Ventral Hernia Reconstruction with GORE ENFORM Biomaterial

Introduction: Ventral hernia repair (VHR) is one of the most common surgeries performed in the United States. Degradable mesh is the recommended choice for patients presenting with high-risk co-morbidities or increased risk for infection. GORE® ENFORM BiomaterialTM is a biosynthetic degradable mesh that has recently been approved for use in ventral hernia reconstruction with no reports of its clinical outcomes. Methods: This study was a single surgeon case series. Patients were included in the study if they underwent VHR with GORE® ENFORM BiomaterialTM. The decision to use GORE® ENFORM BiomaterialTM was the senior surgeon's decision based on the patient's center for disease control classification. Patient comorbidities, hernia characteristics, postoperative hernia recurrence, and surgical site occurrences (SSOs) were collected at in-patient follow-up appointments and chart review. Patients were asked to complete preoperative and postoperative patient-reported outcomes (PROs) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity short form 3a and the hernia-specific quality of life (HerQLes) survey. Results: A total of 15 patients were included in this study. The average length of follow-up was 315 days. Postoperatively, 26.7% of patients had an SSO with 4 surgical site infections. Two patients required an operative washout with mesh removal. One patient experienced hernia recurrence. Eight of the 15 patients completed preoperative and postoperative PROs. Conclusion: This is the first clinical study to report the outcomes of ventral hernia repair using ENFORM mesh. These results show that Enform mesh is an option to consider in complex ventral hernia reconstruction.

Anti-adhesive bioresorbable elastomer-coated composite hernia mesh that reduce intraperitoneal adhesions

Intraperitoneal adhesions (IAs) are a major complication arising from abdominal repair surgeries, including hernia repair procedures. Herein, we fabricated a composite mesh device using a macroporous monofilament polypropylene mesh and a degradable elastomer coating designed to meet the requirements of this clinical application. The degradable elastomer was synthesized using an organo-base catalyzed thiol-yne addition polymerization that affords independent control of degradation rate and mechanical properties. The elastomeric coating was further enhanced by the covalent tethering of antifouling zwitterion molecules. Mechanical testing demonstrated the elastomer forms a robust coating on the polypropylene mesh does not exhibit micro-fractures, cracks or mechanical delamination under cyclic fatigue testing that exceeds peak abdominal loads (50 N/cm). Quartz crystal microbalance measurements showed the zwitterionic functionalized elastomer further reduced fibrinogen adsorption by 73% in vitro when compared to unfunctionalized elastomer controls. The elastomer exhibited degradation with limited tissue response in a 10-week murine subcutaneous implantation model. We also evaluated the composite mesh in an 84-day study in a rabbit cecal abrasion hernia adhesion model. The zwitterionic composite mesh significantly reduced the extent and tenacity of IAs by 94% and 90% respectively with respect to uncoated polypropylene mesh. The resulting composite mesh device is an excellent candidate to reduce complications related to abdominal repair through suppressed fouling and adhesion formation, reduced tissue inflammation, and appropriate degradation rate.

COVID-19 Transition: Does virtual exercise maintain physical function?

Background: In March 2020, COVID-19 mandates to restrict face to face exercise and group based gatherings were enacted. These mandates were enforced within most states in the US. Gerofit, a facility-based exercise program for older Veterans in Durham, NC, transitioned to remote virtual exercise instruction to accommodate continuity of care. Objectives: To explore whether remote virtual exercise (RVE) can sustain physical function within individuals previously participating in onsite face to face exercise (OFF). Methods: Physical function assessments performed during OFF were compared with assessments conducted remotely over virtual platform. Assessments included the 30-second arm curl, the 30-second chair stand, time to complete five chair stands, and either 6-minute walk or 2-minute step test. All assessments for RVE were completed via a remote virtual platform. Only participants enrolled in both OFF and home based RVE with functional assessments within 6-months of pre and post COVID-19 transition were compared. Descriptive comparisons, opposed to statistical, were reported due to the limited sample size. Results: Fourteen OFF Gerofit participants were reassessed remotely within the first 6-months of transitioning to RVE (12 male, 2 female, mean age 73.1, mean body mass index 31.5). Functional assessments between OFF versus RVE were arm curls (21.0 vs 20.4 repetitions), chair stands (15.0 vs 17.5 repetitions), and time to 5 chair stands (9.0 vs 8.4 seconds). Cardiovascular function, reported in normalized percentiles (46.4%tile vs 58.9%tile) Conclusion: Among older Veterans engaged in regular structured exercise, physical function was preserved with transition to virtual exercise.

COVID Transitions: Characteristics of older adults who engage or do not engage in virtual exercise

Background. Exercise is a crucial component of maintaining good health in older individuals. The COVID-19 stay-at-home orders forced Veterans actively engaged in facility-based exercise to stop attending in-person group exercise programs like Gerofit. Objective. To compare the characteristics of Veterans who enrolled (E) or declined enrollment (DE) in the transition from a facility-based exercise program, Gerofit, to a virtual Gerofit-to-Home (GTH) program. Methods. Gerofit is a supervised exercise “VA Best Practice” program for older Veterans implemented at 17 VA medical centers around the country. At the time of COVID-19 mandated closures, 1149 Veterans were actively engaged in facility-based programs and invited to attend GTH classes. Comparisons between those enrolling and those declining enrollment were performed by t-tests. Results. Three hundred and eight of 1149 (27%) Veterans made the transition to telehealth delivered classes, with several sites having enrolled participants aged in their mid-nineties. Age was not associated with GTH adoption rates (74.0 vs. 74.7, p=not significant for E vs. NE). Body mass index (31.3 vs. 30.5 kg/m2, p<0.05), gait speed (1.19 vs. 1.12 m/s, p<0.001), arm curls (20.8 vs. 19.5, p<0.001), and chair stands (14.7 vs. 13.2, p<0.05) were higher in individuals actively participating in GTH compared to those that never enrolled. Conclusions. Some older adults can adopt a virtual approach to group-based exercise, demonstrating its feasibility. Further research is needed to improve GTH implementation for lower functioning individuals. Virtual group-based exercise could reduce negative health effects associated with isolation due to lack of in-person exercise.

Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19

Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.