A prospective comparative study of Lichtenstein procedure with and without mesh-fixation for inguinal hernia repair

Background: Repair of inguinal hernia is one of the most common elective operations performed in general surgery worldwide. Mesh-hernioplasty became the gold standard, because of its low recurrence rate in comparison with tissue repairs. The ideal repair must be simple, safe, easy to perform and require minimal dissection which provides enough space, should be cost effective with less hospital stay, less pain and less recurrence. The present study aimed at comparing the effect of mesh fixation and non-fixation in Lichtenstein technique for inguinal hernia repair.Methods: Hundred (100) patients with primary uncomplicated, unilateral inguinal hernia were treated between April 2019 and September 2020. Patients with inguinal hernia underwent Lichtenstein repair with mesh-fixation (group A) (n=50) and non-fixation (group B) (n=50). The mean operative time, post-operative pain score, average hospital study, post-operative complications and recurrence rates were compared between the two groups.Results: Mean operative time in non-fixation group- (group B) (32.24 min) was shorter as compared to fixation group-(Group A) (49.36 min) with a p value of 0.002. Post-operative pain score was lower in (group B) at 12 and 24 hours (3.71±1.409 and 2.2±0.8169) as compared to Group A at 12 and 24 hours (4.77±1.196 and 2.98±1.295) with a p value of <0.0001. The analgesia required in (group B) was less as compared to (group A). The post-operative complication and recurrence rates were almost identical in both the groups, with lesser incidence of groin pain and paresthesias in group B.Conclusions: In Lichtenstein inguinal hernia repair, non-fixation of mesh is safe and preferable option, with less operative time and less postoperative pain

Layering smart management practices to sustainably maintain rice yields and improve water use efficiency in eastern India

Rice in eastern India is widely cultivated using conventional management practices, including puddled transplanting (PTR) for crop establishment, which are water and energy intensive. To conserve water and maximise its efficient use, improved crop management practices must be identified which are feasible and attractive to farmers. These improved practices include dry direct seeding of rice (dDSR), improved medium-duration rice varieties and alternate wetting and drying (AWD) irrigation management. These have separately been shown to reduce the irrigation water requirement for rice cultivation while maintaining yields similar to those of traditional high yielding long-duration varieties. We conducted a field experiment over two rice-growing seasons to examine the effects on rice grain yield and water productivity of layering these improved management practices, compared to conventional PTR with traditional long-duration rice. We also assessed the usefulness of simple perforated tubes to implement AWD management in the field. dDSR reduced rice grain yield by 3–6% while requiring 23% less irrigation water over PTR. The medium-duration hybrid rice variety produced 2–4% higher grain yield under direct seeding while using 4–5% less irrigation water than the long-duration variety. AWD reduced irrigation water use by 26–52% but also reduced grain yield by 3–14%. Water use efficiency was improved by dDSR, AWD and by using medium-duration hybrid variety. Combining all three management practices reduced irrigation water use by an average of 18% while improving irrigation water productivity by 21%, without significant reduction in grain yield under shallow AWD of 10 cm depth in dDSR and upto 15 cm depth for PTR. This combination is a novel approach to sustainably improve farmers’ rice productivity. Additionally, simple perforated tubes are an effective and innovative tool for farmers to implement AWD management. Our research suggests that farmers in eastern India and similar rice-growing agro-ecologies could reduce the irrigation water applied and increase water use efficiency while maintaining rice crop productivity by combining dry direct seeding with a medium-duration rice variety under AWD irrigation management

In Praise of JESTPE Associate Editors-Part IV

Adefining component that makes the Journal of Emerging and Selected Topics in Power Electronics (JESTPE) a predominant publication in the field of power electronics is our past and current associate editors. Although they are largely hidden and unheard until papers they recommend for publication appear in print, the efforts of our associate editors are extremely important in producing the JESTPE for the readers. The tasks of an associate editor include reading the submissions, finding competent reviewers, reading the comments from the reviewers, and making recommendations to the assigned editors, all of which are to be accomplished in a timely manner. In some cases, associate editors expend lots of time contacting busy reviewers to submit their comments, making recommendations, and addressing rejected paper complaints from the authors

Ibrutinib as first line therapy for mantle cell lymphoma:A multicentre, real-world UK study

During the Covid-19 pandemic, ibrutinib +/- rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. As limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib +/- rituximab for untreated MCL were evaluated for treatment toxicity, response and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 &gt;/=30%). 149 patients from 43 participating centres were enrolled: 74.1% male, median age 75, 75.2% ECOG 0-1, 36.2% high-risk, 8.9% autologous transplant candidates. All patients received &gt;/= 1 cycle ibrutinib (median 8 cycles), 39.0% with rituximab. Grade &gt;/= 3 toxicity occurred in 20.3%, 33.8% required dose reductions/delays. At 15.6 months (mo) median follow-up, 41.6% discontinued ibrutinib; 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2% respectively. ORR was 77.3% (low-risk) vs. 59.0% (high-risk), p=0.05, and 78.7% (ibrutinib-rituximab) vs. 64.9% (ibrutinib), p=0.13. Median progression-free survival was 26.0mo (all patients); 13.7mo (high-risk) vs. not reached (NR) (low-risk), p=0.004. Median overall survival was NR (all); 14.8mo (high-risk) vs. NR (low-risk), p=0.005. Median post-ibrutinib survival was 1.4mo, longer in 41.9% patients receiving subsequent treatment (median 8.6 vs 0.6mo, p=0.002). Ibrutinib +/- rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.</p

Ibrutinib as first line therapy for mantle cell lymphoma: A multicentre, real-world UK study

During the Covid-19 pandemic, ibrutinib +/- rituximab was approved in England for initial treatment of mantle cell lymphoma (MCL) instead of immunochemotherapy. As limited data are available in this setting, we conducted an observational cohort study evaluating safety and efficacy. Adults receiving ibrutinib +/- rituximab for untreated MCL were evaluated for treatment toxicity, response and survival, including outcomes in high-risk MCL (TP53 mutation/deletion/p53 overexpression, blastoid/pleomorphic, or Ki67 >/=30%). 149 patients from 43 participating centres were enrolled: 74.1% male, median age 75, 75.2% ECOG 0-1, 36.2% high-risk, 8.9% autologous transplant candidates. All patients received >/= 1 cycle ibrutinib (median 8 cycles), 39.0% with rituximab. Grade >/= 3 toxicity occurred in 20.3%, 33.8% required dose reductions/delays. At 15.6 months (mo) median follow-up, 41.6% discontinued ibrutinib; 8.1% due to toxicity. Of 104 response-assessed patients, overall (ORR) and complete response (CR) rates were 71.2% and 20.2% respectively. ORR was 77.3% (low-risk) vs. 59.0% (high-risk), p=0.05, and 78.7% (ibrutinib-rituximab) vs. 64.9% (ibrutinib), p=0.13. Median progression-free survival was 26.0mo (all patients); 13.7mo (high-risk) vs. not reached (NR) (low-risk), p=0.004. Median overall survival was NR (all); 14.8mo (high-risk) vs. NR (low-risk), p=0.005. Median post-ibrutinib survival was 1.4mo, longer in 41.9% patients receiving subsequent treatment (median 8.6 vs 0.6mo, p=0.002). Ibrutinib +/- rituximab was effective and well tolerated as first-line treatment of MCL, including older and transplant-ineligible patients. PFS and OS were significantly inferior in one-third of patients with high-risk disease and those unsuitable for post-ibrutinib treatment, highlighting the need for novel approaches in these groups.</p