| Objective:The aim of this study was to evaluate the tissue response to and biocompatibility of four synthetic meshes for pelvic floor reconstruction following implanted in vagina of rats at 1,4 and 12 weeks.Methods:In this study,four synthetic meshes using in clinical prolapse repair,including conventional polypropylene mesh(GynemeshTMPS),lightweight partially absorbable polypropylene mesh(ArtisynTM Y-shaped mesh),lightweight non-absorbable mesh(TiLOOP(?)light)and super lightweight non-absorbable meshes(TiLOOP(?)extralight),were cutted properly(0.6*0.8 cm)and implanted in the submucosa of posterior vagina wall of rats.Explants were harvested at 1,4,and 12 weeks(n=7/mesh type/time point).Histological observation and immunohistochemical assessment of foreign body reaction and tissue integration were conducted.Inflammatory reaction,neovascularization,and fibrosis around the mesh fibres were evaluated by semi-quantitative pathological scoring method.Real-time quantitative polymerase chain reaction(RT-PCR)was used to compare the expression of genes related to extracellular matrix structual proteins and its degradation enzymes,specific growth factors and inflammatory factors at the tissue-mesh interface.Results:(1)The four synthetic meshes were well tolerated,and the degrees of foreign body reaction induced by meshes were decreased gradually.(2)12 weeks after implantation,lightweight and super lightweight non-absorbable meshes elicited slighter inflammatory response and fibrosis(p<0.05).While partially absorbable mesh induced increased fibrosis compared to non-absorbale lightweight mesh(2.80±0.45 vs.1.86±0.69,p= 0.025).(3)There was no difference among the four meshes at any time in neovascularization(p>0.05).(4)mRNA expression of several matrix metalloproteinases(MMPs),such as MMP-1,MMP-2,MMP-9,and inflammatory cytokines,such as IL(Interleukine)-1?,IL-4,IL-10,increased compared with control group(without mesh implantation),which were more significant in partially absorbable mesh.At 12 weeks,gene expression of MMP-2,MMP-9 and IL-1? were significantly increased in partially absorbable mesh group(p<0.05).Conclusion:(1)The foreign body reactions induced by synthetic meshes decreased over time.(2)Partially absorbable mesh have a greater inflammatory response,indicating that using absorbable material didn't improve the biocompatibility of synthetic mesh.(3)Lightweight and super lightweight meshes elicited less inflammatory response and fibrosis,which were promising meshes for pelvic floor reconstruction.(4)Synthetic meshes increased the gene expression of specific MMPs and inflammatory factors.Objective:The objective of this study was to evaluate the effects of human umbilical cord-derived stem cells(HUMSCs)on biocompatibility of and tissue response to polypropylene mesh(GynemeshTMPS)implanted in rat's vagina,exploring the role of tissue-engineered mesh with HUMSCs in pelvic floor reconstruction application.Methods:HUMSCs were isolated and characterized in vitro,and then combined with polypropylene synthetic mesh(GynemeshTMPS)to create a tissue-engineered composite mesh.This tissue-engineered mesh and pure polypropylene mesh were implanted in the submucosa of posterior vagina wall of rats.Mesh/tissue complex were harvested at 1,4 and 12 weeks after implantation.Histological evaluation including inflammatory reaction,neovascularization and fibrosis around the mesh fibres were compared between the two groups,and real-time quantitative polymerase chain reaction(RT-PCR)was used to analyze the expression of specific genes at the tissue-mesh interface.Results:(1)HUMSCs were obtained successfully using enzyme digestion method,which had the phenotype of mesenchymal stem cells,and the ability to osteogenic and adipogenic differentiation.(2)Seeded onto the polypropylene mesh scaffold by Metrigel,HUMSCs could grow and proliferate well in vitro culture.(3)No mesh erosion or infection was observed at any time point.(4)Tissue response decreased over time,and in both groups the scores of inflammatory response and fibrosis between 1 week and 12 weeks had significant differences(p<0.05).(5)1 week after implantation,HUMSCs-seeded mesh elicited greater inflammatory response compared to pure polypropylene mesh(3.33±0.21 vs.2.63±0.18,p=0.026),while 4 and 12 weeks after implantation,the inflammatory response in HUMSCs-seeded mesh was slighter than that in unseeded mesh.(6)At any time point,there was no difference between HUMSCs-seeded and unseeded meshes in neovascularization and fibrosis.(7)The results at 12 weeks showed that mRNA expression of matrix metalloproteinase(MMP)s-1,2 and proinflammatory cytokines IL(Interleukine)-1 decreased in HUMSCs-seeded mesh compare with pure mesh(p<0.05).Conclusion:(1)HUMSCs-seeded and unseeded meshes elicited inflammatory response and fibrosis which decreased over time.(2)HUMSCs-seeded polypropylene mesh induced slighter inflammatory response at 4 and 12 weeks after implantation.(3)With or without HUMSCs,the neovascularization and fibrosis had no differences between two groups at any time point.(4)HUMSCs decreased the inflammatory response and improve the biocompatibility of conventional synthetic mesh by its immunomodulatory property.(5)HUMSCs may have a potential to reduce the postoperative complications like mesh exposure or erosion.Objective:This study aimed to evaluate the success rate,patient satisfaction and adverse events with the use of ring with support pessary in patients with advanced pelvic organ prolapse(POP),and to identify the factors associated with successful pessary use.Methods:In this prospective study,151 patients with symptomatic advanced POP(POP quantification stage III/IV)came to the Centre of Obstetrics and Gynaecology,Peking Union Medical College Hospital,for POP treatment between May 2015 and December 2015.In all,97 patients who chose the ring with support pessaries were included in this study.Successful pessary use was defined as the continuous use of the pessary at a 3-month follow-up visit.Patients' subjective satisfaction was evaluated by Patient Global Impression of Change(PGI-C)questionnaire,and complications related to pessary use were recorded.Independent-samples t tests,nonparametric tests,chi-square tests,Fisher's exact test,and logistic regression were used for data analysis.Results:(1)In all,82 patients continued to use the ring with support pessary for 3 months,whereas 15 patients discontinued,corresponding to a success rate of 84.5%(82/97).(2)Most patients(80/82,97.6%)who achieved success using the ring with support pessary felt satisfied.None complained of their symptoms growing worse with pessary use.(3)A total of 11 patients(13.4%,11/82)experienced vaginal ulceration,25 patients(30.5%,25/82)reported vaginal discharge,and six patients(7.3%,6/82)developed de novo SUI with pessary use.However,no severe complications were observed.(4)Predominant anterior wall prolapse was associated with the successful use of ring with support pessary(odds ratio 5.08,95%confidence interval 1.33-19.43,p = 0.02).Conclusions:(1)The ring with support pessary was successfully used for the treatment of advanced POP with high rates of success and satisfaction.(2)A predominant prolapse in the anterior wall may be a potential influence factor for successful pessary use. |
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