A systematic review of the surgical treatment of large incisional hernia.

PURPOSE: Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. METHODS: A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. RESULTS: Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6%, recurrence hazard <0.5% per year). Wound complications were frequent and most often seen after complex LIH repair. CONCLUSIONS: The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.

A comparative study of ballpoint ink ageing parameters using GC/MS.

For more than a decade scientists tried to develop methods capable of dating ink by monitoring the loss of phenoxyethanol (PE) over time. While many methods were proposed in the literature, few were really used to solve practical cases and they still raise much concern within the scientific community. In fact, due to the complexity of ink drying processes it is particularly difficult to find a reliable ageing parameter to reproducibly follow ink ageing. Moreover, systematic experiments are required in order to evaluate how different factors actually influence the results over time. Therefore, this work aimed at evaluating the capacity of four different ageing parameters to reliably follow ink ageing over time: (1) the quantity of solvent PE in an ink line, (2) the relative peak area (RPA) normalising the PE results using stable volatile compounds present in the ink formulation, (3) the solvent loss ratio (R%) calculated from PE results obtained by the analyses of naturally and artificially aged samples, (4) a modified solvent loss ratio version (R%*) calculated from RPA results. After the determination of the limits of reliable measurements of the analytical method, the repeatability of the different ageing parameters was evaluated over time, as well as the influence of ink composition, writing pressure and storage conditions on the results. Surprisingly, our results showed that R% was not the most reliable parameter, as it showed the highest standard deviation. Discussion of the results in an ink dating perspective suggests that other proposed parameters, such as RPA values, may be more adequate to follow ink ageing over time.

Psychotherapy for Personality Disorders in a Natural Setting: A Pilot Study over Two Years of Treatment.

Long-term assessment of the effects of psychotherapy for personality disorders (PDs) in a natural environment is an important task. Such research contributes to enlarge the practice-based evidence, embedded in broad collaborations between clinicians and researchers in psychotherapy for PDs. The present pilot study used rigorous assessment procedures and incorporated feedback loops of outcome information to the therapists in demonstrating the effects of psychotherapy for PD in a natural setting. The number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for any PD was the primary outcome (along with psychological distress, depression, impulsiveness, and quality of life as secondary measures), assessed at intake, 6, 12, 18, and 24 months of psychotherapy for N = 13 patients with PD. Data were analyzed using hierarchical linear modeling. Results demonstrated a large pre-post effect (d = 2.22) for the observer-rated measure (primary outcome), and small to medium effects for the secondary outcomes; these results were corroborated by a steady decrease of symptoms over all five time points, which was significant for several outcomes. These results add a piece to the literature by demonstrating the effects of long-term psychotherapy for PDs in increasingly diverse contexts and suggest that practice-oriented research can be carried out in a collaborative and systematic manner.

Use of fine-needle aspirate calcitonin to detect medullary thyroid carcinoma: A systematic review.

BACKGROUND: The measurement of calcitonin in washout fluids of thyroid nodule aspirate (FNA-calcitonin) has been reported as accurate to detect medullary thyroid carcinoma (MTC). The results from these studies have been promising and the most updated version of ATA guidelines quoted for the first time that "FNA findings that are inconclusive or suggestive of MTC should have calcitonin measured in the FNA washout fluid." Here we aimed to systematically review published data on this topic to provide more robust estimates. RESEARCH DESIGN AND METHODS: A comprehensive computer literature search of the medical databases was conducted by searching for the terms "calcitonin" AND "washout." The search was updated until April 2015. RESULTS: Twelve relevant studies, published between 2007 and 2014, were found. Overall, 413 thyroid nodules or neck lymph nodes underwent FNA-calcitonin, 95 were MTC lesions and 93 (97.9%) of these were correctly detected by this measurement regardless of their cytologic report. CONCLUSIONS: The present study shows that the above ATA recommendation is well supported. Almost all MTC lesions are correctly detected by FNA-calcitonin and this technique should be used to avoid false negative or inconclusive results from cytology. The routine determination of serum calcitonin in patients undergoing FNA should improve the selection of patients at risk for MTC, guiding the use of FNA-calcitonin in the same FNA sample and providing useful information to the cytopathologist for the morphological assessment and the application of tailored ancillary tests.

Systematic studies of the effect of pressure on magnetic and electronic properties of La2/3Ca1/3MnO3 thin films with various thicknesses /

Interest in mixed-valent perovskite manganese oxides of La\-xAxMnO^ (v4-divalent alkaline earth Ca, Sr or Ba), whose unusual properties were discovered nearly a half century ago, has recently been revived. The discovery of the colossal magnetoresistance and pressure effects introduced new questions concerning the complex interplay between lattice structure, magnetism and transport in doped perovskite manganites. In this study, we report our experimental investigations of pressure and magnetic field dependencies of La-i/sCai/sMnOs (LCMO) epitaxial films with various thickness on SrTiO$ substrate. An analysis of film thickness dependency of the resistivity of LCMO epitaxial films under pressure and magnetic field has been performed by taking into account substrate contributions. This verifies the correlation of lattice distortion with magnetic and transport properties. Strong dependencies of Mn — O — Mn bond bending and Mn — O bond stretching with pressure as well as Mn spin alignment with magnetic field, and the lattice distortion induced by the substrate are discussed.

Quantum Monte Carlo study of electrostatic polarizabilities of H and He atoms /

The infinitesimal differential quantum Monte Carlo (QMC) technique is used to estimate electrostatic polarizabilities of the H and He atoms up to the sixth order in the electric field perturbation. All 542 different QMC estimators of the nonzero atomic polarizabilities are derived and used in order to decrease the statistical error and to obtain the maximum efficiency of the simulations. We are confident that the estimates are "exact" (free of systematic error): the two atoms are nodeless systems, hence no fixed-node error is introduced. Furthermore, we develope and use techniques which eliminate systematic error inherent when extrapolating our results to zero time-step and large stack-size. The QMC results are consistent with published accurate values obtained using perturbation methods. The precision is found to be related to the number of perturbations, varying from 2 to 4 significant digits.

Understanding the Origin of Selectivity in the Asymmetric Lithiation Reaction of N-Heterocycles: A Theoretical Study

The natural abundance of the N-heterocycle containing compounds has pushed the synthetic community toward the invention of new synthetic methods that result in the structural diversity of N-heterocycles. Among this, is the efficient and highly selective diamine mediated asymmetric lithiation process. Amongst the diamine chiral ligands, (-)-sparterine, which is a naturally occurring alkaloid proved to be an efficient one. Many successful, good yielding and highly selective lithiation reactions have been accomplished with the mediation by this chiral diamine base. Although, there are some examples of experimental and theoretical mechanistic studies in the literature, there is a lack of detailed understanding as to how it exactly induces the chirality. In this thesis is described a systematic investigation of how (-)-sparteine influences the stereoselectivity in the course of asymmetric lithiation reaction. This led us to the establishment of the function of A-ring’s β-CH2 effect and D-ring effect. Consequently, the importance of the A-ring and D-ring portions of (-)-sparteine in the stereoselectivity is unraveled. Another part of this thesis deals with the asymmetric lithiation of BF3-activated N,N- dimethylaminoferrocene in the presence of (1R, 2R)-N1,N2-bis(3,3-dimethylbutyl)-N1,N2-dimethylcyclohexane-1,2-diamine ( a (R,R)-TMCDA surrogate) with i-PrLi. Computational findings were in full accord with the experimental observations. Subsequently, the theoretically provided insights into the mechanism of the reaction were exploited in computational design of a new ligand. Unfortunately, the outcome of this design was not experimentally robust and an updated approach towards a successful design was explained.

Economic evaluation of prevention of mother – to – child – transmission of HIV/AIDS interventions in developing countries : a systematic review

Les gouvernements mondiaux et les organismes internationaux ont placé une haute priorité dans la prévention de la transmission mère-enfant du VIH. Cependant, bien qu'il y ait eu des progrès énormes rapportés dans des nations industrialisées, la situation dans les pays en voie de développement est encore déplorable; on y constate un grand écart entre l’engagement international pour réduire cette voie de transmission et l'accès aux interventions. Ceci peut être attribué à la situation économique déplorable dans plusieurs pays en voie de développement. Des interventions prioritaires en santé doivent donc être soigneusement sélectionnées afin de maximiser l'utilisation efficace des ressources limitées. L’évaluation économique est un outil efficace qui peut aider des décideurs à identifier quelles stratégies choisir. L'objectif de cette revue systématique est de recenser toutes les études d'évaluation économique existantes qui ont été effectuées dans les pays en voie de développement sur la prévention de la transmission mère-enfant du VIH. Notre revue a retenu 16 articles qui ont répondu aux critères d'inclusion. Nous avons conçu un formulaire pour l’extraction de données, puis nous avons soumis les articles à un contrôle rigoureux de qualité. Nos résultats ont exposé un certain nombre de défauts dans la qualité des études choisies. Nous avons également noté une forte hétérogénéité dans les estimations des paramètres de coût et d'efficacité de base, dans la méthodologie appliquée, ainsi que dans les écarts utilisés dans les analyses de sensibilité. Quelques interventions comportant la thérapie à la zidovudine ou à la nevirapine à court terme se sont avérées rentables, et ont enregistré des valeurs acceptables de coût-utilité. Les résultats des évaluations économiques analysées dans cette revue ont varié sur la base des facteurs suivants : la prévalence du VIH, la classification du pays selon le revenu, les infrastructures disponible, les coûts du personnel, et finalement les coûts des interventions, particulièrement les prix des médicaments.

A lexical semantic study of Dene Suliné, an Athabaskan language

Cette thèse constitue une étude systématique du lexique du déné sųłiné, une langue athabaskane du nord-ouest canadien. Elle présente les définitions et les patrons de combinatoire syntaxique et lexicale de plus de 200 unités lexicales, lexèmes et phrasèmes, qui représentent une partie importante du vocabulaire déné sųłiné dans sept domaines: les émotions, le caractère humain, la description physique des entités, le mouvement des êtres vivants, la position des entités, les conditions atmospheriques et les formations topologiques, en les comparant avec le vocubulaire équivalent de l'anglais. L’approche théorique choisie est la Théorie Sens-Texte (TST), une approche formelle qui met l’accent sur la description sémantique et lexicographique empiriques. La présente recherche relève d'importantes différences entre le lexique du déné sųłiné et celui de l'anglais à tous les niveaux: dans la correspondence entre la représentation conceptuelle, considérée (quasi-)extralinguistique, et la structure sémantique; dans les patrons de lexicalisation des unités lexicales, et dans les patrons de combinatoire syntaxique et lexicale, qui montrent parfois des traits propres au déné sųłiné intéressants.

Compliance measurement-guided medication management programs in hypertension : a systematic review

Objectif principal: Il n’est pas démontré que les interventions visant à maîtriser voire modérer la médicamentation de patients atteints d’hypertension peuvent améliorer leur gestion de la maladie. Cette revue systématique propose d’évaluer les programmes de gestion contrôlée de la médicamentation pour l’hypertension, en s’appuyant sur la mesure de l’observance des traitements par les patients (CMGM). Design: Revue systématique. Sources de données: MEDLINE, EMBASE, CENTRAL, résumés de conférences internationales sur l’hypertension et bibliographies des articles pertinents. Méthodes: Des essais contrôlés randomisés (ECR) et des études observationnelles (EO) ont été évalués par 2 réviseurs indépendants. L’évaluation de la qualité (de ce matériel) a été réalisée avec l’aide de l’outil de Cochrane de mesure du risque de biais, et a été estimée selon une échelle à quatre niveaux de qualité Une synthèse narrative des données a été effectuée en raison de l'hétérogénéité importante des études. Résultats: 13 études (8 ECR, 5 EO) de 2150 patients hypertendus ont été prises en compte. Parmi elles, 5 études de CMGM avec l’utilisation de dispositifs électroniques comme seule intervention ont relevé une diminution de la tension artérielle (TA), qui pourrait cependant être expliquée par les biais de mesure. L’amélioration à court terme de la TA sous CMGM dans les interventions complexes a été révélée dans 4 études à qualité faible ou modérée. Dans 4 autres études sur les soins intégrés de qualité supérieure, il n'a pas été possible de distinguer l'impact de la composante CMGM, celle-ci pouvant être compromise par des traitements médicamenteux. L’ensemble des études semble par ailleurs montrer qu’un feed-back régulier au médecin traitant peut être un élément essentiel d’efficacité des traitements CMGM, et peut être facilement assuré par une infirmière ou un pharmacien, grâce à des outils de communication appropriés. Conclusions: Aucune preuve convaincante de l'efficacité des traitements CMGM comme technologie de la santé n’a été établie en raison de designs non-optimaux des études identifiées et des ualités méthodologiques insatisfaisantes de celles-ci. Les recherches futures devraient : suivre les normes de qualité approuvées et les recommandations cliniques actuelles pour le traitement de l'hypertension, inclure des groupes spécifiques de patients avec des problèmes d’attachement aux traitements, et considérer les résultats cliniques et économiques de l'organisation de soins ainsi que les observations rapportées par les patients.

The study of RNA tertiary interactions in tRNA structure and function

Le rôle des deux paires de bases universelles inverse Hoogsteen U : A ( RHUAs ) présentent chez les ARNt standards , une dans la boucle T et l'autre dans le noyau de la forme en L , a été étudiée. Pour chacun des RHUAs , un criblage génétique spécialisé in vivo chez les bactéries , le système suppresseur ambre ( pour l'étude de la RHUA dans la boucle T ) et le système d'ARNt de la sélénocystéine ( tRNASec ) ( pour l'étude de la RHUA dans le noyau ) , ont été utilisé pour générer des variants fonctionnels à partir de multiples librairies combinatoires . Ces variants ont ensuite été séquencé et soumis à une analyse systématique qui comprend la modélisation informatique et un type d'analyse phylogénétique. Les résultats du système suppresseur ambre ont montré un ensemble de variants fonctionnels qui ne nécessitent pas le motif RHUA dans la boucle T et qui ont remplacé la méthode standard de l'interaction entre les boucles D et T avec une double hélice interboucle , ILDH . D'autres études ont abouti à la détermination d'un modèle In silico de l'alternative à la norme standard de la boucle T, sous le nom de type III . Les résultats du système tRNASec ont révélé que pour cette ARNt exceptionnel, l'absence de RHUA ( dans le noyau ) assure une flexibilité accrue qui est spécifiquement nécessaire pour la fonction de tRNASec . Ainsi, les ARNt standards , à la différence de tRNASec , avec la présence universelle de RHUA dans le noyau , a été naturellement sélectionnée pour être rigide . Pris ensemble, la RHUA joue un rôle essentiel dans la stabilisation des interactions tertiaires.

The effectiveness of scoliosis screening programs: methods for systematic review and expert panel recommendations formulation

Background: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. METHODS: To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. CONCLUSIONS: In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.

Geodynamics of the Andaman - Sumatra - Java Trench - Arc System Based on Gravity and Seismotectonic Study

This work aims to study the variation in subduction zone geometry along and across the arc and the fault pattern within the subducting plate. Depth of penetration as well as the dip of the Benioff zone varies considerably along the arc which corresponds to the curvature of the fold- thrust belt which varies from concave to convex in different sectors of the arc. The entire arc is divided into 27 segments and depth sections thus prepared are utilized to investigate the average dip of the Benioff zone in the different parts of the entire arc, penetration depth of the subducting lithosphere, the subduction zone geometry underlying the trench, the arctrench gap, etc.The study also describes how different seismogenic sources are identified in the region, estimation of moment release rate and deformation pattern. The region is divided into broad seismogenic belts. Based on these previous studies and seismicity Pattern, we identified several broad distinct seismogenic belts/sources. These are l) the Outer arc region consisting of Andaman-Nicobar islands 2) the back-arc Andaman Sea 3)The Sumatran fault zone(SFZ)4)Java onshore region termed as Jave Fault Zone(JFZ)5)Sumatran fore arc silver plate consisting of Mentawai fault(MFZ)6) The offshore java fore arc region 7)The Sunda Strait region.As the Seismicity is variable,it is difficult to demarcate individual seismogenic sources.Hence, we employed a moving window method having a window length of 3—4° and with 50% overlapping starting from one end to the other. We succeeded in defining 4 sources each in the Andaman fore arc and Back arc region, 9 such sources (moving windows) in the Sumatran Fault zone (SFZ), 9 sources in the offshore SFZ region and 7 sources in the offshore Java region. Because of the low seismicity along JFZ, it is separated into three seismogenic sources namely West Java, Central Java and East Java. The Sunda strait is considered as a single seismogenic source.The deformation rates for each of the seismogenic zones have been computed. A detailed error analysis of velocity tensors using Monte—Carlo simulation method has been carried out in order to obtain uncertainties. The eigen values and the respective eigen vectors of the velocity tensor are computed to analyze the actual deformation pattem for different zones. The results obtained have been discussed in the light of regional tectonics, and their implications in terms of geodynamics have been enumerated.ln the light of recent major earthquakes (26th December 2004 and 28th March 2005 events) and the ongoing seismic activity, we have recalculated the variation in the crustal deformation rates prior and after these earthquakes in Andaman—Sumatra region including the data up to 2005 and the significant results has been presented.ln this chapter, the down going lithosphere along the subduction zone is modeled using the free air gravity data by taking into consideration the thickness of the crustal layer, the thickness of the subducting slab, sediment thickness, presence of volcanism, the proximity of the continental crust etc. Here a systematic and detailed gravity interpretation constrained by seismicity and seismic data in the Andaman arc and the Andaman Sea region in order to delineate the crustal structure and density heterogeneities a Io nagnd across the arc and its correlation with the seismogenic behaviour is presented.

A Study of the Physical and Engineering Behaviour of Cochin Marine Clays

With the increase in population, housing and construction of various facilities have been a problem with urbanization. Having exhausted all the trouble free hand, man is nowon the lookout for techniques to improve areas which were originally considered uninhabitable. Thus this study is based on the nature and engineering behavior of soft clays covering long stretches of coastal line and methods to improve their geotechnical properties .The main aim of the present investigation is to study in detail the physical and engineering behavior of the marine clays of Cochin. While it is well known that the marine clays have been posing numerous problems to foundation engineers all along, the relevant literature reveals that no systematic and comprehensive study has been attempted to date. The: knowledge gained through the study is suitably used to improve these properties with appropriate additives.

A Study Of The Strength And Compressibility Characteristics Of Cochin Marine Clays

With the advent of urbanisation and consequent search for more and more habitable land, it was imperative that the large tracts of marine clays, considered inhabitable earlier, had to be reclaimed and developed. These marine clays, wellknown for its high compressibility and poor shear strength, posed numerous problems to the builders and Cochin was no exception. It is only less than a decade since active research work was initiated on marine clays in general and Cochin marine clays in particular. Eventhough some systematic studies are available on compressibility characteristics, attempts to study the shear strength aspects and development of techniques to improve it have been very limited. This work is an investigation on the consolidation and shear strength characteristics of Cochin marine clays including methods to improve the same