Impact of Crural Relaxing Incisions, Collis Gastroplasty, and Non–Cross-linked Human Dermal Mesh Crural Reinforcement on Early Hiatal Hernia Recurrence Rates

BackgroundHernia recurrence is the leading form of failure after antireflux surgery and may be secondary to unrecognized tension on the crural repair or from a foreshortened esophagus. Mesh reinforcement has proven beneficial for repair of hernias at other sites, but the use of mesh at the hiatus remains controversial. The aim of this study was to evaluate the outcomes of hiatal hernia repair with human dermal mesh reinforcement of the crural closure in combination with tension reduction techniques when necessary.Study DesignWe retrospectively reviewed the records of all patients who had hiatal hernia repair using AlloMax Surgical Graft (Davol), a human dermal biologic mesh. Objective follow-up was with videoesophagram and/or upper endoscopy at 3 months postoperatively and annually.ResultsThere were 82 patients with a median age of 63 years. The majority of operations (85%) were laparoscopic primary repairs of a paraesophageal hernia with a fundoplication. The crura were closed primarily in all patients and reinforced with an AlloMax Surgical Graft. A crural relaxing incision was used in 12% and a Collis gastroplasty in 28% of patients. There was no mesh-related morbidity and no mortality. Median objective follow-up was 5 months, but 15 patients had follow-up at 1 or more years. A recurrent hernia was found in 3 patients (4%).ConclusionsTension-reducing techniques in combination with human biologic mesh crural reinforcement provide excellent early results with no mesh-related complications. Long-term follow-up will define the role of these techniques and this biologic mesh for hiatal hernia repair

Intra-rater reliability, measurement precision, and inter-test correlations of 1RM single-leg leg-press, knee-flexion, and knee-extension in uninjured adult agility-sport athletes: Considerations for right and left unilateral measurements in knee injury control

Objectives Knowledge of single-leg knee strength test reliability for the right and left limb is critical for between-limb clinical decision-making. Knowledge of between-test correlations is essential for understanding whether tests measure similar or different aspects of muscle strength. This study investigated the intra-rater, test-retest reliability and measurement precision of one repetition maximum (1RM) single-leg leg-press (LP), knee-flexion (KF), and knee-extension (KE) for both limbs, and inter-test correlations. Design Repeated measures; Setting University. Participants Six males, seven females (age 25.6±5.5yr; height 171.4±8.4cm; mass 71.8±13.4kg). Main outcome measures Normalised 1RM (percent body-mass (%BM)), intraclass correlation coefficient (ICC) (Avery, 1995; Rivara, 2003), standard error of measurement (SEM; %BM), Pearson's correlation (r), coefficient of determination (r2). Results Mean 1RM test-retest values were (right, left): LP, 214.2–218.5%BM, 213.5–215.4%BM; KF, 35.9–38.9%BM, 37.7–38.2%BM; KE, 43.3–44.6%BM, 36.2–39.3%BM. The ICCs/SEMs were (right, left): LP, 0.98/7.3%BM, 0.94/14.2%BM; KF, 0.75/4.9%BM, 0.95/1.9%BM; KE, 0.87/3.4%BM, 0.78/4.4%BM. Correlations were significant (P < 0.01), r/r2 values were: LP-KF, 0.60/0.36; LP-KE, 0.59/0.35; KF-KE, 0.50/0.25. Conclusions Tests demonstrated good reliability and measurement precision, although ICCs and SEMs were different between limbs. Tests were correlated, but only one-third of the variance was shared between tests. Practitioners should be cognisant of between-limb differences in reliability and include all tests for knee clinical decision-making

Proceedings of the Eighth Annual Deep Brain Stimulation Think Tank: Advances in Optogenetics, Ethical Issues Affecting DBS Research, Neuromodulatory Approaches for Depression, Adaptive Neurostimulation, and Emerging DBS Technologies

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank

Inflammatory biomarkers in Alzheimer's disease plasma

Introduction:Plasma biomarkers for Alzheimer’s disease (AD) diagnosis/stratification are a“Holy Grail” of AD research and intensively sought; however, there are no well-established plasmamarkers.Methods:A hypothesis-led plasma biomarker search was conducted in the context of internationalmulticenter studies. The discovery phase measured 53 inflammatory proteins in elderly control (CTL;259), mild cognitive impairment (MCI; 199), and AD (262) subjects from AddNeuroMed.Results:Ten analytes showed significant intergroup differences. Logistic regression identified five(FB, FH, sCR1, MCP-1, eotaxin-1) that, age/APOε4 adjusted, optimally differentiated AD andCTL (AUC: 0.79), and three (sCR1, MCP-1, eotaxin-1) that optimally differentiated AD and MCI(AUC: 0.74). These models replicated in an independent cohort (EMIF; AUC 0.81 and 0.67). Twoanalytes (FB, FH) plus age predicted MCI progression to AD (AUC: 0.71).Discussion:Plasma markers of inflammation and complement dysregulation support diagnosis andoutcome prediction in AD and MCI. Further replication is needed before clinical translatio

Robotic Left Upper Lobectomy

<p>Interest and access to robot thoracic surgery has increased over the last decade. This increased interest from surgeons, hospitals, and patients has led many surgeons to transition from their standard practice of open or thoracoscopic lobectomy to robotic lobectomy. High-volume robotic programs have shown a decrease in the length of hospital stay, 30-day mortality, and postoperative transfusion requirements when lung resection is performed with the robotic technique compared to video-assisted thoracoscopic surgery and thoracotomy (1).<br></p> <p>This video demonstrates a robotic left upper lobectomy. The patient was a 73-year-old woman who was found to have a 12 mm left upper lobe nodule on a screening computed tomography scan. Positron emission tomography demonstrated mild hypermetabolic activity. She was asymptomatic, and she was able to walk one mile and climb two flights of stairs. Her medical history included hypertension and chronic obstructive pulmonary disease, and she had a 10 pack-year history of smoking. The results of her pulmonary function tests were adequate.</p><p>She was taken for a left upper lobe wedge resection, and the frozen section confirmed adenocarcinoma. She then had a completion robotic lobectomy with mediastinal lymph node dissection of stations 5, 6, 7, and L9. At the completion of the procedure, an intercostal nerve block was performed and a 28 Fr chest tube was placed. The chest tube was subsequently removed, and the patient was sent home on postoperative day two. The final pathology revealed a 1.2 cm moderately differentiated adenocarcinoma, with zero out of eight lymph nodes positive for malignancy, stage T1aN0M0 IA. The robotic technique provides excellent exposure and visualization, and it allows for a complete oncologic resection. </p> <p> </p> <p><b>Reference</b></p> <p>1. Farivar AS, Cerfolio RJ, Vallieres E, et al. Comparing robotic lung resection with thoracotomy and video-assisted thoracoscopic surgery cases entered into the Society of Thoracic Surgeons Database. <i><a href="https://doi.org/10.1097/IMI.0000000000000043">Innovations. 2014;9(1):10-15</a></i>.</p

Patterns of SATB2 and p16 reactivity aid in the distinction of atypical polypoid adenomyoma from myoinvasive endometrioid carcinoma and benign adenomyomatous polyp on endometrial sampling

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168344/1/his14338_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168344/2/his14338.pd

Patterns of SATB2 and p16 reactivity aid in the distinction of atypical polypoid adenomyoma from myoinvasive endometrioid carcinoma and benign adenomyomatous polyp on endometrial sampling

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168344/1/his14338_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168344/2/his14338.pd