BackgroundWith the development of prosthetic mesh and tension free techniques, the recurrence rate following inguinal hernia repair has been reduced, and hernia outcomes research should focus on post-operative quality of life and potential complications.Study designA novel hernia quality of life assessment instrument, HERQL, was developed. The HERQL questionnaire comprises a 4-item summative pain score measuring pain and discomfort resulting from various strenuous activities. Symptomatic and functional domains, as well as post-operative satisfaction are evaluated as well.ResultsA total of 386 HERQL surveys were completed by 183 patients with inguinal hernias. Internal consistency reliability of the summative pain score was satisfactory, with a Cronbach’s alpha of 0.85. Criterion validity was examined by concomitant assessment of the pain/discomfort and health impact subscales of the EQ-5D questionnaire, with substantial to moderate correlations. Pre-operative patients reported more severe hernia protrusion, more pain during mild to heavy exercise, and worse activity restriction and health impairment than the follow-up patients, indicating clinical validity. The conceptual structure of the HERQL demostrated the causal relationship between the formative symptomatic subscales and the reflective functional status indicators. Repeated measurement of the summative pain scores revealed an estimated time effect of -1.63, which was the rate of change in the summative pain score across the pre-operative, immediately post-operative, and follow-up 3-month periods suggesting the clinical responsiveness of the HERQL.ConclusionsThis study will facilitate inguinal hernia outcomes research and enhance the quality of care for this common disease by providing a validated HERQL instrument with enhanced sensitivity.
This retrospective clinicohistopathologic study was performed to delineate the role of laparoscopic cholecystectomy in the management of polypoid lesions of the gallbladder. One hundred forty-three consecutive patients who had a preoperative sonographic diagnosis of polypoid lesions of the gallbladder with a diameter less than 1.5 cm and who underwent laparoscopic cholecystectomy at Cathay General Hospital were included in the analysis. Histopathologic study showed that 22 (15.4%) patients had true tumors, including adenoma (16), adenoma with focal adenocarcinoma (2), adenocarcinoma (3), and carcinoid tumor (1). Tumorlike lesions were found in 121 (84.6%) patients and included cholesterol polyp (106), adenomyomatous hyperplasia (10), inflammatory polyp (3), and papillary hyperplasia (2). The mean diameter of malignant polypoid lesions of the gallbladder was 1.35 +/- 0.42 cm, which was significantly larger than that of cholesterol polyps (0.66 +/- 0.40 cm, P = 0.0001) but not significantly larger than that of adenomyomatous hyperplasias (1.12 +/- 0.42 cm) and adenomas (1.08 +/- 0.47 cm). The mean age of patients with malignant polypoid lesions of the gallbladder (61.2 +/- 13.3 years old) was significantly older than that of patients with adenomyomatous hyperplasia (46.6 +/- 13.4 years, P = 0.03), cholesterol polyps (44.5 +/- 10.5 years, P = 0.0003), and adenomas (41.4 +/- 9.4 years, P = 0.0008). Clinical follow-up showed that most (98.6%) patients benefited from the minimal invasiveness of laparoscopic cholecystectomy with satisfactory surgical results. We conclude that laparoscopic cholecystectomy is a reliable, safe, and minimally invasive biopsy procedure and definite management of polypoid lesions of the gallbladder with a diameter less than 1.5 cm.
The aim of the study is to evaluate gene component analysis for microarray studies. Three dimensional reduction strategies, Principle Component Regression (PCR), Partial Least Square (PLS) and Reduced Rank Regression (RRR) were applied to publicly available breast cancer microarray dataset and the derived gene components were used for tumor classification by Logistic Regression (LR) and Linear Discriminative Analysis (LDA). The impact of gene selection/filtration was evaluated as well. We demonstrated that gene component classifiers could reduce the high-dimensionality of gene expression data and the collinearity problem inherited in most modern microarray experiments. In our study gene component analysis could discriminate Estrogen Receptor (ER) positive breast cancers from negative cancers and the proposed classifiers were successfully reproduced and projected into independent microarray dataset with high predictive accuracy.
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