Abstract Background Inguinal hernia repairs are commonly performed operations. Recently, Neumayer et al examined the gold standard Lichtenstein onlay mesh repair (LMR) against laparoscopic inguinal ...hernia repair and showed that the recurrence rates are higher for laparoscopic mesh repairs when compared with the open onlay mesh repair (laparoscopic = 10.1% versus open = 4.9%). In 1998, the Prolene Hernia System (PHS) mesh, consisting of an onlay and an underlay patch attached with a connector, was introduced as an option for tension-free open repair of inguinal hernias combining the benefits of a posterior and anterior repair from an open approach. Our objective was to evaluate the PHS mesh repair versus the LMR for inguinal hernias. We hypothesized that the recurrence rate of PHS mesh would be lower compared with the LMR with overall similar complication rates. Methods PHS mesh hernia repairs performed from January 2003 to July 2005 and LMR repairs from January 2000 to July 2002 were included. Demographic data such as age, race, and gender as well as comorbid conditions such as chronic obstructive pulmonary disease, congestive heart failure, previous myocardial infarction, diabetes, hypertension, prostatism, and chronic cough were collected. Complications such as cord injury, seroma, hematoma, urinary retention, urinary tract infection, orchitis, and wound infection were recorded. Recurrences in each group were also recorded. A student t test and chi-square analysis were used for statistical analysis. Results Six hundred twenty-two charts were reviewed during the 2 time periods (PHS mesh = 321, LMR = 302). The median follow-up for the study was 17 months. There was no significant difference with regards to age, race, gender, or comorbidities between the 2 groups. Overall, there was a trend toward decreased complications in the PHS mesh group compared with the LMR group (PHS mesh = 17%, LMR = 23%, P = .07), with a significant difference in the hematoma/seroma rates (PHS mesh = 6.9%, LMR = 12.6%, P = .015). Finally, there was a significant decrease in the recurrence rate for the PHS mesh group when compared with the LMR group (PHS mesh = 0.6%, LMR = 2.7%, P = .04). Conclusion Our study shows, during a median follow-up of 17 months, improved outcomes by using the PHS mesh compared with the gold standard Lichtenstein onlay mesh for inguinal hernias with significantly lower recurrence rates. Additionally, in the PHS mesh group, there was a trend toward decreased overall complication rates with significantly less seroma/hematoma rates. Therefore, the PHS mesh repair may represent a superior alternative for the repair of inguinal hernias.
Although observational studies suggest that hyperhomocysteinemia may be a risk factor for coronary allograft vasculopathy (CAV), prospective data on homocysteine‐lowering interventions and CAV ...development are lacking. We, therefore, randomized 44 de novo heart transplant (HT) recipients to 15 mg/day of 5‐methyl‐tetrahydrofolate (n = 22), or standard therapy (control group, n = 22) to investigate the effect of homocysteine lowering on the change in coronary intimal hyperplasia during the first 12 months after transplant, as detected by intra‐vascular ultrasound (IVUS). Although 12 months after HT, homocysteinemia was lower in folate‐treated patients (p < 0.001), coronary intimal area increased similarly in the two groups (p > 0.4). Conversely, hypercholesterolemia and cytomegalovirus infection were both associated with increased intimal hyperplasia (p < 0.04), independently from folate intake. Sub‐group analysis revealed that folate therapy reduced intimal hyperplasia in patients with hyperhomocysteinemia before randomization (n = 19; p = 0.02), but increased intimal hyperplasia in patients with normal homocysteine plasma concentrations (p = 0.02). This bimodal effect of folate therapy persisted significantly after adjusting for cytomegalovirus infection and hypercholesterolemia.
Despite effective in prevent hyperhomocysteinemia after heart transplantation, folate therapy does not seem to affect early CAV onset. However, sub‐group analysis suggests that folate therapy may delay CAV development only in patients with baseline hyperhomocysteinemia, while may favor CAV progression in recipients with normal baseline homocysteinemia.
The Vehicle to Vehicle and Vehicle to Infrastructure V2X communication systems are one of the main topics in research domain. Its performance evaluation is an important step before their on board's ...integration into vehicles and its probable real deployment. Being the first of a series of three publications, this paper studies the physical layer PHY of the upcoming vehicular communication standard IEEE 802.11p. An IEEE.802.11p PHY model, with much associated phenomena, is implemented in Vehicle to Vehicle V2V and Vehicle to Roadside unit V2I, situations through different scenarios. The series of simulation results carried out, perform data exchange between high-speed vehicles over different channels models and different transmitted packet size. We underline several propagation channel and other important parameters which affect both the physical layer network performance and the quality of transmission QoT. The Bit Error Rate BER versus Signal to Noise Ratio SNR of all coding rates is used to evaluate the performance of the communication.
Summary Primary muscle hydatidosis is very rare, accounting for less than 1% of hydatid cyst locations. Clinical symptoms are insidious and non-specific causing a frequent delay in diagnosis. ...Intramuscular hydatid disease can cause a variety of diagnostic problems, especially in the absence of typical radiologic findings. We report the observation of an 82-year-old man consulting for inguinal tumefaction with radiological exploration suggestive of hydatid cyst of the adductors muscles. Magnetic resonance imaging (MRI) is helpful in diagnosis, since it reveals a very suggestive aspect and demonstrates the relationship between cysts and adjacent structures. Treatment of muscle echinococcosis is based on surgery, which is curative and incurs a low risk of local relapse.
Genome-wide association studies (GWAS) have identified several risk
variants for late-onset Alzheimer's disease (LOAD)
1
,
2
. These
common variants have replicable but small effects on LOAD risk and ...generally do
not have obvious functional effects. Low-frequency coding variants, not detected
by GWAS, are predicted to include functional variants with larger effects on
risk. To identify low frequency coding variants with large effects on LOAD risk,
we performed whole exome-sequencing (WES) in 14 large LOAD families and
follow-up analyses of the candidate variants in several large case-control
datasets. A rare variant in
PLD3
(phospholipase-D family,
member 3, rs145999145; V232M) segregated with disease status in two independent
families and doubled risk for AD in seven independent case-control series (V232M
meta-analysis; OR= 2.10, CI=1.47-2.99; p= 2.93×10
-5
, 11,354
cases and controls of European-descent). Gene-based burden analyses in 4,387
cases and controls of European-descent and 302 African American cases and
controls, with complete sequence data for
PLD3,
indicate that
several variants in this gene increase risk for AD in both populations (EA: OR=
2.75, CI=2.05-3.68; p=1.44×10
-11
, AA: OR= 5.48, CI=1.77-16.92;
p=1.40×10
-3
).
PLD3
is highly expressed in
brain regions vulnerable to AD pathology, including hippocampus and cortex, and
is expressed at lower levels in neurons from AD brains compared to control
brains (p=8.10×10
-10
). Over-expression of PLD3 leads to a
significant decrease in intracellular APP and extracellular Aβ42 and
Aβ40, while knock-down of PLD3 leads to a significant increase in
extracellular Aβ42 and Aβ40. Together, our genetic and functional
data indicate that carriers of
PLD3
coding variants have a
two-fold increased risk for LOAD and that
PLD3
influences APP
processing. This study provides an example of how densely affected families may
be used to identify rare variants with large effects on risk for disease or
other complex traits.
This study was carried out of the region of Monastir in Central Tunisia, between July and August 2010. Larvae were collected using a floatation technique with magnesium sulfate in mud samples. The ...fourth instar larva of Culicoides cataneii Clastrier, 1957 and Culicoides sahariensis Callot, Kremer, Bailly-Choumara, 1970 are described, illustrated and drawn. Measurements of instars IV are also presented. This is the first record of Culicoides cataneii and Culicoides sahariensis (Diptera: Ceratopogonidae) to Tunisia.
To evaluate the prognosis of HIV-infected patients admitted to ICUs and to identify factors predictive of short- and long-term survival.
A prospective study from January 1, 1990, to December 31, ...1992, including all consecutive HIV-infected patients admitted to our ICU for the first time. ICU survivors were followed up until January 1, 1994.
An 18-bed infectious diseases ICU in a 1,300-bed university hospital in Paris.
Four hundred twenty-one HIV-related admissions were recorded during the study period (33.5% of 1,258 admissions to ICU); 354 HIV-infected patients were first ICU admissions and were analyzed.
Predictive factors on univariate and multivariate analyses (logistic regression and Cox model) for short- and long-term mortality were performed. Respiratory failure was the main cause of admission (49.2%), followed by neurologic disorders (26.8%), sepsis (10.2%), heart failure (4.5%), and miscellaneous disorders (9.3%). For these groups, in-ICU and in-hospital mortality rates were as follows: 16.7% and 33.9%; 23.2% and 41.1%; 38.9% and 58.3%; 25% and 68.8%; and 12.1% and 24.2%, respectively. In-ICU and in-hospital mortality rates were significantly different across the groups (p=0.026 and 0.002, respectively). Multivariate analysis showed that the in-hospital outcome was significantly associated with functional status (p=0.05), time since AIDS diagnosis (p=0.04), HIV disease stage (0.016), simplified acute physiology score (SAPS I) (p=0.06), need for mechanical ventilation (p<0.000001), and its duration (p=0.0001). In the 281 patients who were discharged alive from the ICU, cumulative survival rates were 51%±38% at 6 months, 28%±38% at 12 months, and 18%±30% at 24 months. Median and crude mean±SD survival times were 199 days and 316±343 days. Multivariate analysis showed that the long-term outcome was significantly associated with functional status (p=0.000001), weight loss (p=0.00001), the CD4 count (p=0.00001), the HIV disease stage (p=0.01), the duration of AIDS (p=0.001), the admission cause group (p=0.03), and the SAPS I at admission (p=0.00001).
The short-term (in-ICU and in-hospital) outcome of HIV-infected patients was mainly related to the severity of the acute illness (SAPS I, cause of admission, need for and duration of mechanical ventilation), and to the preadmission health status, based on functional status and weight loss. Some of these parameters, in particular the SAPS I and preadmission health status, also influenced the long-term outcome. Whereas HIV-related variables had little impact on the in-ICU outcome, they were closely related with the in-hospital outcome and even more strikingly with the long-term outcome. Thus, the life expectancy of HIV-infected patients, which depends primarily on the natural history of the HIV infection, is the most powerful determinant of the long-term prognosis. Our results confirm that ICU support for HIV-infected patients should not be considered futile.
Este estudo do tipo intervenção comunitária controlada unicega não randomizada teve por objetivo avaliar o impacto das visitas realizadas pelos agentes comunitários de saúde e líderes voluntários da ...Pastoral da Criança sobre o pré-natal de gestantes pobres em Rio Grande, Rio Grande do Sul, Brasil. Aplicaram-se questionários padronizados antes e depois do parto buscando conhecer suas características demográficas, reprodutivas, assistência recebida durante o pré-natal e nível sócio-econômico e condição de moradia. Estas gestantes foram divididas em três grupos, sendo dois grupos-intervenção e um controle. Dentre as 339 gestantes estudadas, 115 pertenciam ao grupo cuja intervenção foi realizada pelos agentes comunitários de saúde, 116 pelos líderes voluntários da pastoral e 108 pertenciam ao grupo controle. Gestantes visitadas pelos agentes comunitários iniciaram o pré-natal mais precocemente, realizaram maior número de consultas, exames clínicos e testes laboratoriais, foram mais comumente orientadas sobre amamentação e suplementadas com sulfato ferroso. A participação de familiares nas consultas de pré-natal foi maior entre gestantes visitadas pelos líderes voluntários. Visitas domiciliares podem melhorar a qualidade do pré-natal entre gestantes pobres e aumentar a participação de familiares, sobretudo do marido, na gestação.
The aim of this study is to consider the parietal complications of the hydatid cyst of the liver: the subcutaneous rupture of the cyst and spontaneous cutaneous fistula of liver hydatid cyst. 1(st) ...case: A 24-year-old woman, who underwent surgery 10 years ago for hydatid cyst of the liver, was admitted for a right hypochondrium mass and a fistula draining clear liquid containing cystic elements. Computed tomography (CT) showed a large cystic lesion in the subcutaneous tissue communicating with another cystic mass in the liver. The diagnosis of a cyst-cutaneous fistula due to a peritoneal hydatid cyst was established. The patient underwent surgical treatment and recovered uneventfully. 2(nd) case: A 40-year-old woman presented with a mass in her right hypochondrium. The diagnosis of subcutaneous rupture of a hydatid cyst of liver was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Parietal complications of hydatid cyst of the liver are extremely rare, clinical presentation can be derailing. The diagnosis is usually established by ultrasonography and CT-scan.
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