Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair

BACKGROUND

Inguinal hernia repair is a common low-risk intervention. Patient-reported outcomes (PROs) are being used increasingly as primary outcomes in clinical trials. The aim of this study was to review and meta-analyse the PROs in RCTs comparing laparoscopic versus open inguinal hernia repair techniques in adult patients.

METHODS

A systematic review and meta-analysis was carried out in accordance with PRISMA guidelines. Only RCTs in peer-reviewed journals were considered. PubMed, Ovid Embase, Scopus and the Cochrane Library were searched. In addition, four trial registries were searched. The search interval was between 1 January 1998 and 1 May 2018. Identified publications were reviewed independently by two authors. The review was registered in the PROSPERO database (CRD42018099552). Bias was assessed using the Cochrane Collaboration risk-of-bias tool.

RESULTS

Some 7192 records were identified, from which 58 unique RCTs were selected. Laparoscopic hernia repair was associated with significantly less postoperative pain in three intervals: from 2 weeks to within 6 months after surgery (risk ratio (RR) 0·74, 95 per cent c.i. 0·62 to 0·88), 6 months to 1 year (RR 0·74, 0·59 to 0·93) and 1 year onwards (RR 0·62, 0·47 to 0·82). Paraesthesia (RR 0·27, 0·18 to 0·40) and patient-reported satisfaction (RR 0·91, 0·85 to 0·98) were also significantly better in the laparoscopic repair group.

CONCLUSION

The data and analysis reported in this study reflect the most up-to-date evidence available for the surgeon to counsel patients. It was constrained by heterogeneity of reporting for several outcomes.

Lower rotational inertia and larger leg muscles indicate more rapid turns in tyrannosaurids than in other large theropods

Synopsis

Tyrannosaurid dinosaurs had large preserved leg muscle attachments and low rotational inertia relative to their body mass, indicating that they could turn more quickly than other large theropods.

Methods

To compare turning capability in theropods, we regressed agility estimates against body mass, incorporating superellipse-based modeled mass, centers of mass, and rotational inertia (mass moment of inertia). Muscle force relative to body mass is a direct correlate of agility in humans, and torque gives potential angular acceleration. Agility scores therefore include rotational inertia values divided by proxies for (1) muscle force (ilium area and estimates of m. caudofemoralis longus cross-section), and (2) musculoskeletal torque. Phylogenetic ANCOVA (phylANCOVA) allow assessment of differences in agility between tyrannosaurids and non-tyrannosaurid theropods (accounting for both ontogeny and phylogeny). We applied conditional error probabilities a(p) to stringently test the null hypothesis of equal agility.

Results

Tyrannosaurids consistently have agility index magnitudes twice those of allosauroids and some other theropods of equivalent mass, turning the body with both legs planted or pivoting over a stance leg. PhylANCOVA demonstrates definitively greater agilities in tyrannosaurids, and phylogeny explains nearly all covariance. Mass property results are consistent with those of other studies based on skeletal mounts, and between different figure-based methods (our main mathematical slicing procedures, lofted 3D computer models, and simplified graphical double integration).

Implications

The capacity for relatively rapid turns in tyrannosaurids is ecologically intriguing in light of their monopolization of large (>400 kg), toothed dinosaurian predator niches in their habitats.

The Anatomical and Functional Evolution of the Femoral Fourth Trochanter in Ornithischian Dinosaurs

The femoral fourth trochanter is the attachment site of the caudofemoralis musculature, which is the primary hindlimb retractor in most non-avian dinosaurs. Early ornithischian dinosaurs are uniquely characterized by a fourth trochanter with a prominent pendant process. Throughout the evolution of ornithischians, the fourth trochanter repeatedly converged on two major morphological changes: (1) the distal migration of the trochanter down the femoral shaft and (2) the loss of the pendant process. Both changes, as well as the original evolution of the pendant form, relate to a single major functional shift emphasizing caudofemoral leverage. Direct evidence of muscle scarring across the surface of the pendant process affirms that it served to extend the attachment of the primary caudofemoralis brevis tendon distally. A proximally located fourth trochanter is the basal condition in dinosaurs and other archosaurs, and the development of a pendant process lengthened the functional lever arm with regard to the insertion of the caudofemoralis. This adaptation afforded improved mechanical advantage, perhaps beneficial in the context of the newly assumed herbivorous diets of basal ornithischians. As some derived ornithischians increased in body size, a high-leverage system with a more distal caudofemoralis attachment evolved. In some groups, the fourth trochanter as a whole descended down the femur, eventually reaching a point where the pendant process was unnecessary. Sauropodomorphs, the other great lineage of dinosaur herbivores, converged on the same high-leverage distal fourth trochanter arrangement, but without first transitioning through a prominent pendant form. Anat Rec, 303:1146-1157, 2020. © 2019 Wiley Periodicals, Inc.

Correction: The first pterosaur pelvic material from the Dinosaur Park Formation (Campanian) and implications for azhdarchid locomotion

UALVP 56200, originally identified as a partial pelvis of an azhdarchid pterosaur, is a badly broken tyrannosaurid squamosal. Previous conclusions presented about pelvic myology and locomotion in azhdarchids are unsubstantiated and should be disregarded. UALVP 56200 is briefly redescribed here as a squamosal, and provides insights on the extent of cranial pneumaticity in tyrannosaurids.

A dinosaur community composition dataset for the Late Cretaceous Nemegt Basin of Mongolia

Dinosaur community composition data for eleven fossil localities in the Late Cretaceous Nemegt Basin of Mongolia are compiled from field observations and records in the literature. Counts were generated from skeletons and represent numbers of individuals preserved in each locality. These data were used in the analyses of Funston et al. [1] “Oviraptorosaur anatomy, diversity, and ecology in the Nemegt Basin” in the Nemegt Ecosystems Special Issue of Palaeogeography, Palaeoclimatology, Palaeoecology, where the results are discussed.

Tyrannosauroid integument reveals conflicting patterns of gigantism and feather evolution

Recent evidence for feathers in theropods has led to speculations that the largest tyrannosaurids, including Tyrannosaurus rex, were extensively feathered. We describe fossil integument from Tyrannosaurus and other tyrannosaurids (Albertosaurus, Daspletosaurus, Gorgosaurus and Tarbosaurus), confirming that these large-bodied forms possessed scaly, reptilian-like skin. Body size evolution in tyrannosauroids reveals two independent occurrences of gigantism; specifically, the large sizes in Yutyrannus and tyrannosaurids were independently derived. These new findings demonstrate that extensive feather coverings observed in some early tyrannosauroids were lost by the Albian, basal to Tyrannosauridae. This loss is unrelated to palaeoclimate but possibly tied to the evolution of gigantism, although other mechanisms exist.

Histological evidence for a dynamic dental battery in hadrosaurid dinosaurs

The first histological study of an entire hadrosaurid dental battery provides a comprehensive look at tooth movement within this complex structure. Previous studies have focused on isolated teeth, or in-situ batteries, but this is the first study to examine an entire dental battery of any dinosaur. The absence of direct tooth-to-tooth contact across the entire battery and a unique arrangement of the dental tissues in hadrosaurids led us to compare their teeth with the ever-growing incisors of mammals. The similarity in the distributions of tissues along the incisor, coupled with continuous eruption, make for helpful comparisons to hadrosaurid teeth. The mammalian ever-growing incisor can be used as a model to extrapolate the soft tissue connections and eruptive mechanisms within the hadrosaurid dental battery. Serial sections across the adult dental battery reveal signs of gradual ontogenetic tooth migration. Extensive remodeling of the alveolar septa and the anteroposterior displacement of successive generations of teeth highlight the gradual migration of tooth generations within the battery. These eruptive and ontogenetic tooth movements would not be possible without a ligamentous connection between successive teeth and the jaws, underscoring the dynamic nature of one of the most unique and complex dental systems in vertebrate history.

First Ornithomimid (Theropoda, Ornithomimosauria) from the Upper Cretaceous Djadokhta Formation of Tögrögiin Shiree, Mongolia

The Upper Cretaceous Djadokhta Formation has been intensively surveyed for its fossil vertebrate fauna for nearly a century. Amongst other theropods, dromaeosaurids and parvicursorines are common in the formation, but ornithomimosaurs are extremely rare. A new ornithomimosaur material was discovered from the Djadokhta Formation, represented by eolian deposits, of the Tögrögiin Shiree locality, Mongolia. This is only the third ornithomimosaur specimen reported from this formation, and includes the astragalus, the calcaneum, the third distal tarsal, and a complete pes. The new material is clearly belonged to Ornithomimidae by its arctometatarsalian foot condition and has the following unique characters; unevenly developed pair of concavities of the third distal tarsal, curved contacts between the proximal ends of second and fourth metatarsals, the elongate fourth digit, and a laterally inclined medial condyle on phalanx IV-1. These diagnostic characters of the Djadokhtan ornithomimosaur indicate that this is a new taxon. Our phylogenetic analysis supports three clades within derived ornithomimosaurs, and the new taxon is placed a member of the derived ornithomimosaurs. The present specimen is the first ornithomimid record from eolian Tögrögiin Shiree locality, and is indicative of their capability to adapt to arid environments.

First North American occurrences of Qiupalong (Theropoda: Ornithomimidae) and the palaeobiogeography of derived ornithomimids

Ornithomimid material from the Belly River Group (Campanian) of Alberta, Canada is described as sharing characters with Qiupalong henanensis from the Qiupa Formation of Henan Province, China. Derived characters and character combinations of the pubis and astragalocalcaneum were previously used to diagnose Q. henanensis and support the referral of this material to Qiupalong sp., representing the first known occurrences of Qiupalong outside of China. Qiupalong is the sixth ornithomimid taxon to be reported from the Dinosaur Park Formation and the first ornithomimid genus with a transcontinental distribution. The Alberta material represents the oldest known occurrences of Qiupalong, and a reconsideration of character evidence suggests that this genus is phylogenetically nested within other North American ornithomimids. A North American origin for Qiupalong and subsequent dispersal to Asia is proposed.

The first pterosaur pelvic material from the Dinosaur Park Formation (Campanian) and implications for azhdarchid locomotion

A partial pterosaur pelvis from the Campanian Dinosaur Park Formation of Canada adds to our knowledge of Late Cretaceous pterosaurs. The pelvis is tentatively referred to Azhdarchidae and represents the first pelvic material from a North American azhdarchid. The morphology of the ilium is bizarre compared with other pterosaurs: it is highly pneumatized, the preacetabular process tapers anteriorly, and muscle scars show that it would have anchored strong adductor musculature for the hindlimb. The acetabulum is deep and faces ventrolaterally, allowing the limb to be positioned underneath the body. These features support previous suggestions that azhdarchids were well adapted to terrestrial locomotion.

Response to: Phylogenetic placement, developmental trajectories and evolutionary implications of a feathered dinosaur tail in Mid-Cretaceous amber

In his correspondence, Markus Lambertz [1] raises some concerns about the phylogenetic placement and feather development of DIP-V-15103, the amber-entombed tail section that we recently reported [2] as fragmentary remains of a non-pygostylian coelurosaur (likely within the basal part of Coelurosauria). We here would like to respond to these concerns.

A Feathered Dinosaur Tail with Primitive Plumage Trapped in Mid-Cretaceous Amber

In the two decades since the discovery of feathered dinosaurs [1-3], the range of plumage known from non-avialan theropods has expanded significantly, confirming several features predicted by developmentally informed models of feather evolution [4-10]. However, three-dimensional feather morphology and evolutionary patterns remain difficult to interpret, due to compression in sedimentary rocks [9, 11]. Recent discoveries in Cretaceous amber from Canada, France, Japan, Lebanon, Myanmar, and the United States [12-18] reveal much finer levels of structural detail, but taxonomic placement is uncertain because plumage is rarely associated with identifiable skeletal material [14]. Here we describe the feathered tail of a non-avialan theropod preserved in mid-Cretaceous (∼99 Ma) amber from Kachin State, Myanmar [17], with plumage structure that directly informs the evolutionary developmental pathway of feathers. This specimen provides an opportunity to document pristine feathers in direct association with a putative juvenile coelurosaur, preserving fine morphological details, including the spatial arrangement of follicles and feathers on the body, and micrometer-scale features of the plumage. Many feathers exhibit a short, slender rachis with alternating barbs and a uniform series of contiguous barbules, supporting the developmental hypothesis that barbs already possessed barbules when they fused to form the rachis [19]. Beneath the feathers, carbonized soft tissues offer a glimpse of preservational potential and history for the inclusion; abundant Fe²⁺ suggests that vestiges of primary hemoglobin and ferritin remain trapped within the tail. The new finding highlights the unique preservation potential of amber for understanding the morphology and evolution of coelurosaurian integumentary structures.

The first oviraptorosaur (Dinosauria: Theropoda) bonebed: evidence of gregarious behaviour in a maniraptoran theropod

A monodominant bonebed of Avimimus from the Nemegt Formation of Mongolia is the first oviraptorosaur bonebed described and the only recorded maniraptoran bonebed from the Late Cretaceous. Cranial elements recovered from the bonebed provide insights on the anatomy of the facial region, which was formerly unknown in Avimimus. Both adult and subadult material was recovered from the bonebed, but small juveniles are underrepresented. The taphonomic and sedimentological evidence suggests that the Avimimus bonebed represents a perimortem gregarious assemblage. The near absence of juveniles in the bonebed may be evidence of a transient age-segregated herd or 'flock', but the behaviour responsible for this assemblage is unclear. Regardless, the Avimimus bonebed is the first evidence of gregarious behaviour in oviraptorosaurs, and highlights a potential trend of increasing gregariousness in dinosaurs towards the end of the Mesozoic.

A small azhdarchoid pterosaur from the latest Cretaceous, the age of flying giants

Pterosaur fossils from the Campanian-Maastrichtian of North America have been reported from the continental interior, but few have been described from the west coast. The first pterosaur from the Campanian Northumberland Formation (Nanaimo Group) of Hornby Island, British Columbia, is represented here by a humerus, dorsal vertebrae (including three fused notarial vertebrae), and other fragments. The elements have features typical of Azhdarchoidea, an identification consistent with dominance of this group in the latest Cretaceous. The new material is significant for its size and ontogenetic stage: the humerus and vertebrae indicate a wingspan of ca 1.5 m, but histological sections and bone fusions indicate the individual was approaching maturity at time of death. Pterosaurs of this size are exceedingly rare in Upper Cretaceous strata, a phenomenon commonly attributed to smaller pterosaurs becoming extinct in the Late Cretaceous as part of a reduction in pterosaur diversity and disparity. The absence of small juveniles of large species-which must have existed-in the fossil record is evidence of a preservational bias against small pterosaurs in the Late Cretaceous, and caution should be applied to any interpretation of latest Cretaceous pterosaur diversity and success.

A New Megaraptoran Dinosaur (Dinosauria, Theropoda, Megaraptoridae) from the Late Cretaceous of Patagonia

A skeleton discovered in the Upper Cretaceous Sierra Barrosa Formation (Turonian-Coniacian) of Neuquén Province, Argentina represents a new species of theropod dinosaur related to the long snouted, highly pneumatized Megaraptoridae. The holotype specimen of Murusraptor barrosaensis n.gen et n.sp. (MCF-PVPH-411) includes much of the skull, axial skeleton, pelvis and tibia. Murusraptor is unique in having several diagnostic features that include anterodorsal process of lacrimal longer than height of preorbital process, and a thick, shelf-like thickening on the lateral surface of surangular ventral to the groove between the anterior surangular foramen and the insert for the uppermost intramandibular process of the dentary. Other characteristic features of Murusraptor barrosaensis n.gen. et n. sp.include a large mandibular fenestra, distal ends of caudal neural spines laterally thickened into lateral knob-like processes, short ischia distally flattened and slightly expanded dorsoventrally. Murusraptor belongs to a Patagonian radiation of megaraptorids together with Aerosteon, Megaraptor and Orkoraptor. In spite being immature, it is a larger but more gracile animal than existing specimens of Megaraptor, and is comparable in size with Aerosteon and Orkoraptor. The controversial phylogeny of the Megaraptoridae as members of the Allosauroidea or a clade of Coelurosauria is considered analyzing two alternative data sets.

An approach to scoring cursorial limb proportions in carnivorous dinosaurs and an attempt to account for allometry

From an initial dataset of 53 theropod species, the general relationship between theropod lower-leg length and body mass is identified. After factoring out this allometric relationship, theropod hindlimb proportions are assessed irrespective of body mass. Cursorial-limb-proportion (CLP) scores derived for each of the considered theropod taxa offer a measure of the extent to which a particular species deviates in favour of higher or lower running speeds. Within the same theropod species, these CLP scores are found to be consistent across multiple adult specimens and across disparate ontogenetic stages. Early theropods are found to have low CLP scores, while the coelurosaurian tyrannosauroids and compsognathids are found to have high CLP scores. Among deinonychosaurs, troodontids have consistently high CLP scores, while many dromaeosaur taxa, including Velociraptor and Deinonychus, have low CLP scores. This indicates that dromaeosaurs were not, overall, a particularly cursorily adapted group. Comparisons between the CLP scores of Tyrannosaurus and specimens referred to the controversial genus Nanotyrannus indicate a strong discrepancy in cursorial adaptations, which supports the legitimacy of Nanotyrannus and the previous suggestions of ecological partitioning between Nanotyrannus and the contemporaneous Tyrannosaurus.

Ankylosaurid dinosaur tail clubs evolved through stepwise acquisition of key features

Ankylosaurid ankylosaurs were quadrupedal, herbivorous dinosaurs with abundant dermal ossifications. They are best known for their distinctive tail club composed of stiff, interlocking vertebrae (the handle) and large, bulbous osteoderms (the knob), which may have been used as a weapon. However, tail clubs appear relatively late in the evolution of ankylosaurids, and seemed to have been present only in a derived clade of ankylosaurids during the last 20 million years of the Mesozoic Era. New evidence from mid Cretaceous fossils from China suggests that the evolution of the tail club occurred at least 40 million years earlier, and in a stepwise manner, with early ankylosaurids evolving handle-like vertebrae before the distal osteoderms enlarged and coossified to form a knob.

A possible instance of sexual dimorphism in the tails of two oviraptorosaur dinosaurs

The hypothesis that oviraptorosaurs used tail-feather displays in courtship behavior previously predicted that oviraptorosaurs would be found to display sexually dimorphic caudal osteology. MPC-D 100/1002 and MPC-D 100/1127 are two specimens of the oviraptorosaur Khaan mckennai. Although similar in absolute size and in virtually all other anatomical details, the anterior haemal spines of MPC-D 100/1002 exceed those of MPC-D 100/1127 in ventral depth and develop a hitherto unreported “spearhead” shape. This dissimilarity cannot be readily explained as pathologic and is too extreme to be reasonably attributed to the amount of individual variation expected among con-specifics. Instead, this discrepancy in haemal spine morphology may be attributable to sexual dimorphism. The haemal spine form of MPC-D 100/1002 offers greater surface area for caudal muscle insertions. On this basis, MPC-D 100/1002 is regarded as most probably male, and MPC-D 100/1127 is regarded as most probably female.

Osteohistological variation in growth marks and osteocyte lacunar density in a theropod dinosaur (Coelurosauria: Ornithomimidae)

Background

Osteohistological examinations of fossil vertebrates have utilized a number of proxies, such as counts and spacing of lines of arrested growth (LAGs) and osteocyte lacunar densities (OLD), in order to make inferences related to skeletochronology and mass-specific growth rates. However, many of these studies rely on samplings of isolated bones from single individuals. These analyses do not take individual variation into account, and as a result may lead to misleading inferences of the physiology of extinct organisms. This study uses a multi-element, multi-individual sampling of ornithomimid dinosaurs to test the amount of individual variation in the aforementioned osteohistological indicators. Based on these results we also assess the conclusions of previous studies that tested paleohistological hypotheses using isolated elements.

Results

LAG number was found to be consistent within the hind limb bones of each individual, with the exception of the fibula, which preserves one additional LAG. Considerable differences in LAG spacing were found between elements of the sampled individuals, with larger variation found in elements of the foot compared with the femur, fibula, and tibia. Osteocyte lacunar density ranged between 29000 and 42000 osteocyte lacunae per mm³, and was found to vary more between hind limb bones of an individual and within bones, than between the average values of individuals.

Conclusions

The variation between hind limb elements in LAG number and LAG spacing suggests that direct comparisons of these elements may be misleading, and that LAG spacing is not a reliable proxy for mass-specific growth rates of an individual. Sampling of multiple bones should be performed as an internal check of model-based LAG retro-calculation and growth equations. The observation that osteocyte lacunar density varies more between individual bone elements than between average individual values suggests that the choice of sampled element can greatly influence the result, and care should be taken to not bias interpretations of the physiology of fossil tetrapods.

Electronic supplementary material

The online version of this article (doi:10.1186/s12862-014-0231-y) contains supplementary material, which is available to authorized users.