Trocar site hernia after gastric sleeve.

BACKGROUND: Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias. METHODS: Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey. RESULTS: The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH. CONCLUSIONS: The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.

Inter-fraction movements of the prostate and pelvic lymph nodes during IGRT.

OBJECTIVITIES: The aim of this study was to evaluate inter-fraction movements of lymph node regions that are commonly included in the pelvic clinical target volume (CTV) for high-risk prostate cancer patients. We also aimed to evaluate if the movements affect the planning target volumes. METHODS: Ten prostate cancer patients were included. The patients underwent six MRI scans, from treatment planning to near end of treatment. The CTV movements were analyzed with deformable registration technique with the CTV divided into sections. The validity of the deformable registration was assessed by comparing the results for individual lymph nodes that were possible to identify in all scans. RESULTS: Using repetitive MRI, measurements showed that areas inside the CTV (lymph nodes) in some extreme cases were as mobile as the prostate and not fixed to the bones. The lymph node volumes closest to the prostate did not tend to follow the prostate motion. The more cranial lymph node volumes moved less, but still independently, and they were not necessarily fixed to the pelvic bones. In 95% of the cases, the lymph node motion in the R-L direction was 2-4 mm, in the A-P direction 2-7 mm, and in the C-C direction 2-5 mm depending on the CTV section. CONCLUSION: Lymph nodes and prostate were most mobile in the A-P direction, followed by the C-C and R-L directions. This movement should be taken into account when deciding the margins for the planning target volumes (PTV).

Do gender differences in audio-visual benefit and visual influence in audio-visual speech perception emerge with age?

Gender and age have been found to affect adults' audio-visual (AV) speech perception. However, research on adult aging focuses on adults over 60 years, who have an increasing likelihood for cognitive and sensory decline, which may confound positive effects of age-related AV-experience and its interaction with gender. Observed age and gender differences in AV speech perception may also depend on measurement sensitivity and AV task difficulty. Consequently both AV benefit and visual influence were used to measure visual contribution for gender-balanced groups of young (20-30 years) and middle-aged adults (50-60 years) with task difficulty varied using AV syllables from different talkers in alternative auditory backgrounds. Females had better speech-reading performance than males. Whereas no gender differences in AV benefit or visual influence were observed for young adults, visually influenced responses were significantly greater for middle-aged females than middle-aged males. That speech-reading performance did not influence AV benefit may be explained by visual speech extraction and AV integration constituting independent abilities. Contrastingly, the gender difference in visually influenced responses in middle adulthood may reflect an experience-related shift in females' general AV perceptual strategy. Although young females' speech-reading proficiency may not readily contribute to greater visual influence, between young and middle-adulthood recurrent confirmation of the contribution of visual cues induced by speech-reading proficiency may gradually shift females AV perceptual strategy toward more visually dominated responses.

Age mitigates the correlation between cognitive processing speed and audio-visual asynchrony detection in speech.

Cognitive processing speed, hearing acuity, and audio-visual (AV) experience have been suggested to influence AV asynchrony detection. Whereas the influence of hearing acuity and AV experience have been explored to some extent, the influence of cognitive processing speed on perceived AV asynchrony has not been directly tested. Therefore, the current study investigates the relationship between cognitive processing speed and AV asynchrony detection in speech and, with hearing acuity controlled, assesses whether age-related AV experience mitigates the strength of this relationship. The cognitive processing speed and AV asynchrony detection by 20 young adults (20-30 years) and 20 middle-aged adults (50-60 years) were measured using auditory, visual and AV recognition reaction time tasks, and an AV synchrony judgment task. Strong correlations between audio, visual, and AV reaction times and AV synchrony window size were found for young adults, but not for middle-aged adults. These findings suggest that although cognitive processing speed influences AV asynchrony detection in speech, the strength of the relationship is seemingly reduced by AV experience.

Audio-visual speech experience with age influences perceived audio-visual asynchrony in speech.

Previous research indicates that perception of audio-visual (AV) synchrony changes in adulthood. Possible explanations for these age differences include a decline in hearing acuity, a decline in cognitive processing speed, and increased experience with AV binding. The current study aims to isolate the effect of AV experience by comparing synchrony judgments from 20 young adults (20 to 30 yrs) and 20 normal-hearing middle-aged adults (50 to 60 yrs), an age range for which a decline of cognitive processing speed is expected to be minimal. When presented with AV stop consonant syllables with asynchronies ranging from 440 ms audio-lead to 440 ms visual-lead, middle-aged adults showed significantly less tolerance for audio-lead than young adults. Middle-aged adults also showed a greater shift in their point of subjective simultaneity than young adults. Natural audio-lead asynchronies are arguably more predictable than natural visual-lead asynchronies, and this predictability may render audio-lead thresholds more prone to experience-related fine-tuning.

Audio-visual identification of place of articulation and voicing in white and babble noise.

Research shows that noise and phonetic attributes influence the degree to which auditory and visual modalities are used in audio-visual speech perception (AVSP). Research has, however, mainly focused on white noise and single phonetic attributes, thus neglecting the more common babble noise and possible interactions between phonetic attributes. This study explores whether white and babble noise differentially influence AVSP and whether these differences depend on phonetic attributes. White and babble noise of 0 and -12 dB signal-to-noise ratio were added to congruent and incongruent audio-visual stop consonant-vowel stimuli. The audio (A) and video (V) of incongruent stimuli differed either in place of articulation (POA) or voicing. Responses from 15 young adults show that, compared to white noise, babble resulted in more audio responses for POA stimuli, and fewer for voicing stimuli. Voiced syllables received more audio responses than voiceless syllables. Results can be attributed to discrepancies in the acoustic spectra of both the noise and speech target. Voiced consonants may be more auditorily salient than voiceless consonants which are more spectrally similar to white noise. Visual cues contribute to identification of voicing, but only if the POA is visually salient and auditorily susceptible to the noise type.