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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.

OBJECTIVES Implantable pulse generator (IPG) site pain following neuromodulation procedures is a recognized complication. The site of the IPG placement varies depending on the neuromodulation type and physician preference. The incidence of IPG site pain as a function of the site of IPG implantation has not been studied systematically. MATERIALS AND METHODS We performed a multicenter cross-sectional survey of the incidence, severity, and quality of IPG site pain, location of the IPG, the pain management needs, functional impairment, and cosmetic appearance related to the IPG placement. Contingency table analysis was conducted for categorical variables, and logistic regression analysis and linear regression model was used. RESULTS The survey response rate was 60.5% (n = 510). Overall, 31.0% of patients reported pain at the IPG site in the last 72 hours with 31.4% reporting moderate to severe pain and 7.6% reporting severe pain. Older age was inversely associated with IPG-related pain (OR = 0.97, 95% CI = 0.96-0.99, p = 0.001). IPG implantation site did not have a statistically significant interaction with IPG site pain (p > 0.05). The most important factor for IPG site-associated pain was having a spinal cord stimulator implanted as compared to a deep brain stimulator, or sacral nerve stimulator. Most subjects reported no functional impairment related to IPG site pain (91%), found the IPG site pain as expected (80%), and found IPG site cosmetic appearance as expected (96%). CONCLUSIONS The incidence of IPG site pain is an important complication of invasive neuromodulation. The anatomic location of the IPG placement does not appear to affect the incidence or severity of IPG site pain. However, the presence of a pre-implant chronic pain disorder does appear to affect the frequency and severity of IPG site pain.

PURPOSE This study aims to report long-term outcomes of secondary intraocular lens (IOL) implantation after early cataract surgery in children. METHODS This is a retrospective case series that included children undergoing secondary IOL implantation. The patients had either in-the-bag (ITB) or sulcus implantation; alternative methods of IOL fixation were excluded. Single-piece acrylic IOL was used for ITB and 3-piece acrylic or PMMA IOL for sulcus implantation. The visual acuity outcomes and rate of complications at the last follow-up visit were evaluated. RESULTS One hundred six eyes (70 patients) were analyzed. The mean follow-up was 5.5 ± 3.8 years. Sixty-two eyes (58.5%) had ITB; 44 eyes (41.5%) had sulcus IOL. All but 3 eyes (97.2%) showed stable or improvement in visual acuity. Early inflammation > grade 2 + was noted with sulcus IOL (84% vs 34%, p = 0.01); late inflammation requiring vitrectomy occurred in one eye with sulcus IOL. Mild decentration was seen in 2 eyes with sulcus IOL; one additional subluxed sulcus IOL was exchanged. Sixteen out of 106 eyes (16%) had glaucoma. Eyes that developed glaucoma had early primary surgery (mean, 0.2 years, p

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.

Embryo implantation plays a decisive role in pregnancy. While in the process of implantation, microRNA (miRNA) is an important regulatory factor in the post transcriptional level. However, the role of many miRNAs in embryo implantation remained unknown. In this study, microRNA-183 (miR-183) was found differentially expressed in mouse uterus during implantation. In vivo treatment of miR-183 agomir in the uterine horn before implantation could eliminate the number of implantation site. The localization of miR-183 in mouse uteri gradually changed from epithelial to stromal layer in early pregnancy. Mice implantation models demonstrated that the decrease of miR-183 was mainly caused by maternal factors. Loss and gain function of miR-183 in endometrial cell lines showed that miR-183 could inhibit cell migration, invasion and apoptosis. MiR-183 could inhibit embryo implantation by binding Heparin-Binding EGF-like growth factor (Hbegf) and Laminin gamma one (Lamc1), which were key genes in embryo apposition and penetration. All these evidences indicate that miR-183 plays an important role during embryo implantation. This study provides new insights into the functions of miR-183 during embryo implantation and the development of contraceptive drugs in early pregnancy.

There is a lack of effective tissue repair and regeneration strategies in current clinical practices. Numerous studies have suggested that smart or responsive biomaterials possessing the ability to respond to endogenous stimuli in vivo may positively mediate the tissue micro-environment towards a tissue repair or regeneration. Mechanical stimuli, which constantly exist in a wide range of biological systems and are involved in almost all the physiological processes, belong to such stimuli to which responsive biomaterials can respond. In recent studies, a new type of smart biomaterials, which can dynamically adapt to the mechanical stimuli in vivo and thus has specific functionality consistently mediated by such mechanical stimuli, has emerged. In contrast to common biomaterials that passively react to the mechanical environment of an implantation site, such mechano-active biomaterials have enabled various active or automatic strategies for tissue repair or regeneration, such as providing precise spatial-temporal controls on delivery of drugs or cells in the organs of the musculoskeletal and the circulatory systems; in situ reconstructing the original or a favorable mechanical environment at a lesion site; and accelerating the tissue remodeling or healing process via a mechanobiological effect. This article elucidates a perspective of perfecting tissue repair or regeneration using mechano-active biomaterials, especially highlighting the rationale behind the concept of mechano-active biomaterials and their potential in the repair or regeneration of musculoskeletal and cardiovascular tissues. Albeit outstanding challenges and unknowns, the emergence of mechano-active biomaterials has become a new avenue for tissue engineering and regenerative medicine.

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.

Evaluations of His bundle pacing (HBP) lead location at autopsy examination have been rarely reported. We report an autopsy case of a 98-year-old man who underwent HBP implantation due to atrioventricular block and heart failure. Although selective HBP was achieved with an acceptable threshold, the stimulus-to-QRS interval was relatively longer without correction of the right bundle-branch block. A macroscopic examination revealed that the HBP lead was inserted on the ventricular side passing through the anteroseptal commissure of the tricuspid valve. Transthyretin cardiac amyloidosis may affect the distal conduction system resulting in a long stimulus-to-QRS interval during selective HBP.

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.

Heterotopic pregnancy refers to the simultaneous presence of ectopic pregnancy and intrauterine pregnancy. With the advent of assisted reproductive technology, the overall incidence of heterotopic pregnancies has risen. We report a case of a 36-year-old woman with type 2 diabetes mellitus and 1-year of primary infertility. Following oral ovulation induction cycles and intrauterine insemination, diagnosis of heterotopic cervical pregnancy was made by ultrasonography at 7.4 weeks of gestation. Laser ablation of the cervical pregnancy was performed achieving adequate homeostasis at the implantation site and preserving the intrauterine pregnancy. A healthy infant was delivered at 36 0/7 weeks by cesarean section. Laser ablation is a minimally invasive procedure that appears to lead to successful outcomes in the treatment of heterotopic cervical pregnancy.

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.