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Sensors (Basel, Switzerland) Jul 2022Bluetooth Low Energy (BLE) mesh networks enable diverse communication for the Internet of Things (IoT). However, existing BLE mesh implementations cannot simultaneously...
Bluetooth Low Energy (BLE) mesh networks enable diverse communication for the Internet of Things (IoT). However, existing BLE mesh implementations cannot simultaneously achieve low-power operation, symmetrical communication, and scalability. A major limitation of mesh networks is the inability of the BLE stack to handle network-scalable time synchronization. Pulse-coupled oscillators (PCOs) have been studied extensively and are able to achieve fast and reliable synchronization across a range of applications and network topologies. This paper presents a lightweight physical (PHY) layer accelerator to the BLE stack that enables scalable synchronization command with a PCO. The accelerator is a fully digital solution that can be synthesized with only the standard cells available in any silicon technology. This paper provides a detailed analysis of PCO-based BLE mesh networks and explores per-node system-level requirements. Finally, the analytical results are validated with measurements of a custom radio node based on the ubiquitous AD9364 transceiver.
Topics: Surgical Mesh; Wireless Technology
PubMed: 35891003
DOI: 10.3390/s22145324 -
BJS Open Jul 2023Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Incisional hernia is a common short- and long-term complication of laparotomy and can lead to significant morbidity. The aim of this systematic review and meta-analysis is to provide an up-to-date overview of the laparotomy closure method in elective and emergency settings with the prophylactic mesh augmentation technique.
METHODS
The Scopus, PubMed, and Web of Science databases were screened without time restrictions up to 21 June 2022 using the keywords 'laparotomy closure', 'mesh', 'mesh positioning', and 'prophylactic mesh', and including medical subject headings terms. Only RCTs reporting the incidence of incisional hernia and other wound complications after elective or emergency midline laparotomy, where patients were treated with prophylactic mesh augmentation or without mesh positioning, were included. The primary endpoint was to explore the risk of incisional hernia at different follow-up time points. The secondary endpoint was the risk of wound complications. The risk of bias for individual studies was assessed according to the Revised Cochrane risk-of-bias tools for randomized trials.
RESULTS
Eighteen RCTs, including 2659 patients, were retrieved. A reduction in the risk of incisional hernia at every time point was highlighted in the prophylactic mesh augmentation group (1 year, risk ratio 0.31, P = 0.0011; 2 years, risk ratio 0.44, P < 0.0001; 3 years, risk ratio 0.38, P = 0.0026; 4 years, risk ratio 0.38, P = 0.0257). An increased risk of wound complications was highlighted for patients undergoing mesh augmentation, although this was not significant.
CONCLUSIONS
Midline laparotomy closure with prophylactic mesh augmentation can be considered safe and effective in reducing the incidence of incisional hernia. Further trials are needed to identify the ideal type of mesh and technique for mesh positioning, but surgeons should consider prophylactic mesh augmentation to decrease incisional hernia rate, especially in high-risk patients for fascial dehiscence and even in emergency settings.
PROSPERO REGISTRATION ID
CRD42022336242 (https://www.crd.york.ac.uk/prospero/record_email.php).
Topics: Humans; Incisional Hernia; Laparotomy; Surgical Mesh; Incidence; Abdominal Wound Closure Techniques
PubMed: 37504969
DOI: 10.1093/bjsopen/zrad060 -
Ugeskrift For Laeger Jan 2022This is a review of temporary abdominal closure (TAC) strategies are necessary in cases where definitive surgery is not possible. Indications for TAC include damage... (Review)
Review
This is a review of temporary abdominal closure (TAC) strategies are necessary in cases where definitive surgery is not possible. Indications for TAC include damage control due to unstable physiology, the need for a second look, or lacking technical possibility for fascial closure. The superior method of TAC is vacuum-assisted closure (VAC), with or without a traction mesh. All TAC strategies, including VAC, are associated with an increased number of surgical procedures, increased risk of complications, and prolonged length of stay. TAC should be limited to selected patients and performed by senior surgeons.
Topics: Abdomen; Humans; Negative-Pressure Wound Therapy; Open Abdomen Techniques; Surgical Mesh; Traction
PubMed: 35088692
DOI: No ID Found -
Medicine Nov 2022Laparoscopic Nissen fundoplication and esophagoplasty are the standards for gastroesophageal reflux disease (GERD) and hiatal hernia (HH) repair. Biologically derived...
Laparoscopic Nissen fundoplication and esophagoplasty are the standards for gastroesophageal reflux disease (GERD) and hiatal hernia (HH) repair. Biologically derived mesh is also associated with reduced recurrence. This study attempted to evaluate the effectiveness of a biological mesh in the 4K laparoscopic repair of HH. This retrospective study reviewed patients with a severe GERD complicated with HH from August 2019 to August 2020. All patients underwent the HH repair using a biological mesh under a 4K laparoscope accompanying Nissen fundoplication. Up to 16 months postoperatively, GERD-health-related quality-of-life (GERD-HRQL) scale, radiologic studies on HH recurrence, and symptoms were recorded. The mean surgical time and postoperative hospital stay were 70.9 ± 8.72 min, 4.8 ± 0.76 days, respectively. The postoperative symptom relief rate was 96.5%, and no recurrence exhibited during follow-up. Dysphagia occurred in 10 (9.43%) patients. There were no intraoperative vagus nerve injury or postoperative complications, mesh infection, and reoperation for mesh. The tension-free repair of HH with the biological mesh is an option for clinical use, with effectiveness and few short-term complications being reported.
Topics: Humans; Hernia, Hiatal; Herniorrhaphy; Surgical Mesh; Retrospective Studies; Gastroesophageal Reflux
PubMed: 36397386
DOI: 10.1097/MD.0000000000031782 -
Journal of Biomechanical Engineering Aug 2020The vagina is an important organ of the female reproductive system that has been largely understudied in the field of biomechanics. In recent years, some research has...
The vagina is an important organ of the female reproductive system that has been largely understudied in the field of biomechanics. In recent years, some research has been conducted to evaluate the mechanical properties of the vagina, but much has focused on characterizing the passive mechanical properties. Because vaginal contractions play a central role in sexual function, childbirth, and development and treatment of pelvic floor disorders, the active mechanical properties of the vagina must be also quantified. This review surveys and summarizes published experimental studies on the active properties of the vagina including the differences in such properties determined by anatomic regions and orientations, neural pathways, life events such as pregnancy and menopause, pelvic floor disorders such as prolapse, and surgical mesh treatment. Conflicting experimental findings are presented, illustrating the need for further research on the active properties of the vagina. However, consensus currently exists regarding the negative impact of surgical mesh on vaginal contractility. This review also identifies knowledge gaps and future research opportunities, thus proving a firm foundation for novice and experienced researchers in this emerging area of biomechanics and encouraging more activity on women's sexual and reproductive health research.
Topics: Female; Humans; Muscle Contraction; Pelvic Organ Prolapse; Pregnancy; Surgical Mesh; Vagina
PubMed: 32203570
DOI: 10.1115/1.4046712 -
Ultrasound in Obstetrics & Gynecology :... Apr 2021Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this... (Review)
Review
Imaging is used increasingly in urogynecology. One of the main applications is in the assessment of synthetic implants. Ultrasound is particularly useful for this purpose as most such implants appear highly echogenic on ultrasound but are not visible using other imaging techniques. The worldwide success of synthetic mid-urethral slings, introduced in the late 90s, led to the subsequent introduction of transvaginal mesh in 2003-2004. Widespread use of synthetic implants for both urinary incontinence and prolapse has caused a rise in implant-related complications and increasing negative publicity and litigation, with many products removed from the market. It is not surprising that there is increasing demand for the assessment and evaluation of sling and mesh implants using imaging. This review article discusses the role of translabial/transperineal ultrasound in the evaluation of synthetic implants used in the treatment of urinary incontinence and pelvic organ prolapse. The discussion focuses on those applications of the technique that are useful for surgeons dealing with patients after mesh and/or sling placement. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Female; Gynecology; Humans; Pelvic Organ Prolapse; Postoperative Complications; Suburethral Slings; Surgical Mesh; Ultrasonography; Urinary Incontinence
PubMed: 33206433
DOI: 10.1002/uog.23545 -
International Urogynecology Journal Sep 2022This study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data.
INTRODUCTION AND HYPOTHESIS
This study reports the long-term anatomic and subjective outcomes following sacrocolpopexy based on mesh weight and provides device-specific data.
METHODS
This cohort study compared ultra-lightweight (≤ 20 g/m) with lightweight mesh (≥ 25 g/m). The primary outcome was composite failure defined as at least one of ≥ stage 2 apical prolapse, anterior or posterior vaginal wall beyond hymen, complaint of bulge or retreatment. Effect measure estimates were calculated as the incidence rate ratio of composite failure comparing the use of ultra-light with lightweight mesh. Crude and adjusted incidence rate ratios (IRRs) were obtained using uni- and multivariable Poisson regression models.
RESULTS
Of 358 women who met inclusion criteria, 220 (61%) agreed to attend for review; 95 (43%) had ultra-lightweight mesh and 125 (57%) had lightweight mesh including Upsylon. Median follow-up for ultra-light and lightweight mesh was 36 (IQR 22-42) and 63 (IQR 48-87) months, respectively (p < 0.001). Accounting for differences in follow-up time, there was no significant difference in composite failure between ultra-light and lightweight mesh groups (IRR 1.47, 95% CI 0.83-2.52, p = 0.15). This persisted after adjustment for age, body mass index, parity, smoking and presence of advanced prolapse prior to surgery (IRR 1.52, 95% CI 0.94-2.47, p = 0.087). Mesh exposure for both groups was mostly asymptomatic, and the rate was 7% for the ultra-light group and 8% in the lightweight group. Overall, repeat surgery for recurrent apical prolapse and mesh exposure occurred in 4% and 2%, respectively.
CONCLUSIONS
Ultra-lightweight mesh appears to have similar incidence rate of failure compared to lightweight mesh. Upsylon mesh has a similar low rate of recurrent apical prolapse and mesh exposure.
Topics: Cohort Studies; Female; Gynecologic Surgical Procedures; Humans; Pelvic Organ Prolapse; Surgical Mesh; Treatment Outcome; Vagina
PubMed: 35445355
DOI: 10.1007/s00192-022-05182-w -
International Urogynecology Journal Dec 2020The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in...
INTRODUCTION AND HYPOTHESIS
The paucity of long-term safety and efficacy data to support laparoscopic mesh sacrohysteropexy is noteworthy given concerns about the use of polypropylene mesh in pelvic floor surgery. This study is aimed at determining the incidence of mesh-associated complications and reoperation following this procedure.
METHODS
This was a cross-sectional postal questionnaire study of women who underwent laparoscopic mesh sacrohysteropexy between 2010 and 2018. Potential participants were identified from surgical databases of five surgeons at two tertiary urogynaecology centres in the UK. The primary outcome was patient-reported mesh complication requiring removal of hysteropexy mesh. Secondary outcomes included other mesh-associated complications, reoperation rates and Patient Global Impression of Improvement (PGI-I) in prolapse symptoms. Descriptive statistics and Kaplan-Meier survival analyses were used.
RESULTS
Of 1,766 eligible participants, 1,121 women responded (response proportion 63.5%), at a median follow-up of 46 months. The incidence of mesh complications requiring removal of hysteropexy mesh was 0.4% (4 out of 1,121). The rate of chronic pain service use was 1.8%, and newly diagnosed systemic autoimmune disorders was 5.8%. The rate of reoperation for apical prolapse was 3.7%, and for any form of pelvic organ prolapse it was 13.6%. For PGI-I, 81.4% of patients were "much better" or "very much better".
CONCLUSIONS
Laparoscopic mesh sacrohysteropexy has a low incidence of reoperation for mesh complications and apical prolapse, and a high rate of patient-reported improvement in prolapse symptoms. With appropriate clinical governance measures, the procedure offers an alternative to vaginal hysterectomy with apical suspension. However, long-term comparative studies are still required.
Topics: Cross-Sectional Studies; Female; Gynecologic Surgical Procedures; Humans; Laparoscopy; Pelvic Organ Prolapse; Reoperation; Surgical Mesh; Treatment Outcome
PubMed: 32620978
DOI: 10.1007/s00192-020-04396-0 -
Hernia : the Journal of Hernias and... Feb 2022Before being marketed, hernia mesh must undergo in vivo testing, which often includes biomechanical and histological assessment. Currently, there are no universal... (Review)
Review
PURPOSE
Before being marketed, hernia mesh must undergo in vivo testing, which often includes biomechanical and histological assessment. Currently, there are no universal standards for this testing and methods vary greatly within the literature. A scoping review of relevant studies was undertaken to analyse the methodologies used for in vivo mesh testing.
METHODS
Medline and Embase databases were searched for relevant studies. 513 articles were identified and 231 duplicates excluded. 126 papers were included after abstract and full text review. The data extraction was undertaken using standardised forms.
RESULTS
Mesh is most commonly tested in rats (53%). 78% of studies involve the formation of a defect; in 52% of which the fascia is not opposed. The most common hernia models use mesh to bridge an acute defect (50%). Tensile strength testing is the commonest form of mechanical testing (63%). Testing strip widths and test speeds vary greatly (4-30 mm and 1.625-240 mm/min, respectively). There is little consensus on which units to use for tensile strength testing. Collagen is assessed for its abundance (54 studies) more than its alignment (18 studies). Alignment is not measured quantitatively. At least 21 histological scoring systems are used for in vivo mesh testing.
CONCLUSIONS
The current practice of in vivo mesh testing lacks standardisation. There is significant inconsistency in every category of testing, both in methodology and comparators. We would call upon hernia organisations and materials testing institutions to discuss the need for a standardised approach to this field.
Topics: Animals; Hernia; Herniorrhaphy; Humans; Materials Testing; Prostheses and Implants; Rats; Surgical Mesh; Tensile Strength
PubMed: 33433739
DOI: 10.1007/s10029-020-02360-x -
Biomaterials Advances May 2024Currently, in vitro testing examines the cytotoxicity of biomaterials but fails to consider how materials respond to mechanical forces and the immune response to them;...
Currently, in vitro testing examines the cytotoxicity of biomaterials but fails to consider how materials respond to mechanical forces and the immune response to them; both are crucial for successful long-term implantation. A notable example of this failure is polypropylene mid-urethral mesh used in the treatment of stress urinary incontinence (SUI). The mesh was largely successful in abdominal hernia repair but produced significant complications when repurposed to treat SUI. Developing more physiologically relevant in vitro test models would allow more physiologically relevant data to be collected about how biomaterials will interact with the body. This study investigates the effects of mechanochemical distress (a combination of oxidation and mechanical distention) on polypropylene mesh surfaces and the effect this has on macrophage gene expression. Surface topology of the mesh was characterised using SEM and AFM; ATR-FTIR, EDX and Raman spectroscopy was applied to detect surface oxidation and structural molecular alterations. Uniaxial mechanical testing was performed to reveal any bulk mechanical changes. RT-qPCR of selected pro-fibrotic and pro-inflammatory genes was carried out on macrophages cultured on control and mechanochemically distressed PP mesh. Following exposure to mechanochemical distress the mesh surface was observed to crack and craze and helical defects were detected in the polymer backbone. Surface oxidation of the mesh was seen after macrophage attachment for 7 days. These changes in mesh surface triggered modified gene expression in macrophages. Pro-fibrotic and pro-inflammatory genes were upregulated after macrophages were cultured on mechanochemically distressed mesh, whereas the same genes were down-regulated in macrophages exposed to control mesh. This study highlights the relationship between macrophages and polypropylene surgical mesh, thus offering more insight into the fate of an implanted material than existing in vitro testing.
Topics: Humans; Materials Testing; Surgical Mesh; Polypropylenes; Biocompatible Materials; Macrophages; Urinary Incontinence, Stress
PubMed: 38377947
DOI: 10.1016/j.bioadv.2024.213800