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Placental site trophoblastic tumour (PSTT), a rare variety of gestational trophoblastic disease (GTD), is traditionally limited to the uterus, found within the placental implantation site where it can lead to arteriovenous malformations. GTDs are known to metastasize to the lungs, of which, choriocarcinomas are the commonest. However, arteriovenous malformations related to such metastatic lesions are extremely rare. The occurrence of spontaneous pneumothorax in pulmonary arteriovenous malformations, under any circumstances, is rarely reported. Herein, we report a rare case of metastatic PSTT, found within pulmonary arteriovenous malformations, uniquely presenting with spontaneous pneumothorax.

Background: Implantation is a complicated communication mechanism between the embryo and the endometrium that includes adhesion, nidation, and trophoblast invasion of the inside of the endometrial tissue. It is through this attachment that the fetus gets nutrients and oxygen from the mother to thrive. Aim of the Work: To determine the effect of cesarean section scar on gestational sac implantation site and its relation to future placental location (An ultrasound and retro-chorionic Doppler velocimetric study). Patients and Methods: A Prospective case-control study that include 100 pregnant women with singleton pregnancy, half of them with a history of previous CS and the other half with no history of CS was conducted from October 2020- September 2021 at El-Hussein Hospital Department of Obstetrics and Gynecology Outpatient Clinic and Inpatient. Results: Inverse correlation between GS distance from IO and implantation site, indicating low implantation site for short distance between GS to IO. Also weak inverse relation between GS distance from IO and placental location, indicating low placental location for short distance between GS to IO. Conclusion: Doppler indices but retro-chorionic Doppler was valuable in color mapping and confirmation of chorio-decidual reaction site for easy detection of early implantation site. Relation of gestational sac midpoint to uterine midpoint is a better and easy method of locating the gestational sac site than measuring distance from lower edge of gestational sac to internal OS due to different gestational sacs size. Keywords: Cesarean Section; Doppler; Retro Chorionic Blood Flow

El embarazo ectópico se caracteriza por la implantación anormal del blastocisto fuera de la cavidad uterina. Afecta aproximadamente al 2% de las embarazadas siendo la trompa uterina, el lugar de implantación anómalo más frecuente. La principal complicación es la ruptura de la trompa uterina con la subsecuente hemorragia y riesgo de alteración hemodinámica que amenace la vida de la paciente. El embarazo ectópico puede ser tratado de forma conservadora utilizando metotrexate, y en forma quirúrgica, ante la sospecha de ruptura por la presencia de hemoperitoneo. Tradicionalmente se ha elegido la cirugía abierta o laparotomía, cuando hay presencia de hemoperitoneo; no obstante, en los últimos años la cirugía laparoscópica se ha presentado como una nueva alternativa, segura y con mayores beneficios para los pacientes. A continuación, se reporta el caso clínico de una mujer embarazada que presenta un embarazo ectópico accidentado más hemoperitoneo masivo, manejado de forma exitosa con cirugía laparoscópica, aprovechándose, además, la oportunidad para realizar una revisión bibliográfica del tema.

Background. The majority of tumors of the nasal cavity and paranasal sinus are diagnosed at an advanced stage, requiring invasive and mutilating surgery, and therefore, the reconstruction of post-surgical craniofacial bone defects using various implants is necessary.Purpose of the study: to evaluate the effectiveness of the use of the thin-profile implants made of titanium nickelide in the surgical treatment of nasal cavity and paranasal sinus cancers.Material and Methods. From 2002 to 2020, a total of 60 patients with stage Т3–4n0–1M0 nasal cavity and paranasal sinus cancer were treated at the Cancer Research institute (tomsk). All patients received radiation therapy followed by surgery with reconstruction of bone structures of the subcranial region and orbital walls. In the study group (n=30), the orbital walls were restored with individual thin-profile shape memory titanium nickelide implants. In the control group (n=30), typical porous and tissue titanium nickelide implants were used. They required adjustment during surgery and complicated reparative processes in the postoperative period due to their thickness. Tissue implants did not allow accurate restoration of the orbital walls due to their structure.Results. Surgical rehabilitation with orbital wall reconstruction using thin-profile titanium nickelide implants makes it possible to shorten the duration of surgery and improve the precision of surgical repair. Features of the architectonics of implants do not interfere with the growth of tissues of the recipient zone, thus preventing the development of inflammation in the implantation site. The technique allows adequate restoration of the natural position and function of the eye.

Placenta accreta spectrum (PAS) refers to a spectrum of conditions characterized by the abnormal adherence of the placenta to the implantation site and has been a challenge due to the risk of postpartum hemorrhage, peripartum hysterectomy and maternal mortality. Despite of sonographic findings, no consensus on the prenatal evaluation of PAS has been established yet. We are aiming to establish a scoring system to increase the accuracy of prediction of PAS severity, especially to differentiate placenta percreta and placenta increta. We conducted a retrospective study and collected 2,219 cases of placenta increta and placenta percreta obtained from 20 tertiary care centers in China. Demographic information, clinical characteristics, and sonographic findings were collected. Logistic regression analysis was used to determine the risk factors and sonographic features that were significantly associated with a clinical diagnosis of placenta percreta. The formula and subsequent scoring system were generated. This scoring system was then verified in 67 cases of placenta increta or placenta percreta in Peking University First Hospital from 2016 to 2017. Diagnosis of placental invasion was confirmed by surgical findings or histopathologic results. The scoring system was evaluated using a receiver operating characteristic (ROC) curve. The scoring system combined maternal risk factors and ultrasound features and was then verified in 67 cases. According to ROC curve, the area under the curve (AUC) of our scoring system for prenatal diagnosis of placenta percreta is 0.96 (95%CI, 0.91–1.00, p < .001), for severe postpartum hemorrhage (≥1500 ml) is 0.76 (95%CI, 0.62–0.91, p = .005), for hysterectomy is 0.98 (95%CI, 0.93–1.000, p = .023). Our scoring system combining maternal risk factors and ultrasound features can improve the predictive accuracy of placenta percreta and obstetric outcomes (severe hemorrhage and hysterectomy).

Objectives. The purpose of this analytical review is to evaluate the market for osteoplastic materials and surgical implants, as well as study the features of new-generation materials and the results of clinical applications.Methods. This review summarizes the volumes of research articles presented in the electronic database PubMed and eLIBRARY. A total of 129 scientific articles related to biological systems, calcium phosphate, polymer, and biocomposite matrices as carriers of pharmaceutical substances, primary recombinant protein osteoinductors, antibiotics, and biologically active chemical reagents were analyzed and summarized. The search depth was 10 years.Results. Demineralized bone matrix constitutes 26% of all types of osteoplastic matrices used globally in surgical osteology, which includes neurosurgery, traumatology and orthopedics, dentistry, and maxillofacial and pediatric surgery. Among the matrices, polymer and biocomposite matrices are outstanding. Special attention is paid to the possibility of immobilizing osteogenic factors and target pharmaceutical substances on the scaffold material to achieve controlled and prolonged release at the site of surgical implantation. Polymeric and biocomposite materials can retard the release of pharmaceutical substances at the implantation site, promoting a decrease in the toxicity and an improvement in the therapeutic effect. The use of composite scaffolds of different compositions in vivo results in high osteogenesis, promotes the initialization of biomineralization, and enables the tuning of the degradation rate of the material.Conclusions. Osteoplastic materials of various compositions in combination with drugs showed accelerated regeneration and mineralization of bone tissue in vivo, excluding systemic side reactions. Furthermore, although some materials have already been registered as commercial drugs, a plethora of unresolved problems remain. Due to the limited clinical studies of materials for use on humans, there is still an insufficient understanding of the toxicity of materials, time of their resorption, speed of drug delivery, and the possible long-term adverse effects of using implants of different compositions.

Metallic biomaterials are widely used in implants to strengthen, repair, or replace damaged bone tissue, and their material characteristics have direct influences on short- and long-term implant performance. Of these, titanium and its alloys are the most widely applied due to their superior corrosion resistance, biocompatibility, and mechanical properties, such as in joint replacements, dental implants, and spinal fusion cages. However, Ti and Ti alloys are bioinert materials that have difficulty in binding directly to bone tissue after implantation, due to a lack of osteoconductive and osteoinductive properties. Bacterial adhesion and colonisation at the implantation site may also lead to infection-associated complications. The surface of the titanium implant directly interfaces with blood, cells, and tissues in vivo, and the surface properties can have profound influences on protein- and cell-based interactions that then promote or impede osseointegration. Therefore, the material surface morphology, chemistry and antibacterial function are key parameters in implant design, and contribute to determining the long-term success of the implant. In this review, we systematically present the latest advances in surface modification techniques for orthopaedic implants, including mechanical, physical, chemical, and biological modification. We also analyse and compare different surface modification approaches, including drug loading, metallic element doping, and bionic coatings, as well as topographical modifications such as nanotubes, nanopores and nanowires. Finally, we present a critical analysis and future perspectives on the use of surface modifications to improve the osseointegration and antibacterial properties of orthopaedic implants.

OBJECTIVES Bovine and porcine pericardial patches are frequently used in cardiothoracic and vascular surgery. There are no guidelines recommending the usage of these patches for particular surgical approaches. However, these 2 materials supposedly possess different properties. The clinical advantage of porcine compared with bovine patches remains controversial. In this experimental study, we analysed the incorporation and vascularization of bovine and porcine pericardial patches during the initial phase after implantation. METHODS Bovine and porcine pericardial patches were implanted into the dorsal skinfold chamber of C57BL/6 mice (n = 8 per group) to study vascularization and inflammation at the implantation site using repetitive intravital fluorescence microscopy over a 14-day period. At the end of the in vivo experiments, CD-31-positive cells were determined to evaluate the vascularization by immunohistochemistry. Furthermore, cell proliferation and apoptosis were analysed immunohistochemically. RESULTS Implanted bovine patches exhibited an enhanced vascularization, as indicated by a significantly higher number of CD-31-positive cells and micro-vessels (23.2 ± 4.3 vs 16.5 ± 5.8 mm−2; P = 0.001). Furthermore, bovine patches showed a slightly but not significantly higher functional capillary density. Both patches induced a moderate leukocytic inflammatory host tissue response, and neither bovine nor porcine patches significantly affected apoptosis and cell proliferation at the implantation site. CONCLUSIONS Bovine and porcine pericardial patches are similarly suitable for surgery. Bovine patches exhibited an improved vascularization during the first 14 days after implantation. This may result in a quicker and improved incorporation into the surrounding tissue compared with porcine pericardial patches.

To examine pathway of stem cell transplanted to the brain, stem cells were infected with flourescence. hATSCs in the infarct region were mostly located at the border between intact brain tissue and the area of the infarction and in other sections within the infarct cavity. Examination of section with flourescence indicated that there was significant gliosis or infiltration of leukocytes around the implantation site of the stem cell. Implanted stem cell integrated and migrated to multiple areas of the brain including the contrallateral cortex. The cells persisted in the sites to which they migrated at 30 days after implantation. The heaviest concentrations of cells were transplanted into rats at 24hr after MCAO, more cells were migrated into injured area of brain cortex. Stem cell in the infarct region were found at the border between intact brain tissue and the area of infarction and within the infarct cavity.

Background In this study we report our experience in implanting MICRA TPS (transcatheter pacing system) at various RV sites; observing its safety, and impact on paced QRS in Indian population. Material & methods 35 patients with MICRA TPS deployed from March 2017 to December 2019 at Army Hospital Research and Referral, New Delhi, at RVOT, apical septum and mid septum of RV were enrolled in the study. These patents were followed up and impact of implantation site, procedure related complications, change in pacing parameters, left ventricular ejection fraction and duration of paced QRS were monitored. Results Sick sinus syndrome was the commonest indication of pacing in this study (51.5%), followed by high degree AV block (34.2%). Mean follow up of 1.4 years showed no change in left ventricular ejection fraction, electrical parameters or change in pacing thresholds after implantation. Mean pQRS was broadest (166.60 ms) in apically implanted MICRA TPS and narrowest in mid septum group 139.33 ms. Among 35 cases, in our study one patient developed pericardial effusion, and other had intermittent diaphragmatic pacing. Conclusion Among these three implantation sites mid septum deployment is associated with narrowest paced QRS in Indian population.

Background Recently, left bundle branch area pacing (LBBAP) has been shown to be feasible. However, the right ventricular (RV) implantation site for LBBAP remains elusive. We believe that the RV implantation site should be located at the posteromedial basal septum, and in this paper, we propose a new method to help guide lead implantation. The aim of this study is to demonstrate the feasibility of the proposed method. Methods The RV implantation site was positioned by a combination of a nine-grid system on fluoroscopy and the use of intracardiac echocardiogram (ICE) and then verified by ICE. Results Fifteen patients were enrolled for LBBAP using our method. The acute success rate was 86.7% (13/15), which demonstrated that our method is useful for assisting with lead implantation. According to ICE, the distance between the implantation site and apex (the front) and the distance between the implantation site and tricuspid annulus (the back) were 44.9 ± 10.7 and 33.2 ± 10.4 mm, respectively, and the ratio of the front and the back was 1.57 ± 0.80. The distance between the implantation site and the front junction point of the left-right ventricle (the upper) and the distance between the implantation site and the back junction point (the lower) were 33.4 ± 10.6 and 24.5 ± 10.2 mm, respectively. The ratio of the upper to the lower was 1.76 ± 1.36. These results suggest that the implantation site was at the posteromedial basal septum. The width of the QRS duration increased from 110.4 ± 33.1 ms at baseline to 114.1 ± 16.1 ms post LBBAP (P > 0.05). The operation time was 133 ± 32.9 min. The time of X-ray fluoroscopy was 21.2 ± 5.9 min. The mean time for lead positioning during LBBAP was 33.8 ± 16.6 min. During a follow-up of 3 months, the LBB capture threshold remained stable in 12 patients, except for one patient who had an increase in the LBB capture threshold to 3.0 v/0.4 ms. Conclusions Our preliminary results indicate that the posteromedial basal septum could be seen as the implantation site for LBBAP. As a technique for LBBAP, ICE is a useful method for assisting with lead implantation. It is feasible and safe to use a nine-grid system combined with ICE for LBBAP.

To investigate whether contrast-enhanced (CE)-magnetic resonance imaging (MRI) improves identification of implantation site of ectopic pregnancy.This retrospective study enrolled 63 patients in whom implantation sites had been confirmed at histopathology. Two expert radiologists for gynaecological imaging and two inexpert radiologists independently reviewed non-CE MRI and a combination of non-CE and CE-MRI (non-CE+CE-MRI), then determined implantation site with a confidence level. The following MRI features were also evaluated: extrauterine gestational sac (GS)-like structure (shape, signal intensities at T1-weighted imaging [WI], T2WI, and diffusion-weighted imaging [DWI], presence of the three rings appearance, and distinct low intensity areas at T2WI, presence of tree or dot-like components, degree of contrast enhancement), fallopian tube (dilatation, dilatation with haematoma, degree of contrast enhancement, enhanced components within the tube), and ascites. These findings were compared for non-CE and non-CE+CE-MRI data, and for expert and inexpert groups.The expert group identified implantation sites correctly in 58/63 (92%) cases for non-CE and non-CE+CE-MRI. In the inexpert group, the correct identification was improved from 54/63 (86%) using non-CE MRI to 58/63 (92%) using non-CE+CE-MRI, but was not significant (p=0.29). In comparison between non-CE and non-CE+CE-MRI, dilation of the fallopian tubes was observed more frequently (p=0.004) and the confidence level was elevated significantly in the non-CE+CE-MRI (p0.0001) in the inexpert group. Intergroup comparison revealed that confidence level was significantly higher in the expert group than in the inexpert group using non-CE MRI (p0.0001), although the difference was not significant at non-CE+CE MRI (p=0.49).CE-MRI did not significantly improve correct identification of ectopic pregnancy implantation sites, although the addition of contrast enhancement did enable inexpert radiologists to diagnose confidently.

Non-invasive MRI examination of the left ventricular free wall in cardiovascular patients can provide diagnostic data for determining the required energy efficiency and the implantation site of a power source converting the mechanical oscillations of the cardiac wall into electrical energy for powering an epicardial pacemaker.

Objective : to study the effect of intrasplenic implantation of a tissue-engineered pancreatic construct (TEPC) on experimental diabetes mellitus. Materials and methods . Floating islet-like cultures (FICs) were obtained from the pancreas of newborn rabbits. To form TEPC, FICs were incubated with biopolymer microheterogeneous collagen-containing hydrogel (BMCH). TEPC samples were injected into the splenic pulp of rats with streptozotocin-induced diabetes. Results . TEPC with insulin-producing activity was formed on the 7–10th day of incubation of FICs with BMCH. After TEPC implantation in recipient rats, persistent decrease in hyperglycemia and disappearance of clinical signs of diabetes were noted. Histological analysis revealed the presence of groups of islet cells without signs of immune cell response at the TEPC implantation site. Conclusion . Our findings indicate that xenogeneic islet cells that were part of the TEPC of the pancreas can survive and actively function after implantation in the splenic pulp of diabetic rat.

The etonogestrel (ENG) implant is among the most effective reversible contraceptives. It can be a good option for patients with different chronic diseases due to no clinically significant effects on lipid metabolism or liver function. Some limitations in the use of this type of device are represented by social and psychiatric disorders, where the easy accessibility of the device becomes a negative feature. In these patients several cases of self-removal or damage to the device have been reported. We report the successful insertion of the Nexplanon® device into the scapular region in a young woman with a chronic psychiatric disorder. To verify the presence in the literature of other possible implantation sites, we performed a systematic review of the literature on Pubmed, Google scholar and Scopus from 2000 to 2021 using different combinations of the following terms: (Nexplanon), (contraceptive implant), (insertion). Two manuscripts with three cases were detected. Nexplanon® was implanted in the upper back. In all cases, there were no complications during the insertions and the follow up demonstrated no side effects with contraceptive efficacy. Our report and review is a further confirmation that the scapular region can become a valid insertion site, maintaining good efficacy and safety of the subcutaneous device.

Background Temperature elevation, a classic marker of infection and local temperature elevation, might be a useful predictor of early infection. However temperature measurement around the spine is not readily accessible. The purpose of this study was to explore whether a temperature sensing implant might reproducibly detect local temperature change associated with peri-implant wound infection, in a rabbit model. Methods Twelve adult rabbits were implanted with a spinal screw-rod construct. Temperature probes were placed at the implantation site as well as at a separate scapular site away from the surgical site to serve as control. Animals were inoculated with S. aureus: group 1 (saline control), group 2 (low dose 1 × 102 CFU/site), group 3 (medium dose 1 × 104 CFU/site), and group 4 (high dose 1 × 106 CFU/site) and monitored for 7 days prior to euthanasia. Results The scapular control temperature and implant site temperature in the non-infected animals remained similar throughout the study period. Both the scapular control and implant site temperatures were elevated in the infected animals compared to the non-infected animals. There was a statistically significant difference in the scapular control temperature and implant site temperature in all infected animals but not in the non-infected animals. Difference in temperature elevation between implant site and control scapular site were greatest for the animals with worst clinical appearance during the post-mortem evaluation. Conclusions This rabbit model demonstrates that local temperature measured in proximity to a spinal implant is elevated in the presence of infection with greater elevations associated with worse infections. Availability of an implantable temperature sensor may yield valuable information for the assessment and treatment of suspected spinal wound infection in the clinical setting.

Background: Choosing augmentation equipment is a critical factor in maxillary sinus augmentation. The choice of one of thesematerials for sinus augmentation remains controversial.Purpose: The aim of this clinical study was to compare the biological performance of the new coral hydroxyapatite (CHA)graft material and the synthetic material made from tricalcium phosphate (b-TCP) in sinus augmentation.Materials and Methods: The study consisted of 20 patients (10 men and 10 women) who were edentulous or partiallyedentulous in the posterior maxilla and required the placement of implants. A total of (20) sinus transplants were performed ina single step using implant installation procedures. CHA was used in 10 patients and b-TCP in 10 patients.Results: An average increase in the height of the mineralized tissue of 7.1 ± 1.1 mm in the b-TCP group and 4.6 ± 1.17 mm inthe CHA group was when comparing the preoperative CT scan with that after 9 Months. After the maxillary sinus augmentationprocedure. The average percentage of the density of the transplanted area after 9 months, based on the initial alveolar ridgedensity at the implantation site, was 63.6 % and - 2.89 % for the b-TCP group and the CHA group (P < 0.001 and 0.373)respectively.Conclusion: Both graft materials showed successful biocompatibility and osteoconductivity in sinus augmentation. However,B-TCP appears to be more effective than CHA in osteoconduction.

Background: To investigate the risk factors of the in vivo implantable venous access port (IVAP) catheter fracture. Methods: We retrospectively analyzed 3,102 cases of patients with vascular access devices from November 2013 to March 2016 in the hospital by PACS. The clinical and radiographic features (age, occupation, living habit, IVAP duration, intravascular outer catheter angle, location of catheter tip and IVAP implantation site) were summarized to analyze the related risk factors of fracture in the 3,102 patients. Results: There were 15 cases of fracture in 3,102 patients, and the fracture site were located at the entrance of the internal jugular vein (IJV) (n=12), the outlet of the vascular access devices (n=1), the distal portion of the catheter (n=2). Fracture was closely related to the factors of port time, age and occupation, but not related to the location of the port, the position of the catheter tip and the angle of the inner and the outer catheter. Age and IVAP duration were an independent risk factor for IVAP catheter fracture. Conclusions: Implantable vascular access devices are approved by its advantages of being safe, effective and less invasive. It is important to clarify the related factors and early prevention of fracture.

Since surface plays a key role in bioactivity, the response of the host to the biomaterial will determine the success or failure of the prosthesis. The purpose of this study is to make an exhaustive analysis of the histological and histochemical characteristics of new bone tissue around Zr implants anodized at 60 V (Zr60) supported by histomorphometric methods in a rat model. Fibrous tissue was observed around the control implants (Zr0) and osteoblasts were identifed on the trabeculae close to the implantation site that showed typical cytological characteristics of active secretory cells, regardless of the surface condition. The histomorphometrical analysis revealed a signifcant increase in cancellous bone volume, trabecular thickness and in trabecular number together with a decrease in trabecular separation facing Zr60. TRAP staining showed that there was a relative increase in the number of osteoclasts for Zr60. In addition, a larger number of osteoclast with a greater number of nuclei were detected in the tibiae for Zr60. This research demonstrated that the new bone microarchitecture in contact with Zr60 is able to improve the early stages of the osseointegration process and consequently the primary stability of implants which is a crucial factor to reduce recovery time for patients. Fil: Tano de la Hoz, María Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina Fil: Katunar, Maria Rosa. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina Fil: Gonzalez, Ariel. Universidad Nacional de Mar del Plata; Argentina Fil: Gomez Sanchez, Andrea Valeria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Transferencia de Villa María. Universidad Nacional de Villa María. Centro de Investigaciones y Transferencia de Villa María; Argentina. Universidad Tecnologica Nacional. Facultad Regional Villa Maria; Argentina Fil: Díaz, Alcira Ofelia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones Marinas y Costeras. Universidad Nacional de Mar del Plata. Facultad de Ciencias Exactas y Naturales. Instituto de Investigaciones Marinas y Costeras; Argentina Fil: Ceré, Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mar del Plata. Instituto de Investigaciones en Ciencia y Tecnología de Materiales. Universidad Nacional de Mar del Plata. Facultad de Ingeniería. Instituto de Investigaciones en Ciencia y Tecnología de Materiales; Argentina

A protein dispersion of carbon nanotubes and the nanocomposite structures obtained by laser irradiation of this dispersion were shown to be biocompatible and long-lived. The dispersion and the nanocomposite structures were implanted in laboratory birds, and the histologic pattern at the site of implantation was studied. It was shown that in 35 days after implantation a connective tissue capsule was formed, and tissue strands grew into the liquid and solid implanted materials. In 90 days after implantation, continuation of this process led to bioresorption of the materials, mainly as a solid structure. A normal local inflammatory response was observed. It manifested itself as an accumulation of white blood cells, mainly of the lymphoid series, and in the formation of muscle fibers at the implantation site. Gradual resorption of the nanomaterials was observed against the background of a chronic inflammation, in the absence of changes in the health status of the laboratory birds.

Inadequate thickness of subcutaneous tissue, pectoralis muscle wasting, and/or a lack of availability of subpectoral space can become significant issues in patients with or requiring cardiovascular implantable electronic devices (CIEDs). This is particularly concerning but not exclusive in the elderly population, who may experience discomfort and hypersensitivity of the site as well as the potential for erosion and an increased risk of infection. Thus, the use of an alternative location, the axillary fossa, offers several advantages that make it a suitable option. Specifically, it usually has a preserved fat pad (even in thin patients); is unperturbed by arm movement; is not directly exposed to contact; is easily accessed with no significant compromise of neurovascular structures; and is near the conventional subclavicular sites, with enough lead length to reach in case of the need for generator replacement. Here, we present a series of five patients, including details of their anatomy and the implant techniques used. Two underwent device replacements, with one of them presenting with significant ongoing site discomfort and the other with extreme tissue thinning, respectively. Two patients with no significant fat layer or pectoral muscle wasting had new pacemakers implanted. Lastly, a biventricular implantable cardioverter-defibrillator generator was reimplanted in a younger patient who had issues with protrusion and discomfort in the setting of thin subcutaneous tissue and the subpectoral space being occupied by a large breast implant. In conclusion, the use of the axillary fossa as a new alternative CIED implantation site, using the proposed implant technique, appears feasible and safe and demonstrated excellent results related to patient comfort and adequate device cover in five cases.

BackgroundThe association of prosthetic meshes in the abdominal wall repair, reducing the recurrence rates in an impactful way, has become an almost mandatory routine for the success of these surgeries. After decades using non-biological synthetic implants, from the 90s onwards biological membranes of animal or human origin were introduced – the so called acellular biological matrices - beginning a new era in abdominal wall defects correction.MethodsThirty patients underwent repair for different abdominal wall deformities, with acellular matrices of bovine pericardium, in a total of 40 anatomically individualized implants. The median follow-up was 22 months, with patients evaluated clinically and radiologically. In three cases, biopsies of the implanted areas were performed, allowing histological analysis of the material.ResultsThere was no recurrence of hernias in any of the cases, both clinically and radiologically. There was also no record of hematomas, infections or any phenomenon of a local or systemic reaction nature. Radiologically, it was not possible to visualize the matrices at the implantation site in any of the analysed postoperative periods. Biopsies showed important tissue neoformation replacing the implanted membranes, with important deposition of collagen, normal-looking cellularized tissue, and absence of foreign body reactions.ConclusionsThe analysed matrices showed similarity to other biological membranes described in the international literature. Representing an important update and conceptual evolution, biological matrices must be incorporated into the therapeutic arsenal in abdominal wall repairs.

Objective Bone grafting is an important surgical procedure to restore missing bone in patients with alveolar cleft lip/palate, aiming to stabilize either sides of the maxillary segments by inducing new bone formation, and in bilateral cleft cases also to stabilize the pre-maxilla. Polyphosphate (PolyP), a physiological polymer composed of orthophosphate units linked together with high-energy phosphate bonds, is a naturally existing compound in platelets which, when complexed with calcium as Ca-polyP microparticles (Ca-polyP MPs), was proven to have osteoinductive properties in preclinical studies. Aim To evaluate the feasibility, safety, and osteoinductivity of Ca-polyP MPs as a bone-inducing graft material in humans. Methods This prospective non-blinded first-in-man clinical pilot study shall consist of 8 alveolar cleft patients of 13 years or older to evaluate the feasibility and safety of Ca-PolyP MPs as a bone-inducing graft material. Patients will receive Ca-polyP graft material only or Ca-polyP in combination with biphasic calcium phosphate (BCP) as a bone substitute carrier. During the trial, the participants will be investigated closely for safety parameters using radiographic imaging, regular blood tests, and physical examinations. After 6 months, a hollow drill will be used to prepare the implantation site to obtain a biopsy. The radiographic imaging will be used for clinical evaluation; the biopsy will be processed for histological/histomorphometric evaluation of bone formation. Discussion This is the first-in-man study evaluating the safety and feasibility of the polyP as well as the potential regenerative capacity of polyP using an alveolar cleft model. Trial registration Indonesian Trial Registry INA-EW74C1N. Registered on 12 June 2020

In recent years, various devices have been approved for peripheral artery disease with femoropopliteal lesions. However, treatment of long, calcified, and diffused lesions is still challenging because these lesions are associated with restenosis. This report described the case of an 82-year-old man with bilateral severely calcified and diffused long lesions in the superficial femoral artery that was treated using polymer-coated paclitaxel-eluting stent and interwoven nitinol stent. After 6 months, in-stent restenosis was observed at the implantation site of the interwoven nitinol stents. Polymer-coated paclitaxel-eluting stents were deployed at the in-stent restenosis site. After another 6 months, angiography and intravascular ultrasound imaging revealed no restenosis at the polymer-coated paclitaxel-eluting stent site. Optical coherence tomography was also performed, revealing that the stent struts were well covered by neointima, which was very thin at approximately 0.1 mm. This representative case demonstrated substantial differences in the effects of devices; in other words, the superiority of polymer-coated paclitaxel-eluting stent in treating long, diffuse, and calcified lesions indicated that its implantation is a reasonable option when the initial gain was obtained following sufficient vessel preparation.

As a crucial step for human reproduction, embryo implantation is a low-efficiency process. Despite rapid advances in recent years, the molecular mechanism underlying embryo implantation remains poorly understood. Here, we used the mouse as an animal model and generated a single-cell transcriptomic atlas of embryo implantation sites. By analyzing inter-implantation sites of the uterus as control, we were able to identify global gene expression changes associated with embryo implantation in each cell type. Additionally, we predicted signaling interactions between uterine luminal epithelial cells and mural trophectoderm of blastocysts, which represent the key mechanism of embryo implantation. We also predicted signaling interactions between uterine epithelial-stromal crosstalk at implantation sites, which are crucial for post-implantation development. Our data provide a valuable resource for deciphering the molecular mechanism underlying embryo implantation.

Background HB pacing is a promising approach to achieve physiological pacing, but its efficacy and long-term effects require further validation. In current study, we deemed to investigate the effect of the His bundle pacing (HBP) lead location on pacing parameters. Methods 2D echocardiography imaging was performed after successful implantation, according to which the patients were divided into groups A (whose His lead tips were at the atrial side) and B (whose His lead tips were at the ventricular side). The capture thresholds, sensing values, and H-V intervals between the two groups were compared. Results Thirteen patients were in group A and 16 patients were in group B. The average capture thresholds during, 1 month, and 1 year after operation were 1.20 ± 0.34, 0.69 ± 0.29, and 0.92 ± 0.80 V/0.5 ms for group A and 1.14 ± 0.43, 0.81 ± 0.39, and 0.98 ± 0.59 V/0.5 ms for group B, respectively. The difference between the two groups was not significant. The threshold values in both groups decreased significantly in 1 month and slightly increased in 1 year. The sensing values of group A were 1.87 ± 0.82, 1.95 ± 0.76, and 1.88 ± 0.75 mV, while those of group B were 4.53 ± 1.37, 4.69 ± 1.38, and 4.59 ± 1.42 mV. The difference among the three time points was not significant. However, the sensing values in group A were consistently significantly lower than those in group B. The HV interval in group A was significantly longer than that in group B. Conclusions The implantation site of HBP leads has a significant effect on sensing values for that His leads crossing the tricuspid annulus toward the ventricle are associated with higher sensing values, compared to a more proximal location. Meanwhile, lead location has no evident effect on capture thresholds that is improved significantly shortly after operation.

Subinvolution of the implantation site is a significant contributor to delayed postpartum hemorrhage (PPH). There is immense literature documenting the histologic features, development, and involution of the uteroplacental site; however, practice-oriented literature on subinvolution of the implantation site is sparse. In the present study, we briefly review the physiologic characteristics associated with the normal development and involution of uteroplacental arteries and the proposed pathophysiologic attributes of subinvolution. Furthermore, we engage in a comparison of the condition with preeclampsia. Herein, we report a case of postpartum vaginal bleeding that persisted for two weeks following cesarean delivery. The bleeding was nonresponsive to conservative treatment. Sonography performed revealed that a heterogeneous intrauterine vascular mass measuring 14.6 × 9.2 × 10.4 cm was present, distending the uterine cavity. The presence of retained products of conception could not be ruled out. Therefore, to further confirm the condition, the patient underwent an emergency hysterectomy. Gross examination showed an enlarged and boggy uterus with numerous dilated and ecstatic thrombosed blood vessels in the implantation site of the endomyometrium. Histologic and immunohistochemical examination of the implantation site revealed the presence of persistently patent uteroplacental arteries with variable degrees of thrombosis adjacent to normally involuted vessels. Hence, a diagnosis of placental site vessel subinvolution (VSI) was established in this case. We also reviewed the related literature to illustrate the informative histologic findings of subinvolution. Preparing the ground for diagnosing subinvolution is important as this process defines that the cause of delayed postpartum uterine bleeding is idiopathic, rather than iatrogenic.

Decellularized tissues, in which the extracellular matrix is isolated, have broad applications as implantable biomaterials and/or biological scaffolds for tissue repair, and show good clinical performance. Decellularized tissue characteristics, such as their shape, structure, mechanical properties, and biological activity, are strongly affected by the decellularization protocol. The orthotopic implantation of decellularized tissues, a common procedure, typically induces cell infiltration and extracellular matrix (ECM) reconstruction resulting in tissues that resemble the source tissues. The ectopic implantation of decellularized tissues results in reconstruction that is either adapted to the implantation site or to the decellularized tissue source. In this review, the differences between methods are discussed. In addition, new methods aimed at extending the applications of decellularized tissues are discussed, particularly methods that confer novel functions to decellularized tissues, such as devices that link native tissues with artificial materials using decellularized tissue as an intermediate.

In the past several decades there has been a continuous growth in the field of cardiac implantable electronic devices (CIED) implantation procedures as well as their technological development. CIEDs utilize transvenous leads that are introduced into the heart via the axillary, subclavian, or cephalic veins, as well as a devices generator that is implanted in a subcutaneous pocket, typically in the pre-pectoral region. Despite this significant improvement, complication rates range from 1-6% with current implant tools and techniques. In this review we will discuss the three central parts of the CIED implantation procedure, their impact on implantation site, infections, and possibilities for its prevention.

Purpose. One-piece titanium implants are not routinely used for reconstruction after tooth loss. Several limitations seemed to be apparent although the concept provides a straightforward approach for different clinical situations. A clinical documentation of five prosthetic restorations with one-piece titanium implants serving as a relevant treatment option in dental surgery is pursued. We demonstrate the feasibility and benefits of one-piece titanium implants for fixed dental prosthesis. Detailed descriptions of the technical features and the surgical approach by means of clinical cases are given. The prosthetic workflow when working with one-piece titanium implants is depicted in detail as well as examples for implant-supported tooth replacement in the posterior region and the esthetic zone. Conditions of applications regarding different timing of implant placement using the system and its limitations are discussed. Results. Clinical cases with a follow-up period of up to 10 years are presented to prove the long-term success of one-piece titanium implants in terms of bone and soft-tissue stability respecting the biological criteria for periodontal health. Conclusions. One-piece titanium implants represent a reliable treatment method for single-tooth replacements. Clinical success with long-time bone stability around the implantation site can be achieved. Taken into account the requirements for periodontal tissue stability, uneventful healing without extensive tissue loss is demonstrated by means of clinical cases presenting patients with periodontitis.

Background In patients with obesity and end-stage kidney disease, implantation of the peritoneal dialysis (PD) catheter may be complicated by increased abdominal circumference or skin folds. Relocation of the implantation site to the upper abdomen could solve this problem. However, this would require an extended catheter. Methods We developed an extended PD catheter based on a swan neck Missouri PD catheter with the help of two adaptors and a straight intraperitoneal extension segment. The extended catheter was assembled intraoperatively, and its length was adjusted individually to ensure correct positioning. After the operation, PD was commenced and handled as usual. Results In the period from 2011 to 2021, we implanted 31 extended PD catheters in 29 patients (38% men) with end-stage renal failure and obesity. Median age was 53 (range 28–77) years and body mass index was 35.5 (range 26.4–46.9) kg/m2. The postoperative course was unremarkable except for seroma formation in one patient and dialysate leakage in another. Continuous ambulatory peritoneal dialysis (CAPD) was initiated in 20 and APD in 9 patients. The achieved median Kt/V was 2.10 (range 1.50–3.10). During the follow-up period lasting up to 51 months, there was one case of intraperitoneal catheter disconnection due to an avoidable handling error. The peritonitis rate was 1:40 months. The 1- and 2-year catheter survival was 92% and 67%, respectively, and paralleled patient survival. Conclusions When using a PD catheter with an intraperitoneal extension, PD catheter implantation can be relocated to the upper abdomen in patients with obesity, thus providing optimal position and easy surgical access.

Objective. Previous studies demonstrated the possibility to fabricate stereo-electroencephalography probes with high channel count and great design freedom, which incorporate macro-electrodes as well as micro-electrodes offering potential benefits for the pre-surgical evaluation of drug resistant epileptic patients. These new polyimide probes allowed to record local field potentials, multi- and single-unit activity (SUA) in the macaque monkey as early as 1 h after implantation, and yielded stable SUA for up to 26 d after implantation. The findings opened new perspectives for investigating mechanisms underlying focal epilepsy and its treatment, but before moving to possible human application, safety data are needed. In the present study we evaluate the tissue response of this new neural interface by assessing post-mortem the reaction of brain tissue along and around the probe implantation site. Approach. Three probes were implanted, independently, in the brain of one monkey (Macaca mulatta) at different times. We used specific immunostaining methods for visualizing neuronal cells and astrocytes, for measuring the extent of damage caused by the probe and for relating it with the implantation time. Main results. The size of the region where neurons cannot be detected did not exceed the size of the probe, indicating that a complete loss of neuronal cells is only present where the probe was physically positioned in the brain. Furthermore, around the probe shank, we observed a slightly reduced number of neurons within a radius of 50 µm and a modest increase in the number of astrocytes within 100 µm. Significance. In the light of previous electrophysiological findings, the present data suggest the potential usefulness and safety of this probe for human applications.

Additive manufacturing (AM) allows the fabrication of customized bone scaffolds in terms of shape, pore size, material type and mechanical properties. Combined with the possibility to obtain a precise 3D image of the bone defects using computed tomography or magnetic resonance imaging, it is now possible to manufacture implants for patient-specific bone regeneration. This paper reviews the state-of-the-art of the different materials and AM techniques used for the fabrication of 3D-printed scaffolds in the field of bone tissue engineering. Their advantages and drawbacks are highlighted. For materials, specific criteria, were extracted from a literature study: biomimetism to native bone, mechanical properties, biodegradability, ability to be imaged (implantation and follow-up period), histological performances and sterilization process. AM techniques can be classified in three major categories: extrusion-based, powder-based and liquid-base. Their price, ease of use and space requirement are analyzed. Different combinations of materials/AM techniques appear to be the most relevant depending on the targeted clinical applications (implantation site, presence of mechanical constraints, temporary or permanent implant). Finally, some barriers impeding the translation to human clinics are identified, notably the sterilization process.

Background: To determine the optimal implantation site of orthodontic micro-screws based on cone beam computed tomography (CBCT) analysis in the mandibular anterior tooth region, provide a theoretical basis for orthodontic implant placement and improve post-implantation stability.Methods: Forty patients who underwent CBCT scanning were selected for this study. CBCT scanning was applied to measure the interradicular distance, buccolingual dimension, labial cortical bone thickness and lingual cortical bone thickness between mandibular anterior teeth at planes 2, 4, 6, and 8 mm below the alveolar ridge crest. The data were measured and collected to obtain a comprehensive evaluation of the specific site conditions of the alveolar bone.Results: The interradicular distance, buccolingual dimension and labial cortical bone thickness between the mandibular anterior teeth were positively correlated with the distance below the alveolar ridge crest (below 8 mm). The interradicular distance, buccolingual dimension, labial cortical bone thickness, and lingual cortical bone thickness were all greater than those in other areas between the lateral incisor root and canine incisor root 4, 6, and 8 mm below the alveolar ridge crest.Conclusion: The area between the lateral incisor root and the canine incisor root in planes 4, 6, and 8 mm from the alveolar ridge crest can be used as safe sites for implantation, while 8 mm below the alveolar ridge crest can be the optimal implantation site. An optimal implantation site can be 8 mm below the alveolar ridge crest between the lateral incisor root and the canine incisor root.

Summary The process of implantation and the cellular interactions at the embryo-maternal interface are intrinsically difficult to analyze, as the implanting embryo is concealed by the uterine tissues. Therefore, the mechanisms mediating the interconnection of the embryo and the mother are poorly understood. Here, we established a 3D biomimetic culture environment that harbors the key features of the murine implantation niche. This culture system enabled direct analysis of trophoblast invasion and revealed the first embryonic interactions with the maternal vasculature. We found that implantation is mediated by the collective migration of penetrating strands of trophoblast giant cells, which acquire the expression of vascular receptors, ligands, and adhesion molecules, assembling a network for communication with the maternal blood vessels. In particular, Pdgf signaling cues promote the establishment of the heterologous contacts. Together, the biomimetic platform and our findings thereof elucidate the hidden dynamics of the early interactions at the implantation site.

Background Pacemaker used in small children typically consist of an abdominally placed generator and epicardially affixed leads, making such a system prone to lead dysfunction during growth. Aim of this study was to investigate the feasibility of epicardial pacing with a leadless pacemaker in a lamb model. Animals and methods Seventeen lambs underwent epicardial implantation of a Micra transcatheter pacing system (TPS) (Medtronic, Minneapolis, MN, USA) via left-lateral thoracotomy to the left ventricle (LV) surface (n = 11/17) and to the left atrial appendage (n = 6). Ventricular devices were fixated with the tines within the pericardium, whereas the tines of the atrial devices penetrated the myocardium of the left atrial appendage. After 31 weeks, animals were sacrificed and hearts were explanted for histological analysis. Results Following implantation, median P/R amplitude was 4.25/5.5 mV while median pacing threshold was 1.1/1.9 V at 0.24 ms. After 31 weeks, median P/R amplitude was 3.3/4.2 mV. Median atrial pacing threshold was 0.5/0.24 ms. Eight of 10 ventricular pacemakers had lost capture at standard impulse width even at maximum impulse amplitude. On explantation, firm adhesion of the device to the thoracic wall and dislodgement of the electrode tip was found in those ventricular devices. Conclusions Firm fixation of the Micra electrode to the epicardial surface as applied to the atrial devices resulted in excellent electrical properties during midterm follow up. Pericardial fixation as in the ventricular devices was associated with loss of capture. Therefore, it is important to embed the tines in the myocardium and to choose an alternative implantation site allowing for safe fixation of the Micra TPS in a position perpendicular to ventricular epimyocardium.

Background Cigarette smokers have a reduced risk of developing preeclampsia, possibly attributed to an increase in carbon monoxide (CO) levels. Carbon monoxide is a gasotransmitter that has been implicated in maintaining vascular tone, increasing angiogenesis, and reducing inflammation and apoptosis at physiological concentrations. Moderately increasing CO concentrations may have therapeutic potential to prevent or treat preeclampsia; however, the effects of CO on pregnancy are under studied. Our objective was to investigate the effect of CO on major angiogenic and inflammatory markers in pregnancy, and to evaluate the effect of CO on indicators of placental health. Findings Pregnant CD-1 mice were constantly exposed to either ambient air or 250 ppm CO from conception until gestation day (GD)10.5 or GD16.5. Using a qRT-PCR array, we identified that CO increased expression of major angiogenic genes at the implantation site on GD10.5, but not GD16.5. Pro-inflammatory cytokines in the plasma and tissue lysates from implantation sites in treated mice were not significantly different compared to controls. Additionally, CO did not alter the implantation site phenotype, in terms of proliferative capacity, invasiveness of trophoblasts, or abundance of uterine natural killer cells. Conclusions This study suggests that CO exposure is pro-angiogenic at the maternal-fetal interface, and is not associated with demonstrable concerns during murine pregnancy. Future studies are required to validate safety and efficacy of CO as a potential therapeutic for vascular insufficiency diseases such as preeclampsia and intrauterine growth restriction.

Doxorubicin (DOX) is widely used in the chemotherapy of a wide range of cancers. However, intravenous administration of DOX causes toxicity to most major organs which limits its clinical application. DOX-loaded drug delivery system could provide a continuous sustained-release of drugs and enables high drug concentrations at the target site, while reducing systemic toxicity. Additionally, local chemotherapy with DOX may be a promising approach for lowering post-surgical recurrence of cancer. In this study, the sustained-release DOX-loaded implants were prepared by melt-molding method. The implants were characterized with regards to drug content uniformity, micromorphology and drug release profiles. Furthermore, differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) analyses were carried out to investigate the drug-excipient compatibility. To determine the local penetration of DOX in liver, the minipigs received intrahepatic implantation of DOX-loaded implants by abdominal surgery. UPLC-MS/MS method was used to detect the concentration of DOX in liver tissues. Our results suggested that DOX-loaded implants delivered high doses of drug at the implantation site for a prolonged period and provided valuable information for the future clinical applications of the DOX-loaded implants.

In tissue engineering and regenerative medicine, the formation of vascular beds is an effective method to supply oxygen and nutrients to implanted cells or tissues to improve their survival and promote normal cellular functions. Various types of angiogenic materials have been developed by incorporating growth factors, such as vascular endothelial growth factor, in biocompatible materials. However, these exogenous growth factors suffer from instability and inactivation under physiological conditions. In this study, we designed a novel angiogenic electrospun fiber sheet (C16-FS) composed of Alaska pollock-derived gelatin (ApGltn) modified with hexadecyl (C16) groups to induce localized and sustained angiogenesis without growth factors. C16-FS was thermally crosslinked to enhance its stability. We demonstrated that C16-FS swells in phosphate-buffered saline for over 24 h and resists degradation. Laser doppler perfusion imaging showed that C16-FS induced increased blood perfusion when implanted subcutaneously in rats compared with unmodified ApGltn-fiber sheets (Org-FS) and the sham control. Furthermore, angiogenesis was sustained for up to 7 days following implantation. Immunohistochemical studies revealed elevated nuclear factor-κB and CD31 levels around the C16-FS implantation site compared with the Org-FS implantation site and the control incision site. These results demonstrate that C16-FS is a promising angiogenic material to promote the formation of vascular beds for cell and tissue transplantation without the need for growth factors.