The alveolar-capillary interface is the key functional element of gas exchange in the human lung, and disruptions to this interface can lead to significant medical complications. However, it is currently challenging to adequately model this interface in vitro, as it requires not only the co-culture of human alveolar epithelial and endothelial cells but mainly the preparation of a biocompatible scaffold that mimics the basement membrane. This scaffold should support cell seeding from both sides, and maintain optimal cell adhesion, growth, and differentiation conditions. Our study investigates the use of polycaprolactone (PCL) nanofibers as a versatile substrate for such cell cultures, aiming to model the alveolar-capillary interface more accurately. We optimized nanofiber production parameters, utilized polyamide mesh UHELON as a mechanical support for scaffold handling, and created 3D-printed inserts for specialized co-cultures. Our findings confirm that PCL nanofibrous scaffolds are manageable and support the co-culture of diverse cell types, effectively enabling cell attachment, proliferation, and differentiation. Our research establishes a proof-of-concept model for the alveolar-capillary interface, offering significant potential for enhancing cell-based testing and advancing tissue-engineering applications that require specific nanofibrous matrices.
PURPOSE: Surgical mesh, often made from polypropylene, is commonly recommended to enhance hernia repair outcomes in adults. Concerns about polypropylene, as a cause of allergy and/or autoimmune disease prompted this study to evaluate immunological parameters in patients with mesh and healthy controls. METHODOLOGY: A case-control cohort study was conducted at a university hospital. Electronic patient records of hernia repairs using polypropylene mesh (January 2018-April 2022) were analysed. Blood samples from patients and healthy controls were assessed using various methods, including enzyme-linked immunosorbent assay (ELISA), immunofluorescence, immunoblotting, and flow cytometry. RESULTS: The database search identified 1544 participants. After applying the exclusion criteria 33 patients remained in the polypropylene mesh group. Patients with mesh had lower median IgG3 levels (p = 0.02) and Rheumatoid factor (RF) IgM (p = 0.018) compared to the control group. Although both IgG3 and RF IgM levels were in the normal reference range. In addition, 5 patients in the mesh group tested positive for serum ANCA levels compared to none in the control group (p = 0.053). No other differences in immunoglobulins, autoantibodies, complement, or immune cell subtypes were observed. CONCLUSION: Patients with polypropylene mesh exhibited median IgG3 and RF IgM serum levels that were within the normal reference range but slightly lower compared to the control group. Among patients with polypropylene mesh, five displayed positive serum ANCA levels without autoimmune-related symptoms. Overall, no definitive signs of autoimmunity caused by polypropylene mesh. A larger, prospective study is warranted to further explore potential immune responses to polypropylene mesh.
- MeSH
- Surgical Mesh * adverse effects MeSH
- Adult MeSH
- Immunoglobulin G blood MeSH
- Immunoglobulin M blood MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Herniorrhaphy * instrumentation MeSH
- Polypropylenes * adverse effects MeSH
- Rheumatoid Factor blood MeSH
- Aged MeSH
- Case-Control Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Parastomální hernie (PH) představuje významnou komplikaci u pacientů po operaci s použitím ileálního konduitu, přičemž její výskyt se podle literatury pohybuje v širokém rozmezí 10–65 %. Vzhledem k vysokému riziku a morbiditě spojené s PH se stále více zkoumá možnost prevence této komplikace pomocí profylaktické implantace síťky. Tento přístup, již úspěšně aplikovaný u jiných typů stomických operací, jako jsou kolostomie a ileostomie, slibuje podobné výhody i pro pacienty s ileálním konduitem. Tento systematický přehledový článek hodnotí šest dosavadních studií, které se zaměřují na účinnost a bezpečnost profylaktické síťky při prevenci PH. Výsledky naznačují, že implantace síťky může snížit incidenci PH při minimálním riziku komplikací, což představuje důležitý krok směrem ke zlepšení péče a kvality života pacientů podstupujících tento typ operace.
Parastomal hernia (PH) is a significant complication in patients undergoing surgery with an ileal conduit, with reported incidence rates ranging widely from 10% to 65% in the literature. Due to the high risk and morbidity associated with PH, the potential for prevention through prophylactic mesh implantation is increasingly being explored. This approach, already successfully applied in other types of stoma surgeries, such as colostomies and ileostomies, holds similar promise for patients with an ileal conduit. This systematic review article evaluates six existing studies focusing on the efficacy and safety of prophylactic mesh for PH prevention. The findings suggest that mesh implantation can reduce the incidence of PH with minimal risk of complications, representing an important step toward improved care and quality of life for patients undergoing this type of surgery.
- MeSH
- Surgical Stomas MeSH
- Cystectomy methods MeSH
- Urinary Diversion methods MeSH
- Enterostomy methods MeSH
- Hernia * therapy MeSH
- Humans MeSH
- Postoperative Complications diagnosis prevention & control therapy MeSH
- Prophylactic Surgical Procedures methods MeSH
- Systematic Reviews as Topic MeSH
- Check Tag
- Humans MeSH
Defekty pánevního dna u žen jsou velmi rozšířeným problémem. Odhaduje se, že až 11 % žen potřebuje řešit nějakou formu prolapsu pánevních orgánů (POP, Pelvic Organ Prolapse). Jen stěží lze předpokládat, že se bude tento statistický údaj výrazněji měnit. Operační postupy stále procházejí zákonitým vývojem. V minulosti prováděné samostatné kolporafie v dnešní době již nejsou aktuální a kolpokleiza je indikována výjimečně. Významný počet neuspokojivých výsledků po klasických operacích byl příčinou hledání nových chirurgických technologií v této oblasti. Prevalence reoperací v zemích, kde probíhají relevantní klinické studie, je vysoká. Olsen a kol. ve své studii uvádí 29,2% výskyt recidiv, Whiteside v prospektivní studii prezentuje dokonce 58 % recidiv po vaginálních operacích pro POP (1, 2). Zavedení síťkových implantátů do operativy pánevních prolapsů znamenalo zásadní zvrat v této problematice. Síťkové implantáty začaly být užívány při operacích pánevních prolapsů po dobrých zkušenostech se síťkami při řešení břišních kýl a také po přelomových zkušenostech při řešení stresové inkontinence (SI) implantacemi tahuprostých suburetrálních pásek. Přinesly do operativy POP jeden zásadní prvek - schopnost přemostit i velké plošné defekty pojivové tkáně vzniklé porodním traumatem nebo pánevní operací. Jejich použití při operaci POP je však daleko náročnější než při operacích břišních kýl, protože POP je specifickou kýlou v dynamicky náročném prostoru. Při těchto operacích zasahujeme do velmi citlivých funkcí, jakými jsou močení, defekace a sexuální funkce. Jejich zavedení do chirurgické praxe lze jednoznačně považovat za pokrok, přesto že klinické výsledky při jejich používání byly někdy rozpačité. Především se objevily zcela nové typy komplikací, s jejichž řešením nebyly žádné zkušenosti. Přes řadu komplikací při zavádění pánevních implantátů vývoj dosáhl takové úrovně, kdy lze dosahovat prakticky anatomických rekonstrukcí pánevního dna s vynikajícími funkčními výsledky. Pánevní implantáty lze zavádět transvaginálně nebo transabdominálně. U transabdominálního přístupu je aktuální miniinvazivní laparoskopická nebo roboticky asistovaná technologie implantace. Kvalitní rekonstrukci pánevního dna bez použití síťkových implantátů v současné době není možné provést.
Pelvic floor disorders in women are a very common issue. It is estimated that up to 11% of women are experiencing some form of pelvic organ prolapse (POP). It can hardly be assumed that this statistic will change significantly. Operating technologies are still evolving. Separate colporrhaphys performed in the past are no longer relevant and colpocleisis are indicated rarely. A high rate of unsatisfactory outcomes following conventional surgeries has driven the search for new surgical technologies in this area. Reoperation rates are notably high in countries where relevant clinical trials are ongoing. Olsen et al. report a 29.2% incidence of recurrences, while Whiteside et al. present even 58% of recurrences after vaginal surgery for POP in a prospective study (1, 2). The introduction of mesh implants into pelvic prolapse surgery meant a significant turning point in the treatment of this condition. Mesh implants began to be used in pelvic prolapse surgeries following successful experience with meshes in the treatment of abdominal hernias and also after groundbreaking experience in dealing with stress incontinence (SI) through tension-free suburethral tape implantation. They brought one essential element to POP operations - the ability to bridge even large surface defects of connective tissue caused by childbirth trauma or previous pelvic surgeries. However, their use in POP surgery is far more demanding than in abdominal hernia surgery, because POP is a specific type of hernia in a dynamically demanding space. These operations interfere with very sensitive functions such as urination, defecation and sexual function. While their introduction into surgical practice can clearly be considered a progress, the clinical results of their use have sometimes been less satisfactory. New types of complications emerged, and there was initially no experience in managing them. Despite these challenges, the development of pelvic implant technology has progressed to the point where it is possible to achieve practically anatomical reconstructions of the pelvic floor with excellent functional results. Pelvic implants can be inserted transvaginally or transabdominally. In the transabdominal approach, minimally invasive laparoscopic or robot-assisted implantation technology is currently available. A high-quality pelvic floor reconstruction is not possible without the use of mesh implants.
Sexualita ženy je komplexním jevem, na kterém se podílí řada faktorů. Mezi nejdůležitější z nich patří věk a zdravotní stav, nicméně nezanedbatelný vliv mají i další aspekty. Vzhledem k tomu, že udávaná prevalence sestupu pánevních orgánů v ženské populaci přesahuje 50 %, nelze jeho dopad na sexuální funkce opomenout. Předložený článek prezentuje systematický přehled prací týkajících se problematiky vlivu sestupu pánevních orgánů na sexuální funkce žen. Poruchy sexuálních funkcí jsou u žen se sestupem časté, bez ohledu na jeho stadium či postižený kompartment. Terapie estrogeny nemá na sexualitu žen se sestupem žádný vliv, naopak rehabilitace může přinést určité zlepšení. Nebyl prokázán negativní vliv pesaroterapie na sexuální funkce. Chirurgická terapie s použitím nativní tkáně sexuální funkce obecně spíše zlepšuje. Výjimkou je však zadní poševní plastika, která je často spojována s dyspareunií. Nebyla nalezena korelace mezi pooperační délkou pochvy a změnou sexuálních funkcí. Dopad použití vaginálních implantátů v řešení sestupu na sexualitu žen zůstává nejednoznačný. Naopak sakrokolpopexe jednoznačně sexuální funkce zlepšuje.
A woman's sexuality is a complex phenomenon involving several factors, among which age and health are the most important. However, other aspects are not negligible. The impact of pelvic organ prolapse on sexual function cannot be ignored, as the reported prevalence of pelvic organ prolapse in female population exceeds 50%. This article presents a systematic review of articles dealing with the impact of pelvic organ prolapse on female sexual function. Sexual dysfunction is common in women with pelvic organ prolapse, regardless of prolapse stage or the compartment affected. Estrogen therapy has no effect on sexuality in women with prolapse, while pelvic floor muscle training may provide some improvement. There is no evidence that conservative therapy using a pessary is associated with negative impact on sexual function. Native tissue repair tends to improve sexual function in general, except for posterior colporrhaphy, which was frequently associated with dyspareunia. No correlation between postoperative vaginal length and change in sexual function was identified. The impact of transvaginal mesh repair on sexuality remains unclear. In contrast, there is enough evidence proving that sacrocolpopexy significantly improves sexual function in women.
- Keywords
- sakrokolpopexe, vaginální implantát, sexuální funkce,
- MeSH
- Gynecologic Surgical Procedures MeSH
- Humans MeSH
- Body Image MeSH
- Pelvic Organ Prolapse * MeSH
- Rehabilitation MeSH
- Sexuality * MeSH
- Vagina surgery MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
Souhrn Úvod: Lumbální kýla v dětském věku je extrémně vzácná diagnóza a vyžaduje specifický diagnostický a léčebný přístup. Kazuistika prezentuje první popsaný případ v České republice. Popis případu: Dvacetidvouměsíční chlapec byl vyšetřen na chirurgické ambulanci pro měkkou, volně reponibilní rezistenci v pravé bederní oblasti, která byla dle matky přítomna od narození. Ultrazvukové vyšetření prokázalo defekt v oblasti odpovídající trigonum lumbale superius (Grynfeltti seu Lesshafti) velikosti 17 × 11 mm s herniací střevní kličky. Chlapec podstoupil RTG skeletu a ultrazvuk břicha k vyloučení přidružených vad a následně byl indikován k otevřené hernioplastice. Vzhledem k velikosti defektu byla zvolena primární plastika bez použití síťky. Pooperační průběh byl bez komplikací a při plánovaných kontrolách byl pacient bez známek recidivy kýly a bez vývojové asymetrie. Závěr: Lumbální kýla u dětí je vrozená a často se objevuje v souvislosti s dalšími přidruženými malformacemi, které je nutné vyloučit. Typ operace závisí na velikosti defektu a cílem je zajistit plastiku bez napětí.
Summary Introduction: Lumbar hernia in the pediatric population is an extremely rare diagnosis and therefore requires specific diagnostic and therapeutic approaches. This case report describes the first published case of a pediatric lumbar hernia in the Czech Republic. Case description: A 22-month-old boy was examined at a pediatric surgical clinic due to a soft reducible mass in the right lumbar region, which, according to his mother, has been present from birth. An ultrasound scan confirmed a defect in the anatomical localization of the superior lumbar triangle (the triangle of Grynfeltt-Lesshaft) measuring 17 × 11 mm with a bowel loop herniation. The patient underwent a skeletal X-ray and an abdominal ultrasound in order to rule out associated malformations, following which he was scheduled for an open hernioplasty. Given the small size of the defect, a primary closure without mesh hernioplasty was performed. The postoperative course was uneventful and at clinical follow-ups the patient showed no signs of hernia recurrence or growth asymmetry. Conclusion: Lumbar hernia in children is congenital and frequently occurs with other associated malformations, which must be ruled out. The type of operation depends on the size of the defect and its purpose is to provide a tension-free closure.
BACKGROUND: Identification of real-time adverse drug reactions [ADRs] (as opposed to the risk of ADRs) in older poly-medicated people in primary care is a challenging task, often undertaken without an explicit strategy. This systematic review aims to evaluate replicable instruments and methods for identifying and addressing ADRs. METHODS: A systematic search was conducted in Medline, CINAHL, Scopus, Web of Science and Cochrane library, using controlled vocabulary (MeSH) and free-text terms. Randomised controlled trials (RCTs) implementing strategies to identify or resolve ADRs experienced by patients in primary care were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias tool. Discrepancies were resolved by discussion. RESULTS: From 2,182 unique records, 49 studies were identified for full review. Eight papers reporting results from 6 RCTs were included. All six trials utilised a list of medicine-related unwanted symptoms to identify ADRs. Two of three studies using adverse drug reaction questionnaires reported statistically significant increased rates of ADR reporting. Two of three studies that combined symptom questionnaires with prescriber consultations reported reductions in the number of health problems. Overall, results suggest that the three studies that described multidisciplinary collaborations using lists of ADRs plus prescriber reviews enhanced patient safety. However, the RCTs were unblinded and reported suboptimal retention. When considered as a whole, findings are equivocal and the data are too heterogenous to warrant any firm conclusions, beyond the need for more research to optimise strategies to safeguard patient wellbeing. IMPLICATIONS: Adaptable and scalable instruments with decision support are needed in primary care to identify and mitigate medicine-related harm in older poly-medicated people. The effectiveness of adverse drug reaction identification instruments, the value of comprehensive instruments, and the optimum method of delivery should be explored in multicentre trials.
Medzirebrová herniácia pľúc je definovaná ako protrúzia pľúcneho tkaniva za normálne hranice hrudnej steny. Prvý prípad pľúcnej hernie opísal v roku 1499 Roland. Pomer získaných a vrodených pľúcnych hernií je 4 : 1. Na základe anatomickej lokalizácie sú známe cervikálne, medzirebrové (interkostálne) a diafragmatické formy pľúcnej herniácie. Rizikovou zónou posttraumatickej a pooperačnej medzirebrovej pľúcnej hernie je v dôsledku slabého svalového krytu predná stena hrudníka. Kazuistika prezentuje 71-ročného muža, ktorý pred 9 rokmi podstúpil aortokoronárny bypass, náhradu mitrálnej chlopne, plastiku trikuspidálnej chlopne a zákrok MAZE. Pred pol rokom ďalej podstúpil transapikálnu implantáciu mitrálnej chlopne. Po implantácii chlopne pacient podstúpil opakovanú pleurálnu punkciu z dôvodu pleurálneho výpotku. Pacient prišiel do nemocnice pre bolestivú rezistenciu v mieste jazvy po torakotómii, ktorá sa zväčšila počas Valsalvovho manévru. Ultrasonografia a počítačová tomografia potvrdili diagnózu medzirebrovej pľúcnej hernie. Bola vykonaná resekcia herniálneho vaku a defekt bol uzavretý implantáciou polypropylénovej sieťky. Pacient bol prepustený v dobrom stave. Transapikálna implantácia chlopne predstavuje unikátnu kombináciu rizikových faktorov pre vznik medzirebrovej pľúcnej hernie ako zo strany pacienta, tak aj zo strany operačného prístupu. Dôsledné sledovanie pacientov za účelom včasnej identifikácie prítomnosti medzirebrovej pľúcnej hernie by malo byť bezpodmienečnou súčasťou pooperačného sledovania pacientov po transapikálnej implantácii chlopne.
Intercostal lung herniation is defined as a protrusion of lung tissue beyond the normal limits of the chest wall. The first case of pulmonary hernia was described in 1499 by Roland. The ratio of acquired to congenital lung hernias is 4 : 1. Based on anatomical localisation, cervical, intercostal, and diaphragmatic forms of lung herniation are known. The risk zone for posttraumatic and postoperative intercostal lung hernia is the front wall of the chest due to the poor muscular cover. The case report presents a 71-year-old man who underwent aortocoronary bypass, replacement of the mitral valve, repair of the tricuspid valve, and the MAZE procedure 9 years ago, as well as transapical implantation of the mitral valve through thoracotomy half a year ago. Repeat pleural puncture due to pleural effusion after valve implantation was needed. The pa- tient came to the hospital because of a painful resistance at the site of the thoracotomy scar which increased during the Valsalva manoeuvre. Ultrasonography and computed tomography confirmed the diagnosis of an intercostal lung hernia. A resection of the hernial sac was performed, and the defect was closed by implant- ing a polypropylene mesh. The patient was discharged in a good condition. Transapical valve implantation represents a unique combination of risk factors for the formation of an intercostal lung hernia, both from the patient's side and from the operative approach. Consistent monitoring of patients for the purpose of early identification of the presence of an intercostal lung hernia should be an unconditional part of the postoperative monitoring of patients after transapical valve implantation.
- MeSH
- Heart Valve Prosthesis Implantation * methods adverse effects MeSH
- Diagnosis, Differential MeSH
- Hernia * diagnostic imaging etiology pathology therapy MeSH
- Thoracic Surgical Procedures methods adverse effects MeSH
- Humans MeSH
- Mitral Valve surgery MeSH
- Pleural Effusion etiology MeSH
- Lung Diseases surgery diagnostic imaging etiology pathology MeSH
- Tomography, X-Ray Computed MeSH
- Risk Factors MeSH
- Aged MeSH
- Thoracotomy methods adverse effects MeSH
- Valsalva Maneuver MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Effort-based decision-making is particularly relevant to psychiatric conditions where motivation deficits are prominent features. Despite its clinical significance, the neurochemical mechanisms of this cognitive process remain unclarified. This study explores the impact of serotonin synthesis inhibition (PCPA) and modulation of serotonin release and 5-HT1A receptor agonism (8-OH-DPAT) on effort-based decision-making in rats. Adult male rats were trained in a modified T-maze task where they could obtain a high reward for climbing a mesh barrier or a low reward for no extra effort. Following training, rats received either acute 8-OH-DPAT treatment or subchronic PCPA treatment and were tested on their choices between high- and low-effort arms. The goal-arm choices and goal-arm entrance latencies were recorded. Next, homovanillic acid and 5-hydroxyindoleacetic acid, metabolites of dopamine and serotonin, respectively, were quantified in the rats' prefrontal cortex, striatum, and hippocampus. 8-OH-DPAT significantly increased low-effort, low-reward choices and increased goal-arm latency. In contrast, PCPA treatment did not affect these measures. Both PCPA and 8-OH-DPAT significantly decreased 5-hydroxyindoleacetic acid levels in the prefrontal cortex and the hippocampus. 8-OH-DPAT treatment was also associated with decreased homovanillic acid levels in the hippocampus. Our findings suggest that the overall reduction of serotonin levels alone does not affect effort-based decision-making and highlights the possible role of the hippocampus and the 5-HT1A receptor in this cognitive process.
- MeSH
- 8-Hydroxy-2-(di-n-propylamino)tetralin * pharmacology MeSH
- Serotonin 5-HT1 Receptor Agonists pharmacology MeSH
- Maze Learning drug effects physiology MeSH
- Behavior, Animal drug effects MeSH
- Rats MeSH
- Reward MeSH
- Rats, Sprague-Dawley MeSH
- Decision Making * physiology drug effects MeSH
- Serotonin * metabolism MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Male MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
BACKGROUND/ AIM: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease affecting upper and lower motor neurons, causing progressive atrophy of muscles, hypertonia, and paralysis. This study aimed to evaluate the current evidence and effectiveness of ultrasound in investigating nerve cross-sectional area (CSA) of peripheral nerves, vagus and cervical roots in those with ALS compared with healthy controls and to pool the CSA measurements. METHODS: A systematic search was conducted on Cochrane, Clarivate Web of Science, PubMed, Scopus, and Embase for the mesh terms nerve, ultrasonography, and amyotrophic lateral sclerosis. A quality assessment was performed using the New-Ottawa scale. In addition, a double-arm meta-analysis using Review Manager 5 software version 5.4 was performed. RESULTS: From the seventeen studies included in this review, the overall mean difference showed that individuals with ALS had a significantly smaller CSA in comparison to healthy controls for median, ulnar, C6 root, and phrenic nerves. However, no significant difference in the CSA was found in radial, vagal, sural, and tibial nerves. DISCUSSION: This study confirmed results of some of the included studies regards the anatomic sites, where nerve atrophy in ALS could be detected to potentially support the diagnosis of ALS. However, we recommend further large, prospective studies to assess the diagnostic value of these anatomical sites for the diagnosis of ALS. CONCLUSIONS: Our findings confirmed specific anatomic sites to differentiate ALS patients from healthy controls through ultrasound. However, these findings cannot be used to confirm the ALS diagnosis, but rather assist in differentiating it from other diagnoses. TRIAL REGISTRATION: Retrospectively registered on July 30th 2024 in PROSPERO (PROSPERO (york.ac.uk)) with ID574702.
- Publication type
- Journal Article MeSH
