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Purpose Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk. Methods Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots. Results Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair. Conclusion Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.

Working ponies in the West Nusa Tenggara (NTB) province of Indonesia are relied upon as the principal mode of transport. They have important cultural, logistical and One Health significance for the local community. Given the tropical climate, these ponies face well recognised health and welfare challenges . Parameters relating to the general health and welfare of the ponies were assessed following data analysis of clinical records from three veterinary clinics held in 2018 and 2019. Records relating to 454 clinical examinations of ponies (n=365 stallions) aged between 1 to 25 years (mean 7.59 ± 4.70) were analysed. The mean body condition score (1 to 5 scoring system) across all clinics was 2.89 (±0.49; range 1.5, 4.5), with no significant difference between clinics (P= 0.297). The majority of ponies (84.57%; 95% CI 80.50, 87.92; 307/363) assessed presented with tachypnoea, 37.24% presented with tachycardia (95% CI 32.78, 41.92; 159/427), 14.80% (95% CI 11.10, 19.46; 41/277) recorded rectal temperatures considered hyperthermic (>38.5°C), and 38.0% did not show obvious evidence of sweating (95% CI 32.21, 44.16; 95/250). Ponies examined at the April/May 2019 clinic were more likely to be considered hyperthermic (P=0.009) and/or presented with tachycardia (P

An instrument has been developed to study surface roughness by measuring the angular distributions of scattered light. In our instrument, a beam from a He-Ne laser illuminates the surface at an angle of incidence which may be varied. The scattered li,.ght'distribution is detected by an array of 87 fiber optic sensors positioned in a semicircular yoke which can be rotated about its axis so that the scattered radiation may be sampled over an entire hemisphere. The output from the detector array is digitized, stored, and analyzed in a laboratory computer. The initial experiments have concentrated 'on measurements of stainless steel surfaces which are highly two-dimensional and which yield scattering distributions that are localized in the plane of incidence. The results are analyzed by comparing the angular scattering data with theoretical angular scattering distributions computed from digitized roughness profiles measured by a stylus instrument. The theoretical distributions are calculated by substituting the roughness profiles into the operand of an integral equation for electromagnetic scattering developed by Beckmann and Spizzichino. This approach directly tests the accuracy of the basic optical theory.

Objectives The objective of this clinical trial was to evaluate the long-term effect of endothelin receptor antagonism with bosentan on the morbidity and mortality of patients with severe chronic heart failure. Background Endothelin may play a role in heart failure, but short-term clinical trials with endothelin receptor antagonists have reported disappointing results. Long-term trials are lacking. Methods In 2 identical double-blind trials, we randomly assigned 1,613 patients with New York Heart Association functional class IIIb to IV heart failure and an ejection fraction Results Bosentan did not influence clinical status at 9 months in either trial (p = 0.928 and p = 0.263). In addition, 321 patients in the placebo group and 312 patients in the bosentan group died or were hospitalized for heart failure (hazard ratio [HR]: 1.01; 95% confidence interval [CI]: 0.86 to 1.18; p = 0.90). The bosentan group experienced fluid retention within the first 2 to 4 weeks, as evidenced by increased peripheral edema, weight gain, decreases in hemoglobin, and an increased risk of hospitalization for heart failure, despite intensification of background diuretics. During follow-up, 173 patients died in the placebo group and 160 patients died in the bosentan group (HR: 0.94; 95% CI: 0.75 to 1.16). About 10% of the bosentan group showed meaningful increases in hepatic transaminases, but none had acute or chronic liver failure. Conclusions Bosentan did not improve the clinical course or natural history of patients with severe chronic heart failure and but caused early and important fluid retention.

The historiography of command of amphibious operations during the early modern era is typically addressed in one of two ways. One explanation discounts the treatment of command, suggesting that army—navy discord was inevitable and, in the absence of systemic amelioration of this friction, command as an operational variable always had a negative impact upon operational progress. The other approach more subtly reduces the emphasis placed upon the impact of command in joint operations and argues that its operational exercise through an executive council of war meant that it was largely a settled issue for contemporaries. By drawing upon the evidence of an amphibious campaign undertaken first in the Caribbean and then off the north-eastern American seaboard during the Nine Years War, 1688—97, this article rejuvenates another understanding of combined operational command, which harks back to the views of the principal eighteenth-century author on amphibious warfare, Thomas More Molyneaux. In this analysis, combined operational command is shown to be a negotiated operational construct between the service commanders and the government, as a result of which disagreements related to the command structure and the subsequent dilution of authority through an executive council of war significantly impacted upon operational success.

The military historiography of early modern colonial America currently offers two contrary interpretations. One emphasises the exceptional nature of American warfare as a product of a process of military acculturation between the colonists and the native Americans; the other denies this acculturation in favour of the successful importation of orthodox European forms of warfare. By assessing the military history of the early years of King William's War, 1688–97, including in particular an early attempt to conquer French Canada in 1690 by Sir William Phips, this article contributes to this historiographical debate. King William's War (known on the European continent as the Nine Years' War) has been little studied in this context and the article argues that not only was military acculturation less relevant in the later seventeenth century, but also that the colonists' deployment of amphibious actions against the French demonstrated an increasing recognition that, strategically and militarily, they were requi...

This is the author's PDF version of an article published in Historical research© 2005. The definitive version is available at www.blackwell-synergy.com.

Beef fat samples were prepared and tested as candidate reference materials for organochlorine and organophosphorus pesticides. The CRMs consisted of beef fat spiked with pesticide solutions. One sample (ACSL CRM 1) was prepared containing close to 0.2 mg/kg of each of the organochlorine pesticides dieldrin and heptachlor epoxide. A second sample (ACSL CRM 2) was prepared containing close to 0.8 mg/kg of each of the organophosphorus pesticides diazinon, chlorpyrifos and ethion. The spiking levels and homogeneity of the materials were verified. The coefficients of variation of 5 analyses carried out to test between-jar homogeneity for each reference material were dieldrin, 3.5%; heptachlor epoxide, 1.1%; diazinon, 2.1%; chlorpyrifos, 1.2% and ethion, 3.1%. No instability in any of these compounds was detected over a twelve month period. The candidate reference materials were found to be suitable for certification by interlaboratory testing.

Oliver Hazard Perry was born into a naval family on August 23, 1785 at South Kingston, Rhode Island. His father was Captain Christopher Perry, a militiaman and latterly a privateer during the American War of Independence (1775–1783), who, in 1799, was appointed captain and commander of the USS General Greene, a vessel which he had helped build and in which he served until retirement in 1801. Following a childhood education at Newport, it was perhaps unsurprising therefore that Oliver Perry would, like his four brothers, seek service in the United States navy and, although cut tragically short by an early death at the age of 34, his career in many ways set a benchmark for resoluteness and resourcefulness among the officer corps of the young US navy. Keywords: nineteenth century; biography; maritime history; Northern America

It is surely appropriate for a conflict which was simultaneously provincial and global in its origin and scope that the War of the League of Augsburg is variously called the War of the Grand Alliance, the Palatinate extend French control throughout the duke's lands in the duchy of Savoy, a point underlined by the capture of Susa in early November. Keywords: seventeeth century; diplomacy and international relations; europe; military history; war

Born in Paris the fifth of eight children to Eugene Maurice, prince of Savoy-Carignan (subsequently count of Soissons) and Olympia Mancini (one of Cardinal Mazarin's three nieces), Eugene of Savoy was destined for the church but instead rose to supreme military command in the Holy Roman Empire. Aged 19 Eugene sought a career in the armies of Louis XIV but the king rejected his request for a commission. Undoubtedly Eugene's unprepossessing physique influenced Louis's decision, but it was mainly attributable to the loss of the king's favor by Eugene's mother, one of Louis's former mistresses, and her subsequent flight from the country when she became embroiled in the allegations of poisoning within the French court, the so-called affaire de poisons. Thus spurned, Eugene left France and presented his military ambitions to the emperor, Leopold I, who, as with one of Eugene's elder brothers, recognized the diplomatic potential in commissioning a second cousin of the duke of Savoy. Keywords: seventeeth century; eighteenth century; biography; Europe; military history; war

The second of seven children, and the only surviving son of Charles XI and Ulrika Eleonora of Denmark, Charles was born on June 17, 1682, in Stockholm. Although possessing a rather unremarkable physique and having developed aesthetic interests, a military education proved the mainstay of Charles's upbringing. At his father's side, Charles imbibed both the theory and practice of early modern warfare as pursued by the Swedish military. This training proved both first rate and essential: the former because in the late seventeenth century, Sweden, the principal European power in the Baltic and northern Europe, was an expert exponent of warfare founded upon the reforms of the Military Revolution, and the latter because Charles's entire reign was consumed by participation in the Great Northern War (1699–1721). Keywords: eighteenth century; biography; Eastern Europe; military history; monarchy; Northern Europe

The Wars of the Polish Succession represent a typical example of an eighteenth-century European dynastic conflict. Although the trend can be overblown, religious and confessional origins of war had declined since the conclusion of the Thirty Years' War (1618–1648), during which Cardinal Richelieu persuaded Louis XIII to fight with the Protestant Swedes against the Catholic League of the Holy Roman Empire for the raison d'etat. Thereafter, territorial and familial—in other words, dynastic—interests increasingly became the key diplomatic currency. The promotion of such ambitions frequently led to disputes and wars within the European states system, especially where the succession was uncertain or where it might be readily contested. Elective monarchies such as existed in Poland were particularly vulnerable to the latter circumstance. Ever since its adoption at the creation of the Commonwealth of Poland and Lithuania in 1569, and then subsequent revision upon the death of Sigismund II in 1572, the elective foundation of the Polish monarchy had proved generally unstable. The upper and lower nobility possessing the franchise clearly had no political or personal interests in conferring favor and longevity upon one dynasty. At the same time, the neighboring European powers might gain obvious geo-strategic influence in placing their preferred candidate upon the throne of a country which was one of the largest monarchical domains in early modern Europe. During the eighteenth century, therefore, Poland was often the plaything of the European states system. Keywords: eighteenth century; Europe; military history; monarchy; war

p57KIP2 (KIP2) is a cyclin-dependent kinase inhibitor that arrests cells in G1 and an imprinted gene mapped on chromosome 11p15.5. To investigate the role of KIP2 in Wilms' tumor (WT), DNA and RNA were extracted from archival tissue sections of WT. KIP2 expression was investigated by reverse transcription-polymerase chain reaction and in situ mRNA hybridization. Thirteen of 39 WT were informative for length polymorphism of KIP2 and subjected to reverse transcription-polymerase chain reaction. KIP2 was expressed predominantly from one allele, although a low level of expression was also detected from the other. Three WT with loss of heterozygosity at the KIP2 locus demonstrated that the remaining KIP2 allele was still active, which was also confirmed by in situ hybridization. Furthermore, among 13 KIP2-informative WT, 2 were heterozygous for insulin-like growth factor II (IGF2). Allele-specific analysis demonstrated that one showed monoallelic IGF2 expression, whereas the other showed biallelic expression. In situ hybridization of fetal kidney showed that KIP2 transcripts were detected in a variety of cell types, among which differentiated epithelial structures showed higher expression than undifferentiated mesenchyme, whereas IGF2 was expressed predominantly in undifferentiated mesenchyme and renal vesicles of an early phase. WT demonstrated KIP2 and IGF2 hybridization patterns similar to fetal kidney in that KIP2 transcripts were detected in epithelial structures and blastema, whereas IGF2 transcripts were seen in blastema and immature epithelial structures. Hybridization results indicated that KIP2 expression in WT did not appear to be significantly reduced compared with that in fetal kidney and that WT demonstrated a significant amount of KIP2 transcripts regardless of retention or loss of heterozygosity at the KIP2 locus. These data suggest that although KIP2 may play a role in differentiation of the fetal kidney, it is not likely as a tumor suppressor gene, which is implicated as the cause of the development of a majority of WT.

The haemodynamic effects of angiotensin converting enzyme (ACE) inhibitors have been extensively examined in patients with chronic heart failure. The renal effects of these drugs have, however, been less well studied [1]. The relatively few studies that have evaluated the renal actions of ACE inhibitors in chronic heart failure have shown an acute fall in urinary sodium excretion [2–4]. The present study was designed to investigate the mechanism, or mechanisms, of this early sodium-retaining effect of ACE inhibitors.

This paper describes a C++ class library that implements the Standard for the Exchange of Product Model Data (STEP). The STEP class Library (SCL) is under development at the National Institute of Standards and Technology as part of the National PDES Testbed and provide the core set of STEP functions for tools that are used to validate the STEP information models and for STEP based application prototypes. The library also lowers the economic barrier to developing STEP based applications. The current version of the library provides a STEP compliant file exchange mechanism, consequently, users of the class library will not have to create an input/output mechanism for STEP. The paper provides an introduction to STEP and the specification language, Express, in which it is written. The supporting classes that provide the STEP compliant input/output mechanism and the mapping between the Express specification and the C++ classes are described. The paper concludes with descriptions of some applications that use the class library and a discussion of future directions for the class library.

The pathogenesis of heart failure is not yet fully understood. In animal models there is some evidence to suggest a role for free radicals (FRs). We have investigated malondialdehyde - LM in plasma of patients with heart failure and found it to be raised when compared to controls. We present data to show that Captopril, a drug with an ACE inhibitory effect is a FR scavenger both in vitro and ex-vivo in patients with heart failure.

The pathogenesis of heart failure is not yet fully understood. In animal models there is some evidence to suggest a role for free radicals (FRs). We have investigated malondialdehyde - LM in the plasma of patients with heart failure and found it to be raised when compared to controls. We present data to show that Captopril, a drug with an ACE inhibitory effect is a FR scavenger both in vitro and ex-vivo in patients with heart failure.

We have examined the effects of magnesium replacement therapy upon post-exercise heart rate and incidence of ventricular premature beats (VPB) in digitalised patients with AF. In 11 such patients, all of whom had serum magnesium concentrations of less than 0.85 mmol/l, treatment with magnesium glycerophosphate was associated with a significant reduction in number of VPBs (982 v. 416 VPB/24 h). Five patients had a high prevalence of ventricular ectopy (greater than 300 VPB/24 h) and these subjects showed particularly marked decreases in VPBs during magnesium treatment (1998 v. 690 VPB/24 h). Three patients had slightly increased QTc intervals but these did not change during magnesium replacement. No significant changes were seen in the mean post-exercise heart rate although 2 subjects did show falls of 25% or more during magnesium replacement. We conclude that treatment with magnesium glycerophosphate may be associated with a decreased prevalence of ventricular ectopy in some digitalised patients with chronic AF and mild-moderate hypomagnesaemia.

The solubilities of NaF and LiF have been measured in mixtures of water with methanol, ethanol, ethylene glycol and acetonitrile over the whole composition range. Gibbs free energies of transfer of the fluoride ion from water to the mixed and pure solvents have been calculated from the solubility data via the tetraphenylarsonium tetraphenylborate assumption. The values so obtained indicate that the fluoride ion is preferentially solvated by water as a result of its strong hydrogen-bonding capabilities. Desolvation of the fluoride ion is especially marked in acetonitrile-rich solutions.

This paper focuses on stylus and optical techniques for the measurement of surface roughness in wind tunnel models. The stylus instruments provide detailed information, such as surface profiles and area maps, that may then be used either to calculate statistical properties (i.e., the rms surface roughness) or to study individual surface peaks or other features. By contrast, certain optical techniques yield area-averaged statistical properties of the surface roughness directly. Two instruments that use the technique of optical angular scattering are compared. One is a research instrument that has been developed to study the basic scattering phenomena by testing the optical theories and surface models used in inverse calculations of statistical roughness parameters. The second instrument is more compact and is under development as a hand held, on-line device to be used during manufacture of wind tunnel models for the National Transonic Facility at NASA Langley Research Center. The scattering geometries for the two instruments are compared and results from these instruments and the stylus technique are shown for roughness specimens that are typical of the surface finish of wind tunnel models.

Results are presented for optical scattering measurements of six sinusoidal surfaces with a roughness average Ra ranging from 0.3 to 3 μm and wavelengths ranging from 40 to 800 μm. The probe was an He-Ne laser beam with a 0.6328 μm wavelength. The multipeaked scattering distributions were fitted by a straightforward phase screen integral to find the amplitude and spatial frequency parameters that then yielded results for Ra and the spatial wavelength for each surface. The agreement with the comparable parameters as measured by a stylus instrument is excellent. This leads to the observation that optical scattering with visible light in conjunction with a straightforward optical theory can yield accurate measurements of roughness parameters provided that the surface roughness itself can be accurately modeled with appropriate a priori knowledge and provided that the surface slopes and heights are in the ranges represented by these sinusoidal surfaces.

A 32 year old woman presented with a syncopal attack and dyspnoea on exertion. A diagnosis of primary pulmonary hypertension was confirmed by clinical examination, cardiac catheterisation, and pulmonary angiography. Her symptoms resolved completely with oral diazoxide and the pulmonary arterial pressure was reduced to normal levels over a period of six years. When diazoxide was discontinued on two separate occasions pulmonary hypertension recurred. This demonstrated the continued presence of the underlying stimulus for vasoconstriction.

Twelve patients (mean age 48.8 years, 5 females) with untreated labile or mild essential hypertension completed a randomised, double-blind crossover study comparing the effects of two-week courses of indomethacin, sulindac and matching placebo upon sitting and standing blood pressure. Both indomethacin and sulindac significantly increased systolic BP when compared with placebo; indomethacin tended to have a greater pressor effect than sulindac. During treatment with indomethacin, the mean BP rose from 136/86 to 149/92 (sitting), and from 136/93 to 150/99 standing. The extent of the pressor response was unrelated to baseline BP. The results indicate that both non-steroidal anti-inflammatory drugs (NSAIDs) have a significant pressor effect in individuals with untreated labile or mild hypertension. The fact that sulindac had a pressor effect implies that this response may be unrelated to inhibition of renal prostaglandins, or that the renal-sparing effect of sulindac is only relative. Extra-renal prostaglandins may play a role in the control of BP in this population. Individuals with labile or mild hypertension do not appear to exhibit exaggerated pressor responses during treatment with these NSAIDs, as similar increases in BP have been reported in normal subjects.

This paper focuses on stylus and optical techniques for the measurement of surface roughness in wind tunnel models. The stylus instruments provide detailed information, such as surface profiles and area maps, that may then be used either to calculate statistical properties (i.e., the rms surface roughness) or to study individual surface peaks or other features. By contrast, certain optical techniques yield area-averaged statistical properties of the surface roughness directly. Two instruments that use the technique of optical angular scattering are compared. One is a research instrument that has been developed to study the basic scattering phenomena by testing the optical theories and surface models used in inverse calculations of statistical roughness parameters. The second instrument is more compact and is under development as a hand held, on-line device to be used during manufacture of wind tunnel models for the National Transonic Facility at NASA Langley Research Center. The scattering geometries for the two instruments are compared and results from these instruments and the stylus technique are shown for roughness specimens that are typical of the surface finish of wind tunnel models.

Enthalpies of transfer of potassium fluoride from water to water-methanol mixtures over the whole composition range have been determined by calorimetry. Combination of these values with literature data has enabled calculation of the enthalpies and entropies of transfer for the individual ions through the tetraphenylarsonium tetrapbenylborate ( tatb ) assumption. The values of ΔtH°(F-) and ΔtS°(F-) show a complex dependence on solvent composition which closely parallels the dependence of the other halide ions. These effects are discussed in terms of ion-solvent and solvent-solvent interactions. The halide ions appear to be (weakly) preferentially solvated by H2O, and the alkali metal ions by MeOH.