Outcomes on mesh fixation vs non-fixation in laparoscopic totally extra peritoneal inguinal hernia repair: a comparative study.

OBJECTIVES: Inguinal hernia repair is one of the most common general surgical procedure, and laparoscopic approach gained popularity over the open approach. This study aimed to compare the clinical effects of TEP inguinal hernioplasty with or without mesh fixation. The primary outcome was acute post-operative pain. MATERIAL AND METHODS: A retrospective comparative study on a prospectively collected data was conducted in a large DGH in England between Janu- ary 2017 and December 2019 on 47 patients. The patients were divided into two groups. In group A, mesh fixation was performed with absorbable tackers and in group B no fixation was performed. Patients were followed up to 18 months postoperatively. Data was collected on post-operative pain, cost, recurrences and time taken to return to normal activities. Patients with lower midline scar and complicated inguinal hernias were excluded. RESULTS: Out of the 47 patients 53% (n= 25) were in group A and 47% (n= 22) in group B. All the patients in both groups were male. The mean postopera- tive pain score at 72h in group A was 7.12 (SD 1.13) and 4.91 (SD 1.23) in group B (p <0.001). Group B patients have taken shorter time to return to normal activities in comparison to group A (p <0.001), while recurrence (2%) rate is higher in group B (p> 0.05). CONCLUSION: Pain and time taken to return to normal work postoperatively were significantly less in the non-fixation group. The study recommends non-fixation over fixation as it is feasible, cost-effective, causes less post-operative pain and no differences in terms of recurrences.

Comparative effectiveness of rapid-cycle ultraviolet decontamination to chemical decontamination on high-touch communication devices.

BACKGROUND: This quantitative, comparative-descriptive study of inpatient units in a large military medical center was designed to compare the effectiveness of compact ultraviolet (UV-C) decontamination to standard chemical decontamination in reducing the microbial burden on Vocera (San Jose, CA) communication devices and to characterize changes in staff cleaning practices following UV-C device implementation. METHODS: Aerobic and anaerobic swabs were used to collect microbial samples from Vocera devices (n = 60) before and after chemical decontamination (first sampling) and before and after UV decontamination (second sampling). Cleaning behaviors were assessed by observation and oral inquiry during the baseline sampling and surveyed 8 weeks after UV-C device implementation. Outcomes included aerobic and anaerobic colony-forming units and prevalence of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, or Clostridium difficile, as determined by standard microbiological methods. RESULTS: No differences were found between the two cleaning methods in their ability to reduce aerobic bacteria; however, UV-C was significantly more effective at reducing bacteria grown anaerobically (P < .01). This study elucidated an 8.3% prevalence of methicillin-resistant Staphylococcus aureus on Vocera devices in the inpatient environment. Initially, 42% of respondents reported deviations from manufacturer's cleaning guidelines, and 16.7% reported daily or more frequent cleaning of the Vocera devices. CONCLUSIONS: After implementation, UV-C decontamination reduced average cleaning time by 43% and increased the rate of daily Vocera cleaning to 86.5%. Respondents reported an overall 98% user satisfaction with the UV-C device.

Immunogenicity of pluripotent stem cells and their derivatives.

The ability of pluripotent stem cells to self-renew and differentiate into all somatic cell types brings great prospects to regenerative medicine and human health. However, before clinical applications, much translational research is necessary to ensure that their therapeutic progenies are functional and nontumorigenic, that they are stable and do not dedifferentiate, and that they do not elicit immune responses that could threaten their survival in vivo. For this, an in-depth understanding of their biology, genetic, and epigenetic make-up and of their antigenic repertoire is critical for predicting their immunogenicity and for developing strategies needed to assure successful long-term engraftment. Recently, the expectation that reprogrammed somatic cells would provide an autologous cell therapy for personalized medicine has been questioned. Induced pluripotent stem cells display several genetic and epigenetic abnormalities that could promote tumorigenicity and immunogenicity in vivo. Understanding the persistence and effects of these abnormalities in induced pluripotent stem cell derivatives is critical to allow clinicians to predict graft fate after transplantation, and to take requisite measures to prevent immune rejection. With clinical trials of pluripotent stem cell therapy on the horizon, the importance of understanding immunologic barriers and devising safe, effective strategies to bypass them is further underscored. This approach to overcome immunologic barriers to stem cell therapy can take advantage of the validated knowledge acquired from decades of hematopoietic stem cell transplantation.

Binding of porcine ficolin-alpha to lipopolysaccharides from Gram-negative bacteria and lipoteichoic acids from Gram-positive bacteria.

Protein(s) reactive with N-acetyl-D-glucosamine (GlcNAc) was isolated from porcine nonimmune serum. The molecular weight of the purified protein was found to be mainly 40 kDa on sodium dodecyl sulfate-polyacrylamide gel electrophoresis under reducing conditions. The N-terminal 10 amino acid sequence of the purified protein were found to be identical to that of porcine ficolin-alpha reported previously. In enzyme-linked immunosorbent assay, the purified protein was found to react with lipopolysaccharides (LPS) from different Gram-negative bacteria such as Esherichia coli, Salmonella typhimurium, Salmonella enteritidis, Salmonella abortus equi, Pseudomonas aeruginosa, Shigella flexeneri, and Serratia marcescens and with lipoteichoic acid (LTA) from Gram-positive bacteria such as Streptococcus sanguis, Bacillus subtilis, Streptococcus pyogenes, and Staphylococcus aureus. The purified protein also reacted with E. coli O26 isolated from food poisoning and bovine feces and heat-treated Gram-positive bacteria such as S. aureus, B. cereus, B. subtilis, Enterococcus faecium, and Corynebacterum bovis. On the other hand, porcine IgG isolated from nonimmune serum showed different reactivity with these LPS, LTA, and heat-treated bacterial cells. From the present findings, purified porcine serum protein reactive with GlcNAc is concluded to be ficolin-alpha playing an important role(s) in innate immunity against microbial infection with Gram-positive and -negative bacteria.