Incisional hernia repair after caesarean section: a population based study

BACKGROUND Incisional hernias occur at surgical abdominal incision sites but the association with caesarean section (CS) has not been examined. AIM: To determine whether CS is a risk factor for incisional hernia repair. MATERIAL and METHODS: Population-based cohort study in Australia using linked birth and hospital data for women who gave birth from 2000 to 2011. (n=642,578) Survival analysis was used to explore the association between CS and subsequent incisional hernia repair. Analyses were adjusted for confounding factors including other abdominal surgery. The main outcome measure was surgical repair of an incisional hernia. RESULTS: 217,555 women (33.9%) had at least one CS and 1,554 (0.2%) had an incisional hernia repair. The frequency of incisional hernia repair in women who had ever had a caesarean section was 0.47%, compared to 0.12% in women who never had a caesarean section. After controlling for different follow up lengths and known explanatory variables, the adjusted hazard ratio (aHR) was 2.73 (95%CI 2.45-3.06, P <0.001). Incisional hernia repair risk increased with number of caesarean sections: women with two CS had a threefold increased risk of incisional hernia repair, which increased to 6 fold after five CS (aHR=6.29, 95%CI 3.99-9.93, P<0.001) compared to women with no CS. Prior abdominal surgery including other hernia repair also increased the risk of incisional hernia repair (all p<0.001). CONCLUSIONS: There was a strong association between maternal CS and subsequent incisional hernia repair, which increased as the number of CSs increased, but the absolute risk of incisional hernia repair was low.We thank the New South Wales (NSW) Ministry of Health for access to the population health data and the NSW Centre for Health Record Linkage for linking the data sets. This work was supported by an Australian National Health and Medical Research Council (NHMRC) Centre for Research Excellence Grant (1001066). CLR is supported by a NHMRC Senior Research Fellowship (#APP1021025)

Microscopic Observation Drug Susceptibility Assay (MODS) for Early Diagnosis of Tuberculosis in Children

MODS is a novel liquid culture based technique that has been shown to be effective and rapid for early diagnosis of tuberculosis (TB). We evaluated the MODS assay for diagnosis of TB in children in Viet Nam. 217 consecutive samples including sputum (n = 132), gastric fluid (n = 50), CSF (n = 32) and pleural fluid (n = 3) collected from 96 children with suspected TB, were tested by smear, MODS and MGIT. When test results were aggregated by patient, the sensitivity and specificity of smear, MGIT and MODS against “clinical diagnosis” (confirmed and probable groups) as the gold standard were 28.2% and 100%, 42.3% and 100%, 39.7% and 94.4%, respectively. The sensitivity of MGIT and MODS was not significantly different in this analysis (P = 0.5), but MGIT was more sensitive than MODS when analysed on the sample level using a marginal model (P = 0.03). The median time to detection of MODS and MGIT were 8 days and 13 days, respectively, and the time to detection was significantly shorter for MODS in samples where both tests were positive (P<0.001). An analysis of time-dependent sensitivity showed that the detection rates were significantly higher for MODS than for MGIT by day 7 or day 14 (P<0.001 and P = 0.04), respectively. MODS is a rapid and sensitive alternative method for the isolation of M.tuberculosis from children

La dydrogestérone par voie orale dans le soutien de la phase lutéale en fécondation in vitro est aussi efficace que la progestérone naturelle par voie vaginale

L'objectif de notre étude était de comparer le taux de naissances vivantes après soutien de a phase lutéale en FIV par de la dydrogestérone par voie orale versus de la progestérone naturelle par voie vaginale. Une étude de type vant-parès a été menée entre septembre 2011 et septembre 2013 dans notre centre de PMA au CHU de la Conception à Marseille. Toutes les patientes qui avaient effectué une FIV avec transfert d'embryons frais pendant cette période ont été incluses. Il y a eu 2 périodes d'étude: dans le groupe 1, les patientes ayant bénéficié d'une FIV avec transfert d'embryons frais entre septembre 2011 et août 2012 ont reçu de la progestérone naturelle par voie vaginale (400 mg par jour) en soutien de la phase lutéale et dans le groupe 2 les patientes ayant bénéficié d'une FIV avec transfert d'embryons frais entre septembre 2012 et août 2013 ont reçu de la dydrogestérone par voie orale (30mg par jour) en soutien de la phase lutéale. Le critère de jugement principal était le taux de naissances vivantes et les critères de jugements secondaires étaient: le taux d'implantations, le taux de grossesse cliniques, le taux de fausses couches précoces, le taux de grossesse extra-utérines, le terme à la naissance et les modalités d'accouchement. RESULTATS: le taux de naissances vivantes n'était pas statistiquement différent entre les 2 groupes (19,8% dans le groupe 1 vs. 18,8% dans le groupe 2, p=0,694). Le taux d'implantations et de grossesses cliniques n'étaient pas statistiquement différent dans le groupe progestérone naturelle par voie vaginale versus le groupe dydrogestérone par voie orale (respectivement 29,1% vs. 24,6% p=0,015 et 25,7% vs. 22,2%, p=0,194). De plus, le taux de fausses couches précoces était significativement plus élevé dans le groupe progestérone naturelle par voie vaginale (5,9% vs. 3,2%, p=0,025). CONCLUSION: La dydrogestérone par voie orale dans le soutien de la phase lutéale après FIV avec transfert d'embryons frais apparaît être aussi efficace que la progestérone naturelle par voie vaginale avec des taux de naissances vivantes identiques et mois de fausses couches précocesAIX-MARSEILLE2-BU Méd/Odontol. (130552103) / SudocSudocFranceF

A survey on actuators-driven surgical robots

Robot-assisted surgeries have been integrated and leading to a paradigm shift in surgical fields. With the emergence of Minimally Invasive Surgery (MIS), especially Natural Orifice Transluminal Endoscopic Surgery (NOTES), there are various benefits such as a minimization of side effects, enhancement of precise surgical procedures, and faster recovery after the surgery that patients can take from. However, in order to effectively employ and exploit surgical robots, numerous technical challenges need to be addressed. Among these, actuators play a vital role. To provide deeper understanding on current actuators-driven surgical robot, this study will comprehensively review on four main types of transmission systems namely cable-driven mechanism, flexible fluidic actuators, smart material actuators, and magnetic actuators, in terms of conceptual designs, modelling, and control as well as their advantages and disadvantages. Profound discussions and recommendations for the future of actuators-driven surgical robots will be also pointed out to give the roadmap in the surgical field.Accepted versio

Design and modelling of a variable stiffness manipulator for surgical robots

In Natural Orifice Transluminal Endoscopic Surgery (NOTES), a surgical robot that can access the human colon or stomach via natural orifices should have sufficient flexibility to pass through tortuous paths and to be operated in a confined space. In addition, the robot should possess an acceptable stiffness level to hold payloads during the surgery. This paper presents a new design concept for variable stiffness manipulators using thermoplastic material Polyethylene Terephthalate (PET) and a flexible stainless steel sheath as a heating media. The stiffness phases of PET can be actively adjusted through temperature. Experiments at different conditions showed that the proposed design was at least as flexible as a typical commercial endoscope in compliant mode and at least 9 times stiffer than the endoscope in stiff mode. In addition, flexural modulus of the proposed manipulator with respect to temperature, current, and time was modeled and validated through both simulation and experiments. A tendon-driven flexible robotic arm integrated with a variable stiffness spine was also developed, and ex vivo tests on fresh porcine tissue were conducted. The manipulator in compliant mode can be easily controlled through the tendons, and it is able to hold its shape against considerably large loads in stiff mode. The results demonstrate not only the high potential of the design concept for the future medical application but also the first steps toward building a complete surgical robotic system with fully controlled variable stiffness.NRF (Natl Research Foundation, S’pore)Accepted versio

Towards active variable stiffness manipulators for surgical robots

Variable stiffness for robotics is attracting increasing attention from researchers in the field of surgical robots. A surgical robot that can access the human colon or stomach via natural orifices must be flexible enough to pass through tortuous paths and to work in a confined space. Meanwhile, the robot must also be stiff enough to ensure pushability and to hold high payloads during the surgery. Thus, surgical robots with variable stiffness are desirable. This paper presents a new design concept for variable stiffness manipulators using a thermoplastic material - Polyethylene Terephthalate (PET) - and a flexible stainless steel sheath as a heating solution. The stiffness of PET can be flexibly adjusted through temperature. Experiments and validations were carried out at different conditions. The results showed that our proposed design is at least as flexible as a typical commercial endoscope when flexibility is desired and meanwhile at least 9 times stiffer than the endoscope when stiffness is desired (Flexural modulus was compared). A tendon-driven manipulator based on the proposed concept was also developed. Validation tests showed that the manipulator in compliant mode can be significantly bent through cable actuation, and the manipulator in stiff mode is able to maintain its shape against considerably large loads.NRF (Natl Research Foundation, S’pore)Accepted versio