Perioperative optimization in complex abdominal wall hernias: Delphi consensus statement.

BACKGROUND: The incidence of incisional hernia after major abdominal surgery via a midline laparotomy is 20-41 per cent with short-term follow-up, and over 50 per cent in those surviving an abdominal catastrophe. Abdominal wall reconstruction (AWR) requires complex operations, often involving mesh resection, management of scarred skin, fistula takedown, component separation or flap reconstruction. Patients tend to have more complex conditions, with multiple co-morbidities predisposing them to a vicious cycle of complications and, subsequently, hernia recurrence. Currently there appears to be variance in perioperative practice and minimal guidance globally. The aim of this Delphi consensus was to provide a clear benchmark of care for the preoperative assessment and perioperative optimization of patients undergoing AWR. METHODS: The Delphi method was used to achieve consensus from invited experts in the field of AWR. Thirty-two hernia surgeons from recognized hernia societies globally took part. The process included two rounds of anonymous web-based voting with response analysis and formal feedback, concluding with a live round of voting followed by discussion at an international conference. Consensus for a strong recommendation was achieved with 80 per cent agreement, and a weak recommendation with 75 per cent agreement. RESULTS: Consensus was obtained on 52 statements including surgical assessment, preoperative assessment, perioperative optimization, multidisciplinary team and decision-making, and quality-of-life assessment. Forty-six achieved over 80 per cent agreement; 14 statements achieved over 95 per cent agreement. CONCLUSION: Clear consensus recommendations from a global group of experts in the AWR field are presented in this study. These should be used as a baseline for surgeons and centres managing abdominal wall hernias and performing complex AWR.

Measuring quality of life in patients with abdominal wall hernias: a systematic review of available tools.

INTRODUCTION: Abdominal wall herniation (AWH) is an increasing problem for patients, surgeons, and healthcare providers. Surgical-site specific outcomes, such as infection, recurrence, and mesh explantation, are improving; however, successful repair still exposes the patient to what is often a complex major operation aimed at improving quality of life. Quality-of-life (QOL) outcomes, such as aesthetics, pain, and physical and emotional functioning, are less often and less well reported. We reviewed QOL tools currently available to evaluate their suitability. METHODS: A systematic review of the literature in compliance with PRISMA guidelines was performed between 1st January 1990 and 1st May 2019. English language studies using validated quality-of-life assessment tool, whereby outcomes using this tool could be assessed were included. RESULTS: Heterogeneity in the QOL tool used for reporting outcome was evident throughout the articles reviewed. AWH disease-specific tools, hernia-specific tools, and generic tools were used throughout the literature with no obviously preferred or dominant method identified. CONCLUSION: Despite increasing acknowledgement of the need to evaluate QOL in patients with AWH, no tool has become dominant in this field. Assessment, therefore, of the impact of certain interventions or techniques on quality of life remains difficult and will continue to do so until an adequate standardised outcome measurement tool is available.

Characterization of the hypoxia-inducible factor-1 pathway in hearts of Antarctic notothenioid fishes.

The ability of Antarctic notothenioid fishes to mount a robust molecular response to hypoxia is largely unknown. The transcription factor, hypoxia-inducible factor-1 (HIF-1), a heterodimer of HIF-1α and HIF-1ß subunits, is the master regulator of oxygen homeostasis in most metazoans. We sought to determine if, in the hearts of Antarctic notothenioids, HIF-1 is activated and functional in response to either an acute heat stress or hypoxia. The red-blooded Notothenia coriiceps and the hemoglobinless icefish, Chaenocephalus aceratus, were exposed to their critical thermal maximum (CTMAX) or hypoxia (5.0 ± 0.3 mg of O2 L-1) for 2 h. Additionally, N. coriiceps was exposed to 2.3 ± 0.3 mg of O2 L-1 for 12 h, and red-blooded Gobionotothen gibberifrons was exposed to both levels of hypoxia. Levels of HIF-1α were quantified in nuclei isolated from heart ventricles using western blotting. Transcript levels of genes involved in anaerobic metabolism, and known to be regulated by HIF-1, were quantified by real-time PCR, and lactate levels were measured in heart ventricles. Protein levels of HIF-1α increase in nuclei of hearts of N. coriiceps and C. aceratus in response to exposure to CTMAX and in hearts of N. coriiceps exposed to severe hypoxia, yet mRNA levels of anaerobic metabolic genes do not increase in any species, nor do lactate levels increase, suggesting that HIF-1 does not stimulate metabolic remodeling in hearts of notothenioids under these conditions. Together, these data suggest that Antarctic notothenioids may be vulnerable to hypoxic events, which are likely to increase with climate warming.

The emerging role of sarcopenia as a prognostic indicator in patients undergoing abdominal wall hernia repairs: a systematic review of the literature.

BACKGROUND: There is strong evidence suggesting that excessive fat distribution, for example, in the bowel mesentery or a reduction in lean body mass (sarcopenia) can influence short-, mid-, and long-term outcomes from patients undergoing various types of surgery. Body composition (BC) analysis aims to measure and quantify this into a parameter that can be used to assess patients being treated for abdominal wall hernia (AWH). This study aims to review the evidence linking quantification of BC with short- and long-term abdominal wall hernia repair outcomes. METHODS: A systematic review was performed according to the PRISMA guidelines. The literature search was performed on all studies that included BC analysis in patients undergoing treatment for AWH using Medline, Google Scholar and Cochrane databases by two independent reviewers. Outcomes of interest included short-term recovery, recurrence outcomes, and long-term data. RESULTS: 201 studies were identified, of which 4 met the inclusion criteria. None of the studies were randomized controlled trials and all were cohort studies. There was considerable variability in the landmark axial levels and skeletal muscle(s) chosen for analysis, alongside the methods of measuring the cross-sectional area and the parameters used to define sarcopenia. Only two studies identified an increased risk of postoperative complications associated with the presence of sarcopenia. This included an increased risk of hernia recurrence, postoperative ileus and prolonged hospitalisation. CONCLUSION: There is some evidence to suggest that BC techniques could be used to help predict surgical outcomes and allow early optimisation in AWH patients. However, the lack of consistency in chosen methodology, combined with the outdated definitions of sarcopenia, makes drawing any conclusions difficult. Whether body composition modification can be used to improve outcomes remains to be determined.

Hypoxia-Inducible Factor-1α in Antarctic notothenioids contains a polyglutamine and glutamic acid insert that varies in length with phylogeny.

The long evolution of the Antarctic perciform suborder of Notothenioidei in the icy, oxygen-rich waters of the Southern Ocean may have reduced selective pressure to maintain a hypoxic response. To test this hypothesis, cDNA of the key transcriptional regulator of hypoxic genes, hypoxia-inducible factor-1α (HIF-1α), was sequenced in heart ventricles of the red-blooded notothenioid, Notothenia coriiceps, and the hemoglobinless icefish, Chaenocephalus aceratus. HIF-1α cDNA is 4500 base pairs (bp) long and encodes 755 amino acids in N. coriiceps, and in C. aceratus, HIF-1α is 3576 bp long and encodes 779 amino acids. All functional domains of HIF-1α are highly conserved compared to other teleosts, but HIF-1α contains a polyglutamine/glutamic acid (polyQ/E) insert 9 amino acids long in N. coriiceps and 34 amino acids long in C. aceratus. Sequencing of this region in four additional species, representing three families of notothenioids, revealed that the length of the polyQ/E insert varies with phylogeny. Icefishes, the crown family of notothenioids, contain the longest polyQ/E inserts, ranging between16 and 34 amino acids long, whereas the basal, cold-temperate notothenioid, Eleginops maclovinus, contains a polyQ/E insert only 4 amino acids long. PolyQ/E inserts may affect dimerization of HIF-1α and HIF-1ß, HIF-1 translocation into the nucleus and/or DNA binding.

The evaluation and quantification of respirable coal and silica dust concentrations: a task-based approach.

Silicosis and coal worker's pneumoconiosis are serious occupational respiratory diseases associated with the coal mining industry and the inhalation of respirable dusts containing crystalline silica. The purpose of this study (funded by the Mine Health and Safety Council of South Africa) was to evaluate the individual contributions of underground coal mining tasks to the respirable dust and respirable silica dust concentrations in an underground section by sampling the respirable dust concentrations at the intake and return of each task. The identified tasks were continuous miner (CM) cutting, construction, transfer of coal, tipping, and roof bolting. The respirable dust-generating hierarchy of the tasks from highest to lowest was: transfer of coal > CM right cutting > CM left cutting > CM face cutting > construction > roof bolting > tipping; and for respirable silica dust: CM left cutting > construction > transfer of coal > CM right cutting. Personal exposure levels were determined by sampling the exposures of workers performing tasks in the section. Respirable dust concentrations and low concentrations of respirable silica dust were found at the intake air side of the section, indicating that air entering the section is already contaminated. The hierarchy for personal respirable dust exposures was as follows, from highest to lowest: CM operator > cable handler > miner > roof bolt operator > shuttle car operator, and for respirable silica dust: shuttle car operator > CM operator > cable handler > roof bolt operator > miner. Dust control methods to lower exposures should include revision of the position of workers with regard to the task performed, positioning of the tasks with regard to the CM cutting, and proper use of the line curtains to direct ventilation appropriately. The correct use of respiratory protection should also be encouraged.

The influence of metabolic syndrome, physical activity and genotype on catechol-O-methyl transferase promoter-region methylation in schizophrenia.

The catechol-O-methyl transferase (COMT) 158Val/Met variant has been suggested to play a role in COMT function. Epigenetic regulation of COMT may further influence the prevalence of metabolic syndrome in these patient populations. This study examined the correlation between COMT promoter methylation and metabolic syndrome in schizophrenia patients receiving atypical antipsychotic (AAP) therapy. DNA was extracted from peripheral blood samples of schizophrenia subjects screened for metabolic syndrome. Pyrosequencing was used to analyze two methylation sites of the soluble COMT (COMT-s) promoter region. Associations between AAP use, lifestyle variables, metabolic syndrome and COMT genotype with peak methylation values were analyzed. Data are reported in 85 subjects. Methylation on CpG site 1 had a mean of 79.08% (±4.71) and it was 12.43% (±1.19) on site 2. COMT genotype proved to be an indicator of COMT methylation status on site 1 (F(2, 84)=5.78, P=0.0044) and site 2 (F(2, 84),=3.79, P=0.027). A significant negative correlation between physical activity and COMT promoter region methylation was found in Val/Val homozygous patients (site 1: P=0.013 and site 2: P=0.019). Those homozygous for Met/Met showed a positive correlation between promoter site methylation and physical activity (site 1: P=0.027, site 2: P=0.005), and between CpG site methylation and metabolic syndrome (site 1: P=0.002; site 2: P=0.001). The results of this study suggest that COMT promoter region methylation is largely influenced by COMT genotype and that physical activity plays a significant role in epigenetic modulation of COMT.

The influence of the brain-derived neurotropic factor Val66Met genotype and HMG-CoA reductase inhibitors on insulin resistance in the schizophrenia and bipolar populations.

INTRODUCTION: The brain-derived neurotrophic factor (BDNF) Val66Met variant and HMG-COA reductase inhibitors (statins) have been implicated in insulin resistance with a possible increased risk of diabetes. We sought to determine the effect of the BDNF Met variant and statin medication use on insulin resistance in schizophrenia and bipolar disorder using the homeostasis model assessment of insulin resistance (HOMA-IR). METHODS: A cross-sectional design was used and patients with diabetes or on any medications affecting glucose regulation were -excluded. Associations between insulin resistance and genotype were then analyzed by ANOVA and regression analysis. Subjects were grouped by BDNF genotype as well as presence of statin. RESULTS: Two hundred fifty-two subjects with a mean age of 44 years were included. The group was 53% male and 41% had a diagnosis of bipolar disorder; 78% and 19% were receiving atypical antipsychotics (AAPs) and statin medications, respectively. Analysis showed schizophrenia subjects with the BDNF met allele as well as schizophrenia subjects with both the BDNF met allele and were receiving a statin had significantly higher HOMA-IR values compared to the other groups (p= 0.046 and p= 0.016, respectively). CONCLUSIONS: Our results suggest that in the metabolically high-risk population of schizophrenia the BDNF met allele alone and in combination with statin medications is associated with higher insulin resistance values. This was not seen in the bipolar population. Further validation of these associations remains necessary.

Host status of commercial mango cultivars to Thaumatotibia leucotreta (Lepidoptera: Tortricidae) in South Africa.

The objective of this study was to determine the host status of commercially cultivated mango fruit, Mangifera indica L. (Anacardiaceae) to Thaumatotibia leucotreta (Meyrick) (Lepidoptera: Tortricidae) in South Africa. T. leucotreta was monitored with parapheromone traps in mango orchards in Limpopo and Mpumalanga from 2007 to 2010. Fruit were inspected for the presence of T leucotreta eggs in mango orchards. Mango fruit of the cultivars 'Tommy Atkins', 'Kent', 'Keitt', and 'Sensation' were artificially infested with T. leucotreta eggs on the tree to determine if the larvae were able to develop in fruit. Mature fruit of these cultivars were harvested and were then exposed to T leucotreta eggs and the larval development monitored. Before harvest, fruit were inspected for natural infestations and a packhouse survey was conducted during the 2009-2010 season to determine if any infested fruit were present. T. leucotreta was present in all mango orchards where monitoring was done with traps but no eggs were found on the fruit, which suggests the presence of antixenosis. Development occurred in mature harvested fruit of all cultivars that had been exposed to T. leucotreta eggs. Depending on the cultivar, between 0 and 5.05% of immature fruit on the tree supported development and demonstrate antibiosis. No naturally infested fruit were found in the orchards or during the packhouse survey. Mango in South Africa is not a natural host for T. leucotreta. Mature mango fruit is an acceptable host for T. leucotreta larval development under artificial conditions. The latex plays an important role in the resistance mechanism of mango fruit to T. leucotreta.

Developing a systems approach for Thaumatotibia leucotreta (Lepidoptera: Tortricidae) on 'Hass' avocado in South Africa.

Thaumatotibia leucotreta (Meyrick) (Lepidoptera: Tortricidae) is pest of the avocado, Persea americana (Mill.) (Lauraceae), in South Africa and is regarded as a phytosanitary threat. The objective of this study was to develop a systems approach for T. leucotreta on 'Hass' avocado that will mitigate the pest risk. T. leucotreta males were monitored with pheromone traps, and numbers declined during the winter. Field studies indicated that most of eggs were laid during January in the Deerpark area, and during harvest, only 0.029 lesions produced live larvae. Survival of larvae in fruit infested on the tree and left to develop after harvest varied and depended on the time of infestation before harvest. Fruit firmness was measured and fifth instars were only present in soft fruit. Fenpropathrin and a granulovirus were effective in reducing the infestation levels. Bags used to cover fruit also reduced infestation levels. Lesions caused by T. leucotreta were visible from two weeks after infestation and fruit with lesions can be sorted. The mean infestation rate per orchard was 0.003 lesions per fruit which makes T. leucotreta on Hass amenable to the alternative treatment efficacy approach and maximum pest limit. In the case of T. leucotreta on Hass, poor host status, production, preharvest and postharvest measures were studied and low infestation levels were observed; all these elements would make a systems approach an option. Furthermore, inspection and certification as well as shipping and distribution measures could be added.

Kinematic variables and water transport control the formation and location of arc volcanoes.

The processes that give rise to arc magmas at convergent plate margins have long been a subject of scientific research and debate. A consensus has developed that the mantle wedge overlying the subducting slab and fluids and/or melts from the subducting slab itself are involved in the melting process. However, the role of kinematic variables such as slab dip and convergence rate in the formation of arc magmas is still unclear. The depth to the top of the subducting slab beneath volcanic arcs, usually approximately 110 +/- 20 km, was previously thought to be constant among arcs. Recent studies revealed that the depth of intermediate-depth earthquakes underneath volcanic arcs, presumably marking the slab-wedge interface, varies systematically between approximately 60 and 173 km and correlates with slab dip and convergence rate. Water-rich magmas (over 4-6 wt% H(2)O) are found in subduction zones with very different subduction parameters, including those with a shallow-dipping slab (north Japan), or steeply dipping slab (Marianas). Here we propose a simple model to address how kinematic parameters of plate subduction relate to the location of mantle melting at subduction zones. We demonstrate that the location of arc volcanoes is controlled by a combination of conditions: melting in the wedge is induced at the overlap of regions in the wedge that are hotter than the melting curve (solidus) of vapour-saturated peridotite and regions where hydrous minerals both in the wedge and in the subducting slab break down. These two limits for melt generation, when combined with the kinematic parameters of slab dip and convergence rate, provide independent constraints on the thermal structure of the wedge and accurately predict the location of mantle wedge melting and the position of arc volcanoes.

Melt production beneath Mt. Shasta from boron data in primitive melt inclusions.

Most arc magmas are thought to be generated by partial melting of the mantle wedge induced by infiltration of slab-derived fluids. However, partial melting of subducting oceanic crust has also been proposed to contribute to the melt generation process, especially when young and hot lithosphere is being subducted. The isotopic composition of boron measured in situ in olivine-hosted primitive melt inclusions in a basaltic andesite from Mt. Shasta, California, is characterized by large negative values that are also highly variable (delta(11)B = -21.3 to -0.9 per mil). The boron concentrations, from 0.7 to 1.6 parts per million, are lower than in most other arc lavas. The relation between concentration and isotopic composition of boron observed here supports a hypothesis that materials left after dehydration of the subducting slab may have contributed to the generation of basaltic andesite lavas at Mt. Shasta.

Trends in the smoking habits of young adults with diabetes.

OBJECTIVES: To examine changes in the prevalence of smoking in young adult diabetic patients between 1990 and 1999. SETTING: Walton Diabetes Centre, University Hospital Aintree, Liverpool, UK. DESIGN: Direct questioning as well as the urinary cotinine:creatinine ratio were used to assess the smoking habits of 99 young type 1 diabetic patients in 1991 (mean age 21.5 years, duration of diabetes 7.3 years), and in 112 similar patients in 1999 (mean age 23.4 years, duration of diabetes 9.6 years). RESULTS: The admitted smoking rate was 31/99 (31%) in 1990 compared with 31/112 (28%) in 1999 (not significant). However, in 1990 there were an additional 17 "covert" smokers (patients who denied smoking, but had an unequivocally raised urinary cotinine:creatinine ratio), but only three in 1999 (p<0.05). This gave a corrected validated smoking rate of 48/99 (48%) in 1990 and 34/112 (30%) in 1999, representing a significant fall (p<0.02). CONCLUSION: Smoking rates in young type 1 diabetic patients appear to have fallen during the last decade, and reporting of smoking behaviour is now more honest.

Geochemical evidence for magmatic water within Mars from pyroxenes in the Shergotty meteorite.

Observations of martian surface morphology have been used to argue that an ancient ocean once existed on Mars. It has been thought that significant quantities of such water could have been supplied to the martian surface through volcanic outgassing, but this suggestion is contradicted by the low magmatic water content that is generally inferred from chemical analyses of igneous martian meteorites. Here, however, we report the distributions of trace elements within pyroxenes of the Shergotty meteorite--a basalt body ejected 175 million years ago from Mars--as well as hydrous and anhydrous crystallization experiments that, together, imply that water contents of pre-eruptive magma on Mars could have been up to 1.8%. We found that in the Shergotty meteorite, the inner cores of pyroxene minerals (which formed at depth in the martian crust) are enriched in soluble trace elements when compared to the outer rims (which crystallized on or near to the martian surface). This implies that water was present in pyroxenes at depth but was largely lost as pyroxenes were carried to the surface during magma ascent. We conclude that ascending magmas possibly delivered significant quantities of water to the martian surface in recent times, reconciling geologic and petrologic constraints on the outgassing history of Mars.

Treatment of periodontal disease.

Periodontal surgery is used to control advanced lesions affecting the support for teeth. The choice between conservative treatment and surgical treatment is a technical issue, but client compliance plays an important role. Excision surgical techniques (e.g., gingivectomy) and incisional surgical techniques (e.g., flap surgery) are described in this article. Postoperative, recall, and retreatment programs are explored.

Distortion-free gain and noise correlation in sodium vapor with four-wave mixing and coherent population trapping.

We observed optical gain as great as 30 with nearly distortion-free beam propagation in optically dense sodium vapor, using four-wave mixing. Moreover, 15-dB classical noise correlations were seen in the amplified probe and conjugate beams. To achieve this performance in such a strongly absorbing medium, one must suppress unwanted absorption and self-focusing effects. This is accomplished with coherent population trapping.

Efficient and fast optical phase conjugation by use of two-photon-induced gratings in the orientation of angular momentum.

Optical phase conjugation (OPC) is of interest for many applications. The generation of squeezed light, phase-conjugate mirrors, optical correlation, and turbulence correction would all benefit from improved OPC performance. Using Zeeman sublevels and cross-circularly polarized light in rubidium vapor, we demonstrate an OPC process that uses very low power (30 mW) but is still very fast (60 ns) and efficient (gain of 20). This process is generic enough to be applicable to almost any resonant medium.

Expression of adhesion molecules during tooth resorption in feline teeth: a model system for aggressive osteoclastic activity.

Tooth resorption, a common feline dental problem, is often initiated at the cemento-enamel junction and hence is called cat 'neck' lesion. Studies have demonstrated that osteoclasts/odontoclasts are increased and activated at resorption sites, and that areas of resorption are partly repaired by formation of tissues resembling bone, cementum, and possibly dentin. However, the cellular/molecular mechanisms/factors involved in resorption and repair are unknown. In this study of tissues from cats with 'neck' lesions, we used specific antibodies and immunohistochemical analyses to examine adhesion molecules associated with mineralized tissues, bone sialoprotein (BSP) and osteopontin (OPN), and a cell-surface receptor linked with these molecules, alpha v beta 3, for their localization in these lesions. In addition, to determine general cellular activity during repair, we performed in situ hybridization using a type I collagen riboprobe. Results showed OPN localized to resorption fronts and reversal lines, while BSP was localized to reversal lines. However, some osteoclasts and odontoblasts "sat" on mineralized surfaces not associated with OPN. The cell-surface receptor, alpha v beta 3, was localized to surfaces of osteoclasts/odontoclasts. Type I collagen mRNA was expressed where osteoblasts attempted to repair mineralized tissue. In contrast, odontoblasts did not express mRNA for type I collagen. This study suggests that osteoclastic resorption is the predominant activity in 'neck' lesions and that this activity was accompanied, at least in part, by increased concentrations of OPN and an associated integrin, alpha v beta 3, at resorption sites. Lack of collagen expression by odontoblasts indicates that odontoblasts do not play an active role in attempts at repair.

The effectiveness of ectomycorrhizal fungi in increasing the growth of Eucalyptus globulus Labill. in relation to root colonization and hyphal development in soil.

Forty-seven different isolates of ectomycorrhizal fungi, from the different genera, were screened for their effectiveness in increasing the growth of Eucalyptus globulin La hi 11. where supply of P is deficient. Plants were grown in a P-delicient sand, in pots, in a temperature- control led glasshouse. Seedlings we re harvested 6-S and K7 d after planting, and were assessed for dry matter production and mywirrhizal colonization. Selected treatments were also assessed for P concentrations in the plant and hyphal development in the soil. Dry weights of inoculated plants ranged from 50 to 350% of the dry Weights of uninoculated plants. Growth increases in response to ectorriycorrhizal inoculation corresponded with increased P uptake by the plant.'Early'colonizing fungal species (Descolea maculata, Hebeloma westraliens, Laccaria laccata and Pisolithus tinctorius) were generally more effective in increasing plant growth than'late'colonizing species (Cortinarius spp. and Hyutenmgium spp.), although there was also variation in effectiveness among isolates of the same fungal species. Plant dry weights were positively correlated (r2 = 0·79-0·84) with the length of colonized root, indicating that fungi which colonized roots extensively were The most effective in increasing plant growth. For some fungi, however, plant growth responses to inoculation were not related to colonized root length. These responses could not.be related to the development of hyphae in soil by the mycorrhizal fungi.