2,031 research outputs found

    Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials.

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    BACKGROUND-PURPOSE: Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. METHODS: Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. RESULTS: The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = - 6.32 (- 8.17, - 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. CONCLUSIONS: This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic

    Mitochondrial phylogeography and demographic history of the Vicuña: implications for conservation

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    The vicuña (Vicugna vicugna; Miller, 1924) is a conservation success story, having recovered from near extinction in the 1960s to current population levels estimated at 275 000. However, lack of information about its demographic history and genetic diversity has limited both our understanding of its recovery and the development of science-based conservation measures. To examine the evolution and recent demographic history of the vicuña across its current range and to assess its genetic variation and population structure, we sequenced mitochondrial DNA from the control region (CR) for 261 individuals from 29 populations across Peru, Chile and Argentina. Our results suggest that populations currently designated as Vicugna vicugna vicugna and Vicugna vicugna mensalis comprise separate mitochondrial lineages. The current population distribution appears to be the result of a recent demographic expansion associated with the last major glacial event of the Pleistocene in the northern (18 to 22°S) dry Andes 14–12 000 years ago and the establishment of an extremely arid belt known as the 'Dry Diagonal' to 29°S. Within the Dry Diagonal, small populations of V. v. vicugna appear to have survived showing the genetic signature of demographic isolation, whereas to the north V. v. mensalis populations underwent a rapid demographic expansion before recent anthropogenic impacts

    Formational history of the Wicklow Trough: a marine transgressed tunnel valley revealing ice flow velocity and retreat rates for the largest ice stream draining the late-Devensian British-Irish Ice Sheet.

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    The Wicklow Trough is one of several Irish Sea bathymetric deeps, yet unusually isolated from the main depression, the Western Trough. Its formation has been described as proglacial or subglacial, linked to the Irish Sea Ice Stream (ISIS) during the Last Glacial Maximum. The evolution of the Wicklow Trough and neighbouring deeps, therefore, help us to understand ISIS dynamics, when it was the main ice stream draining the former British–Irish Ice Sheet. The morphology and sub-seabed stratigraphy of the 18 km long and 2 km wide Wicklow Trough is described here from new multibeam echo sounder data, 60 km of sparker seismic profiles and five sediment cores. At a maximum water depth of 82 m, the deep consists of four over deepened sections. The heterogeneous glacial sediments in the Trough overlay bedrock, with indications of flank mass-wasting and subglacial bedforms on its floor. The evidence strongly suggests that the Wicklow Trough is a tunnel valley formed by time-transgressive erosional processes, with pressurised meltwater as the dominant agent during gradual or slow ice sheet retreat. Its location may be fault-controlled, and the northern end of the Wicklow Trough could mark a transition from rapid to slow grounded ice margin retreat, which could be tested with modelling

    Trypanosoma brucei gambiense group 1 is distinguished by a unique amino acid substitution in the HpHb receptor implicated in human serum resistance

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    Trypanosoma brucei rhodesiense (Tbr) and T. b. gambiense (Tbg), causative agents of Human African Trypanosomiasis (sleeping sickness) in Africa, have evolved alternative mechanisms of resisting the activity of trypanosome lytic factors (TLFs), components of innate immunity in human serum that protect against infection by other African trypanosomes. In Tbr, lytic activity is suppressed by the Tbr-specific serum-resistance associated (SRA) protein. The mechanism in Tbg is less well understood but has been hypothesized to involve altered activity and expression of haptoglobin haemoglobin receptor (HpHbR). HpHbR has been shown to facilitate internalization of TLF-1 in T.b. brucei (Tbb), a member of the T. brucei species complex that is susceptible to human serum. By evaluating the genetic variability of HpHbR in a comprehensive geographical and taxonomic context, we show that a single substitution that replaces leucine with serine at position 210 is conserved in the most widespread form of Tbg (Tbg group 1) and not found in related taxa, which are either human serum susceptible (Tbb) or known to resist lysis via an alternative mechanism (Tbr and Tbg group 2). We hypothesize that this single substitution contributes to reduced uptake of TLF and thus may play a key role in conferring serum resistance to Tbg group 1. In contrast, similarity in HpHbR sequence among isolates of Tbg group 2 and Tbb/Tbr provides further evidence that human serum resistance in Tbg group 2 is likely independent of HpHbR functio

    The Influence of Living Near Roadways on Spirometry and Exhaled Nitric Oxide in Elementary Schoolchildren

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    BACKGROUND: Living near major roadways has been associated with an increase in respiratory symptoms, but little is known about how this relates to airway inflammation. OBJECTIVE: We assessed the effects of living near local residential roadways based on objective indicators of ventilatory function and airway inflammation. METHODS: We estimated ambient air pollution, resolved to the level of the child's neighborhood, using a land-use regression model for children 9-11 years of age. We also summed the length of roadways found within a 200-m radius of each child's neighborhood. We had measurements of both air pollution exposure and spirometry for 2,328 children, and also had measurements of exhaled nitric oxide (eNO) for 1,613 of these children. RESULTS: Each kilometer of local roadway within a 200-m radius of the home was associated with a 6.8% increase in eNO (p = 0.045). Each kilometer of any type of roadway (local, major, highway) was also associated with an increase in eNO of 10.1% (p = 0.002). Each microgram per cubic meter increase in PM2.5 was associated with a 3.9% increase in eNO (p = 0.058) and 0.70% decrease in forced vital capacity (FVC) expressed as a percentage of predicted (p = 0.39). Associations between roadway density and both forced expired volume in 1 sec and FVC were negative but not statistically significant at p < 0.05. CONCLUSION: Traffic from local neighborhood roadways may cause airway inflammation as indicated by eNO. This may be a more sensitive indicator of adverse air pollution effects than traditional measures of ventilatory function

    Correlations of Behavioral Deficits with Brain Pathology Assessed through Longitudinal MRI and Histopathology in the R6/2 Mouse Model of HD

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    Huntington's disease (HD) is caused by the expansion of a CAG repeat in the huntingtin (HTT) gene. The R6/2 mouse model of HD expresses a mutant version of exon 1 HTT and develops motor and cognitive impairments, a widespread huntingtin (HTT) aggregate pathology and brain atrophy. Despite the vast number of studies that have been performed on this model, the association between the molecular and cellular neuropathology with brain atrophy, and with the development of behavioral phenotypes remains poorly understood. In an attempt to link these factors, we have performed longitudinal assessments of behavior (rotarod, open field, passive avoidance) and of regional brain abnormalities determined through magnetic resonance imaging (MRI) (whole brain, striatum, cortex, hippocampus, corpus callosum), as well as an end-stage histological assessment. Detailed correlative analyses of these three measures were then performed. We found a gender-dependent emergence of motor impairments that was associated with an age-related loss of regional brain volumes. MRI measurements further indicated that there was no striatal atrophy, but rather a lack of striatal growth beyond 8 weeks of age. T2 relaxivity further indicated tissue-level changes within brain regions. Despite these dramatic motor and neuroanatomical abnormalities, R6/2 mice did not exhibit neuronal loss in the striatum or motor cortex, although there was a significant increase in neuronal density due to tissue atrophy. The deposition of the mutant HTT (mHTT) protein, the hallmark of HD molecular pathology, was widely distributed throughout the brain. End-stage histopathological assessments were not found to be as robustly correlated with the longitudinal measures of brain atrophy or motor impairments. In conclusion, modeling pre-manifest and early progression of the disease in more slowly progressing animal models will be key to establishing which changes are causally related. © 2013 Rattray et al

    Management of children’s fever by parents and caregivers: practical measurement of functional health literacy

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    Functional health literacy is founded on general and numerical literacy and practical skills and is required for the appropriate and effective management of health symptoms in children. This study aimed to assess the health literacy skills of parents and caregivers of preschool-aged children, using a progressive scenario describing a child with fever and presenting tasks relating to selection of a medicine and hypothetical dosing of their child. Participants (n ¼ 417) from 33 childcare- and health-related sites in Sydney, Brisbane, Melbourne and Auckland completed the study. Participants’ responses were largely appropriate regarding actions in response to worsening symptoms, selection of an appropriate product (from a limited range), whereby 84.5% of responses were for a single-ingredient paracetamol product and use of the package directions to state the frequency of dosing (93.1% of frequencies appropriate for paracetamol and 66.7% for ibuprofen). However, in only 50.8% of cases was an appropriate weight-based dose calculated, and doses were not measured to within 10% of the stated dose in 16.7% of cases. Future studies should focus on skill development via educational campaigns for parents and caregivers

    Lovelock theories, holography and the fate of the viscosity bound

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    We consider Lovelock theories of gravity in the context of AdS/CFT. We show that, for these theories, causality violation on a black hole background can occur well in the interior of the geometry, thus posing more stringent constraints than were previously found in the literature. Also, we find that instabilities of the geometry can appear for certain parameter values at any point in the geometry, as well in the bulk as close to the horizon. These new sources of causality violation and instability should be related to CFT features that do not depend on the UV behavior. They solve a puzzle found previously concerning unphysical negative values for the shear viscosity that are not ruled out solely by causality restrictions. We find that, contrary to previous expectations, causality violation is not always related to positivity of energy. Furthermore, we compute the bound for the shear viscosity to entropy density ratio of supersymmetric conformal field theories from d=4 till d=10 - i.e., up to quartic Lovelock theory -, and find that it behaves smoothly as a function of d. We propose an approximate formula that nicely fits these values and has a nice asymptotic behavior when d goes to infinity for any Lovelock gravity. We discuss in some detail the latter limit. We finally argue that it is possible to obtain increasingly lower values for the shear viscosity to entropy density ratio by the inclusion of more Lovelock terms.Comment: 42 pages, 17 figures, JHEP3.cls. v2: reference adde
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