The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment.

PURPOSE: Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. METHODS: Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. RESULTS: The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). CONCLUSIONS: We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.

Simulation of the process of angiogenesis: Quantification and assessment of vascular patterning in the chicken chorioallantoic membrane.

Angiogenesis, the formation of new blood vessels from pre-existing ones, begins during embryonic development and continues throughout life. Sprouting angiogenesis is a well-defined process, being mainly influenced by vascular endothelial growth factor (VEGF). In this study, we propose a meshless-based model capable of mimicking the angiogenic response to several VEGF concentrations. In this model, endothelial cells migrate according to a diffusion-reaction equation, following the VEGF gradient concentration. The chick chorioallantoic membrane (CAM) assay was used to model the branching process and to validate the obtained numerical results. To analyse the angiogenic response, the total vessel number and the total vessel length presented in the CAM images and in the simulations for all the VEGF concentrations tested were quantified. In both the CAM assay and simulation, the treatments with VEGF increased the total vessel number and the total vessel length. The obtained quantitative results were very similar between the two methodologies used. The proposed model accurately simulates the capillary network pattern concerning its structure and morphology, for the lowest VEGF concentration tested. For the highest VEGF concentration, the capillary network predicted by the model was less accurate when compared to the one presented in the CAM assay but this may be explained by changes in blood vessel width at higher VEGF concentrations. This remains to be tested.

The changing regulatory landscape for biomedical implants and its relationship to withdrawal of some vaginal mesh products.

PURPOSE OF REVIEW: Advancements in biomedical engineering and advanced therapies including tissue engineering products necessitate revisions to the regulation and governance of their production and use to ensure patient safety. In this review, the current regulations and recent improvements on the governance of biomedical devices are reviewed. RECENT FINDINGS: Current regulations on approval of biomedical devices failed to address some important aspects related to the definition of biocompatibility of medical implants. The main issue was that the failure to establish design requirements for a specific application - in this case, the pelvic floor. Another issue was the lack of knowledge on disease mechanisms leading to an inability to define clear targets for surgical treatment. A clear example of this is the recent vaginal mesh scandal. SUMMARY: Surgical innovations are inherently challenging. It is no surprise that the regulatory landscape lags behind advancements in biomedical technologies. Very recent modifications to the available regulations particularly in Europe aim to establish a robust, transparent, predictable and sustainable regulatory framework for medical devices, which ensures patient safety while supporting innovation.