The feasibility of local anesthesia for the surgical treatment of umbilical hernia: a systematic review of the literature

Background: Yearly approximately 4500 umbilical hernias are repaired in The Netherlands, mostly under general anesthesia. The use of local anesthesia has shown several advantages in groin hernia surgery. Local anesthesia might be useful in the treatment of umbilical hernia as well. However, convincing evidence is lacking. We have conducted a systematic review on safety, feasibility, and advantages of local anesthesia for umbilical hernia repair. Methods: A systematic review was conducted according to the PRISMA guidelines. Outcome parameters were duration of surgery, surgical site infection, perioperative and postoperative complications, postoperative pain, hernia recurrence, time before discharge, and patient satisfaction. Results: The systematic review resulted in nine included articles. Various anesthetic agents were used, varying from short acting to longer acting agents. There was no consensus regarding the injection technique and no conversions to general anesthesia were described. The most common postoperative complication was surgical site infection, with an overall percentage of 3.4%. There were no postoperative deaths and no allergic reactions described for local anesthesia. The hernia recurrence rate varied from 2 to 7.4%. Almost 90% of umbilical hernia patients treated with local anesthesia were discharged within 24 h, compared with 47% of patients treated with general anesthesia. The overall patient satisfaction rate varied from 89 to 97%. Conclusion: Local anesthesia for umbilical hernia seems safe and feasible. However, the advantages of local anesthesia are not sufficiently demonstrated, due to the heterogeneity of included studies. We, therefore, propose a randomized controlled trial comparing general versus local anesthesia for umbilical hernia repair

Shifts in the Properties of the Higgs Boson from Radion Mixing

We examine how mixing between the Standard Model Higgs boson, $h$, and the radion present in the Randall-Sundrum model of localized gravity modifies the expected properties of the Higgs boson. In particular, we demonstrate that the total and partial decay widths of the Higgs, as well as the $h\to gg$ branching fraction, can be substantially altered from their Standard Model expectations. The remaining branching fractions are modified less than \lsim 5% for most of the parameter space volume.Comment: 17 pages, 7 figs., LaTex; revised versio

Model Independent Approach to Focus Point Supersymmetry: from Dark Matter to Collider Searches

The focus point region of supersymmetric models is compelling in that it simultaneously features low fine-tuning, provides a decoupling solution to the SUSY flavor and CP problems, suppresses proton decay rates and can accommodate the WMAP measured cold dark matter (DM) relic density through a mixed bino-higgsino dark matter particle. We present the focus point region in terms of a weak scale parameterization, which allows for a relatively model independent compilation of phenomenological constraints and prospects. We present direct and indirect neutralino dark matter detection rates for two different halo density profiles, and show that prospects for direct DM detection and indirect detection via neutrino telescopes such as IceCube and anti-deuteron searches by GAPS are especially promising. We also present LHC reach prospects via gluino and squark cascade decay searches, and also via clean trilepton signatures arising from chargino-neutralino production. Both methods provide a reach out to m_{\tg}\sim 1.7 TeV. At a TeV-scale linear e^+e^- collider (LC), the maximal reach is attained in the \tz_1\tz_2 or \tz_1\tz_3 channels. In the DM allowed region of parameter space, a \sqrt{s}=0.5 TeV LC has a reach which is comparable to that of the LHC. However, the reach of a 1 TeV LC extends out to m_{\tg}\sim 3.5 TeV.Comment: 34 pages plus 36 eps figure

Quality of life in patients with CRB1-associated retinal dystrophies:A longitudinal study

Purpose: To assess the longitudinal vision-related quality of life among patients with CRB1-associated inherited retinal dystrophies. Methods: A longitudinal questionnaire study included 22 patients with pathogenic CRB1 variants. The National Eye Institute Visual Function Questionnaire (39 items, NEI VFQ-39) was applied at baseline, two-year follow-up, and 4-year follow-up. Classical test theory was performed to obtain subdomain scores and in particular ‘near activities’ and ‘total composite’ scores. The Rasch analysis based on previous calibrations of the NEI VFQ-25 was applied to create visual functioning and socio-emotional subscales. Results:In total, 22 patients with pathogenic CRB1 variants were included, with a median age of 25.0 years (IQR: 13–31 years) at baseline and mean follow-up of 4.0 ± 0.3 years. A significant decline at 4 years was observed for ‘near activities’ (51.0 ± 23.8 vs 35.4 ± 14.7, p = 0.004) and ‘total composite’ (63.0 ± 13.1 vs 52.0 ± 12.1, p = 0.001) subdomain scores. For the Rasch-scaled scores, the ‘visual functioning’ scale significantly decreased after 4 years (−0.89 logits; p = 0.012), but not at 4-year follow-up (+0.01 logits; p = 0.975). The ‘socio-emotional’ scale also showed a significant decline after 2 years (−0.78 logits, p = 0.033) and 4 years (−0.83 logits, p = 0.021). Conclusion: In the absence of an intervention, a decline in vision-related quality of life is present in patients with pathogenic CRB1 variants at 4-year follow-up. Patient-reported outcome measures should be included in future clinical trials, as they can be a potential indicator of disease progression and treatment efficacy.</p

Large Beyond-Leading-Order Effects in b -> s gamma in Supersymmetry with General Flavor Mixing

We examine squark--gluino loop effects on the process $b \to s \gamma$ in minimal supersymmetry with general flavor mixing in the squark sector. In the regime of heavy squarks and gluino, we derive analytic expressions for the beyond--LO corrections to the Wilson coefficients and find them to be often large, especially at large $\tan\beta$ and $\mu>0$. The ensuing ranges of values of the Wilson coefficients are typically smaller than in the LO approximation, and sometimes even change sign. This has the effect of often reducing, relative to the LO, the magnitude of supersymmetric contributions to $BR(B \to X_s \gamma)$. This ``focusing effect'' is caused by contributions from: (i) an RG evolution of the Wilson coefficients; (ii) a correction to the LO chargino contribution to the Wilson coefficients, which can considerably reduce the LO gluino contribution. This partial cancellation of the two contributions takes place only in the case of general flavor mixing. As a result, stringent lower bounds on the mass scale of superpartners, which apply in the case of minimal flavor violation, can be substantially reduced for even small departures from the scenario. The often disfavored case of $\mu<0$ can also become allowed for $M_{SUSY}$ as small as $\sim$ 200 GeV, compared to > $\sim$ 500 GeV at LO and over 2 TeV in the case of minimal flavor violation. Limits on the allowed amount of flavor mixing among the 2nd and 3rd generation down--type squarks are also typically considerably weakened. The input CKM matrix element $K^{(0)}_{cb}$ can be larger than the experimental value by a factor of ten, or can be as small as zero.Comment: 46 page, 36 figures. v2: some clarifications and Ref.[5] added. Version to appear in JHE

Suppression of charged particle production at large transverse momentum in central Pb-Pb collisions at sNN=2.76\sqrt{s_{\rm NN}} = 2.76 TeV

Inclusive transverse momentum spectra of primary charged particles in Pb-Pb collisions at $\sqrt{s_{_{\rm NN}}}$ = 2.76 TeV have been measured by the ALICE Collaboration at the LHC. The data are presented for central and peripheral collisions, corresponding to 0-5% and 70-80% of the hadronic Pb-Pb cross section. The measured charged particle spectra in $|\eta|<0.8$ and $0.3 < p_T < 20$ GeV/$c$ are compared to the expectation in pp collisions at the same $\sqrt{s_{\rm NN}}$, scaled by the number of underlying nucleon-nucleon collisions. The comparison is expressed in terms of the nuclear modification factor $R_{\rm AA}$. The result indicates only weak medium effects ($R_{\rm AA} \approx$ 0.7) in peripheral collisions. In central collisions, $R_{\rm AA}$ reaches a minimum of about 0.14 at $p_{\rm T}=6$-7GeV/$c$ and increases significantly at larger $p_{\rm T}$. The measured suppression of high-$p_{\rm T}$ particles is stronger than that observed at lower collision energies, indicating that a very dense medium is formed in central Pb-Pb collisions at the LHC.Comment: 15 pages, 5 captioned figures, 3 tables, authors from page 10, published version, figures at http://aliceinfo.cern.ch/ArtSubmission/node/98

D* Production in Deep Inelastic Scattering at HERA

This paper presents measurements of D^{*\pm} production in deep inelastic scattering from collisions between 27.5 GeV positrons and 820 GeV protons. The data have been taken with the ZEUS detector at HERA. The decay channel $D^{*+}\to (D^0 \to K^- \pi^+) \pi^+$ (+ c.c.) has been used in the study. The $e^+p$ cross section for inclusive D^{*\pm} production with $5<Q^2<100 GeV^2$ and $y<0.7$ is 5.3 \pms 1.0 \pms 0.8 nb in the kinematic region {$1.3<p_T(D^{*\pm})<9.0$ GeV and $| \eta(D^{*\pm}) |<1.5$}. Differential cross sections as functions of p_T(D^{*\pm}), $\eta(D^{*\pm}), W$ and $Q^2$ are compared with next-to-leading order QCD calculations based on the photon-gluon fusion production mechanism. After an extrapolation of the cross section to the full kinematic region in p_T(D^{*\pm}) and $\eta$(D^{*\pm}), the charm contribution $F_2^{c\bar{c}}(x,Q^2)$ to the proton structure function is determined for Bjorken $x$ between 2 $\cdot$ 10$^{-4}$ and 5 $\cdot$ 10$^{-3}$.Comment: 17 pages including 4 figure