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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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Modification and preparation of four natural hydrogels and their application in biopharmaceutical delivery. Polym Bull (Berl) 2022. [DOI: 10.1007/s00289-022-04412-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Watanabe J, Yamaguchi S, Takemasa I, Yasui M, Hirano Y, Nakano D, Shiomi A, Munakata S, Naito M, Tsukamoto S, Ishibe A, Kuriu Y, Uchima Y, Mori S, Kanazawa H, Wakabayashi G, Yamada T, Ezu M, Watanabe M, Kinugasa Y. Safety, efficacy, and operability of a newly developed absorbable adhesion barrier (GM142) in patients with primary rectal cancer scheduled for diverting ileostomy during laparoscopic surgery: Randomized controlled trial. Ann Gastroenterol Surg 2022; 6:515-522. [PMID: 35847436 PMCID: PMC9271016 DOI: 10.1002/ags3.12544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 01/22/2023] Open
Abstract
Aim The aim of this study was to compare the outcomes of GM142, a newly developed gelatin film with a concave and convex structure to a commercially available conventional film, hyaluronate‐carboxymethylcellulose. Methods Patients with primary rectal cancer who were scheduled for diverting ileostomy during laparoscopic surgery were eligible for this study. Patients were randomized before surgery and an antiadhesion film was applied under the umbilical incision. The primary outcome was the incidence of adhesion under the midline incision confirmed by second‐look surgery for diverting ileostomy closure. The secondary outcomes were the adhesion severity score, the extent of adhesion score, the presence of intestinal obstruction, and the success of all patching. Results A total of 146 patients were enrolled. A total of 123 patients were included in the full analysis set. The primary outcome of “no adhesion” was observed in 66.1% in the GM142 group and 55.7% in the conventional film group. The noninferiority of GM142 to conventional film was confirmed (P = .0005). The secondary outcomes were similar between the groups. For the safety evaluation, there were no safety concerns regarding allergic reactions to gelatin or increased gelatin‐specific IgE antibody titers. Conclusions The noninferiority of GM142 to conventional film was shown. GM142 showed no major safety issues. The clinical safety profiles of GM142 suggested certain physiological benefits of the gelatin film as an adhesion barrier.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery Gastroenterological Center Yokohama City University Medical Center Yokohama Japan
| | - Shigeki Yamaguchi
- Department of Surgery Division of Colorectal Surgery Tokyo Women's Medical University Tokyo Japan
| | - Ichiro Takemasa
- Department of Surgery Surgical Oncology and Science Sapporo Medical University School of Medicine Hokkaido Japan
| | - Masayoshi Yasui
- Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan
| | - Yasumitsu Hirano
- Department of Gastroenterological Surgery Saitama Medical University International Medical Center Saitama Japan
| | - Daisuke Nakano
- Department of Surgery Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital Tokyo Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery Shizuoka Cancer Center Shizuoka Japan
| | - Shinya Munakata
- Department of Coloproctological Surgery Faculty of Medicine Juntendo University Tokyo Japan
| | - Masanori Naito
- Department of Surgery Kitasato University Medical Center Saitama Japan
- Department of Gastroenterological Surgery St. Marianna University Yokohama West Hospital Yokohama Japan
| | - Shunsuke Tsukamoto
- Department of Colorectal Surgery National Cancer Center Hospital Tokyo Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine Yokohama Japan
| | - Yoshiaki Kuriu
- Department of Surgery Kyoto Prefectural University of Medicine Kyoto Japan
| | | | - Shinichiro Mori
- Department of Digestive Surgery, Breast and Thyroid Surgery Kagoshima University Graduate School of Medical Sciences Kagoshima Japan
| | - Hideki Kanazawa
- Department of Surgery Sagamihara National Hospital National Hospital Organization Kanagawa Japan
| | - Go Wakabayashi
- Department of Surgery Ageo Central General Hospital Saitama Japan
| | - Takeshi Yamada
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic Surgery Nippon Medical School Tokyo Japan
| | | | - Masahiko Watanabe
- Department of Surgery Kitasato University Kitasato Institute Hospital Tokyo Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery Tokyo Medical and Dental University Tokyo Japan
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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: 32] [Impact Index Per Article: 10.7] [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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Shurshina A, Bazunova M, Chernova V, Galina A, Titlova A, Kulish E. The impact of polymers’ supramolecular structure on water vapour sorption and drug release from films on the basis of some polysaccharide. J Drug Deliv Sci Technol 2021. [DOI: 10.1016/j.jddst.2021.102560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Horii T, Tsujimoto H, Kageyama S, Yoshida T, Kobayashi K, Takamori H, Minato H, Ueda J, Hagiwara A, Ichikawa H, Kawauchi A. The usefulness of re-attachability of anti-adhesive cross-linked gelatin film and the required physical and biological properties. Biomed Mater Eng 2020; 31:351-360. [PMID: 33252061 DOI: 10.3233/bme-206009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To overcome the unfavorable issues associated with conventional anti-adhesive HA/CMC film, we developed an anti-adhesive thermally cross-linked gelatin film. OBJECTIVE We tried to clarify the re-attachability of the film and the required properties concerning the film thickness, stiffness and anti-adhesion effect. METHODS To determine the optimal thickness, 5 kinds of the thickness of gelatin film and the conventional film were analyzed by the tensile test, shearing test, buckling test and tissue injury test. Finally, using the optimal film thickness, we tried to clarify the anti-adhesion effect of the reattached film. RESULTS The tensile and shearing test showed gelatin films ≥30 μm thick had greater tensile strength and a smaller number of film fractures, than the conventional film. The buckling and tissue injury test showed gelatin films ≥60 μm thick had higher buckling strength and worse injury scores than the conventional film. The anti-adhesive effect of re-attached gelatin film using optimal thickness (30-40 μm) found the anti-adhesion score was significantly better than that of the control. CONCLUSIONS Provided it has an optimal thickness, gelatin film can be reattached with enough physical strength not to tear, safety stiffness not to induce tissue injury, and a sufficient anti-adhesion effect.
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Affiliation(s)
- Tsunehito Horii
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of Medical Life Systems, Department of Life and Medical Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Hiroyuki Tsujimoto
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of Medical Life Systems, Department of Life and Medical Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Susumu Kageyama
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Tetsuya Yoshida
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Kenichi Kobayashi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hideki Takamori
- Division of Medical Life Systems, Department of Life and Medical Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Hiroshi Minato
- Department of Surgery, Yawata Central Hospital, Yawatagotanda, Yawata, Kyoto, Japan
| | - Jo Ueda
- Department of Gastroenterology, Ueda Clinic, Kitanakaieshita, Takanosu, Akita, Japan
| | - Akeo Hagiwara
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan.,Division of Medical Life Systems, Department of Life and Medical Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Hiroshi Ichikawa
- Division of Medical Life Systems, Department of Life and Medical Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Akihiro Kawauchi
- Department of Urology, Shiga University of Medical Science, Otsu, Shiga, Japan
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Kawai N, Suzuki S, Ouji Y, Takeda M, Sakagami M, Tojo T, Sawabata N, Yoshikawa M, Ikada Y, Taniguchi S. Effect of covering with cross-linked gelatin glue on tissue regeneration in a rat lung injury model. Interact Cardiovasc Thorac Surg 2019; 29:1-7. [PMID: 30793739 DOI: 10.1093/icvts/ivy297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/05/2018] [Accepted: 09/22/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Thoracic reintervention is a common treatment; however, preventing adhesion of the lung to the thoracic cavity wall remains a problem. This study aimed to investigate the effect on pleural adhesion of covering the postoperative pleural injury site with cross-linked gelatin glue (gelatin plus glutaraldehyde, hereafter 'gelatin glue') and to evaluate the proliferation of healing cells on gelatin glue. METHODS We created a rat incisional lung-wound model and compared the effects of sealing the wound with gelatin glue (group A, n = 5), fibrin glue (group B, n = 5) or fibrin glue with a polyglycolic acid sheet (group C, n = 5). Adhesions were assessed 28 days postoperatively and compared among the groups using the Karacam's scoring method. Lung-wound healing was studied histologically at day 7 postoperatively. Mesothelial cell proliferation was investigated on gelatin and fibrin glues in vitro. RESULTS There were no or few adhesions of the chest wall in group A. The adhesion scores (mean ± standard deviation) were 1.2 ± 0.4, 2.6 ± 1.4 and 3.2 ± 1.2 in groups A, B and C, respectively (A vs C, P = 0.0496). During the healing process, the gelatin glue surface was covered by mesothelial-like cells. Proliferation of cultured mesothelial cells was promoted on the gelatin glue compared with the fibrin glue. CONCLUSIONS Covering lung wounds with the gelatin glue reduced adhesions and promoted the growth of healing cells compared with the fibrin glue. These findings suggest that the gelatin glue may help prevent adhesions and thus be a therapeutically effective biomaterial in lung surgery.
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Affiliation(s)
- Norikazu Kawai
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan.,Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan
| | - Shuko Suzuki
- Department of Medical Engineering, Nara Medical University, Nara, Japan.,Queensland Eye Institute, South Brisbane, Queensland, Australia
| | - Yukiteru Ouji
- Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan
| | | | - Masaharu Sakagami
- Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan
| | - Takashi Tojo
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Noriyoshi Sawabata
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
| | - Masahide Yoshikawa
- Department of Pathogen, Infection and Immunity, Nara Medical University, Nara, Japan
| | - Yoshito Ikada
- Department of Medical Engineering, Nara Medical University, Nara, Japan.,Kyoto University, Kyoto, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University, Nara, Japan
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Miyamoto H, Tsujimoto H, Horii T, Ozamoto Y, Ueda J, Takagi T, Saitoh N, Hagiwara A. The influences of a novel anti-adhesion device, thermally cross-linked gelatin film on peritoneal dissemination of tumor cells: The in vitro and in vivo experiments using murine carcinomatous peritonitis models. J Biomed Mater Res B Appl Biomater 2017; 106:2122-2130. [PMID: 29024447 DOI: 10.1002/jbm.b.34017] [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: 04/27/2017] [Revised: 08/16/2017] [Accepted: 09/24/2017] [Indexed: 11/07/2022]
Abstract
To create anti-adhesive materials to be more effective and safer, we developed a thermally cross-linked gelatin film that showed superior anti-adhesive effects with excellent peritoneal regeneration. However, it may act as a convenient scaffold for tumor cell growth, thereby accelerating peritoneal dissemination when used in surgery for abdominal tumors. In this study, we tried to clarify this issue using mouse carcinomatous peritonitis models. First, we examined the in vitro tumor cell growth of mouse B16 melanoma or Colon26 cells on the gelatin film or the conventional hyarulonate/carboxymethylcellulose film. Tumor cell growth on each film was significantly lower than that of the control (no film). Next, we conducted the following in vivo experiments: After the parietal peritoneum was partially removed and covered with each film or without any film, mice were inoculated intraperitoneally with B16 melanoma or Colon26/Nluc cells expressing NanoLuc luciferase gene. At 7 days after the operation, we measured the weight of B16 melanoma tumors or the NanoLuc activity of Colon26/Nluc cells using in vivo imaging at the injured sites. There were no significant differences in the weight of the tumors and the NanoLuc activity among the three groups. We also observed the survival time of mice receiving the same operation and treatments. There was no significant difference in the survival time among the three groups. These results suggest that the gelatin film will likely not accelerate peritoneal dissemination as a convenient scaffold for tumor cell growth when used in surgery for abdominal tumors. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2122-2130, 2018.
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Affiliation(s)
- Hiroe Miyamoto
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Hiroyuki Tsujimoto
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Tsunehito Horii
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
| | | | - Joe Ueda
- Kainan Hospital, Yatomi, Aichi, Japan
| | - Toshitaka Takagi
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Naoto Saitoh
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Akeo Hagiwara
- Department of Medical Life Systems, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Kyoto, Japan
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Horii T, Tsujimoto H, Miyamoto H, Yamanaka K, Tanaka S, Torii H, Ozamoto Y, Takamori H, Nakamachi E, Ikada Y, Hagiwara A. Physical and biological properties of a novel anti-adhesion material made of thermally cross-linked gelatin film: Investigation of the usefulness as anti-adhesion material. J Biomed Mater Res B Appl Biomater 2017; 106:689-696. [DOI: 10.1002/jbm.b.33880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 02/01/2017] [Accepted: 02/28/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Tsunehito Horii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroyuki Tsujimoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroe Miyamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Koki Yamanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Shota Tanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroko Torii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Yuki Ozamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hideki Takamori
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Eiji Nakamachi
- Division of Biomedical Engineering, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Yoshito Ikada
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Akeo Hagiwara
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
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Work of separation - A method to assess intraperitoneal adhesion and healing of parietal peritoneum in an animal model. Clin Biomech (Bristol, Avon) 2017; 41:82-86. [PMID: 28012304 DOI: 10.1016/j.clinbiomech.2016.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Adhesion grades and adhesion breaking strength are widely used to assess severity of intraperitoneal adhesion in animal models. However, the results of adhesion grades have the large deviations due to vary personal experience. Adhesion breaking strength ignores the details of adhesion. This study introduced work of separation, the energy consumption during breakage of adhesion, to better evaluate intraperitoneal adhesion. METHODS The intraperitoneal adhesion was induced by traumas created at rat cecum and adjacent abdominal wall. The wounds were coated with or without sodium hyaluronate. On day 14 after surgery, the intraperitoneal adhesion was assessed by adhesion density grade, adhesion area grade, adhesion breaking strength and work of separation. The healing of parietal peritoneum was evaluated with histology, adhesion breaking strength and work of separation. FINDINGS The severity of adhesion evaluated with work of separation was consistent with those obtained from the grades of adhesion density, adhesion area and adhesion breaking strength. Work of separation had a linear correlation with adhesion breaking strength. Furthermore, the results of histological examination and work of separation demonstrated that adhesion significantly delayed healing process of abdominal wall muscles. INTERPRETATION Work of separation can quantify all intraperitoneal adhesions rather than the major one by other methods. It is a more precise method to evaluate postoperative adhesions, especially those including adipose tissue. This study proved that work of separation could be a reliable method to assess intraperitoneal adhesion and tissue healing.
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Preparation of Extracellular Matrix Developed Using Porcine Articular Cartilage and In Vitro Feasibility Study of Porcine Articular Cartilage as an Anti-Adhesive Film. MATERIALS 2016; 9:ma9010049. [PMID: 28787849 PMCID: PMC5456529 DOI: 10.3390/ma9010049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 11/24/2022]
Abstract
In this study, we examined whether porcine articular cartilage (PAC) is a suitable and effective anti-adhesive material. PAC, which contained no non-collagenous tissue components, was collected by mechanical manipulation and decellularization of porcine knee cartilage. The PAC film for use as an anti-adhesive barrier was easily shaped into various sizes using homemade silicone molds. The PAC film was cross-linked to study the usefulness of the anti-adhesive barrier shape. The cross-linked PAC (Cx-PAC) film showed more stable physical properties over extended periods compared to uncross-linked PAC (UnCx-PAC) film. To control the mechanical properties, Cx-PAC film was thermally treated at 45 °C or 65 °C followed by incubation at room temperature. The Cx-PAC films exhibited varying enthalpies, ultimate tensile strength values, and contact angles before and after thermal treatment and after incubation at room temperature. Next, to examine the anti-adhesive properties, human umbilical vein endothelial cells (HUVECs) were cultured on Cx-PAC and thermal-treated Cx-PAC films. Scanning electron microscopy, fluorescence, and MTT assays showed that HUVECs were well adhered to the surface of the plate and proliferated, indicating no inhibition of the attachment and proliferation of HUVECs. In contrast, Cx-PAC and thermal-treated Cx-PAC exhibited little and/or no cell attachment and proliferation because of the inhibition effect on HUVECs. In conclusion, we successfully developed a Cx-PAC film with controllable mechanical properties that can be used as an anti-adhesive barrier.
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Prevention of Polyglycolic Acid-Induced Peritoneal Adhesions Using Alginate in a Rat Model. BIOMED RESEARCH INTERNATIONAL 2015; 2015:403413. [PMID: 26078949 PMCID: PMC4454711 DOI: 10.1155/2015/403413] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 09/17/2014] [Indexed: 11/17/2022]
Abstract
Postoperative intra-abdominal or intrathoracic adhesions sometimes cause significant morbidity. We have designed three types of alginate-based treatments using strongly cross-linked (SL), weakly cross-linked (WL), and non-cross-linked (NL) alginate with calcium gluconate. In rat experiments, we compared the antiadhesive effects of the three types of alginate-based treatments, fibrin glue treatment (a standard treatment), and no treatment against adhesions caused by polyglycolic acid (PGA) mesh (PGA-induced adhesions). The antiadhesive materials were set on the PGA sheet fixed on the parietal peritoneum of the abdomen. Fifty-six days later, the adhesions were evaluated macroscopically by the adhesion scores and microscopically by hematoxylin-eosin staining and immunostaining. We also tested the fibroblast growth on the surface of the antiadhesive materials in vitro. The antiadhesive effects of WL and NL were superior to the no treatment and fibrin glue treatment. A microscopic evaluation confirmed that the PGA sheet was covered by a peritoneal layer constructed of well-differentiated mesothelial cells, and the inflammation was most improved in the NL and WL. The fibroblast growth was inhibited most on the surfaces of the NL and WL. These results suggest that either the WL or NL treatments are suitable for preventing PGA-induced adhesions compared to SL or the conventional treatment.
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Tsujimoto H, Tanzawa A, Miyamoto H, Horii T, Tsuji M, Kawasumi A, Tamura A, Wang Z, Abe R, Tanaka S, Yamanaka K, Matoba M, Torii H, Ozamoto Y, Takamori H, Suzuki S, Morita S, Ikada Y, Hagiwara A. Biological properties of a thermally crosslinked gelatin film as a novel anti-adhesive material: Relationship between the biological properties and the extent of thermal crosslinking. J Biomed Mater Res B Appl Biomater 2014; 103:1511-8. [DOI: 10.1002/jbm.b.33340] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/22/2014] [Accepted: 11/13/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Hiroyuki Tsujimoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Ayumi Tanzawa
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroe Miyamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Tsunehito Horii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Misaki Tsuji
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Akari Kawasumi
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Atsushi Tamura
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Zhen Wang
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Rie Abe
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Shota Tanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Kouki Yamanaka
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Mari Matoba
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hiroko Torii
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Yuki Ozamoto
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
| | - Hideki Takamori
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
- Research and Development Department; Gunze Ltd.; Ayabe Kyoto 623-8511 Japan
| | - Shuko Suzuki
- Research and Development Department; Gunze Ltd.; Ayabe Kyoto 623-8511 Japan
- Medical Department; Nara Medical University; Kashihara Nara 634-8521 Japan
| | - Shinichiro Morita
- Research and Development Department; Gunze Ltd.; Ayabe Kyoto 623-8511 Japan
| | - Yoshito Ikada
- Medical Department; Nara Medical University; Kashihara Nara 634-8521 Japan
| | - Akeo Hagiwara
- Division of Medical Life System, Department of Life and Medical Science; Doshisha University; Kyotanabe Kyoto 610-0394 Japan
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15
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Yoshizawa K, Taguchi T. Bonding behavior of hydrophobically modified gelatin films on the intestinal surface. J BIOACT COMPAT POL 2014. [DOI: 10.1177/0883911514553731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The bonding behavior was determined for hydrophobically modified alkaline-treated gelatin on wet porcine intestinal surfaces. The modified gelatin films were obtained by reacting the amino groups of alkaline-treated gelatin with fatty acid chlorides of different alkyl chain lengths, namely, hexanoyl (Hx: C6) chloride, decanoyl (Dec: C10) chloride, and stearoyl (Ste: C18) chloride. Three kinds of the films were prepared, 32HxAlGltn, 24DecAlGltn, and 26SteAlGltn that had substitution ratios of hydrophobic groups to the amino groups of 32HxAlGltn, 24DecAlGltn, and 26SteAlGltn of 32%, 24%, and 26%, respectively. The 32HxAlGltn film had the strongest bonding to porcine intestinal surfaces. A thick 32HxAlGltn film remained on the intestinal surface even after the bonded film was scraped off for the measurement of bonding strength. In addition, the burst strength increased with an increase in the substitution ratio of the Hx group. Thus, the HxAlGltn film with the higher Hx modification ratio has a potential as a sealant material to prevent agglutination of intestinal surfaces.
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Affiliation(s)
- Keiko Yoshizawa
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tetsushi Taguchi
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Tsukuba, Japan
- Biomaterials Unit, Nano-Life Field, International Center for Materials Nanoarchitectonics (MANA), National Institute for Materials Science, Tsukuba, Japan
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16
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Chaturvedi AA, Lomme RMLM, Hendriks T, van Goor H. Ultrapure alginate anti-adhesion gel does not impair colon anastomotic strength. J Surg Res 2014; 192:432-9. [PMID: 24980857 DOI: 10.1016/j.jss.2014.05.085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 04/08/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ultrapure alginate gel is promising in terms of adhesion prevention. Because anti-adhesive barriers have been shown to disturb healing of bowel anastomoses, the effect of ultrapure alginate gel on the repair of colon anastomoses was studied. MATERIALS AND METHODS In 102 male Wistar rats, a 0.5-cm segment was resected from the descending colon and continuity was restored by an inverted single-layer end-to-end anastomosis. Animals were randomized into a control, an alginate gel, and a sodium hyaluronate carboxymethyl cellulose film group, each n = 34. Half of each group was sacrificed at day 3 and 7 postoperatively. Anastomotic strength was assessed by measuring both bursting pressure and breaking strength. Hydroxyproline content was measured and histologic analysis was performed. The incidence of adhesion and abscess formation was scored at sacrifice. RESULTS No difference in either anastomotic-bursting pressure or breaking strength was found between experimental groups and the controls at any time point. Both the incidence of adhesion formation (35% versus 71%, P = 0.007) and the adhesion score (0.38 versus 0.79, P = 0.009) were significantly lower in the alginate gel group than in the controls. The abscess rate was higher (46% versus 18%, P = 0.030) in the hyaluronate carboxymethyl cellulose group than in the controls and unchanged in the alginate gel group. CONCLUSIONS While reducing adhesion formation, ultrapure alginate gel does not interfere with the development of colonic anastomotic strength during the crucial early healing period.
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Affiliation(s)
- Ankit A Chaturvedi
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; European Medical Contract Manufacturing B.V, Nijmegen, The Netherlands.
| | - Roger M L M Lomme
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Thijs Hendriks
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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17
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Bae SH, Son SR, Kumar Sakar S, Nguyen TH, Kim SW, Min YK, Lee BT. Evaluation of the potential anti-adhesion effect of the PVA/Gelatin membrane. J Biomed Mater Res B Appl Biomater 2013; 102:840-9. [DOI: 10.1002/jbm.b.33066] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/27/2013] [Accepted: 10/20/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Sang-Ho Bae
- Department of Surgery; College of Medicine; Soonchunhyang University Hospital; Cheonan Chungnam 330-090 Republic of Korea
| | - So-Ra Son
- Department of Tissue Regeneration; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
| | - Swapan Kumar Sakar
- Department of Tissue Regeneration; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
| | - Thi-Hiep Nguyen
- Department of Tissue Regeneration; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
| | - Shin-Woo Kim
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
| | - Young-Ki Min
- Department of Physiology; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
| | - Byong-Taek Lee
- Department of Tissue Regeneration; College of Medicine; Soonchunhyang University; Cheonan Chungnam 330-090 Republic of Korea
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18
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Development of gelatin flakes, a new type of anti-adhesive material: a preliminary study of in vivo rat adhesion models. Surg Today 2013; 44:391-4. [DOI: 10.1007/s00595-013-0608-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 03/04/2013] [Indexed: 10/26/2022]
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