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Cosmological implications of the Machian principle.

The famous idea of Ernst Mach concerning the non-absolute but relational character of particle inertia is taken up in this paper and is reinvestigated with respect to its cosmological implications. From Thirring's general relativistic study of the old Newtonian problem of the relativity of rotations in different reference systems, it appears that the equivalence principle with respect to rotating reference systems, if at all, can only be extended to the system of the whole universe, if the mass of the universe scales with the effective radius or extent of the universe. A reanalysis of Thirring's derivations still reveals this astonishing result, and thus the general question must be posed: how serious this result has to be taken with respect to cosmological implications. As we will show, the equivalence principle is, in fact, fulfilled by a universe with vanishing curvature, i.e. with a curvature parameter k = 0, which just has the critical density rho (crit) = (3H)(2)/8piG, where H is the Hubble constant. It turns out, however, that this principle can only permanently be fulfilled in an evolving cosmos, if the cosmic mass density, different from its conventional behaviour, varies with the reciprocal of the squared cosmic scale. This, in fact, would automatically be realized, if the mass of each cosmic particle scales with the scale of the universe. The latter fact, on one hand, is a field-theoretical request from a general relativistic field theory which fulfills H. Weyl's requirement of a conformal scale invariance. On the other hand, it can perhaps also be concluded on purely physical grounds, when taking into account that as source of the cosmic metrics only an effective mass density can be taken. This mass density represents the bare mass density reduced by its mass equivalent of gravitational self-binding energy. Some interesting cosmological conclusions connected with this fact are pointed out in this paper.

Astronomical Phenomena↗

The prevalence of significant left-right differences in hip bone mineral density.

INTRODUCTION: We determined the prevalence of left-right differences in hip bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) and the resultant consequence, namely: the frequency at which patients would be classified differently if lumbar spine and only one hip (rather than both hips) were measured. METHODS: This was a retrospective DXA scan reanalysis of 3012 white women >or=50 yrs who had scans of both hips using Hologic DXA systems. The difference between left and right hips was considered significant if it exceeded the least significant change (LSC) for any of three hip subregions (total hip, femoral neck, trochanter). The number of women with osteoporosis in both hips, the left hip only, or the right hip only was determined by lowest T-score from total hip, femoral neck, or trochanter. RESULTS: Despite high left-right correlations of subregion BMD, significant left-right differences in BMD were common: the difference exceeded the LSC for 47% of women at total hip, 31% at femoral neck, and 56% at trochanter. Left-right differences in BMD that exceeded the LSC affected the percent agreement of left-right hip classification: for all women irrespective of spine status, there was 77% classification (diagnostic) agreement in hip pairs in which the left-right hip BMD difference exceeded the LSC versus 87% agreement in which LSC was not exceeded (significant difference in proportions, P<0.0001). The greatest risk of different classification would occur in women with normal spines as the diagnosis might be determined by hip T-scores. Using L1-4 lumbar spine T-scores, 1229 women were normal at the spine. Twenty-four (2%) were osteoporotic at both hips. However, 12 women (1%) were osteoporotic only in the left hip (significantly different from zero, P<0.001) and 11 (1%) only in the right hip (P<0.001); of these 23 women, the difference in BMD between the osteoporotic hip and the contralateral hip exceeded the LSC in 16 (70% of those with osteoporosis in only one hip). Using L1-4 lumbar spine T-scores, 1159 women were osteopenic at the spine. Of these, 126 (11%) were osteoporotic at both hips, 54 (5%) only in the left hip (P<0.001), and 42 (4%) only in the right hip (P<0.001); of these 96 women, the difference in BMD between the osteoporotic hip and the contralateral hip exceeded the LSC in 56 (58% of those with osteoporosis in only one hip). CONCLUSIONS: A statistically significant number of women with osteoporosis are potentially classified differently when scanning only one hip as a result of the high prevalence of left-right differences in BMD. Although the percentages are low, the total number of women affected may be large. From a public health perspective, the practice of scanning both hips could potentially identify more women with osteoporosis and may help prevent future hip fractures.

Absorptiometry, Photon↗

Vertebral morphometry: repeat scan precision using the Lunar Expert-XL and the Hologic 4500A. A study for the 'WISDOM' RCT of hormone replacement therapy.

On radiation safety grounds there is concern about the morbidity attributable to routine radiographs of the spine for the identification of new fractures in large-scale trials of fracture prevention. However, the role of the potentially safer low-radiation-dose technique of vertebral morphometry performed by third generation dual-energy X-ray absorptiometry equipment requires evaluation for use in clinical trials. We have therefore investigated the short-term inter-scan imprecision as well as the imprecision attributable to different-day analyses by the same operator and differences in analyses by different operators. The volunteer subjects were participants in a pilot study for a randomized controlled trial of hormone replacement therapy (Women's International Study of long Duration Oestrogen after Menopause, WISDOM). Each subject had two morphometric X-ray analysis scans separated by 2-4 weeks. Exclusions were women with densitometrically defined osteoporosis, as defined by the WHO criterion, and women with a body mass index exceeding 30.9 kg/m2. On average, the women were 58.7 years of age and had bone mineral density values in the lumbar spine which were about 0.7 SD units higher than a reference US female age-matched population. Scans were assessed from vertebrae T7 through L4. In the study there were no clinically significant differences in performance between the Hologic QDR 4500A and the Lunar Expert XL equipment. Between-scan imprecision was significantly worse than imprecision attributable to reanalysis of the same scan by a different operator or the same operator after an interval. Vertebral level had an effect on measurement uncertainty, especially at the level of the diaphragm and at T7. Coefficients of variation, expressed as percentages of mean values, were better for absolute height measurements than for height ratios, ranging from 1.75% to 3.40% for the three heights measured on three separate machines and from 2.34% to 4.11% for the two height ratios. These results compared favorably with the equivalent figures from a parallel study of morphometry precision undertaken using standard lateral radiographs of the thoracic and lumbar spine (3.1-3.6% and 3.8-3.9%, respectively). We conclude that in trials of prevention therapy in women (or men) selected for not having osteoporosis, low-dose vertebral morphometry using the Hologic 4500A, the Lunar Expert XL or similar equipment is preferable on safety grounds to the classical technique based on standard radiographs, although conventional radiology may still be required in those with prevalent or incident deformities to exclude causes other than osteoporosis. The place of this low-dose technique in trials performed on patients with osteoporosis requires further study.

Absorptiometry, Photon↗

Long-term stability of hydrocarbons in NIST gas standard reference material (SRM) 1800.

A gas standard reference material (SRM) containing fifteen hydrocarbons in nitrogen at a nominal 5 nmol mol(-1) was issued in 1993. The certification period for SRM 1800 was assigned as 2 years, because of limited stability data. Over a period of 10 years reanalysis of the lot standard (a sample chosen from the SRM lot to which all other lot samples are compared), SRM samples remaining in stock for sale, and SRMs returned to the National Institute of Standards and Technology (NIST) for recertification, were compared with primary standards to assess the stability of the hydrocarbons. New primary standards were periodically introduced into the original primary standard suite to assess the stability and consistency of the primary standards. Over this ten-year period 11 SRM 1800 samples were reanalyzed, resulting in 210 amount-of-substance fraction (concentration) determinations performed for quality-assurance purposes. Of these measurements 209 (99.5%) agreed within the original 95% confidence interval of the +/-4% expanded uncertainty, demonstrating the stability of the standards. There was also agreement to within +/-2% of the original concentration for 204 (97%) of the measurements. This is well within the original +/-4% expanded uncertainty assigned to the hydrocarbon concentrations at the approximate 95% confidence interval demonstrating stability. These results will enable the expiry date to be increased for future restock issues of SRM 1800.

Environmental Monitoring↗

Independent effects of endogenous and exogenous spatial cueing: inhibition of return at endogenously attended target locations.

Inhibition of return (IOR) is thought to reflect a bias against returning attention to previously attended locations. According to this view, IOR should occur only if attention is withdrawn from the target location prior to target appearance. In the present study, endogenous attention and exogenous cueing were manipulated orthogonally. IOR was observed both when a target appeared at an unexpected location, and when a target appeared at the expected location. A similar pattern of results was obtained in a reanalysis of data from a study with Neglect patients. These results suggest that IOR is independent of endogenous orienting.

Adult↗

How powerful is the dwell-time analysis of multichannel records?

Exact algorithms for the kinetic analysis of multichannel patch-clamp records require hours to days for a single record. Thus, it may be reasonable to use a fast but less accurate method for the analysis of all data sets and to use the results for a reanalysis of some selected records with more sophisticated approaches. For the first run, the tools of single-channel analysis were used for the evaluation of the single-channel rate constants from multichannel dwell-time histograms. This could be achieved by presenting an ensemble of single channels by a "macrochannel" comprising all possible states of the ensemble of channels. Equations for the calculations of the elements of the macrochannel transition matrix and for the steady-state concentrations for individual states are given. Simulations of multichannel records with 1 to 8 channels with two closed and one open states and with 2 channels with two open and two closed states were done in order to investigate under which conditions the one-dimensional dwell-time analysis itself already provides reliable results. Distributions of the evaluated single-channel rate constants show that a bias of the estimations of the single-channel rate constants of 10 to 20% has to be accepted. The comparison of simulations with signal-to-noise ratios of SNR = 1 or SNR = 25 demonstrates that the major problem is not the convergence of the fitting routine, but failures of the level detector algorithm which creates the dwell-times distributions from noisy time series. The macrochannel presentation allows the incorporation of constraints like channel interaction. The evaluation of simulated 4-channel records in which the rate-constant of opening increased by 20% per already open channel could reveal the interaction factor.

Algorithms↗

Detecting natural selection at the molecular level: a reexamination of some "classic" examples of adaptive evolution.

An important criterion used to detect adaptive evolution in DNA sequence data is omega(i) > 1, where omega(i) is the ratio of nonsynonymous to synonymous substitution rates in lineage i. However, the evaluation of multiple omega(i) within a phylogenetic tree can easily inflate the statistical type I error rate. We developed two rigorous methods of analysis that avoid this and other potential pitfalls. We applied these methods to four published examples of adaptive evolution. One case was strongly supported by our reanalysis (abalone sperm lysin), and one was weakly supported (baboon alpha-globin), but two examples (primate lysozyme and Antarctic fish beta-globin) did not show significant evidence of adaptive evolution. Our first method is a "bottom-up" hierarchical maximum likelihood approach, which (1) tests for significant heterogeneity in omega across the phylogeny, (2) locates its source using a sequence of planned comparisons, and (3) tests homogeneous groups of omega for omega > 1, using a modified level of significance that incorporates the pretesting. The second method is a "top-down" log-linear analysis based on estimates of nonsynonymous and synonymous substitutions in pairs of lineages. The log-linear test is applied to pairs of lineages joined at progressively deeper nodes. For each pair, the analysis simultaneously tests for adaptive evolution (omega > 1), a shift in natural selection (omega1 does not = omega2), and unequal evolution rate (the relative rate test). In both tests, we emphasized that the criterion omega1 not equal omega2 is an important additional indicator of a phylogenetic shift in the balance between natural selection and genetic drift between two related lineages.

Adaptation, Biological↗

Additivity of state inventories of greenhouse-gas emissions.

In addition to national inventories of emissions of greenhouse gases, there are inventories for most, but not all, states constituting the United States. This paper analyzes the state inventories to see if reported emissions of carbon dioxide, methane, and nitrous oxide are additive. Considerable reanalysis of the state inventories is required before they can be added to yield a larger-scale inventory. Some specific sources were considered by some states but not by others. Estimation techniques evolved over time as inventories were produced, and there are instances of both double-counting (two states reporting the same emission) and omission (neither state reporting the same emission), where interstate transfers of energy or materials occurred. Nevertheless, the inventories, when adjusted for obvious double-counting or omissions, are probably approximately additive, although it is difficult to quantify the extent to which this is true.

Air Movements↗

Genetic analysis of alcohol intake in recombinant inbred and congenic strains derived from A/J and C57BL/6J progenitors.

The objective of the present study was to map quantitative trait loci (QTL) for alcohol intake using A x B/B x A recombinant inbred (RI) and AcB/BcA recombinant congenic (RC) strains of mice that were independently derived from the A/J and C57BL/6J progenitors. Mice were screened for levels of alcohol consumption with four days of forced exposure to alcohol, followed by three weeks of free choice between water and a 10% alcohol solution. Alcohol consumption data previously collected for 27 A x B/B x A RI strains were reanalyzed using a larger marker set and composite interval mapping. The reanalysis found markers on Chromosome 2 (D2Mit74, 107 cM) (males and females) and on Chromosome 11 (Pmv22, 8 cM) (females only) that exceeded the threshold for significant loci, and found suggestive loci (in males) on Chromosomes 10 (D10 Mit126, 21 cM), 12 (D12Mit37, 1 cM), 15 (Pdgfb, 46.8 cM), and 16 (D16Mit125, 29 cM). An additional suggestive locus was identified in female RI mice on Chromosome 11 (D11Mit120, 47.5 cM). Composite interval mapping (CIM) analysis indicated that there was a significant association between loci at Pdgfb and D2Mit74 in both males and females. Analysis of the AcB/BcA RC strains identified 11 QTL on Chromosomes 2, 3, 5,6, 7, 8, 9, 10, 12, 13, and 15. QTL on Chromosomes 7, 10, 12, and 15 were identified in both the A x B/B x A RI and AcB/BcA RC strains of mice. Additional QTLs identified on Chromosomes 2, 3, 7, 11, and 15 overlap with those previously identified in the literature using strains of mice with a C57BL/6J progenitor.

Alcohol Drinking↗

Comparative chromosome painting defines the high rate of karyotype changes between pigs and bovids.

Human and sheep chromosome-specific probes were used to construct comparative painting maps between the pig (Suiformes), cattle and sheep (Bovidae), and humans. Various yet unknown translocations were observed that would assist in a more complete reconstruction of homology maps of these species. The number of homologous segments that can be identified with sheep probes in the pig karyotype exceeds that described previously by chromosome painting between two non-primate mammals belonging to the same order. Sheep probes painted 62 segments on pig autosomes and delineated not only translocations, but also 9 inversions. All inversions were paracentric and indicate that these rearrangements may be characteristic for chromosomal changes in suiforms. Hybridizations of all sheep painting probes to cattle chromosomes confirmed the chromosome conservation in bovids. In addition, we observed a small translocation that was previously postulated from linkage mapping data, but was not yet described by physical mapping. The chromosome painting data are complemented with a map of available comparative gene mapping data between pig and sheep genomes. A detailed table listing the comparative gene mapping data between pig and cattle genomes is provided. The reanalysis of the pig karyotype with a new generation of human paint probes provides an update of the human/pig comparative genome map and demonstrates two new chromosome homologies. Seven conserved segments not yet identified by chromosome painting are also reported.

Animals↗

Levels of agreement of nerve conduction studies and symptoms in workers at risk of carpal tunnel syndrome.

OBJECTIVE: Information is required on levels of agreement between different sets of median nerve conduction studies (NCS) and symptoms of carpal tunnel syndrome (CTS) in at-risk subjects. METHODS: We performed a reanalysis of an extensive data set from a population of 114 "highly exposed" meat workers (without prior diagnosis of CTS), who were interviewed for the presence of current symptoms typical of CTS and systematically submitted to median NCS. RESULTS: Agreement between presence/absence of symptoms and NCS normal/abnormal findings ranged from 81% for wrist sensory latency (WSL) to 49% for motor conduction velocity wrist-to-palm (MCV-WP) in the nondominant hands (from 60% to 50%, respectively, in the dominant hands). Mean values of WSL, sensory conduction velocity-WP (SCV-WP), wrist motor latency, MCV-WP, and the SCV-WP/SCV-elbow-to-wrist ratio all showed significant differences between symptomatic and asymptomatic workers. In nondominant hands, these parameters all reached significant P values at chi-squared tests for kappa coefficients of agreement, the best kappa coefficients being 0.57 for WSL and 0.40 for SCV-WP. However, in the dominant hand only SCV-WP reached significance (kappa coefficient=0.20). CONCLUSIONS: Given the importance of the dominant hand in working populations, these data support use of SCV-WP (or WSL) as an informative NCS parameter for occupational studies on CTS.

Adult↗

Time versus size: which characteristic of a neural response carries more information?

Considering a variety of quite different candidate neural codes, Cheng and Wasserman [(1996) Biol Cybern 75, 93-103, 105-115] reported data which suggested that amplitude codes transmitted information more faithfully than temporal codes. Reanalyzing their data, the present study measured how well size and time represented information resident within the same neural response feature, namely the response peak. Responses from photoreceptor cells and optic nerve fibers in the peripheral visual system of Limulus polyphemus were therefore re-examined using signal detectability values provided by receiver-operating-characteristic analyses to compare how well the timing and the amplitude of the response peak represent information within a single cell and how well they transmit information between cells. Data were available for several cells in several different light-adaptation states onto which several different test-flash intensities had been superimposed. The present reanalysis of these data replicated the results yielded earlier by the peak candidate code, and compared them with the data produced by two different measurements of the timing of the same response peak. A relative-timing code was derived from measurements of the time that elapsed between the moment when the response exceeded a criterion potential and when it reached its peak. An absolute-timing code was derived from the time that elapsed between test flash onset and the peak. The results clearly indicated that the peak code represented information within cells better than either of the two timing codes. However, both peak and absolute-timing codes clearly transmitted the available information between cells more faithfully than the relative-timing code. These data lead to two conclusions. First, that the same response feature, when measured in different ways, can produce remarkably different information processing outcomes. In this particular case, time represented information resident within a cell less well than did size. Second, that the fidelity of information transmission between nerve cells may be relatively independent of the quantity of information resident within any particular cell.

Models, Neurological↗

See globally, spike locally: oscillations in a retinal model encode large visual features.

We show that coherent oscillations among neighboring ganglion cells in a retinal model encode global topological properties, such as size, that cannot be deduced unambiguously from their local, time-averaged firing rates. Whereas ganglion cells may fire similar numbers of spikes in response to both small and large spots, only large spots evoke coherent high frequency oscillations, potentially allowing downstream neurons to infer global stimulus properties from their local afferents. To determine whether such information might be extracted over physiologically realistic spatial and temporal scales, we analyzed artificial spike trains whose oscillatory correlations were similar to those measured experimentally. Oscillatory power in the upper gamma band, extracted on single-trials from multi-unit spike trains, supported good to excellent size discrimination between small and large spots, with performance improving as the number of cells and/or duration of the analysis window was increased. By using Poisson distributed spikes to normalize the firing rate across stimulus conditions, we further found that coincidence detection, or synchrony, yielded substantially poorer performance on identical size discrimination tasks. To determine whether size encoding depended on contiguity independent of object shape, we examined the total oscillatory activity across the entire model retina in response to random binary images. As the ON-pixel probability crossed the percolation threshold, which marks the sudden emergence of large connected clusters, the total gamma-band activity exhibited a sharp transition, a phenomena that may be experimentally observable. Finally, a reanalysis of previously published oscillatory responses from cat ganglion cells revealed size encoding consistent with that predicted by the retinal model.

Action Potentials↗

Prognostic importance of isolated peritumoral lymphangiosis carcinomatosa in lymph-node-negative colorectal carcinoma.

BACKGROUND: The prognostic value of microinvasion of lymph vessels and lymph nodes has become increasingly important; there is a wide range in prognosis of patients with nodal-negative tumor stages after curative resection for colorectal cancer. AIM: Detection of the prognostic importance of isolated lymph-vessel invasion as a possible precursor of lymph-node metastasis in patients with nodal-negative tumor stages. PATIENTS/METHODS: Retrospective analysis of 894 patients with R0-resected colorectal cancer, uni- and multivariate analysis of tumorbiologic prognostic factors, immunohistochemical proof of tumor cells in negative lymph nodes (pN0) using the epithelial marker HEA-125 (human epithelial antigen). RESULTS: The incidence of lymph-vessel invasion (L) was 37.7% in total. A pN0,L1 status was found in 144 patients (16.1% of all analyzed patients). Comparing patients with pN0,L1 status to those with pN+,L0 status showed that both groups have similar rates of overall survival and tumor relapse. Lymph-node status, lymph-vessel invasion, depth of tumor infiltration (pT) stage, and age were detected as independent prognostic factors by multivariate analysis. After reanalysis of 54 cases primarily classified as 18.5% pN0,L1, microinvasion in lymph nodes was detected by immunohistochemistry. We found a higher rate of tumor relapse (approximately 20%) for those patients. In regard to the overall survival rate, however, there was no difference when compared to patients without immunohistochemical proof of microinvasion. CONCLUSION: Isolated lymph-vessel invasion in nodal-negative tumor stages and a lymph-node-positive tumor status have equivalent prognostic importance in colorectal cancer.

Aged↗

Inferences about predictable events: eye movements during reading.

Eye fixations were recorded to assess whether, how, and when readers draw inferences about predictable events. Predicting context sentences, or non-predicting control sentences, were presented, followed by continuation sentences in which a target word referred to a predictable event (inferential word) or an unlikely event (non-predictable word). There were no effects on initial target word processing measures, such as launch and landing sites, fixation probability, first-fixation duration, or first-pass reading time. However, relative to the control condition, the predicting context (1) speeded up reanalysis of the inferential word, as revealed by a reduction in second-pass reading time and regressions, and (2) interfered with processing of the non-predictable word, as shown by an increase in regressions. These results indicate that predictive inferences are active at late text integration processes, rather than at early lexical-access processes. The pattern of findings suggests that these inferences involve initial activation of rather general concepts following the inducing context, and that they are completed or refined with delay, after the inferential target word is read.

Eye Movements↗

High-throughput analysis of fragile X (CGG)n alleles in the normal and premutation range by PCR amplification and automated capillary electrophoresis.

Fragile X syndrome is caused by expansion of a (CGG)n trinucleotide repeat within the 5' untranslated region of the FMR1 gene transcript. The disease is reliably diagnosed by Southern blotting, but this method constitutes a significant workload and requires large samples. Therefore, for large research or screening projects in which a large majority of the samples will be normal, a more rapid and less expensive method is needed. We present a method for accurate, high-throughput analysis of the FRAXA (CGG)n region in the normal and premutation range. The method is based on polymerase chain reaction (PCR) amplification of DNA extracted from whole blood or eluted from dried blood spots on filter-paper, followed by automated capillary electrophoresis and detection by multicolour fluorescence. This method allows a throughput of 144 samples in 48 h, with an intra-assay accuracy in size determination of 0.2-1.8 bp. We performed a blind reanalysis of samples from 30 patients, previously analysed by Southern blotting or PCR with radioactive labelling. In this study normal and premutation alleles, ranging from 28-121 (CGG)n repeats, were correctly determined with respect to number of (CGG)n repeats. All full-mutation alleles and one large premutation allele in a sample of a heterozygote failed to amplify. The method was used to determine the distribution of FRAXA (CGG)n repeats in the Danish population.

Alleles↗

Statistical downscaling of general-circulation-model- simulated average monthly air temperature to the beginning of flowering of the dandelion (Taraxacum officinale) in Slovenia.

Phenological observations are a valuable source of information for investigating the relationship between climate variation and plant development. Potential climate change in the future will shift the occurrence of phenological phases. Information about future climate conditions is needed in order to estimate this shift. General circulation models (GCM) provide the best information about future climate change. They are able to simulate reliably the most important mean features on a large scale, but they fail on a regional scale because of their low spatial resolution. A common approach to bridging the scale gap is statistical downscaling, which was used to relate the beginning of flowering of Taraxacum officinale in Slovenia with the monthly mean near-surface air temperature for January, February and March in Central Europe. Statistical models were developed and tested with NCAR/NCEP Reanalysis predictor data and EARS predict and data for the period 1960-1999. Prior to developing statistical models, empirical orthogonal function (EOF) analysis was employed on the predictor data. Multiple linear regression was used to relate the beginning of flowering with expansion coefficients of the first three EOF for the Janauary, Febrauary and March air temperatures, and a strong correlation was found between them. Developed statistical models were employed on the results of two GCM (HadCM3 and ECHAM4/OPYC3) to estimate the potential shifts in the beginning of flowering for the periods 1990-2019 and 2020-2049 in comparison with the period 1960-1989. The HadCM3 model predicts, on average, 4 days earlier occurrence and ECHAM4/OPYC3 5 days earlier occurrence of flowering in the period 1990-2019. The analogous results for the period 2020-2049 are a 10- and 11-day earlier occurrence.

Asteraceae↗

Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient data.

The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair. It involved 70 investigators in 20 countries. The aim was to perform systematic reviews and enhance the value of individual studies by reanalysis of data from randomised controlled trials in meta-analyses. Forty-one eligible trials of laparoscopic versus open groin hernia repair were identified involving 7161 participants (with individual patient data available for 4165). Meta-analysis was performed, using individual patient data where possible. Operation times for laparoscopic repair were longer and there was a higher risk of rare serious complications. Return to usual activities was faster, and there was less persisting pain and numbness. Hernia recurrence was less common than after open non-mesh repair but not different to open mesh methods. The review showed that laparoscopic repair takes longer and has more serious complications, but recovery is quicker with less persisting pain. Reduced hernia recurrence was related to the use of mesh rather than the method of mesh placement.

Hernia, Inguinal↗