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Allen RS, Bales K, Feola A, Pardue MT. In vivo Structural Assessments of Ocular Disease in Rodent Models using Optical Coherence Tomography. J Vis Exp 2020. [PMID: 32773758 DOI: 10.3791/61588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Spectral-domain optical coherence tomography (SD-OCT) is useful for visualizing retinal and ocular structures in vivo. In research, SD-OCT is a valuable tool to evaluate and characterize changes in a variety of retinal and ocular disease and injury models. In light induced retinal degeneration models, SD-OCT can be used to track thinning of the photoreceptor layer over time. In glaucoma models, SD-OCT can be used to monitor decreased retinal nerve fiber layer and total retinal thickness and to observe optic nerve cupping after inducing ocular hypertension. In diabetic rodents, SD-OCT has helped researchers observe decreased total retinal thickness as well as decreased thickness of specific retinal layers, particularly the retinal nerve fiber layer with disease progression. In mouse models of myopia, SD-OCT can be used to evaluate axial parameters, such as axial length changes. Advantages of SD-OCT include in vivo imaging of ocular structures, the ability to quantitatively track changes in ocular dimensions over time, and its rapid scanning speed and high resolution. Here, we detail the methods of SD-OCT and show examples of its use in our laboratory in models of retinal degeneration, glaucoma, diabetic retinopathy, and myopia. Methods include anesthesia, SD-OCT imaging, and processing of the images for thickness measurements.
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Affiliation(s)
- Rachael S Allen
- Center of Excellence for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center; Department of Biomedical Engineering, Georgia Institute of Technology;
| | - Katie Bales
- Center of Excellence for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center; Department of Ophthalmology, Emory University
| | - Andrew Feola
- Center of Excellence for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center; Department of Biomedical Engineering, Georgia Institute of Technology
| | - Machelle T Pardue
- Center of Excellence for Visual and Neurocognitive Rehabilitation, Atlanta Veterans Affairs Medical Center; Department of Biomedical Engineering, Georgia Institute of Technology; Department of Ophthalmology, Emory University
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2
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Allen RS, Feola A, Motz CT, Ottensmeyer AL, Chesler KC, Dunn R, Thulé PM, Pardue MT. Retinal Deficits Precede Cognitive and Motor Deficits in a Rat Model of Type II Diabetes. Invest Ophthalmol Vis Sci 2019; 60:123-133. [PMID: 30640976 DOI: 10.1167/iovs.18-25110] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the temporal appearance of retinal, cognitive, and motor deficits in Goto-Kakizaki (GK) rats, a spontaneously occurring, polygenic model of type II diabetes. GK rats develop impaired insulin secretion at 2 weeks and fasting hyperglycemia at 4 weeks. Methods In male and female GK rats and Wistar controls, glucose tolerance test (hyperglycemia) and electroretinogram (ERG, retinal function) were performed at 4 and 8 weeks of age. Spectral domain-optical coherence tomography (retinal structure) was assessed at 6 weeks. Spatial alternation (cognitive function) and number of entries (exploratory behavior) were assessed via Y-maze at 4, 5, 6, 7, and 8 weeks. Rotarod (motor function) was performed at 4, 6, and 8 weeks. Results By 4 weeks, the GK rats exhibited significant glucose intolerance (P < 0.001) and retinal deficits, including delays in ERG implicit times (flicker, P < 0.01; oscillatory potentials, P < 0.001). In addition, the GK rats showed greater ERG amplitudes (P < 0.001) and thinner retinas (P < 0.001). At 7 weeks, the GK rats showed deficits in cognitive function (P < 0.001) and exploratory behavior (P < 0.01). However, no motor function deficits were observed by 8 weeks. Interestingly, the male GK rats showed greater hyperglycemia (P < 0.05), but the female rats showed greater ERG delays (P < 0.001). Conclusions In GK rats, retinal function deficits developed prior to cognitive or motor deficits. Future studies will investigate common mechanistic links, long-term functional and vascular changes, and whether early retinal deficits can predict cognitive dysfunction or late-stage retinal disease.
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Affiliation(s)
- Rachael S Allen
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Andrew Feola
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Cara T Motz
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States
| | - Amy L Ottensmeyer
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Ophthalmology, Emory University, Atlanta, Georgia, United States
| | - Kyle C Chesler
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Ryan Dunn
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
| | - Peter M Thulé
- Section Endocrinology & Metabolism, Atlanta VA Health Care System & Emory University School of Medicine, Decatur, Georgia, United States
| | - Machelle T Pardue
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health Care System, Decatur, Georgia, United States.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States
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Bonometto A, Feola A, Rampazzo F, Gion C, Berto D, Ponis E, Boscolo Brusà R. Factors controlling sediment and nutrient fluxes in a small microtidal salt marsh within the Venice Lagoon. Sci Total Environ 2019; 650:1832-1845. [PMID: 30286351 DOI: 10.1016/j.scitotenv.2018.09.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 06/08/2023]
Abstract
Coastal salt marshes are among the Earth's most productive ecosystems and provide a number of ecosystem services. Water quality regulation by storing, transforming and releasing nutrients, organic matter and suspended sediment is recognized as one of the most important functions of salt marshes. The self-purification capacity of intertidal ecosystems contributes to mitigating nutrient inputs, acting as a buffer zone between watersheds and coastal waters, especially in relation to climate change and the increasing frequency of impulsive extreme events. Understanding sediment and nutrient fluxes and assessing the mechanisms that control them are valuable for the preservation and future restoration of salt marshes and for enhancing their effectiveness in providing water quality regulation services. To investigate the main driving factors in microtidal environments, changes in suspended sediment and nutrient concentrations were measured during several tidal cycles in a small microtidal reconstructed salt marsh in the Venice Lagoon, which was selected as the experimental site. The tidal amplitude, nutrients and total suspended solid concentrations were measured during 6 tidal cycles between September 2011 and October 2013. The water discharge was derived by forcing the hydrodynamic MIKE-DHI numerical model with the measured tidal levels. Fluxes were assessed by coupling field data with the calculated discharges. The salt marsh filtering function was related to the inflow matter concentrations and tidal amplitude. When high suspended solid and nutrient concentrations enter the salt marsh, accumulation processes prevail on release. In contrast, in the case of low concentrations and high tidal excursion, the salt marsh functions as a nutrient and sediment source. During all campaigns, the nitrogen removal function was more effective within the intertidal vegetated areas. Sediment release was the dominant process in the outermost creek, whereas sedimentation prevailed in the inner area of the salt marsh because of the attenuation of hydrodynamic forcing during tide propagation.
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Affiliation(s)
- A Bonometto
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy.
| | - A Feola
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
| | - F Rampazzo
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
| | - C Gion
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
| | - D Berto
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
| | - E Ponis
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
| | - R Boscolo Brusà
- Italian National Institute for Environmental Protection and Research, ISPRA, Loc. Brondolo, 30015 Chioggia, Venezia, Italy
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Allen RS, Motz CT, Feola A, Chesler KC, Haider R, Ramachandra Rao S, Skelton LA, Fliesler SJ, Pardue MT. Long-Term Functional and Structural Consequences of Primary Blast Overpressure to the Eye. J Neurotrauma 2018; 35:2104-2116. [PMID: 29648979 DOI: 10.1089/neu.2017.5394] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Acoustic blast overpressure (ABO) injury in military personnel and civilians is often accompanied by delayed visual deficits. However, most animal model studies dealing with blast-induced visual defects have focused on short-term (≤1 month) changes. Here, we evaluated long-term (≤8 months) retinal structure and function deficits in rats with ABO injury. Adult male Long-Evans rats were subjected to ABO from a single blast (approximately 190 dB SPL, ∼63 kPa, @80 psi), generated by a shock tube device. Retinal function (electroretinography; ERG), visual function (optomotor response), retinal thickness (spectral domain-optical coherence tomography; SD-OCT), and spatial cognition/exploratory motor behavior (Y-maze) were measured at 2, 4, 6, and 8 months post-blast. Immunohistochemical analysis of glial fibrillary acidic protein (GFAP) in retinal sections was performed at 8 months post-blast. Electroretinogram a- and b-waves, oscillatory potentials, and flicker responses showed greater amplitudes with delayed implicit times in both eyes of blast-exposed animals, relative to controls. Contrast sensitivity (CS) was reduced in both eyes of blast-exposed animals, whereas spatial frequency (SF) was decreased only in ipsilateral eyes, relative to controls. Total retinal thickness was greater in both eyes of blast-exposed animals, relative to controls, due to increased thickness of several retinal layers. Age, but not blast exposure, altered Y-maze outcomes. GFAP was greatly increased in blast-exposed retinas. ABO exposure resulted in visual and retinal changes that persisted up to 8 months post-blast, mimicking some of the visual deficits observed in human blast-exposed patients, thereby making this a useful model to study mechanisms of injury and potential treatments.
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Affiliation(s)
- Rachael S Allen
- 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Atlanta, Georgia .,2 Biomedical Engineering, Georgia Institute of Technology , Atlanta, Georgia
| | - Cara T Motz
- 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Atlanta, Georgia
| | - Andrew Feola
- 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Atlanta, Georgia .,2 Biomedical Engineering, Georgia Institute of Technology , Atlanta, Georgia
| | - Kyle C Chesler
- 2 Biomedical Engineering, Georgia Institute of Technology , Atlanta, Georgia
| | - Raza Haider
- 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Atlanta, Georgia
| | - Sriganesh Ramachandra Rao
- 3 Ophthalmology, Biochemistry, and Neuroscience Program, SUNY-University at Buffalo , Buffalo, New York
| | - Lara A Skelton
- 4 Research Service, VA Western NY Healthcare System , Buffalo, New York
| | - Steven J Fliesler
- 3 Ophthalmology, Biochemistry, and Neuroscience Program, SUNY-University at Buffalo , Buffalo, New York.,4 Research Service, VA Western NY Healthcare System , Buffalo, New York
| | - Machelle T Pardue
- 1 Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center , Atlanta, Georgia .,2 Biomedical Engineering, Georgia Institute of Technology , Atlanta, Georgia
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Abstract
This protocol describes mesh insertion into the rectovaginal septum in sheep using a single vaginal incision technique, with and without the trocar-guided insertion of anchoring arms. Parous sheep underwent the dissection of the rectovaginal septum, followed by the insertion of an implant with or without four anchoring arms, both designed to fit the ovine anatomy. The anchoring arms were put in place using a trocar and an "outside-in" technique. The cranial arms were passed through the obturator, gracilis, and adductor magnus muscles. The caudal arms were fixed near the sacrotuberous ligament, through the coccygeus muscles. This technique allows for the mimicking of surgical procedures performed in women suffering from pelvic organ prolapse. The anatomical spaces and elements are easily identified. The most critical part of the procedure is the insertion of the cranial trocar, which can easily penetrate the peritoneal cavity or the surrounding pelvic organs. This can be avoided by a more extensive retroperitoneal dissection and by guiding the trocar more laterally. This approach is designed only for experimental testing of novel implants in large animal models, as trocar-guided insertion is currently not used clinically.
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Affiliation(s)
- Iva Urbankova
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Prague;
| | - Geertje Callewaert
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Pelvic Floor Unit, University Hospitals KU Leuven
| | - Nikhil Sindhwani
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven
| | - Alice Turri
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven
| | - Lucie Hympanova
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Institute for the Care of Mother and Child and Third Faculty of Medicine, Charles University, Prague
| | - Andrew Feola
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven
| | - Jan Deprest
- Centrum for Surgical Technologies, Department of Development and Regeneration, Clinical Specialties Research Groups, Faculty of Medicine, KU Leuven; Pelvic Floor Unit, University Hospitals KU Leuven
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6
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Coudrillier B, Campbell IC, Read AT, Geraldes DM, Vo NT, Feola A, Mulvihill J, Albon J, Abel RL, Ethier CR. Effects of Peripapillary Scleral Stiffening on the Deformation of the Lamina Cribrosa. Invest Ophthalmol Vis Sci 2017; 57:2666-77. [PMID: 27183053 PMCID: PMC4874475 DOI: 10.1167/iovs.15-18193] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose Scleral stiffening has been proposed as a treatment for glaucoma to protect the lamina cribrosa (LC) from excessive intraocular pressure–induced deformation. Here we experimentally evaluated the effects of moderate stiffening of the peripapillary sclera on the deformation of the LC. Methods An annular sponge, saturated with 1.25% glutaraldehyde, was applied to the external surface of the peripapillary sclera for 5 minutes to stiffen the sclera. Tissue deformation was quantified in two groups of porcine eyes, using digital image correlation (DIC) or computed tomography imaging and digital volume correlation (DVC). In group A (n = 14), eyes were subjected to inflation testing before and after scleral stiffening. Digital image correlation was used to measure scleral deformation and quantify the magnitude of scleral stiffening. In group B (n = 5), the optic nerve head region was imaged using synchrotron radiation phase-contrast microcomputed tomography (PC μCT) at an isotropic spatial resolution of 3.2 μm. Digital volume correlation was used to compute the full-field three-dimensional deformation within the LC and evaluate the effects of peripapillary scleral cross-linking on LC biomechanics. Results On average, scleral treatment with glutaraldehyde caused a 34 ± 14% stiffening of the peripapillary sclera measured at 17 mm Hg and a 47 ± 12% decrease in the maximum tensile strain in the LC measured at 15 mm Hg. The reduction in LC strains was not due to cross-linking of the LC. Conclusions Peripapillary scleral stiffening is effective at reducing the magnitude of biomechanical strains within the LC. Its potential and future utilization in glaucoma axonal neuroprotection requires further investigation.
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Affiliation(s)
- Baptiste Coudrillier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Ian C Campbell
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States 2Atlanta VA Medical Center, Decatur, Georgia, United States
| | - A Thomas Read
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Diogo M Geraldes
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Nghia T Vo
- Diamond Light Source, Didcot, United Kingdom
| | - Andrew Feola
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - John Mulvihill
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States
| | - Julie Albon
- Optic Nerve Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff, Wales, United Kingdom 6Cardiff Institute of Tissue Engineering and Repair, Cardiff University, Cardiff, Wales, United Kingdom
| | - Richard L Abel
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - C Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, United States 2Atlanta VA Medical Center, Decatur, Georgia, United States
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7
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Nelson ES, Mulugeta L, Feola A, Raykin J, Myers JG, Samuels BC, Ethier CR. The impact of ocular hemodynamics and intracranial pressure on intraocular pressure during acute gravitational changes. J Appl Physiol (1985) 2017; 123:352-363. [PMID: 28495842 DOI: 10.1152/japplphysiol.00102.2017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 11/22/2022] Open
Abstract
Exposure to microgravity causes a bulk fluid shift toward the head, with concomitant changes in blood volume/pressure, and intraocular pressure (IOP). These and other factors, such as intracranial pressure (ICP) changes, are suspected to be involved in the degradation of visual function and ocular anatomical changes exhibited by some astronauts. This is a significant health concern. Here, we describe a lumped-parameter numerical model to simulate volume/pressure alterations in the eye during gravitational changes. The model includes the effects of blood and aqueous humor dynamics, ICP, and IOP-dependent ocular compliance. It is formulated as a series of coupled differential equations and was validated against four existing data sets on parabolic flight, body inversion, and head-down tilt (HDT). The model accurately predicted acute IOP changes in parabolic flight and HDT, and was satisfactory for the more extreme case of inversion. The short-term response to the changing gravitational field was dominated by ocular blood pressures and compliance, while longer-term responses were more dependent on aqueous humor dynamics. ICP had a negligible effect on acute IOP changes. This relatively simple numerical model shows promising predictive capability. To extend the model to more chronic conditions, additional data on longer-term autoregulation of blood and aqueous humor dynamics are needed.NEW & NOTEWORTHY A significant percentage of astronauts present anatomical changes in the posterior eye tissues after spaceflight. Hypothesized increases in ocular blood volume and intracranial pressure (ICP) in space have been considered to be likely factors. In this work, we provide a novel numerical model of the eye that incorporates ocular hemodynamics, gravitational forces, and ICP changes. We find that changes in ocular hemodynamics govern the response of intraocular pressure during acute gravitational change.
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Affiliation(s)
- Emily S Nelson
- National Aeronautic and Space Administration, Glenn Research Center, Cleveland, Ohio
| | | | - Andrew Feola
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia; and
| | - Julia Raykin
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia; and
| | - Jerry G Myers
- National Aeronautic and Space Administration, Glenn Research Center, Cleveland, Ohio
| | - Brian C Samuels
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
| | - C Ross Ethier
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia; and
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Urbankova I, Vdoviakova K, Rynkevic R, Sindhwani N, Deprest D, Feola A, Herijgers P, Krofta L, Deprest J. Comparative Anatomy of the Ovine and Female Pelvis. Gynecol Obstet Invest 2017; 82:582-591. [DOI: 10.1159/000454771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/26/2016] [Indexed: 11/19/2022]
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Feola A, Marino V, Masullo A, Trabucco Aurilio M, Marsella LT. The protection of individuals affected with Specific Learning Disorders in the Italian Legislation. Clin Ter 2016; 166:e177-81. [PMID: 26152629 DOI: 10.7417/ct.2015.1851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Specific Learning Disorders (SLDs) affect specific abilities in individuals with an otherwise normal academic development. Among Italian School population, their reported prevalence is between 2.5% and 3.5%. Dysfunctions at the base of these disorders interfere with the normal acquisition process of reading, writing and/or mathematical abilities, leading to various degrees of adjustment difficulties in the affected individuals. The aim of this study was to assess the support that Italian Government offers to its citizens affected with SLDs, with a particular focus on assistance during the school-age years, particularly through the introduction of the Law 170/2010 and successive guidelines, supplementing the existing regulations to offer more efficient means and legal instruments aimed at achieving earlier diagnoses.
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Affiliation(s)
- A Feola
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - V Marino
- Section of Legal Medicine University of Rome 'Tor Vergata', Rome, Italy
| | - A Masullo
- Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - M Trabucco Aurilio
- Department Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples, Italy
| | - L T Marsella
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy
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Masullo A, Feola A, Marino V, Iadevaia C, Trabucco Aurilio M, Marsella LT. Sleep disorders and driving licence: the current Italian legislation and medico-legal issues. Clin Ter 2016; 165:e368-72. [PMID: 25366956 DOI: 10.7417/ct.2014.1766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Road traffic accidents (RTA) are a serious issue in all industrialized countries and have dramatic social and healthcare-related implications. Fatigue (sleepiness) is the principal identifiable and preventable cause of road traffic accidents. Obstructive sleep apnoea syndrome (OSAS) and narcolepsy are two of the leading causes of excessive daytime sleepiness. In this article, the authors analyze the current Italian legislation regarding driving licence issuance and fitness to drive, in order to evaluate the potential implications of sleep disorders, particularly OSAS and narcolepsy. In European Legislation and in Italy, OSAS and narcolepsy are not included among the illnesses or invalidating conditions that limit the fitness to drive for driving licence issuance purposes. In fact, they are not included in the Annex III of the European Council Directive 91/439/EEC of the 29th of July 1991 on driving licences. Some Countries of the European Union (Belgium, France, Finland, Great Britain, the Netherlands, Spain and Sweden) had implemented the 91/439/EEC Directive with national restrictions on driving licence issuance policies in case of OSAS and narcolepsy. Given the well-established scientific evidence available, in Italy, the lack of legislation regulating the assessment of the psychophysical requisites for the issuance and renewal of driving licences of individuals affected by sleep disorders seems extremely worrying. Furthermore, the current lack of legal obligation in Italy for healthcare facilities to disclose such diagnoses to the organs responsible for issuing driving licences (such as the Motorizzazione Civile - the Department of motor vehicles) remains the subject of heated debate.
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Affiliation(s)
- A Masullo
- Department of Experimental Medicine, Second University of Naples, Naples
| | - A Feola
- Department of Experimental Medicine, Second University of Naples, Naples
| | - V Marino
- Section of Legal Medicine, University of Rome 'Tor Vergata', Rome
| | - C Iadevaia
- Division of Pulmonology, Second University of Naples, Naples
| | - M Trabucco Aurilio
- Department of Anesthesiological, Surgical and Emergency Sciences, Second University of Naples, Naples
| | - L T Marsella
- Legal Medicine and Social Security Services, Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome, Italy
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11
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Sindhwani N, Liaquat Z, Urbankova I, Vande Velde G, Feola A, Deprest J. Immediate postoperative changes in synthetic meshes – In vivo measurements. J Mech Behav Biomed Mater 2016; 55:228-235. [DOI: 10.1016/j.jmbbm.2015.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/20/2015] [Indexed: 01/02/2023]
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12
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Jallah Z, Liang R, Feola A, Barone W, Palcsey S, Abramowitch SD, Yoshimura N, Moalli P. The impact of prolapse mesh on vaginal smooth muscle structure and function. BJOG 2015; 123:1076-85. [PMID: 26301457 DOI: 10.1111/1471-0528.13514] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the impact of prolapse meshes on vaginal smooth muscle structure (VaSM) and function, and to evaluate these outcomes in the context of the mechanical and textile properties of the mesh. DESIGN Three months following the implantation of three polypropylene prolapse meshes with distinct textile and mechanical properties, mesh tissue explants were evaluated for smooth muscle contraction, innervation, receptor function, and innervation density. SETTING Magee-Womens Research Institute at the University of Pittsburgh. POPULATION Thirty-four parous rhesus macaques of similar age, parity, and pelvic organ prolapse quantification (POP-Q) scores. METHODS Macaques were implanted with mesh via sacrocolpopexy. The impact of Gynemesh(™) PS (Ethicon; n = 7), Restorelle(®) (Coloplast; n = 7), UltraPro(™) parallel and UltraPro(™) perpendicular (Ethicon; n = 6 and 7, respectively) were compared with sham-operated controls (n = 7). Outcomes were analysed by Kruskal-Wallis ANOVA, Mann-Whitney U-tests and multiple regression analysis (P < 0.05). MEAN OUTCOME MEASURES Vaginal tissue explants were evaluated for the maximum contractile force generated following muscle, nerve, and receptor stimulation, and for peripheral nerve density. RESULTS Muscle myofibre, nerve, and receptor-mediated contractions were negatively affected by mesh only in the grafted region (P < 0.001, P = 0.002, and P = 0.008, respectively), whereas cholinergic and adrenergic nerve densities were affected in the grafted (P = 0.090 and P = 0.008, respectively) and non-grafted (P = 0.009 and P = 0.005, respectively) regions. The impact varied by mesh property, as mesh stiffness was a significant predictor of the negative affect on muscle function and nerve density (P < 0.001 and P = 0.013, respectively), whereas mesh and weight was a predictor of receptor function (P < 0.001). CONCLUSIONS Mesh has an overall negative impact on VaSM, and the effects are a function of mesh properties, most notably, mesh stiffness. TWEETABLE ABSTRACT Prolapse mesh affects vaginal smooth muscle.
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Affiliation(s)
- Z Jallah
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - R Liang
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - A Feola
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - W Barone
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Palcsey
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - S D Abramowitch
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - N Yoshimura
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - P Moalli
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Science, University of Pittsburgh, Pittsburgh, PA, USA
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13
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Pannone G, Santoro A, Feola A, Bufo P, Papagerakis P, Lo Muzio L, Staibano S, Ionna F, Longo F, Franco R, Aquino G, Contaldo M, De Maria S, Serpico R, De Rosa A, Rubini C, Papagerakis S, Giovane A, Tombolini V, Giordano A, Caraglia M, Di Domenico M. The role of E-cadherin down-regulation in oral cancer: CDH1 gene expression and epigenetic blockage. Curr Cancer Drug Targets 2015; 14:115-27. [PMID: 24274398 DOI: 10.2174/1568009613666131126115012] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/29/2013] [Accepted: 08/29/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND The prognosis of the oral squamous cell carcinoma (OSCC) patients remains very poor, mainly due to their high propensity to invade and metastasize. E-cadherin reduced expression occurs in the primary step of oral tumour progression and gene methylation is a mode by which the expression of this protein is regulated in cancers. In this perspective, we investigated E-cadherin gene (CDH1) promoter methylation status in OSCC and its correlation with Ecadherin protein expression, clinicopathological characteristics and patient outcome. METHODS Histologically proven OSCC and paired normal mucosa were analyzed for CDH1 promoter methylation status and E-cadherin protein expression by methylation-specific polymerase chain reaction and immunohistochemistry. Colocalization of E-cadherin with epidermal growth factor (EGF) receptor (EGFR) was evidenced by confocal microscopy and by immunoprecipitation analyses. RESULTS This study indicated E-cadherin protein down-regulation in OSCC associated with protein delocalization from membrane to cytoplasm. Low E-cadherin expression correlated to aggressive, poorly differentiated, high grade carcinomas and low patient survival. Moreover, protein down-regulation appeared to be due to E-cadherin mRNA downregulation and CDH1 promoter hypermethylation. In an in vitro model of OSCC the treatment with EGF caused internalization and co-localization of E-cadherin with EGFR and the addition of demethylating agents increased E-cadherin expression. CONCLUSION Low E-Cadherin expression is a negative prognostic factor of OSCC and is likely due to the hypermethylation of CDH1 promoter. The delocalization of E-cadherin from membrane to cytoplasm could be also due to the increased expression of EGFR in OSCC and the consequent increase of E-cadherin co-internalization with EGFR.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Di Domenico
- Department of Biochemistry, Biophisics and General Patology, Second University of Naples, Via L. De Crecchio, 7, 80138 Naples, Italy.
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Maurer MM, Röhrnbauer B, Feola A, Deprest J, Mazza E. Prosthetic Meshes for Repair of Hernia and Pelvic Organ Prolapse: Comparison of Biomechanical Properties. Materials 2015. [PMCID: PMC5455575 DOI: 10.3390/ma8052794] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aims to compare the mechanical behavior of synthetic meshes used for pelvic organ prolapse (POP) and hernia repair. The analysis is based on a comprehensive experimental protocol, which included uniaxial and biaxial tension, cyclic loading and testing of meshes in dry conditions and embedded into an elastomer matrix. Implants are grouped as POP or hernia meshes, as indicated by the manufacturer, and their stiffness in different loading configurations, area density and porosity are compared. Hernia meshes might be expected to be stiffer, since they are implanted into a stiffer tissue (abdominal wall) than POP meshes (vaginal wall). Contrary to this, hernia meshes have a generally lower secant stiffness than POP meshes. For example, DynaMesh PRS, a POP mesh, is up to two orders of magnitude stiffer in all tested configurations than DynaMesh ENDOLAP, a hernia mesh. Additionally, lighter, large pore implants might be expected to be more compliant, which was shown to be generally not true. In particular, Restorelle, the lightest mesh with the largest pores, is less compliant in the tested configurations than Surgipro, the heaviest, small-pore implant. Our study raises the question of defining a meaningful design target for meshes in terms of mechanical biocompatibility.
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Affiliation(s)
- Manfred M. Maurer
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +41-44-6339228; Fax: +41-44-6321145
| | - Barbara Röhrnbauer
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
| | - Andrew Feola
- Center for Surgical Technologies, Faculty of Medicine, Universitair Ziekenhuis “Gasthuisberg” Leuven, Katholieke Universiteit Leuven, Leuven 3000, Belgium; E-Mails: (A.F.); (J.D.)
| | - Jan Deprest
- Center for Surgical Technologies, Faculty of Medicine, Universitair Ziekenhuis “Gasthuisberg” Leuven, Katholieke Universiteit Leuven, Leuven 3000, Belgium; E-Mails: (A.F.); (J.D.)
| | - Edoardo Mazza
- Institute of Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zurich 8092, Switzerland; E-Mails: (B.R.); (E.M.)
- Empa—Swiss Federal Laboratories for Materials Science and Technology, Überlandstrasse 129, Dübendorf 8600, Switzerland
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15
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Feola A, Endo M, Urbankova I, Vlacil J, Deprest T, Bettin S, Klosterhalfen B, Deprest J. Host reaction to vaginally inserted collagen containing polypropylene implants in sheep. Am J Obstet Gynecol 2015; 212:474.e1-8. [PMID: 25446700 DOI: 10.1016/j.ajog.2014.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/25/2014] [Accepted: 11/03/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We aimed to characterize the effect of vaginal or abdominal mesh insertion and of different collagen augmentation of polypropylene mesh in a sheep model. Outcome measures were passive and active biomechanical properties and semiquantitative morphometry. STUDY DESIGN Forty-two Texel sheep were used: 6 were nonimplanted controls (n = 6), the rest were implanted with polypropylene mesh (n = 12; Avaulta Solo; Bard Medical, Covington, GA) or collagen-coated meshes: Avaulta Plus (n = 12; Bard Medical) and Ugytex (n = 12; Sofradim International, Trevoux, France). Through a single incision, the rectovaginal septum was dissected and a 35 × 35-mm mesh was sutured to the underlying tissues. Abdominally, a 50 × 50-mm mesh was laid over a primarily sutured full thickness 40-mm longitudinal incisional defect. Animals were explanted after 60 or 180 days (n = 6 per group). Outcome measures were passive biomechanics by biaxial tensiometry, active contractility of vaginal explants, and histologic evidence. RESULTS Vaginal explants were 2.4 times stiffer compared with native vaginal tissue (P < .001), but without differences in comfort zone stiffness or slope of the load-elongation in the physiologic range between the products that were tested. Collagen coating was associated with a 16-fold reduction in contractile force at 180 days, compared with native vaginal tissue, both for Avaulta Plus (P = .032) and Ugytex (P = .015). Abdominal explants were 1.3-times stiffer compared with native abdominal wall tissue (P < .001) and were 1.9-times stiffer compared with vaginal explants. CONCLUSION Vaginal mesh implantation yields less stiff explants compared with abdominal explants. Vaginal mesh implantation also alters the passive and active biomechanical properties compared with native vaginal tissues. Collagen matrices did not reduce the number of graft-related complications.
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Affiliation(s)
- Andrew Feola
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Masayuki Endo
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Iva Urbankova
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Institute for Care of Mother and Child, Prague, Czech Republic
| | - Jaromír Vlacil
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Institute for Care of Mother and Child, Prague, Czech Republic
| | - Thomas Deprest
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Samantha Bettin
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | - Jan Deprest
- Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Leuven, Belgium; Pelvic Floor Unit, University Hospitals, KU Leuven, Leuven, Belgium.
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16
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Sindhwani N, Feola A, De Keyzer F, Claus F, Callewaert G, Urbankova I, Ourselin S, D'hooge J, Deprest J. Three-dimensional analysis of implanted magnetic-resonance-visible meshes. Int Urogynecol J 2015; 26:1459-65. [PMID: 25800904 DOI: 10.1007/s00192-015-2681-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 02/26/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Our primary objective was to develop relevant algorithms for quantification of mesh position and 3D shape in magnetic resonance (MR) images. METHODS In this proof-of-principle study, one patient with severe anterior vaginal wall prolapse was implanted with an MR-visible mesh. High-resolution MR images of the pelvis were acquired 6 weeks and 8 months postsurgery. 3D models were created using semiautomatic segmentation techniques. Conformational changes were recorded quantitatively using part-comparison analysis. An ellipticity measure is proposed to record longitudinal conformational changes in the mesh arms. The surface that is the effective reinforcement provided by the mesh is calculated using a novel methodology. The area of this surface is the effective support area (ESA). RESULTS MR-visible mesh was clearly outlined in the images, which allowed us to longitudinally quantify mesh configuration between 6 weeks and 8 months after implantation. No significant changes were found in mesh position, effective support area, conformation of the mesh's main body, and arm length during the period of observation. Ellipticity profiles show longitudinal conformational changes in posterior arms. CONCLUSIONS This paper proposes novel methodologies for a systematic 3D assessment of the position and morphology of MR-visible meshes. A novel semiautomatic tool was developed to calculate the effective area of support provided by the mesh, a potentially clinically important parameter.
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Affiliation(s)
- Nikhil Sindhwani
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU, Leuven, Leuven, Belgium.,Interdepartmental Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Andrew Feola
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU, Leuven, Leuven, Belgium.,Interdepartmental Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | - Filip Claus
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Geertje Callewaert
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU, Leuven, Leuven, Belgium.,Interdepartmental Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Iva Urbankova
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU, Leuven, Leuven, Belgium.,Interdepartmental Center for Surgical Technologies, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Sebastien Ourselin
- Centre for Medical Image Computing (CMIC), University College London, London, UK
| | - Jan D'hooge
- Laboratory on Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Cluster Organ Systems, Faculty of Medicine, KU, Leuven, Leuven, Belgium. .,Pelvic Floor Unit, University Hospitals Leuven, Leuven, Belgium. .,Department of Obstetrics and Gynaecology, University Hospitals, KU Leuven, Leuven, 3000, Belgium.
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17
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Endo M, Urbankova I, Vlacil J, Sengupta S, Deprest T, Klosterhalfen B, Feola A, Deprest J. Cross-linked xenogenic collagen implantation in the sheep model for vaginal surgery. ACTA ACUST UNITED AC 2015; 12:113-122. [PMID: 25960708 PMCID: PMC4417472 DOI: 10.1007/s10397-015-0883-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023]
Abstract
The properties of meshes used in reconstructive surgery affect the host response and biomechanical characteristics of the grafted tissue. Whereas durable synthetics induce a chronic inflammation, biological grafts are usually considered as more biocompatible. The location of implantation is another determinant of the host response: the vagina is a different environment with specific function and anatomy. Herein, we evaluated a cross-linked acellular collagen matrix (ACM), pretreated by the anti-calcification procedure ADAPT® in a sheep model for vaginal surgery. Ten sheep were implanted with a cross-linked ACM, and six controls were implanted with a polypropylene (PP; 56 g/m2) control. One implant was inserted in the lower rectovaginal septum, and one was used for abdominal wall defect reconstruction. Grafts were removed after 180 days; all graft-related complications were recorded, and explants underwent bi-axial tensiometry and contractility testing. Half of ACM-implanted animals had palpable induration in the vaginal implantation area, two of these also on the abdominal implant. One animal had a vaginal exposure. Vaginal ACMs were 63 % less stiff compared to abdominal ACM explants (p = 0.01) but comparable to vaginal PP explants. Seven anterior vaginal ACM explants showed areas of graft degradation on histology. There was no overall difference in vaginal contractility. Considering histologic degradation in the anterior vaginal implant as representative for the host, posterior ACM explants of animals with degradation had a 60 % reduced contractility as compared to PP (p = 0.048). Three abdominal implants showed histologic degradation; those were more compliant than non-degraded implants. Vaginal implantation with ACM was associated with graft-related complications (GRCs) and biomechanical properties comparable to PP. Partially degraded ACM had a decreased vaginal contractility.
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Affiliation(s)
- Masayuki Endo
- Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
| | - Iva Urbankova
- Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Institute for Care of Mother and Child, Prague, Czech Republic
| | - Jaromir Vlacil
- Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Institute for Care of Mother and Child, Prague, Czech Republic
| | - Siddarth Sengupta
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Thomas Deprest
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | | | - Andrew Feola
- Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Jan Deprest
- Centre for Surgical Technologies, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Development and Regeneration, Organ Systems Cluster, Faculty of Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Pelvic Floor Unit, University Hospitals KU Leuven, Leuven, Belgium
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18
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Maurer M, Röhrnbauer B, Feola A, Deprest J, Mazza E. Mechanical biocompatibility of prosthetic meshes: A comprehensive protocol for mechanical characterization. J Mech Behav Biomed Mater 2014; 40:42-58. [DOI: 10.1016/j.jmbbm.2014.08.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/29/2014] [Accepted: 08/10/2014] [Indexed: 11/27/2022]
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Feola A, Pal S, Moalli P, Maiti S, Abramowitch S. Varying degrees of nonlinear mechanical behavior arising from geometric differences of urogynecological meshes. J Biomech 2014; 47:2584-9. [PMID: 25011619 DOI: 10.1016/j.jbiomech.2014.05.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/26/2014] [Accepted: 05/30/2014] [Indexed: 11/28/2022]
Abstract
Synthetic polypropylene meshes were designed to restore pelvic organ support for women suffering from pelvic organ prolapse; however, the FDA released two notifications regarding potential complications associated with mesh implantation. Our aim was to characterize the structural properties of Restorelle and UltraPro subjected to uniaxial tension along perpendicular directions, and then model the tensile behavior of these meshes utilizing a co-rotational finite element model, with an imbedded linear or fiber-recruitment local stress-strain relationship. Both meshes exhibited a highly nonlinear stress-strain behavior; Restorelle had no significant differences between the two perpendicular directions, while UltraPro had a 93% difference in the low (initial) stiffness (p=0.009) between loading directions. Our model predicted that early alignment of the mesh segments in the loading direction and subsequent stretching could explain the observed nonlinear tensile behavior. However, a nonlinear stress-strain response in the stretching regime, that may be inherent to the mesh segment, was required to better capture experimental results. Utilizing a nonlinear fiber recruitment model with two parameters A and B, we observed improved agreement between the simulations and the experimental results. An inverse analysis found A=120 MPa and B=1.75 for Restorelle (RMSE=0.36). This approach yielded A=30 MPa and B=3.5 for UltraPro along one direction (RMSE=0.652), while the perpendicular orientation resulted in A=130 MPa and B=4.75 (RMSE=4.36). From the uniaxial protocol, Restorelle was found to have little variance in structural properties along these two perpendicular directions; however, UltraPro was found to behave anisotropically.
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Affiliation(s)
- Andrew Feola
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Siladitya Pal
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pamela Moalli
- Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Spandan Maiti
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven Abramowitch
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA.
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20
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Endo M, Feola A, Sindhwani N, Manodoro S, Vlacil J, Engels AC, Claus F, Deprest JA. Mesh contraction: in vivo documentation of changes in apparent surface area utilizing meshes visible on magnetic resonance imaging in the rabbit abdominal wall model. Int Urogynecol J 2014; 25:737-43. [PMID: 24448724 DOI: 10.1007/s00192-013-2293-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/29/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Our aim was to analyze the apparent contraction of meshes in vivo after abdominal wall reconstruction and evaluate histological and biomechanical properties after explantation. METHODS Nine New Zealand female rabbits underwent repair of two full-thickness 25 × 30-mm midline defects in the upper and lower parts of the abdomen. These were primarily overlaid by 35 × 40-mm implants of a polyvinylidene fluoride (PVDF) DynaMesh (n = 6) or polypropylene meshes Ultrapro (n = 6) and Marlex (n = 6). Edges of the meshes were secured with iron(II,III) oxide (Fe(3)O(4))-loaded PVDF sutures. Magnetic resonance images (MRIs) were taken at days 2, 30 and 90 after implantation. The perimeter of the mesh was traced using a 3D spline curve. The apparent surface area or the area within the PVDF sutures was compared with the initial size using the one-sample t test. A two-way repeat analysis of variance (ANOVA) was used to compare the apparent surface area over time and between groups. RESULTS PVDF meshes and sutures with Fe(3)O(4) could be well visualized on MRI. DynaMesh and Marlex each had a 17 % decrease in apparent surface area by day 2 (p < 0.001 and p = 0.001), respectively, which persisted after day 90. Whereas there was a decrease in apparent surface area in Ultrapro, it did not reach significance until day 90 (p = 0.01). Overall, the apparent surface area decreased 21 % in all meshes by day 90. No differences in histological or biomechanical properties were observed at day 90. CONCLUSIONS There was a reduction in the apparent surface area between implantation and day 2, indicating that most mesh deformation occurs prior to tissue in-growth.
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Affiliation(s)
- Masayuki Endo
- Pelvic Floor Unit, A Programme of Gynaecology, Urology and Gastro-Enterology, University Hospitals Leuven, 3000, Leuven, Belgium
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21
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Hakim L, Endo M, Feola A, Soebadi DM, Deprest J, De Ridder D, Albersen M, Van der Aa F. High-frequency micro-ultrasound: a novel method to assess external urethral sphincter function in rats following simulated birth injury. Neurourol Urodyn 2014; 34:264-9. [PMID: 24436081 DOI: 10.1002/nau.22555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 12/02/2013] [Indexed: 11/08/2022]
Abstract
AIMS We evaluated external urethral sphincter (EUS) function using high-frequency micro-ultrasound (US) in rats that were either uninjured (Control, C) or underwent vaginal distension (VD) as a substitute for vaginal birth injury induced stress urinary incontinence (SUI). METHODS Thirteen female nulliparous Sprague-Dawley rats of 12 weeks were divided into two groups, either C (n = 6) or VD (n = 7). Vaginal balloon distension was performed under pentobarbital anesthesia for 4 hours. Five days after the injury, all animals underwent US assessment of the urethra during high-rate bladder filling and urine leakage/voiding. Urinary leakage, the presence, absence, and pattern of EUS bursting during the voiding phase were registered, and pre-determined parameters of intercontraction interval (ICI), length of contraction (LOC), and rate of contraction (ROC) were registered. RESULTS Our ultrasound findings consistently showed the presence of rhythmic EUS bursting in all of the C rats (6/6), which were absent in all VD rats (0/7). The mean of ROC, ICI, and LOC in C group were 3.02 ± 0.12 contractions/sec, 471.43 ± 17.9 msec, and 103.41 ± 3.28 msec, respectively. CONCLUSIONS Pre-determined parameters of LOC, ICI, and ROC during US provide objective and measurable data on EUS function. US showed the total disappearance of EUS bursting in the VD group as compared to the C group. These results indicate that ultrasound testing may become a valuable non-invasive tool in future translational studies to investigate SUI/urethral function in rat models.
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Affiliation(s)
- Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Urology, Airlangga University School of Medicine/Dr. Soetomo General Hospital, Surabaya, Indonesia
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Liang R, Abramowitch S, Knight K, Palcsey S, Nolfi A, Feola A, Stein S, Moalli PA. Vaginal degeneration following implantation of synthetic mesh with increased stiffness. BJOG 2013; 120:233-243. [PMID: 23240802 DOI: 10.1111/1471-0528.12085] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the impact of the prototype prolapse mesh Gynemesh PS with that of two new-generation lower stiffness meshes, UltraPro and SmartMesh, on vaginal morphology and structural composition. DESIGN A mechanistic study employing a nonhuman primate model. SETTING Magee-Womens Research Institute at the University of Pittsburgh. POPULATION Parous rhesus macaques, with similar age, weight, parity and Pelvic Organ Prolapse-Questionnaire scores. METHODS Following Institutional Animal Care Use Committee approval, 50 rhesus macaques were implanted with Gynemesh PS (n = 12), UltraPro with its blue line perpendicular to the longitudinal axis of vagina (n = 10), UltraPro with its blue line parallel to the longitudinal axis of vagina (n = 8) or SmartMesh (n = 8) via sacrocolpopexy following hysterectomy. Sham-operated animals (n = 12) served as controls. MAIN OUTCOME MEASURES The mesh-vagina complex was removed after 12 weeks and analysed for histomorphology, in situ cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly. RESULTS Relative to sham and the two lower stiffness meshes, Gynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared with sham, implantation with Gynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499 μm versus 866 ± 210 μm, P = 0.02), increased apoptosis particularly in the area of the mesh fibres (P = 0.01), decreased collagen and elastin content (20%, P = 0.03 and 43%, P = 0.02, respectively) and increased total collagenase activity (135%, P = 0.01). Glycosaminoglycan, a marker of tissue injury, was highest with Gynemesh PS compared with sham and other meshes (P = 0.01). CONCLUSION Mesh implantation with the stiffer mesh Gynemesh PS induced a maladaptive remodelling response consistent with vaginal degeneration.
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Affiliation(s)
- R Liang
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA
| | - S Abramowitch
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - K Knight
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Palcsey
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA
| | - A Nolfi
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA
| | - A Feola
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Stein
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA
| | - P A Moalli
- Magee-Womens Research Institute, Department of Obstetrics and Gynecology, School of Medicine, Pittsburgh, PA, USA
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Affiliation(s)
- J Deprest
- Research Unit Biomechanics, Bioimplants and Tissue Engineering, Department of Development and Regeneration, Faculty of Medicine.,Pelvic Floor Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - A Feola
- Research Unit Biomechanics, Bioimplants and Tissue Engineering, Department of Development and Regeneration, Faculty of Medicine
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Skoczylas LC, Jallah Z, Sugino Y, Stein SE, Feola A, Yoshimura N, Moalli P. Regional differences in rat vaginal smooth muscle contractility and morphology. Reprod Sci 2013; 20:382-90. [PMID: 23298869 DOI: 10.1177/1933719112472733] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The objective of this study was to define the regional differences in rat vaginal smooth muscle contractility and morphology. We evaluated circumferential segments from the proximal, middle, and distal rat vagina (n = 21) in vitro. Contractile responses to carbachol, phenylephrine, potassium chloride, and electrical field stimulation (EFS) were measured. Immunohistochemical analyses were also performed. The dose-response curves for carbachol- and phenylephrine-dependent contractions were different in the distal (P = .05, P = .04) compared to the proximal/middle regions. Adjusted for region-dependent changes in contractility, the distal vagina generated lower force in response to carbachol and higher force in response to phenylephrine. There was less force with increasing EFS frequency in the distal (P = .03), compared to the proximal/middle regions. Cholinergic versus adrenergic nerves were more frequent in the proximal region (P = .03). In summary, the results indicate that functional and morphological differences in smooth muscle and nerve fibers of the distal versus proximal/middle regions of the vagina exist.
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Affiliation(s)
- Laura C Skoczylas
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Feola A, Abramowitch S, Jallah Z, Stein S, Barone W, Palcsey S, Moalli P. Deterioration in biomechanical properties of the vagina following implantation of a high-stiffness prolapse mesh. BJOG 2013; 120:224-232. [PMID: 23240801 PMCID: PMC3530836 DOI: 10.1111/1471-0528.12077] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To define the impact of prolapse mesh on the biomechanical properties of the vagina by comparing the prototype Gynemesh PS (Ethicon) to two new-generation lower stiffness meshes, SmartMesh (Coloplast) and UltraPro (Ethicon). DESIGN A study employing a nonhuman primate model. SETTING University of Pittsburgh, PA, USA. POPULATION Forty-five parous rhesus macaques. METHODS Meshes were implanted via sacrocolpopexy after hysterectomy and compared with sham. Because its stiffness is highly directional, UltraPro was implanted in two directions: UltraPro Perpendicular (less stiff) and UltraPro Parallel (more stiff), with the indicated direction referring to the position of the blue orientation lines relative to the longitudinal axis of the vagina. The mesh-vaginal complex (MVC) was excised in toto after 3 months. MAIN OUTCOME MEASURES Active mechanical properties were quantified as the contractile force generated in the presence of 120 mmol/l KCl. Passive mechanical properties (a tissue's ability to resist an applied force) were measured using a multiaxial protocol. RESULTS Vaginal contractility decreased by 80% following implantation with the Gynemesh PS (P = 0.001), 48% after SmartMesh (P = 0.001), 68% after UltraPro Parallel (P = 0.001) and was highly variable after UltraPro Perpendicular (P = 0.16). The tissue contribution to the passive mechanical behaviour of the MVC was drastically reduced for Gynemesh PS (P = 0.003), but not for SmartMesh (P = 0.9) or UltraPro independent of the direction of implantation (P = 0.68 and P = 0.66, respectively). CONCLUSIONS Deterioration of the mechanical properties of the vagina was highest following implantation with the stiffest mesh, Gynemesh PS. Such a decrease associated with implantation of a device of increased stiffness is consistent with findings from other systems employing prostheses for support.
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Affiliation(s)
- A Feola
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Abramowitch
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - Z Jallah
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Stein
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - W Barone
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Palcsey
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA
| | - P Moalli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, Pittsburgh, PA, USA
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Hospital, Magee-Women's Research Institute, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Manodoro S, Endo M, Uvin P, Albersen M, Vláčil J, Engels A, Schmidt B, De Ridder D, Feola A, Deprest J. Graft-related complications and biaxial tensiometry following experimental vaginal implantation of flat mesh of variable dimensions. BJOG 2012; 120:244-250. [DOI: 10.1111/1471-0528.12081] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 12/30/2022]
Affiliation(s)
- S Manodoro
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Clinic of Obstetrics and Gynecology; University of Milan-Bicocca, San Gerardo Hospital; Monza Italy
| | - M Endo
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - P Uvin
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - M Albersen
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - J Vláčil
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - A Engels
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - B Schmidt
- European Competence Center of Healthcare Engineering; Hemmingen Germany
| | - D De Ridder
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
- Pelvic Floor Unit; University Hospitals Leuven; Leuven Belgium
| | - A Feola
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
| | - J Deprest
- Centre for Surgical Technologies, Faculty of Medicine; KU Leuven; Leuven Belgium
- Department of Development and Regeneration, Faculty of Medicine; KU Leuven; Leuven Belgium
- Pelvic Floor Unit; University Hospitals Leuven; Leuven Belgium
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Feola A, Barone W, Moalli P, Abramowitch S. Characterizing the ex vivo textile and structural properties of synthetic prolapse mesh products. Int Urogynecol J 2012; 24:559-64. [PMID: 22885725 DOI: 10.1007/s00192-012-1901-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The use of polypropylene meshes for surgical repair of pelvic organ prolapse (POP) has been limited by complications, including mesh exposure, encapsulation, and pain. Numerous products are available with a wide array of textile and structural properties. It is thought that complications may be related, in part, to mesh structural properties. However, few descriptions of these properties exists to directly compare products. The aim of this study was to determine the textile and structural properties of five commonly used prolapse mesh products using a ball-burst failure protocol. METHODS Porosity, anisotropic index, and stiffness of Gynemesh PS (n = 8), the prototype polypropylene mesh for prolapse repair, was compared with four newer-generation mesh produces: UltraPro (n = 5), SmartMesh (n = 5), Novasilk (n = 5), and Polyform (n = 5). RESULTS SmartMesh was found to be the most porous, at 78 % ± 1.4 %. This value decreased by 21 % for Gynemesh PS (p < 0.001), 14 % for UltraPro and Novasilk (p < 0.001), and 28 % for Polyform (p < 0.001). Based on the knit pattern, SmartMesh and Polyform were the only products considered to be geometrically isotropic, whereas all other meshes were anisotropic. Comparing the structural properties of these meshes, Gynemesh PS and Polyform were the stiffest: 60 % and 42 % stiffer than SmartMesh (p < 0.001) and Novasilk (p < 0.001), respectively. However, no significant differences were found between these two mesh products and UltraPro. CONCLUSIONS Porosity, anisotropy, and biomechanical behavior of these five commonly used polypropylene mesh products were significantly different. This study provides baseline data for future implantation studies of prolapse mesh products.
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Affiliation(s)
- Andrew Feola
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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28
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DI Domenico M, Pierantoni GM, Feola A, Esposito F, Laino L, DE Rosa A, Rullo R, Mazzotta M, Martano M, Sanguedolce F, Perillo L, D'Angelo L, Papagerakis S, Tortorella S, Bufo P, Lo Muzio L, Pannone G, Santoro A. Prognostic significance of N-Cadherin expression in oral squamous cell carcinoma. Anticancer Res 2011; 31:4211-4218. [PMID: 22199283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND N-Cadherin (CDH2) is a calcium-dependent adhesion protein, whose de novo expression, re-expression, up-regulation and down-regulation in human tumors has been demonstrated. The aim of the present work was to define the prognostic role of N-Cadherin in a large series of oral squamous cell carcinomas (OSCCs). MATERIALS AND METHODS A total of 94 selected OSCCs were quantitatively and qualitatively analyzed by immunohistochemistry for N-Cadherin. The association between protein expression and clinico-pathological parameters was assessed by statistical analysis. RESULTS In neoplastic tissue, N-Cadherin levels were more evident than in normal peritumoral epithelium (p<0.05). Protein staining was mainly detected in the neoplastic cells, and only focal nuclear positivity was observed. Expression of cytoplasmic N-Cadherin correlated significantly with poor histological differentiation (p<0.05). Furthermore, we have observed significant a statistical trend for stage and a correlation with worst patient outcome, also confirmed by Kaplan-Meier estimates. CONCLUSION Our work has underlined the key-role of N-Cadherin in oral carcinogenesis and in the prognostic stratification of patients.
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Affiliation(s)
- M DI Domenico
- Department of General Pathology, Second University of Naples, Via L. De Crecchio, 7, 80138 Naples, Italy.
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Feola A, Abramowitch S, Jones K, Stein S, Moalli P. Parity negatively impacts vaginal mechanical properties and collagen structure in rhesus macaques. Am J Obstet Gynecol 2010; 203:595.e1-8. [PMID: 20691414 DOI: 10.1016/j.ajog.2010.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 06/11/2010] [Accepted: 06/15/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the impact of parity on mechanical behavior of the vagina and to correlate these findings with alterations in collagen structure. STUDY DESIGN Mechanical properties of 5 nulliparous and 6 parous rhesus macaques were derived from uniaxial tensile tests. Collagen ratios and alignment were quantified by quantitative fluorescent microscopy and picrosirius red staining. Outcomes were compared by the Student t test or Mann Whitney U test (P < .05) and Spearman's rho for correlation coefficients. RESULTS Mechanical properties were inferior in a parous vs nulliparous vagina with decreased tangent modulus (P = .03), tensile strength (P < .001), and strain energy density (P = .006). Although no difference in collagen ratios (P = .26) were observed, collagen alignment decreased with parity (P = .06). Worsening pelvic organ support negatively correlated with decreasing collagen alignment (r(2) = -0.66) and mechanical properties (r(2) = -0.67). CONCLUSION Vaginal parity is associated with inferior tissue mechanics and loss of collagen alignment. Such behavior likely predisposes to the development of pelvic organ prolapse.
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Affiliation(s)
- Andrew Feola
- Muscular Skeletal Research Center, Department of Bioengineering, University of Pittsburgh, PA, USA
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Feola A, Moalli P, Alperin M, Duerr R, Gandley RE, Abramowitch S. Impact of pregnancy and vaginal delivery on the passive and active mechanics of the rat vagina. Ann Biomed Eng 2010; 39:549-58. [PMID: 20824342 DOI: 10.1007/s10439-010-0153-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 08/21/2010] [Indexed: 12/18/2022]
Abstract
Remodeling of vaginal extracellular matrix and smooth muscle likely plays a critical role in reducing the risk of maternal injury during vaginal delivery by altering the mechanical properties to increase distension and reduce stress. Long-Evans rats were divided into five groups to examine the passive mechanical and active contractile properties throughout pregnancy and postpartum: virgin (n=17), mid-pregnant (Day 14-16, n=12), late-pregnant (Day 20-22, n=14), immediate postpartum (0-2 h after delivery, n=14), and 4 week postpartum (n=15). Longitudinal sections of vaginal tissue were loaded to failure uniaxially for passive mechanical or active contractile properties were examined. For passive mechanics, the tangent modulus decreased 45% by mid-pregnancy and immediately postpartum (p<0.001). The ultimate strain continuously increased up to 43% higher than virgin animals (p=0.007) in the immediate postpartum group. For active mechanics, the maximal contractile force was 36-56% lower through immediate postpartum animals, and was significantly more sensitive to K+ throughout pregnancy and postpartum (p=0.003). The changes observed in the passive and active properties of the rat vagina are consistent with what would be expected from a tissue that is remodeling to maximize its ability to distend at the time of vaginal delivery to facilitate passage of the fetus with minimal injury.
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Affiliation(s)
- Andrew Feola
- Musculoskeletal Research Center, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Alperin M, Feola A, Meyn L, Duerr R, Abramowitch S, Moalli P. Collagen scaffold: a treatment for simulated maternal birth injury in the rat model. Am J Obstet Gynecol 2010; 202:589.e1-8. [PMID: 20510960 PMCID: PMC2921182 DOI: 10.1016/j.ajog.2010.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 03/07/2010] [Accepted: 04/05/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine the impact of a collagen scaffold on the healing response after simulated birth injury in a rodent model. STUDY DESIGN A total of 52 virgin animals were divided into the following groups: control (n = 18), injured untreated (n = 18), and injured treated with porcine small intestinal submucosa (SIS) (n = 16). Histopathology, immunofluorescence of collagens, and vaginal mechanical properties were used to assess the impact of injury and the subsequent healing response. RESULTS Collagen I/V decreased by 44% after birth injury relative to the controls (P = .001). Birth injury resulted in inferior mechanical properties of the vagina with a decrease of 38% in the tangent modulus and 44% in the tensile strength. SIS improved the collagen I/V and I/III ratios by 28% and 46%, respectively, paralleling the trend in the mechanical properties. CONCLUSION Simulated birth injury negatively affected vaginal biochemical and biomechanical properties long term. SIS treatment mitigated the impact of birth injury by enhancing tissue quality.
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Affiliation(s)
- Marianna Alperin
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Alperin M, Feola A, Duerr R, Moalli P, Abramowitch S. Pregnancy- and delivery-induced biomechanical changes in rat vagina persist postpartum. Int Urogynecol J 2010; 21:1169-74. [PMID: 20424824 DOI: 10.1007/s00192-010-1149-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 03/19/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We sought to define changes in vaginal distensibility (VD) induced by pregnancy and vaginal delivery using a novel in vivo biomechanical testing protocol. METHODS Under sedation, a balloon was inserted into the vagina of 27 virgin, pregnant and 4-week postpartum Long-Evans rats and incrementally distended. Pressure-volume curves were generated with slopes characterizing VD (higher slope = less distensible). One-way ANOVA with a Bonferroni post-hoc test were used for statistical analyses. RESULTS Mean pressures at an infusion volume of 1 cc were lower in pregnant and postpartum rats than in virgins (P < 0.001). VD was increased in pregnant vs. virgin rats (P < 0.001) and did not recover to virgin levels post partum (P < 0.001). CONCLUSIONS We have developed a test that measures VD in vivo under clinically relevant loading conditions. The increased VD in the late postpartum period defines a persistent change in biomechanical behavior of the vagina related to pregnancy and vaginal delivery.
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Affiliation(s)
- Marianna Alperin
- Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Jones KA, Feola A, Meyn L, Abramowitch SD, Moalli PA. Tensile properties of commonly used prolapse meshes. Int Urogynecol J 2009; 20:847-53. [PMID: 19495548 PMCID: PMC3028597 DOI: 10.1007/s00192-008-0781-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 11/24/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To improve our understanding of the differences in commonly used synthetic prolapse meshes, we compared four newer generation meshes to Gynecare PS using a tensile testing protocol. We hypothesize that the newer meshes have inferior biomechanical properties. METHODS Meshes were loaded to failure (n = 5 per group) generating load-elongation curves from which the stiffness, the load at failure, and the relative elongation were determined. Additional mesh samples (n = 3) underwent a cyclic loading protocol to measure permanent elongation in response to subfailure loading. RESULTS With the exception of Popmesh, which displayed uniform stiffness, other meshes were characterized by a bilinear behavior. Newer meshes were 70-90% less stiff than Gynecare (p < 0.05) and more readily deformed in response to uniaxial and cyclical loading (p < 0.001). CONCLUSION Relative to Gynecare, the newer generation of prolapse meshes were significantly less stiff, with irreversible deformation at significantly lower loads.
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Affiliation(s)
- Keisha A. Jones
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Reproductive Sciences at Magee Womens Hospital, University of Pittsburgh, PA 15213
| | - Andrew Feola
- Department of Bioengineering, Musculoskeletal Research Center, University of Pittsburgh, PA 15213
| | - Leslie Meyn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Reproductive Sciences at Magee Womens Hospital, University of Pittsburgh, PA 15213
| | - Steven D. Abramowitch
- Department of Bioengineering, Musculoskeletal Research Center, University of Pittsburgh, PA 15213
| | - Pamela A. Moalli
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics & Gynecology and Reproductive Sciences at Magee Womens Hospital, University of Pittsburgh, PA 15213
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Abramowitch SD, Feola A, Jallah Z, Moalli PA. Tissue mechanics, animal models, and pelvic organ prolapse: a review. Eur J Obstet Gynecol Reprod Biol 2009; 144 Suppl 1:S146-58. [PMID: 19285776 DOI: 10.1016/j.ejogrb.2009.02.022] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Pelvic floor disorders such as pelvic organ prolapse, urinary incontinence, and fecal incontinence affect a large number of women each year. The pelvic floor can be thought of as a biomechanical structure due to the complex interaction between the vagina and its supportive structures that are designed to withstand the downward descent of the pelvic organs in response to increases in abdominal pressure. Although previous work has highlighted the biochemical changes that are associated with specific risk factors (i.e. parity, menopause, and genetics), little work has been done to understand the biomechanical changes that occur within the vagina and its supportive structures to prevent the onset of these pelvic floor disorders. Human studies are often limited due to the challenges of obtaining large tissue samples and ethical concerns. Therefore, it is necessary to investigate the use of animal models and their importance in understanding how different risk factors affect the biomechanical properties of the vagina and its supportive structures. In this review paper, we will discuss the different animal models that have been previously used to characterize the biomechanical properties of the vagina: including non-human primates, rodents, rabbits, and sheep. The anatomy and preliminary biomechanical findings are discussed along with the importance of considering experimental conditions, tissue anisotropy, and viscoelasticity when characterizing the biomechanical properties of vaginal tissue. Although there is not a lot of biomechanics research related to the vagina and pelvic floor, the future is exciting due to the significant potential for scientific findings that will improve our understanding of these conditions and hopefully lead to improvements in the prevention and treatment of pelvic disorders.
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Affiliation(s)
- Steven D Abramowitch
- Department of Bioengineering, Musculoskeletal Research Center, University of Pittsburgh, PA 15219, USA.
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