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Currently, there is no agreed upon definition of a designated hernia center (DHC) and no study has investigated the association of hernia center designation with ventral hernia repair (VHR) outcomes. We sought to investigate the current utilization of DHC and the association of hernia center designation with VHR outcomes. All patients who underwent elective, ventral hernia repair with mesh with 30-day follow-up from 2013 through 2020 were in the Americas Hernia Society Quality Collaborative (ACHQC) database. Patients were divided into two groups: those that underwent VHR at a DHC and those that underwent VHR at a non-designated hernia center site (NDHC). Using a 1:1 matched analysis, differences in the incidence of 30-day wound events, the total number of 30-day complications, one-year ventral hernia recurrence rates, and 30-day and one-year patient reported outcomes were compared between DHC and NDHC. A total of 261 sites were included in our analysis; 78 (30%) were identified as DHC. After matching, there were 14,186 VHRs available for analysis. There was no significant difference in 30-day wound morbidity events. Patients who underwent VHR at NDHC were less likely to experience any 30-day complication or 1-year hernia recurrence while patients who underwent VHR at DHC had a statistically significant greater improvement in their HerQLes scores at one-year postoperatively. There is currently no clear superiority to VHR at a DHC. The ACHQC may self-select for surgeons invested in hernia repair outcomes regardless of hernia center designation. More standardized criteria for a hernia center are required in order to positively influence the value of hernia care delivered in the United States. •Currently, there is no agreed upon definition of a hernia center of excellence (COE).•Within the Americas Hernia Society Quality Collaborative (ACHQC) database, approximately 30% of sites are currently identified as designated hernia centers (DHC).•There was no statistically significant difference between DHC and non-DHC (NDHC) with respect to 30-day wound events.•Patients who underwent ventral hernia repair (VHR) at NDHC were less likely to experience a 30-day complication.•Patients who underwent VHR at DHC had a statistically significant greater improvement in hernia related quality of life.

Many surgical risk assessment tools emphasize patient-specific risk factors. Our objective was to use a hernia-specific database to assess risk factors of complications in ventral hernia repair (VHR) focusing on hernia-specific and procedural factors. The ACHQC database was queried for elective VHR in adults from 2012 to 2023. Primary outcome was overall 30-day complications. Multivariable logistic regression was used for analysis. 41,526 VHR were included. The rate of 30-day complications was 18%, surgical site infection 3%, surgical site occurrence requiring procedural intervention 4%, readmission 4%, reoperation 2%, and mortality 0.2%. Multivariable analysis demonstrated that BMI, ASA, frailty, COPD, anticoagulants, defect width, incisional and recurrent hernias, presence of stoma or prior mesh, prior abdominal wall infection, non-clean wound, operative time, open approach and myofascial release were associated with 30-day complications (OR ​= ​1.01–1.66). Preoperative chlorhexidine, bowel preparation and fascial closure were associated with lower complication risk (OR ​= ​0.70–0.89). Hernia and procedural risk factors are associated with early complications following elective VHR. These factors need to be included in surgical risk assessment tools, to supplement patient-specific factors. [Display omitted] •Early complications occurred in 18% of elective ventral hernia repair.•Of patient-specific factors, those focusing on comorbidity burden (e.g. ASA class, frailty score) were associated with complication risk in ventral hernia repair.•A number of hernia-specific and procedural risk factors were associated with complications in ventral hernia repair.

Abstract Background Clinical trials of HER2-directed therapy that omit neoadjuvant conventional chemotherapy for HER+ breast cancer demonstrate that a subset of patients still obtains a pCR. Identifying tumor characteristics which predict pCR may help select patients for de-escalated neoadjuvant dual HER2-targeted treatment without chemotherapy. This is the first study evaluating the HER2/CEP17 ratio by FISH as a biomarker to predict pCR among patients who received neoadjuvant anti-HER2 regimens without chemotherapy. Patients and Methods Data from patients with locally advanced HER2+ breast cancer who received neoadjuvant dual HER2-targeted therapy without conventional chemotherapy from a single center was retrospectively reviewed. All patients were enrolled in one of 3 clinical trials evaluating chemotherapy de-escalation. Logistic regression modeling assessed for a relationship between the HER2/CEP17 FISH ratio obtained from baseline tissue biopsy and pCR based on pathology at the time of definitive breast surgery following neoadjuvant treatment. Results Following neoadjuvant treatment with dual HER2-targeted therapies in 56 patients, the probability of pCR was 73% among patients with a HER2 ratio of 13.1 compared to a probability of 38% among patients with HER2 ratio of 5.5 (OR 4.14, 95% CI 1.44-11.89; P = .012). This positive association persisted after controlling for different treatment regimens administered (OR 2.87, 95% CI 0.9-9.18, P = .020). Conclusions These data found a positive association between the HER2/CEP17 FISH ratio and pCR following neoadjuvant dual HER2-targeted therapy without chemotherapy. Larger prospective studies are needed to validate the HER2 ratio as a biomarker to select patients for neoadjuvant dual anti-HER2 therapy without chemotherapy. This novel exploratory study is the first to examine whether pathologic complete response following various neoadjuvant anti-HER2 doublet therapies without conventional chemotherapy is dependent on the level of HER2 amplification.

Ductal carcinoma in situ (DCIS) is the most common type of pre-invasive breast cancer diagnosed in women. Because the majority of DCIS cases are unlikely to progress to invasive breast cancer, many women are over-treated for DCIS. By understanding the molecular basis of early stage breast cancer progression, we may identify better prognostic factors and design treatments tailored specifically to the predicted outcome of DCIS. Chemokines are small soluble molecules with complex roles in inflammation and cancer progression. Previously, we demonstrated that CCL2/CCR2 chemokine signaling in breast cancer cell lines regulated growth and invasion through p42/44MAPK and SMAD3 dependent mechanisms. Here, we sought to determine the clinical and functional relevance of CCL2/CCR2 signaling proteins to DCIS progression. Through immunostaining analysis of DCIS and IDC tissues, we show that expression of CCL2, CCR2, phospho-SMAD3 and phospho-p42/44MAPK correlate with IDC. Using PDX models and an immortalized hDCIS.01 breast epithelial cell line, we show that breast epithelial cells with high CCR2 and high CCL2 levels form invasive breast lesions that express phospho-SMAD3 and phospho-p42/44MAPK. These studies demonstrate that increased CCL2/CCR2 signaling in breast tissues is associated with DCIS progression, and could be a signature to predict the likelihood of DCIS progression to IDC.

BackgroundRobotic–assisted retromuscular repairs reduce length of stay compared to open surgery. However, no study has evaluated the long-term impact on abdominal core quality of life.MethodsRetrospective cohort study performed using prospectively collected data from the Americas Hernia Society Quality Collaborative (AHSQC) including adults who underwent open or robotic-assisted retromuscular, incisional hernia repair between 2013 and 2019. Differences in Hernia-Related Quality of Life Survey (HerQLes) scores at baseline and 1 year postoperatively were compared using multivariable regression models. Secondary outcomes included perioperative complications, wound morbidity, and hernia recurrence.Results236 patients underwent open (N = 194) and robotic (N = 42) repairs. Median age was 61 years. The open group had larger hernia widths (median [IQR], 13 [9–16] vs. 7 [5–9] cm) and longer LOS (5 [4–6] vs. 1.5 [1–3] days). Median HerQLes summary scores at 1 year were similar at 88 [67, 93] points for open vs 90 [58, 94] for robotic arm. Wound morbidity rates were similar. On multivariate analysis, there was no difference in HerQLes summary score improvement 1 year after repair between techniques (3.3, CI [− 7.7, 14.3]; p = 0.52), however, patients with a comparatively larger hernia width of 7 cm had a 5.9 (CI [1.1, 10.8], p = 0.02) increase in HerQLes scores, and patients with a higher ASA class (3–5) saw an 11-point score improvement (CI [2.2, 20.0], p = 0.02) regardless of approach. Smoking, BMI above 30, or hernia recurrence had no significant impact, while COPD hindered scores (− 17.0, CI [− 32.3, − 1.7], p = 0.03).ConclusionsImprovement in abdominal core quality of life after repair is comparable between open and robotic retromuscular techniques. Larger hernia defects and higher ASA class patients benefitted the greatest. Robotic approaches offer shorter LOS with comparable recurrence and wound morbidity rates 1 year after surgery. The surgical approach should be personalized and guided by the surgeon’s individual and institutional expertise.

Background Addressing social and behavioral determinants of health (SBDs) may help improve health outcomes of community clinic patients. This cross-sectional study explored how assessing SBDs can be used to complement health data collection strategies and provide clinicians with a more in-depth understanding of their patients. Methods Adult patients, ages 18 and older, at an urban community health care clinic in Tennessee, U.S.A., were asked to complete a questionnaire regarding health status, health history and SBDs while waiting for their clinic appointment. The SBD component included items from the National Academy of Medicine, the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences instrument, and the Survey of Household Economics and Decisionmaking. Data collection and analysis occurred in 2017. Results One hundred participants completed the study. The questionnaire took approximately 11 min to complete, and the response rate was 90% or higher for all items except annual household income (unanswered by 40 participants). The median number of negative SBDs was 4 (IQR 2.75–7.0), 96 participants had at least one unmet need, and the most common negative SBD was physical activity (75%; 75/100). Conclusions The hybrid questionnaire provided insight into a community clinic population’s SBDs and allowed for a more complete understanding than a single questionnaire alone. The brief questionnaire administration time and low non-response rate support the questionnaire’s feasibility in the community clinic setting, and results can be used by clinicians to further the personalization goals of precision medicine. Next steps include evaluating how to connect patients with appropriate resources for addressing their SBDs.

A highly electron‐rich S,N heteroacene building block is developed and condensed with FIC and Cl‐IC acceptors to furnish CT‐F and CT‐Cl, which exhibit near‐infrared (NIR) absorption beyond 1000 nm. The C‐shaped CT‐F and CT‐Cl self‐assemble into a highly ordered 3D intermolecular packing network via multiple π−π interactions in the single crystal structures. The CT‐F‐based organic photovoltaic (OPV) achieved an impressive efficiency of 14.30% with a broad external quantum efficiency response extending from the UV‐vis to the NIR (300–1050 nm) regions, outperforming most binary OPVs employing NIR A‐D‐A‐type acceptors. CT‐Cl possesses a higher surface energy than CT‐F, promoting vertical phase segregation and resulting in its preferential accumulation near the bottom interface of the blend. This arrangement, combined with the lower HOMO energy level of CT‐Cl, effectively reduces undesired hole and electron injection under reverse voltage. The PM6:CT‐Cl‐based organic photodetectors (OPDs) devices achieved an ultra‐high shot‐noise‐limited specific detectivity (Dsh*) values exceeding 1014 Jones in the NIR region from 620 to 1000 nm, reaching an unprecedentedly high value of 1.3 × 1014 Jones at 950 nm. When utilizing a 780 nm light source, the PM6:CT‐Cl‐based OPDs show record‐high rise/fall times of 0.33/0.11 µs and an exceptional cut‐off frequency (f‐3dB) of 590 kHz at −1 V. C‐shaped thienodipyrrole‐based A‐D‐A acceptors, CT‐F and CT‐Cl, exhibiting near‐infrared (NIR) absorption beyond 1000 nm, have been designed and synthesized. The CT‐F‐based organic photovoltaic (OPV) achieves a PCE of 14.30%, representing the highest value for OPVs with photoresponses exceeding 1000 nm. The PM6:CT‐Cl organic photodetector (OPD) device, featuring more pronounced vertical phase separation to effectively inhibit the unfavorable charge injections, achieved a low Jd of 2.1 × 10⁻¹¹ A cm⁻2 and an ultra‐high detectivity Dsh* of 1.3 × 10¹⁴ Jones.

Purpose Racial disparities are apparent in the management and outcomes for prostate cancer; however, disparities in compliance to quality measures for radiation therapy for prostate cancer have not been previously studied. Therefore, the goal of the study was to characterize disparities in the compliance rates with quality measures. Methods The comparative effectiveness analysis of radiation therapy and surgery study is a population-based, prospective cohort study that enrolled 3708 men with clinically localized prostate cancer from 2011 to 2012. Compliance with 5 radiation-specific quality measures endorsed by national consortia as of 2011 was assessed, and compliance was compared by race using logistic regression. Results Overall, 604 men received definitive external beam radiation therapy (EBRT) of which 20% were self-reported black, 74% non-Hispanic white, and 6% Hispanic. Less than two-thirds of black and Hispanic men received EBRT that was compliant with all available quality measures ( p  = 0.012). Compared to white men, black men were less likely to receive dose-escalated EBRT (95% vs. 87%, p  = 0.011) and less likely to avoid unnecessary pelvic radiation for low-risk disease (99% vs. 20%, p  < 0.001). Compared to white men, Hispanic men were less likely to undergo image guidance (87% vs. 71%, p  = 0.04). Black and Hispanic men were more likely to receive EBRT from low-quality providers than white men. Conclusions Addressing disparities in access to providers that meet quality guidelines, and improving adherence to evidence-based processes of care may decrease racial/ethnic disparities in prostate cancer outcomes.

BackgroundThe postoperative management of patients undergoing laparoscopic ventral hernia repair (VHR) remains relatively unknown. The purpose of our study was to determine if patient and hernia-specific factors could be used to predict the likelihood of hospital admission following laparoscopic VHR using the Americas Hernia Society Quality Collaborative (AHSQC) database.MethodsAll patients who underwent elective, laparoscopic VHR with mesh placement from October 2015 through April 2019 were identified within the AHSQC database. Patients without clean wounds, those with chronic liver disease, and those without 30-day follow-up data were excluded from our analysis. Patient and hernia-specific variables were compared between patients who were discharged from the post-anesthesia care unit (PACU) and patients who required hospital admission. Comparisons were also made between the two groups with respect to 30-day morbidity and mortality events.ResultsA total of 1609 patients met inclusion criteria; 901 (56%) patients were discharged from the PACU. The proportion of patients discharged from the PACU increased with each subsequent year. Several patient comorbidities and hernia-specific factors were found to be associated with postoperative hospital admission, including older age, repair of a recurrent hernia, a larger hernia width, longer operative time, drain placement, and use of mechanical bowel preparation. Patients who required hospital admission were more likely than those discharged from the PACU to be readmitted to the hospital within 30 days (4% vs. 2%, respectively) and to experience a 30-day morbidity event (18% vs. 8%, respectively).ConclusionsPatient- and hernia-specific factors can be used to identify patients who can be safely discharged from the PACU following laparoscopic VHR. Additional studies are needed to determine if appropriate patient selection for discharge from the PACU leads to decreased healthcare costs for laparoscopic VHR over the long-term.

Background The utilization of mesh is considered the standard of care for incisional hernia repairs to reduce recurrence. However, mesh complications—including infection and enterocutaneous fistulae—can impact patients’ quality of life and culminate in reoperation. Meanwhile, techniques for fascial closure and our understanding of abdominal wall tension physiology have improved since the original studies comparing suture and mesh-based ventral hernia repairs were published, but there have been no contemporary trials comparing these approaches since the evolution of fascial closure techniques. Methods This is a registry-based, multicenter, patient-blinded randomized controlled trial designed to investigate whether a suture-only technique utilizing a posterior rectus sheath release, small bite technique, and 4:1 closure is non-inferior to a retrorectus mesh-based repair for clean, incisional hernias that are 2–6 cm in width. The primary study endpoint is abdominal wall-specific quality of life (HerQLes) at one year postoperatively. Our primary hypothesis is that suture-based incisional hernia repair will be non-inferior to mesh-based repairs with respect to HerQLes summary score at one year postoperatively. Secondary outcomes of interest include hernia recurrence at 1, 2, and 5 years postoperatively, pain as measured by the PROMIS-3a Pain Intensity survey, cost-effectiveness ratios, 30-day readmissions, wound complications, and reoperations. Additional outcomes include hernia recurrence, patient-reported quality of life, wound complications, and hernia-related reoperation at 30 days, 1 year, 2 years, and 5 years. Discussion The risks of mesh-related complications, coupled with the lack of contemporary data, warrant new investigation into the necessity of mesh placement for all incisional hernias. Trial registration Clinicaltrials.gov NCT05599750. Registered on October 26, 2022.