Experimental study of a new original mesh developed for pelvic floor reconstructive surgery.

INTRODUCTION AND HYPOTHESIS: Most synthetic meshes used in transvaginal surgery are made of polypropylene, which has a stable performance, but does not easily degrade in vivo. However, mesh-related complications are difficult to address and have raised serious concerns. A new biomaterial mesh with good tissue integration and few mesh-related complications is needed. To evaluate the effect of a new bacterial cellulose (BC) mesh on pelvic floor reconstruction following implantation in the vagina of sheep after 1 and 12 weeks. METHODS: The meshes were implanted in the submucosa of the posterior vagina wall of sheep. At 1 and 12 weeks after surgery, mesh-tissue complex (MTC) specimens were harvested for histological studies and biomechanical evaluation. At 12 weeks after surgery, MTC specimens were biomechanically assessed by a uniaxial tension "pulley system". RESULTS: The BC mesh elicited a higher inflammatory response than Gynemesh™PS at both 1 and 12 weeks after implantation. Twelve weeks after implantation, the BC mesh resulted in less fibrosis than Gynemesh™PS. Compared with the Gynemesh™PS group, the BC mesh group had increased mRNA expression of MMP-1, MMP-2, and MMP-9 (P < 0.05), but decreased expression of the anti-inflammatory factor IL-4 (P < 0.05). Twelve weeks after implantation, the ultimate load and maximum elongation percentage of the BC mesh were significantly lower than those of Gynemesh™PS. CONCLUSIONS: The BC mesh could not be a promising biomaterial for pelvic floor reconstructive surgery unless the production process and parameters were improved.

The in vivo biocompatibility of titanized polypropylene lightweight mesh is superior to that of conventional polypropylene mesh.

OBJECTIVE: To evaluate the histological response to and changes in the biomechanical properties of titanized polypropylene lightweight mesh and conventional polypropylene mesh at 1 and 12 weeks following implantation in the sheep vagina. METHODS: We compared a titanized polypropylene lightweight mesh (TiLOOP Mesh) to a conventional polypropylene mesh (Gynemesh PS) in a sheep vagina model. Explants were harvested after 1 and 12 weeks (n = 6/mesh type/time point) for histological observation. After 12 weeks, mesh-tissue complex specimens were biomechanically assessed by a uniaxial tension system. RESULTS: One week after implantation, there was no significant difference in the inflammatory response between the two groups. Twelve weeks after implantation, the TiLOOP light mesh elicited a lower inflammatory response than was observed for the Gynemesh PS (1.44 ± 0.61 vs 2.05 ± 0.80, P = .015). Twelve weeks after implantation, the collagen I/III ratio was lower in the TiLOOP light mesh group than in the Gynemesh PS group (9.41 ± 5.06 vs 15.21 ± 8.21, P = .019). The messenger RNA expression levels of the inflammatory factors interleukin 10 and tumor necrosis factor α were lower in the TiLOOP Mesh group than in the Gynemesh PS group at both 1 and 12 weeks (P < .05). There were no significant differences in any of the evaluated biomechanical characteristics between the two meshes (P > .05). CONCLUSION: Although the titanized polypropylene lightweight mesh induces slightly less tissue reactivity and has better in vivo biocompatibility, further studies should be conducted including the complications and the success rate of pelvic organ prolapse in patients before recommending it in pelvic floor reconstruction.

Congenital anal atresia with rectovestibular fistula, scoliosis, unilateral renal agenesis, and finger defect (VACTERL association) in a patient with partial bicornuate uterus and distal vaginal atresia: A case report.

RATIONALE: Vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect (VACTERL) association and Müllerian duct anomalies are rare conditions. We present a rare condition with the co-occurrence of the VACTERL association and Müllerian duct hypoplasia to characterize patients' clinical presentations, outcomes, and treatment. PATIENT CONCERNS: An 11-year-old girl presented to our hospital with severe lower abdominal pain, lower vaginal atresia with enlargement of the upper vagina and a bicornuate uterus with a Y-shaped uterine cavity filled with hematometra on pelvic magnetic resonance imaging. Her medical history included congenital anal atresia with a rectovestibular fistula, congenital right renal deficiency, congenital right thumb malformation, and scoliosis. DIAGNOSES: 1. Congenital genital tract malformations, a partial bicornuate uterus, and distal vaginal atresia (U3aC0V4); 2. VACTERL association (congenital anal atresia with rectovestibular fistula, scoliosis with hemi vertebra and butterfly vertebra, unilateral renal agenesis, and finger defect). INTERVENTIONS: Colpotomy, laparoscopic exploration, pelvic adhesiolysis, and hysteroscopy were performed. OUTCOMES: Two months after surgery, a pelvic examination showed an unobstructed vagina which was 10 cm long and 2 fingers wide, without adhesion or constriction. LESSONS: Clinicians should have a high index of suspicion when evaluating patients with genital malformations associated with VACTERL. Early diagnosis of distal vaginal atresia with appropriate surgical intervention decreases long-term morbidity.

Successful use of pessary for uterine prolapse after pelvic trauma in a nulliparous young female: A case report.

RATIONALE: To date, sporadic studies have shown that a relationship exists between delayed pelvic organ prolapse (POP) and pelvic trauma, and these cases have all been managed with surgical procedures. PATIENT CONCERNS: A 29-year-old, nulliparous (Gravida 0) woman without sexual experience was referred to our gynecology outpatient clinic, complaining of a protruding vaginal mass 5 years after a traffic accident (hit by a truck when she was walking) that caused serious multiple injuries. DIAGNOSES: Stage 2 cystocele, stage 3 uterine prolapse, and stage 2 rectocele, pelvic trauma history. INTERVENTIONS: The woman was successfully managed with the Gellhorn size 2 pessary use. OUTCOMES: The short-term effect of pessary use was significant improvement. LESSONS: This is the first case report of the successful use of a pessary for POP after pelvic trauma in a nulliparous young female.

Induction of human umbilical cord mesenchymal stem cells into tissue-forming cells in a murine model: implications for pelvic floor reconstruction.

HUMSCs were isolated, differentiated and characterized in vitro. Both HUMSCs and smooth muscle cells differentiated from HUMSCs were used to fabricate tissue-engineered fascia equivalents. Forty-eight mature female Sprague Dawley rats were randomly assigned to four groups: group A (GynemeshTMPS, n = 12), group B (GynemeshTMPS + HUMSCs; n = 12), group C (GynemeshTMPS + smooth muscle cells differentiated from HUMSCs; n = 12) and group D (GynemeshTMPS + HUMSCs + smooth muscle cells differentiated from HUMSCs; n = 12). The posterior vaginal wall was incised from the introitus and the mesh was then implanted. Three implants of each type were tested at 1, 4, 8 and 12 weeks. Fibrotic remodeling, inflammation, vascularization and tissue regeneration were histologically assessed. The levels of type I and type III collagen were determined. There was no difference in fibrotic remodeling between cell-seeded and unseeded meshes at any time (p > 0.05). At 12 weeks, there did not appear to be fewer inflammatory cells around the filament bundles in the mesh with cells compared with the mesh alone (P > 0.05). Group D showed a trend toward better vascularization at 12 weeks compared with group A (P < 0.05). Twelve weeks after implantation, a thin layer of new tissue growth covered the unseeded scaffold and a thicker layer covered the cell-seeded scaffold (P < 0.05). No significant difference in the ratio of collagen type I/III could be detected among the different groups after 12 weeks (P > 0.05). HUMSCs with differentiated smooth muscle cells might have a potential role in fascia tissue engineering to repair POP in the future.

Effect of generalized anxiety disorders on the success of pessary treatment for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Our aim was to evaluate the impact of generalized anxiety disorders (GAD) on the effectiveness of pessary treatment for pelvic organ prolapse (POP) in postmenopausal women. METHODS: One-hundred and ten women with symptomatic POP who underwent pessary treatment were enrolled in this prospective study. Subjective evaluations of pelvic floor symptoms were assessed using the Pelvic Floor Distress Inventory (PFDI-20) and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), both at baseline and at the 3-month follow-up visit after pessary use. GAD was measured by the Generalized Anxiety Disorder-7 (GAD-7). Independent samples t tests, Mann-Whitney U test, chi-square test, Fisher's exact test, and Wilcoxon signed rank test were used to analyze data. RESULTS: Twenty-one patients (20.6%) had GAD at baseline. After 3 months of pessary use, PFIQ-7, PFDI-20, and GAD scores were significantly improved in all participants (P < 0.001). In the GAD-negative group, total PFIQ-7 and PFDI-20 scores, including all subscales scores, were significantly decreased from baseline to posttreatment (P < 0.05). However, in the GAD-positive group, both PFIQ-7 and PFDI-20 scores, including subscales, were also significantly decreased from baseline to posttreatment (P < 0.05), except for subscale Colorectal-Anal Impact Questionnaire (CRAIQ-7) of PFIQ-7 (P = 0.225), which represented the impact on quality of life (QoL) from bowel dysfunction. CONCLUSIONS: Both groups of women with or without GAD showed significant improvement in QoL scores after 3 months of pessary treatment. GAD had no influence on the success of pessary treatment for POP.

Hierarchical Porous Polyamide 6 by Solution Foaming: Synthesis, Characterization and Properties.

Porous polym er materials have received great interest in both academic and industrial fields due to their wide range of applications. In this work, a porous polyamide 6 (PA6) material was prepared by a facile solution foaming strategy. In this approach, a sodium carbonate (SC) aqueous solution acted as the foaming agent that reacted with formic acid (FA), generating CO2 and causing phase separation of polyamide (PA). The influence of the PA/FA solution concentration and Na2CO3 concentration on the microstructures and physical properties of prepared PA foams were investigated, respectively. PA foams showed a hierarchical porous structure along the foaming direction. The mean pore dimension ranged from hundreds of nanometers to several microns. Low amounts of sodium salt generated from a neutralization reaction played an important role of heterogeneous nucleation, which increased the crystalline degree of PA foams. The porous PA materials exhibited low thermal conductivity, high crystallinity and good mechanical properties. The novel strategy in this work could produce PA foams on a large scale for potential engineering applications.

Application of random forests to select premium quality vegetable oils by their fatty acid composition.

In order to discriminate premium quality from inexpensive edible oils, the fatty acid profiles of tea, rapeseed, corn, sunflower and sesame oil were compared with the ones from extra virgin olive oil (EVOO). Fatty acid methyl esters were quantified by GC/MS. Principal component analysis (PCA) and random forests (RF) were applied to cluster the samples. RF showed a better ability of discrimination and also revealed the contribution of each variable to the clustering model. The multidimensional scaling (MDS) plot of the RF proximity matrix demonstrated that tea oil was similar to EVOO. Meanwhile, it was observed that the total content of cis-monounsaturated fatty acids (79.48%) in tea oil was close to EVOO (80.71%), especially the oleic acid (77.38% and 77.45%, respectively). The results suggest that tea oil might be a good edible oil choice, considering the high oleic acid content and similar fatty acid profiles compared to those of EVOO.

[Isolation and characterization of a phenanthrene-degrading bacterial strain].

A bacterial strain that degrades phenanthrene was isolated from activated sludge of wastewater treatment plant from a chemical corporation. The strain can utilize phenanthrene as sole source of carbon and energy. It was identified as Burkholderia sp. according to morphological and 16S rRNA gene sequence analysis. Phenanthrene (100 mg x L(-1)) was removed 74.1% within 84 h by this strain. It was suggested that the strain possessed the salicylic acid pathway by LC-MS and UV methods. And the strain contains an inductive catechol 2,3-dioxygenase (C230). The kinetic constants Km and Vmax were 10.93 micromol x L(-1) and 106.38 micromol x min(-1), receptively. It indicates that the affinity of the endoenzyme to catechol is great and catechol is a better substrate.