Mosquito net mesh for abdominal wall hernioplasty: a comparison of material characteristics with commercial prosthetics.

BACKGROUND: The use of sterilized mosquito net as a cheaper alternative to commercial mesh used in hernia repair has previously been published. However, as no standards with regard to the material have been documented, we aimed to define the characteristics of a commonly available and low-cost mosquito net, which has already been shown to be clinically efficacious in groin hernia repair. We compared its characteristics to other commercially available meshes, in keeping with the well-established FDA and MHRA regulatory processes. METHODS: The macromolecular structure of the mosquito net was determined by vibrational spectroscopy. The ultrastructure of the meshes was examined with scanning electron microscopy, and uniaxial and burst tensile strength testing was performed. The following parameters were assessed: polymer type, filament characteristics, pore size, weight, linear density, elasticity, and tensile strength. RESULTS: The mosquito net was a polyethylene homopolymer, knitted from monofilament fibers with a mean filament diameter of 109.7 µm and a mean mesh thickness of 480 µm. The mean pore maximum diameter was 1.9 mm, with 91.2 % porosity, 53.7 g/m(2) mean mesh weight, and a linear mass density of 152 denier. This was comparable to the "large pore" (class I) commercial meshes. The bursting force for polyethylene mosquito net was greater than for UltraPro and Vypro (43.0 vs. 35.5 and 27.2 N/cm, respectively), and the mosquito net exhibited less anisotropy compared to the commercial meshes. CONCLUSIONS: The material and mechanical properties of the polyethylene mosquito net are substantially equivalent to those of commonly used lightweight commercial meshes.

Avoiding migration at open mesh plug inguinal hernioplasty.

The open repair of groin hernias is often augmented with prosthetic biomaterials (mesh) as this favours a lower recurrence rate. The use of such prostheses may be associated with various complications including migration the frequency of which is unclear. A 29-year review of this complication after mesh plug hernioplasty is undertaken and technical advice described to avoid this.

Safety and sterilization of mosquito net mesh for humanitarian inguinal hernioplasty.

BACKGROUND: Inguinal hernia repair is one of the most commonly performed operations in Africa. Prosthetic repair with commercially available mesh is generally considered too expensive in low-income countries. Elective groin hernia surgery with mosquito net mesh has recently been described. However, can mesh sterility in resource-poor countries be guaranteed to ensure both effectiveness and safety? METHODS: Copolymer and polyester mosquito net mesh were steam-sterilized at varying temperatures. PubMed and EMBASE were searched using key words, MeSH, and subject headings (mosquito net mesh, mesh sterilization, inguinal hernia repair). RESULTS: Copolymer mosquito net mesh manufactured in India can be safely sterilized at lower (less "strict") temperatures (121°C) than those usually demanded by advanced health care systems (134°C). The literature search revealed a number of case series but all with limited follow-up. Available data, however, support the use of this type mosquito net mesh in the elective repair of hernias. CONCLUSIONS: Hernia repair with mosquito net mesh is a plausible, safe, cost-effective alternative in low-income countries. Sterilization in steam autoclaves that have accurate temperature control is required.

Immunofibrotic drivers of impaired lung function in postacute sequelae of SARS-CoV-2 infection.

BACKGROUNDIndividuals recovering from COVID-19 frequently experience persistent respiratory ailments, which are key elements of postacute sequelae of SARS-CoV-2 infection (PASC); however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity.METHODSWe performed a prospective cohort study of individuals with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors.RESULTSSixty-one participants were enrolled across 2 academic medical centers at a median of 9 weeks (interquartile range, 6-10 weeks) after COVID-19 illness: n = 13 participants (21%) had mild COVID-19 and were not hospitalized, n = 30 participants (49%) were hospitalized but were considered noncritical, and n = 18 participants (30%) were hospitalized and in the intensive care unit (ICU). Fifty-three participants (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P < 0.05) but these values did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered participants by past COVID-19 severity. Lipocalin-2 (LCN2), MMP-7, and HGF identified by our analysis were significantly higher in the ICU group (P < 0.05), inversely correlated with FVC and DLCO (P < 0.05), and were confirmed in a separate validation cohort (n = 53).CONCLUSIONSubjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets.FundingNational Heart, Lung, and Blood Institute (K08HL130557 and R01HL142818), American Heart Association (Transformational Project Award), the DeLuca Foundation Award, a donation from Jack Levin to the Benign Hematology Program at Yale University, and Duke University.

Immuno-fibrotic drivers of impaired lung function in post-acute sequelae of SARS-CoV-2 infection (PASC).

INTRODUCTION: Subjects recovering from COVID-19 frequently experience persistent respiratory ailments; however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity. METHODS: We performed a prospective cohort study of subjects with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors. RESULTS: Sixty-one subjects were enrolled across two academic medical centers at a median of 9 weeks (interquartile range 6-10) after COVID-19 illness: n=13 subjects (21%) mild/non-hospitalized, n=30 (49%) hospitalized/non-critical, and n=18 subjects (30%) hospitalized/intensive care ("ICU"). Fifty-three subjects (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P<0.05), but did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered subjects by past COVID-19 severity. Lipocalin 2 (LCN2), matrix metalloproteinase-7 (MMP-7), and hepatocyte growth factor (HGF) identified by the model were significantly higher in the ICU group (P<0.05) and inversely correlated with FVC and DLCO (P<0.05), and were confirmed in a separate validation cohort (n=53). CONCLUSIONS: Subjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets. FUNDING: The study was funded in part by the NHLBI (K08HL130557 to BDK and R01HL142818 to HJC), the DeLuca Foundation Award (AP), a donation from Jack Levin to the Benign Hematology Program at Yale, and Divisional/Departmental funds from Duke University.

Molecular dynamics simulation and thermodynamic modeling of the self-assembly of the triterpenoids asiatic acid and madecassic acid in aqueous solution.

The self-assembly behavior of the triterpenoids asiatic acid (AA) and madecassic acid (MA), both widely studied bioactive phytochemicals that are similar in structure to bile salts, were investigated in aqueous solution through atomistic-level molecular dynamics (MD) simulation. AA and MA molecules initially distributed randomly in solution were observed to aggregate into micelles during 75 ns of MD simulation. A "hydrophobic contact criterion" was developed to identify micellar aggregates from the computer simulation results. From the computer simulation data, the aggregation number of AA and MA micelles, the monomer concentration, the principal moments of the micelle radius of gyration tensor, the one-dimensional growth exhibited by AA and MA micelles as the aggregation number increases, the level of internal ordering within AA and MA micelles (quantified using two different orientational order parameters), the local environment of atoms within AA and MA in the micellar environment, and the total, hydrophilic, and hydrophobic solvent accessible surface areas of the AA and MA micelles were each evaluated. The MD simulations conducted provide insights into the self-assembly behavior of structurally complex, nontraditional surfactants in aqueous solution. Motivated by the high computational cost required to obtain an accurate estimate of the critical micelle concentrations (CMCs) of AA and MA from evaluation of the average monomer concentration present in the AA and MA simulation cells, a modified computer simulation/molecular-thermodynamic model (referred to as the MCS-MT model) was formulated to quantify the free-energy change associated with optimal AA and MA micelle formation in order to predict the CMCs of AA and MA. The predicted CMC of AA was found to be 59 microM, compared with the experimentally measured CMC of 17 microM, and the predicted CMC of MA was found to be 96 microM, compared with the experimentally measured CMC of 62 microM. The AA and MA CMCs predicted using the MCS-MT model are much more accurate than the CMCs inferred from the monomer concentrations of AA and MA present in the simulation cells after micelle self-assembly (2390 microM and 11,300 microM, respectively). The theoretical modeling results obtained for AA and MA indicate that, by combining computer simulation inputs with molecular-thermodynamic models of surfactant self-assembly, reasonably accurate estimates of surfactant CMCs can be obtained with a fraction of the computational expense that would be required by using computer simulations alone.

Application of computer simulation free-energy methods to compute the free energy of micellization as a function of micelle composition. 1. Theory.

The widespread use of surfactant mixtures and surfactant/solubilizate mixtures in practical applications motivates the development of predictive theoretical approaches to improve fundamental understanding of the behavior of these complex self-assembling systems and to facilitate the design and optimization of new surfactant and surfactant/solubilizate mixtures. This paper is the first of two articles introducing a new computer simulation-free-energy/molecular thermodynamic (CS-FE/MT) model. The two articles explore the application of computer simulation free-energy methods to quantify the thermodynamics associated with mixed surfactant/cosurfactant and surfactant/solubilizate micelle formation in aqueous solution. In this paper (article 1 of the series), a theoretical approach is introduced to use computer simulation free-energy methods to compute the free-energy change associated with changing micelle composition (referred to as DeltaDeltaGi). In this approach, experimental critical micelle concentration (CMC) data, or a molecular thermodynamic model of micelle formation, is first used to evaluate the free energy associated with single (pure) surfactant micelle formation, g(form,single), in which the single surfactant micelle contains only surfactant A molecules. An iterative approach is proposed to combine the estimated value of gform,single with free-energy estimates of DeltaDeltaGi based on computer simulation to determine the optimal free energy of mixed micelle formation, the optimal micelle aggregation number and composition, and the optimal bulk solution composition. After introducing the CS-FE/MT modeling framework, a variety of free-energy methods are briefly reviewed, and the selection of the thermodynamic integration free-energy method is justified and selected to implement the CS-FE/MT model. An alchemical free-energy pathway is proposed to allow evaluation of the free-energy change associated with exchanging a surfactant A molecule with a surfactant/solubilizate B molecule through thermodynamic integration. In article 2 of this series, the implementation of the CS-FE/MT model to make DeltaDeltaGi free-energy predictions for several surfactant/solubilizate systems is discussed, and the predictions of the CS-FE/MT model are compared with the DeltaDeltaGi predictions of a molecular thermodynamic model fitted to relevant experimental data.

Application of computer simulation free-energy methods to compute the free energy of micellization as a function of micelle composition. 2. Implementation.

In this paper, the implementation of the CS-FE/MT model introduced in article 1 is discussed, and computer simulations are performed to evaluate the feasibility of the new theoretical approach. As discussed in article 1, making predictions of surfactant/solubilizate aqueous solution behavior using the CS-FE/MT model requires evaluation of DeltaDeltaG for multiple surfactant-to-solubilizate or surfactant-to-cosurfactant transformations. The central goal of this article is to evaluate the quantitative accuracy of the alchemical computer simulation method used in the CS-FE/MT modeling approach to predict DeltaDeltaG for a single surfactant-to-solubilizate or for a single surfactant-to-cosurfactant transformation. A hybrid single/dual topology approach was used to morph the ionic surfactant sodium dodecyl sulfate (SDS) into the ionic solubilizate ibuprofen (IBU), and a dual topology approach was used to morph the nonionic surfactant octyl glucoside (OG) into the nonionic solubilizate p-aminobenzoate (PAB). In addition, a single topology approach was used to morph the nonionic surfactant n-decyl dimethylphosphine oxide (C10PO) into the nonionic cosurfactant n-decyl methyl sulfoxide (C10SO), the nonionic surfactant octylsulfinyl ethanol (C8SE) into the nonionic cosurfactant decylsulfinyl ethanol (C10SE), and the nonionic surfactant n-decyl methyl sulfoxide (C10SO) into the nonionic cosurfactant n-octyl methyl sulfoxide (C8SO). Each DeltaDeltaG value was computed by using thermodynamic integration to determine the difference in free energy associated with (i) transforming a surfactant molecule of type A into a cosurfactant/solubilizate molecule of type B in a micellar environment (referred to as DeltaG2) and (ii) transforming a surfactant molecule of type A into a cosurfactant/solubilizate molecule of type B in aqueous solution (referred to as DeltaG1). CS-FE/MT model predictions of DeltaDeltaG for each alchemical transformation were made at a number of simulation conditions, including (i) different equilibration times at each value of the coupling parameter lambda, (ii) different data-gathering times at each lambda value, and (iii) simulation at a different number of lambda values. For the three surfactant-to-cosurfactant transformations considered here, the DeltaDeltaG values predicted by the CS-FE/MT model were compared with DeltaDeltaG values predicted by an accurate molecular thermodynamic (MT) model developed by fitting to experimental CMC data. Even after performing lengthy equilibration and data gathering at each lambda value, physically unrealistic values of DeltaDeltaG were predicted by the CS-FE/MT model for the transformations of SDS into IBU and of OG into PAB. However, more physically realistic DeltaDeltaG values were predicted for the transformation of C10PO into C10SO, and reasonable free-energy predictions were obtained for the transformations of C8SE into C10SE and C10SO into C8SO. Each of the surfactant-to-cosurfactant transformations considered here involved less extensive structural changes than the surfactant-to-solubilizate transformations. As computer power increases and as improvements are made to alchemical free-energy methods, it may become possible to apply the CS-FE/MT model to make accurate predictions of the free-energy changes associated with forming multicomponent surfactant and solubilizate micelles in aqueous solution where the chemical structures of the surfactants, cosurfactants, and solubilizates differ significantly.

Quantifying the hydrophobic effect. 3. A computer simulation-molecular-thermodynamic model for the micellization of ionic and zwitterionic surfactants in aqueous solution.

In this article, the validity and accuracy of the CS-MT model introduced in article 1 for oil aggregates and in article 2 for nonionic surfactants is further evaluated by using it to model the micellization behavior of ionic and zwitterionic surfactants in aqueous solution. In the CS-MT model, two separate free-energy contributions to the hydrophobic driving force for micelle formation are computed using hydration data obtained from computer simulation: gdehydr, the free-energy change associated with dehydration, and ghydr, the change in the hydration free energy. To enable straightforward estimation of gdehydr and ghydr for ionic and zwitterionic surfactants, a number of simplifying approximations were made. Reasonable agreement between the CMCs predicted using the CS-MT model and the experimental CMCs was obtained for sodium dodecyl sulfate (SDS), dodecylphophocholine (DPC), cetyltrimethylammonium bromide (CTAB), two 3-hydroxy sulfonate surfactants (AOS-12 and AOS-16), and a homologous series of four DCNA bromide surfactants with a dimethylammonium head attached to a dodecyl alkyl tail and to an alkyl side chain of length CN, having the chemical formula C12H25CNH2N+1N(CH3)2Br, with N = 1 (DC1AB), 2 (DC2AB), 4 (DC4AB), and 6 (DC6AB). For six of these nine surfactants, the CMCs predicted using the CS-MT model are closer to the experimental CMCs than the CMCs predicted using the traditional molecular-thermodynamic (MT) model. For DC2AB, DC4AB, and DC6AB, which are the most structurally complex of the ionic surfactants modeled, the CMCs predicted using the CS-MT model are in remarkably good agreement with the experimental CMCs, and the CMCs predicted using the traditional MT model are quite inaccurate. Our results suggest that the CS-MT model accurately quantifies the hydrophobic driving force for micelle formation for ionic and zwitterionic surfactants in aqueous solution. For complex ionic and zwitterionic surfactants where it is difficult to accurately quantify the hydrophobic driving force for micelle formation using the traditional MT modeling approach, the CS-MT model represents a very promising alternative.

Quantifying the hydrophobic effect. 1. A computer simulation-molecular-thermodynamic model for the self-assembly of hydrophobic and amphiphilic solutes in aqueous solution.

Surfactant micellization and micellar solubilization in aqueous solution can be modeled using a molecular-thermodynamic (MT) theoretical approach; however, the implementation of MT theory requires an accurate identification of the portions of solutes (surfactants and solubilizates) that are hydrated and unhydrated in the micellar state. For simple solutes, such identification is comparatively straightforward using simple rules of thumb or group-contribution methods, but for more complex solutes, the hydration states in the micellar environment are unclear. Recently, a hybrid method was reported by these authors in which hydrated and unhydrated states are identified by atomistic simulation, with the resulting information being used to make MT predictions of micellization and micellar solubilization behavior. Although this hybrid method improves the accuracy of the MT approach for complex solutes with a minimum of computational expense, the limitation remains that individual atoms are modeled as being in only one of two states-head or tail-whereas in reality, there is a continuous spectrum of hydration states between these two limits. In the case of hydrophobic or amphiphilic solutes possessing more complex chemical structures, a new modeling approach is needed to (i) obtain quantitative information about changes in hydration that occur upon aggregate formation, (ii) quantify the hydrophobic driving force for self-assembly, and (iii) make predictions of micellization and micellar solubilization behavior. This article is the first in a series of articles introducing a new computer simulation-molecular thermodynamic (CS-MT) model that accomplishes objectives (i)-(iii) and enables prediction of micellization and micellar solubilization behaviors, which are infeasible to model directly using atomistic simulation. In this article (article 1 of the series), the CS-MT model is introduced and implemented to model simple oil aggregates of various shapes and sizes, and its predictions are compared to those of the traditional MT model. The CS-MT model is formulated to allow the prediction of the free-energy change associated with aggregate formation (gform) of solute aggregates of any shape and size by performing only two computer simulations-one of the solute in bulk water and the other of the solute in an aggregate of arbitrary shape and size. For the 15 oil systems modeled in this article, the average discrepancy between the predictions of the CS-MT model and those of the traditional MT model for gform is only 1.04%. In article 2, the CS-MT modeling approach is implemented to predict the micellization behavior of nonionic surfactants; in article 3, it is used to predict the micellization behavior of ionic and zwitterionic surfactants.

Quantifying the hydrophobic effect. 2. A computer simulation-molecular-thermodynamic model for the micellization of nonionic surfactants in aqueous solution.

In this article, the validity and accuracy of the CS-MT model is evaluated by using it to model the micellization behavior of seven nonionic surfactants in aqueous solution. Detailed information about the changes in hydration that occur upon the self-assembly of the surfactants into micelles was obtained through molecular dynamics simulation and subsequently used to compute the hydrophobic driving force for micelle formation. This information has also been used to test, for the first time, approximations made in traditional molecular-thermodynamic modeling. In the CS-MT model, two separate free-energy contributions to the hydrophobic driving force are computed. The first contribution, gdehydr, is the free-energy change associated with the dehydration of each surfactant group upon micelle formation. The second contribution, ghydr, is the change in the hydration free energy of each surfactant group upon micelle formation. To enable the straightforward estimation of gdehydr and ghydr in the case of nonionic surfactants, a number of simplifying approximations were made. Although the CS-MT model can be used to predict a variety of micellar solution properties including the micelle shape, size, and composition, the critical micelle concentration (CMC) was selected for prediction and comparison with experimental CMC data because it depends exponentially on the free energy of micelle formation, and as such, it provides a stringent quantitative test with which to evaluate the predictive accuracy of the CS-MT model. Reasonable agreement between the CMCs predicted by the CS-MT model and the experimental CMCs was obtained for octyl glucoside (OG), dodecyl maltoside (DM), octyl sulfinyl ethanol (OSE), decyl methyl sulfoxide (C10SO), decyl dimethyl phosphine oxide (C10PO), and decanoyl-n-methylglucamide (MEGA-10). For five of these surfactants, the CMCs predicted using the CS-MT model were closer to the experimental CMCs than the CMCs predicted using the traditional molecular-thermodynamic (MT) model. In addition, CMCs predicted for mixtures of C10PO and C10SO using the CS-MT model were significantly closer to the experimental CMCs than those predicted using the traditional MT model. For dodecyl octa(ethylene oxide) (C12E8), the CMC predicted by the CS-MT model was not in good agreement with the experimental CMC and with the CMC predicted by the traditional MT model, because the simplifying approximations made to estimate gdehydr and ghydr in this case were not sufficiently accurate. Consequently, we recommend that these simplifying approximations only be used for nonionic surfactants possessing relatively small, non-polymeric heads. For MEGA-10, which is the most structurally complex of the seven nonionic surfactants modeled, the CMC predicted by the CS-MT model (6.55 mM) was found to be in much closer agreement with the experimental CMC (5 mM) than the CMC predicted by the traditional MT model (43.3 mM). Our results suggest that, for complex, small-head nonionic surfactants where it is difficult to accurately quantify the hydrophobic driving force for micelle formation using the traditional MT modeling approach, the CS-MT model is capable of making reasonable predictions of aqueous micellization behavior.

Migration after open mesh plug inguinal hernioplasty: a review of the literature.

Migration has been highlighted as a serious complication of open inguinal hernia repair with the "plug-and-patch" technique. We used an English language Medline search from 1995 to 2006. Review of the literature found that three cases showed poor surgical technique, one case did not show true migration, another was a case of the wrong operation being done, and in the final case, the patient was in overall very poor health. Mesh plug migration after open inguinal hernia repair can be avoided if proper attention to detail is used at the time of initial repair.