A case series of IPOM-AS – intraperitoneal mesh fixation technique for ventral hernia using straight needle suture nylon 2–0

Intraperitoneal onlay mesh (IPOM) technique of mesh fixation using tackers for ventral hernia is widely done. But using tackers is costly (266.29 USD) and causes early and late post-operative pain. The aim of the study was to choose the better method of surgery for ventral hernia using composite mesh and straight needle suture nylon 2–0 for intraperitoneal mesh fixation (IPOM-AS) and will compare it with conventional IPOM technique in which Fixation of mesh is done by Tacker. Ten patients who were diagnosed with ventral hernia between November 2022 and December 2022 in the Department of Surgery, MGM Medical College and MY Hospital, Indore were taken in our study and IPOM-AS technique was performed using three ports on the left side of the abdomen, after reducing the contents of hernia, the axis for internal attachment of composite mesh is identified and marked with pair of sutures (vicryl and rapid vicryl) and intraperitoneal transabdominal fixation of mesh is done using straight needle suture nylon 2–0 with the help of suture passer. This technique was taken in our study and was assessed for cost-effectiveness, early and late post-operative pain, learning curve, early mobilization, early discharge, early return to work, and long-term complications. All the patients had less early and late post-operative pain according to VAS score (mean VAS score 2 on post-operative 1 and 1 on post-operative 2, no pain during the follow-up period), patients were discharged earlier (mostly on post-operative 1) and early return to work was possible and this technique of intraperitoneal mesh fixation using straight needle suture (2.03 USD) is more cost-effective when we compared these patients with those in whom conventional IPOM was done with the help of a tacker (266.29 USD). Good patient compliance was seen. IPOM using composite mesh and straight needle suture (IPOM-AS) for intraperitoneal mesh fixation in ventral hernia is better accepted by patients than the conventional IPOM using tacker for mesh fixation

Low Energy Loss of 0.57 eV and High Efficiency of 8.80% in Porphyrin-Based BHJ Solar Cells

A new A−π–D−π–A small molecule, denoted as <b>MV72</b>, has been designed and synthesized. The molecule comprises a Zn–porphyrin central donor unit and dicyanovinylene-substituted rhodanine (RhCN) end-capping acceptor units linked by bisthienylenevinylene groups as π-conjugated bridges. The optical and electrochemical properties of <b>MV72</b> have been investigated as an electron donor for solution-processed organic solar cells (OSCs), and the results were compared to those of <b>MV71</b>, which consists of the same molecular backbone but with different rhodanine end-capping acceptor units. The effects of the end-capping terminal units on the absorption spectra, molecular crystallinity, frontier molecular energy levels, charge transport properties, morphology of active layers, and photovoltaic performance have been investigated. The OSCs based on optimized active layers of <b>MV71</b>/PC₇₁BM and <b>MV72</b>/PC₇₁BM (donor and acceptor weight ratios and solvent vapor annealing) deliver overall power conversion efficiencies (PCEs) of 7.61% and a remarkable 8.80%, respectively. <b>MV72</b>/PC₇₁BM showed impressively low energy loss, with a value as low as 0.57 eV; accordingly, a high open-voltage (<i>V</i>_OC) of 0.88 V was achieved. The low energy loss in the <b>MV72</b>-based OSCs is related to the increased dipole moment change for <b>MV72</b>, which in turn results in low exciton binding energy

Mycophenolate and azathioprine efficacy in interstitial lung disease: a systematic review and meta-analysis

Objectives Mycophenolate mofetil (MMF) and azathioprine (AZA) are immunomodulatory treatments in interstitial lung disease (ILD). This systematic review aimed to evaluate the efficacy of MMF or AZA on pulmonary function in ILD.Design Population included any ILD diagnosis, intervention included MMF or AZA treatment, outcome was delta change from baseline in per cent predicted forced vital capacity (%FVC) and gas transfer (diffusion lung capacity of carbon monoxide, %DLco). The primary endpoint compared outcomes relative to placebo comparator, the secondary endpoint assessed outcomes in treated groups only.Eligibility criteria Randomised controlled trials (RCTs) and prospective observational studies were included. No language restrictions were applied. Retrospective studies and studies with high-dose concomitant steroids were excluded.Data synthesis The systematic search was performed on 9 May. Meta-analyses according to drug and outcome were specified with random effects, I2 evaluated heterogeneity and Grading of Recommendations, Assessment, Development and Evaluation evaluated certainty of evidence. Primary endpoint analysis was restricted to RCT design, secondary endpoint included subgroup analysis according to prospective observational or RCT design.Results A total of 2831 publications were screened, 12 were suitable for quantitative synthesis. Three MMF RCTs were included with no significant effect on the primary endpoints (%FVC 2.94, 95% CI −4.00 to 9.88, I2=79.3%; %DLco −2.03, 95% CI −4.38 to 0.32, I2=0.0%). An overall 2.03% change from baseline in %FVC (95% CI 0.65 to 3.42, I2=0.0%) was observed in MMF, and RCT subgroup summary estimated a 4.42% change from baseline in %DLCO (95% CI 2.05 to 6.79, I2=0.0%). AZA studies were limited. All estimates were considered very low certainty evidence.Conclusions There were limited RCTs of MMF or AZA and their benefit in ILD was of very low certainty. MMF may support preservation of pulmonary function, yet confidence in the effect was weak. To support high certainty evidence, RCTs should be designed to directly assess MMF efficacy in ILD.PROSPERO registration number CRD42023423223

Ofatumumab versus Teriflunomide in Multiple Sclerosis

BACKGROUND: Ofatumumab, a subcutaneous anti-CD20 monoclonal antibody, selectively depletes B cells. Teriflunomide, an oral inhibitor of pyrimidine synthesis, reduces T-cell and B-cell activation. The relative effects of these two drugs in patients with multiple sclerosis are not known. METHODS: In two double-blind, double-dummy, phase 3 trials, we randomly assigned patients with relapsing multiple sclerosis to receive subcutaneous ofatumumab (20 mg every 4 weeks after 20-mg loading doses at days 1, 7, and 14) or oral teriflunomide (14 mg daily) for up to 30 months. The primary end point was the annualized relapse rate. Secondary end points included disability worsening confirmed at 3 months or 6 months, disability improvement confirmed at 6 months, the number of gadolinium-enhancing lesions per T1-weighted magnetic resonance imaging (MRI) scan, the annualized rate of new or enlarging lesions on T2-weighted MRI, serum neurofilament light chain levels at month 3, and change in brain volume. RESULTS: Overall, 946 patients were assigned to receive ofatumumab and 936 to receive teriflunomide; the median follow-up was 1.6 years. The annualized relapse rates in the ofatumumab and teriflunomide groups were 0.11 and 0.22, respectively, in trial 1 (difference, -0.11; 95% confidence interval [CI], -0.16 to -0.06; P<0.001) and 0.10 and 0.25 in trial 2 (difference, -0.15; 95% CI, -0.20 to -0.09; P<0.001). In the pooled trials, the percentage of patients with disability worsening confirmed at 3 months was 10.9% with ofatumumab and 15.0% with teriflunomide (hazard ratio, 0.66; P = 0.002); the percentage with disability worsening confirmed at 6 months was 8.1% and 12.0%, respectively (hazard ratio, 0.68; P = 0.01); and the percentage with disability improvement confirmed at 6 months was 11.0% and 8.1% (hazard ratio, 1.35; P = 0.09). The number of gadolinium-enhancing lesions per T1-weighted MRI scan, the annualized rate of lesions on T2-weighted MRI, and serum neurofilament light chain levels, but not the change in brain volume, were in the same direction as the primary end point. Injection-related reactions occurred in 20.2% in the ofatumumab group and in 15.0% in the teriflunomide group (placebo injections). Serious infections occurred in 2.5% and 1.8% of the patients in the respective groups. CONCLUSIONS: Among patients with multiple sclerosis, ofatumumab was associated with lower annualized relapse rates than teriflunomide. (Funded by Novartis; ASCLEPIOS I and II ClinicalTrials.gov numbers, NCT02792218 and NCT02792231.)