@article{HacklNacovKammerlohretal.2021, author = {Hackl, Michael and Nacov, Julia and Kammerlohr, Sandra and Staat, Manfred and Buess, Eduard and Leschinger, Tim and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Intratendinous Strain Variations of the Supraspinatus Tendon Depending on Repair Technique: A Biomechanical Analysis Regarding the Cause of Medial Cuff Failure}, series = {The American Journal of Sports Medicine}, volume = {49}, journal = {The American Journal of Sports Medicine}, number = {7}, publisher = {Sage}, address = {London}, issn = {1552-3365}, doi = {10.1177/03635465211006138}, pages = {1847 -- 1853}, year = {2021}, language = {en} } @article{TranStaat2020, author = {Tran, Ngoc Trinh and Staat, Manfred}, title = {Direct plastic structural design under lognormally distributed strength by chance constrained programming}, series = {Optimization and Engineering}, volume = {21}, journal = {Optimization and Engineering}, number = {1}, publisher = {Springer Nature}, address = {Cham}, issn = {1573-2924}, doi = {10.1007/s11081-019-09437-2}, pages = {131 -- 157}, year = {2020}, abstract = {We propose the so-called chance constrained programming model of stochastic programming theory to analyze limit and shakedown loads of structures under random strength with a lognormal distribution. A dual chance constrained programming algorithm is developed to calculate simultaneously both the upper and lower bounds of the plastic collapse limit and the shakedown limit. The edge-based smoothed finite element method (ES-FEM) is used with three-node linear triangular elements.}, language = {en} } @article{HorbachStaatPerezVianaetal.2020, author = {Horbach, Andreas and Staat, Manfred and Perez-Viana, Daniel and Simmen, Hans-Peter and Neuhaus, Valentin and Pape, Hans-Christoph and Prescher, Andreas and Ciritsis, Bernhard}, title = {Biomechanical in vitro examination of a standardized low-volume tubular femoroplasty}, series = {Clinical Biomechanics}, volume = {80}, journal = {Clinical Biomechanics}, number = {Art. 105104}, publisher = {Elsevier}, address = {Amsterdam}, doi = {10.1016/j.clinbiomech.2020.105104}, year = {2020}, abstract = {Background Osteoporosis is associated with the risk of fractures near the hip. Age and comorbidities increase the perioperative risk. Due to the ageing population, fracture of the proximal femur also proves to be a socio-economic problem. Preventive surgical measures have hardly been used so far. Methods 10 pairs of human femora from fresh cadavers were divided into control and low-volume femoroplasty groups and subjected to a Hayes fall-loading fracture test. The results of the respective localization and classification of the fracture site, the Singh index determined by computed tomography (CT) examination and the parameters in terms of fracture force, work to fracture and stiffness were evaluated statistically and with the finite element method. In addition, a finite element parametric study with different position angles and variants of the tubular geometry of the femoroplasty was performed. Findings Compared to the control group, the work to fracture could be increased by 33.2\%. The fracture force increased by 19.9\%. The used technique and instrumentation proved to be standardized and reproducible with an average poly(methyl methacrylate) volume of 10.5 ml. The parametric study showed the best results for the selected angle and geometry. Interpretation The cadaver studies demonstrated the biomechanical efficacy of the low-volume tubular femoroplasty. The numerical calculations confirmed the optimal choice of positioning as well as the inner and outer diameter of the tube in this setting. The standardized minimally invasive technique with the instruments developed for it could be used in further comparative studies to confirm the measured biomechanical results.}, language = {en} } @article{JungStaat2020, author = {Jung, Alexander and Staat, Manfred}, title = {Erratum to "Modeling and simulation of human induced pluripotent stem cell-derived cardiac tissue" [GAMM-Mitteilungen, (2019), 42, 4, 10.1002/gamm.201900002]}, series = {GAMM-Mitteilungen}, volume = {43}, journal = {GAMM-Mitteilungen}, number = {4}, publisher = {Wiley-VCH GmbH}, address = {Weinheim}, issn = {1522-2608}, doi = {10.1002/gamm.202000011}, year = {2020}, language = {en} } @article{RauschHarbrechtKahmannetal.2020, author = {Rausch, Valentin and Harbrecht, Andreas and Kahmann, Stephanie Lucina and Fenten, Thomas and Jovanovic, Nebojsa and Hackl, Michael and M{\"u}ller, Lars P. and Staat, Manfred and Wegmann, Kilian}, title = {Osteosynthesis of Phalangeal Fractures: Biomechanical Comparison of Kirschner Wires, Plates, and Compression Screws}, series = {The Journal of Hand Surgery}, volume = {45}, journal = {The Journal of Hand Surgery}, number = {10}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0363-5023}, doi = {10.1016/j.jhsa.2020.04.010}, pages = {987.e1 -- 987.e8}, year = {2020}, abstract = {Purpose The aim of this study was to compare several osteosynthesis techniques (intramedullary headless compression screws, T-plates, and Kirschner wires) for distal epiphyseal fractures of proximal phalanges in a human cadaveric model. Methods A total of 90 proximal phalanges from 30 specimens (index, ring, and middle fingers) were used for this study. After stripping off all soft tissue, a transverse distal epiphyseal fracture was simulated at the proximal phalanx. The 30 specimens were randomly assigned to 1 fixation technique (30 per technique), either a 3.0-mm intramedullary headless compression screw, locking plate fixation with a 2.0-mm T-plate, or 2 oblique 1.0-mm Kirschner wires. Displacement analysis (bending, distraction, and torsion) was performed using optical tracking of an applied random speckle pattern after osteosynthesis. Biomechanical testing was performed with increasing cyclic loading and with cyclic load to failure using a biaxial torsion-tension testing machine. Results Cannulated intramedullary compression screws showed significantly less displacement at the fracture site in torsional testing. Furthermore, screws were significantly more stable in bending testing. Kirschner wires were significantly less stable than plating or screw fixation in any cyclic load to failure test setup. Conclusions Intramedullary compression screws are a highly stable alternative in the treatment of transverse distal epiphyseal phalangeal fractures. Kirschner wires seem to be inferior regarding displacement properties and primary stability. Clinical relevance Fracture fixation of phalangeal fractures using plate osteosynthesis may have the advantage of a very rigid reduction, but disadvantages such as stiffness owing to the more invasive surgical approach and soft tissue irritation should be taken into account. Headless compression screws represent a minimally invasive choice for fixation with good biomechanical properties.}, language = {en} } @article{GossmannThomasHorvathetal.2020, author = {Gossmann, Matthias and Thomas, Ulrich and Horv{\´a}th, Andr{\´a}s and Dragicevic, Elena and Stoelzle-Feix, Sonja and Jung, Alexander and Raman, Aravind Hariharan and Staat, Manfred and Linder, Peter}, title = {A higher-throughput approach to investigate cardiac contractility in vitro under physiological mechanical conditions}, series = {Journal of Pharmacological and Toxicological Methods}, volume = {105}, journal = {Journal of Pharmacological and Toxicological Methods}, number = {Article 106843}, publisher = {Elsevier}, address = {New York, NY}, doi = {10.1016/j.vascn.2020.106843}, year = {2020}, language = {en} } @article{KnoxBruggemannGossmannetal.2020, author = {Knox, Ronald and Bruggemann, Andrea and Gossmann, Matthias and Thomas, Ulrich and Horv{\´a}th, Andr{\´a}s and Dragicevic, Elena and Stoelzle-Feix, Sonja and Fertig, Niels and Jung, Alexander and Raman, Aravind Hariharan and Staat, Manfred and Linder, Peter}, title = {Combining physiological relevance and throughput for in vitro cardiac contractility measurement}, series = {Biophysical Journal}, volume = {118}, journal = {Biophysical Journal}, number = {Issue 3, Supplement 1}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0006-3495}, doi = {10.1016/j.bpj.2019.11.3104}, pages = {570a}, year = {2020}, abstract = {Despite increasing acceptance of human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) in safety pharmacology, controversy remains about the physiological relevance of existing in vitro models for their mechanical testing. We hypothesize that existing signs of immaturity of the cell models result from an improper mechanical environment. We cultured hiPSC-CMs in a 96-well format on hyperelastic silicone membranes imitating their native mechanical environment, resulting in physiological responses to compound stimuli.We validated cell responses on the FLEXcyte 96, with a set of reference compounds covering a broad range of cellular targets, including ion channel modulators, adrenergic receptor modulators and kinase inhibitors. Acute (10 - 30 min) and chronic (up to 7 days) effects were investigated. Furthermore, the measurements were complemented with electromechanical models based on electrophysiological recordings of the used cell types.hiPSC-CMs were cultured on freely-swinging, ultra-thin and hyperelastic silicone membranes. The weight of the cell culture medium deflects the membranes downwards. Rhythmic contraction of the hiPSC-CMs resulted in dynamic deflection changes which were quantified by capacitive distance sensing. The cells were cultured for 7 days prior to compound addition. Acute measurements were conducted 10-30 minutes after compound addition in standard culture medium. For chronic treatment, compound-containing medium was replaced daily for up to 7 days. Electrophysiological properties of the employed cell types were recorded by automated patch-clamp (Patchliner) and the results were integrated into the electromechanical model of the system.Calcium channel agonist S Bay K8644 and beta-adrenergic stimulator isoproterenol induced significant positive inotropic responses without additional external stimulation. Kinase inhibitors displayed cardiotoxic effects on a functional level at low concentrations. The system-integrated analysis detected alterations in beating shape as well as frequency and arrhythmic events and we provide a quantitative measure of these.}, language = {en} } @article{RauschKahmannBaltschunetal.2020, author = {Rausch, Valentin and Kahmann, Stephanie Lucina and Baltschun, Christoph and Staat, Manfred and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Pressure distribution to the distal biceps tendon at the radial tuberosity: a biomechanical study}, series = {The Journal of Hand Surgery}, volume = {45}, journal = {The Journal of Hand Surgery}, number = {8}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0363-5023}, doi = {10.1016/j.jhsa.2020.01.006}, pages = {776.e1 -- 776.e9}, year = {2020}, abstract = {Purpose Mechanical impingement at the narrow radioulnar space of the tuberosity is believed to be an etiological factor in the injury of the distal biceps tendon. The aim of the study was to compare the pressure distribution at the proximal radioulnar space between 2 fixation techniques and the intact state. Methods Six right arms and 6 left arms from 5 female and 6 male frozen specimens were used for this study. A pressure transducer was introduced at the height of the radial tuberosity with the intact distal biceps tendon and after 2 fixation methods: the suture-anchor and the cortical button technique. The force (N), maximum pressure (kPa) applied to the radial tuberosity, and the contact area (mm²) of the radial tuberosity with the ulna were measured and differences from the intact tendon were detected from 60° supination to 60° pronation in 15° increments with the elbow in full extension and in 45° and 90° flexion of the elbow. Results With the distal biceps tendon intact, the pressures during pronation were similar regardless of extension and flexion and were the highest at 60° pronation with 90° elbow flexion (23.3 ± 53.5 kPa). After repair of the tendon, the mean peak pressure, contact area, and total force showed an increase regardless of the fixation technique. Highest peak pressures were found using the cortical button technique at 45° flexion of the elbow and 60° pronation. These differences were significantly different from the intact tendon. The contact area was significantly larger in full extension and 15°, 30°, and 60° pronation using the cortical button technique. Conclusions Pressures on the distal biceps tendon at the radial tuberosity increase during pronation, especially after repair of the tendon. Clinical relevance Mechanical impingement could play a role in both the etiology of primary distal biceps tendon ruptures and the complications occurring after fixation of the tendon using certain techniques.}, language = {en} } @article{AbelKahmannMellonetal.2020, author = {Abel, Alexander and Kahmann, Stephanie Lucina and Mellon, Stephen and Staat, Manfred and Jung, Alexander}, title = {An open-source tool for the validation of finite element models using three-dimensional full-field measurements}, series = {Medical Engineering \& Physics}, volume = {77}, journal = {Medical Engineering \& Physics}, publisher = {Elsevier}, address = {Amsterdam}, issn = {1350-4533}, doi = {10.1016/j.medengphy.2019.10.015}, pages = {125 -- 129}, year = {2020}, abstract = {Three-dimensional (3D) full-field measurements provide a comprehensive and accurate validation of finite element (FE) models. For the validation, the result of the model and measurements are compared based on two respective point-sets and this requires the point-sets to be registered in one coordinate system. Point-set registration is a non-convex optimization problem that has widely been solved by the ordinary iterative closest point algorithm. However, this approach necessitates a good initialization without which it easily returns a local optimum, i.e. an erroneous registration. The globally optimal iterative closest point (Go-ICP) algorithm has overcome this drawback and forms the basis for the presented open-source tool that can be used for the validation of FE models using 3D full-field measurements. The capability of the tool is demonstrated using an application example from the field of biomechanics. Methodological problems that arise in real-world data and the respective implemented solution approaches are discussed.}, language = {en} } @article{JayaramanMummidisettyLoeschetal.2019, author = {Jayaraman, Chandrasekaran and Mummidisetty, Chaitanya Krishna and Loesch, Alexandra and Kaur, Sandi and Hoppe-Ludwig, Shenan and Staat, Manfred and Jayaraman, Arun}, title = {Postural and metabolic benefits of using a forearm support walker in older adults with impairments}, series = {Archives of Physical Medicine and Rehabilitation}, volume = {Volume 100}, journal = {Archives of Physical Medicine and Rehabilitation}, number = {Issue 4}, publisher = {Elsevier}, address = {Amsterdam}, issn = {0003-9993}, doi = {10.1016/j.apmr.2018.10.001}, pages = {638 -- 647}, year = {2019}, language = {en} } @article{LeschingerBirgelHackletal.2019, author = {Leschinger, Tim and Birgel, Stefan and Hackl, Michael and Staat, Manfred and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {A musculoskeletal shoulder simulation of moment arms and joint reaction forces after medialization of the supraspinatus footprint in rotator cuff repair}, series = {Computer Methods in Biomechanics and Biomedical Engineering}, journal = {Computer Methods in Biomechanics and Biomedical Engineering}, number = {Early view}, publisher = {Taylor \& Francis}, address = {London}, doi = {10.1080/10255842.2019.1572749}, year = {2019}, language = {en} } @article{JungStaat2019, author = {Jung, Alexander and Staat, Manfred}, title = {Modeling and simulation of human induced pluripotent stem cell-derived cardiac tissue}, series = {GAMM - Mitteilungen der Gesellschaft f{\"u}r Angewandte Mathematik und Mechanik}, volume = {42}, journal = {GAMM - Mitteilungen der Gesellschaft f{\"u}r Angewandte Mathematik und Mechanik}, number = {4}, publisher = {Wiley}, address = {Weinheim}, issn = {1522-2608}, doi = {10.1002/gamm.201900002}, pages = {11 Seiten}, year = {2019}, language = {en} } @article{MeyerGaalenLeschingeretal.2019, author = {Meyer, Carolin and Gaalen, Kerstin van and Leschinger, Tim and Scheyerer, Max J. and Neiss, Wolfram F. and Staat, Manfred and M{\"u}ller, Lars P. and Wegmann, Kilian}, title = {Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement}, series = {BioMed Research International}, journal = {BioMed Research International}, doi = {10.1155/2019/9232813}, pages = {Article ID 9232813}, year = {2019}, language = {en} } @article{JungMuellerStaat2019, author = {Jung, Alexander and M{\"u}ller, Wolfram and Staat, Manfred}, title = {Optimization of the flight technique in ski jumping: the influence of wind}, number = {Early view}, publisher = {Elsevier}, address = {Amsterdam}, doi = {10.1016/j.jbiomech.2019.03.023}, year = {2019}, language = {en} } @article{SchierenKleinschmidtSchmutzetal.2019, author = {Schieren, Mark and Kleinschmidt, Joris and Schmutz, Axel and Loop, Torsten and Gatzweiler, Karl-Heinz and Staat, Manfred and Wappler, Frank and Defosse, Jerome}, title = {Comparison of forces acting on maxillary incisors during tracheal intubation with different laryngoscopy techniques: a blinded manikin study}, series = {Anaesthesia}, volume = {74}, journal = {Anaesthesia}, number = {12}, publisher = {Wiley-Blackwell}, address = {Oxford}, isbn = {1365-2044}, doi = {10.1111/anae.14815}, year = {2019}, language = {en} } @article{LinderBecklerDoerretal.2019, author = {Linder, Peter and Beckler, Matthias and Doerr, Leo and Stoelzle-Feix, Sonja and Fertig, Niels and Jung, Alexander and Staat, Manfred and Gossmann, Matthias}, title = {A new in vitro tool to investigate cardiac contractility under physiological mechanical conditions}, series = {Journal of Pharmacological and Toxicological Methods}, volume = {99}, journal = {Journal of Pharmacological and Toxicological Methods}, number = {Article number 106595}, publisher = {Elsevier}, address = {Amsterdam}, issn = {1056-8719}, doi = {10.1016/j.vascn.2019.05.162}, year = {2019}, language = {en} } @article{LeschingerBeschAydinetal.2019, author = {Leschinger, Tim and Besch, Katharina and Aydin, Cansu and Staat, Manfred and Scaal, Martin and M{\"u}ller, Lars Peter and Wegmann, Kilian}, title = {Irreparable rotator cuff tears: a biomechanical comparison of superior capsuloligamentous complex reconstruction techniques and an interposition graft technique}, series = {The Orthopaedic Journal of Sports Medicine}, volume = {7}, journal = {The Orthopaedic Journal of Sports Medicine}, number = {8}, doi = {10.1177/2325967119864590}, pages = {1 -- 5}, year = {2019}, language = {en} } @article{BhattaraiStaat2019, author = {Bhattarai, Aroj and Staat, Manfred}, title = {A computational study of organ relocation after laparoscopic pectopexy to repair posthysterectomy vaginal vault prolapse}, series = {Computer Methods in Biomechanics and Biomedical Engineering: Imaging \& Visualization}, journal = {Computer Methods in Biomechanics and Biomedical Engineering: Imaging \& Visualization}, publisher = {Taylor \& Francis}, address = {London}, issn = {2168-1171}, doi = {10.1080/21681163.2019.1670095}, year = {2019}, language = {en} } @article{CiritsisHorbachStaatetal.2018, author = {Ciritsis, Alexander and Horbach, Andreas and Staat, Manfred and Kuhl, Christiane K. and Kraemer, Nils Andreas}, title = {Porosity and tissue integration of elastic mesh implants evaluated in vitro and in vivo}, series = {Journal of Biomedical Materials Research: Part B: Applied Biomaterials}, volume = {106}, journal = {Journal of Biomedical Materials Research: Part B: Applied Biomaterials}, number = {2}, publisher = {Wiley}, address = {New York, NY}, issn = {1552-4981}, doi = {10.1002/jbm.b.33877}, pages = {827 -- 833}, year = {2018}, abstract = {Purpose In vivo, a loss of mesh porosity triggers scar tissue formation and restricts functionality. The purpose of this study was to evaluate the properties and configuration changes as mesh deformation and mesh shrinkage of a soft mesh implant compared with a conventional stiff mesh implant in vitro and in a porcine model. Material and Methods Tensile tests and digital image correlation were used to determine the textile porosity for both mesh types in vitro. A group of three pigs each were treated with magnetic resonance imaging (MRI) visible conventional stiff polyvinylidene fluoride meshes (PVDF) or with soft thermoplastic polyurethane meshes (TPU) (FEG Textiltechnik mbH, Aachen, Germany), respectively. MRI was performed with a pneumoperitoneum at a pressure of 0 and 15 mmHg, which resulted in bulging of the abdomen. The mesh-induced signal voids were semiautomatically segmented and the mesh areas were determined. With the deformations assessed in both mesh types at both pressure conditions, the porosity change of the meshes after 8 weeks of ingrowth was calculated as an indicator of preserved elastic properties. The explanted specimens were examined histologically for the maturity of the scar (collagen I/III ratio). Results In TPU, the in vitro porosity increased constantly, in PVDF, a loss of porosity was observed under mild stresses. In vivo, the mean mesh areas of TPU were 206.8 cm2 (± 5.7 cm2) at 0 mmHg pneumoperitoneum and 274.6 cm2 (± 5.2 cm2) at 15 mmHg; for PVDF the mean areas were 205.5 cm2 (± 8.8 cm2) and 221.5 cm2 (± 11.8 cm2), respectively. The pneumoperitoneum-induced pressure increase resulted in a calculated porosity increase of 8.4\% for TPU and of 1.2\% for PVDF. The mean collagen I/III ratio was 8.7 (± 0.5) for TPU and 4.7 (± 0.7) for PVDF. Conclusion The elastic properties of TPU mesh implants result in improved tissue integration compared to conventional PVDF meshes, and they adapt more efficiently to the abdominal wall. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 827-833, 2018.}, language = {en} } @article{BhattaraiJabbariAndingetal.2018, author = {Bhattarai, Aroj and Jabbari, Medisa and Anding, Ralf and Staat, Manfred}, title = {Surgical treatment of vaginal vault prolapse using different prosthetic mesh implants: a finite element analysis}, series = {tm - Technisches Messen}, volume = {85}, journal = {tm - Technisches Messen}, number = {5}, publisher = {De Gruyter}, address = {Berlin}, issn = {2196-7113}, doi = {10.1515/teme-2017-0115}, pages = {331 -- 342}, year = {2018}, abstract = {Particularly multiparous elderly women may suffer from vaginal vault prolapse after hysterectomy due to weak support from lax apical ligaments. A decreased amount of estrogen and progesterone in older age is assumed to remodel the collagen thereby reducing tissue stiffness. Sacrocolpopexy is either performed as open or laparoscopic surgery using prosthetic mesh implants to substitute lax ligaments. Y-shaped mesh models (DynaMesh, Gynemesh, and Ultrapro) are implanted in a 3D female pelvic floor finite element model in the extraperitoneal space from the vaginal cuff to the first sacral (S1) bone below promontory. Numerical simulations are conducted during Valsalva maneuver with weakened tissues modeled by reduced tissue stiffness. Tissues are modeled as incompressible, isotropic hyperelastic materials whereas the meshes are modeled either as orthotropic linear elastic or as isotropic hyperlastic materials. The positions of the vaginal cuff and the bladder base are calculated from the pubococcygeal line for female pelvic floor at rest, for prolapse and after repair using the three meshes. Due to mesh mechanics and mesh pore deformation along the loaded direction, the DynaMesh with regular rectangular mesh pores is found to provide better mechanical support to the organs than the Gynemesh and the Ultrapro with irregular hexagonal mesh pores. Insbesondere {\"a}ltere, mehrgeb{\"a}hrende Frauen leiden h{\"a}ufiger an einem Scheidenvorfall nach einer Hysterektomie aufgrund der schwachen Unterst{\"u}tzung durch laxe apikale B{\"a}nder. Es wird angenommen, dass eine verringerte Menge an {\"O}strogen und Progesteron im h{\"o}heren Alter das Kollagen umformt, wodurch die Gewebesteifigkeit reduziert wird. Die Sakrokolpopexie ist eine offene oder laparoskopische Operation, die mit prothetischen Netzimplantaten durchgef{\"u}hrt wird, um laxe B{\"a}nder zu ersetzen. Y-f{\"o}rmige Netzmodelle (DynaMesh, Gynemesh und Ultrapro) werden in einem 3D-Modell des weiblichen Beckenbodens im extraperitonealen Raum vom Vaginalstumpf bis zum Promontorium implantiert. Numerische Simulationen werden w{\"a}hrend des Valsalva-Man{\"o}vers mit geschw{\"a}chtem Gewebe durchgef{\"u}hrt, das durch eine reduzierte Gewebesteifigkeit modelliert wird. Die Gewebe werden als inkompressible, isotrop hyperelastische Materialien modelliert, w{\"a}hrend die Netze entweder als orthotrope linear elastische oder als isotrope hyperlastische Materialien modelliert werden. Die Positionen des Vaginalstumpfs, der Blase und der Harnr{\"o}hrenachse werden anhand der Pubococcygeallinie aus der Ruhelage, f{\"u}r den Prolaps und nach der Reparatur unter Verwendung der drei Netze berechnet. Aufgrund der Netzmechanik und der Netzporenverformung bietet das DynaMesh mit regelm{\"a}ßigen rechteckigen Netzporen eine bessere mechanische Unterst{\"u}tzung und eine Neupositionierung des Scheidengew{\"o}lbes, der Blase und der Urethraachse als Gynemesh und Ultrapro mit unregelm{\"a}ßigen hexagonalen Netzporen.}, language = {en} }