Anatomical variations of ilioinguinal nerve: A systematic review of the literature.

Background: Several anatomical variations of the ilioinguinal nerve branches have been recorded in older studies. Knowledge of these variations is useful for the improvement of peripheral nerve blocks and avoidance of iatrogenic nerve injuries during abdominal surgeries. The purpose of this study is to perform a systematic review of the literature about the anatomical topography and variations of the ilioinguinal nerve. Methods: An extensive search in PubMed, Scopus, and Web of Science electronic databases was conducted by the first author in November 2021, with the use of the PRISMA guidelines. Anatomical or cadaveric studies about the origin, the course, and the distribution of the ilioinguinal nerve were included in this review. Thirty-one cadaveric studies were included for qualitative analysis. Results: Several anatomical variations of the ilioinguinal nerve were depicted including its general properties, its origin, its branching patterns, its course, its relation to anatomical landmarks, and its termination. Among them, the absence of ilioinguinal nerve ranged from 0% to 35%, its origin from L1 ranged from 65% to 100%, and its isolated emergence from psoas major ranged from 47% to 94.5%. Numerous anatomical variations of the ilioinguinal nerve exist, not commonly cited in classic anatomical textbooks. The branches of the ilioinguinal nerve may be damaged during spinal anesthesia and surgical procedures in the lower abdominal region. Conclusion: Therefore, a better understanding of the regional anatomy and its variations is of vital importance for the prevention of ilioinguinal nerve injuries.

Sex differences in vocal behavior in virtual rooms compared to real rooms.

This study investigates speech production under various room acoustic conditions in virtual environments, by comparing vocal behavior and the subjective experience of speaking in four real rooms and their audio-visual virtual replicas. Sex differences were explored. Males and females (N = 13) adjusted their voice levels similarly to room acoustic changes in the real rooms, but only males did so in the virtual rooms. Females, however, rated the visual virtual environment as more realistic compared to males. This suggests a discrepancy between sexes regarding the experience of realism in a virtual environment and changes in objective behavioral measures such as voice level.

Adaptive Spatial Scheduling for Event Traffic in LoRaWAN Networks.

Low-Power Wide-Area Networks constitute a leading, emerging Internet-of-Things technology, with important applications in environmental and industrial monitoring and disaster prevention and management. In such sensor networks, external detectable events can trigger synchronized alarm report transmissions. In LoRaWANs, and more generally in networks with a random access-based medium access algorithm, this can lead to a cascade of frame collisions, temporarily resulting in degraded performance and diminished system operational capacity, despite LoRaWANs' physical layer interference and collision reduction techniques. In this paper, a novel scheduling algorithm is proposed that can increase system reliability in the case of such events. The new adaptive spatial scheduling algorithm is based on learning automata, as well as previous developments in scheduling over LoRaWANs, and it leverages network feedback information and traffic spatial correlation to increase network performance while maintaining high reliability. The proposed algorithm is investigated via an extensive simulation under a variety of network conditions and compared with a previously proposed scheduler for event-triggered traffic. The results show a decrease of up to 30% in average frame delay compared to the previous approach and an order of magnitude lower delay compared to the baseline algorithm. These findings highlight the importance of using spatial information in adaptive schemes for improving network performance, especially in location-sensitive applications.

An On-Demand TDMA Approach Optimized for Low-Latency IoT Applications.

The never-ending evolution of the Internet of Things ecosystem is reshaping the arena of wireless communications and competing against conventional networking solutions in fields such as battery life, device and deployment cost, coverage, and support for an immense number of devices. Inspired by this phenomenon, this paper presents a novel Medium Access Control protocol utilizing long-range technology, based on a Time Division Multiple Access communication protocol variant, adjusted to make better use of each device's hardware. Focusing on Low Power Wide Area Network applications, this implementation improves data latency and offers amplified performance due to better network awareness and dynamic time slot rescheduling. Various simulation scenarios were contrived to evaluate the protocol's performance. The results instate the proposed algorithm as a promising access scheme for the IoT field.

An Adaptive LoRaWAN MAC Protocol for Event Detection Applications.

In recent years, the Internet of Things (IoT) is growing rapidly and gaining ground in a variety of fields. Such fields are environmental disasters, such as forest fires, that are becoming more common because of the environmental crisis and there is a need to properly manage them. Therefore, utilizing IoT for event detection and monitoring is an effective solution. A technique for monitoring such events over a large area is proposed in this research. This work makes use of the Long-Range Wide Area Network (LoRaWAN) protocol, which is capable to connect low-power devices distributed on large geographical areas. A learning-automata-based hybrid MAC model is suggested to reduce the transmission delay, when a small part of the network produces event packets stemming from an event occurrence that is related to environmental monitoring applications, such as events related to forest fires. The proposed hybrid MAC is evaluated via simulation, which indicates that it achieves significantly higher performance in terms of packet delay, when compared to traditional LoRaWAN schemes.

MTHFR Polymorphisms in Girls with Anorexia Nervosa: Implications on Body Weight.

The development of atypical vs typical anorexia nervosa (AN) might be explained by the genetic background. We assessed the link between the subtypes of AN and the genetic polymorphisms of the thrombotic panel and the methyltetrahydrofolate reductase (MTHFR) gene. This cross-sectional pilot study recruited 48 girls with AN and 10 age-matched control girls with normal menstruation. We recorded anthropometric parameters and obtained blood samples for genotyping and hormonal assessment. Classification of AN was performed according to the DSM-V criteria. Girls with AN had 2.66 times higher odds of carrying at least one genetic polymorphism from the MTHFR panel (C677T and A1298C) compared with girls without AN (OR = 2.660, p-value = 0.041; CI 95% 1.057-6.720). The presence of atypical vs typical AN was associated independently with the presence of any of the assessed MTHFR polymorphisms (C677T, OR = 4.929, 95% CI 1.076-22.579, p-value = 0.040; A1298C, OR = 0.097, 95% CI 0.011-0.866, p-value = 0.037) in age and estrogen adjusted models. The atypical presentation of AN is mainly linked with higher prevalence of the MTHFR C677T and lower prevalence of the A1298C polymorphism.

Towards the Definition of an Intelligent Triage and Continuous Monitoring System for Hospital Emergency Departments and Clinics.

Recent statistics have demonstrated that Emergency Departments (EDs) in Greece lack in organization and service. In most cases, patient prioritization is not automatically implemented. The main objective of this paper is to present IntelTriage, a smart triage system, that dynamically assigns priorities to patients in an ED and monitors their vital signs and location during their stay in the clinic through wearable biosensors. Initital scenarios and functional requirements are presented as preliminary results.

Comparison of Triflusal with Aspirin in the Secondary Prevention of Atherothrombotic Events; Α Randomised Clinical Trial.

BACKGROUND: Triflusal has demonstrated an efficacy similar to aspirin in the prevention of vascular events in patients with acute myocardial infarction (ΜΙ) and ischaemic stroke but with less bleeding events. OBJECTIVE: We performed a randomised, multicentre, phase 4 clinical trial to compare the clinical efficacy and safety of triflusal versus aspirin, administered for 12 months in patients eligible to receive a cyclooxygenase-1 (COX-1) inhibitor. METHODS: Patients with stable coronary artery disease or with a history of non-cardioembolic ischaemic stroke were randomly assigned to receive either triflusal 300 mg twice or 600 mg once daily or aspirin 100 mg once daily for 12 months. The primary efficacy endpoint was the composite of: (a) ΜΙ, (b) stroke (ischaemic or haemorrhagic), or, (c) death from vascular causes for the entire follow-up period. The primary safety endpoints were the rate of bleeding events as defined by Bleeding Academic Research Consortium (BARC) criteria. RESULTS: At 12-month follow-up, an equivalent result was revealed between the triflusal (n=559) and aspirin (n=560) in primary efficacy endpoint. Specifically, the combined efficacy outcome rate (i.e. MI, stroke or death from vascular causes) difference was equal to -1.3% (95% confidence interval -1.1 to 3.5) and lied within the a-priori defined equivalence interval (p<0.001). Regarding the primary safety endpoints, patients on triflusal treatment were 50% less likely to develop bleeding events according to the BARC criteria, and especially any clinically overt sign of haemorrhage that requires diagnostic studies, hospitalisation or special treatment (BARC type 2). CONCLUSION: The efficacy of triflusal in the secondary prevention of vascular events is similar to aspirin when administered for 12 months. Importantly, triflusal significantly reduced the incidence of ΜΙ and showed a better safety profile compared with aspirin. (ASpirin versus Triflusal for Event Reduction In Atherothrombosis Secondary prevention, ASTERIAS trial; Clinical Trials.gov Identifier: NCT02616497).

Fournier's gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient.

Fournier's gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation) requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier's gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy), while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier's gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.

Emergency surgery for obstructing colorectal malignancy: prognostic and risk factors.

PURPOSE: Emergency surgery for colorectal malignant obstruction is thought to correlate with poor outcome. The main aim of our study was to identify possible factors that could predict obstruction, and risk factors of poor postoperative outcome. The second aim was to determine any differences between primary anastomosis and stoma creation in the obstruction population, especially in left-sided tumors. METHODS: A retrospective review of 212 patients who underwent surgery for colorectal malignancy between January 2008 and January 2013 was performed. Fifty-five patients (26%) underwent emergency surgery for completely obstructing colorectal carcinoma, and 157 (74%) underwent elective surgery. RESULTS: The groups were comparable for age, gender, ASA score, tumor location, tumor stage, lymph node metastasis and mortality. Advanced tumor stage was recorded as the only prognostic factor of obstruction (p=0.001). Postoperative mortality rate was 9.1% in the obstruction group and 6.4% in the elective group (p=0.498). Analysis didn't reveal any risk factors for poor early outcome in the obstruction group. All patients with right-sided obstructive cancer were treated with resection and primary anastomosis, while the same procedure was performed in almost 61% of operations for left-sided tumors with no anastomotic failure. CONCLUSIONS: Obstructive colorectal malignancy presents at a more advanced stage compared with non-obstructive cancer, with, interestingly, no statistically significant differences in postoperative mortality. Risk factors of poor early outcome couldn't be identified. Resection and primary restitution of continuity is the surgical approach of choice for right-sided obstructive cancers, but it can be, also, safely performed in left-sided cancers.

Laparoscopic adjustable gastric band: 4-year experience and learning curve.

BACKGROUND AND OBJECTIVES: Laparoscopic adjustable gastric banding has become the most popular procedure for the treatment of morbid obesity in Europe. The objectives of this series are to report the results of the 4-year experience of a single surgeon and to define the learning curve. METHODS: A retrospective review of 156 patients who underwent laparoscopic adjustable gastric banding between October 2006 and May 2010 was performed. Patients were separated into 3 groups: group 1 comprised the first 50 patients; group 2 comprised the second 50 patients; and group 3 comprised the last group of patients, with a total of 56 patients. RESULTS: The male-to-female ratio was 1:4 (33 male and 133 female patients). The mean age was 38 years (range, 17-62 years). The mean preoperative body mass index was 44.9 kg/m(2). The mean percent excess weight loss was 41.7% at the 1-year follow-up visit (153 patients, 98%), 49.7% at the 2-year follow-up visit (147 patients, 94%), and 50.2% at the 3-year follow-up visit (127 patients, 81%). The overall complication rate and major complication rate were 15.4% and 3.2%, respectively. There were no deaths. Percent excess weight loss, length of hospitalization (in days), and complication rates were compared among the 3 groups. No significant differences were noted among the groups except in the number of complications (P < .001), but all data were clearly improved in groups 2 and 3. CONCLUSIONS: The analyses in this study have documented one more time that laparoscopic adjustable gastric banding is an effective procedure for the treatment of morbid obesity, achieving >50% excess weight loss at 3 years. It is a procedure with certain complications even when performed by a surgeon with previous experience in laparoscopic surgery. According to our subset analysis, the learning curve is at least 50 procedures.

Splenic inflammatory pseudotumor-like follicular dendritic cell tumor.

Inflammatory pseudotumor of the spleen with expression of follicular dendritic cell markers is an extremely rare lesion with only a few cases reported previously. The present study reports on an inflammatory pseudotumor of the spleen 10 × 8 × 7 cm in size that was incidentally found in a 61-year-old man and increased gradually in size during a period of 3 months. Abdominal ultrasonography revealed a well-circumscribed splenic mass, and abdominal computed tomography confirmed the presence of a well-circumscribed isodense lesion in the splenic hilum with inhomogenous enhancement in the early-phase images and no enhancement on delayed-phase contrast-enhanced images. Magnetic resonance imaging of the abdomen showed a well-defined isodense tumor on T1-weighted images with mildly increased signal intensity on T2-weighted images, and this is only the second study that provides MRI findings of this entity. The patient underwent an uncomplicated open splenectomy for definitive histologic diagnosis. Under microscopic examination, the lesion was an admixture of lymphocytes, plasma cells and spindle cells. In situ hybridization analysis for Epstein-Barr virus (EBV) revealed that most of the spindle cells were positive for EBV, and immunochemistry showed the expression of the follicular dendritic cell markers CD21, CD35 and CD23 within the tumor. The diagnosis of inflammatory pseudotumor-like follicular dendritic cell tumor was established.

Intestinal neuronal dysplasia type B in adults: a controversial entity.

Intestinal neuronal dysplasia (IND) is a well-defined entity which raises controversy among authors, described as a congenital malformation of gastrointestinal innervation and caused by dysplastic embryonal development of the enteric nervous system. It is potentially associated with mild and chronic gastrointestinal motility disturbances. IND is rarely reported in adults and especially elderly patients. The present study reports on the case of a 71-year-old man suffering from longstanding idiopathic constipation and who was misdiagnosed for more than 60 years, despite several hospital admissions and a sigmoidectomy in the meantime. On the last admission, the patient presented with megacolon, abdominal pain and X-ray finding of bowel obstruction. Due to massive large bowel dilatation, an exploratory laparotomy failed to reveal any obvious mechanical cause, and a subtotal colectomy and Hartmann's procedure was performed. Bowel continuity was performed 3 months later. Analysis of full-thickness biopsies revealed enlarged myenteric and submucosal neurons as well as an increased number of giant cells and increased acetylcholinesterase activity in the mucosa. The diagnosis of IND was established. The main diagnostic criteria, the underlining pathophysiology and the recommended therapeutic approach of this rare entity are extensively reviewed.

Presacral ganglioneuroma: diagnostic considerations and therapeutic strategy.

Presacral ganglioneuroma is an extremely rare tumor of neural crest origin. To the best of our knowledge, less than 20 cases have been reported previously. The present study reports on a presacral ganglioneuroma, 10.5 × 8 × 4 cm in size, that was found incidentally in a 35-year-old man with prior history of diverticulitis. He was admitted to our hospital due to lower left abdominal pain. Abdominal computed tomography and magnetic resonance imaging confirmed the extension of the lesion from the S2 level to the coccyx. The mass had low signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images with no intraspinal or rectal extension. T2-weighted images demonstrated a compartmentalized solid tumor with cystic components. Complete tumor resection with free surgical margins was achieved using an abdominal approach. The patient remains asymptomatic 2 years after surgery. We emphasize on clinical features, radiologic appearance and surgical treatment of this rare entity. The clinical and pathologic features of previously reported studies are also briefly reviewed.

Mixed large cell neuroendocrine carcinoma with squamous cell carcinoma of the rectum: Report of a rare case and review of the literature.

INTRODUCTION: Mixed large cell neuroendocrine neoplasms of the rectum are rare and aggressive neoplasms. Survival is poor due to the high rate of lymph node metastases and distant metastases at the time of diagnosis. PRESENTATION OF CASE: We report a case of a 50-year-old male patient with a mixed large cell neuroendocrine carcinoma with squamous cell carcinoma of the rectum located 8cm from the anal verge, treated with low anterior resection and total mesorectal excision with free surgical margins. There were lymph nodes metastases but no distant metastases at the time of diagnosis. The patient refused to receive adjuvant chemotherapy and died 6 months later due to liver failure as a result of multiple hepatic metastases. DISCUSSION: There are not known predisposing factors for the development of neuroendocrine rectal carcinoma. A neuroendocrine carcinoma of the rectum is a rare tumor with an incidence of less than 0.1% of all colorectal malignancies. The median survival ranges from 5 to 10.4 months in several studies and there are not sufficient data in bibliography about ideal adjuvant therapy after resection of mixed squamous large cell neuroendocrine carcinoma of the rectum. CONCLUSION: Low anterior resection and total mesorectal excision with free surgical margins in the presence of lymph nodes metastasis is not a sufficient treatment for rectal neuroendocrine carcinoma. More studies should be done in order to determine the ideal adjuvant treatment of these rare and aggressive tumors.

Combined Case of Blood-Injury-Injection Phobia and Social Phobia: Behavior Therapy Management and Effectiveness through Tilt Test.

The efficacy of behavior therapy based mainly on real-life exposure situations as well as applied tension was examined for a combined case of blood-injury-injection (BII) phobia and social anxiety disorder. Treatment involved 28 behavior therapy sessions, while applied tension technique was also described and practiced. The specific contribution of social skills techniques, fantasy, and real-life situations exposure was examined in a single case design. The subject was a 39-year-old male with anxiety symptoms when confronting an audience, as well as symptoms of the autonomic nervous system (bradycardia and syncope), which were better explained by BII. All self-report measures regarding fear, social phobia, and anxiety were reduced after behavior therapy and remained maintained at followup, while BII decreased further after applied tension techniques. The contribution of behavior therapy to the overall outcome of the case is considered significant for many reasons that are discussed in the pape.

Primary midgut volvulus in adults: report of two cases and review of the literature.

INTRODUCTION: This is a report of two male patients (35 and 54 years old, respectively) admitted to our surgical department with signs of small-bowel obstruction. CASE PRESENTATIONS: Diagnostic workup with plain abdominal radiographs and, more specifically, computed tomography suggested the possibility of bowel rotation. In order to exclude any possibility of associated intestinal ischemia, both patients underwent exploratory laparotomy, which revealed a midgut volvulus without any associated obvious cause or pathology. DISCUSSION: Both patients had an eventful outcome. Epidemiologic characteristics, clinical presentation, diagnostic workup, surgical treatment, and morbidity-mortality rates of small-bowel volvulus have been reviewed and thoroughly discussed.

Impaired glucose metabolism and the exaggerated blood pressure response to exercise treadmill testing in normotensive patients.

The authors aimed to investigate the association between glucose metabolism measures and the exaggerated blood pressure response (EXBPR) to exercise testing in normotensive nondiabetic patients. One hundred and forty-two consecutive patients underwent office blood pressure (BP) measurements, 24-hour BP monitoring, echocardiography, and treadmill exercise test according to the Bruce protocol. The population was divided into 2 groups according to EXBPR at a submaximal workload level. Furthermore, blood samples were obtained for fasting glucose (FG), fasting insulin (FI), and lipid profile assessment. Measures of insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR], quantitative insulin sensitivity check index [QUICKI], and McAuley index) were also estimated, and a standardized oral glucose tolerance test was performed to evaluate glucose levels at 120 minutes (G120). Patients with EXBPR (n=40; 27 men) compared with those without EXBPR (n=102; 66 men) were older by 4+/-6 years (P<.001). FG, FI, G120, HOMA-IR, QUICKI, and McAuley index differed in patients with EXBPR compared with those without EXBPR (P<.001 for all). Logistic multivariable regression models revealed that the studied glucose metabolism measures, duration of exercise, and 24-hour systolic BP remained determinants of EXBPR (P<.05 for all) after adjustment. Impaired glucose measures are significant determinants of EXBPR to exercise testing in normotensive nondiabetic patients, suggesting that impaired glucose metabolism may contribute to adverse cardiovascular prognosis including new-onset hypertension.