Outcomes of a Large Series of Laparoscopic Ventral Hernia Repairs after Liver Transplantation.

BACKGROUND: The hernia defects that develop in liver transplant recipients tend to be complex. Unfortunately, there is a paucity of data to guide post-transplant hernia management. Our goal was to evaluate the outcomes following laparoscopic ventral hernia repair (LVHR) in liver transplant recipients. METHODS: A retrospective review of a prospectively kept database of liver transplant patients at a single tertiary healthcare facility was completed. All patients between 2007 and 2020 who underwent LVHR for a hernia at their transplant incision site were included. The primary outcome studied was hernia recurrence. Secondary outcomes included time-to-hernia repair, complications, and length of stay (LOS). RESULTS: There were 89 patients who met inclusion criteria. 82% were male, mean age was 60 years, and mean body mass index was 30.2 kg/m2. 94.4% were on tacrolimus and 36% on mycophenolate mofetil. Median time-to-hernia repair was 16 months with a mean mesh size of 743 cm2 and length of stay of 3.7 days. None required conversion to an open operation. Postoperative complications included ileus (20.2%), acute kidney injury (11.2%), pneumonia (6.7%), and bleeding requiring re-operation (1.1%). Hernia-related complications included chronic suture site pain (1.1%), seroma requiring intervention (3.3%), surgical site infection (3.3%), nonoperative mesh infection (1.1%), and mesh infection requiring explantation (1.1%). Median follow-up was 23 months. Hernia recurrence occurred in 4.5% and no predictive variables for recurrence were identified. CONCLUSIONS: Although the hernia defects that develop in liver transplant recipients are complex and their comorbidities significant, LVHR can safely and effectively repair these defects with low rates of recurrence and complications.

Möbius Band Surprise: A Systematic Illusion in Imagery.

When a Möbius loop is cut along the middle of the band, the result is a single connected loop, yet anecdotal evidence from science demonstrations and the use of this effect in magic tricks suggest that most people are thoroughly surprised by this because they strongly believe that the result should be two separate loops. Here, we present results from a behavioral experiment confirming this anecdotal evidence and discuss potential theoretical explanations for why this demonstration evokes strong, but misleading intuitions and a related illusion of impossibility.

Expanding the Horizon: Single-port Robotic Vascularized Omentum Lymphatic Transplant.

Vascularized omentum lymphatic transplant is frequently used for the treatment of lymphedema due to demonstrated efficacy, a reduced complication profile, and, in particular, negligible risk of donor site lymphedema. Historically harvested by open laparotomy, more recent techniques involve laparoscopic omental harvest. Although effective and reproducible, laparoscopy may be limited by reduced visualization, minimal tactile feedback, multiple port sites, and imprecise instrumentation. Therefore, we employed the da Vinci Single-Port (SP) surgical robot system for vascularized omentum lymphatic transplant. A 52-year-old man with a 3-year history of progressive left lower extremity swelling and lymphoscintigraphy and magnetic resonance lymphangiogram consistent with lymphedema of unknown etiology underwent vascularized omentum lymphatic transplant to the left groin. A 2.5-cm infraumbilical incision was used for placement of the primary trocar, through which the camera and operating instruments were passed. Following robotic harvest, the omental lymph node flap was transferred to the left groin for microsurgical anastomosis. The procedure was uneventful, and the patient was discharged on postoperative day 1. At 6 weeks, there were no complications. Here, we show for the first time the safety and feasibility of robotic omental lymph node flap harvest for extremity lymphedema using the da Vinci Single-Port robotic system. The benefits of this technology include a minimally-invasive approach that allows for flap dissection and removal through a single 2.5-cm incision. Further investigation is necessary to characterize the indications and limitations of this technique in plastic surgery.

Is There an Upper Age Limit for Bariatric Surgery? Laparoscopic Gastric Bypass Outcomes in Septuagenarians.

PURPOSE: Upper age limits for bariatric surgery are questioned on the merits of increased complication rates in the elderly and questionable efficacy. This study evaluates outcomes of bariatric surgery in patients ≥ 70 years of age. MATERIALS AND METHODS: Retrospective review was performed of patients ≥ 70 years of age who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) between 2001 and 2018. Primary endpoints were 30-day readmission, Clavien-Dindo grade III-V (CD III-IV) complications, and mortality. Secondary data included were weight loss, long-term outcomes, comorbidity resolution, hemoglobin A1C, and lipid panels. RESULTS: A total of 23 patients with an average age of 72 years (range 70-80 years) and mean BMI of 43.3 (range 37.3-56.0) were reviewed. Average length-of-stay was 2.4 days (range 1-6 days), with the only acute complication being aspiration pneumonia in one patient. Median follow-up was 69.3 weeks (range 9-875 weeks). One-year follow-up rate was 96%, during which no deaths or CD III-IV complications occurred. Subsequently, one patient experienced failure-to-thrive requiring temporary enteral nutrition. Average 1 year percent total weight loss (%TWL) was 29%, and this was maintained on subsequent follow-ups. Average 1 year percent excess weight loss (%EWL) was 60%, maintained long-term at 61%. Significant serum biochemical improvements included hemoglobin A1C (6.9 ± 1.4% to 5.6 ± 1.3%, p = 0.001), triglycerides (155 ± 49 mg/dL to 102 ± 41 mg/dL, p = 0.0003), and high-density lipoprotein cholesterol (48 ± 14 mg/dL to 58 ± 22 mg/dL, p = 0.004). CONCLUSION: Laparoscopic RYGB is a safe and effective treatment for obesity and obesity-related comorbidities in septuagenarians.

Obesity and Abdominal Wall Reconstruction: Outcomes, Implications, and Optimization.

It has never been more important for surgeons to effectively and efficiently perform ventral hernia repairs, which optimize outcomes and the value of care. Surgical patients in the United States are becoming increasingly complex. The comorbid diseases each unique patient brings to the operation further complicate the effort to optimize surgical outcomes. Obesity poses specific challenges to surgeons who deal with abdominal wall reconstruction. Herein, we discuss the impact of obesity and its associated comorbidities on the outcome of abdominal wall reconstruction and offer suggestions on how to optimize patients for best results.

A view not to be missed: Salient scene content interferes with cognitive restoration.

Attention Restoration Theory (ART) states that built scenes place greater load on attentional resources than natural scenes. This is explained in terms of "hard" and "soft" fascination of built and natural scenes. Given a lack of direct empirical evidence for this assumption we propose that perceptual saliency of scene content can function as an empirically derived indicator of fascination. Saliency levels were established by measuring speed of scene category detection using a Go/No-Go detection paradigm. Experiment 1 shows that built scenes are more salient than natural scenes. Experiment 2 replicates these findings using greyscale images, ruling out a colour-based response strategy, and additionally shows that built objects in natural scenes affect saliency to a greater extent than the reverse. Experiment 3 demonstrates that the saliency of scene content is directly linked to cognitive restoration using an established restoration paradigm. Overall, these findings demonstrate an important link between the saliency of scene content and related cognitive restoration.

Mental and perceptual feedback in the development of creative flow.

Sketching is considered by artists and designers to be a vital tool in the creative process. However, research shows that externalisation during the creative process (i.e., sketching) is not necessary to create effectively. This study examines whether sketching may play a more important role in the subjective experience of creativity by facilitating the deeply focused, optimal state of consciousness termed 'flow' (being 'in the zone'). The study additionally explored whether sketching affects flow by easing cognitive load or by providing a clearer sense of self-feedback. Participants carried out the creative mental synthesis task (combining sets of simple shapes into creative drawings), experimentally simulating the visual creative process. Ideas were generated either mentally before committing to a final drawing, or with external perceptual support through sketching, and cognitive load was varied by using either three- or five-shape sets. The sketching condition resulted in greater experience of flow and lower perceived task difficulty. However, cognitive load did not affect flow and there was no interaction between load and sketching conditions. These findings are the first to empirically demonstrate that sketching increases flow experience, and that this is not dependent on an associated reduction in overall working memory load.

Modified retrorectus ventral hernia repair.

BACKGROUND: Traditional retrorectus techniques for ventral hernia repair often produce abdominal wall pain related to transfascial suture placement. This report details results of a retrorectus mesh herniorrhaphy technique avoiding transfascial suture fixation. METHODS: A retrospective review of 90 patients who underwent retrorectus ventral hernia repair between 2009 and 2015 was performed. All were treated with primary posterior rectus fascial closure and retrorectus mesh placement. Standard weight polypropylene mesh was used with polypropylene tacking sutures to the posterior rectus sheath with medialization of the rectus muscles and primary closure of the anterior rectus sheath over the mesh repair. RESULTS: The overall complication rate was 19.6%. Hernia recurrence occurred in 2 patients (2.2%) with mean follow-up of 3.0 years. There were 4 cases of superficial infection (4.3%). Two patients (2.2%) developed hematomas and 2 patients developed seromas (2.2%). Late abdominal pain occurred in 6 (6.5%) patients, eventually resolving in all but 2. CONCLUSIONS: Retrorectus ventral hernia repair avoiding transfascial suture placement produces a functional repair with minimal chronic pain and a low rate of complications.

Body image, visual working memory and visual mental imagery.

Body dissatisfaction (BD) is a highly prevalent feature amongst females in society, with the majority of individuals regarding themselves to be overweight compared to their personal ideal, and very few self-describing as underweight. To date, explanations of this dramatic pattern have centred on extrinsic social and media factors, or intrinsic factors connected to individuals' knowledge and belief structures regarding eating and body shape, with little research examining links between BD and basic cognitive mechanisms. This paper reports a correlational study in which visual and executive cognitive processes that could potentially impact on BD were assessed. Visual memory span and self-rated visual imagery were found to be predictive of BD, alongside a measure of inhibition derived from the Stroop task. In contrast, spatial memory and global precedence were not related to BD. Results are interpreted with reference to the influential multi-component model of working memory.

Flow, affect and visual creativity.

Flow (being in the zone) is purported to have positive consequences in terms of affect and performance; however, there is no empirical evidence about these links in visual creativity. Positive affect often--but inconsistently--facilitates creativity, and both may be linked to experiencing flow. This study aimed to determine relationships between these variables within visual creativity. Participants performed the creative mental synthesis task to simulate the creative process. Affect change (pre- vs. post-task) and flow were measured via questionnaires. The creativity of synthesis drawings was rated objectively and subjectively by judges. Findings empirically demonstrate that flow is related to affect improvement during visual creativity. Affect change was linked to productivity and self-rated creativity, but no other objective or subjective performance measures. Flow was unrelated to all external performance measures but was highly correlated with self-rated creativity; flow may therefore motivate perseverance towards eventual excellence rather than provide direct cognitive enhancement.

Oculomotor preparation as a rehearsal mechanism in spatial working memory.

There is little consensus regarding the specific processes responsible for encoding, maintenance, and retrieval of information in visuo-spatial working memory (VSWM). One influential theory is that VSWM may involve activation of the eye-movement (oculomotor) system. In this study we experimentally prevented healthy participants from planning or executing saccadic eye-movements during the encoding, maintenance, and retrieval stages of visual and spatial working memory tasks. Participants experienced a significant reduction in spatial memory span only when oculomotor preparation was prevented during encoding or maintenance. In contrast there was no reduction when oculomotor preparation was prevented only during retrieval. These results show that (a) involvement of the oculomotor system is necessary for optimal maintenance of directly-indicated locations in spatial working memory and (b) oculomotor preparation is not necessary during retrieval from spatial working memory. We propose that this study is the first to unambiguously demonstrate that the oculomotor system contributes to the maintenance of spatial locations in working memory independently from the involvement of covert attention.

Are C-reps contextual representations? A reply to Brewin and Burgess.

Brewin and Burgess (2013) argue that our recent papers investigating the role of contextual representations in intrusive memories do not pose a challenge to dual-representation theory as originally claimed (Pearson, 2012; Pearson, Ross, & Webster, 2012). Here I point out that their alternative explanation for our results can be rejected using data already published in both papers. I also argue that their definition of what constitutes a contextual representation renders their revised dual-representation theory incompatible with experimental results that have previously been argued in the literature to support it. Valuable though their contribution is, it does not impact on our main conclusion that abstract contextual representations serve to increase intrusive memories for traumatic material.

Toward a visuospatial developmental account of sequence-space synesthesia.

Sequence-space synesthetes experience some sequences (e.g., numbers, calendar units) as arranged in spatial forms, i.e., spatial patterns in their mind's eye or even outside their body. Various explanations have been offered for this phenomenon. Here we argue that these spatial forms are continuous with varieties of non-synesthetic visuospatial imagery and share their central characteristics. This includes their dynamic and elaborative nature, their involuntary feel, and consistency over time. Drawing from literatures on mental imagery and working memory, we suggest how the initial acquisition and subsequent elaboration of spatial forms could be accounted for in terms of the known developmental trajectory of visuospatial representations. This extends from the formation of image-based representations of verbal material in childhood to the later maturation of dynamic control of imagery. Individual differences in the development of visuospatial style also account for variation in the character of spatial forms, e.g., in terms of distinctions such as visual versus spatial imagery, or ego-centric versus object-based transformations.

Oculomotor involvement in spatial working memory is task-specific.

Many everyday tasks, such as remembering where you parked, require the capacity to store and manipulate information about the visual and spatial properties of the world. The ability to represent, remember, and manipulate spatial information is known as visuospatial working memory (VSWM). Despite substantial interest in VSWM the mechanisms responsible for this ability remain debated. One influential idea is that VSWM depends on activity in the eye-movement (oculomotor) system. However, this has proved difficult to test because experimental paradigms that disrupt oculomotor control also interfere with other cognitive systems, such as spatial attention. Here, we present data from a novel paradigm that selectively disrupts activation in the oculomotor system. We show that the inability to make eye-movements is associated with impaired performance on the Corsi Blocks task, but not on Arrow Span, Visual Patterns, Size Estimation or Digit Span tasks. It is argued that the oculomotor system is required to encode and maintain spatial locations indicted by a change in physical salience, but not non-salient spatial locations indicated by the meaning of a symbolic cue. This suggestion offers a way to reconcile the currently conflicting evidence regarding the role of the oculomotor system in spatial working memory.

Intrusive images and voluntary memory for affective pictures: contextualization and dual-task interference.

BACKGROUND AND OBJECTIVES: The present study addressed the role of context information and dual-task interference during the encoding of negative pictures on intrusion development and voluntary recall. METHODS: Healthy participants were shown negative pictures with or without context information. Pictures were either viewed alone or concurrently with a visuospatial or verbal task. Participants reported their intrusive images of the pictures in a diary. At follow-up, perceptual and contextual memory was tested. RESULTS: Participants in the context group reported more intrusive images and perceptual voluntary memory than participants in the no context group. No effects of the concurrent tasks were found on intrusive image frequency, but perceptual and contextual memory was affected according to the cognitive load of the task. LIMITATIONS: The analogue method cannot be generalized to real-life trauma and the secondary tasks may differ in cognitive load. CONCLUSIONS: The findings challenge a dual memory model of PTSD but support an account in which retrieval strategy, rather than encoding processes, accounts for the experience of involuntary versus voluntary recall.

Einstein's jacket: evidence for long-term perceptual specificity in mental imagery.

To what extent are visual fantasies constrained by our perceptual experience of the real world? Our study exploits the fact that people's knowledge of the appearance of individuals from the early 20th Century (e.g., Albert Einstein, Winston Churchill) derives predominantly from viewing black-and-white media images. An initial experiment shows that mental imagery for individuals from this period are experienced as significantly less colourful than imagery for individuals from the era of colour media. A second experiment manipulated whether participants were instructed to explicitly imagine using colour or not (i.e., "imagine Albert Einstein wearing a green jacket" vs. "imagine Albert Einstein wearing a jacket"). Results show that colour manipulation only influences imagery for black-and-white era individuals, with no comparable effect on imagery for colour era individuals. This finding is replicated in a third experiment that includes an additional control condition of imagining generic characters (i.e., "Imagine a knight wearing a cloak" vs. "imagine a knight wearing a red cloak"). Again, only imagery for black-and-white era individuals is affected by the colour manipulation. Overall these results provide evidence for long-term perceptual specificity effects in mental imagery. We argue that visual fantasies can be constrained by surface features of underlying representations in memory, even when imagining something we have never directly perceived.

Assessing mental imagery in clinical psychology: a review of imagery measures and a guiding framework.

Mental imagery is an under-explored field in clinical psychology research but presents a topic of potential interest and relevance across many clinical disorders, including social phobia, schizophrenia, depression, and post-traumatic stress disorder. There is currently a lack of a guiding framework from which clinicians may select the domains or associated measures most likely to be of appropriate use in mental imagery research. We adopt an interdisciplinary approach and present a review of studies across experimental psychology and clinical psychology in order to highlight the key domains and measures most likely to be of relevance. This includes a consideration of methods for experimentally assessing the generation, maintenance, inspection and transformation of mental images; as well as subjective measures of characteristics such as image vividness and clarity. We present a guiding framework in which we propose that cognitive, subjective and clinical aspects of imagery should be explored in future research. The guiding framework aims to assist researchers in the selection of measures for assessing those aspects of mental imagery that are of most relevance to clinical psychology. We propose that a greater understanding of the role of mental imagery in clinical disorders will help drive forward advances in both theory and treatment.

Contextual representations increase analogue traumatic intrusions: evidence against a dual-representation account of peri-traumatic processing.

BACKGROUND AND OBJECTIVES: Information processing accounts of post-traumatic stress disorder (PTSD) state that intrusive memories emerge due to a lack of integration between perceptual and contextual trauma representations in autobiographical memory. This hypothesis was tested experimentally using an analogue trauma paradigm in which participants viewed an aversive film designed to elicit involuntary recollections. METHOD: Participants viewed scenes from the film either paired with contextual information or with the contextual information omitted. After viewing the film participants were asked to record for one week any involuntary intrusions for the film using a provided intrusions diary. RESULTS: The results revealed a significant increase in analogue intrusions for the film when viewed with contextual information in comparison to when the film was viewed with the contextual information omitted. In contrast there was no effect of contextual information on valence ratings or voluntary memory for the film, or on the reported vividness and emotionality of the intrusions. LIMITATIONS: The analogue trauma paradigm may have failed to reproduce the effect of extreme stress on encoding that is postulated to occur during PTSD. CONCLUSIONS: The findings have potential implications for trauma intervention as they suggest that the contextual understanding of a scene during encoding can be integral to the subsequent occurrence of traumatic intrusions. The pattern of results found in the study are inconsistent with dual-representation accounts of intrusive memory formation, and instead provide new evidence that contextual representations play a casual role in increasing the frequency of involuntary intrusions for traumatic material.