Anterior versus posterior component separation technique for advanced abdominal wall reconstruction: a proposed algorithm.

OBJECTIVE: The precise indications for employing the anterior component separation technique (ACST) and the Transversus Abdominis Release (TAR) in abdominal wall reconstruction (AWR) remain uncertain, despite the undeniable value of both techniques. The aim of this study was to analyze the anterior fascial closure rate, postoperative wound morbidity, and hernia recurrence rate for both procedures according to the algorithm used for complex AWR. METHODS: A retrospective analysis of prospectively collected data was carried out. Patients undergoing AWR for midline incisional hernias using either open or endoscopic ACST (E-ACST) or TAR between March 2013 and August 2022 were included. Patients with lateral hernia components were excluded. The surgical technique was depending on the pre- and intraoperative findings regarding hernia width and on the estimated traction to achieve anterior fascial closure (see algorithm). Initially, intermediate hernia defects ranging from approximately 10-14 cm in width were repaired using E-ACST. However, as the study advanced, TAR became the preferred method for addressing these types of defects. Open ACST was consistently employed for defects wider than 14-15 cm throughout the entire study duration. Outcomes of interest were anterior fascial closure, surgical site occurrences, and hernia recurrence rate. Follow-up was performed at 1 month, 1 year, and 2 years. RESULTS: A total of 119 patients underwent AWR with CST: 63 patients (52.9%) were included in the ACST group and 56 patients (47.1%) in the TAR group. No significant differences were observed in patient and hernia characteristics. The use of botulinum toxin A (BTA) injection and preoperative progressive pneumoperitoneum (PPP) was more frequently used in the ACST group (BTA 19.0%, PPP 15.9% versus BTA 5.4%, PPP 1.8% for TAR patients). Anterior fascial closure was achieved in 95.2% of the ACST group and 98.2% of the TAR group (p = 0.369). The TAR group demonstrated a significantly lower SSO rate at one month (44.3% versus 14.3%, p < 0.001) and required fewer procedural interventions (SSO-PI) (31.1% versus 8.9%, p = 0.003). The recurrence rate at one year was low and there was no statistically significant difference between the two groups (ACST 1.8% vs TAR 4.5%, p = 0.422). CONCLUSION: Following a proposed algorithm, the anterior fascial closure rate was high and similar for both techniques. As postoperative wound morbidity is significantly increased after ACST, our findings support recommending TAR for defects up to 14 cm in width, while favoring open ACST for larger defects.

Ancestral range reconstruction of remote oceanic island species of Plantago (Plantaginaceae) reveals differing scales and modes of dispersal.

AIM: The aim of this study was to resolve the phylogenetic placement of island taxa, reconstruct ancestral origins and resolve competing hypotheses of dispersal patterns and biogeographical histories for oceanic island endemic taxa within subgenus Plantago (Plantaginaceae). LOCATION: Juan Fernández Islands, the Auckland Islands, Lord Howe Island, New Amsterdam Island, New Zealand, Tasmania, Falkland Islands, Rapa Iti and the Hawaiian Islands. TAXON: Island endemics within Plantago (Plantaginaceae), a globally distributed taxonomic group comprising approximately 250 species. METHODS: We use Bayesian phylogenetic and divergence time analyses and historical biogeographical analysis of molecular sequence data to infer the ancestral origins of the oceanic island species in Plantago. RESULTS: Taxa within subgenus Plantago form clades based on geographic proximities and challenge previous phylogenetic relationships and classification based on morphology. We infer that biogeographic histories of oceanic island taxa from multiple islands were shaped by dispersal at different scales and possibly by different types of birds. The highly remote Hawaiian Islands and Rapa Iti were colonized from North American taxa in a pattern corresponding to known migration routes of large marine birds, rather than from New Zealand as previously hypothesized. The island endemics of Juan Fernández, the Falkland Islands, Lord Howe, Auckland Islands and New Zealand are found to have sources in the nearest continental areas. The analyses confirm recent speciation within subgenus Plantago - which is particularly heightened in island lineages in Hawaii and Rapa Iti - but show slightly older divergence times than previous molecular dating studies. MAIN CONCLUSIONS: Using molecular data to infer ancestral ranges for plants with uncertain taxonomic relationships can greatly improve our understanding of biogeographical histories and help elucidate origins, dispersal modes and routes in widespread lineages with complex distribution patterns such as Plantago. We improve understanding of important floristic exchange areas between continents and islands as a result of long-distance dispersal. We infer that a combination of both stepping stone dispersal and extreme long-distance dispersal can shape insular floras, and that multiple floristic areas can be the sources of closely related island taxa. However, despite the successful dispersal of Plantago, radiation in island archipelagos is generally limited suggesting specific traits may limit diversification.

Slavery and the social dynamics of male homosexual relations in ancient Rome.

More than any other institution, slavery placed its stamp on male homosexual relations in ancient Rome. While the pervasive Hellenization of Roman society in the second and first centuries B.C. mitigated the traditional hostility towards homosexuality and homosexual relations and even, in cultured circles, fostered an idealizing acceptance of male pederastic relations patterned after the model of classical Greece, this transformation of attitudes would have produced less concrete effects had Rome not concurrently become a slave-owning society on a large scale, due to overseas conquests. The strictures of Roman law and tradition applied only to sexual relations among free men and women; sexual relations between freemen and female or male slaves were unlikely to incur much social stigma. Although there is evidence that some Romans did indeed exploit their slaves, fortunately the great lacuna within the law and tradition, together with the emergence of more humane values regarding slavery and sexual relations, allowed genuine love-relationships (both heterosexual and homosexual) to receive a large measure of social sanction as a form of concubinage. Roman culture, however, unlike classical Green civilization, made little contribution to an informed acceptance of homosexual relations grounded in an understanding of human ethics and psychology.