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Objective: To investigate the differences in hernia recurrence and chronic postoperative inguinal pain (CPIP) in randomized, controlled trials comparing fixation and non-fixation of the mesh in laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. Methods: A multi-database systematic search was conducted for randomized, controlled trials comparing fixation versus non-fixation of the mesh in TAPP inguinal hernia repair. All eligible papers were assessed for risk of bias using the revised Cochrane risk of bias tool for randomized trials (RoB 2.0). Quality of evidence was evaluated using the GRADE system. Meta-analyses were performed regarding recurrence and CPIP using RevMan. Results: Seven prospective, randomized controlled trials were included. Laparoscopic TAPP inguinal hernia repair was performed in 1732 patients with 737 procedures performed without fixation and 995 procedures with fixation of the mesh. Despite all trials being RCTs, the trials were limited by substantial bias and the quality of evidence was low regarding hernia recurrence and very low regarding CPIP. Pooled estimates from meta-analyses were an OR of 2.80 (95% CI 0.61–12.77) for hernia recurrence and a mean difference in visual analogue scale (VAS) of 0.17 (95% CI 0.90–1.24) for CPIP, respectively. Conclusion: The current evidence is very uncertain and mesh fixation may have little to no effect regarding hernia recurrence and chronic postoperative inguinal pain in patients operated with TAPP inguinal hernia repair.

Abstract On 4 July 2000, two workshops on handling emergencies in rural areas of Europe were held at the WONCA (World Organisation of National Colleges and Academies of Family Medicine/General [...]

The waters on the West Greenland continental shelf and slope play an important role in the global climate system with their link to the subpolar North Atlantic Ocean circulation system and the Greenland Ice Sheet. Lately, low temperature waters on the West Greenland shelf have been observed as far south as ∼64°N and associated with a cold and relatively saline water mass originating north of Davis Strait in Baffin Bay referred to as Baffin Bay Polar Water (BBPW). Here we use long, seasonal hydrographic time series from West Greenland at ∼64°N to study how frequently BBPW is reaching this far south. The analysis covers the period 1950–2018 with a data gap between 1988 and 2005. BBPW was observed frequently and was responsible for the temperature changes observed in the late 1960s–1980s and more intermittently post‐2008. Some of the large temperature changes we observe in the time series have previously been ascribed to “Great Salinity Anomalies” (GSAs) propagating around the subpolar North Atlantic Ocean circulation system. The prevailing view of the propagation of GSAs has been ascribed to advection of anomalies along the large‐scale circulation system. Our study shows that BBPW may play an important role in the interpretation of GSAs and melt of the Greenland Ice Sheet. Large temporal temperature changes at ∼64°N are associated with arrival of BBPW from the north and not advection of anomalies with the large‐scale current system from the south. This advocates for a shift in water masses caused by changes in the position and/or strength of oceanic currents. The Greenland Ice Sheet is likely to experience significant mass losses in coming decades. One of the challenges is to understand the changing physical nature of waters on the adjacent continental shelf and their effects on tidewater glacier fjords. Lately, low temperature waters on the West Greenland shelf have been observed as far south as ∼64°N and associated with a cold and relatively saline water known as Baffin Bay Polar Water (BBPW) mass originating north of Davis Strait in Baffin Bay. We use unique, long, seasonal hydrographic time series from the West Greenland continental shelf at ∼64°N and an adjacent proglacial fjord to study how frequently BBPW is reaching this far south in the period 1953–2018. BBPW was observed at ∼64°N in the following years: 1954–1955, 1968–1976, 1980–1983, 1985, 1987, 2008, 2012, and 2015–2017. This study shows that BBPW may play an important role in the interpretation of the large‐scale subpolar North Atlantic Ocean circulation system and melt of the Greenland Ice Sheet. We present long‐term seasonal hydrographic time series from the West Greenland shelf at 64°N and adjacent proglacial fjordThe time series reveal the recurrence of Baffin Bay Polar Water (BBPW), a northern water mass originating in Baffin BayLarge temporal temperature changes are associated with arrival of BBPW and not advection of anomalies with the large‐scale current system We present long‐term seasonal hydrographic time series from the West Greenland shelf at 64°N and adjacent proglacial fjord The time series reveal the recurrence of Baffin Bay Polar Water (BBPW), a northern water mass originating in Baffin Bay Large temporal temperature changes are associated with arrival of BBPW and not advection of anomalies with the large‐scale current system

Prior to the general use of antibiotics following World War II, acute mastoiditis was a common clinical diagnosis for an acute infection of the mastoid (the bony breast-like bump found just behind the ear). Classical mastoiditis was usually associated with swelling and redness of the area, and was often associated with displacement of the external ear (the auricle). The condition was treated by mastoidectomy, in which the bony space was opened by a dental drill; open pus and inflammation of the membrane of the bone were usually found. Mastoiditis could progress to the brain case; meningitis (inflammation of the membranes of the brain), cerebral abscess, and possible thrombosis (a blood clot) of the brain's veins could result. As the use of antibiotics increased, the number of patients who required mastoidectomy dropped dramatically. From 1985 to 1988, in an Oslo, Norway hospital, there was an increased number of patients who required mastoidectomy for classical mastoiditis. Most of these patients were admitted during the autumn or winter months when upper respiratory infections are common. Of 24 patients operated on for mastoiditis, 10 were found to have upper respiratory complaints in addition to their infections of the middle ear and mastoid bone. All patients admitted to the hospital with a diagnosis of mastoiditis were operated on and most received antibiotics. However, there was no difference in discharge time following surgery between those patients who did and did not receive antibiotics. Given the broad spectrum of antibiotics available, the reason for the increased incidence of mastoiditis in these patients is not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

The Campania Region has one of the highest renewable energy potentials in Italy. Despite this high potential, the lack of an integrated energy strategy has allowed for deregulated exploitation of the resources of the territory, e.g. surplus of wind energy occurs in Campania due to the large wind farms, geothermal energy is mainly used for thermal baths but its enthalpy could meet domestic heating demand, etc. A lack of an “integrated planning”, does not to make the best use of resources and to contribute to greenhouse gas (GHG) emission reduction.

A model for two-phase pipeline flow is presented, with evaporation and condensation modelled using a relaxation source term based on statistical rate theory. The model is solved numerically using a Godunov splitting scheme, making it possible to solve the hyperbolic fluid-mechanic equation system and the relaxation term separately. The hyperbolic equation system is solved using the multi-stage (MUSTA) finite volume scheme. The stiff relaxation term is solved using two approaches: one based on the Backward Euler method, and one using a time-asymptotic scheme. The results from these two methods are presented and compared for a CO2 pipeline depressurisation case.

Disease activity is highly variable in patients with multiple sclerosis (MS), both untreated and during interferon (IFN)- therapy. Breakthrough disease is often regarded as treatment failure; however, apart from neutralizing antibodies (NAbs), no blood biomarkers have been established as reliable indicators of treatment response, despite substantial, biologically measurable effects. We studied the biologic response to treatment in a cohort of NAb-negative patients to test whether difference in responsiveness could segregate patients with and without breakthrough disease during therapy.

Recently, the Intergovernmental Panel on Climate Change has issued new Good Practice Guidance for Land Use, Land-Use Change, and Forestry (GPG–LULUCF), which stipulates different data analysis and reporting procedures for changes in carbon storage and greenhouse gas (GHG) emissions for six land classes: forest, cropland, grassland, wetland, settlements, and other lands. However, the GPG–LULUCF does not include a decision tree to support the identification and classification of lands. This is a critical first step necessary to proceed on land classification for subsequent calculation of GHG inventories. This article provides a useful decision tree and dichotomous key for classifying lands according to the GPG–LULUCF. Countries and the international community will need this tool to unify common criteria for land classification.

Two natural products have been synthesized using a ZnCl2-mediated benzylic coupling reaction. Both are potent inhibitors of the GTPase activity of FtsZ, a highly conserved protein that is essential for bacterial cytokinesis.

The article focuses on rainforests and its destruction. A background information on rainforests is given. The importance of rainforests are stated. The status and destruction of rainforests are discussed. Some ways to prevent further rainforest destruction by governments and corporations are presented.

In a double-blind controlled study on 45 rheumatoid arthritis patients, no effect of tranexamic acid (Cyklocapron®, 4.5 g per day for 6 weeks) was found in terms of subjective or objective parameters of disease activity. Tranexamic acid did not reduce complement activation, measured by plasma concentrations of the complement C3 split product C3d. Immune complex concentrations in serum were also unaffected. We conclude that plasmin inhibitors do not reduce immune complex mediated complement activation, and they should not be used for treatment of rheumatoid arthritis.

The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extra-laryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, Whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.

Synovial fluid (SF) from rheumatoid arthritis patients (RA) and culture-supernatants of synovial tissue (ST) cells from RA patients and juvenile rheumatoid arthritis (JRA) patients were examined for their ability to promote B cell growth. SF was not suitable for studying B cell growth promotion because with the anti-n driven assay system employed, all 15 samples strongly inhibited B cell proliferation. Supernatants of in vitro unstimulated ST cells from RA and JRA patients affected B cell growth in different ways, ranging from strong inhibition to moderate stimulation. Supernatants of unstimulated peripheral blood mononuclear cells (MNC) from healthy donors did not influence B cell proliferation. After phytohaemagglutinin (PHA) stimulation of the ST cells and normal MNC, culture supernatants of RA ST cells and normal MNC all stimulated B-cell growth, while culture supernatants of PHA-stimulated JRA ST cells displayed a variable picture. The differences between PHA-supernatants from RA, JRA and normal MNC were not statistically significant. These results indicate that the inflamed synovia of JRA and RA patients contain cells that can produce soluble factors with B cell growth promoting activity. Some of the data in the study suggest that these factors are produced in vivo and thus might be responsible for the observed B-cell activaton in joints of these patients.

Uvulopalatopharyngoglossoplasty, UPPGP, is a modification of the uvulopalatopharyngoplasty, UPPP, technique, originally used for surgical treatment of the obstructive sleep apnea syndrome. The first method seems to be the more successful. However, polysomnography performed after UPPGP showed that about 35% of the patients still had obstructive apnea periods during sleep. Eight of these patients were reoperated with a new technique which is a combination of partial tongue resection and anterior suspension of the tongue (glossopexia). After glossopexia all the patients were subjectively relieved of their symptoms. However, polysomnography carried out postoperatively demonstrated that only 2 patients were objectively cured. The authors want to stress the necessity of meticulous polysomnographical registration pre- and postoperatively. Subjective and objective parameters recorded before and after surgery are discussed.

Abstract. In a double-blind cross-over study we compared pituitary and methionine-free biosynthetic human growth hormone (P-hGH and B-hGH) with respect to pharmacokinetics and short-term metabolic effects in 9 hypopituitary children. They treated themselves for 4 weeks with 2 IU scdaily at 20.00 h. After admittance to hospital 2 IU was given: im the first day, and scthe second. They then switched over to the alternative preparation. The serum profiles of B- and P-hGH were identical. Comparing im and scadsorption, the latter was slower and resulted in smaller areas under the curves, indicating greater local degradation.Both preparations caused identical increases in somatomedin-C, but slightly more sustained after scinjection. Plasma glucose, plasma glucagon, and serum insulin fluctuated within normal ranges. The glucose profile pointed at a modest anti-insulin effect of hGH when given in the morning. The concentration in the blood of lactate, alanine, glycerol and B-OH-butyrate, and in serum of triglyceride, cholesterol and carbamide revealed no abnormalities with either hGH preparation. Finally, no development of anti-GH or E. coli polypeptide antibodies was seen. In conclusion, the pharmacokinetics and short-term metabolic effects of B-hGH and P-hGH were identical.

A total of 327 patients were included in a play-the-winner (PTW)-designed study comparing the safety of prophylaxis with enoxaparin and dextran-70 in patients undergoing digestive surgery. In a PTW-designed study the treatment of any next patient will depend on the outcome of the previous one. If successful, the next patient will receive the same treatment. Excessive bleeding, on the basis of specified criteria, severe adverse effects, or occurrence of clinically detected venous thromboembolism was classified as failure. The PTW design allocates most patients to the superior treatment. In this study 200 patients were given enoxaparin and 127 dextran-70. The success rate was 83% in the enoxaparin group and 74.8% in the dextran-70 group (p = 0.05). The survival analysis of 'Number of patients before change in treatment' shows a significant difference in favour of enoxaparin (p = 0.05). Enoxaparin seems to be superior to dextran-70 as a prophylaxis in digestive surgery. The PTW model is a suitable design in such studies.

The high affinity of 45Ca binding to the low density lipoprotein receptor (LDL-R) and the LDL-R-related protein (LRP) was utilized to study the subcellular distribution of these two proteins in rat liver. Like the LDL-R, LRP was manyfold enriched in rat liver endosomal membranes with a relative distribution in early and late endosomal compartments consistent with recycling between endosomes and the cell surface. The high concentration of LRP in hepatic endosomal membranes greatly facilitated demonstration of Ca-dependent binding of apolipoprotein E- and B-containing lipoproteins in ligand blots. LRP was severalfold more abundant than the LDL-R in hepatic parenchymal cells, showed extensive degradation in hepatic endosomes, and was found in high concentrations in the Golgi apparatus and endoplasmic reticulum. These data suggest a high rate of synthesis of LRP that appeared to be unaffected by treatment of rats with estradiol. The repeating cysteine-rich A-motif found in the ligand-binding domain of LRP appeared to be responsible for Ca binding by LRP, LDL-R, and complement factor C9 and accounted for immunological cross-reactivity among these proteins. Weaker ligand-blotting properties and an extraordinary susceptibility to proteolysis most likely contribute to the difficulty of detecting LRP in conventional assays for lipoprotein receptors. Our data suggest an extensive proteolytic processing of this protein and are consistent with a functional role of LRP in lipoprotein metabolism.

Thermoplastic short fibre composite materials are increasingly being used as insulating materials in electricity distribution. Economically they possess good opportunities for material recycling and reuse due to the high virgin price. To investigate the recycling potential of post-consumer components, PPS40%GF and PBT30%GF, representing commonly used insulating materials, have been artificially aged and recycled.To simulate 10 years of service life, injection moulded tensile bars have been aged in different environments varying temperature, humidity and pH. After accelerated ageing, the ageing state has been characterized by tensile and impact strength, viscoelastic behaviour (DMTA), molecular weight, crystallinity (DSC) and fracture behaviour (SEM). These properties have been compared to virgin material. The aged materials have been recycled by regranulation and compounding with different ratios virgin/aged material and different coupling agents to repair the glass-matrix interface. Injection moulded compounds were characterised by short and long term properties.Recompounding PBT30%GF with virgin material and no added coupling agents results in a partial recovery of the fibre-matrix adhesion. Based on the first short-term characterisations PBT30%GF seems not very suitable for reuse in primary applications. PPS40% GF seems more suitable for reuse in primary applications after recycling. Although the short-term mechanical properties of the aged batches do not recover after recycling, the fibre-matrix adhesion improves especially when adding coupling agents. Further long-term testing in creep and humid environments during the remaining part of this project will show whether the improved interface properties make recycled materials valuable for reuse in various industrial applications.

The effects of simvastatin 40 mg per day for 14 weeks on the pituitary-testis axis of 19 men with familial hypercholesterolaemia have been examined in a single-blind study.

In order to evaluate the anticholinergic effect of antidepressant drugs, 11 healthy volunteers were given single oral doses of reference drug, test drugs or placebo on a double-blind basis at weekly intervals. The doses corresponded to average daily patient medications. Spontaneous whole mouth and parotid salivation, and plasma levels of drug and possible metabolites were measured 2, 6 and 10h after drug administration.

A SYNDROME has recently been described1 which is characterized by chronic eosinophilia and eosinophilic granulomatous lesions of the liver associated with fever, leukocytosis, hyperglobulinemia and pulmonary changes. This syndrome has been related to the group of disorders characterized by eosinophilia and pulmonary changes which include Löffler's syndrome2 and tropical eosinophilia.3The etiologic basis of this syndrome has not been proved, but it has been assumed to represent an allergic response to unknown antigens with the liver acting as a "shock organ."lb In one report the antigen is assumed to be a toxin from the helminth Ascaris lumbricoides.1aA patient with the aforementioned clinical entity in whom the basic etiologic mechanism could be clearly demonstrated was recently studied in this clinic. The hepatic lesions were found to be caused by the presence within that organ of the larvae of A. lumbricoides. This patient's case is presented

Gibberellic acid promoted the elongation of internodes but decreased the leaf area. Stover weight and grain yield were increased when gibberellic acid was applied near pollination. Early treatments at weekly intervals decreased grain yield. The yield of Hy2 ✕ O7 was affected more than that of Wf9 ✕ Ml4.

HURLER'S syndrome, gargoylism, lipochondrodystrophy, or dysostosis multiplex was defined by Washington as. . . a disease of congenital origin characterized by chondrodystrophic changes in the skeleton with a tendency toward the deposition of a lipid substance in the tissue, particularly in the brain. On pathologic examination, changes resembling those of amaurotic idiocy are found. The condition appears to combine certain features of Morquio's Disease with some features of Niemann-Pick's Disease. Clinically, it is characterized by dwarf-like stature with marked shortening of the trunk and neck; enlargement and often distortion of the skull with depression of the bridge of the nose and coarseness of facial features; limitation of motion of joints and kyphosis; protrusion of the abdomen with hepato-splenomegaly; clouding of the corneae and mental deficiency. The last two are often absent.1REVIEW OF THE LITERATURESince as far back as 1865, a number of such syndromes have been described, characterized

The apical meristem of the root affords an excellent material with which to study changes in cellular components accompanying growth and differentiation. The ontogeny of cytoplasmic particles can be followed, since the younger cells are constantly dividing and reforming new cytoplasm. Electron microscope pictures of these newly formed cells reveal a dense background of microsomal granules and small, thin walled vesicles of the endoplasmic reticulum. Two types of mitochondria are noted and, as the cells enlarge, mitochondria regarded as immature can no longer be seen, but only mitochondria with well developed cristae. The development of these cristae was found to be associated with an increase in respiration of the tissue as well as with increased rates of oxidation and phosphorylation of isolated mitochondria. As the cells grow and mature, the mitochondria make up an increasing percentage of the total cytoplasmic protein, and this increase probably accounts to a great extent for the increase in tissue respiration. Concomitantly, there is a decrease in microsomal granules. All these changes have been verified by electron microscope pictures of cells in situ, chemical analysis of isolated particulates, and metabolic studies of tissue and isolated fractions.

The accelerated melt of the Greenland Ice Sheet has been linked to a sudden increase in the presence of warm subsurface coastal water in west Greenland. Yet pathways of warm coastal water along the entire west Greenland coast have remained largely unstudied. Here we present the first, near‐synoptic hydrographic observations at both the continental slope and fjord entrances of the west Greenland coastal system from Cape Farewell (59°N) to Melville Bay (75°N) in summer 2016. We observed a distinct north‐south division in the water mass distribution in west Greenland, approximately partitioned by the northern part of Davis Strait, and a division between the continental slope and fjord entrances. Waters from the regional southern freshwater source with origin in the East Greenland Current that rounds Cape Farewell are not observed to enter Baffin Bay. The regional heat source transported by the west Greenland Current is blocked by Southwest Greenland Coastal Water in the south but the deep connections in the north allow warm deep Subpolar Mode Water to enter fjords. Furthermore, we observed cold and relative saline Baffin Bay Polar Water over the inner part of the banks, periodically reaching as far south as 64°N, suggesting the presence of an undescribed southward current at the Southwest Greenland continental shelf. The regional southern freshwater source transported northward along the Greenland west coast did not enter Baffin Bay during summer 2016North of Davis Strait, warm deep Subpolar Mode Water may enter the deep silled fjords unobstructedBaffin Bay Polar Water is observed on the Southwest Greenland coast as far south as 64°N suggesting a seasonal southward coastal current

Abstract. A review of the literature shows that no studies on children with primary genetic lipid disorders have been published. Case reports are presented indicating that hyperlipidaemias presenting in children—both familial hypercholestrolaemia and disorders with secondary hyperlipidaemia (triglycerides) may benefit of the intake of n‐3 fatty acids.

The electrochemical reduction of the triphenylthiopyrylium cation (I) is investigated by cyclic voltammetry and preparative reduction in the presence of alkyl halides such as (II) to give the products (III) and (IV).

The reaction between a number of anion radicals and d,l‐ and meso compounds (I) is shown to be a purely catalytic reduction, and the rates of the electron transfer are measured by cyclic voltammetry and double potential step chronoamperometry.

Indirect electrochemical reductions of benzyl chlorides (I) and (II) are investigated by cyclic voltammetry and preparative electrolysis.

Benzotriazole (I) is reduced polarographically in protic and aprotic media to give (II) or (IV) and the product (III) of reductive cyclization, respectively.

The title reaction is employed for the reduction of vinyl halides such as (I), (III) and (V).