Impact of Crural Relaxing Incisions, Collis Gastroplasty, and Non–Cross-linked Human Dermal Mesh Crural Reinforcement on Early Hiatal Hernia Recurrence Rates

BackgroundHernia recurrence is the leading form of failure after antireflux surgery and may be secondary to unrecognized tension on the crural repair or from a foreshortened esophagus. Mesh reinforcement has proven beneficial for repair of hernias at other sites, but the use of mesh at the hiatus remains controversial. The aim of this study was to evaluate the outcomes of hiatal hernia repair with human dermal mesh reinforcement of the crural closure in combination with tension reduction techniques when necessary.Study DesignWe retrospectively reviewed the records of all patients who had hiatal hernia repair using AlloMax Surgical Graft (Davol), a human dermal biologic mesh. Objective follow-up was with videoesophagram and/or upper endoscopy at 3 months postoperatively and annually.ResultsThere were 82 patients with a median age of 63 years. The majority of operations (85%) were laparoscopic primary repairs of a paraesophageal hernia with a fundoplication. The crura were closed primarily in all patients and reinforced with an AlloMax Surgical Graft. A crural relaxing incision was used in 12% and a Collis gastroplasty in 28% of patients. There was no mesh-related morbidity and no mortality. Median objective follow-up was 5 months, but 15 patients had follow-up at 1 or more years. A recurrent hernia was found in 3 patients (4%).ConclusionsTension-reducing techniques in combination with human biologic mesh crural reinforcement provide excellent early results with no mesh-related complications. Long-term follow-up will define the role of these techniques and this biologic mesh for hiatal hernia repair

Volumetric laser endomicroscopy and its application to Barrett's esophagus: results from a 1,000 patient registry.

Volumetric laser endomicroscopy (VLE) uses optical coherence tomography (OCT) for real-time, microscopic cross-sectional imaging. A US-based multi-center registry was constructed to prospectively collect data on patients undergoing upper endoscopy during which a VLE scan was performed. The objective of this registry was to determine usage patterns of VLE in clinical practice and to estimate quantitative and qualitative performance metrics as they are applied to Barrett's esophagus (BE) management. All procedures utilized the NvisionVLE Imaging System (NinePoint Medical, Bedford, MA) which was used by investigators to identify the tissue types present, along with focal areas of concern. Following the VLE procedure, investigators were asked to answer six key questions regarding how VLE impacted each case. Statistical analyses including neoplasia diagnostic yield improvement using VLE was performed. One thousand patients were enrolled across 18 US trial sites from August 2014 through April 2016. In patients with previously diagnosed or suspected BE (894/1000), investigators used VLE and identified areas of concern not seen on white light endoscopy (WLE) in 59% of the procedures. VLE imaging also guided tissue acquisition and treatment in 71% and 54% of procedures, respectively. VLE as an adjunct modality improved the neoplasia diagnostic yield by 55% beyond the standard of care practice. In patients with no prior history of therapy, and without visual findings from other technologies, VLE-guided tissue acquisition increased neoplasia detection over random biopsies by 700%. Registry investigators reported that VLE improved the BE management process when used as an adjunct tissue acquisition and treatment guidance tool. The ability of VLE to image large segments of the esophagus with microscopic cross-sectional detail may provide additional benefits including higher yield biopsies and more efficient tissue acquisition. Clinicaltrials.gov NCT02215291

Transumbilical Totally Laparoscopic Single-Port Nissen Fundoplication: A New Method of Liver Retraction: The Istanbul Technique

Mustafa Kemal Ataturk, founder of the Turkish Republic, had guarded many German scientists of a Jewish descent before the Second World War. Dr. Rudolf Nissen was one of the outstanding surgeons who had served in the Turkish university hospitals. He had created an antireflux procedure which is named after his own name while he was working in our clinic, the CerrahpaAYa Hospital. From a laparoscopic approach, the Nissen fundoplication was the gold standard intervention for the surgical treatment of gastroesophageal reflux disease (GERD). Currently, video laparoscopic surgery is evolving quickly with the guidance of new technology. Single-port (SP) laparoscopic transumbilical surgery is one of the newest branches of advanced laparoscopy

Goal-recognition-based adaptive brain-computer interface for navigating immersive robotic systems

© 2017 IOP Publishing Ltd. Objective. This work proposes principled strategies for self-adaptations in EEG-based Brain-computer interfaces (BCIs) as a way out of the bandwidth bottleneck resulting from the considerable mismatch between the low-bandwidth interface and the bandwidth-hungry application, and a way to enable fluent and intuitive interaction in embodiment systems. The main focus is laid upon inferring the hidden target goals of users while navigating in a remote environment as a basis for possible adaptations. Approach. To reason about possible user goals, a general user-agnostic Bayesian update rule is devised to be recursively applied upon the arrival of evidences, i.e. user input and user gaze. Experiments were conducted with healthy subjects within robotic embodiment settings to evaluate the proposed method. These experiments varied along three factors: the type of the robot/environment (simulated and physical), the type of the interface (keyboard or BCI), and the way goal recognition (GR) is used to guide a simple shared control (SC) driving scheme. Main results. Our results show that the proposed GR algorithm is able to track and infer the hidden user goals with relatively high precision and recall. Further, the realized SC driving scheme benefits from the output of the GR system and is able to reduce the user effort needed to accomplish the assigned tasks. Despite the fact that the BCI requires higher effort compared to the keyboard conditions, most subjects were able to complete the assigned tasks, and the proposed GR system is additionally shown able to handle the uncertainty in user input during SSVEP-based interaction. The SC application of the belief vector indicates that the benefits of the GR module are more pronounced for BCIs, compared to the keyboard interface. Significance. Being based on intuitive heuristics that model the behavior of the general population during the execution of navigation tasks, the proposed GR method can be used without prior tuning for the individual users. The proposed methods can be easily integrated in devising more advanced SC schemes and/or strategies for automatic BCI self-adaptations

Еволюція історичних уявлень про Україну в середньовічній Франції до середини ХVІІ ст.

У статті розглянуто стан ознайомлення французької громадськості ХІ-ХVІІ ст. з Україною, проаналізовано причини цікавості французів до цієї країни на тлі історичних взаємин України та Франції. Автор простежує еволюцію французьких історичних досліджень про Україну у Франції.The author considers the state of acquaintance of the French society of the XVII century with Ukraine, analyses the reasons of the interest the French took in this country on the phone of the historical relations between Ukraine and France and traces the evolution of the French historical studies in Ukraine

The Index-Based Subgraph Matching Algorithm (ISMA): Fast Subgraph Enumeration in Large Networks Using Optimized Search Trees

Subgraph matching algorithms are designed to find all instances of predefined subgraphs in a large graph or network and play an important role in the discovery and analysis of so-called network motifs, subgraph patterns which occur more often than expected by chance. We present the index-based subgraph matching algorithm (ISMA), a novel tree-based algorithm. ISMA realizes a speedup compared to existing algorithms by carefully selecting the order in which the nodes of a query subgraph are investigated. In order to achieve this, we developed a number of data structures and maximally exploited symmetry characteristics of the subgraph. We compared ISMA to a naive recursive tree-based algorithm and to a number of well-known subgraph matching algorithms. Our algorithm outperforms the other algorithms, especially on large networks and with large query subgraphs. An implementation of ISMA in Java is freely available at http://sourceforge.net/projects/isma

An Algorithm Informed by the Parathyroid Hormone Level Reduces Hypocalcemic Complications of Thyroidectomy

Ó The Author(s) 2010. This article is published with open access at Springerlink.com Background Measurement of the parathyroid hormone (PTH) level following total thyroidectomy (TTx) may allow prediction of postoperative hypocalcemia. We present an algorithmic method of managing hypocalcemia preemptively, based on the PTH level 1 h after operation. Materials and methods We examined 423 consecutive patients undergoing TTx at a single institution. A subset of patients were managed using an algorithm involving routine postoperative oral calcium administration and the early addition of oral calcitriol in patients with a low 1-h postoperative PTH level. Algorithm patients were compared to a concurrent, conventionally managed group. Outcomes measured included serum calcium levels, symptoms of hypocalcemia, postoperative complications, and receipt of intravenous (IV) calcium. Results The algorithm was applied in 135 patients, and 288 patients were managed conventionally. Critically low calcium levels (total calcium \7.5 mg/dl [1.88 mmol/l] or ionized calcium \0.94 mmol/l) were less common in algorithm patients (10.6 % vs. 25.3%; p \ 0.005). Much of this difference was attributable to the protective impact of the algorithm on patients undergoing TTx for cancer, 30% of whom developed critically low calcium levels when managed conventionally. Among patients requiring IV calcium, algorithm patients received fewer doses (1.29 vs