AOPERA: A proposed methodology and inventory of effective tools to link chemicals to adverse outcome pathways.

New approaches, like the Adverse Outcome Pathway (AOP) framework, have been developed to describe how chemicals cause toxicity by linking in vitro assays to adverse health outcomes. However, approaches, tools and resources for development of AOPs have not been well described. Here we review information resources for AOP development and define a streamlined process for linking a chemical to an existing AOP. We propose a four step process to facilitate AOP development: link the uncharacterized chemical directly to Molecular Initiating Events, Key Events, or Adverse Outcomes; identify analogs with toxicological information for the uncharacterized chemical; link the characterized chemical (initial chemical if characterized, a characterized analog if initial chemical is not) to Molecular Initiating Events, Key Events, or Adverse Outcomes; and identify AOPs that contain the Molecular Initiating Events, Key Events, or Adverse Outcomes that were found in Steps 1 and 3. The process and library of informational resources proposed and tested here served as the foundation for an informational online tool (AOPERA) that helps practitioners identify their current-state knowledge gaps, navigate the four-step process, and connect to relevant resources. AOPERA can be found at https://igbb.github.io/AOPERA_HTML. Additionally, we anticipate that by simplifying and standardizing the process of linking a chemical to a known AOP, we will lower the barrier to entry for this objective and increase its accessibility to new practitioners. In turn, this may increase the demand for new or improved AOPs to which practitioners can link chemicals, thereby contributing to the expansion of the library of known AOPs.

An updated traditional classification of inguinal hernias.

The traditional classification of inguinal hernias is the most widely used system today; however, it does not categorize all inguinal hernias nor their levels of complexity. The named systems of Gilbert, Nyhus, and Schumpelick are reviewed, and their common features are analyzed. A simple updating of the traditional classification along with the use of common modifiers creates a system that is all-inclusive and easy to use for data registries. The traditional classification of inguinal hernias (indirect, direct, and femoral) has withstood the test of time for almost 150 years. In this interval, inguinal hernia repairs have experienced significant evolution from simple ligation of the sac or suturing of the muscular defect to improved primary tissue repairs (e.g., Bassini, McVay, Shouldice) based upon better anatomic principles. Also during the past 30 years, two major revolutions in operative repairs have occurred. First, there is the use of mesh and, second, its placement laparoscopically. As a consequence, hernia surgeons today must choose among multiple competing operative techniques. No one operative technique has proven to be best for all inguinal hernias. Also different levels of complexity and severity exist among inguinal hernias, and thus it is essential that we accurately classify the various inguinal hernias, such that we surgeons can provide the best operative solution for each patient. As Fitzgibbons [1] states, "The primary purpose of a classification for any disease is to stratify for severity so that reasonable comparisons can be made between various treatment strategies."

Classification systems for groin hernias.

All groin hernia classifications are somewhat arbitrary and artificial. Currently, there is no consensus among either general surgeons or hernia specialists as to a preferred system. A survey by Zollinger in 1998 of hernia specialists in North American and Europe showed, that although the Nyhus, Gilbert, and Schumpelick-Arit systems were commonly used, the majority of these specialists still used the traditional classification for groin hernias. It is apparent that only the traditional classification of groin hernias has stood the test of time. As stated by Fitzgibbons, "the primary purpose of a classification system for any disease is to stratify for severity so that reasonable comparisons can be made between various treatment strategies." Given the multiplicity of operative techniques and approaches for the repair of groin hernias, it appears that no one classification system can satisfy all. With time, it is likely that we surgeons will settle upon a given operation for a specific type of inguinal hernia. For that given operation to be accepted as proven best, however, it is essential the competing operations be applied to simliar (classified) groups of groin hernia patients.

A history of the Ohio State University Department of Surgery.

Doctor Robert M. Zollinger wrote this piece prior to his death in 1992. He recounts the history of the Ohio State University Department of Surgery from the evolution of the Ohio State University College of Medicine to the years of the department's reorganization and growth after World War II.

The atlas of surgical operations: Elliott Carr Cutler and Robert Zollinger.

The author of Zollinger's Atlas of Surgical Operations describes the development of the Atlas of Surgical Operations over the course of seven editions and 64 years.