Transinguinal preperitoneal repair of giant inguinoscrotal hernias using Kugel mesh

INTRODUCTION

Giant inguinoscrotal hernias are rarely encountered in clinical settings, and their repair is technically challenging. The aim of this study is to evaluate the efficacy of transinguinal preperitoneal repair (TIPP) of giant inguinoscrotal hernias using Kugel mesh.

METHODS

A retrospective analysis was conducted on 9 patients with 11 giant inguinoscrotal hernias who underwent TIPP repair using Kugel mesh between December 2008 and January 2019. Demographics and perioperative and postoperative data were collected, and the operative experience was summarized.

RESULTS

The patients underwent a successful repair procedure with simultaneous omentectomy but without resection of the other abdominal organs. The median operation time was 120min, the median intraoperative blood loss was 75mL and the median defect area was 72 cm². The median duration for diet restoration was 4 days, and the median postoperative hospital stay was 6 days. The drainage tube placed in the preperitoneal space was removed after a median duration of 5 days, and the drainage tube placed in the distal hernia sac was removed after a median duration of 6 days. Three patients suffered from a postoperative increase in intra-abdominal pressure, while one patient deteriorated into abdominal compartment syndrome accompanied by respiratory dysfunction. No haematomas, seromas, incisional or mesh infections, recurrence or chronic pain occurred during the follow-up period.

CONCLUSIONS

TIPP repair using Kugel mesh is a feasible and effective method for giant inguinoscrotal hernias.

Handgrip Strength and Timed Up-and-Go (TUG) Test are Predictors of Short-Term Mortality among Elderly in a Population-Based Cohort in Singapore

OBJECTIVES

Asian studies on how physical tests predict short-term mortality in elderly are scarce. We assessed handgrip strength and timed-up-and-go (TUG) as such predictors among elderly Chinese in Singapore.

DESIGN

Prospective cohort study.

SETTING

Community-dwelling Chinese elderly in Singapore.

PARTICIPANTS

We used data from 13,789 subjects in the prospective, population-based Singapore Chinese Health Study, who had a mean age of 74 (range 63 to 97) years at time of measurements.

MEASUREMENTS

Subjects underwent assessment for handgrip strength and TUG. They were followed for mortality via linkage with nationwide death registry through 2018.

RESULTS

In multivariable analyses, handgrip strength was inversely associated with risk of mortality in a dose-dependent manner: the hazard ratio (HR) [95% confidence interval (CI)] comparing extreme quartiles was 2.05 (1.44-2.90) (Ptrend<0.001). TUG was positively associated with mortality in a stepwise manner: the HR (95% CI) comparing extreme quartiles was 3.08 (2.17-4.38) (Ptrend<0.001). Compared to those with stronger handgrip and faster TUG, participants who either had weaker handgrip or slower TUG had a significant 1.59 to 2.11 fold increase in risk of mortality; while the HR (95% CI) for those who had both weaker handgrip and slower TUG was 3.93 (3.06-5.05). In time-dependent receiver operating characteristic curves, adding handgrip strength and TUG time to a Cox model containing sociodemographic and lifestyle factors, comorbidities, and body measurements significantly improved the area under the curve for the prediction of mortality from 0.5 to 2 years (P≤0.001).

CONCLUSION

Among elderly in a Chinese population, handgrip strength and TUG test were strong and independent predictors of short-term mortality.

Prevalence and Risk Factors Governing the Loss of Muscle Function in Elderly Sarcopenia Patients: A longitudinal Study in China with 4 Years of Follow-Up

OBJECTIVES

Data regarding the occurrence of risk factors that promote the loss of muscle mass, strength and function in sarcopenia patients in elderly Chinese patients are sparse. Here, we investigated the alterations in muscle mass, function and strength in those with sarcopenia over a 4-year period. We further evaluated the risk factors leading to a loss of grip strength, gait speed and skeletal muscle mass index in sarcopenia patients.

DESIGN

A face-to-face cross-sectional survey.

SETTING AND PARTICIPANTS

The study population consisted of 560 Chinese aged over 59 years.

MEASUREMENTS

Study recordings took places over a four-year period from 2014. Muscle mass was assessed through bioelectrical impedance analysis (BIA) performed on an Inbody720, Biospace. Hand-grip strength and 6 m walking speed were used as measurements of muscle strength and function. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria (AWGS).

RESULTS

In total, 474 of the elderly residents completed the follow-up. The rates of decreased ASMI, grip strength, and gait speed in the sarcopenia patients increased over the 4-year period. Following multivariate analysis, age was identified as the main risk factor for all the observed decrease, gender was specifically related to the loss of ASMI, stroke was a risk factor for gait speed and sarcopenia. A high BMI was a risk factor for a low gait speed but was protective for a loss of skeletal muscle mass and sarcopenia.

CONCLUSIONS

Age leads to a decline in muscle strength and function. In elderly Chinese patients with sarcopenia, the rates of reduced grip strength, gait-speed and sarcopenia increased. A high BMI was protective against the decline in muscle mass and sarcopenia, but represented a risk factor for low gait speed. Stoke was identified to cause a loss of gait speed in sarcopenia patients.

CKB1 regulates expression of ribosomal protein L10 family gene and plays a role in UV-B response

Plastid casein kinase 2 (CK2), which is a major Ser/Thr-specific enzyme in higher organisms, plays an essential role in plant development and diverse abiotic stresses. CKB1 is a regulatory subunit beta of CK2. To expand our understand of functions of the CKB1 gene in Arabidopsis thaliana, protein changes among wild-type (WT) and CKB1 gain- and loss-of-function mutants were compared. Proteins extracted from the CKB1 knockout mutant and overexpressing mutant were compared with Col-0 plants using 2D-PAGE. Proteins regulated by CKB1 were identified with matrix-assisted laser desorption ionisation time-of-flight/time-of-flight mass spectrometry (MALDI-TOF/TOF), and its transcript was verified by qRT-PCR. Bioinformatics analysis, including gene ontology and protein-protein interaction analysis, were employed. The results of mass spectra and bioinformatics analysis suggest that CKB1 may have functions in regulation of the ribosomal protein L10 (RPL10) family and is involved in ultraviolet-B (UV-B) response. Furthermore, qRT-PCR verification showed CKB1 expression was up-regulated by UV-B stress. The expression levels of five genes in the RPL10 family were reduced in the ckb1 T-DNA insertion mutants, whereas they increased in the CKB1 overexpressing mutants under both normal conditions and UV-B treatment. In conclusion, CKB1 has important functions in UV-B radiation stress. Our study implies that CKB1 positively regulates UV-B radiation stress signalling, possibly through modulating expression of the RPL10 family.

Adjuvant sunitinib in patients with high-risk renal cell carcinoma: safety, therapy management, and patient-reported outcomes in the S-TRAC trial

Background

Adjuvant sunitinib has significantly improved disease-free survival versus placebo in patients with renal cell carcinoma at high risk of recurrence post-nephrectomy (hazard ratio 0.76; 95% confidence interval, 0.59–0.98; two-sided P = 0.03). We report safety, therapy management, and patient-reported outcomes for patients receiving sunitinib and placebo in the S-TRAC trial.

Patients and methods

Patients were stratified by the University of California, Los Angeles Integrated Staging System and Eastern Cooperative Oncology Group performance status score, and randomized (1 : 1) to receive sunitinib (50 mg/day) or placebo. Single dose reductions to 37.5 mg, dose delays, and dose interruptions were used to manage adverse events (AEs). Patients’ health-related quality of life, including key symptoms typically associated with sunitinib, were evaluated with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

Results

Patients maintained treatment for 9.5 (mean, SD 4.4) and 10.3 (mean, SD 3.7) months in the sunitinib and placebo arms, respectively. In the sunitinib arm, key AEs occurred ∼1 month (median) after start of treatment and resolved within ∼3.5 weeks (median). Many (40.6%) AEs leading to permanent discontinuation were grade 1/2, and most (87.2%) resolved or were resolving by 28 days after last treatment. Patients taking sunitinib showed a significantly lower EORTC QLQ-C30 overall health status score versus placebo, although this reduction was not clinically meaningful. Patients reported symptoms typically related to sunitinib treatment with diarrhea and loss of appetite showing clinically meaningful increases.

Conclusions

In S-TRAC, AEs were predictable, manageable, and reversible via dose interruptions, dose reductions, and/or standard supportive medical therapy. Patients on sunitinib did report increased symptoms and reduced HRQoL, but these changes were generally not clinically meaningful, apart from appetite loss and diarrhea, and were expected in the context of known sunitinib effects.

Clinical trial registration

ClinicalTrials.gov, NCT00375674.

[Spatial distribution of cancer-related burden in Guangzhou from 2010 to 2013]

Objective: To evaluate the burden and to describe the characteristics of spatial distribution caused by malignant tumors among different administrative areas in Guangzhou from 2010- 2013. Methods: Based on data from the Cancer Registry system and population in Guangzhou in 2010- 2013, disability-adjusted life year (DALY) was assessed on the disease burden of cancer, in accordance with the method used in the Global Burden of Disease study. Results: The crude incidence rates of cancer appeared as 256.22/10(5) in 2010-2011 and 270.04/10(5) in 2012-2013, with the crude mortality rates as 143.17/10(5) and 148.01/10(5), respectively, in Guangzhou. Cancers caused 606 238.95 DALYs in 2010-2011 and 623 763.80 DALYs in 2012-2013 for both sexes and 37.63 and 37.81 person year per 1 000 persons, with the standardized DALY rates as 34.51‰, 34.00‰ respectively. Three administrative districts (Yuexiu, Haizhu and Liwan) were with the largest disease burden of cancers that accounted for 45% of the DALYs for the whole Conghua district, with liver cancer was the leading cancer on DALYs, and tracheal, bronchus and lung cancer ranked the first in the other districts. Conclusions: In Guangzhou, disease burden caused by cancers was both prominently seen in the newly developed urban area and the old districts. It remains an arduous task to continue programs on control and prevention of cancers in this city.

[The study of AAV9 expression in cochleae of mice at different ages]

Objective: To determine the extent of transfection and expression of adeno-associated virus (AAV) serotype 9 (AAV9) in the cochleae of mice at different ages. Methods: AAV9-green fluorescent protein (GFP) was inoculated into the cochlea of mice via the round window membrane (RWM) or through cochleostomy at different ages. Four groups were divided according to ages and injection sites: P1SM group, AAV9-GFP was delivered to the scala media by cochleostomy at postnatal day 1; P1RW group, AAV9-GFP was delivered to the scala tympani via RWM at postnatal day 1; P9RW group: AAV9-GFP was injected through RWM at postnatal day 9; and P30RW group, adult mice (P30) were injected through RWM. GFP expression in cochlear whole mount was analyzed and auditory brainstem response (ABR) tests were conducted one month after virus injection (for each animal, only left cochlea was injected and the right side was used as a control). GraphPad Prism 5 statistical software was used for data analysis. Results: All of inner hair cells (IHCs) and most of outer hair cells (OHCs) were transfected via two approaches at P1 injection. There was no significant difference in ABR threshold between injected ears and untreated ears (P>0.05). All of the IHCs and parts of OHCs (69% in apical turn) were transfected via RWM at P9. The strongest GFP expression was observed near the apical turn. Cochlear inoculation via RWM at P30 led to transgene expression in only IHCs. The ABR threshold of injected ears in P9RW group and P30RW group was significantly higher than that of contralateral ears (P<0.01). Conclusions: AAV9 can be highly expressed in the inner and outer hair cells of the cochlea and hearing sensitivity can be preserved if virus injections are performed in neonatal mice. After AAV9 is transfected into the inner ear of adult mice, it is only expressed in the inner hair cells, which leads to the increase of the ABR response threshold of mice. Transfection efficiency is significant higher in neonate mice than in P9 and adult mice.

4965Non-transcriptional disruption of Ca2+i homeostasis and Cx43 function in the right ventricle precedes overt arrhythmogenic cardiomyopathy in PKP2-deficient mice

Background

Plakophilin-2 (PKP2) is classically defined as a protein of the desmosome, an intercellular adhesion structure that also acts as a signaling hub to maintain structural and electrical homeostasis. Mutations in PKP2 associate with most cases of gene-positive arrhythmogenic right ventricular cardiomyopathy (ARVC). A better understanding of PKP2 cardiac biology can help elucidate the mechanisms underlying arrhythmic and cardiomyopathic events that occur consequent to its mutation. Here we sought to captureearly molecular/cellular events that can act as nascent substrates for subsequent arrhythmic/cardiomyopathic phenotypes.

Methods

We used multiple quantitative imaging modalities, as well as biochemical and high-resolution mass spectrometry methods to study the functional/structural properties of cells/tissues derived from cardiomyocyte-specific, tamoxifen-activated, PKP2 knockout mice (“PKP2cKO”). Studies were carried out 14 days post-tamoxifen injection, a time point preceding an overt electrical or structural phenotype.Myocytes from right or left ventricular free wall were studied separately, to detect functional/structural asymmetries.

Results

Most properties of PKP2cKO left ventricular (LV) myocytes were not different from control; in contrast, PKP2cKO right ventricular (RV) myocytes showed increased amplitude and duration of Ca2+transients, increased frequency of spontaneous Ca2+release events, increased [Ca2+] in the cytoplasm and sarcoplasmic reticulum compartments, and dynamic Ca2+accumulation in mitochondria. In addition, RyR2 in RV presented enhanced sensitivity to Ca2+and preferential phosphorylation in a domain known to modulate Ca2+gating. RNAseq at 14 days post-TAM showed no relevant difference in transcript abundance between RV and LV, neither in control nor in PKP2cKO cells, suggesting that in the earliest stage, [Ca2+]i dysfunction is not transcriptional. Rather, we found an RV-predominant increase in membrane permeability that can permit Ca2+entry into the cell. Cx43 ablation mitigated the increase in membrane permeability, the accumulation of cytoplasmic Ca2+and the early stages of RV dysfunction.

Conclusions

Loss of PKP2 creates an RV-predominant arrhythmogenic substrate (Ca2+ dysregulation) that precedes the cardiomyopathy and that is, at least in part, mediated by a Cx43-dependent membrane conduit. Given that asymmetric Ca2+ dysregulation precedes the cardiomyopathic stage, we speculate that abnormal Ca2+ handling in RV myocytes can be a trigger for gross structural changes observed at a later stage.

A comparative assessment of three planes of implant placement in breast augmentation: A Bayesian analysis

BACKGROUND

Techniques based on three planes of implant placement, including the subglandular (SG), subpectoral (SP), and subfascial (SF) planes are used for breast augmentation. The placement that offers the greatest balance of risks and benefits is unclear. This study presents a systematic review with a Bayesian network meta-analysis to compare different implant placement techniques for augmentation mammaplasty.

METHODS

A systematic literature search was performed. We estimated the odds ratios (ORs) for capsular contractures, hematomas, seromas, infections, reoperation rates, rippling, nipple numbness, malplacements, ruptures, and asymmetry among the different interventions. Muscle movement events and satisfaction rates were also evaluated.

RESULTS

A total of 19 studies (25,744 cases) were included. SG placement significantly increased the incidence of capsular contractures (SP vs. SG: OR 0.42; 95% credible interval [CrI] 0.28-0.63; SF vs. SG: OR 0.41; 95% CrI 0.17-0.97), hematomas (SF vs. SG: OR 0.22; 95% CrI 0.06-0.63), and seromas (SF vs. SG: OR 0.04; 95% CrI 0.00-0.81) compared to other placement techniques. Muscle movement only occurred in the SP group, but it did not increase the risk of subsequent malplacements, asymmetries, or ruptures. Most patients were highly satisfied with their surgical results. Comparisons did not show significant differences in the remaining results.

CONCLUSIONS

Our evidence suggests that SG placement increases the risk of capsular contractures, hematomas, and seromas. The SP and SF planes were safe and effective for controlling total complication rates and achieving high satisfaction rates; however, the long-term benefits of the SF technique require further research.

Optimization of Dietary Zinc Requirement for Broiler Breeder Hens of Chinese Yellow-Feathered Chicken

Simple Summary

China is the second-largest global producer of chicken meat, almost half of which is from the Chinese yellow-feathered breed; a systematic program has been initiated to improve its feeding standards. This study evaluated the optimal requirement of dietary zinc for maximal egg production, egg quality, tibial quality, and antioxidant indices of laying broiler breeders. The results revealed several beneficial effects of supplementary zinc on egg production, feed conversion ratio, yolk zinc content, tibial quality and the antioxidant indices in the serum, liver and ovary. The optimal zinc requirement was estimated based on a regression model.

Abstract

This study aimed to establish the optimal dietary zinc requirement of Chinese yellow-feathered Lingnan broiler breeders. A total of 576 breeder hens aged 58 weeks were randomly assigned to six treatments, each with 6 replicates of 16 birds (n = 96/treatment). The hens were fed either a basal diet (22.81 mg/kg Zn) or the same basal diet supplemented with additional 24, 48, 72, 96, and 120 mg Zn/kg up to 65 weeks of age. Compared to the results of birds fed the basal diet (22.81 mg Zn/kg), the dietary supplementation with additional Zn (mg/kg) showed higher egg laying rate (at 48–120 mg), EM (at 96 mg/kg), yolk Zn content (at 24–120 mg/kg), fertility (at 48–120 mg/kg), hatchability (at 48–96 mg/kg), tibial breaking strength (at 24–48 mg/kg), tibial ash content (at 48 mg/kg), serum CuZnSOD activity (at 72 mg/kg) and T-AOC (at 48 mg/kg), and ovarian CuZnSOD and GSH-Px activities (at 96–120 mg/kg), and lower FCR (at 96 mg/kg). The regression model showed that the optimal supplemental Zn for maximal egg laying rate, yolk Zn content, fertility, and hatchability of Chinese yellow-feathered broiler breeders aged 58 to 65 weeks were 71.09, 92.34, 94.44 and 98.65 mg/kg diet, respectively.

Impacts of Graded Levels of Metabolizable Energy on Growth Performance and Carcass Characteristics of Slow-Growing Yellow-Feathered Male Chickens

A dose-response study was conducted to investigate the metabolizable energy (ME) requirement for Lingnan chickens from 9 to 15 weeks of age. One thousand two hundred 8-week-old slow-growing yellow-feathered male chickens were allotted to five dietary ME levels (2805, 2897, 2997, 3095 and 3236 kcal/kg). The results revealed that the daily metabolizable energy intake increased (p < 0.01), whereas the feed intake and feed:gain ratio decreased linearly (p < 0.01) with the increment in dietary ME level. The final body weight and daily gain of the highest ME treatment tended (p > 0.05) to be greater than those obtained with the lower ME levels. The fat content in breast muscle showed a quadratic response (p < 0.05) to the increase in dietary energy level. The shear force values of breast muscle in the 2897, 3095 and 3236 kcal/kg treatments were lower (p < 0.05) than those of the 2997 kcal/kg treatment. In conclusion, among the tested ME levels, 3095 kcal/kg was adequate for feed intake, shear force, and plasma uric acid, and 3236 kcal/kg tended to increase the body weight, body gain, and feed conversion ratio of Lingnan males between 9 and 15 weeks of age; further studies are still required for testing higher levels.

[Method for developing mouse model of endometrios is based on estrogen-releasing thermo-sensitive hydrogel system]

Objective: This study will explore and optimize the conditions for the construction of the mouse model of endometriosis using the estrogen-releasing thermo-sensitive hydrogel system. Methods: (1) The mice were injected subcutaneously with a gradient concentration of estrogen-releasing thermo-sensitive hydrogel systems, and the blood estrogen concentration was measured 3 days later. And then we draw the curve between mouse blood estrogen concentration and thermo-sensitive hydrogel systems concentration, selecting the most appropriate concentration of estrogen-releasing thermo-sensitive hydrogel systems. (2) To explore the release pattern of estrogen-releasing thermo-sensitive hydrogel system, the mice were injected subcutaneously with the optimal concentration of estrogen-releasing thermo-sensitive hydrogel system, and the blood estrogen concentration was measured on the 1st, 3rd, 5th, 7th and 10th day respectively. (3) We transplanted uteruses from donor mice into the abdominal cavities of recipient mice. The recipient mice were divided into three groups named a, b, and c. Group a was intraperitoneally injected with PBS everyday after transplantation, and group b was intraperitoneally injected with estrogen solution everyday after transplantation. And estrogen-releasing thermo-sensitive hydrogel systems mentioned above were injected subcutaneously to group c once a week. Mice were killed 21 days later to observe the success rate of the endometriosis models. Results: (1) The concentration of estrogen in mice was linear with the concentration of estrogenin the estrogen-releasing thermo-sensitive hydrogel systems. And 0.8 mg/ml was the most appropriate concentration of the estrogen-releasing thermo-sensitive hydrogel system. (2) The thermo- sensitive hydrogel systems including 0.8 mg/ml estrogen can release estrogen in mice for 7 days and can achieve effective blood estrogen concentration. (3) All mice in group a, b, and c survived. All mice in group b and c showed ectopic cysts, and no cyst was observed in group a. Conclusions: The construction of the mouse model of endometriosis requires exogenous estrogen. We have found that the novelestrogen-releasing thermo-sensitive hydrogel systems can slowly release estrogen after subcutaneously injection in mice, and the value of the subcutaneously injection of estrogen-releasing thermo-sensitive hydrogel system (0.8 mg/ml) per week to the construction of the mouse model is certain.The estrogen-releasing thermo-sensitive hydrogel system has high application value and is worthy of promotion.