Management of complex hernias with loss of domain using daily and fractioned preoperative progressive pneumoperitoneum: a retrospective single-center cohort study.

PURPOSE: The incidence of complex hernias with loss of domain (CHLD) has been increasing and the treatment of these cases may require auxiliary techniques in addition to surgery. This study aims to refine the progressive preoperative pneumoperitonium (PPP) in patients with CHLD, to achieve an increased in wall dimensions. METHODS: Patients presented with a CHLD undergoing PPP protocol were analyzed between May 2017 and May 2019. Our PPP protocol was to use two daily insufflations of 1000 ml of ambient air during a period of 14 days. We compared the abdominal cavity volume (ACV), the hernial sac volume (HSV) and the volume ratio (VR), before and after our refined PPP. RESULTS: During our evaluation period, the protocol was performed on 16 patients. The mean age was 55.73 (± 12.87), and the mean BMI was 31.35 (± 7.33). The median of HSV was 2104.53 ml; Mean ACV was 6722.36 ml, and median of VR was 29.97% (27.46-34.38 IIQ). The averages were: daily volume of gas ± 1526.66 ml, total volume ± 17,350 ml, and the PPP period of ± 10.7 days. The increase in post-PPP ACV was 52.13% (p < 0.0001), and the VR decreased to 26.9% (p < 0.609). All patients' symptoms and complications were mild (according Clavien-Dindo grades I and II), and there were no loop injuries, no catheter complications, or any surgical re-interventions. CONCLUSION: The study suggests that the use of this method results in a significant increase in ACV, and reduction of the herniated content in a safe and efficient manner, with mild complications.

Thermochemical and Kinetics of CH3SH + H Reactions: The Sensitivity of Coupling the Low and High-Level Methodologies.

The reaction system formed by the methanethiol molecule (CH3SH) and a hydrogen atom was studied via three elementary reactions, two hydrogen abstractions and the C-S bond cleavage (CH3SH + H → CH3S + H2 (R1); → CH2SH + H2 (R2); → CH3 + H2S (R3)). The stable structures were optimized with various methodologies of the density functional theory and the MP2 method. Two minimum energy paths for each elementary reaction were built using the BB1K and MP2 methodologies, and the electronic properties on the reactants, products, and saddle points were improved with coupled cluster theory with single, double, and connected triple excitations (CCSD(T)) calculations. The sensitivity of coupling the low and high-level methods to calculate the thermochemical and rate constants were analyzed. The thermal rate constants were obtained by means of the improved canonical variational theory (ICVT) and the tunneling corrections were included with the small curvature tunneling (SCT) approach. Our results are in agreement with the previous experimental measurements and the calculated branching ratio for R1:R2:R3 is equal to 0.96:0:0.04, with kR1 = 9.64 × 10-13 cm3 molecule-1 s-1 at 298 K.

Thermochemical and kinetics studies of the CH3SH+S (3P) hydrogen abstraction and insertion reactions.

Sulfur-containing molecules have a significant impact on atmosphere and biosphere. In this work we studied, from the point of view of electronic structure and chemical kinetics methods, the elementary reactions between a methanethiol molecule and a sulfur atom leading to hydrogen abstraction C-S bond cleavage (CH(3)SH+S; R1:→ CH(3)S+SH; R2: → CH(2)SH+SH; R3:→ CH(3)+HS(2)). The geometrical structures of the reactants, products, and saddle points for the three reaction paths were optimized using the BB1K method with the aug-cc-pV(T+d)Z basis set. The thermochemical properties were improved using single point coupled-cluster (CCSD(T)) calculations on the BB1K geometries followed by extrapolation to the complete basis set (CBS) limit. This methodology was previously applied and has given accurate values of thermochemical and kinetics properties when compared to benchmark calculations and experimental data. For each reaction, the thermal rate constants were calculated using the improved canonical variational theory (ICVT) including the zero-curvature (ICVT/ZCT) and small-curvature (ICVT/SCT) tunneling corrections. For comparison, the overall ICVT/SCT reaction rate constant at 300 K obtained with single-point CCSD(T)/CBS calculations for the CH(3)SH+S reaction is approximately 1400 times lower than the isovalent CH(3)SH+O reaction, obtained with CVT/SCT. The reaction path involving the hydrogen abstraction from the thiol group is the most important reactive path in all temperatures.

Polymorphisms of Lewis and Secretor genes are related to breast cancer and metastasis in axillary lymph nodes.

ABH and Lewis antigen expression has been associated with cancer development and prognosis, tumor differentiation, and metastasis. Considering that invasive ductal breast carcinoma (IDC) presents multiple molecular alterations, the aim of the present study was to determine whether the polymorphism of ABO, Lewis, and Secretor genes, as well as ABO phenotyping, could be associated with tumor differentiation and lymph nodes metastasis. Seventy-six women with IDC and 78 healthy female blood donors were submitted to ABO phenotyping/genotyping and Lewis and Secretor genotyping. Phenotyping was performed by hemagglutination and genotyping by the polymerase chain reaction with sequence-specific primers. ABO, Lewis, and Secretor genes were classified by individual single nucleotide polymorphism at sites 59, 1067, 202, and 314 of the Lewis gene, 428 of the Secretor gene, and 261 (O1 allele), 526 (O2 and B allele), and 703 (B allele). No association was found between breast cancer and ABO antigen expression (P = 0.9323) or genotype (P = 0.9356). Lewis-negative genotype was associated with IDC (P = 0.0126) but not with anatomoclinical parameters. Nonsecretor genotype was associated with axillary lymph node metastasis (P = 0.0149). In conclusion, Lewis and Secretor genotyping could be useful to predict respectively breast cancer susceptibility and axillary lymph nodes metastasis.