Necessary duration of follow-up to assess complications of mesh in hernia surgery: a time-lapse study based on 460 explants.

PURPOSE: Risk of complications following hernia repair is the key parameter to assess risk/benefit ratio of a technique. As mesh devices are permanent, their risks are life-long. Too many reports in the past assessed mesh safety prematurely after short follow-ups. We aimed to explore what length of follow up would reveal the full extent of complications. METHODS: Time lapses between implantation and excision were analyzed in 460 cases of meshes excised for complications after hernia repair. Patterns of percentage growth and time lapses at 50th and 95th percentiles were used to compare groups of different hernia type, age, gender and reason for excision. RESULTS: The 50th and 95th case percentiles in the dataset were at 3.75 and 15.0 years between mesh implantation and excision. For hernia types, the longest time lapses were for groin hernias (4.0 and 16.11 years at 50th and 95th percentiles). The shortest were for umbilical hernias (2.16 and 9.68 years). Males had later excisions than females (4.11 and 16.1 vs. 2.47 and 9.79 years). Younger patients (< 45 y.o.) had later excisions than older patients (4.12 and 17.68 vs. 3.37 and 10.0 years). Out of all subgroups, the longest time lapses were for groin hernias in younger males (4.77 and 18.89 years) and for mesh erosion into organs (4.67 and 17.0 years). CONCLUSIONS: Follow-up of more than 15 years is needed to fully assess complications after mesh hernia repair. Especially longer periods are needed to detect mesh erosion into organs and complications in younger males. Presently, short observations and lack of reporting standard in the literature prohibit accurate assessment of complication risks. We propose to use cumulative incidence for standardized risk reporting (y% risk at x years). This will show time-dependent patterns and allow comparisons between different techniques and studies of variable duration. Standardization will also help to predict long-term risks beyond shorter (practical) follow-ups and facilitate real-time monitoring during surveillance.

[Reflux nephropathy in children: early diagnosis and monitoring].

Vesicoureteral reflux (VUR) is the most common type of obstructive uropathy in children. Reflux nephropathy (RN) is one of the most common complications of VUR that inevitably leads to chronic kidney disease. Patients with end-stage kidney disease require costly treatment, and the only way to cure them is kidney transplantation. A timely institution of renoprotective therapy is a key factor helping to preserve the function of the native kidneys. Hence, it is necessary to devise new highly sensitive and minimally invasive methods for early diagnosis of RN. The purpose of this article is to review the molecular mechanisms of initiation and progression of kidney fibrosis and the opportunities of instrumental and non-instrumental methods for its diagnosis. Special attention is paid to highly specific and highly sensitive non-invasive methods for the detection of minimal changes in the renal parenchyma. The authors discuss the promising biomarkers for the diagnosis and prediction of RN.

25 Gbps direct modulation and 10 km data transmission with 1310 nm waveband wafer fused VCSELs.

Direct modulation at >25 Gbps is achieved with 1310 nm wavelength wafer fused VCSELs by adjusting the strain in the quantum well active region and the cavity photon lifetime. 25 + Gbps large signal modulation with 10-12 BER at 1310 nm across 10 km of standard single mode fiber is demonstrated.

Polarization mode control of long-wavelength VCSELs by intracavity patterning.

Polarization mode control is enhanced in wafer-fused vertical-cavity surface-emitting lasers emitting at 1310 nm wavelength by etching two symmetrically arranged arcs above the gain structure within the laser cavity. The intracavity patterning introduces birefringence and dichroism, which discriminates between the two polarization states of the fundamental transverse modes. We find that the cavity modifications define the polarization angle at threshold with respect to the crystal axes, and increase the gain anisotropy and birefringence on average, leading to an increase in the polarization switching current. Experimental measurements are explained using the spin-flip model of VCSEL polarization dynamics.

PO-17 - Identification of IgG bound to plasminogen in oncologic diseases.

INTRODUCTION: The binding of plasminogen (Pg) to cell receptors and extracellular ligands facilitates its activation to plasmin, which stimulates the extracellular matrix degradation, neoangiogenesis and tumor invasion. Plasmin can also degrade IgG thereby exposing C-terminal lysine residues. Previously, we have found IgG specifically bounded to Pg in the plasma of patients with malignant tumors. AIM: To identify IgG degraded by plasmin in the plasma of cancer patients. MATERIALS AND METHODS: Methods of ELISA were used for comparative research of levels of IgG bound to Pg in plasma of patients with the prostate cancer (PC, n=25) and lung cancer (LC, n=17). Plasma of healthy donors (n=29) was used as control. All patients signed informed consent for participation in this study. Affinity chromatography on Pg-sepharose was used for the quantification of IgG. Carboxypeptidase was used for remove of C-terminal lysine residues of the IgG. The program ATTESTAT was used for nonparametric analysis. RESULTS: The frequency of occurence of elevated levels of IgG to Pg in plasma was detected in 68% of patients with PC, 59% of patients with LC and only 12% of healthy women and 10% of healthy men. The quantification of antibodies in plasma samples showed that the quantity of IgG to Pg in patients with PC was 27% from the total amount of IgG and in healthy men - 9%. Treatment of diluted plasma samples with carboxypeptidase B abolished the elevated levels of IgG to Pg, as well as the specific activity of the purified IgG to Pg-sepharose. CONCLUSIONS: C-terminal lysine residues which are formed as a result of degradation of native IgG with plasmin can bind to lysine binding sites on the kringle domains of Pg. Increased levels of these degraded IgG can be marker at cancer.

A mechanism of mesh-related post-herniorrhaphy neuralgia.

PURPOSE: The objective is to compare nerve densities in explanted polypropylene meshes in patients with or without chronic pain. Pain has supplanted recurrences as a complication of hernia surgery. The increased incidence of pain mirrors a parallel increase in the use of polypropylene meshes. Neither triple neurectomy nor careful nerve preservation has brought relief. Perhaps because we have forgotten that nerves, in response to some evolutionary mechanism, tend to regenerate, undergo changes imposed by prosthetic elements and architecture, mimicking entrapment and compartment syndromes. METHODS: A total of 33 hernia meshes have been analyzed: 17 excised due to severe pain, two for combined pain and recurrence, 14 sampled during revision for recurrence without pain. Each mesh had standardized sampling for histology and the nerves were highlighted by S100 stain. Nerve densities were assessed within the mesh spaces and in tissue outside the mesh. RESULTS: The density of nerves present in the standardized mesh samples of patients complaining of pain was much more elevated than in the mesh of those patients who had a recurrence but no pain. The difference was statistically significant (p < 0.001). Excluding two patients who had both pain and recurrence, the difference was even more marked (p < 0.0001). CONCLUSIONS: Re-innervation and neo-innervation are known to take place following hernia repairs in indigenous tissue as well as through polypropylene meshes. However, when pain is an overriding issue dictating mesh explant, the degree of mesh innervation is significantly higher when compared to mesh excised for recurrence. That increase has been confirmed statistically.

8.5 W VECSEL output at 1270 nm with conversion efficiency of 59%.

We report on 1270 nm vertical-external-cavity surface-emitting lasers (VECSELs) with up to 59% conversion efficiency and maximum output power of 8.5 W (pump limited), at 5°C heat sink temperature. These VECSELs comprised wafer-fused gain mirrors in the flip-chip (thin-disk) heat dissipation scheme. The reflected pump light from the gain mirror surface was found to depend considerably on temperature and pump power.

Increasing single mode power of 1.3-µm VCSELs by output coupling optimization.

We report on the single mode emission power enhancement of 1.3-µm VCSELs by adjusting the reflectivity of the top GaAs-based DBR for output coupling optimization using selective removal of Bragg reflector layers. Devices with record single mode power of 6.8-mW at room temperature and 2.8-mW at 80°C, with more than 30 dB single mode suppression ratio, have been obtained.

Optical injection locking of transverse modes in 1.3-µm wavelength coupled-VCSEL arrays.

Optical injection locking of 1.3-µm phase-locked VCSEL arrays defined by patterned tunnel junctions and wafer fusion is investigated experimentally and theoretically. The impact of the overlap between the master laser injection beam and the injected modes is demonstrated and explained with a rate equation model that incorporates the spatial variations.

Facial baroparesis: a critical differential diagnosis for scuba diving accidents--case report.

Facial nerve baroparesis is a rare and potentially under-reported complication of scuba diving. A diver, after surfacing from a shallow dive, developed isolated left-sided facial palsy accompanied by pain and decreased hearing in the left ear. No other signs or symptoms attributable to a scuba diving accident were detected. Forty minutes later, he heard a "pop" in the affected ear, after which all symptoms quickly resolved. Repeat neurological and ear examinations were normal. He showed no residual or new symptoms 24 hours later. The differential diagnosis of facial neurological deficit after diving includes decompression sickness, cerebral air embolism due to pulmonary barotrauma, facial nerve barotrauma and common conditions such as stroke and Bell's palsy. It is important to recognize the condition since recompression treatment can further damage the facial nerve.

14XX nm-wavelength electrically-pumped VECSELs fabricated by wafer fusion.

We report on the design, fabrication and characterization of electrically pumped vertical external cavity surface emitting lasers (EP-VECSELs) emitting at 1470 nm. We demonstrate 6.2 mW of CW output power, which represents the highest power value reported so far for EP-VECSELs in the 14XX nm and 15XX nm wavelength bands.

[ANCA-associated vasculitis affecting lungs and kidneys: clinical and morphological characteristic, treatment, outcomes].

Up to 80% of all cases of pulmonary-renal syndrome are due to systemic vasculitis associated with antibodies to neutrophil cytoplasm (ANCA). Most patients die within the first year after the onset of the disease but adequate immunosuppressive therapy ensures the 5-year survival rate of 65-75%. We obtained clinical and morphological data for 34 patients with ANCA-associated vasculitis affecting lungs and kidneys treated at S. P. Botkin Hospital in 1994-2012. 16 patients presented with granulomatous polyangiitis (Wegener 's granulomatosis), 11 with microscopic polyangiitis, and 7 with eosinophilicpolyangiitis (Churg-Strauss syndrome). We made the definitive diagnosis in 79% of the cases. Pulmonary lesions were largely in the form offocal, nodular and infiltrative changes, one third of the patients suffered blood spitting/pulmonary hemorrhage and 15% respiratory distress. Most patients had renal dysfunction (16% required emergency hemodialysis), lesions of ENT skin, joints, peripheral nervous system, and eyes. Therapy with corticosteroids and cytostatics increased the total and renal survival rate up to 91 and 82% respectively despite unfavourable prognostic factors in most patients. Duration of observation was 32.5 [0.1;129] months, the survival rate depended on the severity of lung lesions whereas renal problems had no appreciable effect on life prognosis.

[Dynamics of laboratory markers of endothelial dysfunction during treatment of unstable angina].

This study was aimed to assess the diagnostic value of laboratory markers of endothelial lesions in patients with unstable angina (UA). Plasma levels of CRP, homocysteine, endothelin-1 (ET1), and pregnancy-associated plasma protein (pAPP-A) were measured by an ultrasensitive method in 51 patients. They were followed up for 4 months to evaluate the clinical picture of CHD and dynamics of laboratory parameters. The hospitalized patients with UA had elevated baseline levels of CRP (5.02+-3.35 mg/ml) during the entire study period. PAPP-A and homocysteine levels were significantly decreased (p<0.05 and p<0.0 respectively). Patients with deteriorated clinical picture of CHD had significantly elevated ET1 levels (p<0.05) both on day 1 and 4 months later It is concluded that ET1 levels increase in patients with UA and severe prognostically unfavourable CHD.

[Diagnostics of cavitary processes in the lungs].

The paper concerns CT-semiotics of cavitary processes in the lungs. Their major forms are discussed with reference to underlying pathological changes. The most common manifestations of the diseases associated with the cavitary processes are described. CT is a highly informative method for the visualization of pulmonary cavitation and the surrounding chest structures; this method improves diagnostics of pulmonary pathology.

[Blood microcirculation disorder in patients with bronchopulmonary diseases and methods of microcirculation study].

AIM: To investigate microhemocirculation in patients with bronchopulmonary pathology with application of Doppler flowmetry (DFM). MATERIAL AND METHODS: Videobronchoscopy (Olimpas or Pentax devices) was performed in 203 patients with bronchitis of different inflammation intensity: Functional activity of microhemocirculation in bronchial mucosa was studied with endobronchial laser Doppler flowmetry (LDF) which was also made in 20 healthy controls. RESULTS: LDF-grams demonstrated that patients with chronic bronchitis and pneumonia have congestive regional microcirculation with low activity of components of microcirculatory bed, venous blood congestion, weak blood flow and tissue ischemia. High informative value of the method and its availability was shown by comparison of LDF-grams on treatment day 7 and 14. CONCLUSION: High informative value of LDF procedure is found in diagnosis of vascular and intravascular microcirculatory disorders in patients with bronchopulmonary pathology.

[Verification of the PREFAB alignment database].

The verification of the PREFAB database containing golden standard protein alignments was performed. It has revealed a significant number of differences between the sequences from PREFAB and PDB databases. It was shown that compared to the sequences given in the PDB database 575 alignments refered to a sequence with a gap; such alignments were excluded. Furthermore, compared to the PDB-sequences a single substitute or the insertions were found for 440 aminoacid sequences from PREFAB database; these sequences were edited. SCOP domain analysis has shown that only 502 alignments in the resulting set contain the sequences from the same family. Finally, eliminating duplicates, we have created a new golden standard alignment database PREFAB-P based on PREFAB; the PREFAB-P database contains 581 alignments.

[Phospholipids and structural modification of tissues and cell membranes for adaptation in high altitude mountains].

The nature of the impact of physical factors of high altitudes (3200 m) on the lipids of tissues and membranes of animals was researched. It was established that the adaptation process in Wistar rats was followed by peroxide degradation and subsequent modification of the phospholipids' structure of tissues and microsomal membranes. Adaptive phospholipids reconstruction takes place in microsomal membranes in the tissues of the lungs, brain, liver and skeletal muscles. Together with this, the amount of phosphatidylinositol and phosphatidic acid accumulates, indicating that the hydrolysis of phosphatidylinositol-4, 5 biphosphate to diacylglycerol and secondary messenger--inositol triphosphate, occurs. A decrease in temperature adaptation (+10 degrees C) leads to a more noticeable shift in peroxide oxidation of lipids, phospholipid structure in the tissues and membranes rather than adaptation in thermoneutral conditions (+30 degrees C). Modification of lipid composition of tissues and cell membranes in the highlands obviously increases the adaptive capabilities of cells of the whole body: physical performance and resistance to hypoxia increases in animals.

[Effect of body mass reduction on the level of adiponectin in patients with obesity and type 2 diabetes mellitus].

Patients with obesity and type 2 diabetes mellitus are known to have hypoadiponectinemia partially compensated by switching to low-caloric diet. Reduction of the body mass results in the proportional increase of the adiponectin level and decreased severity of insulin resistance.