Gentamicin for prevention of intraoperative mesh contamination: demonstration of high bactericide effect (in vitro) and low systemic bioavailability (in vivo)

Introduction

Mesh infection is a severe complication after incisional hernia repair and occurs in 1–3 % of all open mesh implantations. For this reason, topical antimicrobial agent applied directly to the mesh is often used procedure. So far, however, this procedure lacks a scientific basis.

Materials and methods

Two different meshes (Parietex?, Covidien; Ultrapro?, Ethicon Johnson & Johnson) were incubated with increasing amounts of three different Staphylococcus aureus strains (ATCC 25923; Mu50; ST239) with or without gentamicin and growth ability were determined in vitro. To further address the question of the systemic impact of topic gentamicin, serum levels were analyzed 6 and 24 h after implantation of gentamicin-impregnated multifilament meshes in 19 patients.

Results

None of the gentamicin-impregnated meshes showed any bacterial growth in vitro. This effect was independent of the mesh type for all the tested S. aureus strains. In the clinical setting, serum gentamicin levels 6 h after implantation of the gentamicin-impregnated meshes were below the through-level (range 0.4–2.9 mg/l, mean 1.2 ± 0.7 mg/l). After 24 h the gentamicin serum levels in all patients had declined 90–65 % of the 6 h values.

Conclusion

Local application of gentamicin to meshes can completely prevent the growth of even gentamicin-resistant S. aureus strains in vitro. The systemic relevance of gentamicin in the clinical controls showed to be very low, without reaching therapeutic concentrations.     

Does Presoaking Synthetic Mesh in Antibiotic Solution Reduce Mesh Infections? An Experimental Study

Background

Prosthetic mesh infection is one of the most challenging complications after hernia repair. We evaluate the efficacy of soaking mesh in antibiotics to prevent prosthetic infection in an animal model of clean–contaminated ventral hernia repair (VHR).

Material and Methods

Rats underwent an acute VHR with one of four synthetic meshes (composite multifilament polyester (Parietex PCO), multifilament polyester (Parietex TET), composite monofilament polypropylene (Ventralight), or monofilament polypropylene (SoftMesh)). Prior to implantation, mesh was soaked in saline or 10 mg/ml of vancomycin for 15 min. Following implantation, meshes were contaminated with 10⁴ CFU of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Thirty days after implantation, mesh samples were cultured and evaluated under scanning electron microscope for biofilm formation.

Results

Presoaking meshes significantly improves bacterial clearance in composite meshes and multifilament polyester mesh. MRSA clearance was as follows for all meshes (saline-soaked vs. vanco-soaked): Parietex PCO (0 vs. 56 %, p?=?0.006), Parietex TET (0 vs. 50 %, p?=?0.01), Ventralight (20 vs. 78 %, p?=?0.012), and SoftMesh (70 vs. 80 %, p?=?0.6). MRSA biofilm formation was consistent with bacterial growth.

Conclusion

Presoaking multifilament and composite mesh in vancomycin solution reduces MRSA bacterial growth. Its implementation may reduce the risk of mesh infection in clean–contaminated cases, although further investigation with human trials should be performed.     

Early report of a randomized comparative clinical trial of Strattice™ reconstructive tissue matrix to lightweight synthetic mesh in the repair of inguinal hernias

Purpose

Biologic grafts are rarely used for inguinal herniorrhaphy. The aim of this study was to compare the clinical outcomes between patients undergoing a Lichtenstein’s hernioplasty with a porcine mesh versus a standard synthetic.

Methods

A prospective, randomized, double-blinded multicenter, evaluation of inguinal hernia repair was conducted between 2008 and 2010. Lichtenstein hernioplasty was performed using Strattice? or lightweight polypropylene (Ultrapro) mesh. Quality of life, pain, overall complication rate, and recurrence were measured.

Results

One hundred and seventy-two patients were randomized to Strattice? (n = 84) or Ultrapro (n = 88). At 3 months postoperatively, there were no differences on the occurrence or type of wound events [RR: 0.98 (95 % CI 0.52–1.86, p = 0.69), Strattice? (15 events) vs. Ultrapro (16 events)]. The mean level of impairment caused by the hernia, assessed by Activities Assessment Scale (AAS), significantly decreased postoperatively in both groups at 3 months (31 % Strattice? and 37 % Ultrapro). Patients in the Strattice group reported significantly less postoperative pain during postoperative days 1 through 3 compared to Ultrapro patients. However, the amount of postoperative pain at 3 months, as assessed by the mean worst pain score on a visual analog scale and the Brief Pain Index, was similar between groups (95 % CI 1.0–29.3). No hernia recurrences were observed in either group.

Conclusions

Strattice? is safe and effective in repairing inguinal hernia, with comparable intra-operative and early postoperative morbidity to synthetic mesh. Long-term follow-up is necessary in order to know whether the clinical outcomes of Strattice are equivalent to standard synthetic mesh in patients undergoing Lichtenstein’s hernioplasty.     

Local tissue ischemia is not necessary for suture-induced adhesion formation

Background

We investigated the hypothesis that local tissue ischemia is responsible for suture-induced adhesion formation.

Methods

A total of 160 interrupted sutures were placed in the parietal peritoneum of 20 Wistar rats. The animals were randomized into an ischemia group, where the sutures were pulled tight and a non-ischemia group, where the sutures were tied as loose loops with air knots to avoid any local ischemia. The midline laparotomy was closed with a running suture. On postoperative day 10, adhesions to the sutures were counted.

Results

There was no statistically significant difference in the number of adhesions forming to sutures with local ischemia (n?=?66/80) versus sutures without local ischemia (n?=?69/80).

Conclusion

We conclude that local tissue ischemia is not necessary for suture-induced adhesion formation and propose an additional mechanical mechanism to explain how suture knots can predispose to adhesiogenesis.     

Forehead contour and hypotelorism in patients with metopic craniosynostosis: comparing minimally invasive and open treatments

Background

Patients with metopic craniosynostosis and trigonocephaly are classically treated with a fronto-orbital advancement. In contrast, a minimally invasive treatment entails a narrow ostectomy of the fused suture, followed by postoperative helmet molding. The goal of this project was to investigate the results of patients treated with minimally invasive techniques by quantifying the deformity of the forehead contour a year after their operation and comparing these measurements to patients who underwent an open operation as a control.

Methods

The 1-year postoperative computed tomography (CT) scans of patients treated with minimally invasive techniques for metopic craniosynostosis (n?=?10) were compared to CT scans of patients treated with an open operation (n?=?20). The straight line measurements between the zygomaticofrontal (ZF) sutures and between the dacryon bilaterally were recorded to assess the degree of hypotelorism. An axial plane two-dimensional angle between frontotemporale bilaterally and the glabella (FT_R-G-FT_L) was used as a measurement of the severity of trigonocephaly.

Results

The average age of patients at surgery for minimally invasive cases was 3.4?±?0.5 months old (mean ± standard error of the mean) compared with the age of patients for open cases at 11.3?±?0.6 months old. Seventy percent of the patients were males and 30 % were females in both the minimally invasive and open groups. The mean distance between the ZF sutures was 76.3?±?1.9 mm in the minimally invasive group and 75.9?±?1.2 mm in the open group (p?=?0.90). The mean distance between the dacryon bilaterally was 15.1?±?1.0 mm in the minimally invasive group and 14.5?±?0.6 mm in the open group (p?=?0.63). The FT_R-G-FT_L angle was 118.5°?±?13.2° in the minimally invasive group and 113.1°?±?2.0° in the open group (p?=?0.21).

Conclusions

In this small, retrospective series, minimally invasive treatment of metopic craniosynostosis appears to have equivalent results to open fronto-orbital advancement in terms of the acuity of trigonocephalic forehead angle and hypotelorism at 1-year follow-up. Additional studies are being conducted to better quantify, validate, and compare these measurements. The end goal is to elucidate the best methods of quantifying normal forehead contours and to determine if minimally invasive treatment is equivalent to the open approach. Level of Evidence: Level IV, therapeutic study.     

Polypropylene meshes coated with a polysaccharide based bioadhesive for intra-abdominal mesh fixation in a rabbit model

Background

In this study, we evaluate a new bioadhesive for intra-abdominal onlay mesh fixation of a polypropylene–polyvinylchloride graft.

Methods

Three pieces of a commercially available polypropylene/polyvinylfluoride mesh, each 3 × 3 cm in size, and three pieces of the same mesh coated with a polysaccharide bioadhesive were fixated to the surface of the anterior abdominal wall of 30 New Zealand white rabbits. The fixation was performed either by using four transabdominal Prolene^® 4/0 sutures, four spiral tacks (Protack 5 mm Tyco), or cyanoacrylate glue (Glubran^® GEM, Viareggio, Italy). Each mesh position and the according kind of fixation were randomized before implantation. The animals were sacrificed 12 weeks postoperatively. After determining the extent of intra-abdominal adhesions, the meshes were excised en bloc with the anterior abdominal wall for tensile strength measurements and histological analysis.

Results

All meshes coated with the bioadhesive adhered to the intact peritoneum without extra fixation. Irrespective of the fixation technique coated meshes led to more and stronger adhesions. Mesh shrinkage by scarring was increased in coated meshes fixed with glue and low in uncoated meshes fixed with tacks. Testing the tensile strength, coated meshes fixed with transfascial sutures achieved the best results (16.14 ± 6.1 N), whereas coated meshes fixed with glue showed the lowest strength (10.39 ± 4.81 N). The foreign body reaction was considerably more distinctive using coated mesh. The mesh ingrowth was not influenced by this reaction.

Conclusions

All meshes coated with the new bioadhesive were self-adhesive in that way; they stayed in position when attached to the peritoneum. Although this may facilitate intra-operative mesh fixation, the bioadhesive displayed several disadvantages, such as stronger adhesions and an increased shrinkage of the implant. The tensile strength was not influenced by the use of the bioadhesive. At present, we see no major advantage for polysaccharide bioadhesive applied in this study.     

Effect of low volume ventilation during cardiopulmonary bypass on oxygenation and postoperative pulmonary outcome

Objective

This study was carried out to evaluate effect of low volume normal frequency ventilation during Cardiopulmonary Bypass (CPB) on immediate postoperative respiratory outcome in patients undergoing elective open heart surgeries.

Background

Lung deflation during CPB is considered as major cause of postoperative pulmonary dysfunction. Various methods of ventilation had been tried during CPB to prevent postoperative lung dysfunction. As yet, little information is available comparing low volume normal frequency ventilation with no ventilation during CPB.

Patients and Methods

Thirty six patients aged 18 years to 65 years were included and randomized into two groups; Group V (n?=?18) or Group NV (n?=?18). Group V patients were ventilated with a tidal volume of 2 mL?kg^?1with 100 % oxygen during CPB after aortic clamp placement, and respiratory rate was continued as per pre CPB period. Ventilation was discontinued in NV group after aorta was cross clamped. Normal ventilation was restored in both groups after release of aortic clamp.

Results

Intraoperative PaO₂ and PaCO₂ were similar in both groups. The group V patients had improved inspiratory capacity (p?=?0.0) in both day 1 (after extubation) and day 2 (24 h after extubation). Extubation was significantly earlier in group V patients (p?<?0.05).

Conclusion

Low volume normal frequency ventilation during cardiopulmonary bypass improves lung mechanics during early postoperative period in patients undergoing open heart surgery.     

The role of vasopressin V1A receptors in cytotoxic brain edema formation following brain injury

Background

The hormone and neuropeptide arginine-vasopressin is designated to the maintenance of osmotic homoeostasis and blood pressure regulation. While experimental data show vasopressin V_1A receptors to regulate aquaporin (AQP)4 water channel dependent brain water movement, the specific role in vasogenic and cytotoxic edema formation remains unclear. The present study was designed to quantify the V_1A receptor mediated regional brain edema formation in two clinically relevant experimental models, brain injury combined with secondary insult and focal ischemia.

Methods

Male Sprague–Dawley rats were randomly assigned to a continuous infusion of vehicle (1 % DMSO) or the selective non-peptide V_1A antagonist SR49059 (83nM?=?1 mg/kg) starting before controlled cortical impact (CCI) injury plus hypoxia and hypotension (HH, 30 min), or middle cerebral artery (MCA) occlusion (2 h?+?2 h reperfusion).

Results

A global analysis of brain water content by the wet/dry weight method allowed optimizing the SR49059 dosage, and demonstrated the down-regulation of brain AQP4 expression by immunoblotting. Microgravimetrical quantification in 64 one mm³ samples per animal (n?=?6 per group) from bregma +2.7 to ?6.3 mm analysis demonstrated brain edema to be reduced at 4 h by SR49059 treatment in the injured and contralateral cortex following CCI?+?HH (p?=?0.007, p?<?0.001) and in the infarct area following MCA occlusion (p?=?0.013, p?=?0.002, p?=?0.004).

Conclusions

Our findings demonstrate that an early cytotoxic brain edema component following brain injury plus secondary insult or focal ischemia results from a vasopressin V_1A receptor mediated response, and occurs most likely through AQP4 up-regulation. The V_1A antagonist SR49059 offers a new avenue in brain edema treatment and prompts further study into the role of vasopressin following brain injury.     

Mesh size in Lichtenstein repair: a systematic review and meta-analysis to determine the importance of mesh size

Purpose

Small mesh size has been recognized as one of the factors responsible for recurrence after Lichtenstein hernia repair due to insufficient coverage or mesh shrinkage. The Lichtenstein Hernia Institute recommends a 7 × 15 cm mesh that can be trimmed up to 2 cm from the lateral side. We performed a systematic review to determine surgeons’ mesh size preference for the Lichtenstein hernia repair and made a meta-analysis to determine the effect of mesh size, mesh type, and length of follow-up time on recurrence.

Methods

Two medical databases, PubMed and ISI Web of Science, were systematically searched using the key word “Lichtenstein repair.” All full text papers were selected. Publications mentioning mesh size were brought for further analysis. A mesh surface area of 90 cm² was accepted as the threshold for defining the mesh as small or large. Also, a subgroup analysis for recurrence pooled proportion according to the mesh size, mesh type, and follow-up period was done.

Results

In total, 514 papers were obtained. There were no prospective or retrospective clinical studies comparing mesh size and clinical outcome. A total of 141 papers were duplicated in both databases. As a result, 373 papers were obtained. The full text was available in over 95 % of papers. Only 41 (11.2 %) papers discussed mesh size. In 29 studies, a mesh larger than 90 cm² was used. The most frequently preferred commercial mesh size was 7.5 × 15 cm. No papers mentioned the size of the mesh after trimming. There was no information about the relationship between mesh size and patient BMI. The pooled proportion in recurrence for small meshes was 0.0019 (95 % confidence interval: 0.007–0.0036), favoring large meshes to decrease the chance of recurrence. Recurrence becomes more marked when follow-up period is longer than 1 year (p < 0.001). Heavy meshes also decreased recurrence (p = 0.015).

Conclusion

This systematic review demonstrates that the size of the mesh used in Lichtenstein hernia repair is rarely discussed in clinical studies. Papers that discuss mesh size appear to reflect a trend to comply with the latest recommendations to use larger mesh. Standard heavy meshes decrease the recurrence in hernia repair. Even though there is no evidence, it seems that large meshes decrease recurrence rates.     

Early and late postoperative inflammatory and collagen deposition responses in three different meshes: an experimental study in rats

Purpose

Although meshes reduce abdominal hernia recurrence, they increase the risk of inflammatory complications. This study aimed to compare the early and late postoperative inflammation and collagen deposition responses induced by three meshes.

Methods

Rats were allocated into three groups. In group I, a polypropylene (PP) mesh was implanted in the abdominal wall. In groups II and III, PP + polyglactin (PP + PG) and PP + titanium (PP + TI) meshes were employed, respectively. On the seventh (7th) postoperative day, collagen deposition and inflammation were evaluated, and immunohistochemistry was performed on abdominal wall biopsies. These data were compared with those obtained on the fortieth (40th) postoperative day in a previous study.

Results

The early inflammatory responses were the same in all groups. With time, it decreased in group I (p = 0.047) and increased in group II (p = 0.003). Group I exhibited early elevated VEGF (p < 0.001), COX2 (p < 0.001), and collagen (p = 0.023) levels, and group II exhibited the most severe inflammatory tissue response. On the 40th postoperative day, the VEGF (p < 0.001) and collagen (p < 0.005) were reduced as compared with the 7th postoperative day in all groups.

Conclusions

Belatedly, the inflammatory reaction decreased in PP mesh group and increased in PP + PG mesh group. The PP mesh induced early great elevations in VEGF, COX2 and collagen levels, whereas the PP + PG mesh caused severe tissue inflammation with small elevation in these levels. PP + TI mesh induced inflammatory response levels between the others. In conclusion, the inflammatory response depends on the mesh density and also the mesh material with clinical implications.     

Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video)

Background

Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract.

Objective

The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR.

Methods

A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared.

Results

All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann–Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann–Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001).

Conclusions

Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.     

Highly purified collagen coating enhances tissue adherence and integration properties of monofilament polypropylene meshes

Introduction and hypothesis

Complications related to tissue integration of polypropylene implants used in the treatment of pelvic organ prolapse are relatively prevalent. Collagen, a biocompatible, less immunogenic material with modulating properties on the inflammatory process, may improve polypropylene integration. The objective was to study biomechanical and histological effects of monofilament polypropylene mesh coated with purified collagen gel.

Methods

Forty rats were implanted with two fragments of polypropylene mesh in their abdominal walls (one on each side of the linea alba). One of the fragments had a collagen gel coating (group I) while the other one did not (group II). The animals were euthanized at 7, 14, 90, and 180 days after implantation and their abdominal walls were excised for analysis.

Results

The biomechanical study showed that mesh adherence to neighboring tissue increased significantly in group II (p?<?0.05). Acute (p?<?0.001) and chronic (p?=?0.004) inflammatory responses as well as granulation tissue formation (p?=?0.001) were less intense in group II at 7 and 14 days. Granulomatous inflammation and foreign body reaction was less significant at 7 days in group II (p?=?0.029 and p?<?0.001). The birefringence analysis showed higher mean brightness density in the late phase of implantation in group II meshes (p?=?0.000).

Conclusion

Polypropylene mesh coated with purified collagen gel increases adherence to tissue, promotes a less intense and lasting inflammatory response and triggers a greater organization and packing arrangement of collagen fibers in the late phase of implantation.     

Vitamin D status of children receiving chronic dialysis

Background

Patients receiving chronic dialysis therapy are presumed to be at risk for 25(OH) D₃ deficiency, but little information is available on its prevalence, manifestations of deficiency, and the impact of ergocalciferol supplementation.

Methods

A single-center, retrospective study of 51 prevalent pediatric patients on hemodialysis or peritoneal dialysis was conducted to address these issues.

Results

Forty of 51 (78.4 %) patients had low (<30 ng/ml) 25(OH) D₃ levels. Of these, 2 % had values?12 years, non-Caucasian race and?>?12-month duration of dialysis were significantly associated with low 25(OH) D₃ levels (p?=?0.006, p?=?0.05, and p?=?0.04, respectively). Twenty-three of the 40 patients deficient in 25(OH) D₃ received repletion therapy with ergocalciferol and had a follow-up level at an average of 2 months following completion of a single course of therapy; 14 (60 %) of the levels were normal. Mean baseline intact parathyroid hormone (iPTH) for patients with 25(OH) D₃ levels?≤?30 was 478.68?±?474.01 pg/ml and treatment with ergocalciferol was not associated with a significant decrease in the mean iPTH value (p?=?0.45).

Conclusions

We conclude that low 25(OH) D₃ levels are common in pediatric patients receiving dialysis and require attention in accordance with current practice guidelines.     

Novel technique of overlaying a poly-l-lactic acid nanosheet for adhesion prophylaxis and fixation of intraperitoneal onlay polypropylene mesh in a rabbit model

Background

One problem with polypropylene mesh (PPM) used to repair abdominal wall hernias is dense adhesions to the visceral surface. The authors developed the biocompatible poly-l-lactic acid (PLLA) nanosheet (thickness?Methods The PLLA nanosheet was fabricated by the spin-coating method and peeling technique with polyvinyl alcohol (PVA) as a supporting film. Two 1.5-cm-square pieces of mesh were implanted on each peritoneal side of the midline incision. The mesh was fixed to the peritoneum with a suture and then overlaid with a 4-cm-square piece of Seprafilm or nanosheet. To examine the fixative property, mesh was overlaid with Seprafilm or nanosheet without a fixed suture. After 4?weeks, mesh adhesion, inflammatory reaction, fixation, and dislocation of mesh were evaluated.

Results

Nanosheet-overlaid meshes were flexible and fit over the peritoneum. Adhesion was observed in 10% of the nanosheet-overlaid meshes and in 50% of the Seprafilm-overlaid meshes. The adhesion tenacity grade was significantly lower with the nanosheet-overlaid meshes (0.1?±?0.1) than with the Seprafilm-overlaid meshes (1.0?±?0.4) (p?=?0.029), and the percentage of the adhesion area also was lower with the nanosheet-overlaid meshes (1.0?±?1.0% vs 8.5?±?3.2%; p?=?0.037). The mean inflammatory cell counts were lower with the nanosheet-overlaid meshes (p?=?0.0023). Regarding the fixative property, 37.5% of the nanosheet-overlaid meshes were fixated on the peritoneum, but no Seprafilm-overlaid mesh was fixated.

Conclusion

Overlaying of a PLLA nanosheet was effective for adhesion prophylaxis of intraperitoneal mesh. It also may have a possible beneficial effect on fixation of mesh.     

Carotid intima media thickness, oxidative stress, and inflammation in children with chronic kidney disease

Objective

We evaluated the association between inflammation and oxidative stress with carotid intima media thickness (cIMT) and elasticity increment module (E_inc) in pediatric patients with chronic kidney disease (CKD).

Methods

This analytical, cross-sectional study assessed 134 children aged 6–17 years with CKD. Anthropometric measurements and biochemistry of intact parathyroid hormone (iPTH), high-sensitivity C-reactive protein (CRP), interleukin (IL)-6, IL-1β, reduced glutathione (GSH), malondialdehyde, nitric oxide, and homocysteine were recorded. Bilateral carotid ultrasound (US) was taken. Patients were compared with controls for cIMT and E_inc using?≥?75  percentile (PC).

Results

Mean cIMT was 0.528?±?0.089 mm; E_inc was 0.174?±?0.121 kPa × 10³; cIMT negatively correlated with phosphorus (r ?0.19, p?=?0.028) and the calcium × phosphorus (Ca × P) product (r ?0.26, p?=?0.002), and positively with iPTH (r 0.19,p?=?0.024). After adjusting for potential confounders, hemodialysis (HD) (β?=?0.111, p?=?<0.001), automated peritoneal dialysis (APD) (β?=?0.064, p?=?0.026), and Ca x P product (β?=??0.002, p?=?0.015) predicted cIMT (R ²?=?0.296). In patients on dialysis, HD (β?=?0.068, p?=?0.010), low-density lipoprotein cholesterol (LDL-C) (β?=?0.001, p?=?0.048), and GSH (β?=??0.0001, p?=?0.041) independently predicted cIMT (R ²?=?0.204); HD, hypoalbuminemia, and high iPTH increased the risk of increased cIMT. In dialysis, E_inc was inversely associated with GSH, and in predialysis, Ca × P correlated with/predicted E_inc (β?=?0.001, p?=?0.009).

Conclusions

cIMT and E_inc strongly associate with several biochemical parameters and GSH but not with other oxidative stress or inflammation markers.     

Exercise-induced inhibition of remodelling is focally offset with fatigue fracture in racehorses

Summary

Bone remodelling is inhibited by high repetitive loading. However, in subchondral bone of racehorses in training, eroded surface doubled in association with fatigue fracture and there was greater surrounding trabecular bone volume suggesting trabecular modelling unloads the bone focally, allowing damage repair by remodelling.

Introduction

Remodelling replaces damaged bone with new bone but is suppressed during high magnitude repetitive loading when damage is most likely. However, in cortical bone of racehorses, at sites of fatigue fracture, focal porosity, consistent with remodelling, is observed in proportion to the extent of surrounding callus. Focal areas of porosity are also observed at sites of fatigue damage in subchondral bone. We hypothesised that fatigued subchondral bone, like damaged cortical bone, is remodelled focally in proportion to the modelling of surrounding trabecular bone.

Methods

Eroded and mineralizing surfaces and bone area were measured using backscattered scanning electron microscopy of post-mortem specimens of the distal third metacarpal bone in 11 racehorses with condylar fractures (cases) and eight racehorses in training without fractures (controls).

Results

Cases had a two-fold greater eroded surface per unit area at the fracture site than controls (0.81?±?0.10 vs. 0.40?±?0.12 mm^?1, P?=?0.021) but not at an adjacent site (0.22?±?0.09 vs. 0.30?±?0.11 mm^?1, P?=?0.59). Area fraction of surrounding trabecular bone was higher in cases than controls (81?±?2 vs. 72?±?2 %, P?=?0.0020) and the eroded surface at the fracture site correlated with the surrounding trabecular area (adjusted R ²?=?0.63, P?=?0.0010).

Conclusion

In conclusion, exercise-induced inhibition of remodelling is offset at sites of fatigue fracture. Modelling of trabecular bone may contribute to unloading these regions, allowing repair by remodelling.     

Continuous Absorbable Intradermal Sutures Yield Better Cosmetic Results than Nonabsorbable Interrupted Sutures in Open Appendectomy Wounds: A Prospective,Randomized Trial

Background

Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable intradermal (A) sutures compared with wound closure with interrupted nonabsorbable (NA) sutures.

Methods

A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two wound-closure groups: the interrupted NA suture group and the A suture group. Of these, 193 patients with sufficient data were invited to the outpatient clinic for cosmetic analysis. Cosmetic results were evaluated after a median of 14 months. For subjective scar assessment, the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS) were used. Objective evaluation was carried out by measuring surface area, average width, and estimated concentration change (ECC) of hemoglobin and melanin in the scar using spectrocutometry. For statistical analyses we used the Mann–Whitney test and Student’s t test.

Results

Both objective and subjective analyses showed better cosmetic results for absorbable intradermal suturing. The difference between the two groups was statistically significant as regards POSAS in both patient (p = 0.032) and observer scales (p = 0.001), and VAS (p = 0.002). Scar surface area was significantly smaller in group A than in group NA (p = 0.002). ECC measurements showed higher values for melanin in group NA than in group A (p = 0.034).

Conclusion

Continuous intradermal absorbable suturing yields a better cosmetic result than interrupted nonabsorbable suturing in lower abdominal transverse appendectomy.     

The effects of different prosthetic materials on the formation of collagen types in incisional hernia

Objective

The aim of this study was to determine the rate of collagen Type I/Type III for different meshes.

Method

Fifty rats were used. Five groups were formed: prolene (n = 10), mersilene (n = 10), parietex (n = 10), e PTFE (n = 10) and control group (n = 10). In all animals, laparotomy was performed using a midline incision. After that four different kinds of meshes are placed into the retro-rectus plane and fixed with a non-absorbable suture. Rectus superficial fascia and skin are closed. In the control group, repairment is done primarily. Thirty days later, meshes are found through the incisions that were done previously. Scar tissues above and near by meshes and also in the control group are taken, and in these tissue samples, the ratio of Type I/III is evaluated histochemically.

Results

The Prolene mesh was found to contain more collagen fibers than e PTFE. As a result of the histopathologic evaluation, it was seen that Group I contained statistically significantly more collagen density than the other four groups (p < 0.05). Moreover, the collagen Type I/III ratio in the specimen taken from the top part and the surrounding area of Group I was found significantly higher than the collagen Type I/III ratios of the rest of the groups (p < 0.05).

Conclusion

As a conclusion, the ratio of collagen Type I/III is the highest in the prolene group.