Comparison of Flow Characteristics Around Refractive and Right-angled Groins in Barotropic and Baroclinic Conditions

Groins are employed to prevent nearshore areas from erosion and to control the direction of flow. However, the groin structure and its associated flow characteristics are the main causes of local erosion. In this study, we investigate the flow patterns around refractive and right-angle groins. In particular, we analytically compare the flow characteristics around a refractive groin and study the degree of accuracy that can be achieved by using a right-angle groin of various projected lengths. To compare the flow characteristics, we replaced the right-angle groin with an approximation of a refractive groin. This replacement had the least effect on the maximum velocity of flow in the channel. Moreover, we investigated the distribution of the density variables of temperature and salinity, and their effects on the flow characteristics around the right-angle groin. A comparison of the flow analysis results in baroclinic and barotropic conditions reveals that the flow characteristic values are very similar for both the refractive and right-angle groins. The geometry of the groin, i.e., right-angle or refractive, has little effect on the maximum speed to relative average speed. Apart from the angular separation, the arm length of the groin in downstream refractive groins has less effect on other flow characteristics than do upstream refractive groins. We also correlated a number of non-dimensional variables with respect to various flow characteristics and groin geometry. These comparisons indicate that the correlation between the thalweg height and width of the channel and groin arm＇s length to projection length have been approximated using linear and nonlinear formulas regardless of inner velocity in the subcritical flow.

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.

Reliability of the K-Force Muscle Controller Dynamometer on Eccentric and Isometric Hip Adduction Strength

Hip adduction strength tests are commonly used in clinical practice to provide an accurate diagnosis of groin injuries. Athletes with reduced adductor muscle strength are at risk of developing groin injuries. Our study aimed to evaluate the relative and absolute test-retest reliability of the side-lying eccentric hip adduction strength test and the long-lever adduction squeeze test using the K-Force hand-held dynamometer. Twenty physically active male individuals with a mean age (±SD) of 30.7 (±7.3) years were included. Both tests presented excellent test-retest reliability (Intraclass Correlation Coefficient: 0.77 - 0.95). The best and mean scores of the eccentric and isometric tests presented the smallest test-retest variation (MDC%: 12.8 - 14.9 and MDC%: 14.6 - 18.7, respectively). Our study showed that the K-Force dynamometer has excellent reliability for assessing hip adduction strength in two different testing positions. We suggest the best and mean of three repetitions for clinical practice as they present the lowest variability. Further research evaluating its clinimetric properties in different populations and gender is recommended.

Urogenital Complications of Groin Hernia Surgery: A Multicentre Study in Guinea

Context and Objective: Groin hernia is a common pathology in visceral surgery (2nd rank after appendicitis), which affects approximately 4.6% of the African population. Restoring the normal anatomy of the groin region is one of the most benign interventions. However, uro-andrological complications are possible. This study aimed to contribute to the improvement of the management of urogenital complications of groin hernia surgery. Patients and Method: We carried out a prospective study of descriptive type with a duration of 6 months from 1 August 2021 to 31 January 2022. The data were collected using a pre-established survey sheet. The study covered several sites (public hospitals and private clinics) in Guinea. Results: The urogenital complications of the surgery of the hernia of the groin represented 15.22% or 14 cases out of 92 patients. The average age was 37.00 years with extremes of 20-69 years. Polygamists occupied the first place. The reason for consultation was dominated by decreased testicular volume (42.86%), followed by a desire to conceive (21.43%). Unilateral testicular atrophy represented 63.64%, bilateral 27.27%. We performed a left orchidectomy in one patient and a cystorraphy in another simple operative follow-up. The other cases consisting of testicular atrophy, due to lack of a suitable technical platform, did not benefit from any specific therapeutic treatment. Conclusion: Urogenital complications of groin hernia surgery are relatively common. Testicular atrophy was the main clinical complication. The left orchidectomy and cystorraphy were the therapeutic procedures performed.

Microstructure and mechanical properties of AZ61 magnesium alloy prepared by repetitive upsetting-extrusion

The process of repetitive upsetting-extrusion （RUE） was used to achieve severe plastic deformation （SPD） for an as-cast AZ61 magnesium alloy in temperature range of 285-380 ℃. The microstructure and mechanical properties of the as-cast and RUE processed AZ61 alloys were investigated. The results indicated that homogeneous fine-grained structure with mean grain size of 3.5 μm was obtained as the accumulated true strain in the axial direction increased to 4.28 after three RUE passes at 285 ℃. The dominant reason of grain refinement was considered the dynamic recrystallization induced by strain localization. It was also found that the microstructural evolution was affected by temperature and accumulated deformation. The mechanical properties of RUE processed AZ61 alloys were significantly improved owing to grain refinement. Furthermore, the relationship between deformation parameters and mechanical properties of AZ61 alloy prepared by RUE processing was revealed by tensile tests carried out at room temperature.

Inguinodynia following Lichtenstein tension-free hernia repair:A review

Chronic Groin Pain (Inguinodynia) following inguinal hernia repair is a significant,though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However,moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain,as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair,use of heavyweight vs lightweight mesh and mesh fixation with sutures vs glue. Though there is no convincing evidence favouring one over the other,lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain,though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both nonsurgical and surgical options have been tried for chronic groin pain,with their consequent risks of analgesic sideeffects,recurrent pain,recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre-and post-herniorraphy.

Current trends in laparoscopic groin hernia repair: A review

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.

Current trends in the diagnosis and management of post-herniorraphy chronic groin pain

Inguinodynia(chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair.This has major impact on quality of life in a significant proportion of patients.The pain is classif ied as neuropathic and nonneuropathic related to nerve damage and to the mesh,respectively.Correct diagnosis of this problem is relatively difficult.A thorough history and clinical examination are essential,as is a good knowledge of the groin nerve distribution.In spite of the common nature of the problem,the literature evidence is limited.In this paper we discuss the diagnostic tools and treatment options,both non-surgical and surgical.In addition,we discuss the criteria for surgical intervention and its optimal timing.

Sports hernia and femoroacetabular impingement in athletes: A systematic review

AIM: To investigate the association between sports hernias and femoroacetabular impingement(FAI) in athletes.METHODS: Pub Med, MEDLINE, CINAHL, Embase, Cochrane Controlled Trials Register, and Google Scholar databases were electronically searched for articles relating to sports hernia, athletic pubalgia, groin pain, long-standing adductor-related groin pain, Gilmore groin, adductor pain syndrome, and FAI. The initial search identified 196 studies, of which only articles reporting on the association of sports hernia and FAI or laparoscopic treatment of sports hernia were selected for systematic review. Finally, 24 studies were reviewed to evaluate the prevalence of FAI in cases of sports hernia and examine treatment outcomes and evidence for a common underlying pathogenic mechanism.RESULTS: FAI has been reported in as few as 12% to as high as 94% of patients with sports hernias, athletic pubalgia or adductor-related groin pain. Cam-type impingement is proposed to lead to increased symphyseal motion with overload on the surrounding extra-articular structures and muscle, which can result in the development of sports hernia and athletic pubalgia. Laparoscopic repair of sports hernias, via either the transabdominal preperitoneal or extraperitoneal approach, has a high success rate and earlier recovery of full sports activity compared to open surgery or conservative treatment. For patients with FAI and sports hernia, the surgical management of both pathologies is more effective than sports pubalgia treatment or hip arthroscopy alone(89% vs 33% of cases). As sports hernias and FAI are typically treated by general and orthopedic surgeons, respectively, a multidisciplinary approach for diagnosis and treatment is recommended for optimal treatment of patients with these injuries.CONCLUSION: The restriction in range of motion due to FAI likely contributes to sports hernias; therefore, surgical treatment of both pathologies represents an optimal therapy.

Physical Modeling of Localized Scour for the Yangtze Estuary Waterway Improvement Project,Phase Ⅰ

In order to examine the effectiveness of engineering protection against localized scour in front of the south groin-group of the Yangtze Estuary Waterway Improvement Project, Phase I , an undistort-ed physical model on a geometric scale of 1:250 is built in this study, covering two groins and their adacent estuarine areas. By use of rinsing fix-bed model as well as localized mobile-bed model, the experiment is undertaken under bi-directional steady flow. According to the experimental results, waterway dredging leads to the increase in steram velocity, the increase being larger during the ebb than during the flood. Construction of the upstream groin has some influence on the flow patterns near the downstream groin. Localized scour in front of the groin-heads is controlled mainly by ebb flow. In the case of a riverbed composed entirely of silt, the depths of localized scour in front of the two groin- heads are 27 m and 29 m, respectively. In reality, the underneath sediment of the prototype riverbed is clay whose threshold velocity is much higher than the stream velocity in the Yangtze Estuary; therefore, the depths of localized scour will not be much larger than the thickness of the silt layer, i. e. 7.4 m and 4.7 m, respectively. The designed aprons covering the riverbed in fron of the groin-heads are very effective in scour control. Aprons of slightly smaller size can also fulfill the task of protection, but the area of localized scour increases significantly.

Review of the current surgical management of vulval cancer

Currently in the United Kingdom, 1200 cases of vulval cancer are diagnosed per annum accounting for 6% of female genital cancers. Although classically a condition that affects older women and associated with lichen sclerosus, there has been a greater incidence of vulval squamous tumours in young women due to the increasing prevalence of promoting human papillomavirus(HPV). The advent of a vaccination programme against HPV 16 and 18, the main aetiological causes of vulval intraepithelial neoplasia and cervical intraepithelial neoplasia, may reduce the incidence in future generations. Primary surgery is the current gold standard treatment and although mortality rates have reduced by 40% since the 1970 s, radical vulval resections are associated with significant morbidity such as wound breakdown, infection, lymphoedema and psychosexual consequences. Over the past decade there has been a move to less mutilating procedures in women diagnosed with early vulval cancer. This is in combination with the introduction of new surgical methods such as sentinel lymph node testing, more directed radiotherapy and chemotherapy options. These treatment methods are being assessed in clinical trials to determine their associated recurrence rates, survival rates and morbidity. Most vulval cancers are squamous cell in origin but, there are other histological subtypes including Paget's disease and vulval melanoma which can require different management approaches. The objective of this paper is to review the current literature on the management of vulval cancer, summarise the new treatments which are being developed and the associated evidence.

Fascinating history of groin hernias:Comprehensive recognition of anatomy,classic considerations for herniorrhaphy,and current controversies in hernioplasty

Groin hernias include indirect inguinal,direct inguinal,femoral,obturator,and supravesical hernias.Here,we summarize historical turning points,anatomical recognition and surgical repairs.Groin hernias have a fascinating history in the fields of anatomy and surgery.The concept of tension-free repair is generally accepted among clinicians.Surgical repair with mesh is categorized as hernioplasty,while classic repair without mesh is considered herniorrhaphy.Although various surgical approaches have been developed,the surgical technique should be carefully chosen for each patient.Regarding as interesting history,crucial anatomy and important surgeries in the field of groin hernia,we here summarized them in detail,respectively.Points of debate are also reviewed;important points are shown using illustrations and schemas.We hope this systematic review is surgical guide for general surgeons including residents.Both a skillful technique and anatomical knowledge are indispensable for successful hernia surgery in the groin.

Eco-Environmental Impact Assessment of Pre-Leisure Beach Nourishment on the Benthic Invertebrate Community at Anping Coast

In recent years, owing to global warming and the rising sea levels, beach nourishment and groin building have been increasingly employed to protect coastal land from shoreline erosion. These actions may degrade beach habitats and reduce biomass and invertebrate density at sites where they were employed. We conducted an eco-environmental evaluation at the Anping artificial beach-nourishment project area. At this site, sand piles within a semi-enclosed spur groin have been enforced by use of eco-engineering concepts since 2003. Four sampling sites were monitored during the study period from July 2002 to September 2008. The environmental impact assessment and biological investigations that we conducted are presented here. The results from this study indicate that both biotic （number of species, number of individual organisms, and Shannon-Wiener diversity） and abiotic parameters （suspended solids, biological oxygen demand, chemical oxygen demand, dissolved inorganic nitrogen, dissolved inorganic phosphorus, total phosphorus, total organic carbon, median diameter, and water content） showed significant differences before and after beach engineering construction. Biological conditions became worse in the beginning stages of the engineering but improved after the restoration work completion. This study reveals that the composition of benthic invertebrates changed over the study period, and two groups of organisms, Bivalvia and Gastropoda, seemed to be particularly suitable to this habitat after the semi-enclosed artificial structures completion.

Acute appendicitis presenting with abdominal wall and right groin abscess:A case report

We report a case of right lower abdominal wall and groin abscess resulting from acute appendicitis. The patient was an 27-year-old man who had no apparent abdominal signs and was brought to the hospital due to progressive painful swelling of right lower abdomen and the groin for 10 d. Significant inflammatory changes of soft tissue involving the right lower trunk were noted without any apparent signs of peritonitis. Laboratory results revealed leukocytosis. Abdominal ultrasonography described the presence of abscess at right inguinal site also communicating with the intraabdominal region. Right inguinal exploration and laparotomy were performed and about 250 mL of pus was drained from the subcutaneous tissue and preperitoneal space. No collection of pus was found intraabdominally and subserous acute appendicitis was the cause of the abscess. The patient fully recovered at the end of the second post-operation week. This case reminds us that acute appendicitis may have an atypical clinical presentation and should be treated carefully on an emergency basis to avoid serious complications.

Study on Coastal Protection Engineering in the Area of Abandoned Yellow River Mouth

This paper reviews the history of coast evolution and coastal protection in the area of the abandoned Yellow River mouth in Jiangsu Province, analyzes the erosion characteristics and dynamic environment, evaluates the efficiency of coastal protection engineering works and designs the dimensions of the main seadike and offshore submerged dam. A gerneral scheme of shore protection for this area is proposed.

Application of Headland Control for Stability of Beaches

Studies on the erosion processes and protective measures at the downcoast of the Friendship Port in Mauritania have been successfully conducted by means of 3-D movable-bed model using light model-sand. The headland control was accepted for the stability of the beach. This paper mainly deals with the shape, orientation, size and erosion depth of the artificial headland. Various forms of headland projects, such as the normal groin, arch groins bending to upcoast ancj to downcoast, offshore breakwater, and T-shaped dike, have been experimentally investigated. Through a comparison of effects of these works on the beach processes, optimized headlands have been obtained, that is, unsymmetrical T-shaped dike or arch groin bending to the downcoast, which has been practically and successfully applied for the stability of beaches.

Osteitis pubis in elite athletes:Diagnostic and therapeutic approach

Osteitis pubis(OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.

A Case of Local Groin Abscess Caused by Transfemoral Coronary Procedures

Bacterial infection due to coronary angiography is an uncommon but important complication of percutaneous coronary intervention (PCI) which is responsible for significant morbidity and extended hospital stay. The reasons for this symptom are still unclear. We report a case of local groin abscess two weeks after the latest procedure. The reasons responsible for the groin abscess in this case might be diabetes mellitus without being properly controlled, left ventricular (LV) systolic dysfunction, multiple operations in the same site, the usage of vascular closure device (VCD), and long time pressure after the procedure. We should pay enough attention to these risk factors in the future clinical practice to avoid this serious complication.

The Femoral Hernia: Some Necessary Additions

Purpose: The anatomic region through which most inguinal hernias emerge is overcrowded by various anatomical structures with intricate relationships. This is reflected by the wide range of anatomic interpretations. Material and Methods: A prospective anatomic study of over 100 fresh cadavers and 47 patients operated on for femoral hernias. Results: It was found that the transversalis fascia did not continue distally into the lymphatic lacuna. Medially this fascia did not reach the lacunar ligament, but was rather positioned above it forming laterally the vascular sheath. Here the fascia participates in the formation of a fossa, which varies in width and depth—the preperitoneal femoral fossa. The results did not confirm the presence of a femoral canal. The distances were measured between the pubic tubercle and the medial margin of the femoral vein, and between the inguinal and the Cooper’s ligaments. The results clearly indicate that in women with femoral hernias these distances are much larger. Along the course of femoral hernia exploration we established the presence of three zones that are rigid and narrow. These are the potential sites for femoral hernia incarceration. Conclusion: In the lower infra-inguinal space, where femoral hernias could appear, the integrity is achieved by means of a complex fusion of fascio-ligamentous structures, where the iliopubic tract, the medial condensations of the transversalis fascia and the lacunar ligament are the most important.

Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.