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Lin Y, Shi H, Yang R, Li S, Tang J, Li S. A transcriptomic analysis of incisional hernia based on high-throughput sequencing technology. Hernia 2024:10.1007/s10029-024-03116-7. [PMID: 39073735 DOI: 10.1007/s10029-024-03116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/17/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Incisional hernia is a common postoperative complication; however, few transcriptomic studies have been conducted on it. In this study, we used second-generation high-throughput sequencing to explore the pathogenesis and potential therapeutic targets of incisional hernias. METHODS Superficial fasciae were collected from 15 patients without hernia and 21 patients with an incisional hernia. High-throughput sequencing of the fascia was performed to generate an expression matrix. We analyzed the matrix to identify differentially expressed genes (DEGs) and performed gene ontology and enrichment analyses of these DEGs. Additionally, an external dataset was utilized to identify key DEGs. RESULTS We identified 1,823 DEGs closely associated with extracellular matrix (ECM) imbalance, bacterial inflammatory response, and fibrillar collagen trimerization. TNNT3, CMAY5, ATP1B4, ASB5, CILP, SIX4, FBN1 and FNDC5 were identified as key DEGs at the intersection of the two expression matrices. Moreover, non-alcoholic fatty liver disease-related, TNF, and IL-17 signaling pathways were identified as key enrichment pathways. CONCLUSIONS We identified eight key DEGs and three pathways associated with incisional hernias. Our findings offer new insights into the pathogenesis of incisional hernias and highlight potential targets for their prevention and treatment.
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Affiliation(s)
- Yiming Lin
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China
| | - Hekai Shi
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China
| | - Rongduo Yang
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China
| | - Shaochun Li
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China
| | - Jianxiong Tang
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China
| | - Shaojie Li
- Department of General Surgery, Fudan University Affiliated Huadong Hosptial, No.221, West Yan'an Road, Jing'an District, Shanghai, 200040, Republic of China.
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Hendrawan S, Lheman J, Weber U, Oberkofler CE, Eryani A, Vonlanthen R, Baer HU. Fibroblast matrix implants-a better alternative for incisional hernia repair? Biomed Mater 2024; 19:035033. [PMID: 38604155 DOI: 10.1088/1748-605x/ad3da4] [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: 10/19/2023] [Accepted: 04/11/2024] [Indexed: 04/13/2024]
Abstract
The standard surgical procedure for abdominal hernia repair with conventional prosthetic mesh still results in a high recurrence rate. In the present study, we propose a fibroblast matrix implant (FMI), which is a three-dimensional (3D) poly-L-lactic acid scaffold coated with collagen (matrix) and seeded with fibroblasts, as an alternative mesh for hernia repair. The matrix was seeded with fibroblasts (cellularized) and treated with a conditioned medium (CM) of human Umbilical Cord Mesenchymal Stem Cells (hUC-MSC). Fibroblast proliferation and function were assessed and compared between treated with CM hUC-MSC and untreated group, 24 h after seeding onto the matrix (n= 3). To study the matricesin vivo,the hernia was surgically created on male Sprague Dawley rats and repaired with four different grafts (n= 3), including a commercial mesh (mesh group), a matrix without cells (cell-free group), a matrix seeded with fibroblasts (FMI group), and a matrix seeded with fibroblasts and cultured in medium treated with 1% CM hUC-MSC (FMI-CM group).In vitroexamination showed that the fibroblasts' proliferation on the matrices (treated group) did not differ significantly compared to the untreated group. CM hUC-MSC was able to promote the collagen synthesis of the fibroblasts, resulting in a higher collagen concentration compared to the untreated group. Furthermore, thein vivostudy showed that the matrices allowed fibroblast growth and supported cell functionality for at least 1 month after implantation. The highest number of fibroblasts was observed in the FMI group at the 14 d endpoint, but at the 28 d endpoint, the FMI-CM group had the highest. Collagen deposition area and neovascularization at the implantation site were observed in all groups without any significant difference between the groups. FMI combined with CM hUC-MSC may serve as a better option for hernia repair, providing additional reinforcement which in turn should reduce hernia recurrence.
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Affiliation(s)
- Siufui Hendrawan
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - Jennifer Lheman
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - Ursula Weber
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Baermed, Centre of Abdominal Surgery, Hirslanden Clinic, 8032 Zürich, Switzerland
| | | | - Astheria Eryani
- Department of Histology, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
| | - René Vonlanthen
- Vivévis AG, Viszeral-, Tumor- und Roboterchirurgie, Kappelistrasse 7, 8002 Zürich, Switzerland
| | - Hans Ulrich Baer
- Tarumanagara Human Cell Technology Laboratory, Faculty of Medicine, Tarumanagara University, Jakarta 11440, Indonesia
- Baermed, Centre of Abdominal Surgery, Hirslanden Clinic, 8032 Zürich, Switzerland
- Department of Visceral and Transplantation Surgery, University of Bern, 3012 Bern, Switzerland
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Talwar AA, Desai AA, McAuliffe PB, Broach RB, Hsu JY, Liu T, Udupa JK, Tong Y, Torigian DA, Fischer JP. Optimal computed tomography-based biomarkers for prediction of incisional hernia formation. Hernia 2024; 28:17-24. [PMID: 37676569 PMCID: PMC11235401 DOI: 10.1007/s10029-023-02835-7] [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: 03/29/2023] [Accepted: 07/04/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Unstructured data are an untapped source for surgical prediction. Modern image analysis and machine learning (ML) can harness unstructured data in medical imaging. Incisional hernia (IH) is a pervasive surgical disease, well-suited for prediction using image analysis. Our objective was to identify optimal biomarkers (OBMs) from preoperative abdominopelvic computed tomography (CT) imaging which are most predictive of IH development. METHODS Two hundred and twelve rigorously matched colorectal surgery patients at our institution were included. Preoperative abdominopelvic CT scans were segmented to derive linear, volumetric, intensity-based, and textural features. These features were analyzed to find a small subset of OBMs, which are maximally predictive of IH. Three ML classifiers (Ensemble Boosting, Random Forest, SVM) trained on these OBMs were used for prediction of IH. RESULTS Altogether, 279 features were extracted from each CT scan. The most predictive OBMs found were: (1) abdominopelvic visceral adipose tissue (VAT) volume, normalized for height; (2) abdominopelvic skeletal muscle tissue volume, normalized for height; and (3) pelvic VAT volume to pelvic outer aspect of body wall skeletal musculature (OAM) volume ratio. Among ML prediction models, Ensemble Boosting produced the best performance with an AUC of 0.85, accuracy of 0.83, sensitivity of 0.86, and specificity of 0.81. CONCLUSION These OBMs suggest increased intra-abdominopelvic volume/pressure as the salient pathophysiologic driver and likely mechanism for IH formation. ML models using these OBMs are highly predictive for IH development. The next generation of surgical prediction will maximize the utility of unstructured data using advanced image analysis and ML.
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Affiliation(s)
- A A Talwar
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, 14th floor South Tower, Philadelphia, PA, 19104, USA
| | - A A Desai
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, 14th floor South Tower, Philadelphia, PA, 19104, USA
| | - P B McAuliffe
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, 14th floor South Tower, Philadelphia, PA, 19104, USA
| | - R B Broach
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, 14th floor South Tower, Philadelphia, PA, 19104, USA
| | - J Y Hsu
- Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - T Liu
- School of Information Science and Engineering, Yanshan University, Qinhuangdao, China
| | - J K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Y Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - D A Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - J P Fischer
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, 14th floor South Tower, Philadelphia, PA, 19104, USA.
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Omar I, Zaimis T, Townsend A, Ismaiel M, Wilson J, Magee C. Incisional Hernia: A Surgical Complication or Medical Disease? Cureus 2023; 15:e50568. [PMID: 38222215 PMCID: PMC10788045 DOI: 10.7759/cureus.50568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Incisional hernia (IH) is a frequent complication following abdominal surgery. The development of IH could be more sophisticated than a simple anatomical failure of the abdominal wall. Reported IH incidence varies among studies. This review presented an overview of definitions, molecular basis, risk factors, incidence, clinical presentation, surgical techniques, postoperative care, cost, risk prediction tools, and proposed preventative measures. A literature search of PubMed was conducted to include high-quality studies on IH. The incidence of IH depends on the primary surgical pathology, incision site and extent, associated medical comorbidities, and risk factors. The review highlighted inherent and modifiable risk factors. The disorganisation of the extracellular matrix, defective fibroblast functions, and ratio variations of different collagen types are implicated in molecular mechanisms. Elective repair of IH alleviates symptoms, prevents complications, and improves the quality of life (QOL). Recent studies introduced risk prediction tools to implement preventative measures, including suture line reinforcement or prophylactic mesh application in high-risk groups. Elective repair improves QOL and prevents sinister outcomes associated with emergency IH repair. The watchful wait strategy should be reviewed, and options should be discussed thoroughly during patients' counselling. Risk stratification tools for predicting IH would help adopt prophylactic measures.
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Affiliation(s)
- Islam Omar
- General Surgery, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge, GBR
| | - Tilemachos Zaimis
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Abby Townsend
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Mohamed Ismaiel
- General Surgery, Altnagelvin Area Hospital, Londonderry, GBR
| | - Jeremy Wilson
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
| | - Conor Magee
- General Surgery, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, GBR
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Ha H, Lee CH, Lee KS, Lee K, Park J, Kim SY, Baek S, Kang ML, Lee DW, Sung HJ. Shape-Configurable Mesh for Hernia Repair by Synchronizing Anisotropic Body Motion. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2023; 19:e2303325. [PMID: 37490554 DOI: 10.1002/smll.202303325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/27/2023] [Indexed: 07/27/2023]
Abstract
Continuous progress has been made in elucidating the relationship between material property, device design, and body function to develop surgical meshes. However, an unmet need still exists wherein the surgical mesh can handle the body motion and thereby promote the repair process. Here, the hernia mesh design and the advanced polymer properties are tailored to synchronize with the anisotropic abdominal motion through shape configuration. The thermomechanical property of shape configurable polymer enables molding of mesh shape to fit onto the abdominal structure upon temperature shift, followed by shape fixing with the release of the heat energy. The microstructural design of mesh is produced through finite element modeling to handle the abdominal motion efficiently through the anisotropic longitudinal and transverse directions. The design effects are validated through in vitro, ex vivo, and in vivo mechanical analyses using a self-configurable, body motion responsive (BMR) mesh. The regenerative function of BMR mesh leads to effective repair in a rat hernioplasty model by effectively handling the anisotropic abdomen motion. Subsequently, the device-tissue integration is promoted by promoting healthy collagen synthesis with fibroblast-to-myofibroblast differentiation. This study suggests a potential solution to promote hernia repair by fine-tuning the relationship between material property and mesh design.
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Affiliation(s)
- Hyunsu Ha
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chan Hee Lee
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kang Suk Lee
- TMD LAB Co. Ltd., 6th floor, 31, Gwangnaru-ro 8-gil, Seongdong-gu, Seoul, 04799, Republic of Korea
| | - Kyubae Lee
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jeongeun Park
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Si Yeong Kim
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Sewoom Baek
- Department of Brain Korea 21 FOUR Project for Medical Science and Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mi-Lan Kang
- TMD LAB Co. Ltd., 6th floor, 31, Gwangnaru-ro 8-gil, Seongdong-gu, Seoul, 04799, Republic of Korea
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Hak-Joon Sung
- Department of Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- Department of Brain Korea 21 FOUR Project for Medical Science and Medical Engineering, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
- TMD LAB Co. Ltd., 6th floor, 31, Gwangnaru-ro 8-gil, Seongdong-gu, Seoul, 04799, Republic of Korea
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Saiding Q, Chen Y, Wang J, Pereira CL, Sarmento B, Cui W, Chen X. Abdominal wall hernia repair: from prosthetic meshes to smart materials. Mater Today Bio 2023; 21:100691. [PMID: 37455815 PMCID: PMC10339210 DOI: 10.1016/j.mtbio.2023.100691] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/15/2023] [Accepted: 06/03/2023] [Indexed: 07/18/2023] Open
Abstract
Hernia reconstruction is one of the most frequently practiced surgical procedures worldwide. Plastic surgery plays a pivotal role in reestablishing desired abdominal wall structure and function without the drawbacks traditionally associated with general surgery as excessive tension, postoperative pain, poor repair outcomes, and frequent recurrence. Surgical meshes have been the preferential choice for abdominal wall hernia repair to achieve the physical integrity and equivalent components of musculofascial layers. Despite the relevant progress in recent years, there are still unsolved challenges in surgical mesh design and complication settlement. This review provides a systemic summary of the hernia surgical mesh development deeply related to abdominal wall hernia pathology and classification. Commercial meshes, the first-generation prosthetic materials, and the most commonly used repair materials in the clinic are described in detail, addressing constrain side effects and rational strategies to establish characteristics of ideal hernia repair meshes. The engineered prosthetics are defined as a transit to the biomimetic smart hernia repair scaffolds with specific advantages and disadvantages, including hydrogel scaffolds, electrospinning membranes, and three-dimensional patches. Lastly, this review critically outlines the future research direction for successful hernia repair solutions by combing state-of-the-art techniques and materials.
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Affiliation(s)
- Qimanguli Saiding
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Yiyao Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
| | - Juan Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Catarina Leite Pereira
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Bruno Sarmento
- I3S – Instituto de Investigação e Inovação Em Saúde and INEB – Instituto de Engenharia Biomédica, Universidade Do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
- IUCS – Instituto Universitário de Ciências da Saúde, CESPU, Rua Central de Gandra 1317, 4585-116, Gandra, Portugal
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, PR China
| | - Xinliang Chen
- Shanghai Key Laboratory of Embryo Original Diseases, The International Peace Maternal and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, 910 Hengshan Road, Shanghai, 200030, PR China
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Mao Y, Xi L, Lu C, Miao J, Li Q, Shen X, Yu C. Incidence, risk factors, and predictive modeling of stoma site incisional hernia after enterostomy closure: a multicenter retrospective cohort study. BMC Gastroenterol 2023; 23:201. [PMID: 37296427 DOI: 10.1186/s12876-023-02805-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stoma site incisional hernia (SSIH) is a common complication, but its incidence and risk factors are not well known. The objective of this study is to explore the incidence and risk factors of SSIH and build a predictive model. METHODS We performed a multicenter retrospective analysis on the patients who underwent enterostomy closure from January 2018 to August 2020. Patient's general condition, perioperative, intraoperative, and follow-up information was collected. The patients were divided into control group (no occurrence) and observation group (occurrence) according to whether SSIH occurred. Univariate and multivariate analysis were used to evaluate the risk factors of SSIH, following which we constructed a nomogram for SSIH prediction. RESULTS One hundred fifty-six patients were enrolled in the study. The incidence of SSIH was 24.4% (38 cases), of which 14 were treated with hernia mesh repair, and the others were treated with conservative treatment. Univariate and multivariate analysis showed that age ≥ 68 years (OR 1.045, 95% CI 1.002 ~ 1.089, P = 0.038), colostomy (OR 2.913, 95% CI 1.035 ~ 8.202, P = 0.043), BMI ≥ 25 kg/m2 (OR 1.181, 95% CI 1.010 ~ 1.382, P = 0.037), malignant tumor (OR 4.838, 95% CI 1.508 ~ 15.517, P = 0.008) and emergency surgery (OR 5.327, 95% CI 1.996 ~ 14.434, P = 0.001) are the independent risk factors for SSIH. CONCLUSIONS Based on the results, a predictive model for the occurrence of SSIH was constructed to screen high-risk groups of SSIH. For patients at high risk for SSIH, how to deal with the follow-up and prevent the occurrence of SSIH is worth further exploration.
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Affiliation(s)
- Yonghuan Mao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ling Xi
- Department of Gerontology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Chen Lu
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
| | - Ji Miao
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Qiang Li
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Xiaofei Shen
- Department of General Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
| | - Chunzhao Yu
- Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- Department of General Surgery, Sir Run Run Hospital of Nanjing Medical University, Nanjing, China.
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8
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Williams DF. The plasticity of biocompatibility. Biomaterials 2023; 296:122077. [PMID: 36907003 DOI: 10.1016/j.biomaterials.2023.122077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Biocompatibility concerns the phenomena that occur within the interactions between biomaterials and human patients, which ultimately control the performance of many facets of medical technology. It involves aspects of materials science, many different forms of engineering and nanotechnology, chemistry, biophysics, molecular and cellular biology, immunology, pathology and a myriad of clinical applications. It is not surprising that an overarching framework of mechanisms of biocompatibility has been difficult to elucidate and validate. This essay discusses one fundamental reason for this; we have tended to consider biocompatibility pathways as essentially linear sequences of events which follow well-understood processes of materials science and biology. The reality, however, is that the pathways may involve a great deal of plasticity, in which many additional idiosyncratic factors, including those of genetic, epigenetic and viral origin, exert influence, as do complex mechanical, physical and pharmacological variables. Plasticity is an inherent core feature of the performance of synthetic materials; here we follow the more recent biological applications of plasticity concepts into the sphere of biocompatibility pathways. A straightforward linear pathway may result in successful outcomes for many patients; we may describe this in terms of classic biocompatibility pathways. In other situations, which usually command much more attention because of their unsuccessful outcomes, these plasticity-driven processes follow alternative biocompatibility pathways; often, the variability in outcomes with identical technologies is due to biological plasticity rather than material or device deficiency.
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Affiliation(s)
- David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, North Carolina, USA.
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9
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Examination of abdominal wall perfusion using varying suture techniques for midline abdominal laparotomy closure. Surg Endosc 2022; 36:3843-3851. [PMID: 34448934 DOI: 10.1007/s00464-021-08701-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/23/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND With a growing interest in the primary prevention of incisional hernias, it has been hypothesized that different suturing techniques may cause various levels of tissue ischemia. Using ICG laser-induced fluorescence angiography (ICG-FA), we studied the effect of different suture materials and closure techniques on abdominal wall perfusion. METHODS Fifteen porcine subjects underwent midline laparotomy, bilateral skin flap creation, and three separate 7 cm midline fascial incisions. Animals underwent fascial closure with 5 different techniques: (1) Running 0-PDS® II (polydioxanone) Suture with large bites; (2) Running 0-PDS II Suture with small bites; (3) Interrupted figure-of-eight (8) PDS II Suture, (4) Running 0-barbed STRATAFIX™ Symmetric PDS™ Plus Knotless Tissue Control Device large bite; (5) Running 0-STRATAFIX Symmetric PDS Plus Device small bites. ICG-FA signal intensity was recorded prior to fascial incision (baseline), immediately following fascial closure (closure), and at one-week (1-week.). Post-mortem, the abdominal walls were analyzed for inflammation, neovascularity, and necrosis. RESULTS PDS II Suture with small bites, fascial closure at the caudal 1/3 of the abdominal wall, and the 1-week time period were all independently associated with increased tissue perfusion. There was also a significant increase in tissue perfusion from closure to 1-week when using small bites PDS II Suture compared to PDS II Suture figure-of-8 (p < 0.001) and a trend towards significance when compared with large bites PDS II Suture (p = 0.056). Additionally, the change in perfusion from baseline to 1 week with small bites was higher than with figure of 8 (p = 0.002). Across all locations, small bite PDS II Suture has greater total inflammation than figure of 8 (p < 0.001). CONCLUSIONS The results suggest that the small bite technique increases abdominal wall perfusion and ICG-FA technology can reliably map abdominal wall perfusion. This finding may help explain the reduced incisional hernia rates seen in clinical studies with the small bite closure technique.
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10
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Ribeiro WG, Nascimento ACC, Ferreira LB, Marchi DDD, Rego GM, Maeda CT, Silva GEB, Artigiani Neto R, Torres OJM, Pitombo MB. Analysis of tissue inflammatory response, fibroplasia, and foreign body reaction between the polyglactin suture of abdominal aponeurosis in rats and the intraperitoneal implant of polypropylene, polypropylene/polyglecaprone and polyester/porcine collagen meshes. Acta Cir Bras 2021; 36:e360706. [PMID: 34495141 PMCID: PMC8428674 DOI: 10.1590/acb360706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/22/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose To compare tissue inflammatory response, foreign body reaction, fibroplasia,
and proportion of type I/III collagen between closure of abdominal wall
aponeurosis using polyglactin suture and intraperitoneal implant of
polypropylene, polypropylene/polyglecaprone, and polyester/porcine collagen
meshes to repair defects in the abdominal wall of rats. Methods Forty Wistar rats were placed in four groups, ten animals each, for the
intraperitoneal implant of polypropylene, polypropylene/polyglecaprone, and
polyester/porcine collagen meshes or suture with polyglactin (sham) after
creation of defect in the abdominal wall. Twenty-one days later,
histological analysis was performed after staining with hematoxylin-eosin
and picrosirius red. Results The groups with meshes had a higher inflammation score (p < 0.05) and
higher number of gigantocytes (p < 0.05) than the sham group, which had a
better fibroplasia with a higher proportion of type I/III collagen than the
tissue separating meshes (p < 0.05). There were no statistically
significant differences between the three groups with meshes. Conclusions The intraperitoneal implant of polypropylene/polyglecaprone and
polyester/porcine collagen meshes determined a more intense tissue
inflammatory response with exuberant foreign body reaction, immature
fibroplasia and low tissue proportion of type I/III collagen compared to
suture with polyglactin of abdominal aponeurosis. However, there were no
significant differences in relation to the polypropylene mesh group.
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Thankam FG, Larsen NK, Varghese A, Bui TN, Reilly M, Fitzgibbons RJ, Agrawal DK. Biomarkers and heterogeneous fibroblast phenotype associated with incisional hernia. Mol Cell Biochem 2021; 476:3353-3363. [PMID: 33942219 DOI: 10.1007/s11010-021-04166-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/16/2021] [Indexed: 11/26/2022]
Abstract
Development of incisional hernia (IH) is multifactorial but inflammation and abdominal wall ECM (extracellular matrix) disorganization are key pathological events. We investigated if the differential expression of fibroblast biomarkers reflects the cellular milieu and the dysregulated ECM in IH tissues. Expression of fibroblast biomarkers, including connective tissue growth factor, alpha-smooth muscle actin (α-SMA), CD34 (cluster of differentiation 34), cadherin-11 and fibroblast specific protein 1 (FSP1), was examined by histology and immunofluorescence in the hernial-fascial ring/neck tissue (HRT) and hernia sack tissue (HST) harvested from the patients undergoing hernia surgery and compared with normal fascia (FT) and peritoneum (PT) harvested from brain-dead healthy subjects undergoing organ procurement for transplantation. The H&E staining revealed alterations in tissue architecture, fibroblast morphology, and ECM organization in the IH tissues compared to control. The biomarker for undifferentiated fibroblasts, CD34, was significantly higher in HST and decreased in HRT than the respective FT and PT controls. Also, the findings revealed an increased level of CTGF (connective tissue growth factor) with decrease in α-SMA in both HRT and HST compared to the controls. In addition, an increased level of FSP1 (fibroblast specific protein 1) and cadherin-11 in HRT with decreased level in HST were observed relative to the respective controls (FT and PT). Hence, these findings support the heterogeneity of fibroblast population at the laparotomy site that could contribute to the development of IH. Understanding the mechanisms causing the phenotype switch of these fibroblasts would open novel strategies to prevent the development of IH following laparotomy.
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Affiliation(s)
- Finosh G Thankam
- Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, 91766, USA
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Nicholas K Larsen
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Ann Varghese
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Thao-Nguyen Bui
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Matthew Reilly
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Robert J Fitzgibbons
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA
| | - Devendra K Agrawal
- Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, 91766, USA.
- Departments of Clinical & Translational Science and Surgery, Creighton University School of Medicine, Omaha, NE, 68178, USA.
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12
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Sneiders D, de Smet GHJ, Hartog FD, Yurtkap Y, Menon AG, Jeekel J, Kleinrensink GJ, Lange JF, Gillion JF. Outcomes of Incisional Hernia Repair Surgery After Multiple Re-recurrences: A Propensity Score Matched Analysis. World J Surg 2021; 45:1425-1432. [PMID: 33521879 PMCID: PMC8026468 DOI: 10.1007/s00268-021-05952-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 11/28/2022]
Abstract
Background Patients with a re-recurrent hernia may account for up to 20% of all incisional hernia (IH) patients. IH repair in this population may be complex due to an altered anatomical and biological situation as a result of previous procedures and outcomes of IH repair in this population have not been thoroughly assessed. This study aims to assess outcomes of IH repair by dedicated hernia surgeons in patients who have already had two or more re-recurrences. Methods A propensity score matched analysis was performed using a registry-based, prospective cohort. Patients who underwent IH repair after ≥ 2 re-recurrences operated between 2011 and 2018 and who fulfilled 1 year follow-up visit were included. Patients with similar follow-up who underwent primary IH repair were propensity score matched (1:3) and served as control group. Patient baseline characteristics, surgical and functional outcomes were analyzed and compared between both groups. Results Seventy-three patients operated on after ≥ 2 IH re-recurrences were matched to 219 patients undergoing primary IH repair. After propensity score matching, no significant differences in patient baseline characteristics were present between groups. The incidence of re-recurrence was similar between groups (≥ 2 re-recurrences: 25% versus control 24%, p = 0.811). The incidence of complications, as well as long-term pain, was similar between both groups. Conclusion IH repair in patients who have experienced multiple re-recurrences results in outcomes comparable to patients operated for a primary IH with a similar risk profile. Further surgery in patients who have already experienced multiple hernia re-recurrences is justifiable when performed by a dedicated hernia surgeon. Supplementary Information The online version of this article (10.1007/s00268-021-05952-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dimitri Sneiders
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gijs H J de Smet
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Floris den Hartog
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yagmur Yurtkap
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anand G Menon
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Johannes Jeekel
- Department of Neuroscience-Anatomy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan Kleinrensink
- Department of Neuroscience-Anatomy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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13
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Verstoep L, de Smet GHJ, Sneiders D, Kroese LF, Kleinrensink GJ, Lange JF, Gillion JF. Hernia width explains differences in outcomes between primary and incisional hernias: a prospective cohort study of 9159 patients. Hernia 2020; 25:463-469. [PMID: 33230648 PMCID: PMC8055619 DOI: 10.1007/s10029-020-02340-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/04/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Data on primary (PH) and incisional hernias (IH) are often pooled, even though several studies have illustrated that these are different entities with worse outcomes for IHs. The aim of this study is to validate previous research comparing PHs and IHs and to examine whether hernia width is an important contributor to the differences between these hernia types. METHODS A registry-based, prospective cohort study was performed, utilizing the French Hernia Club database. All patients undergoing PH or IH repair between September 8th 2011 and May 22nd 2019 were included. Baseline, hernia and surgical characteristics, and postoperative outcomes were collected. Outcomes were analyzed per width category (≤ 2 cm, 3-4 cm, 5-10 cm and > 10 cm). RESULTS A total of 9159 patients were included, of whom 4965 (54%) had PH and 4194 (46%) had IH. PHs and IHs differed significantly in 12/15 baseline characteristics, 9/10 hernia and surgical characteristics, and all outcomes. Overall, complications and re-interventions were more common in patients with IH. After correcting for width, the differences between PH and IH were no longer significant, except for medical complications, which were more common after IH repair compared to PH. CONCLUSION After correcting for hernia width, most outcomes do not significantly differ between PH and IH, indicating that not hernia type, but hernia width is an important factor contributing to the differences between PH and IH.
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Affiliation(s)
- L Verstoep
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - G H J de Smet
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Department of Surgery, Erasmus University Medical Center, PO BOX 2040, Room Ee-173, Dr. Molewaterplein, 3000 CA, Rotterdam, The Netherlands.
| | - D Sneiders
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L F Kroese
- Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | - G-J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - J-F Gillion
- Unité de Chirurgie Viscérale et Digestive, Hôpital Prive d'Antony, Antony, France
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14
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Pilkington JJ, Davies TW, Schaff O, Alexander MY, Pritchett J, Wilkinson FL, Sheen AJ. Systemic biomarkers currently implicated in the formation of abdominal wall hernia: A systematic review of the literature. Am J Surg 2020; 222:56-66. [PMID: 33189313 DOI: 10.1016/j.amjsurg.2020.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgery to the abdominal wall is ubiquitous worldwide and hernia treatment is challenging and expensive, posing a critical need to tailor treatment to individual patient risk-factors. In this systematic review, we consider specific systemic factors with potential as biomarkers of hernia formation. METHODS A healthcare database-assisted search, following PRISMA guidelines, identified journal articles for inclusion and analysis. RESULTS 14 biomarker studies were selected, comparing hernia patients and hernia-free controls, focusing on markers of extracellular matrix (ECM) remodelling and collagen turnover. Matrix metalloproteinase-2 was increased in patients with inguinal hernia. Markers of type IV collagen synthesis were increased in patients with abdominal wall hernia; while markers of fibrillar collagen synthesis were reduced. Additional other ECM signalling proteins differ significantly within published studies. CONCLUSION We identify a lack of high-quality evidence of systemic biomarkers in tailoring treatment strategies relative to patient-specific risks, but recognise the potential held within biomarker-based diagnostic studies to improve management of hernia pathogeneses.
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Affiliation(s)
- J J Pilkington
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - T W Davies
- Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK; UCLH NIHR Biomedical Research Centre, Institute of Sport and Exercise Health, University College London Centre for Altitude Space and Extreme Environment Medicine, London, UK
| | - O Schaff
- Trust Library Services, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Y Alexander
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - J Pritchett
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - F L Wilkinson
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK
| | - A J Sheen
- Centre for Bioscience, Manchester Metropolitan University, John Dalton Building, Chester Street, Manchester, UK; Department of Academic Hernia Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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15
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Thankam FG, Agrawal DK. Infarct Zone: a Novel Platform for Exosome Trade in Cardiac Tissue Regeneration. J Cardiovasc Transl Res 2020; 13:686-701. [PMID: 31907784 DOI: 10.1007/s12265-019-09952-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
The global incidence of coronary artery diseases (CADs), especially myocardial infarction (MI), has drastically increased in recent years. Even though the conventional therapies have improved the outcomes, the post-MI complications and the increased rate of recurrence among the survivors are still alarming. Molecular events associated with the pathogenesis and the adaptive responses of the surviving myocardium are largely unknown. Focus on exosome-mediated signaling for cell-cell/matrix communications at the infarct zone reflects an emerging opportunity in cardiac regeneration. Also, cardiac tissue engineering provides promising insights for the next generation of therapeutic approaches in the management of CADs. In this article, we critically reviewed the current understanding on the biology of cardiac exosomes, therapeutic potential of exosomes, and recent developments in cardiac tissue engineering and discussed novel translational approaches based on tissue engineering and exosomes for cardiac regeneration and CADs.
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Affiliation(s)
- Finosh G Thankam
- Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, 91766, USA
| | - Devendra K Agrawal
- Department of Translational Research, Western University of Health Sciences, 309 E. Second Street, Pomona, CA, 91766, USA.
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