Background: Soybean (Glycine max L. Merr.) is an important nitrogen-fixing crop that provides much of the world's protein and oil. However, the available tools for investigation of soybean gene function are limited. Nevertheless, chemical mutagenesis can be applied to soybean followed by screening for mutations in a target of interest using a strategy known as Targeting Induced Local Lesions IN Genomes (TILLING). We have applied TILLING to four mutagenized soybean populations, three of which were treated with ethyl methanesulfonate (EMS) and one with Nnitroso-N-methylurea (NMU).
Objective To determine the incidence of anal incontinence after the use of cutting seton treatment for anal fistula.Method Literature searches were performed on PubMed, MEDLINE and Google Ô Scholar using the words 'cutting seton(s)', 'seton(s)' and 'anal fistula'. An analysis of the data in the collected references was performed.Results The average rate of incontinence following cutting seton use was 12%. The rate of incontinence increased as the location of the internal opening of the fistula moved more proximally. In the studies that described the types of incontinence, liquid stool was the most common followed closely by flatus incontinence. Incontinence associated with the treatment of fistulas defined as nonspecific cryptoglandular in nature was 18%.Conclusion The high incontinence rates that result from the use of cutting setons suggest that this commonly used therapy can damage the continence musculature. Other techniques that do not involve cutting the sphincter, when available, should be preferred, especially for higher fistulas.
Biologic grafts for hernia repair are a relatively new development in the world of surgery. A thorough search of the Medline database for uses of various biologic grafts in hernia shows that the evidence behind their application is plentiful in some areas (ventral, inguinal) and nearly absent in others (parastomal). The assumption that these materials are only suited for contaminated or potentially contaminated surgical fields is not borne out in the literature, with more than 4 times the experience being reported in clean fields and the average success rates being higher (93% vs 87%). Outcomes prove to be highly dependent on material source, processing methods and implant scenarios with failure rates ranging from zero to more than 30%. Small intestinal submucosa (SIS) grafts have an aggregate failure rate of 6.7% at 19 months whereas acellular human dermis (AHD) grafts have a failure rate of 13.6% at 12 months. Chemically cross-linked grafts have much less published data than the non-cross-linked materials. In particular, the search found 33 articles for SIS, 32 for AHD, and 13 for cross-linked porcine dermis. Furthermore, the cumulative level of evidence for each graft material was fairly low (2.6 to 2.9), and only 1 material (SIS) had level 1 evidence reported in any hernia type (inguinal and hiatal). Together, biologic grafts have published evidence showing success rates better than 90% overall and more than 2000 years of cumulative implant time. Improvements in materials, techniques, and patient selection are likely to improve these numbers as this field of surgery matures.
Background A major clinical problem relating to hernia repair is the formation of intra-abdominal, post-surgical adhesions when mesh products are used to reinforce the abdominal wall. To achieve better outcomes, more technologically-advanced products designed to achieve permanence of repair while eliminating serious complications such as adhesion formation are needed. This study was designed to assess the histological remodeling and adhesiogenic properties of the Zenapro™ Hybrid Hernia Repair Device as compared to uncoated and coated polypropylene. Materials and Methods Zenapro™, Prolene® and Ventralight® ST Mesh were implanted to repair full-thickness abdominal wall defects in rabbits and rats and were allowed to survive for various lengths of time. Animals were euthanized, the implants were identified, and the extent and tenacity of adhesions were evaluated. Tissue samples were collected and evaluated for inflammation, integration of the mesh with the abdominal wall, and collagen deposition. Results A significant difference was found in the extent of adhesions in the Prolene group as compared to the Zenapro group (p = 0.021) and the Ventralight ST group (p = 0.04) in the rat study. The tenacity of the adhesions in the Prolene mesh group trended higher than in the other groups but failed to reach statistical significance. Histological evaluation demonstrated that collagen accumulation was greatest for the Zenapro implants as compared to either the Ventralight ST or Prolene samples. At the conclusion of 6-months in the rabbit model, the Zenapro sites showed signs of a thicker repair composed of more organized mature collagen than was seen in the Ventralight ST samples. Neither device was found to elicit any sort of detrimental inflammatory tissue reaction. Conclusion A combination hernia device composed of a complete extracellular matrix with a synthetic mesh can result in enhanced tissue ingrowth and neovascularization while maintaining high tensile strength and mitigating adhesiogenic effects. Highlights
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