Durability of Macroplastique volume and configuration in women with stress urinary incontinence secondary to intrinsic sphincter deficiency: A retrospective review.

OBJECTIVES: To evaluate the durability of Macroplastique® (MPQ) volume and configuration in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD) using serial three-dimensional ultrasound (3DUS) measurements. METHODS: Following Institutional Review Board approval, charts of women with SUI and ISD (defined based on leak point pressure; lateral imaging of urethral support without hypermobility) who underwent MPQ were reviewed from a prospectively maintained database. All had at least two serial transperineal 3DUS measurements with no MPQ or other bulking agent injection between measurements. 3DUS was performed using the Philips IU22 ultrasound system with endovaginal 3D 9-3V end-fire probe typically at 6-8 weeks post-injection and yearly thereafter. The same imaging team blinded to clinical outcomes evaluated volume and configuration (circumferential/symmetric or asymmetric) at each 3DUS. RESULTS: Between 2011 and 2019, 62 of 174 women met study criteria. Those with prior other bulking agent injection or having ≤1 3DUS follow-up were excluded. Seventy-one percent of patients had one injection, while the remainder had two or more (29%). Median time between first and second 3DUS was 12 months. The mean change in MPQ volume between the first and last 3DUS measurement was -0.2 cc (95% CI: -0.5 to 0.004; P = .054). A median of 5.0 cc were injected in each patient. Forty-seven women had symmetric MPQ at first 3DUS, of whom only five (11%) had a follow-up 3DUS showing asymmetric MPQ distribution. CONCLUSIONS: At mid-term follow-up, repeat transperineal 3DUS after MPQ injection revealed minimal change in volume and configuration in the urethral wall.

Experimental comparative study of arterial implants made of silicone reinforced with polyester fabric and expanded polytetrafluoroethylene (PTFE) in rabbits aorta / Estudo experimental comparativo de implantes arteriais em silicone com reforço de poliéster e politetrafluoretileno expandido (PTFE) em aorta de coelhos

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.

RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.

Temperature changes affect the rheological properties of a silicone-based and an epoxy resin-based root canal sealers.

To evaluate temperature changes on the rheological properties (setting time and complex viscosity (η*)) of GuttaFlow Bioseal (GFB) and AH Plus Jet (AHPJ). Rheological measurements were performed in oscillating mode at the strain amplitude and angular frequency of 0.01% and 10 rad s-1 , respectively. Each sealer (n = 5) was tested running a temperature ramp (rapid increase to 80°C, 1 min constantly at 80°C, and slower decrease to 37°C). Control groups (n = 5) were tested at a constant temperature of 37°C. Kolmogorov-Smirnov and one-way ANOVA (P < 0.05) statistical tests were performed. The temperature ramp reduced setting time of GFB (24.85 to 4.45 min) (P < 0.05), but did not alter that of AHPJ (P > 0.05). GFB exhibited an increased η*, whereas the AHPJ η* was decreased when heated (P < 0.05). Rheological properties of sealers were negatively affected by temperature changes.

Formation of size-controllable spheroids using gingiva-derived stem cells and concave microwells: Morphology and viability tests.

Human mesenchymal stem cells have previously been isolated and characterized from the gingiva, and gingiva-derived stem cells have been applied for tissue engineering purposes. The present study was performed to generate size-controllable stem cell spheroids using concave microwells. Gingiva-derived stem cells were isolated, and the stem cells of 1×105 (group A) or 2×105 (group B) cells were seeded in polydimethylsiloxane-based, concave micromolds with 600 µm diameters. The morphology of the microspheres was viewed under an inverted microscope, and the changes in the diameter and cell viability were analyzed. The gingiva-derived stem cells formed spheroids in the concave microwells. The diameters of the spheroids were larger in group A compared to group B. No significant changes in shape or diameter were noted with increases in incubation time. Cell viability was higher in group B at each time point when compared with group A. Within the limits of the study, the size-controllable stem cell spheroids could be generated from gingival cells using microwells. The shape of the spheroids and their viability were clearly maintained during the experimental periods.

Flexible sensors and their application in healthcare / 军事医学

The traditional approach to accessing healthcare information restricts the further development of healthcare services,thus unable to meet the growing needs of individual healthcare.The flexible sensor technology has emerged along with the development of new materials,machinery and manufacturing technology.As a result,textiles,accessories,human skin and even internal body organs can be integrated with various sensors.The popularization of flexible sensors provides new methods for monitoring health,improving therapeutics,investigating disease status and building the human-machine in-terface.Through a systematic investigation of literature,this paper reviews the applications of flexible sensors in health-care,discusses the key technologies,and introduces the common materials and manufacturing technology.

Treatment outcomes of transurethral macroplastique injection for postprostatectomy incontinence.

PURPOSE: We investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery. MATERIALS AND METHODS: This retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement. RESULTS: The study population comprised 30 men with a mean age of 66.1±5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9±1.9 pads per day. After injection treatment, the mean follow-up period was 9.3±12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%). CONCLUSIONS: Transurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.

Estudo experimental comparativo de remendos arteriais de polidimetilsiloxano com reforço de tecido de poliéster (PDMSr) versus politetrafluoretileno expandido (PTFEe) em aorta de coelhos / Patch of polydimethylsiloxane reinforced with polyester fabric for aortic angioplasty in rabbits

Introdução: Apesar de bons resultados descritos na literatura, o substituto ideal para a utilização como remendo no fechamento arterial ainda não existe. Por este motivo, ainda há espaço para a busca por remendo que seja biocompatível, e que apresente facilidade de manuseio e resultados satisfatórios. Avaliamos remendos arteriais de silicone (polidimetilsiloxano com reforço em poliéster - PDMSr) em comparação com remendos arteriais de PTFEe. Objetivo: O objetivo deste trabalho é comparar, em modelo experimental, em coelhos, os resultados de remendos arteriais feitos em PDMSr com remendos de PTFEe. Materiais e Método: A amostra foi definida em 10 animais que completassem todas as etapas da pesquisa em cada grupo. Os animais foram submetidos à laparotomia mediana e abertura longitudinal da aorta de aproximadamente 8mm, realizando-se o seu fechamento com remendo do grupo selecionado, seguido do fechamento por planos. Os animais foram mantidos em biotério até o 60º PO, quando, então, realizou-se arteriografia de controle, e análise macro e microscópica de peça. Resultados: Para se atingir a amostra desejada, foram necessários 12 procedimentos no grupo PDMSr e 16 no grupo PTFEe. Ocorreram 2 óbitos no grupo PDMSr e 6 no grupo PTFEe. Apesar do número maior de óbitos no grupo PTFEe não houve diferença estatística na sobrevida entre os grupos. Um animal do grupo PDMSr apresentou monoparesia em pata posterior direita e um animal do grupo PTFEe apresentou hérnia incisional. Não houve diferença estatística nas complicações entre os grupos. O tempo operatório foi estatisticamente maior no grupo PTFEe quando comparamos todos os animais, fato que não se repetiu quando excluímos os animais que faleceram...

Introduction: Although good results are reported for various materials for use as patches for arterial closure, as yet none of these is ideal. Therefore, research is continuing into development of a patch that is biocompatible and provides ease of handling, while having satisfactory outcomes. A new silicone arterial patch (polydimethylsiloxane reinforced with polyester fabric, PDMSr) was compared with patches made of expanded polytetrafluoroethylene (ePTFE). Objective: To compare the outcomes between arterial patches made of PDMSr with those made of ePTFE, in an experimental rabbit model. Materials and Method: Rabbits were placed in two groups, and received either PDMSr or ePTFE arterial patches (PDMSr group and ePTFE group, respectively). The animals underwent laparotomy and longitudinal opening of the aorta, which was then closed with the selected patch, followed by suture of all layers. The animals were kept in their cages until the 60th postoperative day, when arteriography, removal of the aorta, and macroscopic and optic and scanning electron microscopic analyzes of the aorta were performed. Ten rabbits from each group that had completed all stages of the research were included in analyses. Results: Twelve procedures were performed in the PDMSr group and 16 in the ePTFE group. There were 2 deaths in the PDMSr group and 6 in the ePTFE group. Despite the higher number of deaths in the ePTFE group, there was no statistical difference in survival rate between the groups. One animal in the PDMSr group developed monoparesis in its right hind paw and 1 animal in the ePTFE group had an incisional hernia. There was no statistical difference in complications between the groups. The operative time was significantly longer in the ePTFE group when all animals were included in analysis, but not when animals that died were excluded...

Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

PURPOSE: We investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery. MATERIALS AND METHODS: This retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement. RESULTS: The study population comprised 30 men with a mean age of 66.1+/-5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9+/-1.9 pads per day. After injection treatment, the mean follow-up period was 9.3+/-12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%). CONCLUSIONS: Transurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.

Sperm motility sorting using microfluidic chip / 中华检验医学杂志

in vitro fertilization in future.

Spermicide permeation through biocompatible polymers.

Although spermicides are safe and effective contraceptive/prophylactic agents, they are inconvenient to use. Formulations that provide a controlled release of spermicide may improve user acceptance, and therefore effectiveness. Using a two-chamber diffusion cell, we measured the rates of permeation of nonoxynol-9 (N9), benzalkonium chloride (BC), and chlorhexidine (CH) through films of ethylene-vinyl acetate copolymer (EVAc) and silicone elastomer (SILASTIC). In addition, we encapsulated N9, BC, and CH into solid polymer matrices and measured the rate of spermicide release following immersion in water. We also developed equations for predicting the release rate of spermicide from a vaginal ring containing encapsulated spermicide, and tested these equations using hollow SILASTIC rings containing pure N9 or BC. N9 diffuses through a thin film of SILASTIC several orders of magnitude slower than through water. The rates of permeation of N9 through EVAc, BC through SILASTIC, and CH through SILASTIC were too low to detect over a one-week experiment. Polymer matrices of EVAc or SILASTIC released N9 at a controlled rate for several days. Based on these measurements, we predict that a vaginal ring containing an inner core of EVAc/N9 surrounded by a thin, permeable layer of SILASTIC will provide a controlled, constant release of N9 for over 30 days. Because of its low permeability in SILASTIC, BC is probably not a good spermicide for a long-acting vaginal ring. Because of its low solubility in water, CH is also not a good candidate for controlled release into the vaginal mucus.

The efficacy and acceptability of a low-dose levonorgestrel intravaginal ring for contraception in a UK cohort.

The efficacy and acceptability of a levonorgestrel-releasing intravaginal ring (IVR) for contraception was assessed in a British cohort studied as part of a multicentre, multinational clinical trial performed under the auspices of the World Health Organisation. One-hundred-and-fifty women took part in the study in two UK centres and completed 1417.5 months of method use. Fifty-nine women discontinued use of the IVR before the end of one year giving an overall discontinuation rate of 39.9 per 100 woman-years. The discontinuation for pregnancy with the ring in situ, was 3.0 per 100 woman-years (life table analysis). Menstrual disturbance, vaginal problems and involuntary expulsion resulted in discontinuation rates of 8.9, 8.4 and 1.6 per 100 woman-years, respectively. This method is an acceptable and effective method of contraception for women.

Nonhormonal mediation of male reproductive tract damage: data from contraceptive drug research.

Chemicals can interfere with hormonal control of the male reproductive tract and/or directly alter male reproductive tract function. A review is presented of those chemicals developed and tested as male contraceptive agents which have a direct effect on the male reproductive tract with minimal disturbance of the hormonal milieu. Such chemicals can have one or more sites of action: 1) the testis, disturbing spermatogenesis; 2) the epididymis, altering sperm maturation; 3) the vas deferens, affecting sperm transport; and 4) the accessory sex glands, entering the ejaculate and changing the functional activity of the spermatozoa. Examples of each mode of action are presented.

PIP: A review of the agents tested in animals and men and shown to have a direct nonhormonal contraceptive effect is subdivided into those affecting spermatogenesis in the testis, sperm maturation in the epididymis, transport in the vas deferens and sperm functional activity via the accessory glands. Chemicals acting in the testis, sperm functional activity via the accessory glands. Chemicals acting in the testis, and tested in men, are bis(dichloracetyl)diamines, later found to have disulfuram-like effects, and nitrofurans, which had several systemic adverse effects. Gossypol acts at this levels, probably by affecting sperm mitochondria. It requires prolonged administration by oral route, and causes hypokalemia. Lonidamine, an indazole-carboxylic acid, was tested in men without reported side effects. Other agents tested in animals are thiophenes, dinitropyrroles, nitroimidazoles, organosiloxanes, indenopyridines, 5-thio-D-glucose, glycerol, ethionine and heavy metals, such as cadmium. Compounds active in the epididymis include sulfasalazine the prostaglandin synthesis inhibitor used for inflammatory bowel disease, as well as alpha-chlorohydrin, and several 6- cholor-deoxy-sugars which have been tried in animals only. Sulfasalazine cause s reversible sperm impairment, primarily enlarged sperm heads. The antifungal agent ketoconazole, a substituted imidazole acts at the level of the accessory glands, immobilizing sperm, but it also has several toxic effects if used on a long-term basis, notably central nervous system, liver and adrenal gland damage. Analogs of ketoconazole with greater antifertility effect and lesser toxicity are being sought. The approach of searching for drugs that act on the male reproductive tract directly without affecting hormonal regulation has not produced any candidates without systemic side effects, but it is hoped that it will provide agents with reversible metabolic effects peculiar to these target tissues.

Pharmacodynamics of a contraceptive vaginal ring releasing norethindrone and estradiol: ovarian function, bleeding control and lipoprotein patterns.

A new contraceptive vaginal ring (CVR), releasing approximately 700 micrograms of norethindrone (NET) and approximately 140 micrograms of estradiol (E2) daily, was studied in eleven women for a total of 61 21-day cycles. Ovarian function, as judged by plasma progesterone (P) and E2 levels, and plasma NET levels were studied by weekly blood samples in 30 cycles. The lipoprotein pattern was studied before, after two and six months of treatment and one month after completed treatment. The CVR gave rise to stable plasma NET levels which however varied considerably between individuals. Signs of luteal activity/ovulation were encountered in 4/30 cycles, all in subjects with the lowest NET plasma levels. E2 levels above 250 pmol/l, indicating follicular activity, were encountered in 22/30 cycles. Breakthrough bleeding and spotting appeared in 40/61 cycles and in 12 per cent of the treatment days. Bleeding control was significantly better in the same subjects when using a CVR releasing levo-Norgestrel and E2. Serum and HDL cholesterol concentrations decreased significantly by 10-12 per cent during treatment. The ratios between apolipoproteins A-I and A-II on one hand and HDL cholesterol on the other increased significantly and the ratio apolipoprotein A-I:A-II decreased significantly, indicating a change in the lipoprotein composition. These changes are qualitatively similar but quantitatively not as pronounced as with the more extensively studied 1-Ng/E2 CVR. The difference in clinical performance and in the effects on the lipoprotein pattern between the presently studied CVR and the 1-Ng/E2 CVR is most likely the result of not using equipment doses of gestagen in the CVRs.

PIP: A new contraceptive vaginal ring (CVR), releasing approximately 700 mcg of norethindrone (NET) and approximately 140 mcg estradiol (E2) daily, was studied in 11 women for a total of 61 21-day cycles. Ovarian function, as judged by plasma progesterone (P) and E2 levels, and plasma NET levels were studied by weekly blood samples in 30 cycles. The lipoprotein pattern was studied before, after 2 and 6 months of treatment, and 1 month after compledted treatment. The CVR gave rise to stable plasma NET levels which, however, varied considerably between individuals. Signs of luteal activity/ovulation were encountered in 4 of 30 cycles, all in subjects with the lowest NET plasma levels. E2 levels above 250 pmol/1, indicating follicular activity, were encountered in 22 of 30 cycles. Breakthrough bleeding and spotting appeared in 40 of 61 cycles and in 12% of the treatment days. Bleeding control was significantly better in the same subjects when using a CVR releasing levonorgestrel and E2. Serum and high density lipoprotein cholesterol (HDL) concentrations decreased significantly by 10-12% during treatment. The ratios between apolipoproteins A-I and A-II on the one hand and HDL cholesterol on the other increased significantly and the ratio of apolipropotein A-I: A-II decreased significantly, indicating a change in the lipoprotein composition. These changes are qualitatively similar but quantitatively not as pronounced as with the more extensivley studied levonorgestrel/E2 CVR. the difference in clinical performance and in the effects on the lipoprotein pattern between the presently studied CVR and the levonorgestrel/E2 CVR is most likely the result of not using equipotent doses of gestagen in the CVRs.

Somatic tissue responses of male rhesus monkeys treated with a contraceptive steroid formulation.

Rhesus monkeys (Macaca mulatta) were treated with testosterone (100 micrograms/kg/day) plus estradiol (0.5 micrograms/kg/day) via subcutaneous polydimethylsiloxane (PDS; Silastic) implants for thirteen months. This steroid regimen inhibited dramatically spermatogenesis. Gross and histopathological examination of the musculoskeletal, circulatory, endocrine (excluding the testis), central nervous, gastrointestinal and respiratory systems failed to uncover any untoward effects of the long-term exposure due to the contraceptive formulation. Similarly, no remarkable effects were observed in the ionic, chemical and formed elements of blood or secondary sex structures. Failure to detect secondary complications attributed to the steroid treatment offers further justification for evaluating a contraceptive strategy based on administering naturally occurring steroids at sustained rates approximating those at which they are produced endogenously in the human male.