1
|
Tian L, Sun T, Fan M, Lu H, Sun C. Novel silk protein/hyaluronic acid hydrogel loaded with azithromycin as an immunomodulatory barrier to prevent postoperative adhesions. Int J Biol Macromol 2023; 235:123811. [PMID: 36841387 DOI: 10.1016/j.ijbiomac.2023.123811] [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: 11/23/2022] [Revised: 02/12/2023] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
Peritoneal adhesions, a common postoperative complication of laparotomy, are still treated with physical barriers, but their efficacy and ease of use are controversial. In this paper, we developed a wound microenvironment-responsive hydrogel composed of Antheraea pernyi silk protein (ASF) from wild cocoons and tyramine-modified hyaluronic acid (HA-Ph) loaded with azithromycin (AZI), glucose oxidase (GOX), and horseradish peroxidase (HRP). In addition, GOX-catalyzed oxygen production enhanced the antibacterial ability of the hydrogel. Moreover, the drug-loaded hydrogel increased macrophage CD206 expression while decreasing IL-6 and TNF-α expression. More importantly, the retarding effect of this novel hydrogel system on AZI almost eliminated the appearance of postoperative adhesions in rats. It was also found that the novel hydrogel enhanced the modulation of the TLR-4/Myd88/NF-κB pathway and TGF-β/Smad2/3 pathway by azithromycin in the locally damaged peritoneum of rats, which accelerated the remodeling of damaged tissues and dramatically reduced the deposition of collagen. Therefore, spraying the novel drug-loaded hydrogel on postoperative abdominal wounds can effectively inhibit the formation of postoperative adhesions.
Collapse
Affiliation(s)
- Linan Tian
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Tongtong Sun
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Mengyao Fan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Hongyan Lu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China
| | - Changshan Sun
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang, Liaoning Province 110016, PR China.
| |
Collapse
|
2
|
Extracellular Vesicles Derived from Adipose Mesenchymal Stem Cells Promote Peritoneal Healing by Activating MAPK-ERK1/2 and PI3K-Akt to Alleviate Postoperative Abdominal Adhesion. Stem Cells Int 2022; 2022:1940761. [PMID: 35578661 PMCID: PMC9107054 DOI: 10.1155/2022/1940761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
Peritoneal regeneration and repair can alleviate postoperative intraperitoneal adhesions, and mesenchymal stem cells (MSCs) have demonstrated the potential for peritoneal repair and regeneration. However, extracellular vesicles (EVs) are the main carriers for the MSC activity. Thus far, the roles of MSC-derived EVs on peritoneal repair are not well understood. To investigate the therapeutic effect of adipose-derived mesenchymal stem cell-derived EVs (ADSC-EVs) in peritoneal injuries, ADSC-EVs were injected in vivo via the tail vein of rats. The antiadhesion effects were evaluated following abdominal surgery. In addition, the levels of the peritoneal fibrinolysis system were determined via enzyme-linked immunosorbent assay. Expression differences in inflammatory and apoptotic markers were detected using immunofluorescence. The expression of extracellular matrix-related indexes and peritoneal healing were observed using immunohistochemistry. In vitro, rat peritoneal mesothelial cell proliferation was assessed via a 5-ethynyl-2-deoxyuridine assay. Cell migration was determined using scratch wound and transwell assays. Related signaling networks were estimated based on sequencing and bioinformatics analyses. The roles of the MAPK–ERK1/2 and PI3K–Akt signaling networks were analyzed using immunoblotting. This is the first report of the effectiveness of ADSC-EVs in the treatment of postoperative adhesions. ADSC-EVs were incorporated in vitro and induced rat peritoneal mesothelial cell proliferation and migration. This was mediated by stimulation of the MAPK–ERK1/2 and PI3K–Akt axes. ADSC-EVs promote the healing of the injured peritoneum, suggesting a promising therapeutic approach for peritoneal adhesions.
Collapse
|
3
|
Holl M, Rasch ML, Becker L, Keller AL, Schultze-Rhonhof L, Ruoff F, Templin M, Keller S, Neis F, Keßler F, Andress J, Bachmann C, Krämer B, Schenke-Layland K, Brucker SY, Marzi J, Weiss M. Cell Type-Specific Anti-Adhesion Properties of Peritoneal Cell Treatment with Plasma-Activated Media (PAM). Biomedicines 2022; 10:biomedicines10040927. [PMID: 35453677 PMCID: PMC9032174 DOI: 10.3390/biomedicines10040927] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative abdominal adhesions are responsible for serious clinical disorders. Administration of plasma-activated media (PAM) to cell type-specific modulated proliferation and protein biosynthesis is a promising therapeutic strategy to prevent pathological cell responses in the context of wound healing disorders. We analyzed PAM as a therapeutic option based on cell type-specific anti-adhesive responses. Primary human peritoneal fibroblasts and mesothelial cells were isolated, characterized and exposed to different PAM dosages. Cell type-specific PAM effects on different cell components were identified by contact- and marker-independent Raman imaging, followed by thorough validation by specific molecular biological methods. The investigation revealed cell type-specific molecular responses after PAM treatment, including significant cell growth retardation in peritoneal fibroblasts due to transient DNA damage, cell cycle arrest and apoptosis. We identified a therapeutic dose window wherein specifically pro-adhesive peritoneal fibroblasts were targeted, whereas peritoneal mesothelial cells retained their anti-adhesive potential of epithelial wound closure. Finally, we demonstrate that PAM treatment of peritoneal fibroblasts reduced the expression and secretion of pro-adhesive cytokines and extracellular matrix proteins. Altogether, we provide insights into biochemical PAM mechanisms which lead to cell type-specific pro-therapeutic cell responses. This may open the door for the prevention of pro-adhesive clinical disorders.
Collapse
Affiliation(s)
- Myriam Holl
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Marie-Lena Rasch
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Lucas Becker
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
| | - Anna-Lena Keller
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Laura Schultze-Rhonhof
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Felix Ruoff
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Markus Templin
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Silke Keller
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
| | - Felix Neis
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Franziska Keßler
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Jürgen Andress
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Cornelia Bachmann
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Bernhard Krämer
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Katja Schenke-Layland
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
- Department of Medicine/Cardiology, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
| | - Sara Y. Brucker
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
| | - Julia Marzi
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Institute of Biomedical Engineering, Eberhard Karls University Tübingen, 72076 Tübingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) “Image-Guided and Functionally Instructed Tumor Therapies”, Eberhard Karls University, 72076 Tübingen, Germany
| | - Martin Weiss
- Department of Women’s Health Tübingen, Eberhard Karls University Tübingen, 72076 Tübingen, Germany; (M.H.); (M.-L.R.); (L.S.-R.); (F.N.); (F.K.); (J.A.); (C.B.); (B.K.); (S.Y.B.)
- NMI Natural and Medical Sciences Institute, University Tübingen, 72770 Reutlingen, Germany; (A.-L.K.); (F.R.); (M.T.); (S.K.); (K.S.-L.); (J.M.)
- Correspondence:
| |
Collapse
|
4
|
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: 88] [Impact Index Per Article: 29.3] [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.
Collapse
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
| |
Collapse
|
5
|
Atta HM, Al-Hendy AA, Abdel Raheim SR, Abdel-Ghany H, Nasif KA, Abdellah AM, Zenhom NM, Kamel HS. Modified Adenovirus Reduces De Novo Peritoneal Adhesions in Rats and Limits Off-Target Transfection. Role of EZH2 in Adhesion Formation. J INVEST SURG 2016; 30:78-87. [PMID: 27690696 DOI: 10.1080/08941939.2016.1229366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM OF THE STUDY Adenovector encoding tissue plasminogen activator (tPA) was shown to reduce experimental peritoneal adhesion. We investigated the targeting potential of our modified adenovector, its ability to reduce adhesions and the epigenetic role of histone methyltransferase EZH2 in adhesion formation. MATERIALS AND METHODS Control lacZ, nonmodified tPA or modified tPA vectors were instilled in the peritoneal cavity after injury in de novo adhesions or after lysis of adhesions in recurrent adhesions. Adhesion severity was scored and adhesions and liver tissues were examined for adenovirus E4 gene and tPA mRNA expression. Levels of tPA, plasminogen activator inhibitor-1 (PAI-1), transforming growth factor-β1 (TGF-β1), and EZH2 expression were measured. RESULTS E4 transcripts were detected in adhesions of nonmodified and modified and in livers of nonmodified but not in livers of modified de novo adhesions. Both nonmodified (p = 0.021) and modified vectors (p = 0.036) reduced the severity of de novo adhesions compared to lacZ vector. Levels of tPA in nonmodified (p = 0.021) and modified adhesions (p = 0.001) were elevated while PAI-1 (p = 0.013 and p = 0.001, respectively) and TGF-β1 levels (p = 0.002 and p = 0.016, respectively) were reduced compared with lacZ group. All vectors were not expressed in recurrent adhesions and severity score were not different among groups. EZH2 levels were elevated in de novo nontreated (p = 0.001) and was further increased in recurrent (p = 0.001) nontreated adhesions compared with noninjured peritoneum. CONCLUSION Modified adenovirus successfully targeted de novo adhesions but not liver tissues and reduced the severity of de novo adhesions. EZH2 is involved in the development and progression of peritoneal adhesions.
Collapse
Affiliation(s)
- Hussein M Atta
- a Department of Surgery , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Ayman A Al-Hendy
- b Department of Obstetrics and Gynecology , Georgia Regents University , Augusta , Georgia , USA
| | - Salama R Abdel Raheim
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Hend Abdel-Ghany
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Khalid A Nasif
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Ahlam M Abdellah
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Nagwa M Zenhom
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| | - Heba S Kamel
- c Department of Biochemistry , Faculty of Medicine, Minia University , El-Minia , Egypt
| |
Collapse
|
6
|
Sandoval P, Jiménez-Heffernan JA, Guerra-Azcona G, Pérez-Lozano ML, Rynne-Vidal Á, Albar-Vizcaíno P, Gil-Vera F, Martín P, Coronado MJ, Barcena C, Dotor J, Majano PL, Peralta AA, López-Cabrera M. Mesothelial-to-mesenchymal transition in the pathogenesis of post-surgical peritoneal adhesions. J Pathol 2016; 239:48-59. [DOI: 10.1002/path.4695] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/30/2015] [Accepted: 01/26/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Pilar Sandoval
- Centro de Biología Molecular-Severo Ochoa; CSIC. Cantoblanco; Madrid Spain
| | - José A Jiménez-Heffernan
- Departamento de Anatomía Patológica; Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IP); Madrid Spain
| | | | | | - Ángela Rynne-Vidal
- Centro de Biología Molecular-Severo Ochoa; CSIC. Cantoblanco; Madrid Spain
| | - Patricia Albar-Vizcaíno
- Unidad de Biología Molecular y Servicio de Nefrología, Hospital Universitario La Princesa; Instituto de Investigación Sanitaria Princesa (IP); Madrid Spain
| | | | - Paloma Martín
- Departamento de Anatomía Patológica; Hospital Universitario Puerta de Hierro; Madrid Spain
| | - María José Coronado
- Unidad de Microscopía Confocal, Instituto de Investigación Sanitaria Hospital Puerta de Hierro; Madrid Spain
| | - Carmen Barcena
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre; Madrid Spain
| | | | - Pedro Lorenzo Majano
- Unidad de Biología Molecular y Servicio de Nefrología, Hospital Universitario La Princesa; Instituto de Investigación Sanitaria Princesa (IP); Madrid Spain
| | - Abelardo Aguilera Peralta
- Unidad de Biología Molecular y Servicio de Nefrología, Hospital Universitario La Princesa; Instituto de Investigación Sanitaria Princesa (IP); Madrid Spain
| | | |
Collapse
|
7
|
Arung W, Dinganga N, Ngoie E, Odimba E, Detry O. First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results. Pan Afr Med J 2015; 21:210. [PMID: 26448805 PMCID: PMC4587088 DOI: 10.11604/pamj.2015.21.210.6689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors’ ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients’ demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1stApril 2009 and 28th February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports.
Collapse
Affiliation(s)
- Willy Arung
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo ; Center of Research and Development in Surgery, University of Liège, Liège, Belgium, bAU2
| | - Nathalie Dinganga
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
| | - Emmanuel Ngoie
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
| | - Etienne Odimba
- Department of General Surgery, University of Lubumbashi Clinics, University of Lubumbashi, Lubumbashi, Katanga Province, Democratic Republic of Congo
| | - Olivier Detry
- Center of Research and Development in Surgery, University of Liège, Liège, Belgium, bAU2 ; Department of Abdominal Surgery and Transplantation, University Hospital of Liège, University of Liège, Liège, Belgium
| |
Collapse
|
8
|
Yan S, Yang L, Yue YZ, Li WL, Zeng L, Yue J, Mao CQ. Effect of ligustrazine nanoparticles nano spray on transforming growth factor-β/Smad signal pathway of rat peritoneal mesothelial cells induced by tumor necrosis factor-α. Chin J Integr Med 2015; 22:629-34. [PMID: 26424291 DOI: 10.1007/s11655-015-2180-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To study the effect of ligustrazine nanoparticles nano spray (LNNS) on transforming growth factor β (TGF-β)/Smad signal protein of rat peritoneal mesothelial cells (RPMC) induced by tumor necrosis factor α (TNF-α), and the anti-adhesion mechanism of LNNS in the abdominal cavity. METHODS The primary culture and subculture of rat peritoneal mesothelial cells (RPMC) was processed by trypsin digestion method in vitro. The third generation was identifified for experiment and divided into 5 groups: a blank group: RPMC without treatment; a control group: RPMC stimulated with TNF-α; RPMC treated by a low-dosage LNNS group (2.5 mg/L); RPMC treated by a medium-dosage LNNS group (5 mg/L); and RPMC treated by a high-dosage LNNS group (10 mg/L). Reverse transcription-polymerase chain reaction was applied to test the expression of fifibronectin, collagen I (COL-I), TGF-β mRNA, and Western blot method to test the Smad protein 7 expression of RPMC. RESULTS Compared with the blank group, a signifificant elevation in fifibronectin (FN), COL-I and TGF-β mRNA expression of RPMC were observed in the control group (P<0.05). Compared with the control group, LNNS suppressed the expressions of FN, COL-I and TGF-β mRNA in a concentrationdependent manner (P<0.05). The expression of Smad7 protein of RPMC was down-regulated by TNF-α stimulation, and up-regulated with the increase of LNNS dose (P<0.05). CONCLUSIONS TNF-α may induce changes in RPMC's viability, leading to peritoneal injury. LNNS could reverse the induction of fifibrosis related cytokine FN, COL-I and TGF-β, up-regulating the expression of Smad7 by TNF-α in RPMC, thus attenuate peritoneal injury by repairing mesothelial cells.
Collapse
Affiliation(s)
- Shuai Yan
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, 215009, China.,First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Lan Yang
- Library of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Yin-Zi Yue
- Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, 215009, China
| | - Wen-Lin Li
- Library of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Li Zeng
- Library of Nanjing University of Chinese Medicine, Nanjing, 210023, China. .,First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Jin Yue
- Yancheng Hospital of Traditional Chinese Medicine, Yancheng, Jiangsu Province, 224000, China
| | - Chun-Qin Mao
- College of Pharmacy of Nanjing University of Chinese Medicine, Nanjing, 210023, China
| |
Collapse
|
9
|
Beyene RT, Kavalukas SL, Barbul A. Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. Curr Probl Surg 2015; 52:271-319. [PMID: 26258583 DOI: 10.1067/j.cpsurg.2015.05.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 12/18/2022]
|
10
|
Imaging visceral adhesion to polymeric mesh using pneumoperitoneal-MRI in an experimental rat model. Surg Endosc 2014; 29:1567-73. [PMID: 25294530 DOI: 10.1007/s00464-014-3843-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intraperitoneal mesh implantation is often associated with formation of adhesion to the mesh. This experimental study examines the potential of minimally invasive pneumoperitoneal-MRI to assess these adhesions in a preclinical context. METHODS Uncoated polyethylene terephthalate meshes were placed intraperitoneally in rats, in regard to the caecum previously scraped to promote petechial bleeding and subsequent adhesions. Examinations were performed 2-weeks post mesh implantation using a rodent dedicated high field MRI. Respiratory-triggered T2-weighted images were acquired prior to and after intraperitoneal injection of ~8-10 mL gas to induce a mechanical stress on the abdominal wall. RESULTS Adhesions are occasionally seen in sham-operated rats as opposed to rats receiving polyethylene terephthalate meshes. On high-resolution images, meshes can be detected due to their characteristic net shape. However, evidence of adherence is only found if intraperitoneal gas injection is performed, when a ~1-cm elevation of the abdominal wall is observed. When adherence occurs between the mesh and the caecum, the latter remains in contact with the wall. Looser adherences between visceral tissue and meshes are also observed. CONCLUSIONS T2-weighted pneumoperitoneal-MRI is a powerful tool for assessing adherence after intraperitoneal mesh implantation. According to the mini-invasive procedure adopted here, this approach may allow a temporal follow-up of adherence fate.
Collapse
|
11
|
Coccolini F, Ansaloni L, Manfredi R, Campanati L, Poiasina E, Bertoli P, Capponi MG, Sartelli M, Di Saverio S, Cucchi M, Lazzareschi D, Pisano M, Catena F. Peritoneal adhesion index (PAI): proposal of a score for the "ignored iceberg" of medicine and surgery. World J Emerg Surg 2013; 8:6. [PMID: 23369320 PMCID: PMC3573980 DOI: 10.1186/1749-7922-8-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/29/2013] [Indexed: 12/24/2022] Open
Abstract
Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology.
Collapse
Affiliation(s)
- Federico Coccolini
- General and Emergency Surgery department, Papa Giovanni XXIII hospital, Piazza OMS-Organizzazione Mondiale della Sanità 1, 24128, Bergamo, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Wang N, Shao Y, Mei Y, Zhang L, Li Q, Li D, Shi S, Hong Q, Lin H, Chen X. Novel mechanism for mesenchymal stem cells in attenuating peritoneal adhesion: accumulating in the lung and secreting tumor necrosis factor α-stimulating gene-6. Stem Cell Res Ther 2012; 3:51. [PMID: 23217986 PMCID: PMC3580481 DOI: 10.1186/scrt142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/04/2012] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We previously found that mesenchymal stem cells (MSCs) injected intravenously could attenuate peritoneal adhesion by secreting tumor necrosis alpha-stimulating gene (TSG)-6, while MSCs injected intraperitoneally could not. However, the underlying mechanism remains unclear. This study was designed to investigate the means by which MSCs exert their effects. METHODS Rat bone marrow-derived MSCs/red fluorescent protein (RFP) were injected either intraperitoneally or intravenously into Sprague-Dawley (SD) rats at different time points after peritoneal scraping. Peritoneal adhesions were evaluated macroscopically at day 14 after scraping. The distribution of MSCs injected intraperitoneally or intravenously was traced by two-photon fluorescence confocal imaging and immunofluorescence microscopy. The co-localization of MSCs and macrophages in the lung and the spleen, and the expression of TSG-6 in MSCs trapped in the lung or the spleen were evaluated by immunofluorescence microscopy. The concentration of TSG-6 in serum was evaluated by ELISA. After intravenous injection of TSG-6- small interfering (si) RNA-MSCs, the expression of TSG-6 in MSCs and the concentration of TSG-6 in serum were reevaluated, and peritoneal adhesions were evaluated macroscopically and histologically. RESULTS MSCs injected intraperitoneally failed to reduce peritoneal adhesion, and MSCs injected intravenously markedly improved peritoneal adhesion. Two-photon fluorescence confocal imaging showed that MSCs injected intravenously accumulated mainly in the lung, where they remained for seven days, and immunofluorescence microscopy showed few MSCs phagocytosed by macrophages. In contrast, large numbers of MSCs accumulated in the spleen with obvious phagocytosis by macrophages even at 4 hours after intraperitoneal injection. Immunofluorescence microscopy showed that MSCs that accumulated in the lung after intravenous injection could express TSG-6 within 12 hours, but TSG-6-siRNA-MSCs or MSCs accumulated in the spleen after intraperitoneal injection did not. ELISA showed that the concentration of TSG-6 in serum was increased at 4 hours after intravenous injection of MSCs, while there was no increase after injection of TSG-6-siRNA-MSCs or after intraperitoneal injection of MSCs. Moreover, intravenous injection of TSG-6-siRNA-MSCs failed to attenuate peritoneal adhesion. CONCLUSIONS Our findings suggest that intravenously injected MSCs accumulated in the lung and attenuated peritoneal adhesion by secreting TSG-6, but intraperitoneally injected MSCs were phagocytosed by macrophages in the spleen and failed to attenuate peritoneal adhesion.
Collapse
|
13
|
Wang N, Li Q, Zhang L, Lin H, Hu J, Li D, Shi S, Cui S, Zhou J, Ji J, Wan J, Cai G, Chen X. Mesenchymal stem cells attenuate peritoneal injury through secretion of TSG-6. PLoS One 2012; 7:e43768. [PMID: 22912904 PMCID: PMC3422344 DOI: 10.1371/journal.pone.0043768] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/24/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Mesothelial cell injury plays an important role in peritoneal fibrosis. Present clinical therapies aimed at alleviating peritoneal fibrosis have been largely inadequate. Mesenchymal stem cells (MSCs) are efficient for repairing injuries and reducing fibrosis. This study was designed to investigate the effects of MSCs on injured mesothelial cells and peritoneal fibrosis. METHODOLOGY/PRINCIPAL FINDINGS Rat bone marrow-derived MSCs (5 × 10(6)) were injected into Sprague-Dawley (SD) rats via tail vein 24 h after peritoneal scraping. Distinct reductions in adhesion formation; infiltration of neutrophils, macrophage cells; number of fibroblasts; and level of transforming growth factor (TGF)-β1 were found in MSCs-treated rats. The proliferation and repair of peritoneal mesothelial cells in MSCs-treated rats were stimulated. Mechanically injured mesothelial cells co-cultured with MSCs in transwells showed distinct increases in migration and proliferation. In vivo imaging showed that MSCs injected intravenously mainly accumulated in the lungs which persisted for at least seven days. No apparent MSCs were observed in the injured peritoneum even when MSCs were injected intraperitoneally. The injection of serum-starved MSCs-conditioned medium (CM) intravenously reduced adhesions similar to MSCs. Antibody based protein array of MSCs-CM showed that the releasing of TNFα-stimulating gene (TSG)-6 increased most dramatically. Promotion of mesothelial cell repair and reduction of peritoneal adhesion were produced by the administration of recombinant mouse (rm) TSG-6, and were weakened by TSG-6-RNA interfering. CONCLUSIONS/SIGNIFICANCE Collectively, these results indicate that MSCs may attenuate peritoneal injury by repairing mesothelial cells, reducing inflammation and fibrosis. Rather than the engraftment, the secretion of TSG-6 by MSCs makes a major contribution to the therapeutic benefits of MSCs.
Collapse
Affiliation(s)
- Nan Wang
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Qinggang Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Li Zhang
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Hongli Lin
- Department of Nephrology, the First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Jie Hu
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Diangeng Li
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Suozhu Shi
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Shaoyuan Cui
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Jianhui Zhou
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
| | - Jiayao Ji
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Jiajia Wan
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- Medical College, NanKai University, Tianjin, China
| | - Guangyan Cai
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- * E-mail: (XC); (GC)
| | - Xiangmei Chen
- State Key Laboratory of Kidney Diseases, Department of Nephrology, PLA General Hospital and Military Medical Postgraduate College, Beijing, China
- * E-mail: (XC); (GC)
| |
Collapse
|
14
|
Sadek KH, Cagampang FR, Bruce KD, Macklon N, Cheong Y. Variation in stability of housekeeping genes in healthy and adhesion-related mesothelium. Fertil Steril 2012; 98:1023-7. [PMID: 22795637 DOI: 10.1016/j.fertnstert.2012.06.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/18/2012] [Accepted: 06/19/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the stability of various housekeeping genes (HKG) within healthy versus scarred peritoneal mesothelium. The use of HKG as internal controls for quantitative real-time polymerase chain reaction (qRT-PCR) studies is based on the assumption of their inherent stability. However, recent evidence suggests that this is not true for all HKG and that stability may be tissue specific and affected by certain pathologies. DESIGN Paired mesothelial (n = 10) and adhesion tissue samples (n = 10) were taken during laparoscopic surgery. The stability of 12 candidate reference genes in the mesothelial tissues were evaluated; these include ATP5b, SDHA, CYC1, 18S rRNA, RPL13A, ACTB, YWHAZ, TOP1, UBC, EIF4A2, GAPDH, and B2M. SETTING Hospital. PATIENT(S) Female patients undergoing laparoscopic gynecological surgery were recruited from the Princess Anne Hospital, United Kingdom. INTERVENTION(S) Assessment of HKG expression stability using geNorm algorithm software. MAIN OUTCOME MEASURE(S) Stability measure (M) generated by geometric averaging of multiple target genes and mean pairwise variation of genes. RESULT(S) The most stable HKGs observed across both healthy and adhesion-related mesothelium were found to be ACTB, YWHAZ, and CYC1. ACTB had a higher expression in healthy mesothelium compared with in peritoneal adhesion tissue. CONCLUSION(S) This study indicates that ACTB, YWHAZ, and CYC1 are the appropriate internal controls for qRT-PCR analysis in mesothelial gene expression studies. Published discrepancies in gene expression studies using the mesothelium may therefore be due in part to inappropriate HKG selection.
Collapse
Affiliation(s)
- Khaled Hassan Sadek
- Human Development and Health Unit, University of Southampton Faculty of Medicine, Southampton, United Kingdom.
| | | | | | | | | |
Collapse
|
15
|
Atta HM. Prevention of peritoneal adhesions: a promising role for gene therapy. World J Gastroenterol 2011; 17:5049-58. [PMID: 22171139 PMCID: PMC3235588 DOI: 10.3748/wjg.v17.i46.5049] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 07/14/2011] [Accepted: 07/21/2011] [Indexed: 02/06/2023] Open
Abstract
Adhesions are the most frequent complication of abdominopelvic surgery, yet the extent of the problem, and its serious consequences, has not been adequately recognized. Adhesions evolved as a life-saving mechanism to limit the spread of intraperitoneal inflammatory conditions. Three different pathophysiological mechanisms can independently trigger adhesion formation. Mesothelial cell injury and loss during operations, tissue hypoxia and inflammation each promotes adhesion formation separately, and potentiate the effect of each other. Studies have repeatedly demonstrated that interruption of a single pathway does not completely prevent adhesion formation. This review summarizes the pathogenesis of adhesion formation and the results of single gene therapy interventions. It explores the promising role of combinatorial gene therapy and vector modifications for the prevention of adhesion formation in order to stimulate new ideas and encourage rapid advancements in this field.
Collapse
|
16
|
Arung W, Meurisse M, Detry O. Pathophysiology and prevention of postoperative peritoneal adhesions. World J Gastroenterol 2011; 17:4545-53. [PMID: 22147959 PMCID: PMC3225091 DOI: 10.3748/wjg.v17.i41.4545] [Citation(s) in RCA: 277] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/26/2011] [Accepted: 09/03/2011] [Indexed: 02/06/2023] Open
Abstract
Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.
Collapse
|
17
|
Bove GM, Chapelle SL. Visceral mobilization can lyse and prevent peritoneal adhesions in a rat model. J Bodyw Mov Ther 2011; 16:76-82. [PMID: 22196431 DOI: 10.1016/j.jbmt.2011.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Peritoneal adhesions are almost ubiquitous following surgery. Peritoneal adhesions can lead to bowel obstruction, digestive problems, infertility, and pain, resulting in many hospital readmissions. Many approaches have been used to prevent or treat adhesions, but none offer reliable results. A method that consistently prevented or treated adhesions would benefit many patients. We hypothesized that an anatomically-based visceral mobilization, designed to promote normal mobility of the abdominal contents, could manually lyse and prevent surgically-induced adhesions. MATERIAL AND METHODS Cecal and abdominal wall abrasion was used to induce adhesions in 3 groups of 10 rats (Control, Lysis, and Preventive). All rats were evaluated 7 days following surgery. On postoperative day 7, unsedated rats in the Lysis group were treated using visceral mobilization, consisting of digital palpation, efforts to manually lyse restrictions, and mobilization of their abdominal walls and viscera. This was followed by immediate post-mortem adhesion evaluation. The rats in the Preventive group were treated daily in a similar fashion, starting the day after surgery. Adhesions in the Control rats were evaluated 7 days after surgery without any visceral mobilization. RESULTS The therapist could palpate adhesions between the cecum and other viscera or the abdominal wall. Adhesion severity and number of adhesions were significantly lower in the Preventive group compared to other groups. In the Lysis and Preventive groups there were clear signs of disrupted adhesions. CONCLUSIONS These initial observations support visceral mobilization may have a role in the prevention and treatment of post-operative adhesions.
Collapse
Affiliation(s)
- Geoffrey M Bove
- University of New England College of Osteopathic Medicine, Department of Pharmacology, 11 Hills Beach Rd., Biddeford, ME 04046, United States.
| | | |
Collapse
|
18
|
Chiu CC. Open adhesiolysis is more effective in reducing adhesion reformation than laparoscopic adhesiolysis in an experimental model (Br J Surg 2010; 97: 420-427). Br J Surg 2010; 97:962; author reply 962-3. [PMID: 20474016 DOI: 10.1002/bjs.7146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|