Clinical Outcomes of Mid-Urethral Sling (MUS) Procedures for the Treatment of Female Urinary Incontinence: A Multicenter Study.

Introduction: Stress urinary incontinence (SUI) has a significant impact on the quality of life of many women. Due to embarrassment, most women do not seek medical attention for this condition. The treatment of this problem includes preventive therapies, and in the more advanced stage of urinary incontinence, surgery is a solution. Despite doubts regarding the implantation of urological tapes, the use of tension-free minimally invasive methods constitutes the "gold standard" in the treatment of stress urinary incontinence in women. Objective: The purpose of this article was to evaluate the efficacy and safety of ultralight, polypropylene urogynecological tape (Dallop® NM ULTRALIGHT, Tricomed S.A., Poland) in the surgical treatment of female stress urinary incontinence and mixed urinary incontinence. Methods: This is a multicenter, retrospective cohort study. The included women were adults with stress urinary incontinence (Grade 2 with a positive cough test or Grade 3) or had mixed urinary incontinence and who had undergone "retropubic" or "transobturator" surgery and completed a postoperative follow-up. Results: The study included 68 women from three hospitals. All women completed <6-month and >6-month follow-ups. The median age was 55 (range 36−80). The average value of BMI in the "retropubic" group was 28.6 ± 5.58, and in the "transobturator" group, it was 26.1 ± 4.60. Sixty-three percent (63%, n = 43) of patients were operated on using the "transobturator" method, while thirty-seven percent (37%, n = 25) were operated on using the "retropubic" method. Both the "retropubic" and "transobturator" groups had comparable results in the treatment of SUI. The study showed efficiencies of 84% for the "transobturator" method and 80% for the "retropubic" method. In the "retropubic" group, intraoperative complications were reported in three patients (7%), in comparison to none in the "transobturator" group. There were no tape-related adverse events or infections reported in any case. Conclusions: The presented research confirms the safety and efficacy of retropubic and transobturator tape methods in both short- and long-term follow-up­the success rate was over 80%. In addition to the surgical method used, the experience of the surgeons also has an impact on the final outcome of the surgery. The conducted multi-center study offers the opportunity to eliminate the influence of the human factor on the effectiveness of the procedure.

Evaluation of Biophysical Properties of Potential Materials for the Manufacture of Protective Garments for Preterm Infants.

Preterm infants, due to immature and dysfunctional skin, have increased water loss through the skin and consequently a decreased body temperature. In order to develop protective garments for preterm infants, it is important to select materials that will protect the child against water and heat loss. The authors are currently involved in the development of protective garments for premature babies, which are similar to baby clothes and contain a membrane that is partially permeable for vapor in combination with textile materials. This article presents the study of materials intended for the production of protective garments for pre-term infants. Samples of materials were investigated to determine biophysical comfort (tests of heat resistance, vapor resistance according to PN-EN ISO 11092:2014-11 and air permeability according to PN-EN ISO 9237) and porosity, surface mass in accordance with PN-EN 12127, and thickness in accordance with PN-EN ISO 5084. In order to determine the porosity of materials and to visualize the structure, tests on computer microtomography were carried out. The mechanical properties of the tested materials and the evaluation of the total hand value were characterized; the samples were tested on the KES device. The aim of this study was to select the most suitable fabrics for protective garments for premature infants to prevent excessive heat and moisture loss from the body, which can lead to hypothermia. For laminates, the optimal results of vapor resistance and heat resistance were obtained for laminate (15 g·m-2 PE foil + 15 g·m-2 PP non-woven), with a level of thermal resistance of 0.0766 m2·K·W-1 and vapor resistance of 188.729 m2·Pa·W-1, and for laminate (15 g·m-2 PE foil + 10 g·m-2 PP non-woven), with a level of thermal resistance of 0.0683 m2·K·W-1 and vapor resistance of 164.085 m2·Pa·W-1. For knitted fabrics, knitwear single cotton 155 g·m-2 showed the highest thermal resistance (0.0296 m2·K·W-1), and knitwear interlock polyester 120 g·m-2 showed the lowest thermal resistance (0.0179 m2·K·W-1). Knitwear cotton 120 g·m-2 had the highest water vapor resistance (8.402 m2·Pa·W-1), while knitwear interlock polyester 130 g·m-2 sample had the lowest resistance (6.356 m2·Pa·W-1). Garments for premature babies should have moisture barrier properties and high thermal insulation. They should also be characterized by optimal air permeability properties. Sample two-layer laminate (15 g·m-2 PE foil + 15 g·m-2 PP non-woven) had the best vapor resistance and thermal insulation properties. Moreover, this sample was characterized by good air permeability and surface weight compared to the other laminate samples. During the design of garments for premature babies, it is important to reduce the surface weight to as low as possible. Among the knitted fabrics, a knitwear single cotton 120 g·m-2 knitwear polyester interlock 120 g·m-2 was selected for having the best THV or tactile comfort. In addition, these knits were chosen for their lower surface weight. Based on the conducted tests, two-layer laminate (15 g·m-2 PE foil + 15 g·m-2 PP non-woven), the knitwear single cotton 120 g·m-2, and knitwear polyester interlock 120 g·m-2 were selected for further research.

Modification of Alginates to Modulate Their Physic-Chemical Properties and Obtain Biomaterials with Different Functional Properties.

Modified alginates have a wide range of applications, including in the manufacture of dressings and scaffolds used for regenerative medicine, in systems for selective drug delivery, and as hydrogel materials. This literature review discusses the methods used to modify alginates and obtain materials with new or improved functional properties. It discusses the diverse biological and functional activity of alginates. It presents methods of modification that utilize both natural and synthetic peptides, and describes their influence on the biological properties of the alginates. The success of functionalization depends on the reaction conditions being sufficient to guarantee the desired transformations and provide modified alginates with new desirable properties, but mild enough to prevent degradation of the alginates. This review is a literature description of efficient methods of alginate functionalization using biologically active ligands. Particular attention was paid to methods of alginate functionalization with peptides, because the combination of the properties of alginates and peptides leads to the obtaining of conjugates with properties resulting from both components as well as a completely new, different functionality.

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The Role of Mesh Implants in Surgical Treatment of Parastomal Hernia.

A parastomal hernia is a common complication following stoma surgery. Due to the large number of hernial relapses and other complications, such as infections, adhesion to the intestines, or the formation of adhesions, the treatment of hernias is still a surgical challenge. The current standard for the preventive and causal treatment of parastomal hernias is to perform a procedure with the use of a mesh implant. Researchers are currently focusing on the analysis of many relevant options, including the type of mesh (synthetic, composite, or biological), the available surgical techniques (Sugarbaker's, "keyhole", or "sandwich"), the surgical approach used (open or laparoscopic), and the implant position (onlay, sublay, or intraperitoneal onlay mesh). Current surface modification methods and combinations of different materials are actively explored areas for the creation of biocompatible mesh implants with different properties on the visceral and parietal peritoneal side. It has been shown that placing the implant in the sublay and intraperitoneal onlay mesh positions and the use of a specially developed implant with a 3D structure are associated with a lower frequency of recurrences. It has been shown that the prophylactic use of a mesh during stoma formation significantly reduces the incidence of parastomal hernias and is becoming a standard method in medical practice.

The Chitosan Implementation into Cotton and Polyester/Cotton Blend Fabrics.

Chitosan is an environmentally friendly agent that is used to achieve the antimicrobial properties of textiles. Nowadays, the binding of chitosan to the textiles has been thoroughly researched due to the increasing demands on the stability of achieved properties during the textile care processes. Most crosslinking agents for chitosan are not safe for humans or environment, such as glutaric aldehyde (GA) and formaldehyde derivatives. Eco-friendly polycarboxyilic acids (PCAs) are usually used in after-treatment. In this work, chitosan powder was dissolved in citric acid with sodium hydrophosphite (SHP) as a catalyst. Standard cotton (CO) and polyester/cotton (PES/CO) fabrics were pretreated in 20% NaOH, similar to mercerization, in order to open the structure of the cotton fibers and hydrolyze polyester fibers, continued by finishing in the gelatin chitosan bath. Afterwards, the hot rinsing process, followed by drying and curing, closed the achieved structure. The main objective was to achieve durable antimicrobial properties to multiple maintenance cycles CO and PES/CO fabric in order to apply it in a hospital environment. The characterization of fabrics was performed after treatment, first and fifth washing cycles according ISO 6330:2012 by field emission scanning electron microscopy (FE-SEM), Fourier transform infrared spectroscopy (FTIR-ATR), electrokinetic analysis (EKA), by the determination of tensile properties and mechanical damage (wear), and the antimicrobial activity. The application of 20% NaOH led to the swelling and mercerization of cotton cellulose, and hydrolysis of polyester, resulting in better mechanical properties. It has been confirmed that the chitosan particles were well implemented into the cotton fiber and onto to the polyester component of PES/CO blend. The presence of chitosan was confirmed after five washing cycles, but in lower quantity. However, achieved antimicrobial activity is persistent.

Treatment of very large cranial defects with individually shaped polypropylene polyester knitwear prostheses: a series of 11 cases.

BACKGROUND: Very large cranial defects are not very common in neurosurgical practice and there is not any widely acknowledged standard of their treatment. One of the useful methods in such cases is individual forming of polypropylene-polyester knitwear. Such material was used in the past but before 2008 it was available only as standardized plates. Currently, it can be also produced as individually-shaped implants. The authors give their definition of very large cranial defects and present their experience with this cranioplastic method in such defects. METHODS: The authors collected data on 11 cases of patients with very large cranial defects, from a total of 156 cases, operated on in 5 Polish neurosurgical departments. The necessary implants were prepared for individual patients according to the data provided by a computed tomography examination and with the use of computer aided machining. RESULTS: All defects were larger than 120 cm2 (129 to 178 cm2) and exceeded 1/4 of the calvaria area. Patients were operated between 2008 to 2012. In all patients, a very good aesthetic result and correct skull reconstruction was achieved. The follow-up time in all cases exceeded 1 year and reached 4 years in one case. No complications were observed. CONCLUSIONS: Individually pre-shaped polypropylene-polyester knitwear prostheses are a good alternative to the existing cranioplasty methods, particularly in very large cranial defects.

Characteristic Features of Wound Dressings Based on Butyric-Acetic Chitin Copolyesters-Results of Clinical Trials.

The article presents the results of clinical trials of wound dressings whose main ingredient is butyric-acetic chitin copolyester (BAC 90:10). It is a chitin derivative soluble in typical organic solvents. During the trial, the dressings were used on wounds resulting from venous insufficiency or diabetes. The trial evaluated the safety of use and efficacy of three forms of the dressing including porous membrane (Medisorb R Membrane), porous membrane with silver (Medisorb R Ag), and powder (Medisorb R Powder). The clinical trial had a multi-centre character. Three medical units were engaged in the study. The trial included 36 patients (12 men and 24 women). The mean age of the participants was 65 years of age (age range: 26-96). The choice of dressings was made on the basis of preliminary evaluation of the wound, clinical signs of infection, or risk of infection. Medisorb R Membrane dressing was used in 23 patients, Medisorb R Ag dressing was used in 15 patients, and Medisorb R powder was used in two patients. During the course of the trial, there were 10 control visits planned. The obtained results prove the safety and efficacy of dressings in question. The efficacy of treatment was evaluated as good. In the majority of patients, the ulceration was decreased both on the surface and in depth. The success of the treatment relied not only on the applied dressing, but also the stage of the basic disease, the accompanying diseases, and the age of the patient.

Influence of Porous Dressings Based on Butyric-Acetic Chitin Co-Polymer on Biological Processes In Vitro and In Vivo.

In spite of intensively conducted research allowing for the development of more and more advanced wound dressing materials, there is still a need for dressings that stimulate not only reparative and regenerative processes, but also have a positive effect on infected and/or difficult-to-heal wounds. Porous dressing materials based on butyric-acetic chitin co-polyester containing 90% of butyryl and 10% of acetyl groups (BAC 90/10) can also be included in the group mentioned above. Two types of dressings were obtained by the salt leaching method, i.e. a porous sponge Medisorb R and Medisorb Ag with an antibacterial additive. The aim of the study was to evaluate biological effects of porous Medisorb R and Medisorb Ag dressings under in vitro and in vivo conditions. In an in vitro biodegradation test, no mass loss of Medisorb R dressing was observed within 14 days of incubation in physiological fluids at 37 °C. However, on the basis of the FTIR (Fourier Transform Infrared Spectroscopy) tests, surface degradation of Medisorb R dressing was observed. Additionally, the antibacterial activity of the porous Medisorb Ag dressing containing microsilver as an antibacterial additive was confirmed. The in vivo studies included inflammatory activity, skin irritation and sensitisation tests, as well an assessment of local effect after contact with subcutaneous tissue up to 6 months and skin wounds up to 21 days. In the in vivo tests, the dressings exhibited neither effects of skin irritation nor sensitisation. Under macroscopic examination, in full thickness defects of subcutaneous tissue and skin, the dressings caused wound healing with no inflammation, undergoing the most gradual biodegradation between weeks 4 and 8, and the observed differences were statistically significant. In the histological assessment, a weakened, limited inflammatory process associated with degradation of the material has been observed. The process of skin wound healing under Medisorb R dressing in the early period was accelerated compared to that observed in the control group with a gauze dressing.

Chitosan and Its Derivatives - Biomaterials with Diverse Biological Activity for Manifold Applications.

Derived from chitin, chitosan is a natural polycationic linear polysaccharide being the second most abundant polymer next to cellulose. The main obstacle in the wide use of chitosan is its almost complete lack of solubility in water and alkaline solutions. To break this obstacle, the structure of chitosan is subjected to modification, improving its physic-chemical properties and facilitating application as components of composites or hydrogels. Derivatives of chitosan are biomaterials useful for different purposes because of their lack of toxicity, low allergenicity, biocompatibility and biodegradability. This review presents the methods of chemical modifications of chitosan which allow to obtain tailor- made properties required for a variety of biomedical applications. Selected pharmaceutical and biomedical applications of chitosan derivatives are also highlighted. Possibility to manage waste from arthropod and crab processing is also emphasized.

Analysis of structure and properties of antibacterial vascular patch used in abdominal aorta aneurysm surgeries.

BACKGROUND: Biocompatible materials are used for treatment of blood circulatory system diseases, especially abdominal aortic aneurysms. The most popular and often used are knitted and polymer vascular patches. The aim of this study was to optimize the manufacturing process of implantable materials, ensuring antibacterial activity useful for treating abdominal aorta aneurysms. METHODS: The vascular patch was manufactured from Trevira® yarn. The parameters of the intermediate product and vascular patch were tested according to standard procedures. RESULTS: The vascular patch, manufactured from microsilver-containing yarn, with crimps on the surface of the patch, has been found useful for treatment of abdominal aorta aneurysms. Introducing crimps on the surface of the patch resulted in reduction of water permeability and enabled cutting of the graft at various angles without fraying at the cut ends of the biomaterial. The final vascular patch was marked by a gradual release of silver within 48 hours. CONCLUSIONS: On the basis of the performed test, it has been demonstrated that an implantable material for the treatment of abdominal aorta aneurysms was obtained, and that it can be considered as an alternative for currently used vascular patches. The final vascular patch was marked by a gradual release of silver during the first period of incubation. The antibacterial properties of the final product were confirmed by observation of a significant reduction in the number of Staphylococcus aureus and Klebsiella pneumoniae bacterial colonies.

Preparation Method of Porous Dressing Materials Based on Butyric-Acetic Chitin Co-Polyesters.

A method for obtaining highly porous materials in the form of film, based on the butyric-acetic chitin co-polyesters, containing 90% of butyryl and 10% of acetyl groups, was developed. The highly porous films, with thickness up to 0.11 mm, were obtained by two methods: (a) pouring 5% BAC 90/10 solution in ethanol on the layer of solid salts (porophor agent) which after solidification was eluted with water; (b) application of the suspension of porophor agent in BAC 90/10 solution in the solvent mixture with density similar to bulk porophor agent. In the final stage, the materials were obtained with porosity up to 95⁻99% and tensile strength 5 cN, which can be used as an active layer of medical dressings. The optimised procedure was used in the production of porous medical dressings (Medisorb) on an industrial scale. In the industrial method, NaCl was used as a porophor agent in the solid form and as a 3% solution in polymer. The final materials were characterised by porosity and other functional parameters at the level recommended for medical dressings. Medisorb series materials do not show in vitro cytotoxic activity.