Abstract: A device and method for monitoring pain of a user (50) are presented. The device (10) comprises a receiving unit (12) for receiving an accelerometer signal (38) from an accelerometer sensor (30) worn by the user (50), wherein the accelerometer signal (38) comprises components of a pulse signal (20) and a respiration signal (22); and a processing unit (14) configured to: derive the pulse signal (20) and the respiration signal (22) from the accelerometer signal (38); adapt the pulse signal (20) based on the respiration signal (22) in order to obtain a corrected pulse signal (40); and derive a pain descriptor based on the corrected pulse signal (40).

Abstract: Methods and apparatus for assessing the condition of and treating patients for heart failure by the delivery of continuous positive airway pressure are disclosed. Treatment of obstruction due to reflex vocal cord closure often experienced by heart failure patients is distinguished from treatment of upper airway obstruction typically associated with Obstructive Sleep Disorder. Treatment may also be implemented by delivering synchronized cardiac pressure oscillations superimposed on a respiratory pressure level to provide assistance for the heart. Heart treatment pressure dose indicator may be calculated for prescribing and monitoring the delivery of treatment. The apparatus may also generate data to track heart failure condition that may be indicative of the degree of severity of heart failure based upon breathing patterns to assist in the diagnosis and management of heart failure patients.

Abstract: A system and method of managing therapy provided to patients in an institution. The system monitors all aspects of the medication delivery to a patient, as well as other information related to the patient, such as values of vital signs, laboratory results and patient factors such as history, diagnosis, allergies and the like. The system includes one or more databases of information, including institutionally developed rules, guidelines and protocol representing the best medical practices of the institution. The system provides alerts and/or recommendations based on the application of the rules to the information being monitored, and alerts care givers accordingly, providing for dynamic adjustment of the patient's therapy. The system also monitors the status of the alerts, and if no action is taken in a selected period of time, may escalate the priority of the alert and/or halt the delivery of medication to the patient until the alert is resolved.

Abstract: A method of pattern recognition for defining aerobic HR training zones measured during incremental cardiopulmonary exercise testing wherein such HR training zones are derived from distinct points in the incremental exercise response for % fat, % CHO, and PetCO2. Also disclosed is a method for providing feedback to the exercising subject indicating the % time the subject exercised in each of the zones using recorded HR data from each workout.

Abstract: Embodiments include a sensor arrangement including a primary sensor in the form of a self-adhering surface electrode that records electric signals. The self-adhering surface electrode includes a primary sensor to contact skin, and a secondary sensor, which differs from the primary sensor, to detect a secondary physical variable. In addition, the sensor arrangement includes an adapter, via which the primary sensor and the secondary sensor are interconnected to form a detachable unit.

Abstract: A headset for detecting brain electrical activity may include a flexible substrate having first and second ends each configured to engage an ear of a subject and dimensioned to fit across the forehead of a subject. The headset may also include a plurality of electrodes disposed on the substrate and configured to contact the subject when the headset is positioned on the subject. First and second electrodes may contact top center and lower center regions of the forehead, respectively, third and fourth electrodes may contact front right and front left regions of the forehead, respectively, fifth and sixth electrodes may contact right side and left side regions of the forehead, respectively, and electrodes included within the securing devices may contact the ear regions. The third and fourth electrodes may be moveable in at least a vertical direction relative to the other electrodes.

Abstract: A medical instrument including a probe adapted to be inserted into an orifice of an animal's body. Electromagnetic radiation is sensed by a sensor mounted on the probe. The sensor can then determine, by variations in the amount of radiation received, whether the walls of the body orifice block the radiation, thereby indicating a position of the sensor, and thus, the probe, within the orifice.

Abstract: The present invention provides a mattress for measuring physiological parameters of a heart, comprising a mattress body, a first electrode, a second electrode and an electromagnetic shield, wherein the first electrode and the second electrode are located on the upper surface of the mattress body and the first electrode and the second electrode have a space therebetween; at least a portion of the electromagnetic shield is located on the lower surface of the mattress body and is insulated from the first electrode and the second electrode. In the above mattress provided by the present invention, the first electrode and the second electrode are shielded from ambient electromagnetic radiation effectively. The electromagnetic shield, by blocking the electromagnetic wave propagation path, prevents the electrodes from being polluted by electromagnetic radiation, achieving more accurate measurement.

Abstract: A system and method for detecting a driver's sudden heart attack applies to detecting whether the driver of a vehicle is suffering a sudden heart attack. The method comprises steps: persistently capturing vital-sign signals of respiration rate, heart rhythm and blood pressure of the driver and transmitting the vital-sign signals to a monitoring system; a processor of the monitoring system using an artificial neural network to train the vital-sign signals and establish personalized models specific to the driver and respectively having threshold values; the monitoring system examining whether any one of the vital-sign signals exceeds its threshold value; if at least one type of the vital-sign signals exceeds the threshold value thereof, determining a risk level of the driver according to the quantity of the types of the vital-sign signals exceeding the threshold values thereof, and emitting an alert if necessary.

Abstract: A method for associating physiological sensors to patients includes acquiring associated physiological data from a first physiological sensor associated with an identified patient. The method also includes acquiring unassociated physiological data from a second physiological sensor associated with an unidentified patient. The method further includes comparing a parameter in the unassociated physiological data to a common or correlated parameter in the associated physiological data to determine if the second physiological sensor is associated with the identified patient.

Abstract: A system for heart rate detection includes a random sampling module configured to provide nonuniform random samples below a Nyquist rate of a biosignal that contains heart rate information; and a heart rate detection module configured to receive a plurality of the nonuniform random samples during a predetermined time window, calculate a power spectral density based on a Lomb-Scargle periodogram of the window samples and calculate a heart rate value based on a frequency corresponding to a highest power peak of the calculated power spectral density. The disclosure also relates to a corresponding method for heart rate detection and a non-transitory computer readable medium.

Abstract: In order to provide a CT image with high-spatial resolution and a CPR image without deterioration due to interpolation by scanning while always moving a site of interest of an object to the scanning center, a bed on which the object is placed is moved in a direction orthogonal to the body-axis direction of the object or a scanner angle is changed when scanning the object while moving it in a direction crossing the rotation direction i.e., the body-axis direction of the object, during the rotation of a rotary disk where a radiation source and a radiation detector are disposed oppositely. Image reconstruction is performed using bed movement information (movement information in a direction orthogonal to the body-axis direction) or scanner angle information during scanning.

Abstract: A couch device according to an embodiment includes a couchtop, shape control members, and driving circuitry. The couchtop includes a movable base couchtop and a transformable couchtop mounted above the movable base couchtop and capable of bending a part thereof from a flat shape. The shape control members control the shape of the transformable couchtop. The driving circuitry moves the couchtop to an opening of a gantry device that collects data for taking medical images. The transformable couchtop includes divided couchtops, and transformation support members for fixing the transformable couchtop to the movable base couchtop are fitted to divided sections. Each of the shape control members adjusts a position of a specific transformation support member so that an installation location thereof is a fixed point of the movable base couchtop.

Abstract: In a panoramic imaging apparatus, a panoramic image is displayed on a monitor. The panoramic image is an image in which an overall dentition is in optimal focus, or an image in which a region of interest that is a portion of the image of the overall dentition is in optimal focus. Both images are reconstructed from frame data that has been collected by an initial first scan. Feature points of one or more teeth and a supporting portion that supports the tooth in the dentition in the panoramic image displayed on the monitor are designated. A length based on the positions of the designated feature points is measured in the panoramic image. The degree of loss in alveolar bone that supports the tooth is analyzed based on the measured length. The analysis information is provided to a dentist as check information regarding periodontal disease.

Abstract: An X-ray generator generating an X-ray cone beam and a two-dimensional X-ray detector detecting the X-ray cone beam are supported by a support arm while facing each other, and the X-ray generator and the two-dimensional X-ray detector are turned with an object interposed therebetween. A filter constitution body is disposed between the two-dimensional X-ray detector and the object. Filters having X-ray beam energy distribution conversion characteristics different from each other are arrayed in the filter constitution body. In X-ray photography, a filter constitution body moving mechanism is moved in a direction along a detection surface of the two-dimensional X-ray detector such that the filter constitution body traverses the X-ray cone beam in turning the support arm.

Abstract: Disclosed is a rotating-grating cone beam CT imaging apparatus. This imaging apparatus is composed of a frame, a frame angle sensor, an X-ray source equipped with a rotating grating, a flat panel detector, a main controller and an image reconstruction workstation. Like a general cone beam CT imaging apparatus, this imaging apparatus also adopts an open structure. But unlike the general cone beam CT imaging apparatus, the rotating grating limits X-rays emitted from the X-ray source to a plurality of narrow-angle cone beams or sector beams. In the process that the X-ray source and the detector rotate around an imaging object, projection images of the narrow-angle cone beams or sector beams on the flat panel detector move back and forth continually through the rotation of the rotating grating, so as to acquire projection information about the imaging object in an entire scanning region. Finally, the projection information is reconstructed into a volume image in the image reconstruction workstation.

Abstract: An apparatus for cone beam computed tomography of an extremity has a digital radiation detector and a first device to move the detector along a circular detector path extending so that the detector moves both at least partially around a first extremity of the patient and between the first extremity and a second, adjacent extremity. The detector path has radius R1 sufficient to position the extremity approximately centered in the detector path. There is a radiation source with a second device to move the source along a concentric circular source path having a radius R2 greater than radius R1, radius R2 sufficiently long to allow adequate radiation exposure of the first extremity for an image capture by the detector. A first circumferential gap in the source path allows the second extremity to be positioned in the first circumferential gap during image capture.

Abstract: An x-ray imaging system is provided.

Abstract: According to one embodiment, a dose distribution display apparatus includes storage circuitry, processing circuitry, and display circuitry. The storage circuitry stores position information of a support frame which supports an X-ray tube, and X-ray information concerning X-rays generated by the X-ray tube. The processing circuitry edits at least one of the X-ray information and the position information in accordance with an operator instruction, and generates a plurality of simulated dose distributions in time series based on the X-ray information and the position information, at least one of which has been edited, The display circuitry sequentially superimposes and displays the simulated dose distributions on an object model.

Abstract: A breast imaging system comprising an imaging apparatus with an illumination source, a detector, a breast support, a compression paddle slidable between an upper position and an lower position relatively to the detector, a compression command displacing the compression paddle upon actuation, wherein the compression command is placed at a reachable distance from the patient, wherein the breast imaging system further comprises a feedback device giving feedback information perceivable by the patient, the feedback information varying according to the position of the compression paddle.

Abstract: An X-ray diagnostic apparatus according to an embodiment includes an obtaining unit and a calculating unit. The obtaining unit is configured to, with regard to a plurality of X-ray images that are acquired with time by using a contrast media, obtains first transition information that indicates a time-course transition of a signal intensity of the contrast media in a region of interest that corresponds to a blood vessel and obtains second transition information that indicates a time-course transition of the signal intensity of the contrast media in a region to which the contrast media flows earlier than the region of interest. The calculating unit is configured to analyze the first transition information by using the second transition information to calculate blood flow information on each blood flow in the region of interest.

Abstract: An obtaining unit obtains, with respect to a plurality of groups of time-course fluoroscopic images that are obtained by acquiring a subject, in at least two directions, each of which intersect, first transition information that indicates transition of a signal intensity of a contrast media in a proximal region to which the contrast media flows earlier than a region of interest. A three dimensional reconstruction unit reconstructs three-dimensional image data in the region of interest such that a value that is obtained by projecting a voxel value approximates a value of a corresponding pixel in each of the groups of time-course fluoroscopic images, the voxel value being represented by second transition information that is obtained by deforming the first transition information with a factor that is related to the contrast media. A display displays the fluoroscopic image with a blood vessel image based on the three-dimensional image data.

Abstract: There is provided an image processing apparatus for reconstructing a tomographic image of a subject based on a plurality of projection images obtained by detecting radiation emitted from a plurality of different positions. The image processing apparatus reconstructs a first tomographic image from the plurality of projection images, extracts a fixed pattern occurring in the first tomographic image due to a radiation detector, and forms a second tomographic image by updating the first tomographic image using a value concerning intensity of the fixed pattern as a regularization term. The image processing apparatus outputs, as the tomographic image of the subject, the second tomographic image obtained by the update.

Abstract: A medical imaging apparatus includes a data acquirer configured to acquire measured data acquired by detecting an X-ray transmitted by an X-ray source to an object, and an image processor configured to acquire an initial image based on the measured data, alternately estimate region of interest (ROI)-outside measured data and ROI-inside measured data based on the measured data and the initial image, and acquire a reconstructed image based on the ROI-inside measured data.

Abstract: A stethoscope device is disclosed, which comprises a heart sound sensor comprising a sensing portion to detect a heart sound signal having a periodic first heart sound and a periodic second heart sound; an electrocardiogram sensor comprising two electrodes to detect an electrocardiogram signal having a periodic R wave; a microprocessor for extracting amplitudes of the R wave from the electrocardiogram signal and analyzing appearing positions of the R wave to provide appearing positions of a periodic notification pulse wave to a predetermined reference signal and combine the reference signal with the heart sound signal to form a sound signal; and an output unit to output the sound signal; wherein each pulse of the notification pulse wave of the sound signal provides a notification sound.

Abstract: A method for aligning spatially different subvolumes of ultrasonic data of a blood vessel comprising: acquiring temporally discrete signals of a blood vessel with elements of a two dimensional array of ultrasonic transducer elements from spatially different depths of scanning opposed by each transducer element, said array being located in a first position with respect to the blood vessel during the acquiring; Doppler processing the temporally discrete signals received from each transducer element to produce spectral Doppler data of the scanning depth opposed by each transducer element; producing a first three dimensional map of the spectral Doppler data in spatial relationship to the position of the array with respect to the blood vessel; acquiring temporally discrete signals of the blood vessel with elements of the two dimensional array of ultrasonic transducer elements from spatially different depths of scanning opposed by each transducer element, said array being located in a second position with respect t

Abstract: According to one embodiment, an ultrasound diagnosis apparatus includes a transmitter, a receiver, a needle tip position acquisition unit, a ROI setting unit, an image generator, and a display controller. The transmitter transmits ultrasound beams to a subject into which a puncture needle is inserted while scanning the subject. The receiver receives signals reflected from the subject. The needle tip position acquisition unit successively acquires the position of the needle tip of the puncture needle. The ROI setting unit sets a region of interest at least in a direction in which the puncture needle is inserted. The image generator generates an image of the region of interest according to the position of the needle tip based on the signals. The display controller displays the image of the region of interest.

Abstract: Issuance of ultrasound pulses to a volume and receiving echo data is followed by estimating, based on the received data, center frequency subvolume-by-subvolume. Distinguishing between heart and lung tissue occurs based on a result of the estimating, and may include automatically identifying a spatial boundary (332) between the heart and lung tissue (324, 328), or a user display of center frequencies that allows for visual distinguishing. The issuance can include issuing, ray line by ray line, pair-wise identical, and/or pair-wise mutually inverted, ultrasound pulses. Center frequency calculations may be made for incremental sampling locations of respective imaging depth along each of the A-lines generated from echo data of the rays. The distinguishing might entail averaging center frequencies for locations along an A-line, and applying a central frequency threshold to the average. The leftmost of the qualifying A-lines, i.e.

Abstract: Provided is an ultrasound imaging apparatus including: a data acquisition unit configured to acquire ultrasound data for an object including a first region and a second region used to determine a shape of the first region; a controller configured to extract the second region of the object from the ultrasound data, set at least one guide line corresponding to the first region, and measure the at least one guide line corresponding to the first region; and a display configured to display measurement information regarding the at least one guide line.

Abstract: Disclosed herein is an ultrasound imaging apparatus for generating an ultrasound image normally even when an ultrasound probe is mounted in a reverse direction. The ultrasound imaging apparatus includes an ultrasound probe, a connector configured to connect the ultrasound probe to a main body, and the main body configured to generate an ultrasound image using a signal transmitted through the connector regardless of a direction in which the connector is mounted on the main body.

Abstract: An ultrasonic probe includes a connection layer including a conductor array for connecting a transducer array and a printed circuit board (PCB) to an application specific integrated circuit (ASIC). The ultrasonic probe includes a transducer array which transmits and receives an ultrasonic wave, a first electronic circuit electrically connected to the transducer array, a second electronic circuit electrically connected to the first electronic circuit, and a connection layer disposed between the transducer array and the first electronic circuit and including a first conductor array in contact with the transducer array so that the transducer array is electrically connected to the first electronic circuit and a second conductor array in contact with the second electronic circuit so that the second electronic circuit is electrically connected to the first electronic circuit.

Abstract: A ultrasonic probe including: a case including: an opening; and a coupling portion; and a probe lens comprising: a first portion being exposed through the opening and a second portion coupled to the coupling portion of the case, wherein one of the coupling portion of the case and the second portion of the probe lens comprises a groove, and other one of the coupling portion of the case and the second portion of the probe lens comprises a shape matching the groove to couple the case and the probe lens to each other.

Abstract: An apparatus and method for generating high quality, high frame rate images in a handheld or hand-carried ultrasound imaging machine. The apparatus includes a time-multiplexed beamformer coefficient generator that supplies the necessary delay and weight coefficients to process multiple beams in parallel via a beamforming coefficient bus. This approach reduces the required hardware and power consumption to satisfy the physical space and power requirements of a handheld probe. To improve image quality, the ultrasound machine may optionally use synthetic aperture to improve penetration and resolution. The ultrasound machine may also use pulse inversion harmonics to improve image quality by improving signal-to-noise ratio.

Abstract: A method for mapping fibrous media by propagation of ultrasound from a set transducers, wherein: a number of unfocused incident ultrasonic waves having different wavefronts are emitted; the signals reverberated by the medium toward each transducer are captured; coherent signals respectively corresponding, for each transducer, to contributions coming from different fictitious focal points in the medium are determined; and then the orientation of the fibers is determined by comparing a spatial coherence between said coherent signals, in a plurality of directions.

Abstract: A memory alloy is used during manufacture of a transducer. The memory of the alloy may correct for deviations or bending during manufacture, such as a superelastic alloy returning an array to a flat state after being twisted during handling. The memory of the alloy may cause a desired change in array geometry during manufacture, such as a shape memory alloy twisting an array into a curved or helix due to applied heat. The array may be fixed in place by the memory alloy or bonding after positioning by the memory alloy, preventing further substantial alteration.

Abstract: Disclosed are an ultrasound diagnostic apparatus and an operating method thereof, which quickly and accurately set a volume of interest (VOI).

Abstract: An apparatus for performing a nerve block procedure, the apparatus being composed of an echogenic needle or an echogenic soft tissue tunneling device and an echogenic catheter configured for controlled delivery of a medication. The apparatus may further include a sheath such that at least one of the needle or tunneling device and sheath is echogenic. The present invention also encompasses a system for performing a nerve block procedure, the system includes introducing an echogenic needle in the general area of a nerve bundle, positioning the echogenic needle adjacent the nerve bundle utilizing sonic imaging techniques, introducing an echogenic catheter configured for controlled delivery of a fluid through the echogenic needle, withdrawing the echogenic needle, positioning the echogenic catheter adjacent the nerve bundle utilizing sonic imaging techniques, and delivering fluid to the nerve bundle through the echogenic catheter.

Abstract: A relationship is established between points or regions in images of objects deformed in different ways, for example images of the human chest in a mammography and 3D ultrasound process. While a plurality of recording parameters which can be used for such an automatic image registration are often known in X-ray and other imaging methods, precise recording parameters, in particular for the position of the chest, are usually not available in ultrasound processes. The object is to additionally detect the position, in particular the tilt, of the chest and the ultrasound transducer in a chest ultrasound. A linking of multiple ultrasound recordings to one another or a comparably more precise automatic image registration using other modalities can then be carried out using the position of the ultrasound transducer relative to the chest. The position is detected in a manner that is specific to the case.

Abstract: Provided herein is technology relating to collecting and preparing samples. For example, the technology relates particularly, but not exclusively, to devices, systems, and kits that allow a subject to collect and prepare a sample for analysis.

Abstract: Methods for obtaining a sample from a subject include providing a sample collection room. Samples may be small, e.g., a finger-stick. A method is provided for sample collection comprising: obtaining, in a sample collection room, a sample from said body part of said subject; monitoring activity in the sample collection room using at least two motion capture devices positioned to view a field of interest in the sample collection room; and alerting a technician performing the sample collection if a non-conforming action by the technician is detected by at least one of the motion capture devices.

Abstract: A disposable biopsy device includes a vacuum generating assembly generating a vacuum. The disposable biopsy device also includes a tissue cutting assembly including a hollow outer needle having a longitudinal axis and an inner cutter needle positioned within the hollow outer needle. The tissue cutting assembly is pneumatically coupled to the vacuum assembly such that the vacuum drives a cutting motion of the inner cutter needle along the longitudinal axis of the hollow outer needle.

Abstract: The described invention provides a disposable handheld biopsy device for taking biopsies, the biopsy device comprising a tissue cutting assembly which has features to control the tissue length that will be severed by the cutting assembly; and a vacuum assembly which has features to control the vacuum level. The disposable handheld biopsy device of the described invention is simple, lightweight, portable, and cost effective to manufacture and dispose of.

Abstract: The biopsy device generally comprises: a cannula body having a longitudinal axis and a probing region extending along the longitudinal axis, the probing region having a sample receiving window defined therein for receiving a sample of a surrounding tissue when performing a biopsy; and a plurality of optical fibers mounted along an exterior portion of the cannula body, each of the plurality of optical fibers having a fiber end in the probing region of the cannula body, at least one of the plurality of optical fibers being adapted to illuminate the surrounding tissue with an optical signal generated by the at least one light generator and at least one of the plurality of optical fibers being adapted to detect an optical signal response with the at least one light detector, the optical signal response being caused by the propagation of the optical signal in the surrounding tissue.

Abstract: Transcatheter methods are disclosed for introducing a large transcatheter implant or other device into an artery from an adjacent vein, for example from the inferior vena cava into the abdominal aorta. Such an access route can be formed by direct puncture through the adjoining vessels. In addition, methods and devices are also disclosed for closing arteriovenous fistulas or other cardiovascular passageways.

Abstract: The present disclosure includes vessel closure devices, systems, and methods. A closure system configured to close a body lumen opening may include a handle member. A tube set configured to deliver and/or deploy a closure element may be coupled to the handle member. The closure system may also include an inner lumen with an anchor member at least partially disposed in the inner lumen. A plunger member may be movably coupled to the handle member.

Abstract: A surgical retractor and configured to minimize tearing of the gloves without compromising the ability to grip tissue. The surgical retractor has a handle, a blade, and a plurality of retraction elements. The retraction elements may be fixed to the blade but arranged in a specific configuration that minimizes tearing of the gloves without compromising the ability to grip tissue. The retraction elements may also be made deployable by having a deployed configuration in which the retraction elements are exposed, and a stowed configuration it which the retraction elements are hidden.

Abstract: Configurations are described for conducting minimally invasive medical diagnoses and interventions utilizing elongate instruments and assemblies comprising one or more imaging devices, and one or more remote retraction and distraction devices. Retraction and distraction devices, such as balloons, mechanical retraction members, and/or trocar screw geometries may be utilized to access, investigate, and intervene at the joint capsule, or inside of the joint capsule. Imaging devices, such as optical image capture devices, ultrasound transducers, and optical coherence tomography fibers, may be utilized to assist with navigation of the pertinent tools during diagnostic and interventional steps.

Abstract: An adjustable suture-button construct for ligament reconstruction. The construct is a knotless, adjustable, flexible suture loop, a first fixation device (a free or removable slotted button) and optionally a second fixation device (a fixed, non-removable button). Suture ends of the knotless suture loop provide a variable-length graft support that can be adjusted prior to, during, or after deployment of the constructs. The removable, detachable fixation device is provided with attachment feature(s) to permit assembly onto the adjustable loop. The removable, detachable fixation device is attached to the tibia end of the loop construct after the loop construct is passed through the tibial tunnel (i.e., once the loop exits the anterior tibia cortex). If a fixed, non-removable button is employed, the fixed, non-removable button is securely attached (by stitching, for example) to the graft.

Abstract: Devices and systems for use in soft tissue repair are provided, as are methods of manufacturing the same. In one exemplary embodiment, an implantable surgical construct includes an implant and a continuous braided closed filament loop that is attached to the implant. The continuous loop can be formed from a single strand of filament such that portions of the filament, sometimes referred to as tails, can be arranged with respect to each other to form a braided configuration. A related method of manufacture can involve passing portions of a single strand of filament around different sets of posts and selectively over and under each other to create the braided configuration. Other devices, systems, and methods of manufacturing are also provided, including some that involve using multiple strands of suture to form a continuous braided closed filament loop.

Abstract: Methods and devices for treatment of tissues are provided. The methods can be used to interlock first and second components of the composition for protection of tissue or an organ. The devices can be used to treat a number of treatment sites, for example, to provide structural support to hiatal hernia repairs.