Laparoscopic Pectopexy: A Biomechanical Analysis

Introduction

Pectopexy, a laparoscopic method for prolapse surgery, showed promising results in recent literature. Further improving this approach by reducing surgical time may decrease complication rates and patient morbidity. Since laparoscopic suturing is a time consuming task, we propose a single suture /mesh ileo-pectineal ligament fixation as opposed to the commonly used continues approach.

Methods

Evaluation was performed on human non-embalmed, fresh cadaver pelves. A total of 33 trials was performed. Eight female pelves with an average age of 75, were used. This resulted in 16 available ligaments. Recorded parameters were ultimate load, displacement at failure and stiffness.

Results

The ultimate load for the mesh + simplified single “interrupted” suture (MIS) group was 35 (± 12) N and 48 (± 7) N for the mesh + continuous suture (MCS) group. There was no significant difference in the ultimate load between both groups (p> 0.05). This was also true for displacement at failure measured at 37 (± 12) mm and 36 (±5) mm respectively. There was also no significant difference in stiffness and failure modes.

Conclusion

Given the data above we must conclude that a continuous suture is not necessary in laparoscopic mesh / ileo-pectineal ligament fixation during pectopexy. Ultimate load and displacement at failure results clearly indicate that a single suture is not inferior to a continuous approach. The use of two single sutures may improve ligamental fixation. However, overall stability should not benefit since the surgical mesh remains the limiting factor.     

Cell migration patterns and ongoing somatic mutations in the progression of follicular lymphoma

Follicular lymphoma (FL) constitutes the neoplastic equivalent of germinal center B-cells. Like its physiological counterpart, FL grows in (atypical) follicular structures, the formation of which is as yet poorly understood. Recent data indicate that in early tumour stages, neoplastic FL cells home to and colonise reactive germinal centers. Laser microdissection (LMD) and micromanipulation techniques now allow for the molecular genetic analysis of single cell mutation patterns in FL. The purpose of the present study was the analysis of the sequence and order of somatic mutations in FL, i.e. the influence of the germinal center microenvironment on the clonal evolution in different grades of FL. By generating phylogenetic trees as calculated from tumour cell sequences, the clonal evolution from a putative progenitor cell was elucidated and finally, the tumour cell migration pattern in disease progression was assessed by analyzing biopsies at different time points in relapsed tumours. Four patients suffering from FL were included in the study. A primary FL grade 1 showed clustering of genetically related subclones in distinct follicles. A moderate interfollicular exchange of tumour cells was detected. Three cases of FL grade 2 were found to show decreased subclonal clustering in follicles and an increase in the interfollicular migration. Accumulations of replacement mutations in antigen binding domains (CDR) and silent mutations in non-antigen binding domains (FR), respectively, indicating antigen influence on hypermutation were only found in the case of FL grade 1. Our conclusion is that the microenvironment in germinal centers exercises influence on clonal evolution and tumour cell distribution patterns in FL. With increasing histologic grade during disease progression, a reduced intraclonal diversity and selection of subclones also occurs outside the setting of transformation to high-grade lymphoma. Antigen-dependent hypermutations were only seen in FL grade 1, while in progressed FL, random mutation patterns and a decrease of clonal diversity were found.     

The KdpF subunit is part of the K(+)-translocating Kdp complex of Escherichia coli and is responsible for stabilization of the complex in vitro

The kdpABC operon codes for the high affinity K(+)-translocating Kdp complex (P-type ATPase) of Escherichia coli. Upon expression of this operon in minicells, a so far unrecognized small hydrophobic polypeptide, KdpF, could be identified on high resolution SDS-polyacrylamide gels in addition to the subunits KdpA, KdpB, and KdpC. Furthermore, it could be demonstrated that KdpF remains associated with the purified complex. As determined by mass spectrometry, this peptide is present in its formylated form and has a molecular mass of 3100 Da. KdpF is not essential for growth on low K(+) (0.1 mM) medium, as shown by deletion analysis of kdpF, but proved to be indispensable for a functional enzyme complex in vitro. In the absence of KdpF, the ATPase activity of the membrane-bound Kdp complex was almost indistinguishable from that of the wild type. In contrast, the purified detergent-solubilized enzyme complex showed a dramatic decrease in enzymatic activity. However, addition of purified KdpF to the KdpABC complex restored the activity up to wild type level. It is interesting to note that the addition of high amounts of E. coli lipids had a similar effect. Although KdpF is not essential for the function of the Kdp complex in vivo, it is part of the complex and functions as a stabilizing element in vitro. The corresponding operon should now be referred to as kdpFABC.     

Early identification of neonates at risk: traits of newborn piglets with respect to survival

Despite technological changes and improved management, piglet mortality remains a problem for both production and welfare. Most preweaning mortality occurs within the first 3 days after birth because of problems with adaptation and development. Thus, the purpose of our study was to determine the physiologic state of newborn pigs with respect to piglet survival. Data were collected from 1024 live-born piglets of 106 primiparous German Landrace sows to analyze relationships between farrowing traits, early postnatal vitality and blood chemistry, including immunity of piglets at birth. Surviving piglets were compared with those that died during the first 10 days of life. The survivors were significantly heavier at birth (P=0.001), were born earlier in the birth order (P=0.04), reached the udder and took in first colostral milk more quickly (P=0.001) and had a smaller drop in rectal temperature I h after birth (P=0.001) than dead. However, dead piglets had significantly higher blood levels of inorganic phosphorus (P=0.0001), calcium (P=0.04) and urea (P=0.05), but a lower concentration of alpha2-macroglobulin and lower lymphocyte proliferation indices in response to pokeweed mitogen (P=0.05). Models fitted for discrimination between survivors and piglets that died included, in addition to birth weight and litter size, the foraging behavior of neonates (time from birth to first suckle) and their thermoregulatory capacity (rectal temperature 1 h after birth) in the first experimental unit, as well as prenursing biochemical measures (inorganic phosphorus, calcium and glucose) in the second experimental unit. These ethophysiological and biochemical traits of early postnatal vitality are important determinants of maturity and development at birth. Hence, breeding programs and perinatal housing and feeding conditions should ensure a high physiological maturity to improve mortality rates of neonates.     

Experimentell erzeugte Polydaktylie und Bruchdreifachbildung bei Rana fusca

Ohne ZusammenfassungAm Schlusse meiner Arbeit möchte ich Herrn GeheimratKallius meinen verbindlichsten Dank aussprechen für die Erlaubnis, die Arbeit in seinem Institute zu Ende zu führen.     

Benefits of recruitment in honey bees: effects of ecology and colony size in an individual-based model

Why do some social insects have sophisticated recruitment systems,while other species do not communicate about food source locationsat all? To answer this question, it is necessary to identifythe social or ecological factors that make recruitment adaptiveand thus likely to evolve. We developed an individual-basedmodel of honey bee foraging to quantify the benefits of recruitmentunder different spatial distributions of nondepleting resourcepatches and with different colony sizes. Benefits of recruitmentwere strongly dependent on resource patch quality, density,and variability. Communication was especially beneficial ifpatches were poor, few, and variable. A sensitivity analysisof the model showed that under conditions of high resource densityrecruitment could even become detrimental, especially if foragingduration was short, tendency to scout was high, or recruitsneeded a long time to find communicated locations. Colony size,a factor often suspected to influence recruitment evolution,had no significant effect. These results may explain the recentexperimental findings that in honey bees, benefits of waggledance recruitment seem to vary seasonally and with habitat.They may also explain why some, but not other, species of socialbees have evolved a strategy to communicate food locations tonest mates.