Analysis of retromuscular drain output and postoperative outcomes for heavyweight versus mediumweight polypropylene mesh following open ventral hernia repair

PURPOSE

Heavyweight polypropylene (HWPP) mesh is thought to increase inflammatory response and delay tissue integration compared to mediumweight (MWPP). Reactive fluid volume (i.e., drain output) may be a reasonable surrogate for integration. We hypothesized that daily drain output is higher with HWPP compared to MWPP in open retromuscular ventral hernia repair (VHR).

METHODS

This is a post-hoc analysis of a multicenter, randomized clinical trial conducted March 2017-April 2019 comparing MWPP and HWPP for VHR. Retromuscular drain output in milliliters was measured at 24-h intervals up to postoperative day seven. Univariate analyses compared differences in daily drain output and time to drain removal. Multivariable analyses compared total drain output and wound morbidity within 30 days and hernia recurrence at 1 year.

RESULTS

288 patients were included; 140 (48.6%) HWPP and 148 (51.4%) MWPP. Daily drain output for days 1-3 was higher for HWPP vs. MWPP (total volume: 837.8 mL vs. 656.5 mL) (p < 0.001), but similar on days 4-7 (p > 0.05). Median drain removal time was 5 days for both groups. Total drain output was not predictive of 30-day wound morbidity (p > 0.05) or hernia recurrence at 1 year (OR 1, p = 0.29).

CONCLUSION

While HWPP mesh initially had higher drain outputs, it rapidly returned to levels similar to MWPP by postoperative day three and there was no difference in clinical outcomes. We believe that drains placed around HWPP mesh can be managed similarly to MWPP mesh.

Outcomes of posterior component separation with transversus abdominis release for repair of abdominally based breast reconstruction donor site hernias

PURPOSE

Abdominally based autologous breast reconstruction (ABABR) is common after mastectomy, but carries a risk of complex abdominal wall hernias. We report experience with posterior component separation (PCS) and transversus abdominis release (TAR) with permanent synthetic mesh repair of ABABR-related hernias.

METHODS

Patients at Cleveland Clinic Foundation and Penn State Health were identified retrospectively. Outcomes included postoperative complications, hernia recurrence, and patient-reported outcomes (PROs): Hernia Recurrence Inventory, HerQLes Summary Score, Patient-Reported Outcome Measurement Information System (PROMIS) Pain Intensity 3a Survey, and the Decision Regret Scale (DRS).

RESULTS

Forty patients underwent PCS/TAR repair of hernias resulting from pedicled (35%), free (5%), muscle-sparing TRAMs (15%), and DIEPs (28%) from August 2014 to March 2021. Following PCS, 30-day complications included superficial surgical site infection (13%), seroma (8%), and superficial wound breakdown (5%). Five patients (20%) developed clinical hernia recurrence. At a minimum of 1 year, 17 (63%) reported a bulge, 12 (44%) reported pain, median HerQLes Quality Of Life Scores improved from 33 to 63/100 (p value < 0.01), PROMIS 3a Pain Intensity Scores improved from 52 to 38 (p value < 0.05), and DRS scores were consistent with low regret (20/100).

CONCLUSION

ABABR-related hernias are complex and technically challenging due to missing abdominal wall components and denervation injury. After repair with PCS/TAR, patients had high rates of recurrence and bulge, but reported improved quality of life and pain and low regret. Surgeons should set realistic expectations regarding postoperative bulge and risk of hernia recurrence.

Abdominal wall mass resections: single-center closure practices and outcomes following oncologic resections of abdominal wall fascia

PURPOSE

Radical resections for abdominal wall tumors are rare, thus yielding limited data on reconstruction of defects. We describe surgical management and long-term outcomes following radical tumor resection.

METHODS

This was a single-center retrospective review of patients between January 2010 and December 2022. Variables included operative characteristics, wound complications, hernia development, tumor recurrence, and reoperation. A multivariable analysis compared wound morbidity for suture and mesh repairs while adjusting for defect width, fascial closure, and CDC wound class.

RESULTS

120 patients were identified. Mean follow-up was 3.9 ± 3.4 years. Seventy-five (62.5%) of the masses were primary; most commonly desmoid (n = 25) and endometrioma (n = 27). Forty-five masses were metastases. Mean tumor width was 6.2 ± 3.4 cm; mean defect width was 8.1 ± 4.1 cm. Sixty-one patients (50.8%) had mesh placed, with variation in technique. Postoperative CT scans were available for 88 (73.3%) patients. Forty SSOs (33.3%), 11 SSIs (9.2%), and 18 (15%) SSOPIs occurred within 30 days. On multivariable analysis, increased defect width was associated with SSOPI (OR 1.17, p = 0.041) and CDC wound class II-III was associated with SSI (OR 8.38 and 49.1, p < 0.05) and SSOPI (OR 5.77 and 17.4, p < 0.05); mesh was not associated with these outcomes. Seven patients (5.8%) underwent 30-day reoperations and 35 (20.8%) required additional operations after 30 days. Thirteen percent developed abdominal wall (n = 8) or intra-abdominal tumor recurrence (n = 8) requiring reoperation. Twenty-seven (22.5%) patients developed hernias with a mean fascial defect width of 9.8 ± 7.2 cm.

CONCLUSION

Abdominal wall mass resections are morbid, often contaminated cases with high postoperative complication rates. Risks and benefits of mesh implantation should be tailored on an individual basis.

Real-time x-ray abnormality alerts for emergency departments using a radiographer comment model - a multisite pilot study

INTRODUCTION

The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time.

METHODS

A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in patients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021-2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site.

RESULTS

Radiographers (n = 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947-0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9% - 5.3%.; 95% CI).

CONCLUSION

The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9% - 5.3%.; 95% CI) was low.

IMPLICATIONS FOR FUTURE PRACTICE

A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments.

Opioid prescribing practices and patient-requested refill patterns following laparoscopic inguinal hernia repair

PURPOSE

Excessive post-operative opioid prescribing has led to efforts to match prescriptions with patient need after surgery. We investigated opioid prescribing practices, rate of patient-requested opioid refills, and associated factors after laparoscopic inguinal hernia repair (LIHR).

METHODS

LIHRs at a single institution from 3/2019 to 3/2021 were queried from the Abdominal Core Health Quality Collaborative for demographics, perioperative details, and patient-reported opioid usage. Opioid prescriptions at discharge and opioid refills were extracted from the medical record. Univariate and multivariable regression were used to identify factors associated with opioid refills within 30-days of surgery.

RESULTS

Four hundred and ninety LIHR patients were analyzed. The median number of opioid tablets prescribed was 12 [interquartile range (IQR) 10-15], and 4% requested a refill. On univariate analysis, patients who requested refills were younger [55 years (IQR 37-61) vs. 62 years (IQR 36.8-61), p = 0.012], more likely to have undergone transabdominal preperitoneal repair (75% vs. 26.4%, p < 0.001), have a scrotal component (30% vs. 11%, p = 0.022), and have permanent tacks used (80% vs. 49.4%, p = 0.014). There was a 12% increase in the odds of opioid refill for every 1 tablet of oxycodone prescribed at discharge (95% CI for OR 1.04-1.21, p = 0.003) after controlling for age and surgery type. Patient-reported opioid use was available for 289 (59%) patients. Post-operatively, 67% of patients used ≤ 4 opioid tablets, and 87% used no more than 10 opioid tablets.

CONCLUSION

Most patients use fewer opioid tablets than prescribed. Requests for opioid refills are rare following LIHR (4%) and associated with higher opioid prescribing.

Comparing anterior gastropexy to no anterior gastropexy for paraesophageal hernia repair: a study protocol for a randomized control trial

BACKGROUND

More than half of patients undergoing paraesophageal hernia repair (PEHR) will have radiographic hernia recurrence at 5 years after surgery. Gastropexy is a relatively low-risk intervention that may decrease recurrence rates, but it has not been studied in a prospective manner. Our study aims to evaluate the effect of anterior gastropexy on recurrence rates after PEHR, compared to no anterior gastropexy.

METHODS

This is a two-armed, single-blinded, registry-based, randomized controlled trial comparing anterior gastropexy to no anterior gastropexy in PEHR. Adult patients (≥18 years) with a symptomatic paraesophageal hernia measuring at least 5 cm in height on computed tomography, upper gastrointestinal series, or endoscopy undergoing elective minimally invasive repair are eligible for recruitment. Patients will be blinded to their arm of the trial. All patients will undergo laparoscopic or robotic PEHR, where some operative techniques (crural closure techniques and fundoplication use or avoidance) are left to the discretion of the operating surgeon. During the operation, after closure of the diaphragmatic crura, participants are randomized to receive either no anterior gastropexy (control arm) or anterior gastropexy (treatment arm). Two hundred forty participants will be recruited and followed for 1 year after surgery. The primary outcome is radiographic PEH recurrence at 1 year. Secondary outcomes are symptoms of gastroesophageal reflux disease, dysphagia, odynophagia, gas bloat, regurgitation, chest pain, abdominal pain, nausea, vomiting, postprandial pain, cardiovascular, and pulmonary symptoms as well as patient satisfaction in the immediate postoperative period and at 1-year follow-up. Outcome assessors will be blinded to the patients' intervention.

DISCUSSION

This randomized controlled trial will examine the effect of anterior gastropexy on radiographic PEH recurrence and patient-reported outcomes. Anterior gastropexy has a theoretical benefit of decreasing PEH recurrence; however, this has not been proven beyond a suggestion of effectiveness in retrospective series. If anterior gastropexy reduces recurrence rates, it would likely become a routine component of surgical PEH management. If it does not reduce PEH recurrence, it will likely be abandoned.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04007952 . Registered on July 5, 2019.

P-524 Bi-allelic CFAP61 variants cause male infertility in humans and mice with severe oligoasthenoteratozoospermia

Study question

Are mutations in cilia and flagella-associated protein 61 (CFAP61) associated with human male infertility?

Summary answer

Bi-allelic variants ([NM_015585.4: c.1654C&gt;T (p.R552C) and c.2911G&gt;A (p.D971N), c.144-2A&gt;G and c.1666G&gt;A (p.G556R)] in CFAP61 were identified as contributory genetics factor in severe oligoasthenoteratozoospermia (OAT).

What is known already

Cfap61 knockout mice were infertile due to multiple morphological abnormalities of the sperm flagella (MMAF). However, so far there is no direct evidence that mutations of CFAP61 cause OAT and male infertility.

Study design, size, duration

Variant screening was performed by whole-exome sequencing (WES) from 325 infertile patients with OAT and 392 fertile individuals. A knockout mouse model was generate to confirm the candidate disease-causing gene, intracytoplasmic sperm injection (ICSI) was used to evaluate the efficiency of clinical treatment.

Participants/materials, setting, methods

A total 325 OAT-affected patients and 392 men with normal fertility were recruited from China. WES was performed, followed by Sanger sequencing validation. In silico bioinformatics predictions and in vitro functional analyses were performed to evaluate the impacts of candidate disease-causing variants. Hematoxylin and eosin (H&E) staining, electron microscopy, and immunofluorescence assays were performed to evaluate the sperm morphology. Two OAT-affected men with CFAP61 variants were treated by ICSI, and pregnancy outcomes were followed.

Main results and the role of chance

We identified bi-allelic CFAP61 variants [NM_015585.4: c.1654C&gt;T (p.R552C) and c.2911G&gt;A (p.D971N), c.144-2A&gt;G and c.1666G&gt;A (p.G556R)] in two (0.62%) of the 325 OAT-affected men. In silico bioinformatics analysis predicted that all four variants were deleterious, and in vitro functional analysis confirmed the deleterious effects of the mutants. Notably, H&E staining and electron microscopy analyses of the spermatozoa revealed multiple morphological abnormalities of sperm flagella, the absence of central pair microtubules, and mitochondrial sheath malformation in sperm flagella from man with CFAP61 variants. Further immunofluorescence assays revealed markedly reduced CFAP61 staining in the sperm flagella. In addition, Cfap61-deficient mice showed the OAT phenotype, suggesting that loss of function of CFAP61 was the cause of OAT. Two individuals accepted ICSI therapy using their own ejaculated sperm, and one of them succeeded in fathering a healthy baby.

Limitations, reasons for caution

Limitations include the lack of in vivo data from the one of patients, and the exact molecular mechanism should be further investigated.

Wider implications of the findings

Our findings indicate that CFAP61 is essential for spermatogenesis and that bi-allelic CFAP61 variants lead to OAT and male infertility in humans and mice. In addition, our results show that ICSI treatment can be recommended for CFAP61-related OAT.

Trial registration number

not applicable

Inflammatory indexes in preoperative blood routine to predict early recurrence of hepatocellular carcinoma after curative hepatectomy

Background

The inflammation indexes in blood routine play an essential role in evaluating the prognosis of patients with hepatocellular carcinoma, but the effect on early recurrence has not been clarified. The study aimed to investigate the risk factors of early recurrence (within 2 years) and recurrence-free survival after curative hepatectomy and explore the role of inflammatory indexes in predicting early recurrence.

Methods

The baseline data of 161 patients with hepatocellular carcinoma were analyzed retrospectively. The optimal cut-off value of the inflammatory index was determined according to the Youden index. Its predictive performance was compared by the area under the receiver operating characteristic curve. Logistic and Cox regression analyses were used to determine the risk factors of early recurrence and recurrence-free survival.

Results

The area under the curve of monocyte to lymphocyte ratio (MLR) for predicting early recurrence was 0.700, which was better than systemic inflammatory response index (SIRI), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune-inflammatory index (SII). MLR, tumour size, tumour differentiation and BCLC stage are all risk factors for early recurrence and recurrence-free survival of HCC. Combining the above four risk factors to construct a joint index, the area under the curve for predicting early recurrence was 0.829, which was better than single MLR, tumour size, tumour differentiation and BCLC stage. Furthermore, with the increase of risk factors, the recurrence-free survival of patients is worse.

Conclusion

The combination of MLR and clinical risk factors is helpful for clinicians to identify high-risk patients with early recurrence and carry out active postoperative adjuvant therapy to improve the prognosis of patients.

[High frequency hearing loss detection rate in occupational noise exposed workers in China: a Meta-analysis]

Objective: A Meta-analysis was used to evaluate the high frequency hearing loss detection rate, its area and time distributions in occupational noise exposed workers in China to provide evidence for the prevention and control of occupational noise-induced deafness. Methods: From February to April 2020, the number of hearing tests and the number of binaural high frequency average hearing threshold ≥40 dB of workers exposed to noise in key occupational disease monitoring and occupational health risk assessment project in China was collected from China National Knowledge Infrastructure (CNKI) , VIP database and PubMed database. The retrieval time was set from the establishment of the database to February 28, 2020. The R 3.6.2 software was used to calculate the pooled high frequency hearing loss detection rate. Results: A total of 28 studies, included 34 data and 1259571 occupational noise exposed workers, were enrolled. The articles covered 16 provinces in 2015-2018. The pooled high frequency hearing loss detection rate in occupational noise exposed workers was 9.45% (95%CI: 7.64%-11.64%) . The high frequency hearing loss detection rate (10.54%) was higher in 2018 than other years (2017: 10.17%, 2016: 9.21%, 2015: 7.88%) . The high frequency hearing loss detection rate (12.23%) was higher in central China than in eastern (10.21%) , western (7.91%) and north-eastern (5.21%) China. Conclusion: The overall high frequency hearing loss detection rate in occupational noise exposed workers is generally high in China. It is important to strengthen the hearing protection in occupational noise exposed workers to facilitate the occupational noise-induced deafness prevention and control in China.

The value of preoperative systemic immune-inflammation index in predicting vascular invasion of hepatocellular carcinoma: a meta-analysis

Vascular invasion and systemic immune-inflammation index (SII) are risk factors for the prognosis of patients with hepatocellular carcinoma. At present, the correlation between the two is not clear. This meta-analysis explored the relationship between preoperative SII and vascular invasion in patients with hepatocellular carcinoma. According to the search formula, the Pubmed, Embase, Cochrane, Web of Science, and CNKI databases were searched for the relevant research until March 2020. After the quality evaluation of the included literature, the odds ratio (OR) and its corresponding 95% confidence interval (CI) were used as the effect measure. Stata 15. 0 software was used for statistical analysis. The meta-analysis eventually included seven retrospective cohort studies of 3583 patients with hepatocellular carcinoma. The results showed that the choice of SII cut-off value affects SII's efficiency in predicting the risk of vascular invasion. In the cohort of studies with appropriate SII cut-off value, the high SII preoperative group had a higher risk of vascular invasion (OR=2.62; 95%CI: 2.07-3.32; P=0.000) and microvascular invasion (OR=1.82; 95%CI: 1.01-3.25; P=0.045) than the low SII group. The tumor diameter (OR=2.88; 95%CI: 1.73-4. 80; P=0.000) of the high SII group was larger than that of the low SII group. There was no publication bias in this study (Begg's test, P=0.368). As a routine, cheap, and easily available index, SII can provide a certain reference value for clinicians to evaluate vascular invasion before operation.

Extracellular vesicles and diabetic kidney disease: a systematic review

Extracellular vesicles (EVs) are small lipid-encapsulated vesicles secreted from specific cells that can be taken up by other cells, thereby allowing for the efficient transport of macromolecules such as lipids, proteins, and nucleic acids between tissues and organs in vivo. These EVs have been found to play critical roles in normal tissue homeostasis and disease development, serving to regulate complex processes, including inflammation, immunity, and angiogenesis. At present, the leading global cause of the end-stage renal disease (ESRD) is diabetic kidney disease (DKD), with the prevalence of this latter condition being predicted to increase in the near future due to rising type 2 diabetes mellitus (T2DM) incidence. Recent work from several research groups has highlighted a potential role for EVs in the development of DKD. The present review, therefore, serves to explore the relevance of EVs to the development, detection, and treatment of DKD in an effort to better understand this complex disease state.

0834 Different Neural Circuits Were Associated With Different Parts of Relationships Among Sleep, Pain and Anxiety in Women with Primary Dysmenorrhoea

Introduction

Although the relationships amongst sleep, pain and anxiety have been evidenced, the underlying neurological mechanisms remain elusive. Primary dysmenorrhea is a good model of spontaneous pain with clear painful (menstruation, state) and pain free (e.g., peri-ovulatory phase, trait) conditions. We sought to investigate the state- and trait-related neural signatures that link sleep and anxiety in primary dysmenorrhea.

Methods

Thirty female subjects with primary dysmenorrhea and 30 healthy female controls completed resting-state functional magnetic resonance imaging, the State-Trait Anxiety Inventory and sleep quality assessments during menstruation and peri-ovulatory phases. As we have reported that there was altered default mode network in the primary dysmenorrhea, posterior parietal cortex (PPC) was therefore chosen as the seed to elucidate the functional connectivity that may correlate with sleep and anxiety.

Results

The primary dysmenorrheic subjects exhibited sleep disturbances throughout the menstrual cycle with increased state anxiety. The primary dysmenorrheic subjects demonstrated significantly higher correlations between the sleep quality and the PPC-insula and -putamen functional connectivity during the peri-ovulatory phase. During menstruation, the primary dysmenorrheic subjects demonstrated significantly lower correlations between their state-anxiety scores and the PPC-occipital cortex functional connectivity.

Conclusion

After regressing out the effects of trait anxiety, the correlation between sleep quality and the PPC-putamen functional connectivity was not significant, indicating anxiety-mediated sleep-pain relationship. The PPC-insula functional connectivity, by contrast, was remained significant. Furthermore, state anxiety was associated with the PPC-occipital cortex functional connectivity that was significantly impaired in primary dysmenorrheic subjects. These findings hinted pain and anxiety mediating sleep quality in different neurological circuits.

Support

Taipei City Goverment(10401-62-046 and 10501-62-046)

Animal rabies in the People's Republic of China

Since the late 1990s, the People's Republic of China (China) has consistently reported the second largest number of human rabies cases in the world; in this country, rabid dogs are the major source of rabies virus (RABV) transmission for both human and domestic animal rabies cases. In addition, other animal species have been reported to contract and transmit the virus. In this paper, an overview of the animal rabies situation in China is presented by referring to published articles (both English and Chinese) and governmental documents (guidelines, plans, notices and reports), which summarise the rabies situation in dogs, livestock, ferret badgers, bats, canids and rodents, and its threat to public health and animal husbandry in the country. Additionally, to obtain the complete phylogeny, full nucleoprotein gene sequences of representative field RABV strains circulating in China and its surrounding countries have been subjected to phylogenetic analysis, which showed, in agreement with previous studies, that RABVs in China have a broad genetic diversity that can be classified into three major clades, seven lineages and a number of sub-lineages. While significant progress on animal rabies epidemiology in China has been made, animal cases are still underestimated when compared with reported human cases. Rabies continues to spread into new areas even though human cases have been declining steadily since 2007. To minimise infection at the transmission source and to realise the goal of eliminating dog-mediated human rabies by 2030, surveillance and control.

Detection of Babesia spp., Theileria spp. and Anaplasma ovis in Border Regions, northwestern China

Babesia spp., Theileria spp. and Anaplasma ovis are important intracellular agents that are transmitted by tick bites. However, Babesia spp., Theileria spp. and A. ovis in ticks have not been systematically reported along the border of northwestern China. In this study, a total of 1,084 adult ticks, including 134 Haemaphysalis punctata, 337 Hyalomma asiaticum, 233 Dermacentor nuttalli, 69 Rhipicephalus turanicus and 265 Dermacentor marginatus were collected from 11 counties or cities of Xinjiang Uygur Autonomous Region. The ticks were identified from morphological and molecular characteristics. Two fragments of 18S rRNA gene were used to determine the species level of Babesia and Theileria. Msp4 gene encoding major surface protein 4 was used to determine A. ovis. Of the 1,084 samples, five species of Babesia (B. occultans, B. caballi, B. motasi, B. major and Babesia sp. detected in this study), two kinds of Theileria (Theileria ovis and Theileria sp. detected in this study) and A. ovis with six phylogenic branches were detected in the border of northwestern China. Babesia occultans, first found in China, was first molecularly detected in D. nuttalli. Babesia caballi and Babesia sp. detected in this study were first molecularly detected in Hy. asiaticum. Genotype III of A. ovis was predominant in the border regions of northwestern China.

Retrospective study of porcine circovirus 3 infection in China

PCV3 is an emerging swine virus associated with porcine dermatitis and nephropathy syndrome (PDNS), reproductive failure, respiratory diseases and systematic inflammation. Although first identified in 2015, the earliest case has been traced back to 2009 in the United States. In China, PCV3 infection was first detected in 2015, but little information has been available about its occurrence and prevalence there before 2015. In this study, 200 porcine clinical samples collected from 20 provinces, five autonomous regions and four municipalities between 1990 and 1999 were analysed for PCV3 infection by PCR. Results showed that 6.5% of the porcine samples collected from eight provinces and one autonomous region were PCV3 positive, with the earliest cases occurring in 1996. Nucleotide sequence analysis showed that PCV3 strains obtained in this study shared 96.6%-99.7% and 97.1%-99.4% sequence identity at the ORF2 gene and genome levels with all available reference strains from China and other countries, indicating the high genetic stability of PCV3 over the past 20 years.

Concurrent Umbilical Hernia Repair at the Time of Liver Transplantation: A Six-Year Experience from a Single Institution

BACKGROUND

Umbilical hernias are common in patients with end-stage liver disease undergoing liver transplantation. Management of those persisting at the time of liver transplantation is important to define.

OBJECTIVE

To evaluate the long-term results of patients undergoing simultaneous primary umbilical hernia repair (UHR) at the time of liver transplantation at a single institution.

METHODS

Retrospective chart review was performed on patients undergoing simultaneous UHR and liver transplantation from 2010 through 2016. 30-day morbidity and mortality outcomes and long-term hernia recurrence were investigated.

RESULTS

59 patients had primary UHR at the time of liver transplantation. All hernias were reducible with no overlying skin breakdown or leakage of ascites. 30-day morbidity and mortality included 5 (8%) superficial surgical site infections, 1 (2%) deep surgical site infection, and 7 (12%) organ space infections. Unrelated to the UHR, 10 (17%) patients had an unplanned return to the operating room, 16 (27%) were readmitted within 30 days of their index operation, and 1 (2%) patient died. With a mean follow-up of 21.8 months, 7 (18%) patients experienced an umbilical hernia recurrence.

CONCLUSION

Despite the high perioperative morbidity associated with the transplant procedure, concurrent primary UHR resulted in an acceptable long-term recurrence rate with minimal associated morbidity.

Retrospective study of porcine circovirus type 2 infection reveals a novel genotype PCV2f

Porcine postweaning multisystemic wasting syndrome (PMWS) caused by porcine circovirus type 2 (PCV2) is a disease causing severe economic losses annually worldwide to the pig industry. PCV2 infection was first reported in China in 2000, and currently has three major genotypes, PCV2a, b and d, circulating in this country. To further elucidate the origin and prevalence of PCV2 in China, 123 clinical pig tissue samples collected in 25 provinces between 1990 and 1999 were analysed by PCV2-specific PCR, resulting in identification of 23 PCV2 strains collected between 1996 and 1999. Phylogenetic analysis based on the nucleotide sequences of open reading frame 2 (ORF2) showed that 20 of the 23 grouped within PCV2a, while the remaining three strains formed an independent clade, so far unreported and therefore named PCV2f. This genotype shared lower sequence identity with other known genotypes. This study provides further understanding of the genetic diversity and evolution of PCV2 and has tracked PCV2 infection in China back to 1996 rather than 2000.

Correlation between circulating tumor cells EGFR expression and T cell subsets in advanced non-small cell lung cancer patients after tyrosine kinase inhibitor treatment

Research indicates that after EGFR-tyrosine kinase inhibitors (EGFR-TKIs) treatment of non-small cell lung cancer (NSCLC), patient immune function significantly improved, and that circulating tumor cells (CTCs) measurements and peripheral blood epidermal growth factor receptor (EGFR) mutation data can guide TKIs treatment. Sixty-six advanced NSCLC patients treated with TKIs were enrolled and CTCs, EGFR expression, T cell subsets and natural killer (NK) cells in peripheral blood were measured using flow cytometry before and after treatment and assessed with respect to patient prognosis. CTCs and EGFR expression were negatively correlated with cellular immune function and immune recovery after EGFR-TKI treatment. Thus, CD4+/ CD8+ ratios and NK cells may be useful prognostic indicators for advanced NSCLC patients who receive TKIs treatment.

Mate choice and host discrimination behavior of the parasitoid Trichogramma chilonis

Trichogramma chilonis Ishii (Hymenoptera: Trichogrammatidae) is an important natural enemy of many species of lepidopterous pests and a widely used biological control agent. Detailed knowledge about its mate choice and host discrimination behavior is lacking. In this study, we studied the mate choice and host discrimination behavior of T. chilonis in experimental arenas through video tracking. Males' mate recognition capacity was realized by perceiving the sex pheromone of females. When offered two females of different species, male could distinguish the conspecific female from Trichogrammatoidea bactrae Nagaraja (Hymenoptera: Trichogrammatidae), a species that has overlapping hosts with T. chilonis. When placed with two females of different mating status, male preferred mating with the virgin female to the mated female. T. chilonis females could distinguish unparasitized host eggs from parasitized ones (parasitized by conspecific females or heterospecific females). They preferred to stay on and lay eggs in unparasitized host eggs. When T. chilonis females were only provided with parasitized host eggs (parasitized by T. chilonis and T. bactrae females), conspecific superparasitism occurred more often than heterospecific superparasitism. Furthermore, the host egg discrimination ability of T. chilonis females was mainly achieved through antennal perception.

Wnt5a is involved in the pathogenesis of cutaneous lichen planus

BACKGROUND

Cutaneous lichen planus (CLP) is a chronic inflammatory and immune-mediated disease. Wnt5a is one of the most extensively studied Wnt proteins, and has important functions in stimulating inflammation, cell proliferation, cell fate determination and cell differentiation. Wnt5a expression in CLP has not been comprehensively studied to date.

AIM

To determine the expression and distribution of Wnt5a in CLP.

METHODS

Skin samples were obtained from patients with CLP and healthy controls (HCs). The WNT5A gene was detected by real-time quantitative PCR, and Wnt5a protein by immunohistochemical analysis and western blotting.

RESULTS

WNT5A mRNA was upregulated in CLP samples compared with the HC skin samples (P < 0.001). Wnt5a protein was overexpressed in all layers of the epidermis and dermis in CLP lesions compared with HC skin (all P < 0.001). These results were confirmed by western blotting.

CONCLUSIONS

The data presented in this study suggest that Wnt5a pathway may play an important role in the pathogenesis of CLP.

Hypoxia differentially regulates human nucleus pulposus and annulus fibrosus cell extracellular matrix production in 3D scaffolds

OBJECTIVE

We hypothesize that intervertebral disc (IVD) cells from distinct region respond differently to oxygen environment, and that IVD cells from patients with disc degeneration can benefit from hypoxia condition. Therefore, we aimed to determine the transcriptional response and extracellular matrix (ECM) production of nucleus pulposus (NP) and annulus fibrosus (AF) cells to different oxygen tension.

METHOD

Human NP and AF from degenerated IVD were seeded in 3D scaffolds and subjected to varying oxygen tension (2% and 20%) for 3 weeks. Changes in ECM were evaluated using quantitative real-time reverse transcriptase polymerase chain reaction, histological and immunohistological analyses.

RESULTS

Hypoxia significantly enhances NP cells phenotype, which resulted in greater production of sulfated glycosaminoglycan (GAG) and collagen type II within the constructs and the cells expressed higher levels of genes encoding NP ECM. A significantly stronger fluorescent signal for hypoxia-inducible factor (HIF-1α) as also found in the NP cells under the hypoxic than normoxic condition. However, there was little effect of hypoxia on the AF cells.

CONCLUSIONS

The NP and AF cells respond differently to hypoxia condition on the 3D scaffold, and hypoxia could enhance NP phenotype. When used in concert with appropriate scaffold material, human NP cells from degenerated disc could be regenerated for tissue engineering application.

Molecular epidemiology of lyssaviruses in Eurasia

The Lyssavirus genus, a member of the Rhabdoviridae family, consists of seven established related viruses (genotypes 1-7). Rabies cases in Eurasia are principally attributed to three of these genotypes, namely genotype 1 (RABV, classical rabies) and to a lesser extent genotypes 5 and 6 (European bat lyssaviruses type-1 and -2). In addition, four newly identified divergent lyssaviruses have been isolated from insectivorous bats. The molecular diversity of classical rabies viruses (genotype 1, RABV) has been studied at the global level and reference has been made to the existence of a number of European strains in a range of mammalian species. It is accepted that these viruses cluster within a 'Cosmopolitan Lineage' having ancestral roots in Europe in the 17th century before its widespread dispersal to Asia, Africa and the Americas as a result of European exploration and colonization.

Monoclonal antibodies against the nucleocapsid proteins of henipaviruses: production, epitope mapping and application in immunohistochemistry

Four monoclonal antibodies (mAbs) were generated by immunizing BALB/C mice with recombinant nucleocapsid protein (N) of Nipah virus (NiV) and Hendra virus (HeV) expressed in E. coli. Two mAbs each were obtained for the HeV N and NiV N, respectively. All four mAbs displayed specific reactivity with the recombinant N proteins of both viruses by western blot, which was further confirmed by immunofluorescent antibody assay using fixed insect cells infected with recombinant baculoviruses expressing either the HeV or NiV N protein. Epitope mapping using a 12-mer random peptide phage display library revealed two linear antigenic sites of the henipavirus N proteins, KLxR (aa 17-20) and FKREM (aa 446-450), which have not been reported previously. Two of the mAbs were able to specifically recognize HeV antigens by immunohistochemical staining of lung tissue sections of a horse experimentally infected with HeV. These reagents will be a useful addition to the collection of tools essential for further research and improvement in diagnosis of henipaviruses.

An outbreak of pig rabies in Hunan province, China

The first dog-associated outbreak of rabies in swine in China (Hunan province) has been diagnosed and the related virus isolated. Sequence analysis showed that the pig isolate was a genotype 1 rabies virus with a very high nucleotide identity to local dog isolates.

In situ hybridization and RT-PCR detection of Macrobrachium rosenbergii nodavirus in giant freshwater prawn, Macrobrachium rosenbergii (de Man), in Taiwan

Between January and March 2006, suspected outbreaks of white tail disease were observed in post-larvae and juveniles of Macrobrachium rosenbergii in hatcheries and nursery ponds at Kaohsiung and Pingtung Counties in southern Taiwan. Pathognomonic lesions showed the presence of large oval and/or irregular basophilic, cytoplasmic inclusion bodies in the infected muscles and hepatopancreas. Reverse transcriptase polymerase chain reaction (RT-PCR) assay and in situ hybridization (ISH) revealed evidence of M. rosenbergii nodavirus (MrNV) infection but did not detect extra small virus. Phylogenetic analysis indicated that there were very high identities between nucleotide sequences among six strains obtained in this study (99.5-100%), moderate identities with Caribbean and Indian strains (98.2-98.6%), but slightly lower identity with a Chinese strain (95.2%). This is the first confirmation of MrNV in giant freshwater prawns, using an RT-PCR and ISH, in Taiwan.

Circulating endothelial progenitor cell deficiency contributes to impaired arterial elasticity in persons of advancing age

Reduced arterial elasticity is a hallmark of ageing in healthy humans and appears to occur independently of coexisting disease processes. Endothelial-cell injury and dysfunction may be responsible for this fall in arterial elasticity. We hypothesized that circulating endothelial progenitor cells (EPCs) are involved in endothelial repair and that lack of EPCs contributes to impaired arterial elasticity. A total of 56 healthy male volunteers were divided into young (n=26) and elderly (n=30) groups. Large and small artery elasticity indices were noninvasively assessed using pulse wave analysis. The number of circulating EPCs was measured by using flow cytometry. Cells demonstrating DiI-acLDL and FITC-ulex lectin double-positive fluorescence were identified as EPCs. C1 large artery elasticity and C2 small artery elasticity indices were significantly reduced in the elderly group compared with the young group (11.73+/-1.45 vs 16.88+/-1.69 ml/mm Hg x 10, P<0.001; 8.40+/-1.45 vs 10.58+/-1.18 ml/mm Hg x 100, P<0.001, respectively). In parallel, the number of circulating EPCs was significantly reduced in the elderly group compared with the young group (0.13+/-0.02 vs 0.17+/-0.04%, P<0.05). The number of circulating EPCs correlated with C1 large and C2 small artery elasticity indices (r=0.47, P<0.01; r=0.4, P<0.01). The present findings suggest that the fall in circulating EPCs with subsequently impaired endothelial-cell repair and function contributes to reduced arterial elasticity in humans with ageing. The decrease in circulating EPCs may serve as a surrogate biologic measure of vascular function and human age.

Phytoremediation of an arsenic-contaminated site using Pteris vittata L.: a two-year study

A field study was conducted to determine the efficiency of Chinese brake fern (Pteris vittata L.), an arsenic hyperaccumulator, on removal of arsenic from soil at an arsenic-contaminated site. Chinese brake ferns were planted on a site previously used to treat wood with chromated copper arsenate (CCA). Arsenic concentrations in surface and profile soil samples were determined for 2000, 2001, and 2002. In both 2001 and 2002, senesced and senescing fronds only, as well as all fronds, were harvested. Frond arsenic concentrations were not significantly different between the three harvests. Compared to senesced fronds, live fronds resulted in the greatest amount of arsenic removal. There were no significant differences in soil arsenic concentrations between 2000, 2001, and 2002, primarily due to the extreme variability in soil arsenic concentrations. However, the mean surface soil arsenic was reduced from 190 to 140 mg kg(-1). Approximately 19.3 g of arsenic were removed from the soil by Chinese brake fern. Therefore, this fern is capable of accumulating arsenic from the CCA -contaminated site and may be competitive, in terms of cost, to conventional remediation systems. However, better agronomic practices are needed to enhance plant growth and arsenic uptake to obtain maximum soil arsenic removal and to minimize remediation time.

A new approach to detect QRS complexes based on a histogram and genetic algorithm

A new approach, based on a histogram and genetic algorithm (GA), has been developed to rapidly and reliably detect QRS complexes of the ECG curve. Here, the new approach is described and the principle of the histogram and GA is explained. The results of detection of QRS complexes using the new method are given. Additionally, as an example of its novel application, the P-wave and f-wave (when atrial fibrillation is absent and present, respectively) are extracted easily and efficiently from the ECG curve using the method.

Impact of endoscopic ultrasound combined with fine-needle aspiration biopsy in the management of esophageal cancer

BACKGROUND AND STUDY AIMS

Endoscopic ultrasound (EUS) in combination with fine-needle aspiration biopsy (FNA) is a highly accurate method for the preoperative staging of esophageal cancer. Its impact on medical decision-making and the cost of care is unknown. This prospective case series was undertaken in order to determine the impact of EUS in combination with FNA on patients' choice of therapy and on the cost of care.

PATIENTS AND METHODS

Sixty consecutive patients with esophageal cancer, referred for preoperative EUS staging in a large tertiary-care academic medical center, were enrolled. The accuracy of EUS, the impact of EUS-based staging on the patients' choice of therapy, and costs were studied.

RESULTS

The accuracy rates for EUS combined with FNA in tumor and lymph-node staging were 83 % and 89 %, respectively. Twenty-five patients (42 %) had EUS stage I and II and were candidates for curative surgery. Twenty-eight patients (47 %) had stage III, and seven (12 %) had stage IV. All patients with stage I had surgery, while all patients with stage IV had medical therapy. The majority (62 %) of patients with stage II had surgery, while only a minority (25 %) of patients with stage III had surgery. Thirty-six patients (60 %) underwent medical therapy. Patients' medical decisions in favor of surgical or medical therapy correlated strongly with the results of their EUS staging ( P = 0.005), but not with age, sex, or referring physicians (surgeons vs. nonsurgeons). EUS-guided therapy potentially decreased the cost of care by $ 740 424 ($ 12 340/patient) by reducing the number of thoracotomies.

CONCLUSIONS

Patients' decisions regarding therapy correlated with their overall tumor staging, suggesting that the information provided by EUS played a significant role in patients' decision-making. The use of EUS in combination with FNA reduces the cost of managing patients with esophageal cancer.

Root-parasitic nematodes enhance soil microbial activities and nitrogen mineralization

Obligate root-parasitic nematodes can affect soil microbes positively by enhancing C and nutrient leakage from roots but negatively by restricting total root growth. However, it is unclear how the resulting changes in C availability affect soil microbial activities and N cycling. In a microplot experiment, effects of root-parasitic reniform nematodes ( Rotylenchulus reniformis) on soil microbial biomass and activities were examined in six different soils planted with cotton. Rotylenchulus reniformis was introduced at 900 nematodes kg(-1) soil in May 2000 prior to seeding cotton. In 2001, soil samples were collected in May before cotton was seeded and in November at the final harvest. Extractable C and N were consistently higher in the R. reniformis treatments than in the non-nematode controls across the six different soils. Nematode inoculation significantly reduced microbial biomass C, but increased microbial biomass N, leading to marked decreases in microbial biomass C:N ratios. Soil microbial respiration and net N mineralization rates were also consistently higher in the nematode treatments than in the controls. However, soil types did not have a significant impact on the effects of nematodes on these microbial parameters. These findings indicate that nematode infection of plant roots may enhance microbial activities and the turnover of soil microbial biomass, facilitating soil N cycling. The present study provides the first evidence about the direct role of root-feeding nematodes in enhancing soil N mineralization.

Phylogenetic comparison of classical swine fever virus in China

An N-terminal fragment of the E2 gene of classical swine fever (CSF) virus encoding major immunogenic sites was amplified by RT-PCR directly from 110 clinical specimens representing 109 epizootic sites during the last decade in China. Phylogenetic relationships between these viruses as well as 20 reference strains were determined by comparison of their nucleotide sequences. A phylogenetic tree showed that 103 of the 110 field viruses (93.6%) were clustered within group 2 and subdivided into three subgroups, while the remaining seven viruses (6.4%), along with two Chinese reference strains, Shimen and HCLV (attenuated vaccine strain), were clustered into subgroup 1.1 within group 1. However, none of the Chinese CSF viruses were members of subgroup 1.2 (represented by reference strain Brescia). This is the first report on the distribution of CSF virus genotypes in China. Results indicated that CSF viruses predominating in recent epizootics within China are genetically divergent from the reference strain Shimen and the vaccine strain HCLV.

Liquid-phase microextraction of phenolic compounds combined with on-line preconcentration by field-amplified sample injection at low pH in micellar electrokinetic chromatography

This paper describes a novel method that applies field-amplified sample injection (FASI) in micellar electrokinetic chromatography (MEKC) with a low pH background electrolyte (BGE). Six phenolic compounds prepared in water or NaOH solution were used as the test analytes. Sample was injected electrokinetically after the introduction of a plug of water. During the injection, the water plug was pumped out of the capillary inlet by the electroosmotic flow, and the phenolic anions migrated very quickly in the direction of the outlet. When the anions reached the boundary between the water plug and BGE, they were neutralized and ceased moving. Thereafter, MEKC was initiated for the separation. This on-line preconcentration method could be conveniently coupled with a liquid-liquid-liquid microextraction procedure, in which a hollow fiber was used as an extraction solvent support to extract the analytes from the water sample. The acceptor phase consisted of 8 mM NaOH. After extraction, the extract was analyzed directly by MEKC, as described.

The catalytic properties of human carbonic anhydrase IX

Human carbonic anhydrase IX (CA IX) is an integral membrane protein and a member of the alpha class of carbonic anhydrases that includes the human and animal enzymes. We have prepared a truncated, recombinant form of human CA IX of 255 residues consistent with full-length human CA II, among the most efficient of the carbonic anhydrases. Catalysis by and inhibition of this form of human CA IX has been investigated using stopped-flow spectrophotometry and 18O exchange measured by mass spectrometry. In kinetic constants for the hydration of CO2, CA IX closely resembled CA II with maximal proton transfer-dependent 18O exchange near 1 micros(-1) and kcat/Km near 55 microM(-1) x s(-1). Human CA IX was very strongly inhibited by three classic sulfonamides and cyanate, with inhibition constants that are close to those for CA II.