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Background: The frequency of laparoscopic approaches increased in hernia surgery over the past years. After mesh placement in IPOM position, the real extent of the meshes configurational changes after termination of pneumoperitoneum is still largely unknown. To prevent a later mesh folding it might be useful to place the mesh while it is kept under tension. Conventionally used meshes may lose their Effective Porosity under these conditions due to poor elastic properties. The aim of this study was to evaluate a newly developed elastic thermoplastic polyurethane (TPU) containing mesh that retains its Effective Porosity under mechanical strain in IPOM position in a porcine model. It was visualized under pneumoperitoneum using MRI in comparison to polyvinylidenefluoride (PVDF) meshes with similar structure. Methods: In each of ten minipigs, a mesh (TPU containing or native PVDF, 10 × 20 cm) was randomly placed in IPOM position at the center of the abdominal wall. After 8 weeks, six pigs underwent MRI evaluation with and without pneumoperitoneum to assess the visibility and elasticity of the mesh. Finally, pigs were euthanized and abdominal walls were explanted for histological and immunohistochemical assessment. The degree of adhesion formation was documented. Results: Laparoscopic implantation of elastic TPU meshes in IPOM position was feasible and safe in a minipig model. Mesh position could be precisely visualized and assessed with and without pneumoperitoneum using MRI after 8 weeks. Elastic TPU meshes showed a significantly higher surface increase under pneumoperitoneum in comparison to PVDF. Immunohistochemically, the amount of CD45-positive cells was significantly lower and the Collagen I/III ratio was significantly higher in TPU meshes after 8 weeks. There were no differences regarding adhesion formation between study groups. Conclusions: The TPU mesh preserves its elastic properties in IPOM position in a porcine model after 8 weeks. Immunohistochemistry indicates superior biocompatibility regarding CD45-positive cells and Collagen I/III ratio in comparison to PVDF meshes with a similar structure. [ABSTRACT FROM AUTHOR]

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Introduction. The purpose of this study was to analyse the value of 3-dimensional computed tomography cholangiography (3D-ERC) compared to conventional retrograde cholangiography in the preoperative diagnosis of hilar cholangiocarcinoma (HC) with special regard to the resection margin status (R0/R1). Patients and Methods. All hepatic resections performed between January 2011 and November 2013 in patients with HC at the Department of General, Visceral and Transplant Surgery of the RWTH Aachen University Hospital were analysed. All patients underwent an ERC and contrast-enhanced multiphase CT scan or a 3D-ERC. Results. The patient collective was divided into two groups (group ERC: n=17 and group 3D-ERC: n=16). There were no statistically significant differences between the two groups with regard to patient characteristics or intraoperative data. Curative liver resection with R0 status was reached in 88% of patients in group ERC and 87% of patients in group 3D-ERC (p=1.00). We could not observe any differences with regard to postoperative complications, hospital stay, and mortality rate between both groups. Conclusion. Based on our findings, preoperative imaging with 3D-ERC has no benefit for operative planning and R0 resection status. It cannot replace the exploration by an experienced surgeon in a centre for hepatobiliary surgery. [ABSTRACT FROM AUTHOR]

Background:Although acute appendicitis is the most common cause for abdominal surgery in children, its etiology is still largely unknown. The aim of this study was to evaluate the role of bacterial and viral pathogens for the etiology of appendicitis in children.Methods:Between 2000 and 2010, 277 children underwent appendectomy in our institution. On this collective, a retrospective study was performed on to identify the presence of bacterial or viral pathogens.Results:Intraoperatively, 39% of cases showed acute, 9% of cases chronic, and 41% of cases ulcerous inflammation. Bowel perforation was found in 7% of cases and four percent of the children had no inflammation of the appendix at all.Escherichia coliwas the predominant bacterium with an incidence of 27.4%, followed by streptococci (9.8%). Concerning viral pathogens, adenovirus was the most common with an incidence of 5.4% followed by rotavirus (4.7%). Significant correlations between histopathological findings and present pathogens were found: in cases of bowel perforation there were significantly more infections withE. colibacteria (32.2%,p< .001),streptococci(12.2%,p< 0.001), andPseudomonas aeruginosa(6.7%,p< .001) whereas chronic inflammations were accompanied with a significantly elevated rate of yersinia infections (2.5%,p= .016). Acute inflammations were significantly more often associated with campylobacter (1.7%,p= .011) and oxyures infections (6.1%,p< .001). In relation to the patients’ age, a significant accumulation of different pathogens was observed. CRP- and leukocyte counts showed differences between viral and bacterial inflammations.Conclusions:Our data indicates that appendicitis in children might be triggered by bacterial and viral pathogens and that the type of pathogen directly correlates with patient age, type of inflammation, and level of inflammation values. To confirm and further evaluate these findings, additional studies need to be conducted. [ABSTRACT FROM PUBLISHER]

Background: Midline laparotomy wound failure like burst abdomen remains one of the major complications after abdominal surgery. The use of sutures with a closer resemblance to abdominal wall physiology, like elastic threads, could decrease the risk of these complications occurring. Thus, we evaluated the possibility of using a new elastic thread composed of thermoplastic polyurethane (TPU) as a suture for the closure of midline laparotomies compared to conventionally used polypropylene (PP) in a rabbit model. Methods: The elastic TPU thread was processed and tensile tests were performed. Twenty female chinchilla rabbits underwent midline laparotomy. They were randomized to a TPU and a PP group depending on the suture used for fascia closure. After 7 or 21 days, the abdominal walls were assessed macroscopically for wound healing complications and were explanted for histopathological investigation. Results: Tensile tests showed a mean elastic elongation of 55.5% and a sufficient material strength of the TPU thread. In animal experiments, there was no difference between the groups at 7 days; however, the TPU suture showed significantly less CD68 positive cells ( p < 0.001) and a higher collagen I/III ratio ( p = 0.011) than PP did after 21 days. The amount of apoptotic cells was significantly elevated in the TPU group ( p = 0.007) after 21 days. No differences were found concerning granuloma size and number of Ki67-positive cells. Conclusions: The newly developed TPU thread shows promising tensile characteristics. Midline laparotomy closure is feasible and safe in a rabbit model. Immunohistochemistry indicates similar biocompatibility and wound healing after implantation compared to PP after 21 days. To confirm these findings and to proof long-term capability further studies need to be conducted. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 417-423, 2015. [ABSTRACT FROM AUTHOR]

Background: The surgical treatment method in which the peritoneal cavity is opened anteriorly and deliberately left open, hence often called "open abdomen" has become the standard of care in damage-control procedures as well as in the management of intra-abdominal hypertension and in severe intra-abdominal sepsis. Whereas open abdomen has been closed in two stages traditionally, a modern trend is to close the fascial layers within the initial hospitalization to avoid complications like enterocutaneous fistula and hernia formation. The aim of this study was to determine crucial factors influencing the possibility of fascial closure after open abdomen.Methods: Between 2003 and 2013, 355 adult patients were treated with open abdomen in our institution. Their data were collected and retrospectively analyzed. They were divided into two groups depending on fascial closure or not (fascial closure, n = 137 (39%) vs. non-fascial closure, n = 218 (61%)).Results: The patients who reached fascial closure had a significantly higher rate of initially performed open abdomen (97 patients (71%) vs. 118 (54%), p = 0.002) and the periods of time until a second and a third look operation were significantly shorter (2.7 ± 2.5 vs. 4.2 ± 6.6 days, p = 0.021 and 5.6 ± 3.7 vs. 8.5 ± 8.6 days, p = 0.006). Furthermore, the presence of peritonitis (64 patients (47%) vs. 83 patients (38%), p = 0.023) and large bowel resection (74 patients (54%) vs. 90 patients (41%), p = 0.022) were significantly higher in this group. Rates of in-hospital mortality (97 patients (44%) vs. 38 patients (28%), p = 0.002) and the presence of pancreatitis (19 patients (9%) vs. 3 patients (2%), p = 0.013) were significantly higher in the non-fascial closure group.Conclusions: The probability to reach fascial closure after open abdomen seems to increase when open abdomen is performed initially and when early second and third look operations are performed. The presence of pancreatitis seems to be the only negative prognostic marker concerning fascial closure. [ABSTRACT FROM AUTHOR]

To reduce infection rates after mesh implantation antibiotic-coated meshes were designed. The aim of the study was to analyze biocompatibility and in vitro efficiency of a modified gentamicin-supplemented polyvinylidenfluoride mesh. Twenty rats were randomized to two groups (PVDF group and Genta group). Mesh material was implanted subcutaneously. Blood samples were taken to determine the gentamicin serum concentration. Seven and 90 days after mesh implantation, animals were euthanized. The inflammatory tissue response was characterized by analyzing the foreign body granuloma. Cellular immune response was analyzed by immunohistochemical investigations. The collagen type I/III ratio was estimated by crosspolarization microscopy. In vitro agar diffusion test, suspension test, and gentamicin release were characterized. Agar diffusion and suspension test showed efficient antibiotic effects of the mesh in vitro. Serum concentrations of gentamicin showed a peak value 1 h postoperatively with a decline within the next day. The total size of the granuloma was significantly smaller in the Genta group compared to the PVDF group at both points of time. Except of a short period of increased expression of CD68 in the Genta group after 7 days, no further difference was found analyzing cellular immune response. The collagen type I/III ratio was widely constant analyzing the two mesh types without significant differences comparing both mesh materials. A significantly decreased foreign body granuloma formation compared to the pure PVDF mesh group was found. In vitro analysis showed efficient antibiotic effects of the Gentamicin supplementation compared to the pure PVDF mesh. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A:, 2012. [ABSTRACT FROM AUTHOR]

Background: Abdominal hernia repair is the most frequently performed operation in surgery. Mesh repair in hernia surgery has become an integral component. Although meshes made of PVDF are already in clinical use, so far no data of long-term biocompability are available. Methods: In this study a PVDF mesh was compared to a polypropylene mesh with regard to its long-term biocompatibility. A total of 28 rats were randomized to two groups. Mesh material was implanted subcutaneously; animals were euthanized seven days and six months postoperatively. The quantity of inflammatory tissue response was characterized by measuring the diameter of the foreign body granuloma. Furthermore quality of cellular immune response (T-lymphocytes, macrophages, and neutrophils), and inflammation (COX-2) was analyzed by immunohistochemistry. Furthermore the collagen type I/III ratio was determined. Results: Macrophages, T-lymphocytes, neutrophiles, and COX-2 declined significantly up to six months postoperatively in comparison to day 7 for both PVDF and PP meshes, and in both groups the collagen ratio increased significantly in the course of time. PVDF meshes showed a foreign body granuloma size significantly reduced compared to PP (7 days: 20 ± 2 μm vs. 27 ± 2 μm; 6 months 15 ± 2 μm vs. 22 ± 3 μm; p < .001). However no significant differences were found analyzing cellular response six months postoperatively. Conclusions: Our current data suggest that even in the long-term course after six months and despite a higher effective surface of the PVDF samples it showed a smaller foreign body granuloma than with PP whereas the cellular response was similar. [ABSTRACT FROM AUTHOR]

Background: Mesh reinforcement in hiatal hernia repair becomes more frequent but is charged by complications such as erosion or stenosis of the oesophagus. These complications are accompanied by an intense inflammatory infiltrate around the polymer fibres. To characterize this effect, the response to polypropylene fibres in the absence of tension was examined. Methods: In rats, polypropylene sutures (USP size 1, 3-0 and 7-0) were placed in the subcutis of the abdominal wall without knot or tension. On postoperative days 3, 7 and 21, specimens were excised. The expressions of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 were measured by immunohistochemistry. Results: In the absence of tension, sutures were surrounded by a foreign body granuloma with an inflammatory infiltrate not encircling the fibre but forming almost symmetric comet-tail-like infiltrates on opposite sides. The expression of c-myc, β-catenin, Notch3, COX-2, CD68 and Ki-67 was significantly reduced over time in the comet tail, but not in the granuloma. Conclusions: Even in tension-free conditions, surgical sutures cause a foreign body response with infiltrates of inflammatory cells. This reaction is shaped like a comet tail, and its extension depends on the diameter of the used fibre. Therefore, for reduction of perifilamental infiltrates, not only absence of tension is required, but also a small-sized fibre textile. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The incidence of clinically significant anastomotic leaks after upper gastrointestinal surgery is approximately 4 % – 20 %, and the associated mortality can be as high as 80 %. Depending on the clinical presentation, the treatment options are surgery, conservative treatment with external drainage, or endoscopic treatment. This report presents 39 cases of clinically apparent anastomotic leaks or fistulas after surgery for upper gastrointestinal cancers that were treated by endoscopy with insertion of fibrin glue alone (n = 24) or with a combination of Vicryl plug and fibrin glue (n = 15). Thirteen of the 15 patients who underwent Vicryl/fibrin treatments showed complete healing of the anastomotic leak or fistula after one to four sessions. Long-term follow-up results are presented. Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with low morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repeated major surgery and its associated risks. [ABSTRACT FROM AUTHOR]

The article presents a study which measures the nitrogen natural abundance values of 320 individuals belonging to 45 different plant species of savannas in Brazil. The study determines the function of nitrogen of soil to soil depth. It cites the many factors that contribute to the important variability within individual species which include N-fixing legumes.

The article discusses the development and use of a safe and simple technique for the removal and replacement of a percutaneous endoscopic gastrostomy (PEG) tube following buried bumper syndrome. It mentions that the new method does not require using needle and a knife or complex endoscopic maneuvers and can be used in a routine procedure under sedation and can be carried out by all endoscopists.

Abstract: Little is known about species differences in the peripheral nerve system and quantitative evaluation of main tissue components has rarely been done. Nevertheless, animal models are used for example in pain research without exact knowledge of degree of fibrosis in pathological states which would determine possible treatment options. It would therefore be of crucial interest to describe the degree of fibrosis and the remaining functional nerve tissue as exact as possible. In the present study we evaluated collagen (stroma) and nerve fiber (parenchyma) composition of peripheral nerves in three species (human, rat, pig) and used digital colour-separation and analysis for collagen type differentiation and quantification of immuno-positive-stained area. We found similar ratios of collagen types I and III in epineurium and similar immuno-positive area for staining of neurofilament and S-100β. In contrast, we measured significantly different ratios of collagen type I to type III in the endoneurium. This combined analysis of the main tissue components of peripheral nerves could be an easy-to-use tool in evaluating changes during damage caused by scaring, systemic disease or compression syndromes. The calculated collagen type I/III ratio may serve as an objective diagnostic value for the description or as prognostic marker for therapeutic approaches in peripheral nerve pathology. However, in particular studies of collagen accumulation in nerves, species dependant differences have to be considered. [Copyright &y& Elsevier]

Recent efforts to chart human brain growth across the lifespan using large-scale MRI data have provided reference standards for human brain development. However, similar models for nonhuman primate (NHP) growth are lacking. The rhesus macaque, a widely used NHP in translational neuroscience due to its similarities in brain anatomy, phylogenetics, cognitive, and social behaviors to humans, serves as an ideal NHP model. This study aimed to create normative growth charts for brain structure across the macaque lifespan, enhancing our understanding of neurodevelopment and aging, and facilitating cross-species translational research. Leveraging data from the PRIMatE Data Exchange (PRIME-DE) and other sources, we aggregated 1,522 MRI scans from 1,024 rhesus macaques. We mapped non-linear developmental trajectories for global and regional brain structural changes in volume, cortical thickness, and surface area over the lifespan. Our findings provided normative charts with centile scores for macaque brain structures and revealed key developmental milestones from prenatal stages to aging, highlighting both species-specific and comparable brain maturation patterns between macaques and humans. The charts offer a valuable resource for future NHP studies, particularly those with small sample sizes. Furthermore, the interactive open resource (https://interspeciesmap.childmind.org) supports cross-species comparisons to advance translational neuroscience research.