Developing repair materials for stress urinary incontinence to withstand dynamic distension

Polypropylene mesh used as a mid-urethral sling is associated with severe clinical complications in a significant minority of patients. Current in vitro mechanical testing shows that polypropylene responds inadequately to mechanical distension and is also poor at supporting cell proliferation.Our objective therefore is to produce materials with more appropriate mechanical properties for use as a sling material but which can also support cell integration.Scaffolds of two polyurethanes (PU), poly-L-lactic acid (PLA) and co-polymers of the two were produced by electrospinning. Mechanical properties of materials were assessed and compared to polypropylene. The interaction of adipose derived stem cells (ADSC) with the scaffolds was also assessed. Uniaxial tensiometry of scaffolds was performed before and after seven days of cyclical distension. Cell penetration (using DAPI and a fluorescent red cell tracker dye), viability (AlamarBlue assay) and total collagen production (Sirius red assay) were measured for ADSC cultured on scaffolds.Polypropylene was stronger than polyurethanes and PLA. However, polypropylene mesh deformed plastically after 7 days of sustained cyclical distention, while polyurethanes maintained their elasticity. Scaffolds of PU containing PLA were weaker and stiffer than PU or polypropylene but were significantly better than PU scaffolds alone at supporting ADSC.Therefore, prolonged mechanical distension in vitro causes polypropylene to fail. Materials with more appropriate mechanical properties for use as sling materials can be produced using PU. Combining PLA with PU greatly improves interaction of cells with this material

Cesarean section rate is a matter of maternal age or parity?

Objective: To determine the impact of women\u2019s age on the cesarean section (CS) rate according to Robson groups 1, 2A, 3 and 4A. Study design: Retrospective cohort study of term, livebirth, singleton pregnancies with spontaneous or induced labor who delivered at the San Paolo Hospital from 1996 through 2019, and had the Robson group assigned. Women were grouped in 5 age classes ( 6424, 25\u201329, 30\u201334, 35\u201339 and 6540 years). The primary outcome was the rate of CS. Results: 24 843 women were included: 36.4% classified as Robson group 1, 18.9% as Robson group 2A, 34.4% as Robson group 3 and 10.2% as Robson group 4A. The CS rate of women in Robson groups 1, 2A, 3 and 4A was 6.6%, 21.8%, 1.6% and 4.3% respectively. In nulliparous women [Robson groups 1 and 2A] group 1, the adjusted OR of CS increased steadily from 30 to 6540 years, when compared to women aged 25\u201329 years. On the contrary, in multiparous women [Robson groups 3 and 4A] significant increased OR were present only for women 6540 years. In young women [ 6424 years] there was a significant reduction in the number of cesarean sections only in Robson group 1. Conclusion: The results of our study show that multiparous women aged 6540, either in spontaneous or induced labor have an independent twofold increased risk of delivering by cesarean section when compared to women of 25\u201329 years. On the contrary, in nulliparous women, the risk slightly, but significantly, increases with age and again becomes twofold in women 6540 years

Review: The laparoscopic approach to pelvic floor surgery

Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.Key words: Colposuspension; Sacrocolpopexy; Laparoscopy; Mesh; Graft related complications; Learning curv

Update on Italian-validated questionnaires for pelvic floor disorders

Introduction: Pelvic floor disorders (PFDs), which include urinary incontinence, pelvic organ prolapse, sexual dysfunction and gastrointestinal disorders, affect over 20% of the adult population. Prevalence may also be underestimated, since a certain portion of patients may be reluctant to talk to physicians about PFDs due to embarrassment. Consequently, there is a need for self-assessed diagnostic tools with the capability to screen population and collect clinical information. Symptom and quality of life (QoL) questionnaires - also identified as patient-reported outcomes (PROs) - have been developed with this purpose. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in the English language, few of them have been validated for the Italian language. The objective of this article is to update the list of Italian-validated PROs for PFDs along with practical information concerning literature references and suggestions on how to obtain every single questionnaire. Evidence acquisition: PubMed/MEDLINE databases and websites were used to update the list of available Italian-validated questionnaires about PFDs. Once identified, the possibility to get a copy of the questionnaire was verified and steps to obtain it are reported in the tables. Evidence synthesis: Eight additional questionnaires validated into the Italian language, for diagnosis and overall management of common urinary, vaginal, sexual and bowel conditions, were retrieved. The complete list of PFDs PROS is reported in a modular format for consultation. Conclusions: This format is intended to serve as a tool to promote appropriateness in PROs adoption while investigating PFDs in Italian patients

The double deceit generated by an insertion mechanism in chronic myeloid leukemia with t(9;9;22)

The Philadelphia chromosome (Ph), produced by the reciprocal t(9;22)(q34;q11.2), is the cytogenetic hallmark of chronic myeloid leukemia (CML) and is observed in more than 90% of CML cases. At diagnosis, 5–10% of CML patients show variant translocations with the involvement of at least a third chromosome, in addition to chromosomes 9 and 22. In the majority of variant t(9;22) translocations, the Ph chromosome is cytogenetically detectable whereas the der(9) is rearranged with a different partner chromosome. The most frequent location of the BCR/ABL fusion gene in complex chromosomal rearrangements is 22q11.2, but in rare variant cases, BCR/ABL is translocated or inserted at sites other than 22q11.2; in fact, in several cases, the BCR/ABL fusion gene is located at 9q34. Moreover, in rare cases, the Ph is masked in the form of additional material transposed on the derivative chromosome 22. The mechanism of these rearrangements is difficult to determine as serial translocations or a single simultaneous event could be alternatively hypothesized . In the present report, we describe a Ph+ CML case showing an insertion into the long arm of the chromosome 9 of a region belonging to the der(9)t(9;22) and located centromerically to ABL; this chromosomal rearrangement was detected in concomitance with the presence of the 5'BCR/3'ABL fusion gene on the Ph chromosome