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Tafti AA, Mohammadi H, Rezaei M, Bonadaki SHS. Use of a bioresorbable polylactide sheet (OrthoWrap ® Bioresorbable sheet) on tendon healing after extensor tendon repair: a controlled clinical trial. BMC Musculoskelet Disord 2025; 26:1. [PMID: 39743570 DOI: 10.1186/s12891-024-08241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 12/23/2024] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Adhesion formation poses a significant challenge for both patients and hand surgeons following tendon repair. One common strategy to prevent adhesion formation is the use of physical barriers. This study aimed to compare the outcomes of extensor tendon repair with and without the application of the OrthoWrap® bioresorbable Sheet, specifically in terms of adhesion prevention. METHODS This triple-blind randomized clinical trial was conducted on patients with trauma to the extensor zone VI tendons. Participants were randomly assigned to one of two groups. In the intervention group, OrthoWrap® bioresorbable Sheet was applied in addition to the standard tendon repair protocol. Over a three-month follow-up period, the Visual Analogue Scale (VAS) score, extension lag, and metacarpophalangeal joint flexion were assessed. Additionally, the mobility of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints was evaluated using the Strickland classification. RESULTS A total of 42 patients in the OrthoWrap® group and 43 in the control group were evaluated over the three-month period. Both groups showed a significant reduction in mean extension lag at the metacarpophalangeal joint over time. No significant condition-by-time interactions were found for MP joint flexion or VAS scores (p > 0.05). However, significant improvements in MP joint flexion and VAS scores were observed over time. The OrthoWrap® group demonstrated significantly more favorable outcomes compared to the control group. CONCLUSION The clinical application of OrthoWrap® in extensor tendon repair demonstrated statistically significant but modest improvements in extension lag (2.5°). While patients treated with OrthoWrap® showed better outcomes in Strickland's classification, the clinical significance of these small differences and their impact on patient function requires further investigation. TRIAL REGISTRATION IRCT, IRCT20180627040252N3. Registered 20,220,617, Https//irct.behdasht.gov.ir/trial/56,652.
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Affiliation(s)
- Abbas Abdoli Tafti
- Orthopedic Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamidreza Mohammadi
- Orthopedic Department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Morteza Rezaei
- Orthopedic Department, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Nian H, Pu Z, Li J. Response to letter to the editor on: "Establishment and evaluation of a stable and reliable rat model of peritoneal adhesions". Surgery 2024; 176:1783-1784. [PMID: 39266409 DOI: 10.1016/j.surg.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/14/2024]
Affiliation(s)
- Hongyu Nian
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Zhenjun Pu
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Junliang Li
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou, China; Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China; Key Laboratory of Molecular Diagnostics and Precision Medicine for Surgical Oncology in Gansu Province, Gansu Provincial Hospital, Lanzhou, China; Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China.
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Wen J, Liu K, Bu Y, Zhang Y, Zheng Y, He J, Huang Y, Hu D, Wang K. An injectable and antifouling hydrogel prevents the development of abdominal adhesions by inhibiting the CCL2/CCR2 interaction. Biomaterials 2024; 311:122661. [PMID: 38875883 DOI: 10.1016/j.biomaterials.2024.122661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/16/2024]
Abstract
Abdominal adhesion, a serious complication of abdominal surgery, often resists mitigation by current drug administration and physical barriers. To address this issue, we developed an injectable, antifouling hydrogel through the free-radical polymerization of methacrylate chondroitin sulfate (CS-GMA) and 2-methacryloyloxyethyl phosphorylcholine (MPC) monomers, dubbed the CGM hydrogel. We systematically analyzed its physicochemical properties, including rheological strength, biocompatibility, and antifouling capabilities. A rat abdominal cecum adhesion model was constructed to assess the effectiveness of CGM hydrogel in preventing postoperative adhesion and recurrent adhesion. In addition, multi-omics analyses identified the relationship between adhesion development and CCL2/CCR2 interaction. Notably, CGM hydrogel can thwart the recruitment and aggregation of fibroblasts and macrophages by inhibiting the CCL2/CCR2 interaction. Moreover, CGM hydrogel significantly dampens the activity of fibrosis-linked cytokines (TGF-βR1) and recalibrates extracellular matrix deposition-related cytokines (t-PA and PAI-1, Col Ⅰ and MMP-9). Cumulatively, the dual action of CGM hydrogel-as a physical barrier and cytokine regulator-highlights its promising potential in clinical application for abdominal adhesion prevention.
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Affiliation(s)
- Jinpeng Wen
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Kailai Liu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yizhuo Bu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yuchen Zhang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yunhe Zheng
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jiangchuan He
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yu Huang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Datao Hu
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Ke Wang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China.
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Okur S, Yanmaz LE, Bolat İ, Golgeli A, Tarık OÖ, Okur DT, Kiliçlioglu M, Baykal B. Application of infrared thermography in assessing presence and severity of intra-abdominal adhesions. J Therm Biol 2024; 123:103920. [PMID: 39003832 DOI: 10.1016/j.jtherbio.2024.103920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/14/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
Abdominal surgeries can sometimes lead to the formation of intra-abdominal adhesions, which may result in severe complications. Despite the availability of several diagnostic procedures, thermography has not been used for identifying intra-abdominal adhesions. Therefore, the objective of the current study was to assess abdominal temperature changes in rats with experimentally induced intra-abdominal adhesions. A total of 48 female rats were randomly divided into 4 groups (n = 12 each): Control (Group C), Laparotomy (Group Lap), Peritoneal Button Creation (Group PBC), and Uterus horn (Group UH). Skin temperature of abdominal region was measured before the procedure (T0) and daily thereafter until day 7 (T7). On day 7, all rats were euthanized for macroscopic evaluation, adhesion scoring, histopathological, immunohistochemical and immunofluorescence analyses. Significant differences were observed between Group C and Group PBC and Group UH at T5, while at T6 and T7, there was a difference between Group C and Group Lap, Group PBC, and Group UH in abdominal skin temperature (P < 0.05). The highest level of inflammation, angiogenesis, IL-1β, and VEGF were observed in Group PBC followed by Group UH, Group Lap, and Group C (P < 0.05). There was a significant difference in adhesion formation between Group C and Groups Lap, PBC, and UH (P = 0.02). However, no significant difference was found in adhesion scores between Groups Lap, PBC, and UH (P = 0.25). A significant difference was found in mean abdominal skin temperature between adhesion scores 4 and 0, 1, and 2 (P < 0.05), while no significant difference was observed between adhesion scores 3 and 4 (P > 0.05). In conclusion, the current study suggests that the presence of intra-abdominal adhesions is associated with an increase in abdominal temperature, and this increase is correlates with the severity of adhesion.
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Affiliation(s)
- Sitkican Okur
- Department of Veterinary Surgery, Atatürk University, Erzurum, 25000, Turkey.
| | - Latif Emrah Yanmaz
- Department of Veterinary Surgery, Burdur Mehmet Akif Ersoy University, Burdur, 15030, Turkey
| | - İsmail Bolat
- Department of Veterinary Pathology, Atatürk University, Erzurum, 25000, Turkey
| | - Ayse Golgeli
- Department of Veterinary Surgery, Atatürk University, Erzurum, 25000, Turkey
| | - Orhun Ömer Tarık
- Department of Veterinary Surgery, Atatürk University, Erzurum, 25000, Turkey
| | - Damla Tugce Okur
- Department of Veterinary Obstetrics and Gynecology, Atatürk University, Erzurum, 25000, Turkey
| | - Metin Kiliçlioglu
- Department of Veterinary Pathology, Atatürk University, Erzurum, 25000, Turkey
| | - Büsra Baykal
- Department of Veterinary Surgery, Atatürk University, Erzurum, 25000, Turkey
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Moriyama M, Nakamura K, Nagata H, Wada I, Nagira K, Azuma Y, Sato E, Harada T, Taniguchi F. Role of tenascin C in lesion formation in early peritoneal endometriosis. F&S SCIENCE 2024; 5:69-79. [PMID: 38092313 DOI: 10.1016/j.xfss.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To identify cytokines or extracellular matrix components that contribute to adhesion to, and invasion of, the peritoneum, proximal to lesions in the early phase of endometriosis. DESIGN Laboratory-based study. SETTING University Hospital and Laboratory of Animal Science. PATIENTS AND ANIMALS Five women with ovarian endometrioma, 138 wild-type (WT) C57BL/6N mice, and 48 Tenascin C (Tnc) knockout (TncKO) mice. INTERVENTIONS To establish a murine endometriosis model, 20 pieces of minced uterine tissue fragments from each horn were administered intraperitoneally to syngeneic mice. Three days later, endometriotic lesions and peritoneal tissues were collected. Separately, we transfected human peritoneal mesothelial cells (HMrSV5) or human endometrial stromal cells (hESCs) with Tnc small interfering ribonucleic acid. MAIN OUTCOME MEASURES We employed a polymerase chain reaction array to profile gene expression in the murine peritoneum, in both peritoneum distal to lesions and peritoneum surrounding lesions (PSL). The expression of upregulated genes in the PSL was verified in the peritoneal samples by real-time reverse transcription-polymerase chain reaction. TncKO mice were used to investigate the role of Tnc in the development of endometriosis. We evaluated the proliferative activity or inflammatory state of lesions by Ki67 or CD3 immunostaining. Intraperitoneal distribution of macrophages was assessed by fluorescence-activated cell sorting. Using Tnc small interfering ribonucleic acid, we examined the invasive capacity of hESCs in a coculture system with HMrSV5. RESULTS Tnc gene expression was significantly higher in PSL than in peritoneum distal to lesions. The weight and number of TncKO lesions in TncKO hosts were lower than those of WT lesions in WT hosts. In contrast, the weight and number of nonattached TncKO lesions in TncKO hosts were higher than those of nonattached WT lesions in WT hosts. We observed decreased Ki67-positive cells or H-scores for CD3, a lower proportion of M1 macrophages, and a higher proportion of M2 macrophages in TncKO lesions in TncKO recipients. Silencing of Tnc expression in hESCs and HMrSV5 diminished the invasivity of hESCs. CONCLUSION Tnc may be a crucial factor in the development of early peritoneal endometriosis.
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Affiliation(s)
- Maako Moriyama
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kazuomi Nakamura
- Advanced Medicine, Innovation and Clinical Research Center, Tottori University Hospital, Yonago, Tottori, Japan
| | - Hiroki Nagata
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Ikumi Wada
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Kei Nagira
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Yukihiro Azuma
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Eri Sato
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Tasuku Harada
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Fuminori Taniguchi
- Division of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.
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Kargozar S, Gorgani S, Nazarnezhad S, Wang AZ. Biocompatible Nanocomposites for Postoperative Adhesion: A State-of-the-Art Review. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 14:4. [PMID: 38202459 PMCID: PMC10780749 DOI: 10.3390/nano14010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
To reduce and prevent postsurgical adhesions, a variety of scientific approaches have been suggested and applied. This includes the use of advanced therapies like tissue-engineered (TE) biomaterials and scaffolds. Currently, biocompatible antiadhesive constructs play a pivotal role in managing postoperative adhesions and several biopolymer-based products, namely hyaluronic acid (HA) and polyethylene glycol (PEG), are available on the market in different forms (e.g., sprays, hydrogels). TE polymeric constructs are usually associated with critical limitations like poor biocompatibility and mechanical properties. Hence, biocompatible nanocomposites have emerged as an advanced therapy for postoperative adhesion treatment, with hydrogels and electrospun nanofibers among the most utilized antiadhesive nanocomposites for in vitro and in vivo experiments. Recent studies have revealed that nanocomposites can be engineered to generate smart three-dimensional (3D) scaffolds that can respond to different stimuli, such as pH changes. Additionally, nanocomposites can act as multifunctional materials for the prevention of adhesions and bacterial infections, as well as tissue healing acceleration. Still, more research is needed to reveal the clinical potential of nanocomposite constructs and the possible success of nanocomposite-based products in the biomedical market.
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Affiliation(s)
- Saeid Kargozar
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Sara Gorgani
- Tissue Engineering Research Group (TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran; (S.G.); (S.N.)
| | - Simin Nazarnezhad
- Tissue Engineering Research Group (TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran; (S.G.); (S.N.)
| | - Andrew Z. Wang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA;
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Chen J, Tang X, Wang Z, Perez A, Yao B, Huang K, Zhang Y, King MW. Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions. Bioeng Transl Med 2023; 8:e10565. [PMID: 38023705 PMCID: PMC10658569 DOI: 10.1002/btm2.10565] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
Postsurgical adhesions are a common complication of surgical procedures that can lead to postoperative pain, bowel obstruction, infertility, as well as complications with future procedures. Several agents have been developed to prevent adhesion formation, such as barriers, anti-inflammatory and fibrinolytic agents. The Food and Drug Administration (FDA) has approved the use of physical barrier agents, but they have been associated with conflicting clinical studies and controversy in the clinical utilization of anti-adhesion barriers. In this review, we summarize the human anatomy of the peritoneum, the pathophysiology of adhesion formation, the current prevention agents, as well as the current research progress on adhesion prevention. The early cellular events starting with injured mesothelial cells and incorporating macrophage response have recently been found to be associated with adhesion formation. This may provide the key component for developing future adhesion prevention methods. The current use of physical barriers to separate tissues, such as Seprafilm®, composed of hyaluronic acid and carboxymethylcellulose, can only reduce the risk of adhesion formation at the end stage. Other anti-inflammatory or fibrinolytic agents for preventing adhesions have only been studied within the context of current research models, which is limited by the lack of in-vitro model systems as well as in-depth study of in-vivo models to evaluate the efficiency of anti-adhesion agents. In addition, we explore emerging therapies, such as gene therapy and stem cell-based approaches, that may offer new strategies for preventing adhesion formation. In conclusion, anti-adhesion agents represent a promising approach for reducing the burden of adhesion-related complications in surgical patients. Further research is needed to optimize their use and develop new therapies for this challenging clinical problem.
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Affiliation(s)
- Jiahui Chen
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Xiaoqi Tang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Ziyu Wang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Arielle Perez
- UNC School of Medicine Department of SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Benjamin Yao
- Montefiore Medical Center Department of Obstetrics & Gynecology & Women's Health ServicesMontefiore Medical CenterBronxNew YorkUSA
| | - Ke Huang
- Joint Department of Biomedical EngineeringNorth Carolina State University & University of North Carolina at Chapel HillRaleighNorth CarolinaUSA
- Department of Molecular Biomedical SciencesNorth Carolina State UniversityRaleighNorth CarolinaUnited States
| | - Yang Zhang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Martin W. King
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
- College of Textiles, Donghua UniversityShanghaiSongjiangChina
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Liu X, Song X, Zhang Z, Yang S, Li L, Lin C, Chen M, Liu C, Li X, Zhang Y, Hu G. Multifunctional Oxidized Dextran-Metformin as a Tissue-Adhesive Hydrogel to Prevent Postoperative Peritoneal Adhesions in Patients with Metabolic Syndrome. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2303767. [PMID: 37845002 PMCID: PMC10667813 DOI: 10.1002/advs.202303767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/26/2023] [Indexed: 10/18/2023]
Abstract
Patients with metabolic syndrome (MetS) undergoing surgery are at high risk of developing peritoneal adhesions and other severe postoperative complications. However, the single shielding function and absence of physiological activity render conventional methods less useful in preventing adhesions in patients with MetS. To address this challenge, a convenient method is introduced for developing a novel tissue-adhesive hydrogel called oxidized dextran-metformin (ODE-ME) via Schiff base linkages. This injectable ODE-ME hydrogel exhibits excellent tissue-adhesive properties and various physiological functions, particularly enhanced antibacterial effects. Furthermore, in vivo experiments demonstrate that the hydrogel can effectively alleviate hyperglycemia, reduce excessive inflammation, and improve fibrinolytic activity in MetS mice, thereby preventing adhesions and promoting incisional healing. The hydrogel concurrently isolates injured tissues and lowers the blood glucose levels immediately after surgery in mice. Therefore, the ODE-ME hydrogel functions as a multifunctional barrier material and has potential for preventing postoperative peritoneal adhesions in patients with MetS in clinical settings.
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Affiliation(s)
- Xi Liu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Xianwen Song
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, P. R. China
| | - Zequn Zhang
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Shutong Yang
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, P. R. China
| | - Liang Li
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Changwei Lin
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Miao Chen
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Chuntai Liu
- National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou, 450002, P. R. China
| | - Xiaorong Li
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
| | - Yi Zhang
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha, 410083, P. R. China
| | - Gui Hu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan, 410013, P. R. China
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Zhang H, Wu Z, Zhou J, Wang Z, Yang C, Wang P, Fareed MS, He Y, Su J, Cha R, Wang K. The Antimicrobial, Hemostatic, and Anti-Adhesion Effects of a Peptide Hydrogel Constructed by the All-d-Enantiomer of Antimicrobial Peptide Jelleine-1. Adv Healthc Mater 2023; 12:e2301612. [PMID: 37552211 DOI: 10.1002/adhm.202301612] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/21/2023] [Indexed: 08/09/2023]
Abstract
Peptide hydrogels are believed to be potential biomaterials with wide application in the biomedical field because of their good biocompatibility, injectability, and 3D printability. Most of the previously reported polypeptide hydrogels are composed of l-peptides, while the hydrogels formed by self-assembly of d-peptides are rarely reported. Herein, a peptide hydrogel constructed by D-J-1, which is the all-d-enantiomer of antimicrobial peptide Jelleine-1 (J-1) is reported. Field emission scanning electron microscope (FE-SEM) and rheologic study are performed to characterize the hydrogel. Antimicrobial, hemostatic, and anti-adhesion studies are carried out to evaluate its biofunction. The results show that D-J-1 hydrogel is formed by self-assembly and cross-linking driven by hydrogen bonding, hydrophobic interaction, and π-π stacking force of aromatic ring in the structure of D-J-1. It exhibits promising antimicrobial activity, hemostatic activity, and anti-adhesion efficiency in a rat sidewall defect-cecum abrasion model. In addition, it also exhibits good biocompatibility. Notably, D-J-1 hydrogel shows improved in vitro and in vivo stability when compared with its l-enantiomer J-1 hydrogel. Therefore, the present study will provide new insight into the application of d-peptide hydrogel, and provides a new peptide hydrogel with antibacterial, hemostatic, and anti-adhesion efficacy for clinical use.
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Affiliation(s)
- Hanru Zhang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
- Department of Obstetrics & Gynecology, Gansu Provincial Maternity and Child Care Hospital, North Road 143, Qilihe District, Lanzhou, 730000, P. R. China
| | - Zhiyu Wu
- The First School of Clinical Medicine, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Jingjing Zhou
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Zhaopeng Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Changyan Yang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Panpan Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Muhammad Subaan Fareed
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Yuhang He
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Jie Su
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
| | - Ruitao Cha
- Laboratory of Theoretical and Computational Nanoscience, CAS Center for Excellence in Nanoscience, National Center for NanoScience and Technology, No. 11 Zhongguancun Beiyitiao, Beijing, 100190, P. R. China
| | - Kairong Wang
- Key Laboratory of Preclinical Study for New Drugs of Gansu Province, School of Basic Medical Sciences, Research Unit of Peptide Science, Chinese Academy of Medical Sciences 2019RU066, Lanzhou University, West Donggang Road 199, Lanzhou, 730000, P. R. China
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Zarbaliyev E, Turhan N, Dündar F, Sevmiş M, Çelik S, Çağlikülekçi M. The Relationship Between Small Peritoneal Flap Defects and Postoperative Seroma in TAPP Repair of Inguinal Hernias. Surg Laparosc Endosc Percutan Tech 2023; 33:493-498. [PMID: 37796240 DOI: 10.1097/sle.0000000000001211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Total abdominal preperitoneal (TAPP) is one of the most frequently used surgical treatment methods in the treatment of inguinal hernia (IH). One of the most common early postoperative complications after hernia repair is seroma/hematoma. In this study, we aimed to study the role of unclosed peritoneal flap defects on the development of postoperative seroma. MATERIAL AND METHODS The study was performed retrospectively in 2 university hospitals. All patients over the age of 18 years who underwent laparoscopic TAPP surgery in Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital General Surgery Clinic and Van Yüzüncü Yıl University Faculty of Medicine General Surgery Clinic between January 1, 2018, and December 31, 2021, were included. Patients were divided into those with peritoneal defects (group 1) and those without (group 2). Whether there was a peritoneal defect or not was compiled from video recordings. In addition, risk factors affecting the development of seroma were determined. RESULTS A total of 250 patients, 16 (6.4%) women and 234 (93.6%) men, were included in the study. There were bilateral hernias in 35 (14%) patients, and a total of 320 hernias were analyzed in the study. It was determined that an American Society of Anaesthesiologists (ASA) III score increased the risk of seroma 15.97 fold (P<0.001, 95% CI, 4.94 to 51.56), direct hernia type increased risk 7.1 fold (P<0.03, 95% CI, 1.204 to 42.422), hernia descending into scrotum increased risk 22.48 fold (P<0.001, 95% CI, 6.66 to 75.84) and closure of the peritoneal flap completely without leaving any defect increased the risk of seroma 8.67 fold (P<0.001, 95% CI, 3.254 to 23.115). CONCLUSIONS The presence or leaving of small-diameter defects on the peritoneal flap may reduce seroma development without increasing the risk of complications. Prospective randomized studies are required to reach definitive conclusions.
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Affiliation(s)
- Elbrus Zarbaliyev
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Nihan Turhan
- Department of General Surgery, Martyr Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, İstanbul
| | - Faruk Dündar
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Murat Sevmiş
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
| | - Sebahattain Çelik
- Department of General Surgery, Faculty of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | - Mehmet Çağlikülekçi
- Department of General Surgery, Gaziosmanpaşa Hospital, Istanbul Yeni Yüzyil University
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11
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Esber S, Etrusco A, Laganà AS, Chiantera V, Arsalan HM, Khazzaka A, Dellino M, Sleiman Z. Clinical Outcomes after the Use of Antiadhesive Agents in Laparoscopic Reproductive Surgery. Gynecol Obstet Invest 2023; 88:325-335. [PMID: 37757758 PMCID: PMC10794970 DOI: 10.1159/000534170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Intra-abdominal adhesions are abnormal fibrous attachments between tissues and organs that can be congenital or acquired. Adhesion formation is a critical postoperative complication that may lead to bowel obstruction, chronic abdominal pain, and infertility. Physical barrier agents separate opposing peritoneal surfaces in the critical 5-day period of remesotheliazation. These agents are subdivided into solid or liquid/gel. Liquid agents seem easier to use in laparoscopic procedures than solid agents. METHODS The search for suitable articles published in English was carried out using the following databases: MEDLINE, Embase, Global Health, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database, Web of Science, and search register (ClinicalTrial.gov). Only studies reporting data about the impact of the use of an antiadhesive agent on adhesion formation after a primary gynecologic laparoscopic surgery were considered eligible. RESULTS Twenty-two papers that met the inclusion criteria were included in this systematic review. CONCLUSIONS Surgeons should consider applying antiadhesive agents after gynecologic surgery to help reduce adhesion formation and its adverse effects. However, further studies are still needed to confirm their impact on reproductive outcome and to implement clear guidelines on their per-operative application.
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Affiliation(s)
- Sabine Esber
- Department of Obstetrics and Gynecology, Saint Joseph University, Beirut, Lebanon
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy,
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
- Unit of Gynecologic Oncology, National Cancer Institute - IRCCS - Fondazione "G. Pascale", Naples, Italy
| | | | - Aline Khazzaka
- Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Miriam Dellino
- Obstetrics and Gynaecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon
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12
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Liao J, Li X, Fan Y. Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions. Bioact Mater 2023; 26:387-412. [PMID: 36969107 PMCID: PMC10030827 DOI: 10.1016/j.bioactmat.2023.02.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/26/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
Postoperative adhesion (POA) widely occurs in soft tissues and usually leads to chronic pain, dysfunction of adjacent organs and some acute complications, seriously reducing patients' quality of life and even being life-threatening. Except for adhesiolysis, there are few effective methods to release existing adhesion. However, it requires a second operation and inpatient care and usually triggers recurrent adhesion in a great incidence. Hence, preventing POA formation has been regarded as the most effective clinical strategy. Biomaterials have attracted great attention in preventing POA because they can act as both barriers and drug carriers. Nevertheless, even though much reported research has been demonstrated their efficacy on POA inhibition to a certain extent, thoroughly preventing POA formation is still challenging. Meanwhile, most biomaterials for POA prevention were designed based on limited experiences, not a solid theoretical basis, showing blindness. Hence, we aimed to provide guidance for designing anti-adhesion materials applied in different soft tissues based on the mechanisms of POA occurrence and development. We first classified the postoperative adhesions into four categories according to the different components of diverse adhesion tissues, and named them as "membranous adhesion", "vascular adhesion", "adhesive adhesion" and "scarred adhesion", respectively. Then, the process of the occurrence and development of POA were analyzed, and the main influencing factors in different stages were clarified. Further, we proposed seven strategies for POA prevention by using biomaterials according to these influencing factors. Meanwhile, the relevant practices were summarized according to the corresponding strategies and the future perspectives were analyzed.
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Affiliation(s)
- Jie Liao
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Xiaoming Li
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
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13
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Erdi M, Sandler A, Kofinas P. Polymer nanomaterials for use as adjuvant surgical tools. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1889. [PMID: 37044114 PMCID: PMC10524211 DOI: 10.1002/wnan.1889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
Materials employed in the treatment of conditions encountered in surgical and clinical practice frequently face barriers in translation to application. Shortcomings can be generalized through their reduced mechanical stability, difficulty in handling, and inability to conform or adhere to complex tissue surfaces. To overcome an amalgam of challenges, research has sought the utilization of polymer-derived nanomaterials deposited in various fashions and formulations to improve the application and outcomes of surgical and clinical interventions. Clinically prevalent applications include topical wound dressings, tissue adhesives, surgical sealants, hemostats, and adhesion barriers, all of which have displayed the potential to act as superior alternatives to current materials used in surgical procedures. In this review, emphasis will be placed not only on applications, but also on various design strategies employed in fabrication. This review is designed to provide a broad and thought-provoking understanding of nanomaterials as adjuvant tools for the assisted treatment of pathologies prevalent in surgery. This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery.
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Affiliation(s)
- Metecan Erdi
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
| | - Anthony Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, Washington, DC, USA
| | - Peter Kofinas
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
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14
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Erdi M, Saruwatari MS, Rozyyev S, Acha C, Ayyub OB, Sandler AD, Kofinas P. Controlled Release of a Therapeutic Peptide in Sprayable Surgical Sealant for Prevention of Postoperative Abdominal Adhesions. ACS APPLIED MATERIALS & INTERFACES 2023:10.1021/acsami.3c00283. [PMID: 36884271 PMCID: PMC10485170 DOI: 10.1021/acsami.3c00283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Formation of asymmetric, rigid scar tissue known as surgical adhesions is caused by traumatic disruption of mesothelial-lined surfaces in surgery. A widely adopted prophylactic barrier material (Seprafilm) for the treatment of intra-abdominal adhesions is applied operatively as a pre-dried hydrogel sheet but has reduced translational efficacy due its brittle mechanical properties. Topically administered peritoneal dialysate (Icodextrin) and anti-inflammatory drugs have failed to prevent adhesions due to an uncontrolled release profile. Hence, inclusion of a targeted therapeutic into a solid barrier host matrix with improved mechanical properties could provide dual utility in adhesion prevention and as a surgical sealant. Spray deposition of poly(lactide-co-caprolactone) (PLCL) polymer fibers through solution blow spinning has yielded a tissue-adherent barrier material with previously reported adhesion prevention efficacy due to a surface erosion mechanism that inhibits deposition of inflamed tissue. However, such an approach uniquely presents an avenue for controlled therapeutic release through mechanisms of diffusion and degradation. Such a rate is kinetically tuned via facile blending of "high" molecular weight (HMW) and "low" molecular weight (LMW) PLCL with slow and fast biodegradation rates, respectively. Here, we explore viscoelastic blends of HMW PLCL (70% w/v) and LMW PLCL (30% w/v) as a host matrix for anti-inflammatory drug delivery. In this work, COG133, an apolipoprotein E (ApoE) mimetic peptide with potent anti-inflammatory properties was selected and tested. In vitro studies with PLCL blends presented low (∼30%) and high (∼80%) percent release profiles over a 14-day period based on the nominal molecular weight of the HMW PLCL component. Two independent mouse models of cecal ligation and cecal anastomosis significantly reduced adhesion severity versus Seprafilm, COG133 liquid suspension, and no treatment control. The synergy of physical and chemical methods in a barrier material with proven preclinical studies highlights the value of COG133-loaded PLCL fiber mats in effectively dampening the formation of severe abdominal adhesions.
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Affiliation(s)
- Metecan Erdi
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Michele S Saruwatari
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, Washington, District of Columbia 20010, United States
| | - Selim Rozyyev
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, Washington, District of Columbia 20010, United States
| | - Christopher Acha
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Omar B Ayyub
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
| | - Anthony D Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, Washington, District of Columbia 20010, United States
| | - Peter Kofinas
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland 20742, United States
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15
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Kikuchi I, Momoeda M, Ujihira T, Iguchi M, Koga K, Morita M. Clinical feasibility of absorbable gelatin film adhesion barrier (GM142 "TENALEAF®") in gynecological laparoscopic surgery: Safety assessment for first-in-human use and surgical video. J Obstet Gynaecol Res 2023; 49:980-987. [PMID: 36577514 DOI: 10.1111/jog.15527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022]
Abstract
AIM To evaluate the safety and operability of the GM142 (TENALEAF®, Medical Division, Gunze Limited, Tokyo, Japan) adhesion barrier applied in patients undergoing surgery for benign gynecologic disease. METHODS This multicenter open study enrolled 34 patients from November 2018 to October 2019. RESULTS The primary outcome was the incidence of adverse events (AE) within 12 weeks postoperatively. None of the 30 patients completing the study experienced a life-threatening AE. Thirteen patients (43.3%) suffered 30 mild or moderate AE in total. No intestinal obstruction (0/30) was observed, with the sample size justified by the AdSpray® trial (8/61 patients with AE). No gelatin-specific Immunoglobulin E (IgE) antibodies were induced in the patients. The adhesion barrier could be easily inserted (even via trocar) and positioned. After malfunctions were reported in six patients, the instructions for use were updated for trocar use. CONCLUSION This study showed the safety and clinical feasibility GM142 as an adhesion barrier.
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Affiliation(s)
| | - Mikio Momoeda
- Department of Integrated Women's Health, St. Luke's International Hospital, Tokyo, Japan
| | - Takafumi Ujihira
- Department of Obstetrics and Gynecology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | | | - Kaori Koga
- Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, Japan
| | - Mineto Morita
- Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan
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16
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Keckstein JS, Keckstein S, Brunecker K, Neugebauer A, Nüssle D, Hoffmann S, Andress J, Neis F, Scharpf M, Enderle M, Rothmund R, Brucker SY, Jun MW, Kraemer B. Hybrid argon plasma coagulation (HybridAPC) versus sharp excision for the treatment of endometriosis: a prospective randomized clinical trial. Arch Gynecol Obstet 2023; 307:187-194. [PMID: 35284956 PMCID: PMC9837017 DOI: 10.1007/s00404-022-06473-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/16/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Endometriosis is a benign, but potentially serious gynaecological condition in terms of abdominal pain and impaired fertility. Laparoscopic excision techniques are considered the therapeutic standard. HybridAPC is presented as a novel technique for the non-contact thermal ablation of peritoneal endometriosis with simultaneous protection of the underlying thermosensitive structures by creating a needle-free elevated fluid cushion which enables a safer exposure and distance, as well as potentially improved peritoneal conditioning prior to APC. METHODS In this prospective randomized clinical trial, 39 patients with 132 superficial endometriotic lesions in total were treated with HybridAPC or sharp excision in an initial laparoscopic procedure according to randomization. In a second-look laparoscopy, adhesion formation was rated macroscopically. Histologic samples were taken from previously treated areas for evaluation of eradication rate. RESULTS The eradication rate was not significantly different between HybridAPC treatment and sharp excision (65 vs. 81%, p = .55). Adhesions formed in 5% of HybridAPC-treated lesions and in 10% after sharp excision (p = .49). HybridAPC treatment was significantly faster than sharp excision (69 vs. 106 s, p < .05). No intra- and postoperative complications were registered. CONCLUSION This clinical trial demonstrates the feasibility of this novel surgical technique with a promising impact on adhesion prevention. Compared to sharp excision, HybridAPC is likely to be a safe, tissue-preserving, and fast method for the treatment of peritoneal endometriosis.
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Affiliation(s)
- Julia S Keckstein
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany.
- Department of Obstetrics and Gynecology, Klinikum Starnberg, Oßwaldstr. 1, 82319, Starnberg, Germany.
| | - Simon Keckstein
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kristin Brunecker
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | | | - Daniela Nüssle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Sascha Hoffmann
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Jürgen Andress
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Felix Neis
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Marcus Scharpf
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Markus Enderle
- Erbe Elektromedizin GmbH, Waldhoernlestr. 17, 72072, Tübingen, Germany
| | - Ralf Rothmund
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
- Praxis Im Frauenzentrum Lindenhofspital, 3012, Bern, Switzerland
| | - Sara Y Brucker
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Martin Weiss Jun
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
| | - Bernhard Kraemer
- Department of Women's Health, Tuebingen University Hospital, Calwerstr. 7, 72076, Tübingen, Germany
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Lipid emulsions prevent postoperative abdominal adhesions. Asian J Surg 2023; 46:465-471. [PMID: 35688763 DOI: 10.1016/j.asjsur.2022.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/27/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Adhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. METHODS Thirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. RESULTS Intraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. CONCLUSION Intraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.
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Sabbagh MG, Aliakbarian M, Khodashahi R, Ferns GA, Rahimi H, Ashrafzadeh K, Tavakkoli M, Arjmand MH. Targeting Lysyl Oxidase as a Potential Therapeutic Approach to Reducing Fibrotic Scars Post-operatively: Its Biological Role in Post-Surgical Scar Development. Curr Drug Targets 2023; 24:1099-1105. [PMID: 37929723 DOI: 10.2174/0113894501249450231023112949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/08/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
Abdominal and pelvic surgery, or any surgical injury of the peritoneum, often leads to chronic abdominal adhesions that may lead to bowel obstruction, infertility, and pain. Current therapeutic strategies are usually ineffective, and the pathological mechanisms of the disease are unclear. Excess collagen cross-linking is a key mediator for extra-cellular matrix deposition and fibrogenesis. Lysyl oxidase is a key enzyme that catalyzes the formation of stabilizing cross-links in collagen. Dysregulation of Lysyl oxidase (Lox) expressing upregulates collagen cross-linking, leading ECM deposition. Tissue hypoxia during surgery induces molecular mechanisms and active transcription factors to promote the expression of several genes related to inflammation, oxidative stress, and fibrosis, such as transforming growth factor beta, and Lox. Studies have shown that targeting Lox improves clinical outcomes and fibrotic parameters in liver, lung, and myocardial fibrosis, therefore, Lox may be a potential drug target in the prevention of postsurgical adhesion.
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Affiliation(s)
- Mahin Ghorban Sabbagh
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rozita Khodashahi
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Infectious Diseases and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon-A Ferns
- Division of Medical Education, Brighton & Sussex Medical School, Brighton, UK
| | - Hoda Rahimi
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ashrafzadeh
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Tavakkoli
- Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad-Hassan Arjmand
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
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Erdi M, Rozyyev S, Balabhadrapatruni M, Saruwatari MS, Daristotle JL, Ayyub OB, Sandler AD, Kofinas P. Sprayable tissue adhesive with biodegradation tuned for prevention of postoperative abdominal adhesions. Bioeng Transl Med 2023; 8:e10335. [PMID: 36684071 PMCID: PMC9842025 DOI: 10.1002/btm2.10335] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/23/2022] [Indexed: 01/25/2023] Open
Abstract
Adhesions are dense, fibrous bridges that adjoin tissue surfaces due to uncontrolled inflammation following postoperative mesothelial injury. A widely used adhesion barrier material in Seprafilm often fails to prevent transverse scar tissue deposition because of its poor mechanical properties, rapid degradation profile, and difficulty in precise application. Solution blow spinning (SBS), a polymer fiber deposition technique, allows for the placement of in situ tissue-conforming and tissue-adherent scaffolds with exceptional mechanical properties. While biodegradable polymers such as poly(lactic-co-glycolic acid) (PLGA) have desirable strength, they exhibit bulk biodegradation rates and inflammatory profiles that limit their use as adhesion barriers and result in poor tissue adhesion. Here, viscoelastic poly(lactide-co-caprolactone) (PLCL) is used for its pertinent biodegradation mechanism. Because it degrades via surface erosion, spray deposited PLCL fibers can dissolve new connections formed by inflamed tissue, allowing them to function as an effective, durable, and easy-to-apply adhesion barrier. Degradation kinetics are tuned to match adhesion formation through the design of PLCL blends comprised of highly adhesive "low"-molecular weight (LMW) constituents in a mechanically robust "high"-molecular weight (HMW) matrix. In vitro studies demonstrate that blending LMW PLCL (30% w/v) with HMW PLCL (70% w/v) yields an anti-fibrotic yet tissue-adhesive polymer sealant with a 14-day erosion rate countering adhesion formation. PLCL blends additionally exhibit improved wet tissue adhesion strength (~10 kPa) over a 14-day period versus previously explored biodegradable polymer compositions, such as PLGA. In a mouse cecal ligation model, select PLCL blends significantly reduce abdominal adhesions severity versus no treatment and Seprafilm-treated controls.
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Affiliation(s)
- Metecan Erdi
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Selim Rozyyev
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical CareChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
| | | | - Michele S. Saruwatari
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical CareChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
| | - John L. Daristotle
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of TechnologyCambridgeMassachusettsUSA
| | - Omar B. Ayyub
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Anthony D. Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical CareChildren's National Medical CenterWashingtonDistrict of ColumbiaUSA
| | - Peter Kofinas
- Department of Chemical and Biomolecular EngineeringUniversity of MarylandCollege ParkMarylandUSA
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EROĞLU E, UYANIKGİL Y. İntrabdominal Adezyon Oluşum Mekanizmalarına ve Tedavi Stratejilerine Histopatolojik Bakış. ARŞIV KAYNAK TARAMA DERGISI 2022. [DOI: 10.17827/aktd.1116761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hayat standartlarını olumsuz etkileyen abdominal adezyonlar, postoperatif dönemde görülen önemli bir sağlık sorunudur. Peritoneal kavite ve serozal yüzeylerde oluşan, abdominal travmalara sebep olan kimyasal ve termal faktörler ya da enfeksiyon ve yabancı cisim reaksiyonları adezyon oluşumuna sebep olabilir. Abdominal adezyonların sınıflandırması genellikle adezyon yoğunluğuna ve prognoz ciddiyetine göre yapılsa da henüz dünya çapında kabul görmüş standart bir sınıflandırma sistemi mevcut değildir. Abdominal adezyonlar ağrı, infertilite, cerrahi sonrası hastanede yatış süresinin uzaması ve ekonomik yük gibi olumsuz sonuçlarla klinik yansımalar gösterir. Sonuç olarak, postoperatif süreçte karşılaşılan adezyonlar ciddi bir sorundur ve adezyon oluşumunu engellemek için ileri çalışmaların laboratuvar ortamından klinik araştırma modellerine uyarlanması gerekmektedir. Bu derleme çalışması intraabdominal adezyon oluşumu, histopatolojisi, derecelendirilmesi, önlenmesi ve klinik önemi ile ilgili literatürü gözden geçirmek için hazırlanmıştır.
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21
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Nadri S, Rahmani A, Hosseini SH, Habibizadeh M, Araghi M, Mostafavi H. Prevention of peritoneal adhesions formation by core-shell electrospun ibuprofen-loaded PEG/silk fibrous membrane. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2022; 50:40-48. [PMID: 35296208 DOI: 10.1080/21691401.2021.1883043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 06/14/2023]
Abstract
Adhesion bands are pathological fibrous tissues that create in the middle of tissues and organs, often reasons of intestinal obstruction, and female infertility. Here, we explored the anti-adhesive and inflammatory capacities of PEG/silk and Ibuprofen-loaded PEG/Silk core-shell nanofibrous membranes, respectively. The ibuprofen-loaded Silk Fibroin-Poly ethylene Glycol (SF-PEG) core-shell membrane was fabricated by electrospinning and considered in terms of morphology, surface wettability, drug release, and degradation. To reveal the membrane capability for adhesion bands inhibition, the membrane was stitched among the abdominal partition and peritoneum and then evaluated using two scoring adhesion systems. According to results, the fibrous membrane hindered cell proliferation, and the scoring systems and pathology showed that in a rat model, Ibuprofen-loaded PEG/Silk core-shell membrane caused a lightening in post-operative adhesion bands and the low-grade inflammatory reaction in animal models. Collectively, we fabricated new ibuprofen-loaded PEG/SF membranes with anti-adhesion and anti-inflammation properties. Moreover, this core-shell electrospun fibrous membrane has not even now been used to prevent peritendinous adhesion generation.
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Affiliation(s)
- Samad Nadri
- Department of Medical Nanotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
- Zanjan Metabolic Diseases Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
- Zanjan Pharmaceutical Nanotechnology Research Center, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Ali Rahmani
- Department of Medical Nanotechnology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Seyed Hojjat Hosseini
- Department of Pharmacology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mina Habibizadeh
- Department of Pharmacy Biomaterial, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahmood Araghi
- Department of Pathology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Hossein Mostafavi
- Department of Physiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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22
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Chua JW, Thangaveloo M, Lim DXE, Madden LE, Phillips ARJ, Becker DL. Connexin43 in Post-Surgical Peritoneal Adhesion Formation. Life (Basel) 2022; 12:1734. [PMID: 36362888 PMCID: PMC9697983 DOI: 10.3390/life12111734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 09/10/2024] Open
Abstract
OBJECTIVE Post-surgical peritoneal adhesions are a serious problem for the quality of life and fertility. Yet there are no effective ways of preventing their occurrence. The gap junction protein Cx43 is known to be involved in fibrosis in several different organs and disease conditions often associated with inflammation. Here we examined the Cx43 dynamic expression in an ischemic button model of surgical adhesions. METHODS Using the mouse ischemic button model, Cx43 antisense was delivered in Pluronic gel to attenuate Cx43 expression. The severity of button formation and immunofluorescence analysis of Cx43 and TGF-β1 were performed. The concentration of tissue plasminogen activator via ELISA was also performed. RESULTS As early as 6 h after button formation, the Cx43 levels were elevated in and around the button and some weak adhesions were formed. By 24 h Cx43 levels had increased further and adhesions were more defined. At 7 days the adhesions were much more robust, opaque, and vascularized, requiring blunt or sharp dissection to break them. Cx43 antisense attenuated its upregulation and, reduced the number and severity of adhesions that formed. CONCLUSION Targeting Cx43 after surgical procedures may be a potential therapeutic strategy for preventing adhesion formation or at least reducing their severity.
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Affiliation(s)
- Jia Wang Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
| | - Moogaambikai Thangaveloo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
| | - Debbie Xiu En Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
| | - Leigh E. Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
| | | | - David L. Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore 308232, Singapore
- Skin Research Institute Singapore, Singapore 308232, Singapore
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23
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Alamdaran SA, Vahed SH, Seyedin G. Ultrasound Changes of Postoperative Adhesion Types Over Time in Children. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0042-1757152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AbstractPostoperative fibrotic band formation is a common complication that causes bowel obstruction, chronic pain, and especially reoperation problems. We tried to evaluate the ultrasound signs of different adhesions over time in children. This descriptive study was performed in children hospital of Mashhad University of Medical Sciences. Sixty-five children aged 4 months to 15 years (mean age of 7.2 ± 6.5 years) were enrolled in the study. Complete abdominal sonography using 5 to 12 MHz multifrequency probes was performed by a pediatric radiologist. The sonographic findings and data analysis were performed. In first week after surgery, the fibrinous exudates are seen as hypoechoic shadows. It has uneven thickness and usually encases the bowel loops in a circular shape. In second week, they gradually become straighter with uniform thickness. In this period, in 68% of cases, a hyperechoic line is formed in the center of hypoechoic fibrinous exudates, which is usually placed between the bowel loops (interloop fibrosis). The omentum or mesentery entrapment in the fibrinous exudates was occurred in ∼50% and 25% of these cases, respectively. In this state, echogenic omentum or mesentery was seen simultaneously with the hypoechoic fibrinous exudates. After 1 month from surgical procedure, One of the following four sonographic patterns are seen: attachment hyperechoic omentum to retroperitoneum (50%), attachment hyperechoic mesentery to anterior abdominal wall (26%), interloop fibrosis (39%), and severe hypoechoic fibrotic band (30%). Absence of visceral sliding was seen in 65 to 80% of patients. Overall, there are five morphologic patterns of adhesion on ultrasound: fibrinous exudates, interloop fibrosis, fibrotic band, fixed omentum to retroperitoneum, and fixed mesentery to abdominal wall.
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Affiliation(s)
- Seyed Ali Alamdaran
- Clinical Research Development Unit, Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Golnaz Seyedin
- Surgen, Mashhad University of Medical Sciences, Mashhad, Iran
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24
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Zeng H, Liu X, Zhang Z, Song X, Quan J, Zheng J, Shen Z, Ni Y, Liu C, Zhang Y, Hu G. Self-healing, injectable hydrogel based on dual dynamic covalent cross-linking against postoperative abdominal cavity adhesion. Acta Biomater 2022; 151:210-222. [PMID: 35995405 DOI: 10.1016/j.actbio.2022.08.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/04/2022] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
Clinically, increasing the peritoneal barrier is an effective adjunct to reducing postoperative peritoneal adhesion. This study presents a facile template for preparing a supramolecular hybrid hydrogel through dynamic covalent cross-linking between carboxymethyl chitosan (CMCS), 2-formylphenylboronic acid (2-FPBA), and quercetin (Que). The as-prepared complex CMCS/2-FPBA/Que (CFQ) hydrogel exhibited favorable antibacterial, anti-inflammatory, and antioxidant effects. A L929 cytotoxicity evaluation confirmed the favorable cytocompatibility of the CFQ hydrogel. The postoperative anti-adhesion ability of the CFQ hydrogel was further evaluated in rats with lateral wall defects and cecal abrasions. Compared with control groups, the tissue adhesion rate was significantly reduced by increasing the Que concentration in all the hydrogel-treated groups. Additionally, the sustained-release time of the C3F0.8Q0.08 hydrogel can exceed 14 days, which is highly desirable for clinical wound treatment. STATEMENT OF SIGNIFICANCE: Postoperative adhesions are a very common postoperative complication that seriously affects the quality of life of patients. The currently commonly used methods for preventing adhesion mainly use degradable barrier materials for physical separation. In this study, we prepared a dual dynamic covalently cross-linked CFQ hydrogel, which is not only degradable and injectable, but also has multiple properties such as antibacterial, antioxidant and anti-inflammatory, which can effectively prevent postoperative adhesion and promote wound healing.
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Affiliation(s)
- Huihui Zeng
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Xi Liu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Zequn Zhang
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Xianwen Song
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Jun Quan
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Jun Zheng
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Zhaolong Shen
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China
| | - Yaqiong Ni
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China
| | - Chuntai Liu
- National Engineering Research Center for Advanced Polymer Processing Technology, Zhengzhou University, Zhengzhou 450002, China
| | - Yi Zhang
- Hunan Provincial Key Laboratory of Micro & Nano Materials Interface Science, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China.
| | - Gui Hu
- Department of Gastrointestinal Surgery, The Third Xiangya Hospital of Central South University, Tongzipo Road, Changsha, Hunan 410013, P. R. China.
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25
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Autologous Blood-derived Patches Used as Anti-adhesives in a Rat Uterine Horn Damage Model. J Surg Res 2022; 275:225-234. [DOI: 10.1016/j.jss.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/07/2022] [Accepted: 02/10/2022] [Indexed: 11/20/2022]
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26
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Osumi W, Yamamoto M, Masubuchi S, Hamamoto H, Ishii M, Izuhara K, Taniguchi K, Kuramoto T, Suzuki Y, Tanaka K, Okuda J, Uchiyama K. A new spray-type adhesion barrier (AdSpray) improves condition for surgical treatment in the reversal of Hartmann procedure: A case report. Medicine (Baltimore) 2021; 100:e28000. [PMID: 35049209 PMCID: PMC9191308 DOI: 10.1097/md.0000000000028000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Hartmann procedure (HP) often causes severe postoperative adhesions in the pelvic space; therefore, the reversal of Hartmann procedure (RHP) is a challenging surgery. A new spray-type antiadhesion agent, AdSpray, has been reported to be useful in three-dimensional fields such as the liver. However, there are no reports of its use in HP. We present a case of a male patient with rectal cancer who underwent laparoscopic HP with AdSpray to prevent postoperative adhesions. PATIENT CONCERNS A 52-year-old man presented with melena and constipation. DIAGNOSIS Colonoscopy revealed an almost obstructive type II tumor at the rectosigmoid colon, and histopathological examination revealed moderately differentiated adenocarcinoma. Enhanced abdominal computed tomography revealed slightly enlarged regional lymph nodes but no ascites around the tumor, and there was no metastasis to the liver or lungs. Therefore, we diagnosed clinical stage T4aN1bM0 rectosigmoid colon cancer. Intraoperatively, a metastatic tumor of the liver surface and a high degree of valve retention in the oral colon were identified. INTERVENTIONS After performing laparoscopic HP with AdSpray, we scheduled a laparoscopic RHP with staged hepatic surgery for synchronous liver metastasis from colorectal cancer 1 month later. OUTCOMES No postoperative inflammatory adhesions were observed in the pelvis or around the rectal stump, allowing us to perform RHP by a single-incision laparoscopic surgery from the stoma site without any problem. The operation time for RHP was 80 minutes; the patient was in good general condition after the operation, and he was discharged on postoperative day 7. LESSONS In laparoscopic HP, Adspray was easy to use for three-dimensional fields such as the pelvis and effectively prevented postoperative inflammatory adhesions. Thus, RHP may become less risky and be performed more as a minimally invasive surgery.
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Affiliation(s)
- Wataru Osumi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Masashi Yamamoto
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Shinsuke Masubuchi
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Hiroki Hamamoto
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Masatsugu Ishii
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Keisuke Izuhara
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Kohei Taniguchi
- Translational Research Program, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Toru Kuramoto
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Yusuke Suzuki
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Keitaro Tanaka
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Junji Okuda
- Cancer Center, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
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27
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Song BR, Park IS, Park DY, Kim YJ, Kim MS, Lee KB, Park SR, Choi BH, Min BH. Anti-adhesive effect of chondrocyte-derived extracellular matrix surface-modified with poly-L-lysine (PLL). J Tissue Eng Regen Med 2021; 16:279-289. [PMID: 34788485 DOI: 10.1002/term.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 12/08/2022]
Abstract
After an injury, soft tissue structures in the body undergo a natural healing process through specific phases of healing. Adhesions occur as abnormal attachments between tissues and organs through the formation of blood vessels and/or fibrinous adhesions during the regenerative repair process. In this study, we developed an adhesion-preventing membrane with an improved physical protection function by modifying the surface of chondrocyte-derived extracellular matrices (CECM) with anti-adhesion function. We attempted to change the negative charge of the CECM surface to neutral using poly-L-lysine (PLL) and investigated whether it blocked fibroblast adhesion to it and showed an improved anti-adhesion effect in animal models of tissue adhesion. The surface of the membrane was modified with PLL coating (PLL 10), which neutralized the surface charge. We confirmed that the surface characteristics except for the potential difference were maintained after the modification and tested cell attachment in vitro. Adhesion inhibition was identified in a peritoneal adhesion animal model at 1 week and in a subcutaneous adhesion model for 4 weeks. N-CECM suppressed fibroblast and endothelial cell adhesion in vitro and inhibited abdominal adhesions in vivo. The CECM appeared to actively inhibit the infiltration of endothelial cells into the injured site, thereby suppressing adhesion formation, which differed from conventional adhesion barriers in the mode of action. Furthermore, the N-CECM remained intact without degradation for more than four weeks in vivo and exerted anti-adhesion effects for a long time. This study demonstrated that PLL10 surface modification rendered a neutral charge to the polymer on the extracellular matrix surface, thereby inhibiting cell and tissue adhesion. Furthermore, this study suggests a means to modify extracellular matrix surfaces to meet the specific requirements of the target tissue in preventing post-surgical adhesions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Bo Ram Song
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea.,Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
| | - In Su Park
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Young Jick Kim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Moon Suk Kim
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Kyi Beom Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - So Ra Park
- Department of Physiology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Byung Hyune Choi
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Byoung-Hyun Min
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea.,Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea.,Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
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28
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Chua JW, Madden L, Lim SBH, Philips ARJ, Becker DL. Development of a refined ex vivo model of peritoneal adhesion formation, and a role for connexin 43 in their development. Mol Cell Biochem 2021; 477:295-305. [PMID: 34716547 DOI: 10.1007/s11010-021-04282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
Abstract
Despite many advances across the surgical sciences, post-surgical peritoneal adhesions still pose a considerable risk in modern-day procedures and are highly undesirable. We have developed a novel mouse peritoneal strip ex vivo adhesion model which may serve to bridge the gap between single cell culture systems and in vivo animal drug testing for the assessment of potential anti-adhesion agents, and study of causality of the process. We investigated the optimal conditions for adhesion formation with mouse peritoneal tissue strips by modifying an existing ex vivo rat model of peritoneal adhesions. We assessed the impact of the following conditions on the formation of adhesions: contact pressure, abrasions, and the presence of clotted blood. Macroscopic adhesions were detected in all mouse peritoneal strips exposed to specific conditions, namely abrasions and clotted blood, where peritoneal surfaces were kept in contact with pressure using cotton gauze in a tissue cassette. Adhesions were confirmed microscopically. Interestingly, connexin 43, a gap junction protein, was found to be upregulated at sites of adhesions. Key features of this model were the use of padding the abraded tissue with gauze and the use of a standardised volume of clotted blood. Using this model, peritoneal strips cultured with clotted blood between abraded surfaces were found to reproducibly develop adhesion bands at 72 h. Our goal is to develop a model that can be used in genetically modified mice in order to dissect out the role of particular genes in adhesion formation and to test drugs to prevent adhesion formation.
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Affiliation(s)
- Jia Wang Chua
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | - Leigh Madden
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | - Sophia Beng Hui Lim
- Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore
| | | | - David L Becker
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore. .,Skin Research Institute Singapore, Level 17, Clinical Sciences Building, 11, Mandalay Road, Singapore, 308232, Singapore.
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29
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Shean CJW, Butt A. Automatic implantable cardioverter defibrillator (AICD) within the abdomen as a cause of adhesive small bowel obstruction (ASBO): a case report. J Surg Case Rep 2021; 2021:rjab423. [PMID: 34594493 PMCID: PMC8478473 DOI: 10.1093/jscr/rjab423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/29/2021] [Indexed: 11/15/2022] Open
Abstract
Adhesive small bowel obstruction (ASBO) is commonly caused by intra-abdominal adhesions, usually from prior surgery. Conservative management is the mainstay of treatment, with adhesiolysis required for non-resolving obstruction. An unusual patient presentation of ASBO is presented here, where the cause is proposed as an automatic implantable cardioverter defibrillator (AICD) within the abdomen. Although the patient had several presentations of ASBO successfully treated with conservative management, a non-resolving obstruction required surgical management. At laparotomy, the AICD was found to be in close association with extensive matted adhesions to adjacent small bowel. Adhesiolysis was performed, with the AICD implanted in a subrectus pocket. The patient had an uncomplicated recovery, and at review 6 weeks following the operation was found to have a normal bowel habit with nil further episodes concerning for obstruction. This case highlights the importance of non-classical risk factors being a possible cause of ASBO.
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Affiliation(s)
| | - Amir Butt
- Department of General Surgery, The Canberra Hospital, Garran, ACT, Australia
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30
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Correa S, Grosskopf AK, Lopez Hernandez H, Chan D, Yu AC, Stapleton LM, Appel EA. Translational Applications of Hydrogels. Chem Rev 2021; 121:11385-11457. [PMID: 33938724 PMCID: PMC8461619 DOI: 10.1021/acs.chemrev.0c01177] [Citation(s) in RCA: 467] [Impact Index Per Article: 116.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/17/2022]
Abstract
Advances in hydrogel technology have unlocked unique and valuable capabilities that are being applied to a diverse set of translational applications. Hydrogels perform functions relevant to a range of biomedical purposes-they can deliver drugs or cells, regenerate hard and soft tissues, adhere to wet tissues, prevent bleeding, provide contrast during imaging, protect tissues or organs during radiotherapy, and improve the biocompatibility of medical implants. These capabilities make hydrogels useful for many distinct and pressing diseases and medical conditions and even for less conventional areas such as environmental engineering. In this review, we cover the major capabilities of hydrogels, with a focus on the novel benefits of injectable hydrogels, and how they relate to translational applications in medicine and the environment. We pay close attention to how the development of contemporary hydrogels requires extensive interdisciplinary collaboration to accomplish highly specific and complex biological tasks that range from cancer immunotherapy to tissue engineering to vaccination. We complement our discussion of preclinical and clinical development of hydrogels with mechanical design considerations needed for scaling injectable hydrogel technologies for clinical application. We anticipate that readers will gain a more complete picture of the expansive possibilities for hydrogels to make practical and impactful differences across numerous fields and biomedical applications.
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Affiliation(s)
- Santiago Correa
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | - Abigail K. Grosskopf
- Chemical
Engineering, Stanford University, Stanford, California 94305, United States
| | - Hector Lopez Hernandez
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | - Doreen Chan
- Chemistry, Stanford University, Stanford, California 94305, United States
| | - Anthony C. Yu
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | | | - Eric A. Appel
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
- Bioengineering, Stanford University, Stanford, California 94305, United States
- Pediatric
Endocrinology, Stanford University School
of Medicine, Stanford, California 94305, United States
- ChEM-H Institute, Stanford
University, Stanford, California 94305, United States
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
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31
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Akdaş Reis Y, Tapisiz OL, Göktolga Ü, Şimşek G, Erten Ö, Kiykaç Altinbaş Ş, Erkaya S. The Effect of Disulfiram in the Prevention of Postoperative Adhesion Formation in an Experimental Rat Uterine Horn Model. Reprod Sci 2021; 28:2650-2660. [PMID: 33782899 DOI: 10.1007/s43032-021-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Postoperative adhesions can cause serious complications, including intestinal obstruction, chronic abdominopelvic pain, and infertility in women. Here we investigate the effects of disulfiram on the postoperative adhesion model. Female Wistar rats were used (n = 72). The animals were separated into six groups (12 rats per group): group 1 (control), group 2 (300 mg/kg disulfiram administered for 3 days preoperatively), group 3 (50 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 4 (300 mg/kg disulfiram administered for 3 days preoperatively and 14 days postoperatively), group 5 (50 mg/kg disulfiram administered 14 days postoperatively only), and group 6 (300 mg/kg disulfiram administered 14 days postoperatively only). A histopathologic examination was performed. Immunohistochemical stainings for matrix metalloproteinase-2 and 9 (MMP-2, and MMP-9) and vascular endothelial growth factor (VEGF) were evaluated. The macroscopic adhesion scores were significantly lower in the disulfiram groups (groups 3, 4, and 6) compared to the control group (p < 0.05). Inflammation scores were lower in all groups receiving disulfiram, but only reached statistical significance in group 4 (p < 0.05). In the immunohistochemical evaluation of the groups, MMP-9 was significantly lower in group 5 than group 4 (p < 0.05). There was no significant difference between the groups for MMP-2 and VEGF. We found that disulfiram reduced postoperative adhesion formation. Disulfiram becomes more effective (by directly reducing inflammation) when initiated during the preoperative period at high doses.
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Affiliation(s)
- Yıldız Akdaş Reis
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey.
| | - Omer Lutfi Tapisiz
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey
| | - Ümit Göktolga
- Department of Obstetrics and Gynecology, Bahceci Health Group, Istanbul, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Kecioren Education and Research Hospital, Ankara, Turkey
| | - Özlem Erten
- Department of Obstetrics and Gynecology, Evliya Celebi Training and Research Hospital, Kütahya University of Health Sciences, Kütahya, Turkey
| | - Şadıman Kiykaç Altinbaş
- Department of Obstetrics and Gynecology, Etlik Zübeyde Hanım Women's Health Training and Research Hospital, 06010, Ankara, Turkey
| | - Salim Erkaya
- Department of Obstetrics and Gynecology, Dr. Zekai Tahir Burak Women's Health Training and Research Hospital, Ankara, Turkey
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Khanal N, Thapa A, Raut A, Ghimire B, Pradhan S, Shrestha S. Intra-abdominal propylene suture fragment leading to complete small bowel obstruction: A case report. Int J Surg Case Rep 2021; 85:106174. [PMID: 34274756 PMCID: PMC8319363 DOI: 10.1016/j.ijscr.2021.106174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Propylene sutures are non-absorbable sterile surgical sutures, which when present intra-abdominally act as a foreign body leading to adhesion formation. Post-operative adhesions are a common cause of bowel obstruction, with complete closed loop obstruction presenting as a surgical emergency. CASE DETAILS A 66-year-old man who had undergone a laparotomy for bowel obstruction two years back, presented to our emergency department with features of complete bowel obstruction. Midline laparotomy revealed propylene suture and intra peritoneal adhesions acting as a constricting band around the jejunum to be the cause. DISCUSSION Adhesions are common perturbing problem after surgeries. The presence of a foreign body further incites the process of adhesion formation by causing hindrance to the fibrinolysis process. In this case, the adhesive bands acted synergistically with the encircling prolene suture material from the previous surgery in causing a complete loop obstruction. CONCLUSION Propylene sutures used in routine surgical procedures can migrate intra-abdominally, and lead to adhesion formation. Adhesions along with the non-absorbable suture can cause complete bowel obstruction.
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Affiliation(s)
- Niharika Khanal
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Anjila Thapa
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal.
| | - Akash Raut
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Bikal Ghimire
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Susan Pradhan
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Sujan Shrestha
- Surgical Gastroenterology, Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Deniset JF, Fedak PWM. Post-Operative Adhesions: A Comprehensive Review of Mechanisms. Biomedicines 2021; 9:biomedicines9080867. [PMID: 34440071 PMCID: PMC8389678 DOI: 10.3390/biomedicines9080867] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/27/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Post-surgical adhesions are common in almost all surgical areas and are associated with significant rates of morbidity, mortality, and increased healthcare costs, especially when a patient requires repeat operative interventions. Many groups have studied the mechanisms driving post-surgical adhesion formation. Despite continued advancements, we are yet to identify a prevailing mechanism. It is highly likely that post-operative adhesions have a multifactorial etiology. This complex pathophysiology, coupled with our incomplete understanding of the underlying pathways, has resulted in therapeutic options that have failed to demonstrate safety and efficacy on a consistent basis. The translation of findings from basic and preclinical research into robust clinical trials has also remained elusive. Herein, we present and contextualize the latest findings surrounding mechanisms that have been implicated in post-surgical adhesion formation.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
- Correspondence:
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Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
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Zhuang BW, Xie XH, Yang DP, Lin MX, Wang W, Lu MD, Kuang M, Xie XY. Percutaneous thermal ablation of hepatic tumors: local control efficacy and risk factors for artificial ascites failure. Int J Hyperthermia 2021; 38:461-470. [PMID: 33752538 DOI: 10.1080/02656736.2021.1882708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To investigate the risk factors affecting the technical failure of artificial ascites (AA) formation and to evaluate the local control efficacy of percutaneous thermal ablation assisted by the AA for hepatic tumors. METHODS A total of 341 patients with 362 hepatic tumors who underwent thermal ablation assisted by AA were reviewed retrospectively. The technical success of AA, the volume of liquid, and local efficacy after ablation were assessed. Predictive factors for the technical failure of AA formation and local tumor progression (LTP) were analyzed using univariate and multivariate analysis. RESULTS The technical success rate of AA formation was 81.8% (296/362). The amount of fluid was higher when the tumor was located in the left lobe of the liver than when it was located in the right lobe (median 950 ml versus 700 ml, p < 0.001). Previous hepatic resection (OR: 12.63, 95% CI: 2.93-54.45, p < 0.001), ablation (OR: 6.48, 95% CI: 1.36-30.92, p = 0.019) and upper-abdomen surgery (OR: 11.34, 95% CI: 1.96-65.67, p = 0.007) were the independent risk factors of AA failure. In the AA success group, the complete ablation rate was higher and the LTP rate was lower than that in the AA failure group (98.7 versus 92.4%, p = 0.012; 8.8 versus 21.2%, p = 0.004). Multivariate analysis identified AA failure (p = 0.004), tumor size (>3.0 cm) (p = 0.002) and metastatic liver tumor (p = 0.008) as independent risk factors for LTP. CONCLUSION History of hepatic resection, ablation and upper abdomen surgery were significant predictive factors affecting the technical failure of AA formation. Successful introduction of AA before thermal ablation can achieve better local tumor control efficacy.
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Affiliation(s)
- Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Dao-Peng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ming-de Lu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of liver Surgery, The Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.,Department of liver Surgery, The Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China
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Arjmand MH, Hashemzehi M, Soleimani A, Asgharzadeh F, Avan A, Mehraban S, Fakhraei M, Ferns GA, Ryzhikov M, Gharib M, Salari R, Sayyed Hoseinian SH, Parizadeh MR, Khazaei M, Hassanian SM. Therapeutic potential of active components of saffron in post-surgical adhesion band formation. J Tradit Complement Med 2021; 11:328-335. [PMID: 34195027 PMCID: PMC8240116 DOI: 10.1016/j.jtcme.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/26/2020] [Accepted: 01/04/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Abdominal adhesions are common and often develop after abdominal surgery. There are currently no useful targeted pharmacotherapies for adhesive disease. Saffron and its active constituents, Crocin and Crocetin, are wildly used in traditional medicine for alleviating the severity of inflammatory or malignant disease. PURPOSE The aim of this study was to investigate the therapeutic potential of the pharmacological active component of saffron in attenuating the formation of post-operative adhesion bands using different administration methods in a murine model. MATERIAL METHOD saffron extract (100 mg/kg), Crocin (100 mg/kg), and Crocetin (100 mg/kg) were administered intraperitoneally and by gavage in various groups of male Wistar rat post-surgery. Also three groups were first treated intra-peritoneally by saffron extract, Crocin, and Crocetin (100 mg/kg) for 10 days and then had surgery. At the end of the experiments, animals sacrificed for biological assessment. RESULT A hydro-alcoholic extract of saffron and crocin but not crocetin potently reduced the adhesion band frequency in treatment and pre-treatment groups in the mice given intra-peritoneal (i.p) injections. Following the saffron or crocin administration, histological evaluation and quantitative analysis represented less inflammatory cell infiltration and less collagen composition, compared to control group. Moreover, the oxidative stress was significantly reduced in treatment groups. CONCLUSION These findings suggest that a hydro-alcoholic extract of saffron or its active compound, crocin, is a potentially novel therapeutic strategy for the prevention of adhesions formation and might be used as beneficial anti-inflammatory or anti-fibrosis agents in clinical trials. TAXONOMY Abdominal surgeries/post-surgical adhesions.
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Key Words
- APC, activated protein C
- Crocetin
- Crocin
- DSS, dextran sodium sulfate
- Fibrosis
- HE, Hematoxylin & Eosin
- IP, intera-peritoneal
- Inflammation
- MDA, malondialdehyde
- PDGF, platelet-derived growth factor
- PSAB, post-surgical adhesion band
- Post-surgical adhesion band formation
- SOD, superoxidase dismutase
- Saffron
- TAA, thioacetamide
- TGF-β, transforming growth factor-beta
- α-SMA, α-smooth muscle actin
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Affiliation(s)
- Mohammad-Hassan Arjmand
- Medical Plants Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | | | - Atena Soleimani
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Asgharzadeh
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Student Research Committee and Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Saeedeh Mehraban
- Immunology Research Center, Inflammation and Inflammatory Diseases Division, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Fakhraei
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A. Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, BN1 9PH, UK
| | - Mikhail Ryzhikov
- Division of Pulmonary and Critical Care Medicine, Washington University, School of Medicine, Saint Louis, MO, USA
| | - Masoumeh Gharib
- Department of Pathology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Pharmaceutical Sciences in Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mohammad Reza Parizadeh
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Khazaei
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Cooke-Barber J, Scorletti F, Rymeski B, Eshelman-Kent D, Nagarajan R, Burns K, Jenkins T, Dasgupta R. Long-term follow-up of surgical outcomes for patients with Wilms tumor and neuroblastoma. Cancer 2021; 127:3232-3238. [PMID: 34043819 DOI: 10.1002/cncr.33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are minimal data on long-term surgical outcomes of patients who have undergone resection for Wilms tumor (WT) and neuroblastoma (NB). METHODS A retrospective review of patients in a long-term survivor clinic between the years 1967 and 2016 in a pediatric tertiary care hospital (>5 years posttreatment) was performed. RESULTS Eighty-six survivors of WT and 86 survivors of NB who had ongoing follow-up in the survivors' clinic were identified. The median age at diagnosis was 2.5 years (range, 0.4-15.7 years) with a mean follow-up of 22.3 years (±10.4 years) for WT. The median age at diagnosis for patients with NB was 0.9 years (range, 0.1-8.6 months); mean follow-up of 21.7 years (±7.9 years). Twelve patients with WT (14.0%) had at least 1 repeat laparotomy, 11.1% for bowel obstruction, at a median of 3 months from initial surgery. Twelve patients (14.0%) with NB required laparotomy and 8.1% for bowel obstruction, at a median of 12 years after initial surgery. The incidence of hypertension in patients with WT who had undergone nephrectomy was not outside of population norms. Patients who underwent thoracotomy for a NB have a higher incidence of scoliosis and Horner syndrome. CONCLUSIONS Small bowel obstruction requiring laparotomy is significantly higher than the literature norms for both tumor patient populations and typically occurs in the early postoperative period for patients with WT and remotely in patients with NB. The long-term surgical complications of patients who underwent resection for NB and WT clearly merit follow-up and patient education within multidisciplinary long-term survivorship clinics.
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Affiliation(s)
- Jo Cooke-Barber
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Federico Scorletti
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beth Rymeski
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Debra Eshelman-Kent
- Center for Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rajaram Nagarajan
- Center for Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Karen Burns
- Center for Cancer and Blood Diseases Institute, Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd Jenkins
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Zwicky SN, Stroka D, Zindel J. Sterile Injury Repair and Adhesion Formation at Serosal Surfaces. Front Immunol 2021; 12:684967. [PMID: 34054877 PMCID: PMC8160448 DOI: 10.3389/fimmu.2021.684967] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 12/19/2022] Open
Abstract
Most multicellular organisms have a major body cavity containing vital organs. This cavity is lined by a mucosa-like serosal surface and filled with serous fluid which suspends many immune cells. Injuries affecting the major body cavity are potentially life-threatening. Here we summarize evidence that unique damage detection and repair mechanisms have evolved to ensure immediate and swift repair of injuries at serosal surfaces. Furthermore, thousands of patients undergo surgery within the abdominal and thoracic cavities each day. While these surgeries are potentially lifesaving, some patients will suffer complications due to inappropriate scar formation when wound healing at serosal surfaces defects. These scars called adhesions cause profound challenges for health care systems and patients. Therefore, reviewing the mechanisms of wound repair at serosal surfaces is of clinical importance. Serosal surfaces will be introduced with a short embryological and microanatomical perspective followed by a discussion of the mechanisms of damage recognition and initiation of sterile inflammation at serosal surfaces. Distinct immune cells populations are free floating within the coelomic (peritoneal) cavity and contribute towards damage recognition and initiation of wound repair. We will highlight the emerging role of resident cavity GATA6+ macrophages in repairing serosal injuries and compare serosal (mesothelial) injuries with injuries to the blood vessel walls. This allows to draw some parallels such as the critical role of the mesothelium in regulating fibrin deposition and how peritoneal macrophages can aggregate in a platelet-like fashion in response to sterile injury. Then, we discuss how serosal wound healing can go wrong, causing adhesions. The current pathogenetic understanding of and potential future therapeutic avenues against adhesions are discussed.
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Affiliation(s)
- Simone N Zwicky
- Department of Visceral Surgery and Medicine, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Deborah Stroka
- Department of Visceral Surgery and Medicine, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
| | - Joel Zindel
- Department of Visceral Surgery and Medicine, Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland
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Post-Surgical Peritoneal Scarring and Key Molecular Mechanisms. Biomolecules 2021; 11:biom11050692. [PMID: 34063089 PMCID: PMC8147932 DOI: 10.3390/biom11050692] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Post-surgical adhesions are internal scar tissue and a major health and economic burden. Adhesions affect and involve the peritoneal lining of the abdominal cavity, which consists of a continuous mesothelial covering of the cavity wall and majority of internal organs. Our understanding of the full pathophysiology of adhesion formation is limited by the fact that the mechanisms regulating normal serosal repair and regeneration of the mesothelial layer are still being elucidated. Emerging evidence suggests that mesothelial cells do not simply form a passive barrier but perform a wide range of important regulatory functions including maintaining a healthy peritoneal homeostasis as well as orchestrating events leading to normal repair or pathological outcomes following injury. Here, we summarise recent advances in our understanding of serosal repair and adhesion formation with an emphasis on molecular mechanisms and novel gene expression signatures associated with these processes. We discuss changes in mesothelial biomolecular marker expression during peritoneal development, which may help, in part, to explain findings in adults from lineage tracing studies using experimental adhesion models. Lastly, we highlight examples of where local tissue specialisation may determine a particular response of peritoneal cells to injury.
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Raisi A, Dezfoulian O, Davoodi F, Taheri S, Ghahremani SA. Salvia miltiorrhiza hydroalcoholic extract inhibits postoperative peritoneal adhesions in rats. BMC Complement Med Ther 2021; 21:126. [PMID: 33879143 PMCID: PMC8056503 DOI: 10.1186/s12906-021-03300-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background One of the most prevalent postoperative complications is believed to be intra-abdominal peritoneal adhesions, which is followed by several complications. Several adhesion prevention products have been examined, yet none of them were found to be completely effective. The current research is conducted to evaluate the beneficial effects of Salvia miltiorrhiza hydroalcoholic extract in inhibiting postoperative peritoneal adhesions in rats. Methods Forty rats were randomly classified into five equal groups (n = 8): 1) the normal group did not undergo surgical operations, 2) the control group in which the adhesion was induced, and which did not receive any treatment, 3) distilled water group that received distilled water, and 4,5) treatment groups treated with 1 and 5% of Salvia miltiorrhiza hydroalcoholic extract. The rats were euthanized 14 days following the surgery and the macroscopic score, the microscopic score of granulomatous inflammation and granulation tissue formation, IHC markers (vimentin, CD31, IL-1β, COX-2, and iNOS), and oxidative stress biomarkers (MDA, GPx, CAT, and TAC) were assessed in the experimental groups of the study. Results The difference between the control group and other groups for the adhesions macroscopic score, microscopic score, IHC markers, and oxidative stress biomarkers was significant (p < 0.05). Distilled water had no protective effect on the formation of peritoneal adhesions. Salvia miltiorrhiza treatment in two different doses significantly reduced macroscopic and microscopic scores, MDA concentration, Vimentin, IL-1β, COX-2, and iNOS compared to the control group (p < 0.05). The levels of GPx, CAT, and TAC in the treatment groups increased significantly compared with the control group (p < 0.05). Our findings revealed that a higher dose of Salvia miltiorrhiza was more effective in reducing peritoneal adhesions, proinflammatory and mesenchymal cell markers, and oxidative stress. Conclusions Salvia miltiorrhiza extract, owing to its strong antioxidant and anti-inflammatory properties, could effectively reduce peritoneal adhesions. Therefore, Salvia miltiorrhiza is recommended to be used as an effective anti-peritoneal post-operative adhesive agent.
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Affiliation(s)
- Abbas Raisi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran.
| | - Omid Dezfoulian
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran.
| | - Farshid Davoodi
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
| | - Shayan Taheri
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
| | - Soroush Afshar Ghahremani
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Lorestan University, Khorramabad, Iran
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Ito T, Shintani Y, Fields L, Shiraishi M, Podaru MN, Kainuma S, Yamashita K, Kobayashi K, Perretti M, Lewis-McDougall F, Suzuki K. Cell barrier function of resident peritoneal macrophages in post-operative adhesions. Nat Commun 2021; 12:2232. [PMID: 33854051 PMCID: PMC8046819 DOI: 10.1038/s41467-021-22536-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Post-operative adhesions are a leading cause of abdominal surgery-associated morbidity. Exposed fibrin clots on the damaged peritoneum, in which the mesothelial barrier is disrupted, readily adhere to surrounding tissues, resulting in adhesion formation. Here we show that resident F4/80HighCD206− peritoneal macrophages promptly accumulate on the lesion and form a ‘macrophage barrier’ to shield fibrin clots in place of the lost mesothelium in mice. Depletion of this macrophage subset or blockage of CD11b impairs the macrophage barrier and exacerbates adhesions. The macrophage barrier is usually insufficient to fully preclude the adhesion formation; however, it could be augmented by IL-4-based treatment or adoptive transfer of this macrophage subset, resulting in robust prevention of adhesions. By contrast, monocyte-derived recruited peritoneal macrophages are not involved in the macrophage barrier. These results highlight a previously unidentified cell barrier function of a specific macrophage subset, also proposing an innovative approach to prevent post-operative adhesions. Peritoneal adhesions are a major cause of complications after abdominal surgery. Here the authors use a post-operative abdominal adhesion model in mice to show that resident F4/80HighCD206− macrophages form a protective barrier that can be enhanced by IL-4 administration or adoptive transfer of these cells.
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Affiliation(s)
- Tomoya Ito
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Yusuke Shintani
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura Fields
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Manabu Shiraishi
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mihai-Nicolae Podaru
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Satoshi Kainuma
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kizuku Yamashita
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kazuya Kobayashi
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fiona Lewis-McDougall
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ken Suzuki
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
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An JM, Shahriar SMS, Hasan MN, Cho S, Lee YK. Carboxymethyl Cellulose, Pluronic, and Pullulan-Based Compositions Efficiently Enhance Antiadhesion and Tissue Regeneration Properties without Using Any Drug Molecules. ACS APPLIED MATERIALS & INTERFACES 2021; 13:15992-16006. [PMID: 33797224 DOI: 10.1021/acsami.0c21938] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Pharmacological-based treatment approaches have been used over time to prevent postlaparotomy adhesion. However, the rapid elimination of therapeutics from the peritoneum, and their unwanted side effects, easy flow from the wound site by gravity, and low therapeutic efficacy increase the urgent need for the next generation of antiadhesion agents. This article represents the development of biocompatible and biodegradable antiadhesion agents that consist of carboxymethyl cellulose (CMC) and pullulan with three different types of physical characteristics such as the solution type (ST), film type (FT), and thermosensitive type (TST). These antiadhesion agents that contain no drugs exhibit excellent physical characteristics and superior stability over 30 days in the operative sites without any toxicity and side effects that make the compositions strong candidates as novel antiadhesion agents. Also, the proposed samples reveal superior antiadhesion and tissue regeneration properties in Sprague-Dawley (SD) rats after surgery over Medicurtain. Medicurtain effectively prevented postlaparotomy adhesion in ∼42% of experimental animals, whereas ST 2.25-10, ST 2.5-5, ST 2.5-10, FT 20, and TST 1.5 were effective in 100% of animals. Thus, we believe these antiadhesion agents could be promising to reduce adhesion-related complications during and post-surgical operations and deserve consideration for further study for clinical purposes.
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Affiliation(s)
- Jeong Man An
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
| | - S M Shatil Shahriar
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
- Interdisciplinary Graduate Program in Biomedical Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198-5940, United States
| | - Mohammad Nazmul Hasan
- Department of Green Bioengineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
| | - Sungpil Cho
- 4D Biomaterials Center, Korea National University of Transportation, Jeungpyeong 27909, Republic of Korea
| | - Yong-Kyu Lee
- Department of Chemical and Biological Engineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- KB Biomed Inc., Chungju 27469, Republic of Korea
- Department of Green Bioengineering, Korea National University of Transportation, Chungju 27469, Republic of Korea
- 4D Biomaterials Center, Korea National University of Transportation, Jeungpyeong 27909, Republic of Korea
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Yu J, Wang K, Fan C, Zhao X, Gao J, Jing W, Zhang X, Li J, Li Y, Yang J, Liu W. An Ultrasoft Self-Fused Supramolecular Polymer Hydrogel for Completely Preventing Postoperative Tissue Adhesion. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2008395. [PMID: 33734513 DOI: 10.1002/adma.202008395] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/11/2021] [Indexed: 06/12/2023]
Abstract
The intermolecular H-bonding density heavily influences the gelation and rheological behavior of hydrogen-bonded supramolecular polymer hydrogels, thus offering a delicate pathway to tailor their physicochemical properties for meeting a specific biomedical application. Herein, one methylene spacer between two amides in the side chain of N-acryloyl glycinamide (NAGA) is introduced to generate a variant monomer, N-acryloyl alaninamide (NAAA). Polymerization of NAAA in aqueous solution affords an unprecedented ultrasoft and highly swollen supramolecular polymer hydrogel due to weakened H-bonds caused by an extra methylene spacer, which is verified by variable-temperature Fourier transform infrared (FTIR) spectroscopy and simulation calculation. Intriguingly, poly(N-acryloyl alaninamide) (PNAAA) hydrogel can be tuned to form a transient network with a self-fused and excellent antifouling capability that results from the weakened dual amide H-bonding interactions and enhanced water-amide H-bonding interactions. This self-fused PNAAA hydrogel can completely inhibit postoperative abdominal adhesion and recurrent adhesion after adhesiolysis in vivo. This transient hydrogel network allows for its disintegration and excretion from the body. The molecular mechanism studies reveal the signal pathway of PNAAA hydrogel in inhibiting inflammatory response and regulating fibrinolytic system balance. This self-fused, antifouling ultrasoft supramolecular hydrogel is promising as a barrier biomaterial for completely preventing postoperative tissue adhesion.
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Affiliation(s)
- Jing Yu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Ke Wang
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chuanchuan Fan
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Xiaoye Zhao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jushan Gao
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wanghui Jing
- School of Pharmacy, Health Science Center, Xi'an Jiaotong University, Xi'an, 710061, China
| | - Xiaoping Zhang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Jia Li
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Yuan Li
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Jianhai Yang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin, 300350, China
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Anton-Sales I, Roig-Sanchez S, Traeger K, Weis C, Laromaine A, Turon P, Roig A. In vivo soft tissue reinforcement with bacterial nanocellulose. Biomater Sci 2021; 9:3040-3050. [PMID: 33666604 DOI: 10.1039/d1bm00025j] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The use of surgical meshes to reinforce damaged internal soft tissues has been instrumental for successful hernia surgery; a highly prevalent condition affecting yearly more than 20 million patients worldwide. Intraperitoneal adhesions between meshes and viscera are one of the most threatening complications, often implying reoperation or side effects such as chronic pain and bowel perforation. Despite recent advances in the optimization of mesh porous structure, incorporation of anti-adherent coatings or new approaches in the mesh fixation systems, clinicians and manufacturers are still pursuing an optimal material to improve the clinical outcomes at a cost-effective ratio. Here, bacterial nanocellulose (BNC), a bio-based polymer, is evaluated as a soft tissue reinforcement material regarding mechanical properties and in vivo anti-adhesive performance. A double-layer BNC laminate proved sufficient to meet the standards of mechanical resistance for abdominal hernia reinforcement meshes. BNC-polypropylene (BNC-PP) composites incorporating a commercial mesh have also been prepared. The in vivo study of implanted BNC patches in a rabbit model demonstrated excellent anti-adherent characteristics of this natural nanofibrous polymer 21-days after implantation and the animals were asymptomatic after the surgery. BNC emerges as a novel and versatile hernioplasty biomaterial with outstanding mechanical and anti-adherent characteristics.
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Affiliation(s)
- Irene Anton-Sales
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Catalonia, Spain.
| | - Soledad Roig-Sanchez
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Catalonia, Spain.
| | - Kamelia Traeger
- Department of Research and Development, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, 08191 Barcelona, Spain.
| | - Christine Weis
- Department of Research and Development, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, 08191 Barcelona, Spain.
| | - Anna Laromaine
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Catalonia, Spain.
| | - Pau Turon
- Department of Research and Development, B. Braun Surgical, S.A.U., Carretera de Terrassa 121, Rubí, 08191 Barcelona, Spain.
| | - Anna Roig
- Institute of Materials Science of Barcelona (ICMAB-CSIC), Campus UAB, 08193 Bellaterra, Catalonia, Spain.
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Chandel AKS, Shimizu A, Hasegawa K, Ito T. Advancement of Biomaterial-Based Postoperative Adhesion Barriers. Macromol Biosci 2021; 21:e2000395. [PMID: 33463888 DOI: 10.1002/mabi.202000395] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/28/2020] [Indexed: 01/16/2023]
Abstract
Postoperative peritoneal adhesion (PPA) is a prevalent incidence that generally happens during the healing process of traumatized tissues. It causes multiple severe complications such as intestinal obstruction, chronic abdominal pain, and female infertility. To prevent PPA, several antiadhesion materials and drug delivery systems composed of biomaterials are used clinically, and clinical antiadhesive is one of the important applications nowadays. In addition to several commercially available materials, like film, spray, injectable hydrogel, powder, or solution type have been energetically studied based on natural and synthetic biomaterials such as alginate, hyaluronan, cellulose, starch, chondroitin sulfate, polyethylene glycol, polylactic acid, etc. Moreover, many kinds of animal adhesion models, such as cecum abrasion models and unitary horn models, are developed to evaluate new materials' efficacy. A new animal adhesion model based on hepatectomy and conventional animal adhesion models is recently developed and a new adhesion barrier by this new model is also developed. In summary, many kinds of materials and animal models are studied; thus, it is quite important to overview this field's current progress. Here, PPA is reviewed in terms of the species of biomaterials and animal models and several problems to be solved to develop better antiadhesion materials in the future are discussed.
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Affiliation(s)
- Arvind K Singh Chandel
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Shimizu
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Kiyoshi Hasegawa
- Department of Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Taichi Ito
- Center for Disease Biology and Integrative Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Vediappan RS, Bennett C, Cooksley C, Finnie J, Trochsler M, Quarrington RD, Jones CF, Bassiouni A, Moratti S, Psaltis AJ, Maddern G, Vreugde S, Wormald PJ. Prevention of adhesions post-abdominal surgery: Assessing the safety and efficacy of Chitogel with Deferiprone in a rat model. PLoS One 2021; 16:e0244503. [PMID: 33444337 PMCID: PMC7808615 DOI: 10.1371/journal.pone.0244503] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/10/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction Adhesions are often considered to be an inevitable consequence of abdominal and pelvic surgery, jeopardizing the medium and long-term success of these procedures. Numerous strategies have been tested to reduce adhesion formation, however, to date, no surgical or medical therapeutic approaches have been successful in its prevention. This study demonstrates the safety and efficacy of Chitogel with Deferiprone and/or antibacterial Gallium Protoporphyrin in different concentrations in preventing adhesion formation after abdominal surgery. Materials and methods 112 adult (8–10 week old) male Wistar albino rats were subjected to midline laparotomy and caecal abrasion, with 48 rats having an additional enterotomy and suturing. Kaolin (0.005g/ml) was applied to further accelerate adhesion formation. The abrasion model rats were randomized to receive saline, Chitogel, or Chitogel plus Deferiprone (5, 10 or 20 mM), together with Gallium Protoporphyrin (250μg/mL). The abrasion with enterotomy rats were randomised to receive saline, Chitogel or Chitogel with Deferiprone (1 or 5 mM). At day 21, rats were euthanised, and adhesions graded macroscopically and microscopically; the tensile strength of the repaired caecum was determined by an investigator blinded to the treatment groups. Results Chitogel with Deferiprone 5 mM significantly reduced adhesion formation (p<0.01) when pathologically assessed in a rat abrasion model. Chitogel with Deferiprone 5 mM and 1 mM also significantly reduced adhesions (p<0.05) after abrasion with enterotomy. Def-Chitogel 1mM treatment did not weaken the enterotomy site with treated sites having significantly better tensile strength compared to control saline treated enterotomy rats. Conclusions Chitogel with Deferiprone 1 mM constitutes an effective preventative anti-adhesion barrier after abdominal surgery in a rat model. Moreover, this therapeutic combination of agents is safe and does not weaken the healing of the sutured enterotomy site.
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Affiliation(s)
- Rajan Sundaresan Vediappan
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Catherine Bennett
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Clare Cooksley
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - John Finnie
- SA Pathology and Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Markus Trochsler
- Department of Surgery, The University of Adelaide, Adelaide, Australia
| | - Ryan D. Quarrington
- Adelaide Spinal Research Group, Centre for Orthopaedic and Trauma Research, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Claire F. Jones
- Adelaide Spinal Research Group, Centre for Orthopaedic and Trauma Research, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- School of Mechanical Engineering, University of Adelaide, Adelaide, Australia
| | - Ahmed Bassiouni
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Stephen Moratti
- Department of Chemistry, Otago University, Dunedin, New Zealand
| | - Alkis J. Psaltis
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - Guy Maddern
- Department of Surgery, The University of Adelaide, Adelaide, Australia
| | - Sarah Vreugde
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
| | - P. J. Wormald
- Department of Surgery—Otolaryngology Head and Neck Surgery, The University of Adelaide, Adelaide, Australia
- * E-mail:
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Stapleton LM, Lucian HJ, Grosskopf AK, Smith AAA, Totherow KP, Woo YJ, Appel EA. Dynamic Hydrogels for Prevention of Post‐Operative Peritoneal Adhesions. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Haley J. Lucian
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Abigail K. Grosskopf
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | - Anton A. A. Smith
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | | | - Y. Joseph Woo
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Eric A. Appel
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
- ChEM‐H Institute Stanford University Stanford CA 94305 USA
- Department of Pediatrics (Endocrinology) Stanford University School of Medicine Stanford CA 94305 USA
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Hu Q, Xia X, Kang X, Song P, Liu Z, Wang M, Lu X, Guan W, Liu S. A review of physiological and cellular mechanisms underlying fibrotic postoperative adhesion. Int J Biol Sci 2021; 17:298-306. [PMID: 33390851 PMCID: PMC7757036 DOI: 10.7150/ijbs.54403] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/13/2020] [Indexed: 12/27/2022] Open
Abstract
Postoperative adhesions (PA) are fibrotic tissues that are the most common driver of long-term morbidity after abdominal and pelvic surgery. The optimal drug or material to prevent adhesion formation has not yet been discovered. Comprehensive understanding of cellular and molecular mechanisms of adhesion process stimulates the design of future anti-adhesive strategies. Recently, disruption of peritoneal mesothelial cells were suggested as the 'motor' of PA formation, followed by a cascade of events (coagulation, inflammation, fibrinolysis) and influx of various immune cells, ultimately leading to a fibrous exudate. We showed that a variety of immune cells were recruited into adhesive peritoneal tissues in patients with small bowel obstruction caused by PA. The interactions among various types of immune cells contribute to PA development following peritoneal trauma. Our review focuses on the specific role of different immune cells in cellular and humoral mechanisms underpinning adhesion development.
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Affiliation(s)
- Qiongyuan Hu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Xuefeng Xia
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Xing Kang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Peng Song
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Zhijian Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Meng Wang
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Xiaofeng Lu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Wenxian Guan
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Song Liu
- Department of Gastrointestinal Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
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Modeling the Early Steps of Ovarian Cancer Dissemination in an Organotypic Culture of the Human Peritoneal Cavity. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1330:75-94. [PMID: 34339031 DOI: 10.1007/978-3-030-73359-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The majority of ovarian cancer patients present clinically with wide-spread metastases throughout the peritoneal cavity, metastasizing to the mesothelium-lined peritoneum and visceral adipose depots within the abdomen. This unique metastatic tumor microenvironment is comprised of multiple cell types, including mesothelial cells, fibroblasts, adipocytes, macrophages, neutrophils, and T lymphocytes. Modeling advancements, including complex 3D systems and organoids, coupled with 2D cocultures, in vivo mouse models, and ex vivo human tissue cultures have greatly enhanced our understanding of the tumor-stroma interactions that are required for successful metastasis of ovarian cancer cells. However, advanced multifaceted model systems that incorporate frequency and spatial distribution of all cell types present in the tumor microenvironment of ovarian cancer are needed to enhance our knowledge of ovarian cancer biology in order to identify methods for preventing and treating metastatic disease. This review highlights the utility of recently developed modeling approaches, summarizes some of the resulting progress using these techniques, and suggests how these strategies may be implemented to elucidate signaling processes among cell types of the tumor microenvironment that promote ovarian cancer metastasis.
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50
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Adenuga AT, Akande OW. Peritonitis following unsafe abortion: a retrospective study in a tertiary health facility in North Central Nigeria. Pan Afr Med J 2020; 37:354. [PMID: 33796168 PMCID: PMC7992427 DOI: 10.11604/pamj.2020.37.354.22775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/24/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION surgical complications following unsafe abortion (UA) are not uncommon and are associated with high morbidity and mortality in developing countries. The commonest need for the general surgeon following UA is after a diagnosis of peritonitis which can occur following use of sharp objects introduced through the vagina. This study aims to highlight the presentation, management types and outcome of patients who presented with peritonitis following UA. METHODS this study is a retrospective review of cases of peritonitis following UA seen over 4 years from January 2015 to December 2019 in a tertiary health facility in North Central Nigeria. RESULTS a total of 14 patients with peritonitis following UA were included in the study. The mean age of patients who presented was 27.4 years (19-40 years) with a mean estimated gestational age at abortion of 7.8 weeks. The average time from the UA procedure till presentation at the hospital was 8.6 days. There were 9 bowel injuries and 5 pelvic abscesses. A total of 3/9 patients had primary resection and anastomosis while 6/9 had stoma formed as part of their management. Pelvic abscesses were drained. In patients with bowel injury, those who had primary anastomosis had a 100% incidence of enterocutaneous fistula formation with associated sepsis requiring repeat exploration and formation of stoma. Mortality in this group was 67% (2/3) compared to the 0% (0/6) mortality rate seen in patients who had stoma. The overall mortality was four out of fourteen patients (28.6%). CONCLUSION peritonitis following UA is associated with marked morbidity and mortality as many of the patients present late. Initial preoperative resuscitation and stabilization should be followed by a swift laparotomy. Patients with bowel injury who had primary anastomosis had higher morbidity, reoperation rates and mortality than patients who had stomas.
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