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Purpose: The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias. Methods: A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey. Comparisons based on training level were made using χ test of independence, Fisher's exact, and Fisher's exact with Monte Carlo estimate as appropriate. A p value <0.05 was considered significant. Results: The survey was returned by 183 residents from 250 surgical programs. Resident postgraduate year (PG-Y) level was equivalent among groups. Preferred techniques for open ventral hernia varied; the most common (32 %) was intra-abdominal placement of mesh with defect closure. Twenty-two percent of residents had not heard of the retrorectus technique for hernia repair, 48 % had not performed the operation, and 60 % were somewhat comfortable with and knew the general categories of mesh prosthetics products. Mesh choices, biologic and synthetic, varied among the different products. The most common type of hernia education was teaching in the operating room in 87 %, didactic lecture 69 %, and discussion at journal club 45 %. Number of procedures, comfort level with open and laparoscopic techniques, indications for mesh use and technique, familiarity and use of retrorectus repair, and type of hernia education varied significantly based on resident level ( p < 0.05). Conclusion: Exposure to hernia techniques and mesh prosthetics in surgical residency programs appears to vary. Further evaluation is needed and may help in standardizing curriculums for hernia repair for surgical residents. [ABSTRACT FROM AUTHOR]

Background:Bilateral risk-reducing salpingo-oophorectomy (BRRSO) is the only effective way of reducing mortality from ovarian cancer. This study investigates uptake of BRRSO in 700 BRCA1/2 mutation carriers from Greater Manchester.Methods:Dates of last follow-up and BRRSO were obtained, and the following variables were investigated: ovarian cancer risk/gene, age and breast cancer history. The date of the genetic mutation report was the initiation for Kaplan-Meier analysis.Results:The uptake of BRRSO in BRCA1 mutation carriers was 54.5% (standard error 3.6%) at 5 years post testing compared with 45.5% (standard error 3.2%) in BRCA2 mutation carriers (P=0.045). The 40-59 years category showed the greatest uptake for BRRSO and uptake was significantly lower in the over 60 s (P<0.0001). Of the unaffected BRCA1 mutation carriers, 65% (standard error 5.1%) opted for surgery at 5 years post-testing compared with 41.1% (standard error 5.1%) in affected BRCA1 mutation carriers (P=0.045).Conclusion:The uptake of BRRSO is lower in women previously affected by breast cancer and in older women. As there is no efficient method for early detection of ovarian cancer, uptake should ideally be greater. Counselling should be offered to ensure BRCA1/2 mutation carriers make an informed decision about managing their ovarian cancer risk. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) incidence increases with age, and early onset of the disease is an indication of genetic predisposition, estimated to cause up to 30% of all cases. To identify genes associated with early-onset CRC, we investigated gene expression levels within a series of young patients with CRCs who are not known to carry any hereditary syndromes (n=24; mean 43 years at diagnosis), and compared this with a series of CRCs from patients diagnosed at an older age (n=17; mean 79 years). Two individual genes were found to be differentially expressed between the two groups, with statistical significance; CLC was higher and IFNAR1 was less expressed in early-onset CRCs. Furthermore, genes located at chromosome band 19q13 were found to be enriched significantly among the genes with higher expression in the early-onset samples, including CLC. An elevated immune content within the early-onset group was observed from the differentially expressed genes. By application of outlier statistics, H3F3A was identified as a top candidate gene for a subset of the early-onset CRCs. In conclusion, CLC and IFNAR1 were identified to be overall differentially expressed between early- and late-onset CRC, and are important in the development of early-onset CRC. [ABSTRACT FROM AUTHOR]

Purpose: Secure abdominal wall closure for laparotomy incisions is paramount in prevention of hernia formation. Despite the importance, abdominal closure is often delegated to the resident surgeon. The purpose of this study was to assess residents’ formal training, knowledge, and technique in abdominal wall closure. Methods: All surgical residents in our training program participated in a skills laboratory and completed a questionnaire. The skills portion involved closure of a 10-cm incision on a simulated abdominal wall. Participants were timed, videotaped, and graded using a standardized grading system. Lengths of the suture bites were measured. Regression analysis was used to compare results based on number of closures. A P-value of <0.05 was considered significant. Results: Ten surgical residents participated. The average time for closure was 4:23 min (range 3:08–5:65 min). The average distance between the bite and the incision was 0.9 cm and between bites was 0.8 cm. All knots were satisfactory and intact following closure. Participants’ experience varied with a range from 0 to 230 previous abdominal closures. All residents chose to perform closure in a continuous fashion using a slowly absorbing suture. All but one resident stated that sutures should be placed 1 cm from the incision with 1 cm advances. Only one resident knew the correct suture-to-wound length ratio for closure, and only four residents were familiar with the literature about abdominal wall closure. With increasing closure experience, there was significant improvement in time and motion of suturing ( P = 0.02), respect of tissue ( P = 0.0002), instrument handling ( P = 0.004), orientation of needle ( P = 0.0076), and flow of closure ( P = 0.046). Residents who had performed more closures took significantly larger suture bites ( P = 0.03) with larger distances between bites ( P = 0.03). Conclusions: Surgical technique improves with increased experience with abdominal closures; however, residents at all levels have the physical ability to adequately perform this task. Education regarding closure appears to be lacking, and further study warranted. [ABSTRACT FROM AUTHOR]

Presymptomatic genetic testing in childhood for adult onset conditions is generally discouraged as it does not directly benefit the child and removes their autonomy. In certain cancer prone conditions such as Familial Adenomatous Polyposis and Von Hippel Lindau disease there are risks of disease in childhood and benefit to children not inheriting a mutation in being able to forego unpleasant screening tests. Li–Fraumeni syndrome caused by constitutional TP53 mutations there are also implications in childhood with a risk of around 20% of a childhood malignancy. However, as yet no evidence based surveillance programme has been identified. We describe our experience of childhood testing for four children in two Li–Fraumeni families caused by TP53 mutations. [ABSTRACT FROM AUTHOR]

To combat spectral overcrowding, the FCC investigated new ways to manage RF resources. The idea was to let people use licensed frequencies, provided they can guarantee interference perceived by the primary license holders will be minimal. With advances in software and cognitive radio, practical ways of doing this are on the horizon. In 2003, the FCC released a memorandum seeking comment on the interference temperature model for controlling spectrum use. Analyzing the viability of this model and developing a medium access protocol around it are the main goals of this article. A model consisting of interference sources, primary licensed users, and secondary unlicensed users is modeled stochastically. If impact on licensed users is defined by a fractional decrease in coverage area, and this is held constant, the capacity achieved by secondary users is directly proportional to the number of unlicensed nodes, and is independent of the interference and primary users’ transmissions. Using the basic ideas developed in the system analysis, interference temperature multiple access, a physical and data-link layer implementing the interference temperature model, was formulated, analyzed, and simulated. A system implementing this model will measure the current interference temperature before each transmission. It can then determine what bandwidth and power it should use to achieve a desired capacity without violating an interference ceiling called the interference temperature limit. Ultimately, the resulting performance from the interference temperature model is low, compared to the amount of interference it can cause to primary users. Partly due to this research, in May 2007, the FCC rescinded its notice of proposed rule-making implementing the interference temperature model. [ABSTRACT FROM AUTHOR]

Laparoscopic ventral hernia repair is an accepted method for incisional hernia repair. Although techniques vary, transfascial suturing of the mesh to the abdominal wall has been proposed as a viable way to fixate the mesh and reduce recurrence rates. We report a 54-year-old woman who had previously undergone a laparoscopic ventral hernia repair following a laparoscopic tubal ligation using a Composix mesh. The patient presented with a symptomatic hernia recurrence. The computed tomography scan showed a periumbilical hernia containing fat. The patient underwent diagnostic laparoscopy and lysis of adhesions. During the lysis of adhesions, a recurrence through the previously placed composite mesh was encountered where holes had been made by the previously placed transfascial sutures. The hernia was reduced, mesh was removed, and an ePTFE mesh was used to repair the hernia. The mechanism of recurrence appeared to be improperly placed transfascial sutures; overly large bites of mesh caused excessive tension and ultimately a hole in the mesh. Hernia recurrence due to mesh or transfascial suture failure is rarely reported and most often caused by inadequate fixation. Our case highlights the need for meticulous placement of transfascial sutures and demonstrates a mechanism of recurrence due to inadequate placement. [ABSTRACT FROM AUTHOR]

The NOMAD (“Nadir and Occultation for MArs Discovery”) spectrometer suite on board the ExoMars Trace Gas Orbiter (TGO) has been designed to investigate the composition of Mars’ atmosphere, with a particular focus on trace gases, clouds and dust. The detection sensitivity for trace gases is considerably improved compared to previous Mars missions, compliant with the science objectives of the TGO mission. This will allow for a major leap in our knowledge and understanding of the Martian atmospheric composition and the related physical and chemical processes. The instrument is a combination of three spectrometers, covering a spectral range from the UV to the mid-IR, and can perform solar occultation, nadir and limb observations. In this paper, we present the science objectives of the instrument and explain the technical principles of the three spectrometers. We also discuss the expected performance of the instrument in terms of spatial and temporal coverage and detection sensitivity. [ABSTRACT FROM AUTHOR]