Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia

BACKGROUND Women have a 3%lifetime chance of developing an inguinal hernia,which is not as common in men.Due to its cosmetic benefits,single-incision laparoscopic transabdominal preperitoneal(SIL-TAPP)inguinal hernia repair is becoming in-creasingly popular in the management of inguinal hernia in women.However,there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal(CL-TAPP)inguinal hernia repair for the treatment of inguinal hernia in women.AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients.METHODS We retrospectively compared the clinical information and follow-up data of fe-male inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hos-pital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts.RESULTS This study included 123 patients,with 71 undergoing SIL-TAPP repair and 52 un-dergoing CL-TAPP repair.The two cohorts of patients and inguinal hernia charac-teristics were similar,with no statistically meaningful difference.The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort(0,0%)than in patients in the CL-TAPP cohort(4,7.7%)and was significantly different(P<0.05).In addition,the median[interquartile range(IQR)]total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort[$3287(3218-3325)]than in patients in the CL-TAPP cohort[$3511(3491-3599)].Postoperatively,the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort(0,0%)than in the CL-TAPP cohort(4,7.7%),and the median(IQR)cosmetic score was significantly higher in the SIL-TAPP cohort[10(10-10)]than in the CL-TAPP cohort[9(9-10)].CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female in-guinal hernia patients.Moreover,female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who un-derwent CL-TAPP repair.In addition,female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision.Therefore,SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.

Robot-assisted partial splenectomy for benign splenic tumors:Four case reports

BACKGROUND Robotic-assisted partial splenectomy(RAPS)is a superior approach for treating splenic cysts and splenic hemangiomas,as it preserves the immune function of the spleen and reduces the risk of overwhelming post splenectomy infection.Curren-tly,there are no standardized guidelines for performing a partial splenectomy.CASE SUMMARY Four patients with splenic cysts or splenic hemangiomas were treated by RAPS.Critical aspects with RAPS include carefully dissecting the splenic pedicle,accurately identifying and ligating the supplying vessels of the targeted segment,and ensuring precise hemostasis during splenic parenchymal transection.Four successful RAPS cases are presented,where the tumors were removed by pret-reating the splenic artery,dissecting and ligating the corresponding segmental vessels of the splenic pedicle,transecting the ischemic segment of the spleen,and using electrocautery for optimal hemostasis.Four patients underwent successful surgeries with minimal bleeding during the procedure,and there were no signs of bleeding or recurrence postoperatively.CONCLUSION Four cases confirm the feasibility and superiority of RAPS for the treatment of benign splenic tumors.

Research progress on the immune microenvironment of the gallbladder in patients with cholesterol gallstones

Cholesterol gallstones are very common in hepatobiliary surgery and have been studied to a certain extent by doctors worldwide for decades.However,the mechanism of cholesterol gallstone formation is not fully understood,so there is currently no completely effective drug for the treatment and prevention of cholesterol gallstones.The formation and development of cholesterol gallstones are caused by a variety of genetic and environmental factors,among which genetic susceptibility,intestinal microflora disorders,impaired gallbladder motility,and immune disorders are important in the pathogenesis of cholesterol gallstones.This review focuses on recent advances in these mechanisms.We also discuss some new targets that may be effective in the treatment and prevention of cholesterol gallstones,which may be hot areas in the future.

Influence of baryons on the spatial distribution of matter:higher order correlation functions

Physical processes involving baryons could leave a non-negligible imprint on the distribution of cosmic matter.A series of simulated data sets at high resolution with identical initial conditions are employed for count-in-cell analysis,including one N-body pure dark matter run,one with only adiabatic gas and one with dissipative processes.Variances and higher order cumulants Sn of dark matter and gas are estimated.It is found that physical processes with baryons mainly affect distributions of dark matter at scales less than 1 h-1 Mpc.In comparison with the pure dark matter run,adiabatic processes alone strengthen the variance of dark matter by～10%at a scale of 0.1 h-1 Mpc,while the Sn parameters of dark matter only mildly deviate by a few percent.The dissipative gas run does not differ much from the adiabatic run in terms of variance for dark matter,but renders significantly different Sn parameters describing the dark matter,bringing about a more than 10%enhancement to S3 at 0.1 h-1 Mpc and z=0 and being even larger at a higher redshift.Distribution patterns of gas in two hydrodynamical simulations are quite different.Variance of gas at z=0 decreases by～30%in the adiabatic simulation but by～60%in the nonadiabatic simulation at 0.1 h-1 Mpc.The attenuation is weaker at larger scales but is still obvious at～10 h-1 Mpc.Sn parameters of gas are biased upward at scales 〈～4 h-1 Mpc,and dissipative processes show an～84%promotion at z=0 to S3 at 0.1 h-1 Mpc in contrast with the～7%change in the adiabatic run.The segregation in clustering between gas and dark matter could have dramatic implications on modeling distributions of galaxies and relevant cosmological applications demanding fine details of matter distribution in a strongly nonlinear regime.

Minimum Time Extrema Estimation for Large-Scale Radio-Frequency Identification Systems

We consider the extrema estimation problem in large-scale radio-frequency identification(RFID)systems,where there are thousands of tags and each tag contains a finite value.The objective is to design an extrema estimation protocol with the minimum execution time.Because the standard binary search protocol wastes much time due to inter-frame overhead,we propose a parameterized protocol and treat the number of slots in a frame as an unknown parameter.We formulate the problem and show how to find the best parameter to minimize the worst-case execution time.Finally,we propose two rules to further reduce the execution time.The first is to find and remove redundant frames.The second is to concatenate a frame from minimum value estimation with a frame from maximum value estimation to reduce the total number of frames.Simulations show that,in a typical scenario,the proposed protocol reduces execution time by 79%compared with the standard binary search protocol.