Multicentric observational study of pain after the use of a self-gripping lightweight mesh.

INTRODUCTION: Investigation in the field of inguinal hernia surgery is now focused on postoperative pain. The extended use of lightweight meshes and alternative methods of fixation may play a relevant role in the reduction of pain. In this study, a new self-gripping lightweight polypropylene mesh is tested. METHODS: A multicentric, observational study was scheduled to prospectively evaluate this new mesh. Ten centers agreed to participate. Only primary, type 1 or 2 uncomplicated hernias in adults were included. The mesh was placed as a Lichtenstein procedure without any fixation. A complete pain questionnaire was followed at 1 week, and at 1, 3 and 6 months postoperatively. The principal goal of the study was to evaluate maximum pain score at 6 months. Pain was assessed by a visual analog scale. A total of 256 patients were operated. Mean operative time was 35.6 min; 76.2% of patients were operated in an ambulatory setting. RESULTS: There were a few postoperative complications: 2 wound infections, 17 seromas, 21 hematomas, 6 orchitis. The incidence of acute pain was 27.3% at week 1 and 7.5% at month 1. The incidence of chronic pain was 3.6% at month 3 and 2.8% at month 6. No recurrences or long-term complications were observed. CONCLUSION: This self-gripping mesh can be used safely in type 1 and 2 primary, uncomplicated inguinal hernia with minimal morbidity and most patients under ambulatory setting. The registered incidence of chronic pain is lower than 3%.

Bioabsorbable staple-line reinforcement to reduce staple-line bleeding in the transection of mesenteric vessels during laparoscopic colorectal resection: a pilot study.

BACKGROUND: Staple line hemorrhage and leak are the 2 most dreaded complications of laparoscopyassisted resection of colorectal cancer (LARCC). Recently, anastomotic staple lines have been reinforced with a range of absorbable and non-absorbable bioprosthetic reinforcement materials. This pilot prospective study used the bioabsorbable Seamguard (BSG; WL Gore & Associates, Flagstaff, AZ) for routine reinforcement of the mesenteric vascular staple transection to prevent mesenteric hemorrhage and to assess its safety and feasibility in a consecutive series of laparoscopic colonic resections. METHODS: Twenty-five patients consecutively scheduled to undergo LARCC were enrolled in the study. All operations were performed with a standard LARCC technique which included loading of the BSG sleeves onto the jaws of the cutter/stapler. RESULTS: There were 23 wholly LARCC cases and 2 open conversions. BSG was used in all 25 patients. No patient experienced staple-line bleeding or other complications during the surgical procedure. The mean number of staple-line reinforcement sleeves used was 2.6 (range, 2-4). The mean operative time was 118 minutes (range, 65-184 minutes). Additional measures to achieve hemostasis were not required in any case. The mean cost was US 475.20 dollars for the procedure. CONCLUSIONS: This small pilot study has shown the routine use of BSG mesenteric staple line reinforcement to be safe, quick and effective during LARCC.

Effects of age, weight, and fat slaughter end points on estimates of breed and retained heterosis effects for carcass traits.

The influence of different levels of adjusted fat thickness (AFT) and HCW slaughter end points (covariates) on estimates of breed and retained heterosis effects was studied for 14 carcass traits from serially slaughtered purebred and composite steers from the US Meat Animal Research Center (MARC). Contrasts among breed solutions were estimated at 0.7, 1.1, and 1.5 cm of AFT, and at 295.1, 340.5, and 385.9 kg of HCW. For constant slaughter age, contrasts were adjusted to the overall mean (432.5 d). Breed effects for Red Poll, Hereford, Limousin, Braunvieh, Pinzgauer, Gelbvieh, Simmental, Charolais, MARC I, MARC II, and MARC III were estimated as deviations from Angus. In addition, purebreds were pooled into 3 groups based on lean-to-fat ratio, and then differences were estimated among groups. Retention of combined individual and maternal heterosis was estimated for each composite. Mean retained heterosis for the 3 composites also was estimated. Breed rankings and expression of heterosis varied within and among end points. For example, Charolais had greater (P < 0.05) dressing percentages than Angus at the 2 largest levels of AFT and smaller (P < 0.01) percentages at the 2 largest levels of HCW, whereas the 2 breeds did not differ (P > or = 0.05) at a constant age. The MARC III composite produced 9.7 kg more (P < 0.01) fat than Angus at AFT of 0.7 cm, but 7.9 kg less (P < 0.05) at AFT of 1.5 cm. For MARC III, the estimate of retained heterosis for HCW was significant (P < 0.05) at the lowest level of AFT, but at the intermediate and greatest levels estimates were nil. The pattern was the same for MARC I and MARC III for LM area. Adjustment for age resulted in near zero estimates of retained heterosis for AFT, and similarly, adjustment for HCW resulted in nil estimates of retained heterosis for LM area. For actual retail product as a percentage of HCW, the estimate of retained heterosis for MARC III was negative (-1.27%; P < 0.05) at 0.7 cm but was significantly positive (2.55%; P < 0.05) at 1.5 cm of AFT. Furthermore, for MARC III, estimates of heterosis for some traits (fat as a percentage of HCW as another example) also doubled in magnitude depending on different levels of AFT end point. Rational exploitation of breeds requires special attention to use of different end points and levels of those end points, mainly for fat thickness.

Genetic analysis of carcass traits of steers adjusted to age, weight, or fat thickness slaughter endpoints.

Carcass measurements from 1,664 steers from the Germ Plasm Utilization project at U.S. Meat Animal Research Center were used to estimate heritabilities (h(2)) of, and genetic correlations (r(g)) among, 14 carcass traits adjusted to different endpoints (age, carcass weight, and fat thickness): HCW (kg), dressing percent (DP), adjusted fat thickness (AFT, cm), LM area (LMA, cm(2)), KPH (%), marbling score (MS), yield grade (YG), predicted percentage of retail product (PRP), retail product weight (RPW, kg), fat weight (FW, kg), bone weight (BNW, kg), actual percentage retail product (RPP), fat percent (FP), and bone percent. Fixed effects in the model included breed group, feed energy level, dam age, birth year, significant (P < 0.05) interactions, covariate for days on feed, and the appropriate covariate for endpoint nested (except age) within breed group. Random effects in the model were additive genetic effect of animal and total maternal effect of dam. Parameters were estimated by REML. For some traits, estimates of h(2) and phenotypic variance changed with different endpoints. Estimates of h(2) for HCW, DP, RPW, and BNW at constant age, weight, or fat thickness were 0.27, -, and 0.41; 0.19, 0.26, and 0.18; 0.42, 0.32, and 0.50; and 0.43, 0.32, and 0.48, respectively. Magnitude and/or sign of r(g) also changed across endpoints for 54 of the 91 trait pairs. Estimates for HCW-LMA, AFT-RPW, LMA-YG, LMA-PRP, LMA-FW, LMA-RPP, and LMA-FP at constant age, weight, or fat thickness were 0.32, -, and 0.51; -0.26, -0.77, and -; -0.71, -0.89, and -0.66; 0.68, 0.85, and 0.63; -0.16, -0.51, and 0.22; 0.47, 0.57, and 0.27; and -0.44, -0.43, and -0.18, respectively. Fat thickness was highly correlated with YG (0.86 and 0.85 for common age and weight) and PRP (-0.85 and -0.82 for common age and weight), indicating that selection for decreased fat thickness would improve YG and PRP. Carcass quality, however, would be affected negatively because of moderate r(g) (0.34 and 0.35 for common age and weight) between MS and AFT. Estimates of h(2) and phenotypic variance indicate that enough genetic variation exists to change measures of carcass merit by direct selection. For some carcass traits, however, magnitude of change would depend on effect of endpoint on h(2) and phenotypic variance. Correlated responses to selection would differ depending on endpoint.

[Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair]. / Técnica quirúrgica básica consensuada para el tratamiento por vía laparoscópica de las hernias ventrales.

Laparoscopic ventral hernia repair is currently the subject of intense debate, even though it provides a series of advantages over open surgery and is feasible and safe. Various studies have shown this technique to be as effective as open repair with a lower recurrence rate. Despite the excellent results of laparoscopic repair of ventral hernias, there are numerous controversies associated with this procedure. These controversies concern the indications and contraindications of the procedure, and technical aspects such as how to create the pneumoperitoneum, perform adhesiolysis, manage the hernia sac, and insert and fix the mesh to the anterior abdominal wall. Also controversial are outcome, complications related to postoperative seroma, and which type and size of mesh should be used. The present article aims primarily to address many of these issues, based on the experience of distinct surgeons with expertise in this approach, in order to provide data to establish a consensus on how laparoscopic ventral hernia repair should be performed.

Heritability estimates for carcass traits of cattle: a review

We present estimates of heritability for carcass traits of cattle published in the scientific literature. Seventy-two papers published from 1962 to 2004, which reported estimates of heritability for carcass traits, were reviewed. The unweighted means of estimates of heritability for 14 carcass traits by slaughter end point (age, weight, and fat depth) were calculated. Among the three end points, carcass weight, backfat thickness, longissimus muscle area, and marbling score were the carcass traits with the most estimates of heritability (56 is less than or equal to "n", and "n" is less than or equal to 66). The averages for these traits indicate that they are similarly and moderately heritable (0.40, 0.36, 0.40, and 0.37, respectively). However, heritability estimates for most traits varied greatly, which could be due to differences in breed groups, methods of estimation, effects in the model, number of records, measurement errors, sex, and management. Few studies have compared heritability estimates for carcass traits adjusted to different end points. Results from such studies have been inconsistent, although some studies revealed that heritability estimates for several carcass traits are sensitive to the covariate included in the model for the end point, implying that direct response to selection would be different for some traits depending on slaughter end point. The effect of different end points on estimates of heritability for many carcass traits has not been studied.

Extreme genetic diversity among Pirital virus (Arenaviridae) isolates from western Venezuela.

Pirital-like virus isolates from rodents collected in a variety of habitats within a six-state area of central Venezuela were analyzed genetically by amplifying a portion of the nucleocapsid protein gene using RT-PCR. Comparisons of the sequences from 30 selected Pirital-like virus isolates demonstrated up to 26% divergence in nucleotide sequences and up to 16% divergence in deduced amino acid sequences. Within the Pirital monophyletic group, 14 distinct lineages or genotypes, differing by at least 6% in nucleotide sequences, were identified. Although sample sizes were small for some lineages, many of the different genotypes were sampled in only one region or locality, suggesting allopatric divergence. Complement fixation tests with representatives of the most divergent Pirital virus lineages failed to delineate multiple species or subtypes within the Pirital clade. These results indicate that the previously proposed 12% nucleocapsid protein amino acid sequence divergence cutoff value for delineating arenavirus species is not appropriate for the entire family. When individual clones were examined from PCR amplicons, a mean of 0.17% sequence diversity vs the consensus sequences was detected, suggesting diverse quasispecies populations within infected rodent hosts. Possible explanations for the extreme genetic diversity within and among Pirital virus populations in infected rodents are discussed.

Guanarito virus (Arenaviridae) isolates from endemic and outlying localities in Venezuela: sequence comparisons among and within strains isolated from Venezuelan hemorrhagic fever patients and rodents.

Despite intensive surveillance, Venezuelan hemorrhagic fever (VHF), caused by Guanarito (GTO) virus, has been detected in only a small region of western Venezuela. To determine whether VHF is associated with a particular regional GTO virus strain(s), 29 isolates from rodents and humans throughout the surrounding regions were analyzed by partial sequencing of the nucleocapsid protein gene. Phylogenetic trees delineated nine distinct GTO genotypes that differ by 4-17% in nucleotides and up to 9% in amino acid sequences; most appeared to be restricted to discrete geographic regions, although a few genotypes were isolated in several locations. Each genotype included at least one strain recovered from a rodent, but only two genotypes were isolated from VHF cases. The presence outside of the endemic/epidemic region of two genotypes isolated also from VHF cases suggests that human pathogenic viruses occur outside of the endemic zone, but do not frequently infect people and/or cause apparent disease there. VHF does not appear to be associated with a GTO virus genotype that is restricted to a certain rodent species. When quasispecies diversity was examined, rodent isolates had higher sequence variation than human isolates. One rodent isolate included a mixture of two phylogenetically distinct genotypes, suggesting a dual infection.

Natural rodent host associations of Guanarito and pirital viruses (Family Arenaviridae) in central Venezuela.

The objective of this study was to elucidate the natural rodent host relationships of Guanarito and Pirital viruses (family Arenaviridae) in the plains of central Venezuela. Ninety-two arenavirus isolates from 607 animals, representing 10 different rodent species, were characterized to the level of serotype. The 92 isolates comprised 19 Guanarito virus strains and 73 Pirital virus strains. The 19 Guanarito virus isolates were from Zygodontomys brevicauda; 72 (98.6%) of the 73 Pirital virus isolates were from Sigmodon alstoni. These results indicate that the natural rodent associations of these 2 sympatric arenaviruses are highly specific and that Z brevicauda and S. alstoni are the principal rodent hosts of Guanarito and Pirital viruses, respectively.

Isolation and characterization of pirital virus, a newly discovered South American arenavirus.

Specific rodent species are principal hosts for each of the well-characterized members of the virus family Arenaviridae. Guanarito virus (Arenaviridae) is the etiologic agent of Venezuelan hemorrhagic fever. A previous study on the epidemiology of Venezuelan hemorrhagic fever revealed extensive arenavirus infection (presumed to be caused by Guanarito virus) in two rodent species. Sigmodon alstoni and Zygodontomys brevicauda, collected from the region of Venezuela in which the disease is endemic. In the present study, four arenavirus isolates recovered from the Municipality of Guanarito (two isolates each from S. alstoni and Z. brevicauda) were characterized to learn more about the natural rodent host relationships of Guanarito virus. Serologic tests and analyses of nucleocapsid protein gene sequence data indicated that the two isolates from Z. brevicauda are strains of Guanarito virus and that the two isolates from S. alstoni are representatives of a novel New World arenavirus (proposed name Pirital) that is antigenically and phylogenetically distinct from all known New World arenaviruses. The results of the present study provide further evidence that the cane mouse Z. brevicauda is a natural host of Guanarito virus and suggest that the cotton rat S. alstoni is the natural reservoir host of Pirital but not Guanarito virus.

Isolation, characterization and geographic distribution of Caño Delgadito virus, a newly discovered South American hantavirus (family Bunyaviridae).

Rodents collected from the Venezuelan llanos (plains) during field studies of viral hemorrhagic fever were tested for evidence of hantavirus infection. Hantavirus antibody was found in one (7.7%) of 13 Oryzomys bicolor, one (3.4%) of 29 Rattus rattus, 10 (6.0%) of 166 Sigmodon alstoni and one (2.2%) of 45 Zygodontomys brevicauda. Hantavirus-specific RNA was detected in lung tissues from four antibody-positive rodents: two S. alstoni from Portuguesa State and one S. alstoni each from Cojedes and Barinas States. A hantavirus isolate (herein identified as VHV-574) was recovered from lung tissue from a hantavirus RNA-positive S. alstoni collected from Portuguesa State. The results of serological tests and analyses of small and medium RNA segment nucleotide sequence data indicated that VHV-574 represents a novel hantavirus (proposed name 'Caño Delgadito') that is distinct from all previously characterized hantaviruses. The results of analyses of nucleotide sequence data from the four hantavirus RNA-positive S. alstoni suggested that Caño Delgadito virus is widely distributed in the Venezuelan llanos.

Genetic characterization of rabies field isolates from Venezuela.

Twenty samples from cases of rabies in humans and domestic animals diagnosed in Venezuela between 1990 and 1994 and one sample from a vampire bat collected in 1976 were characterized by reactivity to monoclonal antibodies against the viral nucleoprotein and by patterns of nucleotide substitution in the nucleoprotein gene. Three antigenic variants were found: 1, 3, and 5. Antigenic variant 1 included all samples from dogs and humans infected by contact with rabid dogs. Unique substitutions permitted identification of two separate outbreaks of dog rabies in the Maracaibo Depression and Los Llanos region and in the Andean region of Venezuela. Samples from the vampire bat and two head of cattle were characterized as antigenic variant 3 and showed a nucleotide sequence homology of 96 to 98% to each other and to samples of vampire bat-associated rabies throughout Latin America. Ten of the remaining 12 samples were characterized as antigenic variant 5. Genetic studies indicated that 11 of these samples formed a highly homologous and distinctive group but were closely related to samples of vampire bat-associated rabies. The 12th sample of variant 5 (from a cat) showed only 78 to 80% genetic homology to samples of rabies associated with vampire bats. The application of antigenic and genetic typing to rabies surveillance in Latin America is essential to improve control programs. Recognition of the source of outbreaks of dog rabies and identification of wildlife species maintaining sylvatic cycles of rabies transmission permit better utilization of public health resources.