzed retrospectively.Results: Twenty-two primary and 9 incisional hernias with an average defect size of 34.5 cm2 were repaired. An average implant of 420 cm2 always completely covered diastasis recti and/or scars from previous midline laparotomies. Average procedure time was 128 min. One conversion was required due to peritoneal injury. Postoperatively there was one local infection and one patient suffered an interparietal herniation. There were no recurrences during the average 8-month follow-up period.Conclusion: With technical modification of precostal access and pneumatic balloon dilation of both retro-rectus compartments, the complex procedure can be simplified through time saving and straightforward unidirectional 'top-down' dissection. The better overview facilitates the crossover for connecting both retro-rectus spaces. In addition, the cranial access allows the anterior- and posterior layers to be closed up to the xiphoid. [ABSTRACT FROM AUTHOR]

Aims: The frequency of the use of intratympanic steroids (ITS) as a treatment for idiopathic sudden sensorineural hearing loss (ISSNHL) in Europe is still unknown and remains a contentious issue amongst otolaryngologists. We undertook a survey of otolaryngologists in Germany and Austria to establish if there is any professional consensus with which to form a protocol for its use.Methods: A survey of 21 questions was distributed electronically to otolaryngologists in Germany and Austria and data on demographics, indications for intratympanic treatment, procedure, follow-up, and outcomes were analysed.Results: We received 908 responses. 49.1% of otolaryngologists used ITS for ISSNHL. Of those otolaryngologists who use ITS, 73.7% do not use it as primary treatment. 20.6% use ITS in conjunction with oral steroids for primary treatment and only 5.8% use ITS as monotherapy for primary treatment. 90.5% use ITS as salvage therapy. 81.1% do not consider the use of ITS after 2 weeks from the onset of symptoms. 8.3% used a tympanostomy tube and while the most commonly used steroid was dexamethasone at a concentration of 4 mg/ml (61%), a wide variety or other steroids and concentrations were used.Conclusions: This survey illustrates wide variation of current practice of intratympanic corticosteroid injection for ISSHL in Germany and Austria. In the absence of high-level evidence, knowing what current practice is allows clinicians to assess what they do against what their colleagues are doing, and if they do something very different, make them question their practice. Moreover, the obtained data will help to direct future clinical trials with the aim to compare the outcomes of more commonly used protocols. [ABSTRACT FROM AUTHOR]

Background: In inguinal hernia repair, chronic pain must be expected in 10-12% of cases. Around one-quarter of patients (2-4%) experience severe pain requiring treatment. The risk factors for chronic pain reported in the literature include young age, female gender, perioperative pain, postoperative pain, recurrent hernia, open hernia repair, perioperative complications, and penetrating mesh fixation. This present analysis of data from the Herniamed Hernia Registry now investigates the influencing factors for chronic pain in male patients after primary, unilateral inguinal hernia repair in TAPP technique.Methods: In total, 20,004 patients from the Herniamed Hernia Registry were included in uni- and multivariable analyses. For all patients, 1-year follow-up data were available.Results: Multivariable analysis revealed that onset of pain at rest, on exertion, and requiring treatment was highly significantly influenced, in each case, by younger age (p < 0.001), preoperative pain (p < 0.001), smaller hernia defect (p < 0.001), and higher BMI (p < 0.001). Other influencing factors were postoperative complications (pain at rest p = 0.004 and pain on exertion p = 0.023) and penetrating compared with glue mesh fixation techniques (pain on exertion p = 0.037).Conclusions: The indication for inguinal hernia surgery should be very carefully considered in a young patient with a small hernia and preoperative pain. [ABSTRACT FROM AUTHOR]

Background: Adhesion formation remains an important issue in hernia surgery. Liquid agents were developed for easy and versatile application, especially in laparoscopy. The aim of this study was to compare the antiadhesive effect of fibrin sealant (FS, Artiss®), Icodextrin (ID, Adept®) and Polyethylene glycol (PEG, CoSeal®) alone and in combination and to evaluate the resulting effect on tissue integration of the mesh.Methods: A total of 56 Sprague-Dawley rats were operated in open IPOM technique. A middleweight polypropylene mesh of 2 × 2 cm size was implanted and covered with 1: FS, 2: ID, 3: PEG, 4: FS + ID, 5: FS + PEG, 6: PEG + ID, 7: control group, uncovered mesh (n = 8 per treatment/control). Observation period was 30 days. Macroscopic and histological evaluation was performed.Results: Severe adhesions were found in group 2 (ID), group 6 (PEG + ID) and the controls. Best results were achieved with FS alone or FS + ID. Mesh integration in the treatment groups was reduced in comparison with the control group. This is a new finding possibly relevant for the outcome of intraperitoneal mesh repair. Group 6 (PEG + ID) showed an impairment of tissue integration with <50 % of the mesh surface in seven samples.Conclusion: FS alone and in combination with ID yielded excellent adhesion prevention. ID alone did not show significant adhesion prevention after 30 days. Tissue integration of FS-covered meshes was superior to ID or PEG alone or combined. PEG did show adhesion prevention comparable to FS but evoked impaired tissue integration. So Artiss® is among the most potent antiadhesive agents in IPOM repair. [ABSTRACT FROM AUTHOR]

Purpose: In patients with terminal ostomies, parastomal hernias (PSHs) occur on a frequent basis. They are commonly associated with various degrees of complaints and occasionally lead to life-threatening complications. Various strategies and measures have been tested and evaluated, but to date there is a lack of published evidence with regard to the best surgical technique for the prevention of PSH development.Methods: We conducted a retrospective analysis of prospectively collected data of eighty patients, who underwent elective permanent ostomy formation between 2009 and 2014 by means of prophylactic implantation of a three-dimensional (3D) funnel mesh in intraperitoneal onlay (IPOM) position.Results: PSH developed in three patients (3.75%). No mesh-related complications were encountered and none of the implants had to be removed. Ostomy-related complications had to be noted in seven (8.75%) cases. No manifestation of ostomy prolapse occurred. Follow-up time was a median 21 (range 3-47) months.Conclusion: The prophylactical implantation of a specially shaped, 3D mesh implant in IPOM technique during initial formation of a terminal enterostomy is safe, highly efficient and comparatively easy to perform. As opposed to what can be achieved with flat or keyhole meshes, the inner boundary areas of the ostomy itself can be well covered and protected from the surging viscera with the 3D implants. At the same time, the vertical, tunnel-shaped part of the mesh provides sufficient protection from an ostomy prolapse. Further studies will be needed to compare the efficacy of various known approaches to PSH prevention. [ABSTRACT FROM AUTHOR]

Purpose: Parastomal hernias (PSHs) have been a major clinical problem. The aim of this study was to evaluate a new method of PSH repair in combination with an additional flat mesh reinforcement of the abdominal wall. Methods: In a pilot case series, seven patients suffering from complex PSHs (≥5 cm diameter and/or recurrence) underwent surgery and were treated by intraperitoneal onlay technique (IPOM) with a synthetic 3-D funnel-shaped mesh implant. The demographics, perioperative, and follow-up data are presented in this report. Results: The surgical strategy varied between purely laparoscopic ( n = 1), laparoscopically assisted (hybrid n = 3), or open techniques ( n = 3) using original or suture-reconstructed mesh devices. The funnel mesh implantations in IPOM technique were combined with attached flat meshes in the appropriate position of the abdominal wall. No procedure-related complications occurred. The mean length of hospital stay was 12 days and the mean operating time was 171 min. No recurrence of PSH or incisional hernias was observed during a mean follow-up period of 12.3 months (range from 7 to 22). Conclusion: The use of a 3-D mesh implant has so far shown to be a promising option in the treatment of primary and recurrent PSHs. Its use proved to be reasonable in both laparoscopic and open IPOM technique. PSHs were preferably repaired using the original, unmodified implant, but when we also found it safe to incise, place and then suture the mesh around the pre-existing ostomy. [ABSTRACT FROM AUTHOR]

Aim Transanal irrigation (TAI) has been reported to be a cheap and effective treatment for the 'anterior resection syndrome (ARS)'. This study aimed to evaluate its effect on the quality of life (QOL) of patients suffering from ARS. Method In a prospective study involving two colorectal centres, 14 patients (11 male; median age 68 (45-80) years) were included in the study. The median duration of ARS was 19 (9-48) months. The median number of defaecations was 8 (4-12)/day and 3 (2-5)/night. All patients were trained to perform TAI using the Peristeen™ System under the guidance of a stoma nurse. Anal physiology was performed, quality of life (QOL) was estimated by the SF-36 and Rockwood (ASCRS) questionnaires and continence by the Cleveland Incontinence Score. Results At the last follow up the median time of using TAI was 29 (15-46) months. The median volume of water used for the irrigation was 900 (500-1500) ml. There was a significant decrease in the number of defaecations during the day (baseline, 8 [4-12]; last follow up, 1 [1-2]) and at night (baseline, 3 [2-5]; last follow up, 0 [0-0]). The Cleveland Incontinence Score fell from 17 [15-20] (baseline) to 5 [4-9] (last follow up) and the mental component of the SF-36 and all domains of the Rockwood QOL instrument improved. Conclusion Transanal irrigation is an effective treatment of anterior resection syndrome and results in a marked improvement of the continence score and QOL. [ABSTRACT FROM AUTHOR]

Aspergillus pleural empyema is a rare but often fatal infection complicating thoracic surgery. Three men and one woman aged 23–47 years were diagnosed with Aspergillus pleural empyema after lung resection. Underlying diseases were lung cancer ( n = 2), Hodgkin’s disease ( n = 1) and thoracic trauma ( n = 1). The treatment protocol consisted of systemic anti-fungal treatment with caspofungin and voriconazole, intrapleural application of amphotericin B and surgical debridement with secondary closure of the leaking bronchial stump. Two patients with chronic Aspergillus pleural empyema had been pretreated with itraconazole and/or amphotericin B. Two patients were treated with a thoracostoma. Two patients had undergone pneumonectomy for previously diagnosed pulmonary aspergillosis. Caspofungin was given for 13–60 days, Voriconazole for up to 100 days. Surgical debridement was performed in all cases and in two cases the created thoracostoma was closed during a second surgical procedure. Aspergillus PCR using blood samples, bronchoalveolar lavage or aspiration fluid was used for monitoring. All four patients had complete clinical and microbiological remission. Our case series shows promising results and underscores the importance of a combined therapeutic approach for Aspergillus pleural empyema consisting of anti-fungal treatment and surgery. Voriconazole and caspofungin seem to be a suitable combination for this infection. [ABSTRACT FROM AUTHOR]

In continuous casting of steel, the slow solidification results in a flat increase of the solidified shell thickness. Thus, the liquid core reaches up to 20 m into the strand. In most of the numerical flow simulations of continuous steel casting, the solidification process and its influence on the flow are completely neglected. Furthermore, only the upper part of the liquid core is simulated, which requires the introduction of an unphysical boundary condition at the lower bound of the simulated domain. On the other hand, the flow of the liquid steel in numerical solidification simulations is often not considered because of the complexity of solidification models. In this paper, a model that considers the shape of the solidification front in the flow simulation as well as the loss of material through the solidification front is presented. Therefore, the shell thickness has to be known a priori from theoretical or empirical results. Thus it is possible to model a great part of the liquid core inside the strand with respect to inclusion behaviour and variations of the solidified shell thickness due to the flow. Applications to intermediate, thick and thin slab casters as well as round bloom casters will be described. [ABSTRACT FROM AUTHOR]

Background: Candida krusei (Ck) may cause severe infections in immunocompromised hosts and is innately resistant to fluconazole.Patients and Methods: During an 18-month period, seven patients with Ck infection were identified at our center. All were treated in the transplant intensive care unit. Candida isolates were grown on Sabouraud agar, and chromosomal DNA was extracted; clonality was investigated using random amplified polymorphic DNA-polymerase chain reaction with primers M13, OPA-18, and OPE-18.Results: Among the patients with Ck infection, there were three pancreas recipients with intra-abdominal infection, one liver recipient with cholangitis, one lung recipient with pleural empyema, one patient with pleural empyema after esophageal perforation, and one case of pneumonia in a patient with a ventricular assist device. Treatment consisted of caspofungin (n = 3), voriconazole (n = 1), or a combination of the two (n = 2) together with surgery (n = 3) or pigtail catheter drainage (n = 3). One patient underwent drainage without antifungal treatment, and one patient did not have drainage. The infection was controlled in all cases. The patient with the assist device died from multiple organ dysfunction, the lung recipient died after four months from graft failure, and one pancreas graft was lost. Four patients (57%) harbored the same Ck strain.Conclusion: Solid organ recipients seem to be at particular risk for Ck infections; clonal outbreaks may occur in intensive care units. [ABSTRACT FROM AUTHOR]

Genetic predisposition, environmental toxins and aging contribute to Parkinson's disease (PD) multifactorial etiology. Weak environmental neurotoxic factors may accumulate over time increasing the disease risk in genetically predisposed subjects. Polymorphic genes encoding drug-metabolizing-enzymes (DMEs) are considered to account for PD susceptibility by determining individual toxic response variability. In this work, the allelic distributions and genotype associations of three major brain-expressed DMEs were characterized, in sporadic PD cases and controls. No significant association was found between CYP2D6 genotype and PD, but subjects with extensive metabolizer (EM) CYP2D6 phenotype, and the variant GSTP1*B genotype were at significantly higher PD risk than the corresponding poor or intermediary metabolizers ( CYP2D6 poor metabolizer phenotype+intermediary metabolizers). A significant association was observed between the GSTP1*B allele and zygosity with PD ( GSTP1*A/*B– 51.58%/34.37%, odds ratio (OR) = 2.29; 95% confidence interval (95% CI) = 1.25–4.18; * B/* B– 6.32%/1.05%, OR = 10.67; 95% CI = 1.19–94.79). This association was particularly strong in the elder patients group (≥69 year) who showed double PD risk for GSTP1*B heterozygous, whilst GSTP1*B/*B homozygous were exclusively found amongst patients. An interaction between GSTM1 and GSTP1 was observed in this late onset PD group. The present results suggest that native GSTP1 encoding the fully active transferase variant should play a relevant role in dopaminergic neuroprotection. [ABSTRACT FROM AUTHOR]

A gel based on aqueous solutions of cysteine and silver nitrate is obtained for the first time. The possibility of gelation in the presence of competing ions and ligands is studied. Structural transformations occurring at an early stage of the gelation are studied by the dynamic light scattering, IR Fourier spectroscopy, and viscometry. The process of the self-organization in the system under consideration is assumed to be accompanied by the formation of fractal structures. [ABSTRACT FROM AUTHOR]

Cigarette smoking has inconsistently been associated with an increased risk of colorectal cancer. One of the enzymes responsible for the detoxification of the carcinogenic compounds present in tobacco smoke is glutathione S -transferase-μ (GST-μ). The gene that codes for this enzyme is GSTM1 . In this study, we evaluated the associations and interaction between GSTM1 deletion, smoking behaviour and the development of colorectal cancer. We performed a pooled analysis within the International Collaborative Study on Genetic Susceptibility to Environmental Carcinogens (GSEC). We selected six studies on colorectal cancer, including 1130 cases and 2519 controls, and restricted our analyses to Caucasians because the number of patients from other races was too limited. In addition we performed a meta-analysis including the studies from the GSEC database and other studies identified on MEDLINE on the same subject. The prevalence of the GSTM1 null genotype was within the range reported in other studies: 51.8% of the cases had the GSTM1 null genotype versus 56.6% of the controls. No significant association between the GSTM1 null genotype and colorectal cancer was found (odds ratio 0.92, 95% confidence interval 0.73-1.14). Our results suggest a possible positive association between lack of the GST-μ enzyme and colorectal cancer for non-smoking women (odds ratio 1.47, 95% confidence interval 0.80-2.70). There was no interaction between the effects of smoking and GSTM1 genotype on colorectal cancer risk in men and women (χ 2 =0.007, p =0.97). Our findings do not support an association between the GSTM1 null genotype and colorectal cancer. In addition, we did not find any modification of the smoking-induced colorectal cancer risk by GSTM1 genotype [ABSTRACT FROM AUTHOR]

There is no doubt that respirometry is a useful measurement principle in the field of wastewater treatment. Although a large variety of methods and case studies have been published, respirometry has become neither a standard tool for control nor for assessment and optimisation of treatment plants. The drawback of the conventional method for determining nitrification kinetics is the long experimental time. This disadvantage can be avoided by ?turning over? the experiment. Starting with low ammonia concentrations the steep slope of the Monod curve is measured first. The low concentration branch of the Monod curve is also the part where e.g. inhibition can be detected. Therefore the proposed procedure allows us to speed up the measurement of nitrification kinetics and to measure nitrification inhibition on-line.