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"Lederman, Matt"
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Relationship Between Tissue Ingrowth and Mesh Contraction
Contraction is a well‐documented phenomenon occurring within two months of mesh implantation. Its etiology is unknown, but it is suggested to occur as a result of inadequate tissue ingrowth into the mesh and has been associated with hernia recurrence. In continuation of our previous studies, we compared tissue ingrowth characteristics of large patches of polyester (PE) and heavyweight polypropylene (PP) and their effect on mesh contraction. The materials used were eight PE and eight PP meshes measuring 10 × 10 cm2. After random assignment to the implantation sites, the meshes were fixed to the abdominal wall fascia of swine using interrupted polypropylene sutures. A necropsy was performed three months after surgery for evaluation of mesh contraction/shrinkage. Using a tensiometer, tissue ingrowth was assessed by measuring the force necessary to detach the mesh from the fascia. Histologic analysis included inflammatory and fibroblastic reactions, scored on a 0–4 point scale. One swine developed a severe wound infection that involved two PP meshes and was therefore excluded from the study. The mean area covered by the PE meshes (87 ± 7 cm2) was significantly larger than the area covered by the PP meshes (67 ± 14 cm2) (p = 0.006). Tissue ingrowth force of the PE meshes (194 ± 37 N) had a trend toward being higher than that of the PP meshes (159 ± 43 N), although it did not reach statistical significance. There was no difference in histologic inflammatory and fibroblastic reactions between mesh types. There was a significant correlation between tissue ingrowth force and mesh size (p = 0.03, 95% CI: 0.05–0.84). Our results confirm those from previous studies in that mesh materials undergo significant contraction after suture fixation to the fascia. PE resulted in less contraction than polypropylene. A strong integration of the mesh into the tissue helps prevent this phenomenon, which is evidenced by a significant correlation between tissue ingrowth force and mesh size.
Journal Article
Video-assisted surgery represents more than a loss of three-dimensional vision
Loss of depth cues is a major challenge facing surgeons performing video-assisted surgery (VAS). Whether the degradation of image quality from a video-displayed image plays a direct role in performance of VAS has not been studied.
Twenty-four volunteer novice subjects were randomized to binocular direct-vision (BDV), monocular direct-vision (MDV), or video-imaging (VI) conditions. Each subject completed ten trials of a simple cutting task in a box trainer using standard laparoscopic instruments.
VI subjects made significantly fewer correct incisions than both of the other groups for all trials. Differences between the BDV and MDV groups did not reach statistical significance. Improvement in performance was more rapid in the BDV group than in either the MDV or VI groups.
The degradation of image quality with VI has a detrimental influence on VAS performance above and beyond the loss of binocular vision.
Journal Article
Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator
The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task. Performance and error data were recorded for each trial. The intermediate group performed better than the novice group in each trial. The differences were significant in trial 1 for balloons popped (
P
=
.001), completion time (
P
=
.04), and errors (
P
=
.03). Trial 2 showed significance only for balloons popped (
P
=
.002). Trial 3 showed significance for balloons popped (
P
=
.004) and errors (
P
=
.008). The novice group showed significant improvement between trials 1 and 3 (
P<0.05). No improvement was noted in the intermediate group. Measures of consistency and reliability were greater than 0.8 in both groups with the exception of novice completion time where test-retest reliability was 0.74. The GI Mentor II simulator can distinguish between novice and intermediate endoscopists. The simulator assesses skills with levels of consistency and reliability required for high-stakes assessment.
Journal Article
Objective psychomotor skills assessment of experienced and novice flexible endoscopists with a virtual reality simulator
The objective of this study was to determine whether the GI Mentor II virtual reality simulator can distinguish the psychomotor skills of intermediately experienced endoscopists from those of novices, and do so with a high level of consistency and reliability. A total of five intermediate and nine novice endoscopists were evaluated using the EndoBubble abstract psychomotor task. Each subject performed three repetitions of the task. Performance and error data were recorded for each trial. The intermediate group performed better than the novice group in each trial. The differences were significant in trial 1 for balloons popped (P=.001), completion time (P=.04), and errors (P=.03). Trial 2 showed significance only for balloons popped (P=.002). Trial 3 showed significance for balloons popped (P=.004) and errors (P=.008). The novice group showed significant improvement between trials 1 and 3 (P<0.05). No improvement was noted in the intermediate group. Measures of consistency and reliability were greater than 0.8 in both groups with the exception of novice completion time where test-retest reliability was 0.74. The GI Mentor II simulator can distinguish between novice and intermediate endoscopists. The simulator assesses skills with levels of consistency and reliability required for high-stakes assessment.
Journal Article
MEET THE PRESS DAILY for April 25, 2022, MSNBC
The Secretaries of State and Defense meet with President Zelenskyy in Kyiv vowing more aid and the return of American diplomats as the U.S. faces questions about its objective to weaken Russia. Russia continues its offensive in eastern Ukraine, and according to Ukrainian officials, and targeting several railway stations in central and western Ukraine as well. Judge Arthur Engoron has found former President Donald Trump in contempt in the civil case over his business dealings. GUESTS: Volodymyr Omelyan
Transcript
NBC NIGHTLY NEWS for December 29, 2022, NBC
After days of what industry experts call a massive meltdown, tonight, Southwest Airlines says it's prepared to return to normal operations tomorrow. Denver highways shut down by snow. Federal prosecutors now probing into George Santos' finances. A Chinese Navy fighter jet came within 10 feet of a U.S. Air Force plane risking a collision as the U.S. plane conducts routing patrols.
Transcript
NBC NIGHTLY NEWS for July 3, 2022, NBC
Akron, Ohio officers release bodycam footage of shooting. Outrage in Akron following officer-involved shooting. Delays and cancellations upend holiday travel. The average cost for gas is $4.81 a gallon. States impose new gas taxes starting July 1st. Cheney says multiple criminal referrals to DOJ is possible. January 6 committee could issue criminal referrals for Trump. Biden is under pressure over abortion, gas prices and inflation. There is new call to end protests at justices' homes. Russia claims control of eastern Ukraine city. Mother of captured American shares new details. Harry Styles concert has been canceled after mall shooting. Jet engine truck explodes at Michigan air show. What do consumers need to know about pet leasing? Pet leasing is legal in 42 states.
Transcript
NIGHTLY NEWS for April 30, 2022, NBC
Massive tornado tears through Kansas town. Inside the final stand at Mariupol. Angelina Jolie was apparently rushed to safety while visiting Ukraine. Inside military operation sending weapons to Ukraine. President attends correspondents' dinner amid COVID concerns. Prison break manhunt: was guard on the escape? Bill Murray breaks his silence on film set allegations. Country icon Naomi Judd dies from disease of mental illness.
Transcript
NBC NIGHTLY NEWS for April 17, 2022, NBC
Ukraine refuses to surrender Mariupol. Kyiv Mayor shortens curfew amid signs of normalcy. Mass shooting at teen house party kills 2. Three high profile mass shootings over THE holiday weekend. Easter celebrations return after 2 years of pandemic. Mask mandate is said to begin in Philly as cases rise in 27 states. China lockdowns cause supply chain slowdown. Credit card debt spikes as inflations rises. Boston's Logan Airport partially evacuated. Mysterious artifacts found under Notre Dame Cathedral. Ship stuck in Chesapeake is finally freed.
Transcript