Long-Term Outcomes After Epigastric Hernia Repair in Women—A Nationwide Database Study

Aim: Women have the highest prevalence of epigastric hernia repair. Outcomes after epigastric hernia repair are rarely reported independently, although pathology and surgical techniques may be different than for other primary ventral hernias. The aim of this study was to evaluate long-term outcomes after epigastric hernia repairs in women on a nationwide basis.Methods: Nationwide cohort study from the Danish Hernia Database. Complete data from women undergoing elective epigastric hernia repair during a 12 years period (2007–2018) was extracted. A 100% follow-up was obtained by combining data from the National Civil Register. The primary outcome was operation for recurrence, secondary outcomes were readmission and operation for complications. Outcomes for open sutured repair, open mesh repair mesh, and laparoscopic repairs were compared.Results: In total, 3,031 women underwent elective epigastric hernia repair during the study period. Some 1,671 (55.1%) women underwent open sutured repair, 796 (26.3%) underwent open mesh repair, and 564 (18.6%) underwent laparoscopic repair. Follow-up was median 4.8 years. Operation for recurrence was higher after sutured repairs than after open mesh and laparoscopic repairs (7.7% vs. 3.3%, vs. 6.2%, p < 0.001). The risk of operation for complications was slightly higher after open mesh repair compared with sutured repair and laparoscopic repair (2.6% vs. 1.2%, vs. 2.0%, p = 0.032), with more operations for wound complications in the open mesh group (2.0%, p = 0.006).Conclusion: More than half of the women underwent a suture-based repair, although mesh repair reduces risk of recurrence. Open mesh repair had the lowest risk of recurrence, but on the expense of slightly increased risk of wound-related complications

Inferring ice fabric from birefringence loss in airborne radargrams : application to the eastern shear margin of Thwaites Glacier, West Antarctica

This work is ITGC Contribution No. ITGC-036 and is an output from the Thwaites Interdisciplinary Margin Evolution (TIME) project as part of the International Thwaites Glacier Collaboration (ITGC), supported by Natural Environment Research Council (NERC) research grant #NE/S006788/1 supporting T. J. Young and P. Christoffersen, and National Science Foundation (NSF) research grant #1739027 supporting S. M. Tulaczyk and D. M. Schroeder. Logistics for this project were provided by the NSF-U.S. Antarctic Program and NERC-British Antarctic Survey. R. Culberg is supported by a USA Department of Defense NDSEG Fellowship and N. L. Bienert is supported by an NSF Graduate Research Fellowship.In airborne radargrams, undulating periodic patterns in amplitude that overprint traditional radiostratigraphic layering are occasionally observed, however, they have yet to be analyzed from a geophysical or glaciological perspective. We present evidence supported by theory that these depth-periodic patterns are consistent with a modulation of the received radar power due to the birefringence of polar ice, and therefore indicate the presence of bulk fabric anisotropy. Here, we investigate the periodic component of birefringence-induced radar power recorded in airborne radar data at the eastern shear margin of Thwaites Glacier and quantify the lateral variation in azimuthal fabric strength across this margin. We find the depth variability of birefringence periodicity crossing the shear margin to be a visual expression of its shear state and its development, which appears consistent with present-day ice deformation. The morphology of the birefringent patterns is centered at the location of maximum shear and observed in all cross-margin profiles, consistent with predictions of ice fabric when subjected to simple shear. The englacial fabric appears stronger inside the ice stream than outward of the shear margin. The detection of birefringent periodicity from non-polarimetric radargrams presents a novel use of subsurface radar to constrain lateral variations in fabric strength, locate present and past shear margins, and characterize the deformation history of polar ice sheets.Publisher PDFPeer reviewe

Particle Size Distributions Obtained Through Unfolding 2D Sections: Towards Accurate Distributions of Nebular Solids in the Allende Meteorite

Size distributions of nebular solids in chondrites suggest an efficient sorting of these early forming objects within the protoplanetary disk. The effect of this sorting has been documented by investigations of modal abundances of CAIs (e.g., [1-4]) and chondrules (e.g., [5-8]). Evidence for aerodynamic sorting in the disk is largely qualitative, and needs to be carefully assessed. It may be a way of concentrating these materials into planetesimal-mass clumps, perhaps 100 fs of ka after they formed. A key parameter is size/density distributions of particles (i.e., chondrules, CAIs, and metal grains), and in particular, whether the radius-density product (rxp) is a better metric for defining the distribution than r alone [9]. There is no consensus between r versus rxp based models. Here we report our initial tests and preliminary results, which when expanded will be used to test the accuracy of current dynamical disk models

Frictionless bead packs have macroscopic friction, but no dilatancy

The statement of the title is shown by numerical simulation of homogeneously sheared packings of frictionless, nearly rigid beads in the quasistatic limit. Results coincide for steady flows at constant shear rate γ in the limit of small γ and static approaches, in which packings are equilibrated under growing deviator stresses. The internal friction angle ϕ, equal to 5.76 $\pm$ 0.22 degrees in simple shear, is independent on the average pressure P in the rigid limit. It is shown to stem from the ability of stable frictionless contact networks to form stress-induced anisotropic fabrics. No enduring strain localization is observed. Dissipation at the macroscopic level results from repeated network rearrangements, like the effective friction of a frictionless slider on a bumpy surface. Solid fraction Φ remains equal to the random close packing value ≃ 0.64 in slowly or statically sheared systems. Fluctuations of stresses and volume are observed to regress in the large system limit, and we conclude that the same friction law for simple shear applies in the large psystem limit if normal stress or density is externally controlled. Defining the inertia number as I = γ m/(aP), with m the grain mass and a its diameter, both internal friction coefficient $\mu$∗ = tan ϕ and volume 1/Φ increase as powers of I in the quasistatic limit of vanishing I, in which all mechanical properties are determined by contact network geometry. The microstructure of the sheared material is characterized with a suitable parametrization of the fabric tensor and measurements of connectivity and coordination numbers associated with contacts and near neighbors.Comment: 19 pages. Additional technical details may be found in v

Solid behavior of anisotropic rigid frictionless bead assemblies

We investigate the structure and mechanical behavior of assemblies of frictionless, nearly rigid equal-sized beads, in the quasistatic limit, by numerical simulation. Three different loading paths are explored: triaxial compression, triaxial extension and simple shear. Generalizing recent results [1], we show that the material, despite rather strong finite sample size effects, is able to sustain a finite deviator stress in the macroscopic limit, along all three paths, without dilatancy. The shape of the yield surface is adequately described by a Lade-Duncan (rather than Mohr-Coulomb) criterion. While scalar state variables keep the same values as in isotropic systems, fabric and force anisotropies are each characterized by one parameter and are in one-to-one correspondence with principal stress ratio along all three loading paths.The anisotropy of the pair correlation function extends to a distance between bead surfaces on the order of 10% of the diameter. The tensor of elastic moduli is shown to possess a nearly singular, uniaxial structure related to stress anisotropy. Possible stress-strain relations in monotonic loading paths are also discussed

Internal states of model isotropic granular packings. I. Assembling process, geometry and contact networks

This is the first paper of a series of three, reporting on numerical simulation studies of geometric and mechanical properties of static assemblies of spherical beads under an isotropic pressure. Frictionless systems assemble in the unique random close packing (RCP) state in the low pressure limit if the compression process is fast enough, slower processes inducing traces of crystallization, and exhibit specific properties directly related to isostaticity of the force-carrying structure. The different structures of frictional packings assembled by various methods cannot be classified by the sole density. While lubricated systems approach RCP densities and coordination number z^*~=6 on the backbone in the rigid limit, an idealized "vibration" procedure results in equally dense configurations with z^*~=4.5. Near neighbor correlations on various scales are computed and compared to available laboratory data, although z^* values remain experimentally inaccessible. Low coordination packings have many rattlers (more than 10% of the grains carry no force), which should be accounted for on studying position correlations, and a small proportion of harmless "floppy modes" associated with divalent grains. Frictional packings, however slowly assembled under low pressure, retain a finite level of force indeterminacy, except in the limit of infinite friction.Comment: 29 pages. Published in Physical Review

Rheophysics of dense granular materials : Discrete simulation of plane shear flows

We study the steady plane shear flow of a dense assembly of frictional, inelastic disks using discrete simulation and prescribing the pressure and the shear rate. We show that, in the limit of rigid grains, the shear state is determined by a single dimensionless number, called inertial number I, which describes the ratio of inertial to pressure forces. Small values of I correspond to the quasi-static regime of soil mechanics, while large values of I correspond to the collisional regime of the kinetic theory. Those shear states are homogeneous, and become intermittent in the quasi-static regime. When I increases in the intermediate regime, we measure an approximately linear decrease of the solid fraction from the maximum packing value, and an approximately linear increase of the effective friction coefficient from the static internal friction value. From those dilatancy and friction laws, we deduce the constitutive law for dense granular flows, with a plastic Coulomb term and a viscous Bagnold term. We also show that the relative velocity fluctuations follow a scaling law as a function of I. The mechanical characteristics of the grains (restitution, friction and elasticity) have a very small influence in this intermediate regime. Then, we explain how the friction law is related to the angular distribution of contact forces, and why the local frictional forces have a small contribution to the macroscopic friction. At the end, as an example of heterogeneous stress distribution, we describe the shear localization when gravity is added.Comment: 24 pages, 19 figure

Modelling climate change responses in tropical forests: similar productivity estimates across five models, but different mechanisms and responses

Accurately predicting the response of Amazonia to climate change is important for predicting climate change across the globe. Changes in multiple climatic factors simultaneously result in complex non-linear ecosystem responses, which are difficult to predict using vegetation models. Using leaf- and canopy-scale observations, this study evaluated the capability of five vegetation models (Community Land Model version 3.5 coupled to the Dynamic Global Vegetation model – CLM3.5–DGVM; Ecosystem Demography model version 2 – ED2; the Joint UK Land Environment Simulator version 2.1 – JULES; Simple Biosphere model version 3 – SiB3; and the soil–plant–atmosphere model – SPA) to simulate the responses of leaf- and canopy-scale productivity to changes in temperature and drought in an Amazonian forest. The models did not agree as to whether gross primary productivity (GPP) was more sensitive to changes in temperature or precipitation, but all the models were consistent with the prediction that GPP would be higher if tropical forests were 5 °C cooler than current ambient temperatures. There was greater model–data consistency in the response of net ecosystem exchange (NEE) to changes in temperature than in the response to temperature by net photosynthesis (An), stomatal conductance (gs) and leaf area index (LAI). Modelled canopy-scale fluxes are calculated by scaling leaf-scale fluxes using LAI. At the leaf-scale, the models did not agree on the temperature or magnitude of the optimum points of An, Vcmax or gs, and model variation in these parameters was compensated for by variations in the absolute magnitude of simulated LAI and how it altered with temperature. Across the models, there was, however, consistency in two leaf-scale responses: (1) change in An with temperature was more closely linked to stomatal behaviour than biochemical processes; and (2) intrinsic water use efficiency (IWUE) increased with temperature, especially when combined with drought. These results suggest that even up to fairly extreme temperature increases from ambient levels (+6 °C), simulated photosynthesis becomes increasingly sensitive to gs and remains less sensitive to biochemical changes. To improve the reliability of simulations of the response of Amazonian rainforest to climate change, the mechanistic underpinnings of vegetation models need to be validated at both leaf- and canopy-scales to improve accuracy and consistency in the quantification of processes within and across an ecosystem.This research was enabled by a grant from the Andes–Amazon Initiative of The Gordon and Betty Moore Foundation. L. Rowland gratefully acknowledges financial support from the Natural Environment Research Council (UK) for a NERC PhD studentship, and NERC grant NE/J011002/1; PM also acknowledges support from ARC FT110100457

Cancer and systemic inflammation: treat the tumour and treat the host

Determinants of cancer progression and survival are multifactorial and host responses are increasingly appreciated to have a major role. Indeed, the development and maintenance of a systemic inflammatory response has been consistently observed to confer poorer outcome, in both early and advanced stage disease. For patients, cancer-associated symptoms are of particular importance resulting in a marked impact on day-to-day quality of life and are also associated with poorer outcome. These symptoms are now recognised to cluster with one another with anorexia, weight loss and physical function forming a recognised cluster whereas fatigue, pain and depression forming another. Importantly, it has become apparent that these symptom clusters are associated with presence of a systemic inflammatory response in the patient with cancer. Given the understanding of the above, there is now a need to intervene to moderate systemic inflammatory responses, where present. In this context the rationale for therapeutic intervention using nonselective anti-inflammatory agents is clear and compelling and likely to become a part of routine clinical practice in the near future. The published literature on therapeutic intervention using anti-inflammatory agents for cancer-associated symptoms was reviewed. There are important parallels with the development of useful treatments for the systemic inflammatory response in patients with rheumatological disease and cardiovascular disease

The Apolipoprotein M/S1P Axis Controls Triglyceride Metabolism and Brown Fat Activity

Summary: Apolipoprotein M (apoM) is the carrier of sphingosine-1-phosphate (S1P) in plasma high-density lipoproteins. S1P is a bioactive lipid interacting with five receptors (S1P1–5). We show that lack of apoM in mice increases the amount of brown adipose tissue (BAT), accelerates the clearance of postprandial triglycerides, and protects against diet-induced obesity (i.e., a phenotype similar to that induced by cold exposure or β3-adrenergic stimulation). Moreover, the data suggest that the phenotype of apoM-deficient mice is S1P dependent and reflects diminished S1P1 stimulation. The results reveal a link between the apoM/S1P axis and energy metabolism. : Apolipoprotein M (apoM) is the carrier of sphingosine-1-phosphate (S1P) in lipoproteins. Christoffersen et al. show that lack of apoM in mice increases the amount of brown adipose tissue, accelerates the turnover of fat, and protects against obesity. The results reveal a link between the apoM/S1P axis and energy metabolism. Keywords: apolipoproteins, sphingolipids, sphingosine-1-phosphate, lipoproteins, lipid metabolism, triglyceride, brown adipose tissue, apo