Intraneural fibrosis within ilioinguinal nerve in inguinal hernia patients with preoperative pain: it's the sign of irreversible nerve injury, isn't it?

PURPOSE: Preoperative pain is known as one of the most powerful risk factors for chronic postoperative inguinal pain (CPIP), while its pathogenesis has not been fully elucidated. The aim of the present study was to evaluate patients with preoperative pain from the pathological perspective and discuss the potential pathogenesis of CPIP in those patients. METHODS: This was a single-institutional retrospective study. The study population was inguinal hernia patients with preoperative pain who underwent open anterior hernia repair for primary inguinal hernia with pragmatic ilioinguinal neurectomy during surgery between March 2021 and March 2023. The primary and secondary outcomes were proportion of collagen deposition and mucus accumulation within ilioinguinal nerve in those patients, respectively, which were evaluated histologically using Image J software. RESULTS: Forty patients were evaluated. Median value of proportion of intraneural collagen deposition was 38.3% (27.7-95.9). These values were positively correlated with the duration of pain (r2=0.468, P<0.001). Median value of proportion of mucus accumulation in ilioinguinal nerve was 50.1% (0-82.0). These values had no correlation with any clinicopathological variables. CONCLUSIONS: In the present study population, all patients with preoperative pain had intraneural fibrosis within ilioinguinal nerve, and its degree had a positive correlation with the pain duration.

Density functional theory based first-principle calculation of Nb-doped anatase TiO2 and its interactions with oxygen vacancies and interstitial oxygen.

The structure and electronic properties of Nb-doped anatase (TNO) were studied from first principles using the density functional theory based band structure method. Four independent types of unit cells were studied; i.e., pure anatase, anatase with Nb dopant at Ti sites (Nb(Ti)), and cells with either interstitial oxygen (O(i)) or oxygen vacancies (V(O)). In addition, a unit cell with a Nb(Ti) and O(i), and a cell with Nb(Ti) and V(O) were investigated to clarify the role of nonstoichiometry in TNO. From the calculated results, the importance of the adjacent Nb(Ti)-V(O) and Nb(Ti)-O(i) structures was pointed out, and the experimental observation of the relationship between nonstoichiometry and electronic conductivity was rationalized. The shape of the impurity states found in these structures was used to comprehend the experimental observation of carrier concentration and the charge state of Nb dopant. The changes in lattice constants supported the existence of these structures as well. On the contrary, the cell with a simple Nb(Ti) did not show significant changes in structure and electronic properties, other than the emission of an electron in the conduction band. A stabilization of the impurity state was observed in the adjacent Nb(Ti)-V(O) structure compared to the V(O). The possibility of an essential role of this state in electric conduction was discussed. The formation of the adjacent Nb(Ti)-O(i) structure by O(2) gas annealing was discussed using statistical mechanics. The Gibbs free energies were calculated for O(i) atoms in TNO and compared to that of O(2) molecules in the gas phase. The analysis was qualitatively consistent with experimental behavior under the assumption of the Nb(Ti)-V(O) structures.