Hernia Center

Wstp: Neuroborelioza jest jedn z najczstszych pozamzgowych manifestacji zakaenia Borrelia burgdorferi i moe prowadzi do uszkodzenia nerwu twarzowego.Poraenie nerwu VII skutkuje asymetri twarzy, ograniczeniem funkcji mini mimicznych, trudnociami w artykulacji, poykaniu i mimice emocjonalnej.Rehabilitacja w przebiegu neuroboreliozy obejmuje zarwno kinezyterapi, jak i metody fizykalne, w tym elektrostymulacj mini twarzy, ktrej celem jest pobudzenie osabionych wkien miniowych,

Endoscopic Mini or Less Open Sublay (eMILOS) is a transhernial endoscopically assisted approach for anterior abdominal wall hernia repair that has demonstrated excellent long-term outcomes. Performed through a small skin incision directly over the hernia, the eMILOS technique minimizes additional access trauma, but remains technically demanding with conventional instruments. This study investigates the preclinical feasibility of adapting the da Vinci SP system to perform the transhernial SP MILOS technique. This preclinical study evaluated the technical feasibility of performing daVinci SP MILOS hernia repair using human cadavers. The da Vinci SP robotic platform and its standard instruments were employed. Procedural steps, technical considerations, limitations, and potential advantages were systematically documented. The procedure was completed through a 1.8-cm skin incision. Correct placement of the Access Port (AP) and defining the custom remote center (CRC) at the posterior fascial edge was essential for optimal trocar orientation and to limit collisions with the incision. The AP can be positioned below the skin or below the fascia depending on work flow and surgeon preference. The retrorectus space was developed robotically from xiphoid to pubis, with full 360° transhernial exposure. Transversus abdominis release and lateral dissection into the preperitoneal and pretransversalis planes were successfully achieved. In this preclinical cadaveric study, the SP MILOS technique provided 360° transhernial access to the retrorectus space without platform repositioning. Our initial experience supports its feasibility as a new single-port robotic option for ventral hernia repair, eliminating access trauma to the abdominal wall through a single, minimal skin incision.

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection globally, responsible for a wide spectrum of epithelial lesions ranging from benign warts to invasive malignancies of the cervix, vulva, anus, and oropharynx. More than 200 genotypes have been identified, with low-risk types such as HPV-6 and HPV-11 linked to genital warts, and high-risk types, notably HPV-16 and HPV-18, associated with oncogenic transformation. Transmission occurs primarily through direct sexual contact, although nonsexual and vertical routes have been described. The majority of infections remain asymptomatic and transient, yet persistent infection with high-risk genotypes can lead to neoplastic progression. Diagnosis is mainly clinical, supported by histopathology and molecular HPV DNA detection when indicated. Current management focuses on lesion removal through topical agents (podophyllotoxin, imiquimod, sinecatechins) and ablative or surgical techniques, though recurrence remains frequent. Preventive strategies are central to disease control, with prophylactic HPV vaccination demonstrating remarkable efficacy in reducing infection rates and HPV-related disease burden worldwide. The bivalent, quadrivalent, and nonavalent vaccines provide durable protection for at least 10–14 years and are recommended before sexual debut. Expanding global vaccine coverage, combined with continued screening and education, remains vital to reducing HPV-related morbidity and mortality.

Gastroesophageal reflux disease (GERD) is a widespread gastrointestinal disorder with a significant global burden. Its multifactorial etiology is influenced by unmodifiable risk factors such as sex-based differences; men, for instance, show a higher predisposition for more severe complications like esophageal adenocarcinoma. GERDs pathophysiology is heavily connected with mechanical failure of the anti-reflux barrier, a two-component system that consists of the intrinsic lower esophageal sphincter (LES) and the extrinsic crural diaphragm. Interference in the form of hiatal hernia, hypotensive LES pressure or transient LES relaxations leads to reflux. Modern approach highlights the critical role of microscopic mucosal damage, which causes visceral hypersensitivity and allows the distinction of various phenotypes like non-erosive reflux disease and reflux hipersensitivity. Diagnosis is guided by the Lyon Consensus 2.0 using endoscopy, manometry, and impedance-pH monitoring. Treatment is a multi-step process – it includes lifestyle modification, numerous pharmacological agents such as proton pump inhibitors or newer potassium-competitive acid blockers, and, for refractory cases, interventional treatment via laparoscopic Nissen fundoplication, transoral incisionless fundoplication or magnetic sphincter augmentation.

I would like to draw scholarly attention to the accelerating relevance of Industry 5.0 and its transformative implications for marketing strategy, consumer engagement, and organizational competitiveness. While Industry 4.0’s foundations automation, digitalization, and data-driven processes have substantially shaped contemporary marketing, the transition toward Industry 5.0 represents a more human-centered evolution. This paradigm emphasizes collaborative intelligence, sustainability, personalization, and meaningful human–machine interaction (Nahavandi, 2019). Despite its strategic significance, discussions on Industry 5.0 within mainstream marketing scholarship remain insufficiently developed, calling for deeper theoretical and empirical inquiry.

Pension funds for unionized workers increasingly invest with private equity asset managers. In this paper, we provide an overview of the private equity business model and the ways it can both negatively impact workers and their communities and create risks for pension funds' investment returns. Drawing on a case study of the 2023-2024 hotel workers' strike in Southern California, we also show how pension fund leaders can and increasingly are taking steps to mitigate the risks posed by private equity managers. We argue that such measures are not only permitted but mandated by trustees' fiduciary duty to safeguard beneficiaries' interests when making investment decisions.

With a decrease in recurrence since modern hernia repair, chronic postoperative inguinal pain is the most important patient-centered outcome. Surgical intervention is often necessary in cases refractory to conservative measures but remains understudied. To evaluate causes of refractory chronic postoperative inguinal pain and review the operative approaches used to treat patients who experience it. This case series used electronic medical record data from a single-institution hernia center during the period August 1, 2009, to September 17, 2024. Participants were adult patients who underwent surgery for chronic postoperative inguinal pain; those who underwent surgeries during which the inguinal canal was not entered or involved were excluded. Patients were followed up from their remedial surgery date to their most recent surgeon follow-up visit date. Remedial surgical approach (laparoscopic, robotic, open, combined), use of mesh, nerve management, and mesh excision. The primary outcome was subjective pain improvement after remedial surgery; other outcomes were postoperative complications and need for additional operations. A total of 818 adult patients underwent surgery for chronic postoperative inguinal pain (median [IQR] age, 53 [42-64] years; 193 [23.6%] were female and 625 [76.4%] male). Among them, 779 patients (95.2%) underwent previous inguinal repair with nearly half (49.3%) undergoing 2 or more surgeries. Of remedial surgeries, 221 (27.0%) were open alone, 113 (13.8%) were laparoscopic alone, 57 (7.0%) were robotic alone, 349 (42.7%) were hybrid open and laparoscopic, and 78 (9.5%) were hybrid open and robotic. Seven hundred thirty patients (89.2%) underwent a neurectomy, with triple neurectomies in 401 surgeries (54.9%). Mesh was removed in 559 patients (68.3%). Among patients with at least 5 days of postoperative follow-up, inguinal pain improved in 798 patients (98.5%), with 560 patients (70.2%) reporting more than a 50% reduction in inguinal pain and 226 (28.3%) reporting a 50% or smaller improvement. Twelve patients (1.5%) had no significant improvement in subjective pain. Forty-two patients (5.1%) experienced complications. Chronic postoperative inguinal pain is a common, debilitating complication of inguinal hernia repair. Remedial surgery is complex, but tailored surgical approaches that consider neurectomy, mesh excision, and recurrent inguinal hernia repair can be safe and effective in experienced centers.

Abstract The roots of three Cynanchum species—Cynanchum wilfordii (CW), C. auriculatum (CA), and C. rostellatum (CR)—are widely used for medicinal purposes in Northeast Asia. Unlike CW and CA, CR lacks storage roots and features long, slender roots. To explore these species' genomes and support breeding efforts, we assembled nearly complete pseudo-haploid reference genomes with centromere and telomere repeats for all three, along with 28 haplotype-resolved genomes from nine CW, three CA, and two CR accessions. Graph-based pangenome integration and association scans identified key genes involved in root diversity in CW. Additionally, the Cynanchum pangenome and expression data indicated lower abscisic acid (ABA) biosynthesis in CR due to structural variation in ABSCISIC ALDEHYDE OXIDASE 3. ABA deficiency hampers stomatal control, while extremely long roots likely adapt to water loss. Our findings offer insights into root development and aid genomics-based breeding of these valuable root crops.