Explantation Rate Research Articles

Open vs. Robot-Assisted Artificial Urinary Sphincter Implantation in Women with Stress Urinary Incontinence: A Multicenter Comparative Study.

Background: The artificial urinary sphincter has been an effective treatment for stress urinary incontinence caused by intrinsic sphincter deficiency in women. However, the use of this device has been limited by the technical difficulties and risks associated with the open implantation procedure. Preliminary studies using robotic techniques have shown promising results, but only one small study has compared robotic to open procedures. This study aims to compare the outcomes of robotic and open artificial urinary sphincter implantation in women with stress urinary incontinence due to intrinsic sphincter deficiency in a large multicenter cohort. Methods: Data were collected retrospectively from female patients who underwent open or robot-assisted artificial urinary sphincter implantation from 2006 to 2020 at 12 urology departments. The primary outcome was the rate of complications within 30 days after surgery, graded using the Clavien-Dindo Classification. Perioperative and functional outcomes were compared between the two groups. Results: A total of 135 patients were included, with 71 in the robotic group and 64 in the open group. The open group had a higher rate of intraoperative complications (27.4% vs. 12.7%; p = 0.03) and postoperative complications (46.8% vs. 15.5%; p < 0.0001). More patients in the robotic group achieved full continence (83.3% vs. 62.3%; p = 0.01). The open group had higher explantation (27.4% vs. 1.4%; p < 0.0001) and revision rates (17.5% vs. 5.6%; p = 0.02). The estimated 1-year explantation-free survival rate was higher in the robotic group. (98.6% vs. 78.3%; p = 0.001). Conclusions: Robot-assisted implantation may reduce perioperative morbidity and improve functional outcomes compared to open implantation in women with stress urinary incontinence.

Effect of Salicylic Acid in Inhibiting Fungal Contamination in in vitro Cultures of Date Palm (Phoenix dactylifera L.) and Enhancing Embryogenesis and Plantlet Development

Abstract In this study, we evaluated the role of salicylic acid in diminishing fungal contamination in in vitro cultures of date palm and the effect of salicylic acid on the regeneration of somatic embryos from callus formed on shoot tips. The most prevalent fungi were Alternaria alternata (37%), Fusarium solani (25%), Aspergillus fumigatus (18%), and Penicillium expansum (6%). Salicylic acid limited and at higher concentrations retarded mycelial growth using potato dextrose agar. Salicylic acid at concentrations of 1.5 and 2.0 mM added to MS medium with 2iP and NAA significantly increased the embryogenesis rate of calli explants to 64.9% and 56.7%, respectively, compared with the control (12.3%). Salicylic acid also increased plantlet development from embryos by about 27% compared with the control. Salicylic acid caused better shoot and root growth and increased chlorophyll content. The results showed that the addition of salicylic acid at 1.5 mM to the MS medium resulted in a significant increase in the concentrations of IAA and ABA, as well as a decrease in the concentration of IBA in leaves.

Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain Secondary to Endometriosis.

Chronic pelvic pain (CPP) is a multifaceted condition that poses significant challenges in clinical management owing to its complex and varied pathophysiology, including neuropathic, somatic, visceral, and musculoskeletal components. Endometriosis is frequently associated with CPP, necessitating a comprehensive, multimodal treatment strategy. This approach typically includes physical and behavioral therapy, pharmacologic interventions, surgical management of endometriosis, and various pain-modulating procedures. Neuromodulation, particularly spinal cord stimulation (SCS), has been used in refractory cases; however, its use is often met with limited success and a notable rate of explants. This case series presents nine patients with intractable CPP secondary to endometriosis, unresponsive to conventional treatments, who were treated with dorsal root ganglion stimulation (DRG-S). Between 2022 and 2023, ten patients with severe CPP secondary to endometriosis, unresponsive to various multimodal treatments-including previous interventional pain procedures, gynecologic surgery, and in some cases, SCS-were recruited for this prospective study. Of these, nine patients underwent permanent DRG-S, with bilateral L1 and S2 DRG-S leads placed (four leads per patient). Patients were assessed for pain intensity using the visual analog scale (VAS), narcotic consumption, and quality of life (QoL) using the 12-item short-form (SF-12) survey, with a 12-month follow-up period. Nonparametric statistical analyses were conducted using SPSS. One patient was excluded from the study owing to a lack of pain relief during the DRG-S trial. The remaining nine patients underwent permanent bilateral L1 and S2 DRG-S placement. Significant improvement in pain scores was observed and sustained throughout the follow-up period (VAS 9± 1.5-2± 2.0; p= 0.003), along with a marked reduction in opioid consumption, with four patients becoming completely free of narcotics (p= 0.046). SF-12 physical scores improved by 60.2± 7.8 (p= 0.006), and SF-12 mental scores improved by 45.9± 2.76 (p= 0.01). Bilateral L1 and S2 DRG-S yielded robust and sustained outcomes, including significant improvements in pain scores, reduced narcotic consumption, and enhanced QoL over a 12-month follow-up period.

Artificial urinary sphincter implantation after transperineal open reconstruction of post-prostatectomy vesicourethral anastomotic stenosis

Purpose This study evaluates the effectiveness of artificial urinary sphincter (AUS) implantation following transperineal reanastomosis in men with vesicourethral anastomotic stenosis (VUAS) and stress urinary incontinence (SUI) after radical prostatectomy (RP), focusing on long-term explantation rates and urinary continence. Methods Patients treated between 2009 and 2020 were retrospectively analyzed. Those undergoing AUS implantation post-transperineal reanastomosis for recurrent VUAS, excluding cases with prior pelvic irradiation and overactive bladder, were included. Primary outcomes were AUS explantation rates and patient-reported continence. Median follow-up was calculated using reverse Kaplan-Meier estimates, and explantation-free survival illustrated via Kaplan-Meier analyses. Results At final follow-up, 19 patients were included at a median follow-up of 79 months. Explantation occurred in 16% (N = 3) of cases, with a median time to explantation of 107 months. No urethral erosion was observed. Explantation-free survival at 2, 5, and 10 years was 100%, 87%, and 73%, respectively. The median number of pads/day decreased significantly postoperatively, with 78% (N = 14) reporting subjective continence and 89% (N = 16) achieving social continence. Conclusion AUS implantation following transperineal reanastomosis for VUAS post-RP offers favorable long-term outcomes, with low explantation rates and no erosion, making it a viable management strategy.

In vitro proparation of pear (Pyrus L.)

Background. The micropropagation methods are used for the conservation of Pyrus L. phytodiversity, as well as for the creation of collections of the threatened species and pear cultivars including genotypes necessary for breeding and genetic studies. Materials and Methods. The two Pyrus species, P. communis, and P. salicifolia Pall. as well as four pear P. communis cultivars, ’Bere Desiatova’, ’Umans’ka Juvileina’, ’Kniahynia Olga’, and ’Sofia Umans’ka’, were chosen as the experimental plants. Young shoots of Pyrus species and cultivars with apical meristem from three-year-old plants were used as primary explants. The effectiveness of sterilization was determined by the rate of sterile and viable explants. Rooted in vitro test tube shoots with 3–4 roots 2–5 cm long were transplanted to adapt into nutrient disks Jiffy-7 and Ellepress. The statistical analysis of the results was performed according to Ronald Fisher (2017) and Peter Bruce with co-workers (Bruce et al., 2020) using Statistica ver.10 (StatSoft, Inc. STATISTICA version 10.0). Results and Discussion. According to our results, mercury dichloride (HgCl2) was the most effective of all tested sterilizers of P. communis. The P. communis explants steri­lization technique was extremely difficult or unsuccessful for P. salicifolia, probably due to the dense pubescence on shoots and buds of this species. Therefore, we used the seeds as explants for micropropagation of P. salicifolia according to the standard protocol. In the best variant of Murashige–Skoog (MS) medium modification for P. communis, where MS-276 was modified by 2.0 mg/L 6-benzylaminopurine (6-BAP) and 0.01 mg/L indole-3-butyric acid (IBA), a value of 9.50 microclones per passage was obtained. However, the most active shoot formation of P. salicifolia in vitro was observed in the variant where the Driver and Kuniyuki (DKW) medium was modified by adding 2.5 mg/L 6-BAP. To induce rhizogenesis, the best medium for P. communis and P. salicifolia rhizogenesis was MS-302, modified by the addition of 0.5 mg/L α-naphthaleneacetic acid (NAA). In this variant, the first root in microclones developed in 8–10 days, and after a month, rooting reached 87.50% of P. communis and 98.54 % of P. salicifolia. The efficiencies of both Pyrus species adaptation were better with Ellepress peat plugs, than with Jiffy-7 peat pellets. Conclusion. It is recommended to cultivate explants of P. communis on MS medium with the addition of 2.0 mg/L 6-BAP and 0.01 mg/L IBA, and P. salicifolia on DKW medium with the addition of 2.5 mg/L 6-BAP and 0.1 mg/L IBA. It is also recommended that MS medium with the addition of 0.5 mg/L NAA be used for rooting of the microclones of both Pyrus species, and Ellepress peat plugs for the adaptation of regenerated plants.

Cost Savings in Chronic Pain Patients Initiating Peripheral Nerve Stimulation (PNS) with a 60-Day PNS Treatment.

This study evaluates the financial impact on healthcare payers when chronic pain patients initiate peripheral nerve stimulation (PNS) with a 60-day percutaneous PNS (60-Day PNS) treatment versus a conventional brief PNS trial (PNS-BT) with possible follow-on of a permanently implanted PNS system (PNS-PI). Centers for Medicare & Medicaid Services (CMS) fee-for-service (FFS) data were analyzed to identify patients with at least 12months of follow-up (median 26.4months) who initiated PNS treatment with: (1) 60-Day PNS or (2) PNS-BT. An economic decision tree model assessed the cost to payers in each cohort. Clinical response to 60-Day PNS was estimated by retrospectively reviewing anonymized outcomes from a national real-world database, focusing on patients≥65years of age who were implanted with a 60-day percutaneous PNS system. For the economic model, a Monte Carlo simulation with 10,000 iterations was used to generate 95% confidence intervals, considering variability in treatment outcome probability and costs. Based on CMS data, among 60-Day PNS patients, 18% (229/1265) proceeded to a permanently implanted PNS system with a 4% explant rate (10/229). Among PNS-BT patients, 41% (1140/2811) received a permanent implant with a 7% rate of explant (77/1140). Estimated PNS-related weighted average costs for the 60-Day PNS cohort [US$17,344; 95% confidence interval (CI): $16,168-$18,527] were lower than the PNS-BT cohort ($24,392; 95% CI $22,865-$25,941) when considering the percent of patients who advanced to a permanently implanted PNS system. The total cost per successful outcome also favored 60-Day PNS ($25,228 per success for the 60-Day PNS cohort vs. $64,502 per success for the PNS-BT cohort) as a first-line approach in PNS treatment. The findings suggest that, when PNS for chronic pain is warranted, initiating PNS with a 60-day treatment is more cost-effective than utilizing a brief conventional trial.

Comparative analysis of 333 proGAV® and proGAV 2.0® adjustable valves in pediatric hydrocephalus treatment: survival and complication rate assessment

ObjectiveProGAV and ProGAV2.0 adjustable valves are extensively used for treating hydrocephalus in pediatric patients. This study aims to conduct a comprehensive comparison between these two valves concerning their survival and complication rates.MethodsThis retrospective study included all pediatric patients who underwent ProGAV or ProGAV2.0 valve implantation at our neurosurgical clinic from August 2008 to August 2020. A comparative analysis was performed considering age, gender, follow-up duration, complication and survival rates, adjustments, spontaneous adjustments, and adjustment difficulty rates. All valves were followed up for a maximum of 3 years.ResultsInclusion involved 333 cases (mean age of 5.4 ± 5.1 years; 54.1% males), comprising 173 cases (52.0%) with ProGAV valve implantation and 160 cases (48.0%) with ProGAV 2.0. Early complications within the first month post-implantation were observed in 51 cases (15.3%). No significant differences were noted in valve implantation indications, age distribution, or survival duration (27.1 vs. 27.8 months, p = 0.629) between the two groups. Predominant indications for implantation were post-hemorrhagic hydrocephalus and aqueduct stenosis for both valve types. Notably, both valves showed non-significantly different explantation rates during the first three years after implantation (34.7% vs. 29.7%, p < 0.289). However, there was a significantly higher early post-implantation complication rate (22% vs. 9.4%, p = 0.002), and a significantly increased association with difficulties in valve adjustments and spontaneous adjustments (p = 0.041 and 0.011, respectively). ProGAV2.0 cases displayed notably enhanced clinical and radiological improvement within the initial 6 months after implantation (p = 0.001 and p = 0.038). Younger children (< 2 years of age) also experienced significantly more valve adjustment difficulties (p = 0.049) and had higher rates of valve explantation (p < 0.001).ConclusionThe findings of this study highlight the superior performance of the ProGAV2.0 valve in terms of complication rate and maladjustment rate when employed in the treatment of pediatric hydrocephalus. Both valves demonstrated an acceptable survival rate with 65.3% for ProGAV and 71.3% for ProGAV2.0 within three years of implantation.

Efficacy and Safety of Artificial Urinary Sphincters in Female Patients With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Stress urinary incontinence (SUI) significantly affects the quality of life in women, causing social, psychological, and physical distress. While artificial urinary sphincter (AUS) implantation is a well-established treatment for male incontinence, it is less commonly used in female patients and is typically considered for cases where other treatments have failed. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of AUS implantation in treating SUI in female patients, focusing on continence rates, revision rates, explant rates, and perioperative complications. A comprehensive literature search was conducted across PubMed, Scopus, Google Scholar, and the Cochrane Library in September 2024. Studies published in English over the past 15 years were included if they reported outcomes such as continence, revision, explant, and complication rates in female patients who underwent AUS implantation. Data were analyzed using Review Manager 5.4, applying a fixed-effects model where appropriate, based on heterogeneity (I2 > 50%). Publication bias was assessed using funnel plots and Egger's test. Eight studies, comprising a total of 300 female patients, were included in the analysis. AUS implantation significantly improved continence rates, achieving an overall continence rate of 72% (OR = 0.01, 95% CI: 0.00 to 0.02; p < 0.00001). Revision rates were 22.5%, explant rates were 17.6%, and overall postoperative complications were 26.3%. No significant bias was detected. AUS implantation is an effective and safe treatment option for a specific group of women with SUI, particularly in cases where other standard treatments have failed. It shows satisfactory continence rates with considerable revision and explant rates. However, further large-scale, long-term studies are needed to optimize outcomes and confirm these findings.

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI. Level of evidence4.

Complication and Explantation Rates of Penile Prostheses in Transmasculine Patients: A Meta-analysis

ObjectiveTo synthesize current literature on penile prosthesis implantation post-gender affirming phalloplasty to correlate implant types and complication rates. MethodsA meta-analysis of penile prosthesis in transmasculine patients was initiated in December 2022. Inclusion criteria encompassed randomized clinical trials, cohort studies, and cross-sectional studies reporting on penile prosthesis complications post-gender-affirming phalloplasty. Exclusion criteria were review articles, meta-analyses, studies that exclusively reported on cisgender patients or surgeries other than penile prosthesis implantation. An initial search of five databases yielded a total of 1593 articles. Upon screening, 15 full-text articles were eligible for inclusion. 9 studies were included in the analysis. ResultsThe overall complication rate for the inflatable prosthesis group was 38% (95% CI: 21, 59) and for the malleable prosthesis group was 37% (95% CI: 18, 62). The most probable complications in the inflatable group were infection (14.5%), dysfunction (12.9%), dislocation (5.7%), and leakage (5.4%). The most probable complications in the malleable group were dislocation (14.9%), infection (11.2%), dysfunction (9.1%), and extrusion (7.6%). There was no significant difference in the probability of any complications between the malleable and inflatable prosthesis groups.The best estimate of explantation rates for any reason for the inflatable group was 19% (95% CI: 9, 38) and for the malleable group 13% (95% CI: 4, 33). There was no significant difference in the probability of any reason for explantation between the malleable and inflatable prosthesis groups.

(277) CHLORHEXIDINE JET LAVAGE AND CONVENTIONAL ANTIMICROBIAL SOLUTIONS IN IPP SURGERY: SIMILAR EXPLANT RATE BUT DIFFERENT INFLAMMATORY RESPONSE

Abstract Introduction Infection remains a significant concern in inflatable penile prosthesis (IPP) surgery. Chlorhexidine gluconate jet lavage has seen increasing use as an intraoperative antimicrobial irrigation solution and dip for hydrophilic implants, and has been proposed as a measure to mitigate postoperative infections. However, the data supporting its effectiveness in reducing infection rates remains mixed. Objective This study aims to investigate the association between the use of this solution and its effect on infection relative to traditional antimicrobials during IPP implantation at a high-volume academic practice. Methods A retrospective analysis was conducted on data from patients who underwent IPP surgery from a single surgeon at a tertiary care center from 2020 to 2023. Patient records were reviewed to identify those who had suspected or confirmed postoperative IPP infection. The incidence of postoperative explant due to infection was recorded and compared between patients who received chlorhexidine irrigation and dip and those who received conventional antimicrobials (rifampin, gentamicin +/- amphotericin B irrigation, and rifampin + gentamicin dip for hydrophilic implants). Postoperative inflammatory markers including white blood count (WBC), C-reactive protein (CRP), and procalcitonin were also assessed in postoperative patients who experienced persistent pain or inflammation beyond the normal expected postoperative course and were compared between groups. Statistical analysis was done using RStudio. Fisher’s exact test was employed to calculate p-value. Results Of 207 patients who underwent IPP during the study period, 46% (n = 95) received chlorhexidine lavage and dip and 54% (n = 112) received conventional antimicrobial solution. Of the 207 patients, 10% (n = 21) exhibited at least one exam finding or pain concerning for possible device infection and 2.4% (n = 5) required IPP explant. We found that among the patients suspected for possible infection, 12.6% (n = 12) had received chlorhexidine solution compared to 8% (n = 9) of the conventional antimicrobial group (p = 0.35). Explant rates overall for infection were 3.2% for the chlorhexidine group compared to 1.8% for the conventional antibiotic (p = 0.66). In the subgroup of patients suspected of infection (n = 21), there was no statistically significant difference in the elevation of WBC, CRP and procalcitonin between those treated with chlorhexidine lavage and dip and those treated with the conventional antimicrobials (p = 0.27, p = 0.27, p = 0.24) (table 1.) Conclusions In our single-center cohort of patients undergoing IPP, use of chlorhexidine lavage and dip was associated with a comparable rate of infections and postoperative inflammatory findings compared to conventional antimicrobials. Given the relatively low rate of infections, larger, prospective multi-center studies are needed to better evaluate the safety and efficacy of chlorhexidine solution for preventing postoperative IPP infection. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific.

Multidevice spinal cord stimulation trials: shared decision making in the era of multiple neuromodulation paradigms.

Aim: There is a lack of evidence-based standards for matching spinal cord stimulation (SCS) paradigm to individual patients. We aim to determine the feasibility and safety of a new alternative trial strategy, a sequential multidevice trial.Materials & methods: A retrospective analysis was performed on 116 patients who underwent SCS trials, single device or sequential multidevice (tonic and high-frequency), for chronic low back pain to assess feasibility and compare trial-to-implantation rate and explantation rate.Results: Multidevice SCS trials are feasible and safe. There was no statistically significant difference in the trial-to-implantation and explantation rates between the two groups.Conclusion: Multidevice SCS trial, prioritizing patient preference, may serve as an alternative trial strategy to improve long-term success of SCS.

Long-term explantation risk in patients with chronic pain treated with spinal cord or dorsal root ganglion stimulation

ObjectiveTo investigate long-term explantation risks and causes for the explantation of neuromodulation devices for the treatment of chronic pain from different manufacturers.MethodsThis retrospective analysis included patients implanted with a system...

Standard Total Ankle Arthroplasty vs. Patient-Specific Instrumentation: A Comparative Study.

This retrospective study aims to compare surgical outcomes between two cohorts of patients who underwent total ankle arthroplasty (TAA) using either standard technique or patient-specific instrumentation (PSI). A consecutive series of patients who affected of end-staged ankle osteoarthritis were retrospectively assessed and divided into two groups based on TAA techniques: a TAA standard technique group and a TAA-using PSI group. The two groups were compared in terms of operative time, additional procedures, complications (neurovascular and wound problems, infection, loosening and osteolysis, revision and explantation rates, and perioperative fracture), clinical scores, and range of motion (ROM). Fifty-one patients underwent standard TAA, while 13 patients underwent TAA with PSI. At 1-year follow-up, there were no significant differences in complication rates between the two groups (p > 0.05). AOFAS scores were similar, with the standard TAA group scoring 83.33 ± 7.55 and the PSI group scoring 82.92 ± 9.7 (p = 0.870). Likewise, the postoperative ROM did not differ significantly, with 15.12 ± 7.6 degrees for the standard TAA group and 16.05 ± 6.7 degrees for the PSI group (p = 0.689). However, the standard TAA group experienced significantly longer operative time (107.1 ± 22.1 min) compared to the PSI group (91.92 ± 22.9 min, p = 0.032). Additionally, the standard TAA group required more adjunctive procedures (29.7%) compared to the PSI group (7.7%, p = 0.04). Residual pain was also more frequently reported in the standard TAA group (62.7%) than in the PSI group (30.7%, p = 0.038). While both techniques resulted in comparable complication rates, clinical scores and ROM, the PSI group reported significantly shorter operative time and less residual pain, thus requiring fewer postoperative procedures.

Medium-term outcomes after magnetic sphincter augmentation vs. fundoplication for reflux disease due to hiatal hernia: a propensity-score matched comparison in 282 patients.

An increasing number of reflux patients opt for magnetic sphincter augmentation (MSA) instead of fundoplication. However, few studies comparethe medium-term efficacy and safety of the procedures. We conducted a retrospective single-center analysis of consecutive MSA and Nissen fundoplication cases between 01/2015 and 06/2020. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. We also compared adverse event rates. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis. We used propensity-score matching to reduce confounding between treatments. Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analyzed. On average, patients were 55 ± 12years old and overweight (BMI: 28 ± 5). At 3.9years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15-0.96; p = 0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30-1.16; p = 0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p = 0.68). Fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p = 0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p < 0.01) and gas/bloating (10% vs. 18%, p = 0.06) after fundoplication. Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p = 0.54) or surgical revision (2% vs. 1%, p = 1.0) were non-significant. The device explantation rate was 4% (5/141). MSA reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge. Randomized head-to-head studies between available surgical options are needed.

Aspects of medium-term in vitro storage of raspberry varieties (Rubus idaeus L.)

The study aims to optimize the procedure for storing 12 varieties of Rubus idaeus L. of different fruiting types. The experiment used 1/2 Murashige and Skoog (MS) medium supplemented with agar (6.8 g/L), sucrose (20 g/L), and 6-benzylaminopurine (0.3 mg/L). The effects of temperature (+23 ℃ and +15 ℃) were examined, as well as that of a retardant, chlorocholine chloride at 0.2 g/L (CCC), used as part of the nutrient medium. A high percentage of viable explants (48.7- 73.0 %) was found to survive up to nine months under different cold storage conditions. From month 9 to month 12, the percentage of viable explants decreased (by 1.3-2.1 times depending on storage conditions). It was found optimal to store the studied varieties of R. idaeus in vitro at a lower temperature (+15℃) on 1/2 MS medium supplemented with 0.3 mg/L of 6-benzylaminopurine without the addition of a growth inhibitor. After 12 months of storage, the percentage of viable explants amounted to 56.9. The growth percentage of viable explants after in vitro storage at +15 ℃ on media without CCC amounted to 98.6, with an average propagation factor of 5.6, number of microshoots of 2.7 pcs./explant, and microshoot length of 1.3 cm. The presence of CCC in the medium was noted to reduce the growth rate of explants, while adversely affecting the percentage of viable explants. Thus, after 12 months of in vitro storage at +15 ℃ on media with the addition of CCC, the percentage of viable explants amounted to 39.2 %. It was noted that from month 3 to month 12 of storage at +15 ℃ on nutrient media with the addition of CCC, the number of microshoots and their length changed insignificantly (by 1.2 and 2.6 times), as compared to the indicators of microshoots cultivated in a grow room (by 1.8 and 3.3 times). The development of explants of the studied R. idaeus genotypes after in vitro storage was found to be affected by the type of fruiting and varietal features of the crop.

Acellular Dermal Matrix-Assisted, Prosthesis-Based Breast Reconstruction: A Comparison of SurgiMend PRS, AlloDerm, and DermACELL.

Acellular dermal matrices (ADMs) are frequently employed in immediate prosthesis-based breast reconstruction (iPBR) to provide structural support. Despite differences in ADM derivatives, few studies directly compare their outcomes in the setting of iPBR. We sought to conduct a large head-to-head study comparing 3 ADMs used across our institution. A multicenter retrospective review of patients undergoing iPBR with SurgiMend PRS (fetal bovine-derived; Integra Lifesciences, Princeton, NJ), AlloDerm (human-derived; LifeCell Corp, Bridgewater, NJ), or DermACELL (human-derived; Stryker Corp, Kalamazoo, MI) between January 2014 to July 2022 was performed. Primary outcomes included rates of unplanned explantation and total reconstructive failure. Secondary outcomes included 90-day postoperative complications and long-term rates of capsular contracture development. A total of 738 patients (1228 breasts) underwent iPBR during the study period; 405 patients received DermACELL (54.9%), 231 received AlloDerm (31.3%), and 102 received SurgiMend PRS (13.8%). Rates of short-term complications, total reconstruction failure, reoperation within 90 days, capsular contracture, and unplanned explantation were comparable. These findings remained true upon multivariate analysis accounting for baseline differences between cohorts, whereby ADM type was not an independent predictor of any outcome of interest. Conversely, factors such as body mass index, diabetes mellitus, smoking history, neoadjuvant and adjuvant chemotherapy, adjuvant radiation, skin-sparing mastectomy, Wise pattern and periareolar incisions, use of tissue expanders, and a subpectoral plane of insertion were significant predictors of postoperative complications. Low rates of complications support the equivalency of fetal bovine and human-derived ADMs in iPBR. Patient characteristics and operative approach are likely more predictive of postoperative outcomes than ADM derivative alone.

A Long-term Evaluation of Acellular Dermal Matrix for Immediate Implant-based Breast Reconstruction following Risk-reducing Mastectomy.

Acellular dermal matrices (ADMs) are sometimes used in implant-based breast reconstructions (IBR), but long-term ADM-related evaluations are scarce. In this study, we evaluated early and late complications and patient-related outcomes (PROs) over an 8-year postoperative period in women who had undergone immediate IBR following risk-reducing mastectomy with bovine ADM (SurgiMend). This prospective observational single-center analysis involved 34 women at high risk for breast carcinoma. Complications were prospectively recorded during the first year, followed by 4 years of postoperative retrospective chart reviews. Long-term evaluations were done using a questionnaire. Preoperative, 1 year, and 5- to 8-year postoperative PRO assessments were obtained based on results from the BREAST-Q questionnaire. In 56 breasts, complications after a mean of 12.4 months follow-up included implant loss (7.1%), implant change (1.8%), hematoma (7.1%), breast redness (41.1%), and seroma (8.9%). Most breasts (80.3%) were graded Baker I/II, which indicated a low capsular contracture incidence. After a mean of 6.9 years, the total implant explantation rate was 33.9%, and the revision surgery rate was 21.4%. Two cases of breast cancer were reported during the long-term evaluation. BREAST-Q results indicated significantly decreased satisfaction with outcome (P = 0.024). A positive trend regarding psychosocial well-being and declining trend regarding satisfaction with both breast physical- and sexual well-being parameters were reported. The observed complication rates agree with previous findings concerning ADM-assisted IBR. A high demand for revision surgery exists, and PROs remain relatively stable over time.

Life on the line - Incidence and management of central venous catheter complications in intestinal failure

Background & AimsLoss of venous access is threatening for patients with intestinal failure (IF) under long-term parenteral nutrition (PN). We aimed to identify the incidence of central venous catheter (CVC) complications, compare different devices, and analyze interventional recanalizing procedures to restore the patency of occluded CVCs. MethodsFor this retrospective cohort study, patient data from a prospective IF database spanning 16 years was analyzed at a tertiary referral center. Catheter dwell times (CDT) were distinguished by Kaplan-Meier survival analysis and subgroup analyses were performed for different CVC types (tunneled/ port catheters). Specific complications (occlusion, catheter-related infection (CRI), displacement, and material defect) were analyzed. Explantation rates and CDT were compared. ResultsOverall, 193 CVCs in 77 patients with IF under PN could be enrolled (62.524 “CVC-days”). Broviac type “B” was found to be significantly superior to type “A” regarding occlusion, CRI, and material defects (log-rank test: p=0.05; p=0.026; p=0.005 respectively). Port catheters were displaying the highest incidence of CRI (2.13 events/1000 catheter days). Interventional catheter recanalization was performed 91 times and significantly increased the CDT from a median of 131 days (IQR: 62; 258) to 388.5 days (IQR: 262; 731) (Mann-Whitney-U-test: p= <0.001) without increasing complications. ConclusionsDifferent complication rates and CDT were seen depending on CVC type. Tunneled catheters were significantly superior concerning CRI. Interventional catheter recanalization is a viable alternative to fibrinolytics to restore CVC patency, but long-term patency data is scarce.

Device-related outcomes following hypoglossal nerve stimulator implantation.

Hypoglossal nerve stimulation (HGNS) has been widely used to treat obstructive sleep apnea in selected patients. Here we evaluate rates of revision and explant related to HGNS implantation and assess types of adverse events contributing to revision and explant. Postmarket surveillance data for HGNS implanted between January 1, 2018 and March 31, 2022, were collected. Event rates and risk were calculated using the postmarket surveillance event counts and sales volume over the same period. Indications were categorized for analysis. Descriptive statistics were reported and freedom from explant or revision curves were grouped by year of implantation. Of the 20,881 HGNS implants assessed, rates of explant and revision within the first year were 0.723% and 1.542%, respectively. The most common indication for explant was infection (0.378%) and for revision was surgical correction (0.680%). Of the 5,820 devices with 3-year postimplantation data, the rate of explant was 2.680% and of revision was 3.557%. During this same interval, elective removal (1.478%) was the most common indication, and for revisions, surgical correction (1.134%). The efficacy of HGNS is comparable in the real world setting to published clinical trial data. Rates of explant and revision are low, supporting a satisfactory safety profile for this technology. Moroco AE, Wei Z, Byrd I, etal. Device-related outcomes following hypoglossal nerve stimulator implantation. J Clin Sleep Med. 2024;20(9):1497-1503.