Bilateral Spigelian Hernias Robotic Repair: A Novel Approach to a Rare Surgical Entity.

Spigelian hernias are an uncommon protrusion defect noted between the rectus abdominis and the transversus abdominis muscles, at the semilunar line, with a low incidence of approximately 0.12% to 2% of all ventral hernias. Furthermore, the incidence of bilateral cases is noted to be even lower in the general population. They are associated with bowel incarceration and strangulation; hence surgical repair is indicated. Therapeutic alternatives for Spigelian hernias include open repair, however laparoscopic repair stands as the standard of care in these cases. Feasible and successful robotic repair has been reported, with associated advantages in terms of visualization and surgical instrument dexterity. We present the first ever reported cases of bilateral Spigelian hernias repaired using robotic approach. Two female Puerto Rican patients referred to our institution complaining of abdominal pain, where imaging studies found bilateral Spigelian hernias. In both cases, a transabdominal preperitoneal repair was performed using the Da Vinci Surgical System. Both patients were discharged home tolerating oral intake with adequate wound healing. On follow up visits, patients denied abdominal discomfort and had adequate wound healing. Robotic surgery for Spigelian hernias poses an advantage over laparoscopic repair as improved visualization, mobility, and precision in movements allow for more gentle tissue manipulation. Furthermore, this is the first evidence of safe and effective repair in the uncommon entity of bilateral cases, providing a newer alternative in the setting of such presentation.

Spatial and Temporal Dynamics of the Vegetation Cover from the Bijagual Massif, Boyacá, Colombia, during the 1986-2021 Period.

Landscape changes based on spectral responses allow showing plant cover changes through diversity, composition, and ecological connectivity. The spatial and temporal vegetation dynamics of the Bijagual Massif from 1986 to 2021 were analyzed as a measure of ecological integrity, conservation, and territory. The covers identified were high open forest (Hof), dense grassland of non-wooded mainland (Dgnm), a mosaic of pastures and crops (Mpc), lagoons (Lag), and bare and degraded lands (Bdl). The Bijagual Massif has 8574.1 ha. In 1986, Dgnm occupied 42.6% of the total area, followed by Mpc (32.8%) and Hof (24.5%); by 2000, Mpc and Hof increased (43.7 and 28.1%, respectively), while Dgnm decreased (28%); by 2021, Dgnm was restricted to the northeastern zone and continued to decrease (25.2%), Mpc occupied 52.9%, Hof 21.7% and Bdl 0.1%. Of the three fractions of the connectivity probability index, only dPCintra and dPCflux contribute to ecological connectivity. Hof and Dgnm show patches with biota habitat quality and availability. Between 1986 and 2021, Dgnm lost 1489 ha (41%) and Hof 239.5 ha (11%). Mpc replaced various covers (1722.2 ha; 38%) in 2021. Bijagual has a valuable biodiversity potential limited by Mpc. Territorial planning and sustainable agroecological and ecotourism proposals are required due to the context of the ecosystems.

Antioxidant Responses and Phytochemical Accumulation in Raphanus Species Sprouts through Elicitors and Predictive Models under High Temperature Stress.

Crop production is being impacted by higher temperatures, which can decrease food yield and pose a threat to human nutrition. In the current study, edible and wild radish sprouts were exposed to elevated growth temperatures along with the exogenous application of various elicitors to activate defense mechanisms. Developmental traits, oxidative damage, glucosinolate and anthocyanin content, and antioxidant capacity were evaluated alongside the development of a predictive model. A combination of four elicitors (citric acid, methyl jasmonate-MeJa, chitosan, and K2SO4) and high temperatures were applied. The accumulation of bioactives was significantly enhanced through the application of two elicitors, K2SO4 and methyl jasmonate (MeJa). The combination of high temperature with MeJa prominently activated oxidative mechanisms. Consequently, an artificial neural network was developed to predict the behavior of MeJa and temperature, providing a valuable projection of plant growth responses. This study demonstrates that the use of elicitors and predictive analytics serves as an effective tool to investigate responses and enhance the nutritional value of Raphanus species sprouts under future conditions of increased temperature.

An Alternative Method for the Selective Synthesis of Ortho-nitro Anilines Using Bismuth Nitrate Pentahydrate.

BACKGROUND: Nitroaromatic compounds are important scaffolds used for the syn-thesis of a variety of compounds, such as explosives, herbicides, dyes, perfumes and phar-maceuticals. Bismuth nitrate pentahydrate is a widely used reagent in organic synthesis; how-ever, its utility as a nitrating agent for anilines is underexplored. OBJECTIVE: The aim of this work is to propose and find the proper reaction conditions of an alternative nitrating agent constituted by a mixture of bismuth nitrate / acetic anhydride in DCM with a series of substituted anilines under mild reflux. METHODS: Several anilines having both activating and deactivating substituents in the ortho, meta and para positions were the substrate for the nitration reaction. Experimental conditions were performed in "one-pot" conditions before product purification. RESULTS: Bi(NO3)3•5H2O demonstrated to be effective and somehow regioselective when it came to the nitration of anilines in the ortho position. Although other products were also identified under these conditions, in most cases, the ortho derivative was the major or even the only product obtained with moderate to high yields in the range of 50% - 96%. CONCLUSION: Bi(NO3)3•5H2O is an efficient and safe nitrating agent since the use of concen-trated and corrosive acids like sulfuric and nitric is avoided; furthermore, bismuth nitrate is low-priced and no special care nor equipment is required.

Promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions are associated with tumor differentiation, nodal involvement and survival.

Differentially methylated regions (DMRs) can be used as head and neck squamous cell carcinoma (HNSCC) diagnostic, prognostic and therapeutic targets in precision medicine workflows. DNA from 21 HNSCC and 10 healthy oral tissue samples was hybridized to a genome-wide tiling array to identify DMRs in a discovery cohort. Downstream analyses identified differences in promoter DNA methylation patterns in oral, laryngeal and oropharyngeal anatomical regions associated with tumor differentiation, nodal involvement and survival. Genome-wide DMR analysis showed 2,565 DMRs common to the three subsites. A total of 738 DMRs were unique to laryngeal cancer (n=7), 889 DMRs were unique to oral cavity cancer (n=10) and 363 DMRs were unique to pharyngeal cancer (n=6). Based on the genome-wide analysis and a Gene Ontology analysis, 10 candidate genes were selected to test for prognostic value and association with clinicopathological features. TIMP3 was associated with tumor differentiation in oral cavity cancer (P=0.039), DAPK1 was associated with nodal involvement in pharyngeal cancer (P=0.017) and PAX1 was associated with tumor differentiation in laryngeal cancer (P=0.040). A total of five candidate genes were selected, DAPK1, CDH1, PAX1, CALCA and TIMP3, for a prevalence study in a larger validation cohort: Oral cavity cancer samples (n=42), pharyngeal cancer tissues (n=25) and laryngeal cancer samples (n=52). PAX1 hypermethylation differed across HNSCC anatomic subsites (P=0.029), and was predominantly detected in laryngeal cancer. Kaplan-Meier survival analysis (P=0.043) and Cox regression analysis of overall survival (P=0.001) showed that DAPK1 methylation is associated with better prognosis in HNSCC. The findings of the present study showed that the HNSCC subsites oral cavity, pharynx and larynx display substantial differences in aberrant DNA methylation patterns, which may serve as prognostic biomarkers and therapeutic targets.

Falciform ligament thrombosis after umbilical vein recanalization in the setting of acute pancreatitis, a rare entity.

We present the case of a 79-year-old man who presents falciform ligament thrombosis after umbilical vein recanalization as an uncommon complication of acute pancreatitis. The performance of abdomino-pelvic CT with contrast, allowed its diagnosis, as well as the establishment of an adequate treatment with favorable evolution.

The pathway to the natural gas industry: Financial development, coal consumption, and carbon dioxide emissions in P.R. China.

This paper revisits the causal links between financial development, coal consumption, and CO2 emissions in P.R. China over the 1977-2017 period to validate the development of its natural gas industry. It uses a Bootstrap ARDL bound test with structural breaks to establish stationarity, short- and long-run dynamics, and causality of the series. The results show there are no long-run relationships among these three variables, but a Granger causality test does indicate the presence of both a two-way Granger causality between coal consumption and CO2 emissions, and a one-way Granger causality running from financial development to both coal consumption and CO2 emissions. These results have important policy implications for the Chinese government's efforts to meet its commitment at the 75th UN General Assembly to achieve carbon neutrality. In that context, the promotion of its natural gas industry, including carbon pricing mechanisms and taxation schemes while enacting environmentally friendly energy abatement policies become a must.

Application of Phytosociological Information in the Evaluation of the Management of Protected Areas.

The classification system of plant communities using phytosociological methods can be applied to their conservation in protected areas, as well as in establishing adequate protections and granting legal status to such areas. A new integrative index is developed to classify plant communities for the evaluation of the conservation status of protected areas, obtained from the product of three statistical indices of diversity: Syntaxonomic Distinctness, Rarefaction and Areas Prioritisation, which has been named DRA (acronym of the three indices used). The DRA is used to assess whether the status granted to Protected Areas matches the values provided by the plant communities within them and which were the basis for the identification and description of the Habitats of Community Interest (Habitats Directive-92/43/CEE). The proposed method was applied to the network of protected natural areas on the Andalusian coast, including 14 areas with different protection status, where, once the plant communities they contain were identified, the DRA index was applied to each of them and compared with the Legal Protection Index, i.e., the current protection regime; it becomes clear, objectively, that not all the statuses assigned, whether the IUCN criteria or those of the Andalusian government, correspond to the real levels of protection they should have on the basis of their plant communities.

Novel ciprofloxacin and norfloxacin-tetrazole hybrids as potential antibacterial and antiviral agents: Targeting S. aureus topoisomerase and SARS-CoV-2-MPro.

This study was designed to synthesize hybridizing molecules from ciprofloxacin and norfloxacin by enhancing their biological activity with tetrazoles. The synthesized compounds were investigated in the interaction with the target enzyme of fluoroquinolones (DNA gyrase) and COVID-19 main protease using molecular similarity, molecular docking, and QSAR studies. A QSAR study was carried out to explore the antibacterial activity of our compounds over Staphylococcus aureus a QSAR study, using descriptors obtained from the docking with DNA gyrase, in combination with steric type descriptors, was done obtaining suitable statistical parameters ( R 2 = 87.00 , Q L M O 2 = 71.67 , and Q E X T 2 = 73.49 ) to support our results. The binding interaction of our compounds with CoV-2-Mpro was done by molecular docking and were compared with different covalent and non-covalent inhibitors of this enzyme. For the docking studies we used several crystallographic structures of the CoV-2-Mpro. The interaction energy values and binding mode with several key residues, by our compounds, support the capability of them to be CoV-2-Mpro inhibitors. The characterization of the compounds was completed using FT-IR, 1H-NMR, 13C-NMR, 19F-NMR and HRMS spectroscopic methods. The results showed that compounds 1, 4, 5, 10 and 12 had the potential to be further studied as new antibacterial and antiviral compounds.

How do digital lives affect resident mental health in the digital era? Empirical evidence based on Chinese general social survey.

Having good mental health means we are better able to connect, function, cope and thrive. The widespread application of digital technology in daily life provides new ways and promising tools for residents to maintain their mental health. Given the importance of mental health for everyone, and the fact that mental health problems are prevalent worldwide, this study discusses how digital lives affects the mental health of residents. The results suggest that digital lives are significantly and positively associated with mental health. Mechanisms analysis identifies personal perceptions (self-rated physical exercise and subjective wellbeing) as the important paths for digital lives to promote mental health, while social perceptions (social trust and social fairness) play a suppressing effect on the relationship between them. The results of further discussion show that the degree of the influence of digital lives on mental health of individuals is heterogeneous among different regions. Due to the difference in development level, the positive impact of digital lives is greater in urban areas than in rural areas, and it is stronger in western regions than in eastern and central regions. This study enriches the nascent research stream of digitalization, explores new paths of harnessing digital technologies for mental health, and offers useful insights for the government to guide them in formulating digital development strategies and achieving the Healthy China Strategy.

Sensory descriptors for three edible Chilean seaweeds and their relations to umami components and instrumental texture.

Although seaweeds exhibit many benefits as a food source, few studies have characterized their sensory attributes. An expert nine-member panel developed a vocabulary with 25 descriptors to describe the appearance, aroma, flavor, texture, and aftertaste of raw and cooked seaweeds consumed in Chile: Durvillaea antarctica, Pyropia spp., and Ulva lactuca. Subsequently, the vocabulary was used in a ranking descriptive analysis (RDA) to evaluate the sensory properties and relate them with physicochemical and physical data. Sensory attributes of the three seaweeds were very different from each other but similar between treatments (raw and cooked). Pyropia spp., both cooked and hydrated, had the highest glutamate content (310 and 324 mg (100 g) -1 d.w., respectively), and was perceived by the sensory panel as having the most umami taste. Cooked D. antarctica was perceived as sweeter, had more caramel notes than the hydrated seaweed and was sensed as cartilaginous and hard in accordance with its mechanical properties. Generalized Procrustes analysis revealed that D. antarctica exhibited most of the desirable descriptors, such as caramel, umami and marine aromas while U. lactuca was described as bitter and moldy. This primary vocabulary can assist food scientists and chefs in the development of seaweed products and dishes for the consumer market.

Bedside Intraperitoneal Chemotherapy for Recurrent Pseudomyxoma Peritonei, an Alternative to Current Methods in a Low-Resource Tertiary Center.

Pseudomyxoma peritonei (PMP) is a condition presenting with tumors of the abdominal cavity presenting which could lead abdominal distention and ascites secondary to mucus production. Tumors of this type are potentially fatal due to their obstructing of abdominal structures. The current management of the condition includes surgical debulking with intraoperative or postoperative chemotherapy with protocols such as hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy (EPIC), respectively. We describe herein a case in which a tumor debulking surgery was performed. Afterwards, we placed intraperitoneal catheters so that a 4-day regimen of bedside intraperitoneal 5-fluorouracil chemotherapy could be administered on her bedside. Chemotherapy was infused and removed with the use of Hemovac and Jackson-Pratt drainage catheter systems attached to suction, for the intrahospital management of recurrent PMP in a young Hispanic female patient. Though it requires further study, we propose this method as a safe and effective alternative to current strategies at low income or resources centers.

The Diverse Biological Activity of Recently Synthesized Nitro Compounds.

The search for new and efficient pharmaceuticals is a constant struggle for medicinal chemists. New substances are needed in order to treat different pathologies affecting the health of humans and animals, and these new compounds should be safe, effective and have the fewest side effects possible. Some functional groups are known for having biological activity; in this matter, the nitro group (NO2) is an efficient scaffold when synthesizing new bioactive molecules. Nitro compounds display a wide spectrum of activities that include antineoplastic, antibiotic, antihypertensive, antiparasitic, tranquilizers and even herbicides, among many others. Most nitro molecules exhibit antimicrobial activity, and several of the compounds mentioned in this review may be further studied as lead compounds for the treatment of H. pylori, P. aeruginosa, M. tuberculosis and S. mutans infections, among others. The NO2 moiety triggers redox reactions within cells causing toxicity and the posterior death of microorganisms, not only bacteria but also multicellular organisms such as parasites. The same effect may be present in humans as well, so the nitro groups can be considered both a pharmacophore and a toxicophore at the same time. The role of the nitro group itself also has a deep effect on the polarity and electronic properties of the resulting molecules, and hence favors interactions with some amino acids in proteins. For these reasons, it is fundamental to analyze the recently synthesized nitro molecules that show any potential activity in order to develop new pharmacological treatments that enhance human health.

Strategies of Elicitation to Enhance Bioactive Compound Content in Edible Plant Sprouts: A Bibliometric Study.

Vegetable sprouts are a food source that presents high content of bioactive compounds which can also be enhanced through elicitation mechanisms. To better understand the scientific production and research trends on this topic, a bibliometric analysis by means of the Web of Science database was carried out. The results showed significant growth in research on the elicitation of edible plants sprouts. The three most productive journals were the Journal of Agricultural and Food Chemistry, followed by Food Chemistry and LWT-Food Science and Technology. The co-occurrence of keyword analysis of the different authors showed that the main research topics in this domain were 'germination', 'antioxidant activity', 'sprouts', 'glucosinolates' and 'phenolics'. The countries with the highest number of scientific publications were China, followed by India and USA. The productivity patterns of the authors conformed to Lotka's law. This study provides an overview of research on elicitation to enrich bioactive compounds in sprouts, and the need to review and update the trends on this subject.

Linkages between share pledging, stock price risk and profitability: Evidence from the P.R. China.

Share pledging has become popular as a method of loan collateral among Chinese shareholders. Our research used a sample of Chinese listed firms between 2008-2018 and produced two main findings. Firstly, we found a negative association between stock price risk and firm profitability. Our second finding was that the interaction effect of share pledging and stock price risk is greater on firm profitability than the effect of stock price risk itself. We examined the role of share pledging by modeling pooled OLS and fixed effects using share pledging behavior, controlling shareholders' share pledging and the share pledging ratio to reinforce the robustness of our results. Furthermore, we investigated the Davis Double Play effect of share pledging to analyze how share pledging affects stock price risk. We found that higher EPS and investor expectations cannot mitigate the positive impact of share pledging on stock price risk. That is, the reduction of EPS and the deterioration of investor expectations caused by share pledging risk will not further aggravate the stock price risk, as shareholders may have taken some managerial actions to affect the transmission mechanism.

Cost and clinical outcomes of postoperative intensive care unit versus general floor management in head and neck free flap reconstructive surgery patients.

PURPOSE: To compare clinical, surgical, and cost outcomes in patients undergoing head and neck free-flap reconstructive surgery in the setting of postoperative intensive care unit (ICU) against general floor management. METHODS: Retrospective analysis of head and neck free-flap reconstructive surgery patients at a single tertiary academic medical center. Clinical data was obtained from medical records. Cost data was obtained via the Mayo Clinic Rochester Cost Data Warehouse, which assigns Medicare reimbursement rates to all professional billed services. RESULTS: A total of 502 patients were included, with 82 managed postoperatively in the ICU and 420 on the general floor. Major postoperative outcomes did not differ significantly between groups (Odds Ratio[OR] 1.54; p = 0.41). After covariate adjustments, patients managed in the ICU had a 3.29 day increased average length of hospital stay (Standard Error 0.71; p < 0.0001) and increased need for take-back surgery (OR 2.35; p = 0.02) when compared to the general floor. No significant differences were noted between groups in terms of early free-flap complications (OR 1.38;p = 0.35) or late free-flap complications (Hazard Ratio 0.81; p = 0.61). Short-term cost was $8772 higher in the ICU (range = $5640-$11,903; p < 0.01). Long-term cost did not differ significantly. CONCLUSION: Postoperative management of head and neck oncologic free-flap patients in the ICU does not significantly improve major postoperative outcomes or free-flap complications when compared to general floor care, but does increase short-term costs. General floor management may be appropriate when cardiopulmonary compromise is not present.

A novel combined transoral and transcervical surgical approach for recurrent metastatic medullary thyroid cancer to the parapharyngeal space.

Medullary thyroid cancer (MTC) represents less than 1% of all thyroid cancers. Complete surgical resection remains the mainstay of treatment for locoregional disease. Unfortunately, patients with recurrence may present with metastasis to challenging anatomic locations. We describe the first case of a recurrent MTC metastatic to the parapharyngeal space (PPS) that was managed using a combined transoral robotic surgery (TORS) and transcervical (TC) approach. We review the presentation, natural history, diagnosis and management of recurrent MTC, and describe a novel combined TORS-TC surgical approach for the treatment of PPS metastasis. A 66-year-old male with history of MTC treated with total thyroidectomy in 2000 and a liver resection in 2011 for metastatic MTC was referred to our Head and Neck Surgery Clinic in October 2016 due to increased calcitonin and CEA levels. Exam was significant for mild right tonsillar/pharyngeal bulging and induration. Imaging with PET-CT and MRI showed an enlarging ovoid mass centered within the right PPS without the presence of another systemic metastasis. FNA was consistent with MTC. The patient was taken to the operating room for a combined TORS-TC approach. Final pathology was consistent with metastatic MTC. Until recently, PPS tumors have been managed using highly morbid and cosmetically disfiguring open surgical approach. TORS provides a safe and effective alternative.

The Anesthesiologist's Response to Hurricane Natural Disaster Incidents: Hurricane Harvey.

From personal experience and available resources, such as the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness templates from the manual for department procedures, the authors describe the primarily flooding impact of Hurricane Harvey in their area of Texas. They review the necessary analysis, development, and implementation of logistics; staffing and relief models; coordination with hospital partners; and dissemination of the planned procedures. The authors emphasize the commitment of anesthesiologists to patient care and rescue efforts outside of the operating room.