Left hepatic lobe herniation through an incisional anterior abdominal wall hernia and right adrenal myelolipoma: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Herniation of the liver through an anterior abdominal wall hernia defect is rare. To the best of our knowledge, only three cases have been described in the literature.</p> <p>Case presentation</p> <p>A 70-year-old Mexican woman presented with a one-week history of right upper quadrant abdominal pain, nausea, vomiting, and jaundice to our Department of General Surgery. Her medical history included an open cholecystectomy from 20 years earlier and excessive weight. She presented with jaundice, abdominal distension with a midline surgical scar, right upper quadrant tenderness, and a large midline abdominal wall defect with dullness upon percussion and protrusion of a large, tender, and firm mass. The results of laboratory tests were suggestive of cholestasis. Ultrasound revealed choledocholithiasis. A computed tomography scan showed a protrusion of the left hepatic lobe through the anterior abdominal wall defect and a well-defined, soft tissue density lesion in the right adrenal topography. An endoscopic common bile duct stone extraction was unsuccessful. During surgery, the right adrenal tumor was resected first. The hernia was approached through a median supraumbilical incision; the totality of the left lobe was protruding through the abdominal wall defect, and once the lobe was reduced to its normal position, a common bile duct surgical exploration with multiple stone extraction was performed. Finally, the abdominal wall was reconstructed. Histopathology revealed an adrenal myelolipoma. Six months after the operation, our patient remains in good health.</p> <p>Conclusions</p> <p>The case of liver herniation through an incisional anterior abdominal wall hernia in this report represents, to the best of our knowledge, the fourth such case reported in the literature. The rarity of this medical entity makes it almost impossible to specifically describe predisposing risk factors for liver herniation. Obesity, the right adrenal myelolipoma mass effect, and the previous abdominal surgery are likely to have contributed to incisional hernia formation.</p

Ciencia abierta en España 2023: informe de situación y análisis de la percepción

Proyecto RTI2018-094360-B-I00Durante el período 2019-2022, en el marco del proyecto Ciencia abierta en España (RTI2018-094360-B-I00), nuestro grupo de investigación ha analizado la percepción de la ciencia abierta y de sus elementos componentes (acceso abierto, datos abiertos, revisión abierta, modelos de evaluación) por parte de los agentes implicados en el sistema de investigación (autores, editores de revistas, vicerrectores y profesionales de bibliotecas). En primer lugar, llevamos a cabo una aproximación cualitativa a la percepción de las barreras y los elementos favorecedores de la ciencia abierta mediante un conjunto de entrevistas y un grupo de discusión a dichos agentes (González- Teruel, A. et al. 2022). En total se realizaron 23 entrevistas: editores de revistas científicas universitarias (9 entrevistas), investigadores (9), vicerrectores (3), y responsables de agencias de evaluación (2) y un focus group en el cual participaron ocho profesionales de bibliotecas universitariasA partir de aquí, realizamos una aproximación cualitativa y cuantitativa mediante encuestas aplicadas a estos mismos agentes y centradas en su percepción sobre la situación respecto del acceso abierto, los datos abiertos, la revisión abierta, los modelos de evaluación y la ciencia abierta en general. Se han publicado los resultados referentes a los vicerrectores (Abad-García, et al., 2022), los editores de revistas científicas (Melero et al., 2023), el personal de bibliotecas (Santos-Hermosa y Boté-Vericad, 2023) y está pendiente de publicación el estudio con las opiniones de los autores (Ollé et al., 2023).El objetivo general de este informe consiste en describir el grado de desarrollo de la ciencia abierta en España en 2023 y también la percepción de los principales agentes implicados (investigadores, editores de revistas científicas, vicerrectores, directores de agencias de evaluación, profesionales de bibliotecas) sobre las barreras y los elementos favorecedores de la ciencia abierta en general y de sus principales componentes (acceso abierto, datos abiertos, revisión abierta, evaluación de la ciencia), en particular.El documento se estructura en tres grandes apartados, que se refieren a los principales componentes de la ciencia abierta: acceso abierto, datos de investigación y evaluación de la ciencia. Para cada uno de ellos, se lleva a cabo un repaso de los aspectos legales y las políticas de promoción, una descripción de los avances en lo que respecta a contenidos (publicaciones, repositorios, etc.) y se acompaña de un análisis de la percepción de los investigadores, editores, bibliotecarios y vicerrectores respecto de las barreras y elementos favorecedores para impulsar la apertura de las publicaciones, de los datos abiertos y de nuevos modelos de evaluación científica. Finalmente se incluye un apartado dedicado a la percepción de la ciencia abierta en general

A novel long non-coding RNA connects obesity to impaired adipocyte function

Background Long non-coding RNAs (lncRNAs) can perform tasks of key relevance in fat cells, contributing, when defective, to the burden of obesity and its sequelae. Here, scrutiny of adipose tissue transcriptomes before and after bariatric surgery (GSE53378) granted identification of 496 lncRNAs linked to the obese phenotype. Only expression of linc-GALNTL6-4 displayed an average recovery over 2-fold and FDR-adjusted p-value <0.0001 after weight loss. The aim of the present study was to investigate the impact on adipocyte function and potential clinical value of impaired adipose linc-GALNTL6-4 in obese subjects. Methods We employed transcriptomic analysis of public dataset GSE199063, and cross validations in two large transversal cohorts to report evidence of a previously unknown association of adipose linc-GALNTL6-4 with obesity. We then performed functional analyses in human adipocyte cultures, genome-wide transcriptomics, and untargeted lipidomics in cell models of loss and gain of function to explore the molecular implications of its associations with obesity and weight loss. Results The expression of linc-GALNTL6-4 in human adipose tissue is adipocyte-specific and co-segregates with obesity, being normalized upon weight loss. This co-segregation is demonstrated in two longitudinal weight loss studies and two cross-sectional samples. While compromised expression of linc-GALNTL6-4 in obese subjects is primarily due to the inflammatory component in the context of obesity, adipogenesis requires the transcriptional upregulation of linc-GALNTL6-4, the expression of which reaches an apex in terminally differentiated adipocytes. Functionally, we demonstrated that the knockdown of linc-GALNTL6-4 impairs adipogenesis, induces alterations in the lipidome, and leads to the downregulation of genes related to cell cycle, while propelling in adipocytes inflammation, impaired fatty acid metabolism, and altered gene expression patterns, including that of apolipoprotein C1 (APOC1). Conversely, the genetic gain of linc-GALNTL6-4 ameliorated differentiation and adipocyte phenotype, putatively by constraining APOC1, also contributing to the metabolism of triglycerides in adipose. Conclusions Current data unveil the unforeseen connection of adipocyte-specific linc-GALNTL6-4 as a modulator of lipid homeostasis challenged by excessive body weight and meta-inflammation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Hyperbolic Bloch points in ferrimagnetic exchange spring

Bloch points in magnetic materials are attractive entities in view of magnetic information transport. Here, Bloch point configuration has been investigated and experimentally determined in a magnetic trilayer (Gd12Co88/Nd17Co83/Gd24Co76) with carefully adjusted composition within the ferrimagnetic GdxCo1-x alloys in order to engineer saturation magnetization, exchange length, and interlayer couplings (ferromagnetic vs antiferromagnetic). X-ray vector magnetic tomography has allowed us to determine experimentally Bloch point polarity (related to topological charge) and Bloch point helicity γ (determined by magnetostatic energy). At the bottom layer (close to the ferromagnetic interface), Bloch points adopt a standard circulating configuration with helicity γ close to π/2. Within the top layer (with much lower saturation magnetization), Bloch points nucleate within a Neel-like exchange spring domain wall created by the antiferromagnetic coupling and adopt an uncommon hyperbolic configuration, characterized by much larger helicity angles. Our results indicate a path for Bloch point engineering in future applications adjusting material parameters and domain wall characteristics

Breast cancer 1 (BrCa1) may be behind decreased lipogenesis in adipose tissue from obese subjects.

Journal Article; Research Support, Non-U.S. Gov't;CONTEXT Expression and activity of the main lipogenic enzymes is paradoxically decreased in obesity, but the mechanisms behind these findings are poorly known. Breast Cancer 1 (BrCa1) interacts with acetyl-CoA carboxylase (ACC) reducing the rate of fatty acid biosynthesis. In this study, we aimed to evaluate BrCa1 in human adipose tissue according to obesity and insulin resistance, and in vitro cultured adipocytes. RESEARCH DESIGN AND METHODS BrCa1 gene expression, total and phosphorylated (P-) BrCa1, and ACC were analyzed in adipose tissue samples obtained from a total sample of 133 subjects. BrCa1 expression was also evaluated during in vitro differentiation of human adipocytes and 3T3-L1 cells. RESULTS BrCa1 gene expression was significantly up-regulated in both omental (OM; 1.36-fold, p = 0.002) and subcutaneous (SC; 1.49-fold, p = 0.001) adipose tissue from obese subjects. In parallel with increased BrCa1 mRNA, P-ACC was also up-regulated in SC (p = 0.007) as well as in OM (p = 0.010) fat from obese subjects. Consistent with its role limiting fatty acid biosynthesis, both BrCa1 mRNA (3.5-fold, p<0.0001) and protein (1.2-fold, p = 0.001) were increased in pre-adipocytes, and decreased during in vitro adipogenesis, while P-ACC decreased during differentiation of human adipocytes (p = 0.005) allowing lipid biosynthesis. Interestingly, BrCa1 gene expression in mature adipocytes was restored by inflammatory stimuli (macrophage conditioned medium), whereas lipogenic genes significantly decreased. CONCLUSIONS The specular findings of BrCa1 and lipogenic enzymes in adipose tissue and adipocytes reported here suggest that BrCa1 might help to control fatty acid biosynthesis in adipocytes and adipose tissue from obese subjects.This work was supported by research grants from the Ministerio de Educación y Ciencia (SAF2008-02073 and SAF2009-10461), the Fundación Mutua Madrileña, and the Instituto de Salud Carlos III (ISCIIIRETIC RD06, CIBERObN)Ye

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)