Vaginal degeneration following implantation of synthetic mesh with increased stiffness.
Vaginal degeneration following implantation of synthetic mesh with increased stiffness.
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DOI：
10.1111/1471-0528.12085
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Moalli PA
中科院分区：
文献类型：
--
作者：
Liang R;Abramowitch S;Knight K;Palcsey S;Nolfi A;Feola A;Stein S;Moalli PA
比较原型脱垂网片Gynemesh PS与新一代低硬度网片UltraPro和SmartMesh对阴道形态和结构成分的影响。一项使用非人灵长类(NHP)模型的机械研究。匹兹堡大学的玛吉-女性研究所。产后恒河猴，年龄、体重、胎次和POP-Q得分相似。根据IACUC的批准，将50只恒河猴子宫切除后植入Gynemesh PS(n=12)、UltraPro(其蓝线垂直于阴道纵轴)(n=10)、UltraPro(其蓝线垂直于阴道纵轴)(n=8)和SmartMesh(n=8)。假手术组(n=12)作为对照。12周后取出网状阴道复合体(MVC)，进行组织形态、细胞原位凋亡、总胶原蛋白、弹性蛋白、糖胺多糖含量和总胶原酶活性分析。相应地进行了适当的统计和相关分析。相对于Sham和两个较低硬度的网眼，Gynemesh PS对阴道组织形态和成分的负面影响最大。与Sham组比较，Gynemesh PS组肌层明显变薄(15 5 7±499μm vs 86 6±2 10μm，P=0.0 2)，细胞凋亡率增加(P=0.0 1)，胶原和弹性蛋白含量分别减少2 0%(P=0.0 3)和43%(P=0.0 2)，总胶原酶活性增加135%(P=0.0 1)。Gynemesh PS组的GAG(糖胺多聚糖)含量最高(P=0.01)，Gynemesh PS组与Sham组和其他组比较差异有统计学意义(P=0.01)。网片植入较硬网片Gynemesh PS可引起与阴道退行性变一致的不良改建反应。
To compare the impact of the prototype prolapse mesh Gynemesh PS to that of two new generation lower stiffness meshes, UltraPro and SmartMesh, on vaginal morphology and structural composition. A mechanistic study employing a non-human primate (NHP) model. Magee-Womens Research Institute at the University of Pittsburgh. Parous rhesus macaques, with similar age, weight, parity and POP-Q scores. Following IACUC 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) and SmartMesh (n=8) via sacrocolpopexy following hysterectomy. Sham operated animals (n=12) served as controls. The mesh-vagina complex (MVC) was removed after 12 weeks and analyzed for histomorphology, in situ cell apoptosis, total collagen, elastin, glycosaminoglycan content and total collagenase activity. Appropriate statistics and correlation analyses were performed accordingly. Relative to sham and the two lower stiffness meshes, Gynemesh PS had the greatest negative impact on vaginal histomorphology and composition. Compared to sham, implantation with Gynemesh PS caused substantial thinning of the smooth muscle layer (1557 ± 499μm vs 866 ± 210 μm, P=0.02), increased apoptosis particularly in the area of the mesh fibers (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)). GAG (glycosaminoglycan), a marker of tissue injury, was the highest with Gynemesh PS compared to sham and other meshes (P=0.01). Mesh implantation with the stiffer mesh Gynemesh PS induced a maladaptive remodeling response consistent with vaginal degeneration.
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影响因子：
9.8
作者：
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通讯作者：
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发表时间：
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