Explore the vast range of titles available.

BackgroundThe enhanced-view totally extraperitoneal (eTEP) hernia repair technique was first described for laparoscopic inguinal hernia repair and later applied to laparoscopic ventral and incisional hernia repair. We present our center’s early operative outcomes utilizing principles of this technique during robotic ventral and incisional hernia repair for implementation of the robotic eTEP Rives–Stoppa (eRS) and eTEP transversus abdominis release (eTAR) techniques.MethodsA review of a prospectively maintained database of hernia patients was conducted identifying 37 patients who underwent robotic eTEP for ventral, incisional, flank or parastomal hernia repair between March and October 2017. All patients underwent retrorectus dissection with selective utilization of transversus abdominis release (TAR) as indicated.Results37 patients including 13 male and 24 female with mean age, body mass index, and ASA score of 54, 35.5, and 2.4, respectively, underwent a mean operation room time of 198 min. Mean length of stay was 0.7 days. There were no intraoperative complications. Two patients developed subcutaneous seromas requiring interventional radiology drainage. One patient was readmitted at 30 days for PO intolerance that was managed expectantly. Mean postoperative follow-up visit occurred at 36 days with no sign of early hernia recurrences.ConclusionThe enhanced-view totally extraperitoneal approach is both safe and feasible in robotic-assisted repair of ventral and incisional hernias. Although long-term outcomes and patient selection criteria require further study, we believe this technique will become an important tool in the armamentarium of minimally invasive hernia surgeons.

Scientists from nearly all disciplines face the problem of simultaneously evaluating many hypotheses. Conducting multiple comparisons increases the likelihood that a non-negligible proportion of associations will be false positives, clouding real discoveries. Drawing valid conclusions require taking into account the number of performed statistical tests and adjusting the statistical confidence measures. Several strategies exist to overcome the problem of multiple hypothesis testing. We aim to summarize critical statistical concepts and widely used correction approaches while also draw attention to frequently misinterpreted notions of statistical inference. We provide a step-by-step description of each multiple-testing correction method with clear examples and present an easy-to-follow guide for selecting the most suitable correction technique. To facilitate multiple-testing corrections, we developed a fully automated solution not requiring programming skills or the use of a command line. Our registration free online tool is available at www.multipletesting.com and compiles the five most frequently used adjustment tools, including the Bonferroni, the Holm (step-down), the Hochberg (step-up) corrections, allows to calculate False Discovery Rates (FDR) and q-values. The current summary provides a much needed practical synthesis of basic statistical concepts regarding multiple hypothesis testing in a comprehensible language with well-illustrated examples. The web tool will fill the gap for life science researchers by providing a user-friendly substitute for command-line alternatives.

BackgroundThe enhanced-view totally extraperitoneal (eTEP) technique has been previously described for Laparoscopic Inguinal Hernia Repair. We present a novel application of the eTEP access technique for the repair of ventral and incisional hernias.MethodsRetrospective review of consecutive laparoscopic retromuscular hernia repair cases utilizing the eTEP access approach from five hernia centers between August 2015 and October 2016 was conducted. Patient demographics, hernia characteristics, operative details, perioperative complications, and quality of life outcomes utilizing the Carolina’s Comfort Scale (CCS) were included in our data analysis.ResultsSeventy-nine patients with mean age of 54.9 years, mean BMI of 31.1 kg/m2, and median ASA of 2.0 were included in this analysis. Thirty-four percent of patients had a prior ventral or incisional hernia repair. Average mesh area of 634.4 cm2 was used for an average defect area of 132.1 cm2. Mean operative time, blood loss, and length of hospital stay were 218.9 min, 52.6 mL, and 1.8 days, respectively. There was one conversion to intraperitoneal mesh placement and one conversion to open retromuscular mesh placement. Postoperative complications consisted of seroma (n = 2) and trocar site dehiscence (n = 1). Comparison of mean pre- and postoperative CCS scores found significant improvements in pain (68%, p < 0.007) and movement limitations (87%, p < 0.004) at 6-month follow-up. There were no readmissions within 30 days and one hernia recurrence at mean follow-up of 332 ± 122 days.ConclusionsOur initial multicenter evaluation of the eTEP access technique for ventral and incisional hernias has found the approach feasible and effective. This novel approach offers flexible port set-up optimal for laparoscopic closure of defects, along with wide mesh coverage in the retromuscular space with minimal transfascial fixation.

Complete atrioventricular block (CAVB) is a largely intractable disease that leads to severe bradyarrhythmia. The only treatment is the implantation of a pacemaker device. Left untreated, CAVB patients experience QT prolongation and ventricular overload, increasing susceptibility to cardiac remodeling and heart failure, as well as potentially lethal tachyarrhythmias. Animal models of CAVB offer a direct avenue to investigate the disease and potential disease-modifying therapies. However, existing models have limitations due to phenotype instability and high attrition rate. We aimed to create an improved method for disease model creation and report beating rate and variability analysis of the model. We report a modified surgical model of CAVB in rats by adapting a clinical radiofrequency energy generator to ablate the atrioventricular node region of the rat heart. Compared to previous ablation methods that utilize sharp needle entry into the AV node (AVN) region, the modified method resulted in a significantly higher success rate with a lower attrition rate. The rat model of CAVB showed stable conduction block for at least four weeks after model creation, supporting their suitability as a preclinical model of severe bradyarrhythmia due to AV conduction block. Models showed severe beat-to-beat variability with decreased overall autonomic innervation. We present a rodent model of a complete and stable AV block, which enhances the rigor and reproducibility of the disease model and downstream applications.

BackgroundTransversus abdominis release (TAR) has evolved as an effective approach to complex abdominal wall reconstructions. Although the role of robotics in hernia surgery is rapidly expanding, the benefits of a robotic approach for abdominal wall reconstruction have not been established well. We aimed to compare the impact of the application of robotics to the TAR procedure on the perioperative outcomes when compared to the open TAR repairs.MethodsCase-matched comparison of patients undergoing robotic TAR (R-TAR) at two specialized hernia centers to a matched historic cohort of open TAR (O-TAR) patients was performed. Outcome measures included patient demographics, operative details, postoperative complications, and length of hospitalization.Results38 consecutive patients undergoing R-TAR were compared to 76 matched O-TAR. Patient demographics were similar between the groups, but ASA III status was more prevalent in the O-TAR group. The average operative time was significantly longer in the R-TAR group (299 ± 95 vs.. 211 ± 63 min, p < 0.001) and blood loss was significantly lower for the R-TAR group (49 ± 60 vs. 139 ± 149 mL, p < 0.001). Wound morbidity was minimal in the R-TAR, but the rate of surgical site events and surgical site infection was not different between groups. Systemic complications were significantly less frequent in the R-TAR group (0 vs. 17.1%, p = 0.026). The length of hospitalization was significantly reduced in the R-TAR group (1.3 ± 1.3 vs. 6.0 ± 3.4 days, p < 0.001).ConclusionsIn our early experience, robotic TAR was associated with longer operative times. However, we found that the use of robotics was associated with decreased intraoperative blood loss, fewer systemic complications, shorter hospitalizations, and eliminated readmissions. While long-term outcomes and patient selection criteria for robotic TAR repair are under investigations, we advocate selective use of robotics for TAR reconstructions in patients undergoing AWR.

[This corrects the article DOI: 10.1371/journal.pone.0245824.].[This corrects the article DOI: 10.1371/journal.pone.0245824.].

Comparing the scientific output of different researchers applying for a grant is a tedious work. In Hungary, to help reviewers to rapidly rank the scientific productivity of a researcher, a grant decision support tool was established and is available at www.scientometrics.org. In the present study, our goal was to assess the impact of this decision support tool on grant review procedures. The established, publicly available scientometric portal uses four metrics, including the H-index, the yearly citations without self-citations, the number of publications in the last five years, and the number of highly cited publications of a researcher within eleven independent scientific disciplines. Publication-age matched researchers are then ranked and the results are provided to grant reviewers. A questionnaire was completed by reviewers regarding utilization of the scientometric ranking system. The outcome of the grant selection was analyzed by comparing scientometric parameters of applying and funded applicants. We compared three grant allocation rounds before to two grant allocation rounds after the introduction of the portal. The scientometric decision support tool was introduced in 2020 to assist grant selection in Hungary and all basic research grant applicants (n = 6,662) were screened. The average score of funded proposals compared to submitted proposals increased by 94% after the introduction of the ranking. Correlation between ranking scores and actual grant selection was strong in life and material sciences but some scientific panels had opposite correlation in social sciences and humanities. When comparing selection outcome to H-index across all applicants, both type I and type II errors decreased. All together 540 reviewers provided feedback representing all eleven scientific disciplines and 83.05% of the reviewers (especially younger reviewers) found the ranking useful. The scientometric decision support tool can save time and increase transparency of grant review processes. The majority of reviewers found the ranking-based scientometric analysis useful when assessing the publication performance of an applicant.

Hepatomegaly, particularly an enlarged left liver lobe, is a well-recognized challenge in bariatric surgery, contributing significantly to staged procedures, conversions to open surgery, and aborted operations. Impaired intraoperative visualization hinders safe access to the hiatus and gastroesophageal junction, increasing the risk of complications. This report focuses on the laparoscopic mobilization of the left liver lobe as a reliable technique to address these challenges, offering improved exposure and facilitating precise surgical dissection. This technique should be considered a last resort to provide proper visualization of the hiatus when other retraction methods have failed. In our experience, this approach was applied in seven patients (six sleeve gastrectomies and one gastric bypass) with good outcomes. All patients tolerated the procedures well, and no intra- or post-operatively complications directly attributable to the mobilization technique were observed. These findings underscore the safety and efficacy of this method, making it a valuable tool for both primary and revisional bariatric surgeries.

Reinforcement learning (RL) is the subfield of machine learning focused on optimal sequential decision making under uncertainty. An optimal RL strategy maximizes cumulative utility by experimenting only if and when the information generated by experimentation is likely to outweigh associated short-term costs. RL represents a holistic approach to decision making that evaluates the impact of every action (ie, data collection, allocation of resources, and treatment assignment) in terms of short-term and long-term utility to stakeholders. Thus, RL is an ideal model for a number of complex decision problems that arise in public health, including resource allocation in a pandemic, monitoring or testing, and adaptive sampling for hidden populations. Nevertheless, although RL has been applied successfully in a wide range of domains, including precision medicine, it has not been widely adopted in public health. The purposes of this review are to introduce key ideas in RL and to identify challenges and opportunities associated with the application of RL in public health. We provide a nontechnical review of the theoretical and methodologic underpinnings of RL. A running example of RL for the management of an infectious disease is used to illustrate ideas. RL has the potential to make a transformative impact in a range of sequential decision problems in public health. By allocating resources if, when, and where they are most impactful, RL can improve health outcomes while reducing resource consumption. Public health researchers and stakeholders should consider RL as a means of efficiently using data to inform optimal evidence-based decision making.

Environmental DNA (eDNA) techniques have only recently been applied in the marine environment to detect the presence of marine species. Species-specific primers and probes were designed to detect the eDNA of the endangered Maugean skate (Zearaja maugeana) from as little as 1 L of water collected at depth (10-15 m) in Macquarie Harbour (MH), Tasmania. The identity of the eDNA was confirmed as Z. maugeana by sequencing the qPCR products and aligning these with the target sequence for a 100% match. This result has validated the use of this eDNA technique for detecting a rare species, Z. maugeana, in the wild. Being able to investigate the presence, and possibly the abundance, of Z. maugeana in MH and Bathurst harbour (BH), would be addressing a conservation imperative for the endangered Z. maugeana. For future application of this technique in the field, the rate of decay was determined for Z. maugeana eDNA under ambient dissolved oxygen (DO) levels (55% saturation) and lower DO (20% saturation) levels, revealing that the eDNA can be detected for 4 and 16 hours respectively, after which eDNA concentration drops below the detection threshold of the assay. With the rate of decay being influenced by starting eDNA concentrations, it is recommended that samples be filtered as soon as possible after collection to minimize further loss of eDNA prior to and during sample processing.