Randomized clinical trial comparing self-gripping mesh with a standard polypropylene mesh for open inguinal hernia repair.

BACKGROUND: The introduction of mesh for open inguinal hernia repair has reduced the rate of recurrence, allowing research to focus on prevention of postoperative pain. In an effort to reduce chronic pain, a semiresorbable, lighter and self-gripping mesh was developed. METHODS: A double-blind randomized clinical trial was conducted comparing the self-gripping mesh with a standard polypropylene mesh repair. Patients over 18 years of age undergoing open primary hernia repair were included. Pain was measured on a six-point verbal rating scale (VRS) and a 150-mm visual analogue scale (VAS). Postoperative pain reduction from baseline pain (ΔVAS), complications and return to work/hobbies were studied. Data were collected at baseline, 3 weeks, 3 months and 1 year after surgery (primary outcome). RESULTS: A total of 363 patients were analysed. Median age was 59 (range 19-88) years. Baseline VRS and VAS scores were similar for the two groups. There was no difference in VRS scores at 1-year follow-up. Duration of surgery was significantly shorter with the self-gripping mesh (mean 40 min versus 49 min for standard mesh repair; P < 0·001). At 3 weeks, ΔVAS in patients receiving the self-gripping mesh was significantly larger (-10·6 versus -5·0 respectively; P = 0·049) and less subjective discomfort was reported (P = 0·016). Complication rates, return to work and recurrence rates were similar, although there were more recurrences in the self-gripping mesh group (5·5 versus 2·2 per cent; P = 0·103). CONCLUSION: A self-gripping mesh for hernia repair may result in less pain in the early postoperative phase but chronic postherniorraphy pain is not affected. Recurrence rates may be a potential disadvantage. REGISTRATION NUMBER: NTR1212 (http://www.trialregister.nl).

Temperature dependence of spin pumping and Gilbert damping in thin Co/Pt bilayers.

We report on the temperature dependence of the spin-pumping effect and the Gilbert damping in Co/Pt bilayers grown on Silicon oxide by measuring the change of the linewidth in a ferromagnetic resonance (FMR) experiment. By varying the Co thickness d(Co) between 1.5 nm and 50 nm we find that the damping increases inversely proportional to d(Co) at all temperatures between 300 K and 5 K, showing that the spin pumping effect does not depend on temperature. We also find that the linewidth increases with decreasing temperature for all thicknesses down to about 30 K, before leveling off to a constant, or even decreasing again. This behavior is similar to what is found in bulk ferromagnets, leading to the conclusion that in thin films a conductivity-like damping mechanism is present similar to what is known in crystals.

Surgery for chronic inguinodynia following routine herniorrhaphy: beneficial effects on dysejaculation.

PURPOSE: Pain during sexual activities and ejaculation is reported by 3-4% of men after routine inguinal herniorrhaphy. The potential beneficial effects of surgery for chronic groin pain on dysejaculation are unknown. The objective of this study was to determine dysejaculation rates in a series of patients reporting chronic postherniorrhaphy pain and evaluate the effects of tailored neurectomy on dysejaculation. METHODS: We evaluated male patients (>18 years) operated for chronic groin pain after inguinal herniorrhaphy during a 6-year time period (2004-2010). Dysejaculation was defined as a burning or searing sensation associated with ejaculation. Men reporting symptoms possibly associated with dysejaculation were sent a questionnaire investigating pain characteristics (VAS, 0-100), influence on sex life and effects of the tailored neurectomy. A Post-Herniorrhaphy Dysejaculation Score (PHDS, 0-12 points) was introduced to quantify the severity of the dysejaculation syndrome. RESULTS: A series of 100 males operated for chronic inguinal pain after standard herniorrhaphy were studied. Thirty-four men reported symptoms of dysejaculation prior to the tailored neurectomy. Sex life was negatively influenced in 20 of these, and 5 completely abstained from any sexual activity. Following surgery including tailored neurectomy, funicular release and/or mesh removal, VAS for dysejaculation pain was significantly reduced [n = 20, 55 (95% CI 47-63) versus 21 (95% CI 13-29), p < 0.001]. PHDS scores were also significantly attenuated [n = 20, 10 (3-12) versus 2 (0-10), p < 0.001]. Sex life normalized in two-thirds of these men (13/20). CONCLUSION: Dysejaculation in men suffering from chronic pain after routine inguinal herniorrhaphy is not uncommon. A tailored neurectomy, funicular release and/or mesh removal offer relief in the majority of these patients.

Addressing asymmetry of the charge and strain in a two-dimensional fullerene peapod.

We prepared a two-dimensional C70 fullerene peapod by the sequential assembly of (12)C graphene, C70 fullerenes and (13)C graphene. The local changes in the strain and doping were correlated with local roughness revealing asymmetry in the strain and doping with respect to the top and bottom graphene layers of the peapod.

Giant magnetic susceptibility of gold nanorods detected by magnetic alignment.

We have determined the magnetic properties of single-crystalline Au nanorods in solution using an optically detected magnetic alignment technique. The rods exhibit a large anisotropy in the magnetic volume susceptibility (Δχ(V)). Δχ(V) increases with decreasing rod size and increasing aspect ratio and corresponds to an average volume susceptibility (χ(V)), which is drastically enhanced relative to bulk Au. This high value of χ(V) is confirmed by SQUID magnetometry and is temperature independent (between 5 and 300 K). Given this peculiar size, shape, and temperature dependence, we speculate that the enhanced χ(V) is the result of orbital magnetism due to mesoscopic electron trajectories within the nanorods.

A randomised controlled trial of injection therapy versus neurectomy for post-herniorrhaphy inguinal neuralgia: rationale and study design.

BACKGROUND: Chronic inguinal neuralgia is considered to be an important complication after hernia repair. As a high-level evidence-based treatment regime is currently lacking, these patients usually receive a random combination of pain medication, local nerve blocks or an occasional surgical neurectomy. A controlled trial ('GroinPain Trial') was constructed to identify the optimal treatment modality in this population. The aim and rationale of the trial are presented in this paper. PATIENTS AND METHODS: Adult patients with chronic post-herniorrhaphy inguinal pain (>3 months) caused by inguinal nerve entrapment having a temporary pain reduction after a lidocain nerve block are eligible for randomisation. They received either repetitive nerve blocks with lidocain, corticosteroids and hyaluronic acid, or a 'tailored' surgical neurectomy. RESULTS: Patient enrollment started in February 2006 and is expected to end in June 2010. The initial results will be available at the end of 2010. CONCLUSIONS: This trial is the first randomised controlled effort comparing two invasive treatment modalities for peripheral inguinal nerve entrapment. As awareness and knowledge on chronic neuropathic pain after inguinal herniorrhaphy in the near future is expected to increase, the findings of this trial will aid in optimising care in this patient population.

What is the most accurate estimate of pregnancy rates in IVF dropouts?

BACKGROUND: Dropouts in IVF-programmes affect cumulative pregnancy rates (CPRs), but it is unknown what the impact of loss to follow-up is. METHODS: Data were obtained from 588 couples starting IVF treatment ('as treated group'). Cycle-based and real-time-based CPRs were calculated using three assumptions for dropouts: dropouts having no probability of pregnancy, dropouts having the same probability of pregnancy as those continuing treatment and dropouts stopping because of medical reasons having no chance of pregnancy and those stopping because of other reasons having the same probability of pregnancy as those continuing treatment. CPRs obtained in the 'as treated group' were compared with CPRs calculated using the data set including the follow-up data of the dropouts ('completed group'). RESULTS: In 1.7% of couples, no follow-up could be obtained. The cycle-based CPR after three IVF-cycles ranged from 63% to 71% in the 'as treated group' and was 65% in the 'completed group'. The real-time-based CPR after 9 months ranged from 54% to 59% in the 'as treated group' and was 55% in the 'completed group'. The PR in dropouts was 14% (95% confidence interval 8.22%). CONCLUSIONS: In IVF programmes, outcome data of dropouts remain unknown, and CPRs should be calculated by assuming dropouts to have a PR between no probability and the same probability as those who continue treatment. Our study shows that the most accurate estimate for the PR in dropouts is 14%.

The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis.

BACKGROUND To review the accuracy of multivariate models for the prediction of ovarian reserve and pregnancy in women undergoing IVF compared with the antral follicle count (AFC) as single test. METHODS We performed a computerized MEDLINE and EMBASE search to identify articles published on multivariate models for ovarian reserve testing in patients undergoing IVF. In order to be selected, articles had to contain data on the outcome of IVF in terms of either pregnancy and/or poor response and on the prediction of these events based on a multivariate model. For the selected studies, sensitivity and specificity of the test in the prediction of poor ovarian response and non-pregnancy were calculated. Overall performance was assessed by estimating a summary receiver operating characteristic (ROC) curve, which was compared with the ROC curve for the AFC as the current best single test. RESULTS We identified 11 studies reporting on the predictive capacity of multivariate models in ovarian reserve testing. All studies reported on the prediction of poor ovarian response, whereas none reported on the occurrence of pregnancy. The sensitivity for prediction of poor ovarian response varied between 39% and 97% and the specificity between 50% and 96%. Logistic regression analysis indicated that cohort studies provided a significantly better discriminative performance than case-control studies. As cohort studies are superior to case-control studies, further analysis was limited to the cohort studies. For the cohort studies, a summary ROC curve could be estimated, which had a shape similar to that previously made for the AFC. CONCLUSIONS The accuracy of multivariate models for the prediction of ovarian response in women undergoing IVF is similar to the accuracy of AFC. No data are available on the capacity of these models to predict pregnancy, let alone live birth. On the basis of these findings, the use of more than one single test for the assessment of ovarian reserve cannot currently be supported.

[Fecal incontinence in community-dwelling elderly: findings from a study of prevalence, consultation of physicians, psychosocial aspects and treatment]. / Fecale incontinentie bij zelfstandig wonende ouderen: onderzoeksresultaten naar vóórkomen, hulpvraaggedrag, psychosociale aspecten en behandeling.

OBJECTIVE: To gain insight into the prevalence of faecal incontinence, looking for medical attention, treatment and the impact of faecal incontinence on the quality of life in community-residing men and women of 60 years and over. DESIGN: Enquiry and interview. METHOD: A questionnaire about the incidence of faecal incontinence and the request for help from the family doctor was mailed in 2000 to persons aged 60 and older listed in seven general practices in and round Nijmegen. In an interview with persons with faecal incontinence questions were asked about the need for assistance and the psychosocial consequences of the incontinence. RESULTS: Of the 3887 questionnaires mailed, 3345 were available for analysis, from 1536 males and 1809 females. The prevalence of faecal incontinence was 6%. The male-female distribution was equal and a rise in prevalence was seen with advancing age. One-third of the population discussed the incontinence with their physician, more women (58%) than men (42%). The faecal incontinence had hardly any impact on daily or social activities but the subjects did feel anxiety, shame or frustration. Treatment, if given (14/17), consisted of a prescription for diapers (n = 2) or of referral to an internist for examination of the intestines (n = 4). CONCLUSION: Faecal incontinence occurred in 6% of persons aged 60 or older living independently. Explicit looking for medical attention was not common. There were hardly any male-female differences. The most impact on the quality of life concerned the emotional wellbeing. Treatment had a little effect.