A comparative and prospective study of ventral hernia repair by laparoscopic and open technique

Background: Ventral hernia repair is becoming more common through laparoscopic techniques; however, there is a lack of comprehensive data on the associated complication rates. We undertook a prospective study to contrast the early establishments of laparoscopic and open ventral hernia surgeries in order to fill this gap. The aim of the study was to assess and contrast the efficiency and reliability of open and laparoscopic techniques for the treatment of ventral hernias. Methods: A prospective study was carried out at All India Institute of Medical Science, New Delhi, India between 2011 and 2014 to assess the dissimilarities between open and laparoscopic approaches in ventral hernia repairs. The study included a total of 40 cases each for open/laparoscopic ventral hernia repair procedures. Results: Eighty cases were investigated, forty of which underwent open repairs and forty of which underwent laparoscopic procedures. In this study, the oldest patient was 77 years old, and the youngest patient was 25 years old. The vast majority (49%) of patients were in their fourth to sixth decades of life. Incisional hernias were in bulk, that had formed from earlier midline lower scars. In both open and laparascopic surgery, there were 40 patients- 43 females and 37 males.   Conclusions: Ventral hernia repair via laparoscopic surgery is showing encouraging results and is currently a widely used technique. When compared to open repairs, it has benefits like decreased postoperative pain, shorter hospital stays, and fewer short-term problems. Laparoscopic hernia surgery also results in a lower risk of wound infections, an earlier restoration of bowel function, and a quicker return to regular activities

The prevalence of seroma formation after modified radical mastectomy: an observational analysis of risk factors

Background: Seroma, a medically apparent subcutaneous accumulation of effusion fluid after breast carcinoma, growing in 30% of patients. The main hurdle in breast cancer surgery is the formation of a seroma, with an unknown root cause. The objective of this study was to determine the relation between some elements connected with, modified radical mastectomy and seroma formation before the operative period, during the operative period, and after the operative period. Methods: This was an observational study including 200 female patients who were undergoing modified radical mastectomy at All India Institute of Medical Sciences, New Delhi, Delhi from January 2011 to December 2014. After the surgery, the patient was kept under observation for seroma formation. Chi square and t tests were used for the statistical analysis of this study. Results: Seroma formation was more prevalent in old-age patients and overweight patients. The more the initial drain volume the more will be the seroma formation. After the operation, arm physiotherapy was started. 40 patients of older age had the formation of seroma. 30 patients developed seroma whose tumor size was more than 3 cm. Conclusions: The occurrence of seroma was more prominent in older age patients and overweight patients. With prompt physiotherapy and flap fixation under muscles can reduce the occurrence of seroma formation and some interventions in the time of operation can help in decreasing seroma formation

Optimization and Analysis of an Elite Electric Propulsion System

Abstract- Electric propulsion has a promising system to create new possibilities in this technological era as well as control the harmful gaseous emission. This paper put a vision on several parameters of electric propulsion. The engine’s performance is comparable to the current propulsion devices and provides a lightweight solution to the robust technologies’ dependent on chemical energy sources. There are a plethora of factors which is enhanced by electric propulsion such as, overall efficiency, capabilities, and robustness of future air vehicles as well as mainly overcome from exhaust hazards. Electric propulsion systems have the potential of utilizing the electrically-driven propulsion system which is coupled electrically to power-generating devices. As a result, the electric propulsion system operated with greater flexibility and the synergistic benefits of aero-propulsive coupling and enhance performance in comparison with traditional designs. The experimentally calculated thrust of the engine model is approximately 547.6365, Newton

Fasudil in Combination With Bone Marrow Stromal Cells (BMSCs) Attenuates Alzheimer\u27s Disease-Related Changes Through the Regulation of the Peripheral Immune System.

Alzheimer\u27s disease (AD) is a chronic progressive neurodegenerative disease. Its mechanism is still not clear. Majority of research focused on the central nervous system (CNS) changes, while few studies emphasize on peripheral immune system modulation. Our study aimed to investigate the regulation of the peripheral immune system and its relationship to the severity of the disease after treatment in an AD model of APPswe/PSEN1dE9 transgenic (APP/PS1 Tg) mice. APP/PS1 Tg mice (8 months old) were treated with the ROCK-II inhibitor 1-(5-isoquinolinesulfonyl)-homo-piperazine (Fasudil) (intraperitoneal (i.p.) injections, 25 mg/kg/day), bone marrow stromal cells (BMSCs; caudal vein injections, 1 × 1

Risk of stroke in the periprocedural period: a literature review comparing carotid endarterectomy and stenting

Background Atherosclerosis of the carotid arteries is a pathophysiological process increasing the risk of stroke. Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are two recognised procedures indicated by National Institute of Clinical Excellence (NICE) guidelines aiming to reduce the risk of stroke. However, both are associated with periprocedural complications (defined as within 30 days), particularly stroke. This review aims to identify which treatment, CAS or CEA, has a lower risk of periprocedural stroke in patients with symptomatic or asymptomatic carotid artery stenosis. Methods NICE Evidence Search identified relevant UK guidelines. Search strategies combining free-text terms searched the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, CINAHL, and EMBASE for systematic reviews post-2011, and RCTs from 2015 onwards. Studies were included if they contained a comparison of CEA vs CAS with regards to periprocedural risk of stroke, and if they contained novel studies not seen in the NICE guidance. English language and full-text limits were applied. Results Searches identified 202 articles. Two reviewers performed independent screening identifying 3 guidelines, 7 systematic reviews, and 1 randomised control trial eligible for inclusion. Guidelines currently advocate usage of both procedures, unlike Scottish Guidelines (SIGN) who only support CEA. Four appraised systematic reviews found a statistically significant increase in stroke probability with CAS (p0.05). Discussion This review’s findings suggest that CAS is associated with an increased risk of periprocedural stroke when compared to CEA. Current UK guidelines by NICE and SIGN may require revisiting and take into account the new evidence not included in the original guidelines. There is a need for ongoing research as stenting technology improves over time

Bad news: analysis of the quality of information on influenza prevention returned by Google in English and Italian

Information available to the public influences the approach of the population toward vaccination against influenza compared with other preventative approaches. In this study, we have analyzed the first 200 websites returned by searching Google on two topics (prevention of influenza and influenza vaccine), in English and Italian. For all the four searches above, websites were classified according to their typology (government, commercial, professional, portals, etc.) and for their trustworthiness as defined by the Journal of the American Medical Association (JAMA) score, which assesses whether they provide some basic elements of information quality (IQ): authorship, currency, disclosure, and references. The type of information described was also assessed to add another dimension of IQ. Websites on influenza prevention were classified according to the type of preventative approach mentioned (vaccine, lifestyle, hygiene, complementary medicine, etc.), whether the approaches were in agreement with evidence-based medicine (EBM) or not. Websites on influenza vaccination were classified as pro- or anti-vaccine, or neutral. The great majority of websites described EBM approaches to influenza prevention and had a pro-vaccine orientation. Government websites mainly pointed at EBM preventative approaches and had a pro-vaccine orientation, while there was a higher proportion of commercial websites among those which promote non-EBM approaches. Although the JAMA score was lower in commercial websites, it did not correlate with the preventative approaches suggested or the orientation toward vaccines. For each of the four search engine result pages (SERP), only one website displayed the health-of-the-net (HON) seal. In the SERP on vaccines, journalistic websites were the most abundant category and ranked higher than average in both languages. Analysis using natural language processing showed that journalistic websites were mostly reporting news about two specific topics (different in the two languages). While the ranking by Google favors EBM approaches and, in English, does not promote commercial websites, in both languages it gives a great advantage to news. Thus, the type of news published during the influenza season probably has a key importance in orienting the public opinion due to its high visibility. This raises important questions on the relationships between health IQ, trustworthiness, and newsworthiness

Role of skeletal scintigraphy in soft tissue sarcoma: Improving the diagnostic yield

Background: The presence of skeletal metastases significantly influences the therapeutic strategy adopted for soft tissue sarcoma. However, literature on the prevalence of skeletal metastases in soft tissue sarcoma is limited and none of the available data is based on the Indian patient population. Aim: To determine the prevalence of skeletal metastases at presentation in patients of soft tissue sarcoma and to rationalise the use of preoperative skeletal scintigraphy in such patients. Methods and Material: Preoperative bone scans were evaluated in 122 patients with soft tissue sarcoma (median age, 34 years; range, 4-83). The scans were classified into 3 grades: Grade 1: metastases very likely; Grade 2: equivocal; Grade 3: normal or benign lesion. In all the patients studied, the ability of the patient to localize the site or sites of pain was recorded and that was correlated with the site of metastases in scintigraphy. Result: Seventeen (13.9%) patients had Grade 1 scan; 16 of them had bony pain that was not readily explainable by trauma or other local factors. Ten ( 8.1%) patients had Grade 2 scan, five of them had bony pain which was not readily explainable by trauma or other local factors. Ninety-five patients (77.8%) had Grade 3 scan. Of these, 9 had localised bone pain which could be definitely associated with trauma or joint degeneration. Conclusion: The prevalence of skeletal metastases at presentation in patients with soft tissue sarcoma is low (13.9%). The low rates of skeletal metastases in bone pain-free patients (0.9%) versus the high rate in symptomatic patients (76.1%) supports the use of bone scanning in symptomatic patients only

Health information quality of websites on periodontology

Aim: This study aimed to assess the quality of the information available on the Web on gum disease. Methods: The term ‘gum disease’ was searched in Google and in MedlinePlus. The first 200 websites were analysed by the Journal of the American Medical Association (JAMA) criteria and the Health On the Net Foundation (HONCode) certification, instruments for assessing quality of health information. Data was analysed through the Mann-Whitney test or KruskalWallis test, followed by the Dunn’s test, using the GraphPad Prism Software version 6. Results: MedlinePlus presented a significantly higher JAMA score than Google. Google’s first ten results had a higher JAMA score than the remaining websites. Journalism and health portals are the most reliable affiliations, while commercial and dental practices had low JAMA scores. JAMA score was significantly higher in websites with the HONCode certification compared to the ones without it. Conclusion: There are current concerns regarding patients’ use of the Internet for accessing health information. However, the conclusion we can make is that Google seems to favour websites with high quality information, at least in terms of JAMA score or HONCode accreditation. The JAMA score of dental practices’ websites could be improved by providing basic information such as authorship and date

Second echelon node predicts metastatic involvement of additional axillary nodes following sentinel node biopsy in early breast cancer

BACKGROUND : In many patients with early breast cancer, the sentinel lymph node (SLN) is the sole site of regional nodal metastasis. This subgroup of patients may not benefit from completion axillary lymph node dissection (CALND). AIMS: This pilot study evaluates the status of 2nd echelon (station) lymph nodes in the axilla as a predictor of additional positive nodes in the axilla in the presence of sentinel node metastasis. SETTINGS AND DESIGN: Cross-sectional study of 40 breast cancer patients. MATERIALS AND METHODS: Forty patients with invasive breast cancer underwent SLN biopsy followed by 2nd echelon lymph node biopsy in the same sitting. SLN mapping was performed using a combined technique of isosulfan blue and 99 mTc-sulfur colloid. SLNs (Station I) were defined as blue and/or hot nodes. These nodes were then injected with 0.1 ml of blue dye using a fine needle and their efferent lymphatic was traced to identify the Station II nodes. Then a complete ALND was performed. All the specimens were sent separately for histopathological evaluation. RESULTS : SLNs (Station I nodes) were successfully identified in 98% (39/40) patients. Of the 17 patients with a positive SLN, 8 (47%) patients had no further positive nodes in the axilla, 9 (53%) patients had additional metastasis in nonsentinel lymph nodes upon CALND. Station II nodes were identified in 76% (13/17) patients with a positive SLN. Station II nodes accurately predicted the status of the remaining axilla in 92% patients (12/13). STATISTICAL ANALYSIS : We calculated the Sensitivity, Negative predictive value, Positive predictive value, False negative rate and Identification rate. CONCLUSION : Station II nodes may predict metastatic involvement of additional nodes in the axilla