1
|
Song W, Lee C, Jeong H, Kim S, Hwang NS. Sprayable anti-adhesive hydrogel for peritoneal macrophage scavenging in post-surgical applications. Nat Commun 2024; 15:8364. [PMID: 39333108 PMCID: PMC11436759 DOI: 10.1038/s41467-024-52753-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 09/19/2024] [Indexed: 09/29/2024] Open
Abstract
Post-surgical adhesions frequently occur after intra-abdominal surgery, leading to severe complications. Despite the development of various types of adhesion barriers to address post-surgical adhesions, several limitations persist, including off-target localization, handling difficulties, and potential immunogenicity. Here, we report a spray-type adhesion barrier for broad, fast application, forming two sequential networks. The first network is formed by a polyelectrolyte complex of sulfated hyaluronic acid and chitosan, while the second network is established through pluronic® F127 thermogelation. This sprayable barrier served as both a physical protector for the damaged peritoneum and an immunomodulator for peritoneal macrophages, as evidenced its effectiveness in a rat ischemic button model. Taken together, this efficient adhesion barrier presents a promising solution for post-surgical adhesions.
Collapse
Affiliation(s)
- Wonmoon Song
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Changyub Lee
- School of Chemical and Biological Engineering, Institute for Chemical Processes, Seoul National University, Seoul, Republic of Korea
| | - Haein Jeong
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Seoyeon Kim
- School of Chemical and Biological Engineering, Institute for Chemical Processes, Seoul National University, Seoul, Republic of Korea
| | - Nathaniel S Hwang
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea.
- School of Chemical and Biological Engineering, Institute for Chemical Processes, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Kortenbrede L, Heider J, Heckroth H, Leimenstoll M, Steuer H, Sütterlin J, Weise F, Hokamp T. Development and Characterization of Biodegradable Polyurethane-Urea-Based Hydrogels for the Prevention of Postoperative Peritoneal Adhesions. ACS OMEGA 2024; 9:34008-34020. [PMID: 39130550 PMCID: PMC11307292 DOI: 10.1021/acsomega.4c04577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 08/13/2024]
Abstract
Postoperative peritoneal adhesions occur after more than 60% of abdominal surgeries and can cause severe long-term side effects, such as chronic pain, infertility, and intestinal obstructions. However, currently available products for adhesion prophylaxis often lack efficiency or are too heavy to handle. Hydrogels are promising materials to be used for adhesion prevention as they show good mechanical stability and biocompatibility. Herein, we present a novel two-component sprayable, biodegradable, fast-curing, and shape-adaptive polyurethane urea (PUU) hydrogel system and the establishment of a full characterization approach to investigate its suitability for adhesion prophylaxis according to predefined chemical, mechanical, and biological criteria. We demonstrate that this PUU hydrogel system exhibits a fast-curing behavior, is resilient toward mechanical forces, is biocompatible, and reveals a degradation behavior within a desired time frame to reliably avoid the formation of adhesions. In addition, the PUU hydrogel system functions as an effective barrier for invading cells in vitro. Overall, we propose a guideline for the development and in vitro characterization of synthetic hydrogels for application in minimally invasive adhesion prophylaxis.
Collapse
Affiliation(s)
- Lana Kortenbrede
- Covestro
Deutschland AG, Coatings and Adhesives, Leverkusen 51365, Germany
| | - Johanna Heider
- NMI
Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen 72770, Germany
| | - Heike Heckroth
- Covestro
Deutschland AG, Coatings and Adhesives, Leverkusen 51365, Germany
| | - Marc Leimenstoll
- Macromolecular
Chemistry, Cologne University of Applied
Science, Campus Leverkusen,
Campusplatz 1, Leverkusen 51379, Germany
| | - Heiko Steuer
- NMI
Technology Transfer GmbH, Reutlingen 72770, Germany
| | - Jan Sütterlin
- Covestro
Deutschland AG, Coatings and Adhesives, Leverkusen 51365, Germany
| | - Frank Weise
- NMI
Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen 72770, Germany
| | - Tobias Hokamp
- NMI
Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen 72770, Germany
- NMI
Technology Transfer GmbH, Reutlingen 72770, Germany
| |
Collapse
|
3
|
Quach G, Zielinski MD. Surgical management of small bowel obstruction: What you need to know. J Trauma Acute Care Surg 2024; 96:357-363. [PMID: 37962129 DOI: 10.1097/ta.0000000000004195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Affiliation(s)
- Giang Quach
- From the Division of Trauma and Acute Care Surgery, Michael E. DeBakey Department of Surgery (G.Q., M.D.Z.), Baylor College of Medicine, Houston, Texas
| | | |
Collapse
|
4
|
Torres-de la Roche LA, Catena U, Clark TJ, Devassy R, Leyland N, De Wilde RL. Perspectives in adhesion prevention in gynaecological surgery. Facts Views Vis Obgyn 2023; 15:291-296. [PMID: 38128088 PMCID: PMC10832654 DOI: 10.52054/fvvo.15.4.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Adhesions are a frequent, clinically relevant, and often costly complication of surgery that can develop in any body location regardless of the type of surgical procedure. Adhesions result from surgical trauma inducing inflammatory and coagulation processes and to date cannot be entirely prevented. However, the extent of adhesion formation can be reduced by using good surgical technique and the use of anti-inflammatory drugs, haemostats, and barrier agents. Strategies are needed in the short-, medium- and longer-term to improve the prevention of adhesions. In the short-term, efforts are needed to increase the awareness amongst surgeons and patients about the potential risks and burden of surgically induced adhesions. To aid this in the medium- term, a risk score to identify patients at high risk of adhesion formation is being developed and validated. Furthermore, available potentially preventive measures need to be highlighted. Both clinical and health economic evaluations need to be undertaken to support the broad adoption of such measures. In the longer- term, a greater understanding of the pathogenic processes leading to the formation of adhesions is needed to help identify effective, future treatments to reliably prevent adhesions from forming and lyse existing ones.
Collapse
|
5
|
Kaoukabani G, Gokcal F, Fanta A, Liu X, Shields M, Stricklin C, Friedman A, Kudsi OY. A multifactorial evaluation of objective performance indicators and video analysis in the context of case complexity and clinical outcomes in robotic-assisted cholecystectomy. Surg Endosc 2023; 37:8540-8551. [PMID: 37789179 DOI: 10.1007/s00464-023-10432-z] [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: 05/30/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The increased digitization in robotic surgical procedures today enables surgeons to quantify their movements through data captured directly from the robotic system. These calculations, called objective performance indicators (OPIs), offer unprecedented detail into surgical performance. In this study, we link case- and surgical step-specific OPIs to case complexity, surgical experience and console utilization, and post-operative clinical complications across 87 robotic cholecystectomy (RC) cases. METHODS Videos of RCs performed by a principal surgeon with and without fellows were segmented into eight surgical steps and linked to patients' clinical data. Data for OPI calculations were extracted from an Intuitive Data Recorder and the da Vinci ® robotic system. RC cases were each assigned a Nassar and Parkland Grading score and categorized as standard or complex. OPIs were compared across complexity groups, console attributions, and post-surgical complication severities to determine objective relationships across variables. RESULTS Across cases, differences in camera control and head positioning metrics of the principal surgeon were observed when comparing standard and complex cases. Further, OPI differences across the principal surgeon and the fellow(s) were observed in standard cases and include differences in arm swapping, camera control, and clutching behaviors. Monopolar coagulation energy usage differences were also observed. Select surgical step duration differences were observed across complexities and console attributions, and additional surgical task analyses determine the adhesion removal and liver bed hemostasis steps to be the most impactful steps for case complexity and post-surgical complications, respectively. CONCLUSION This is the first study to establish the association between OPIs, case complexities, and clinical complications in RC. We identified OPI differences in intra-operative behaviors and post-surgical complications dependent on surgeon expertise and case complexity, opening the door for more standardized assessments of teaching cases, surgical behaviors and case complexities.
Collapse
Affiliation(s)
| | - Fahri Gokcal
- Good Samaritan Medical Center, Brockton, MA, USA
| | - Abeselom Fanta
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
| | - Xi Liu
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
| | - Mallory Shields
- Applied Research, Intuitive Surgical Inc., Peachtree City, GA, USA
| | | | | | | |
Collapse
|
6
|
Chen J, Tang X, Wang Z, Perez A, Yao B, Huang K, Zhang Y, King MW. Techniques for navigating postsurgical adhesions: Insights into mechanisms and future directions. Bioeng Transl Med 2023; 8:e10565. [PMID: 38023705 PMCID: PMC10658569 DOI: 10.1002/btm2.10565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 12/01/2023] Open
Abstract
Postsurgical adhesions are a common complication of surgical procedures that can lead to postoperative pain, bowel obstruction, infertility, as well as complications with future procedures. Several agents have been developed to prevent adhesion formation, such as barriers, anti-inflammatory and fibrinolytic agents. The Food and Drug Administration (FDA) has approved the use of physical barrier agents, but they have been associated with conflicting clinical studies and controversy in the clinical utilization of anti-adhesion barriers. In this review, we summarize the human anatomy of the peritoneum, the pathophysiology of adhesion formation, the current prevention agents, as well as the current research progress on adhesion prevention. The early cellular events starting with injured mesothelial cells and incorporating macrophage response have recently been found to be associated with adhesion formation. This may provide the key component for developing future adhesion prevention methods. The current use of physical barriers to separate tissues, such as Seprafilm®, composed of hyaluronic acid and carboxymethylcellulose, can only reduce the risk of adhesion formation at the end stage. Other anti-inflammatory or fibrinolytic agents for preventing adhesions have only been studied within the context of current research models, which is limited by the lack of in-vitro model systems as well as in-depth study of in-vivo models to evaluate the efficiency of anti-adhesion agents. In addition, we explore emerging therapies, such as gene therapy and stem cell-based approaches, that may offer new strategies for preventing adhesion formation. In conclusion, anti-adhesion agents represent a promising approach for reducing the burden of adhesion-related complications in surgical patients. Further research is needed to optimize their use and develop new therapies for this challenging clinical problem.
Collapse
Affiliation(s)
- Jiahui Chen
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Xiaoqi Tang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Ziyu Wang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Arielle Perez
- UNC School of Medicine Department of SurgeryUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Benjamin Yao
- Montefiore Medical Center Department of Obstetrics & Gynecology & Women's Health ServicesMontefiore Medical CenterBronxNew YorkUSA
| | - Ke Huang
- Joint Department of Biomedical EngineeringNorth Carolina State University & University of North Carolina at Chapel HillRaleighNorth CarolinaUSA
- Department of Molecular Biomedical SciencesNorth Carolina State UniversityRaleighNorth CarolinaUnited States
| | - Yang Zhang
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
| | - Martin W. King
- Department of Textile Engineering, Chemistry and ScienceNorth Carolina State UniversityRaleighNorth CarolinaUSA
- College of Textiles, Donghua UniversityShanghaiSongjiangChina
| |
Collapse
|
7
|
Liao J, Li X, Fan Y. Prevention strategies of postoperative adhesion in soft tissues by applying biomaterials: Based on the mechanisms of occurrence and development of adhesions. Bioact Mater 2023; 26:387-412. [PMID: 36969107 PMCID: PMC10030827 DOI: 10.1016/j.bioactmat.2023.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/26/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023] Open
Abstract
Postoperative adhesion (POA) widely occurs in soft tissues and usually leads to chronic pain, dysfunction of adjacent organs and some acute complications, seriously reducing patients' quality of life and even being life-threatening. Except for adhesiolysis, there are few effective methods to release existing adhesion. However, it requires a second operation and inpatient care and usually triggers recurrent adhesion in a great incidence. Hence, preventing POA formation has been regarded as the most effective clinical strategy. Biomaterials have attracted great attention in preventing POA because they can act as both barriers and drug carriers. Nevertheless, even though much reported research has been demonstrated their efficacy on POA inhibition to a certain extent, thoroughly preventing POA formation is still challenging. Meanwhile, most biomaterials for POA prevention were designed based on limited experiences, not a solid theoretical basis, showing blindness. Hence, we aimed to provide guidance for designing anti-adhesion materials applied in different soft tissues based on the mechanisms of POA occurrence and development. We first classified the postoperative adhesions into four categories according to the different components of diverse adhesion tissues, and named them as "membranous adhesion", "vascular adhesion", "adhesive adhesion" and "scarred adhesion", respectively. Then, the process of the occurrence and development of POA were analyzed, and the main influencing factors in different stages were clarified. Further, we proposed seven strategies for POA prevention by using biomaterials according to these influencing factors. Meanwhile, the relevant practices were summarized according to the corresponding strategies and the future perspectives were analyzed.
Collapse
|
8
|
Karaman K, Çakıroğlu H, Tuncer FB, Şekeroğlu MR, Yılmaz F. The preventive effect of omega-3 fish oil on the formation of peritoneal adhesions. POLISH JOURNAL OF SURGERY 2023; 96:8-14. [PMID: 38353094 DOI: 10.5604/01.3001.0016.2730] [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] [Indexed: 02/19/2023]
Abstract
<br><b>Introduction:</b> Postoperative peritoneal adhesions that form after abdominal surgery still continue to exist as an unresolved health problem.</br> <br><b>Aim:</b> The aim of the study is to examine whether omega-3 fish oil has a preventive effect on postoperative peritoneal adhesions.</br> <br><b>Material and methods:</b> Twenty-one female Wistar albino rats were separated into 3 groups (sham, control and experimental), each consisting of 7 rats. In the sham group, only laparotomy was performed. In both the control and experimental group rats, the right parietal peritoneum and cecum were traumatised to form petechiae. Following this procedure, the abdomen was irrigated with omega-3 fish oil in the experimental group. The rats were re-explored on the 14<sup>th</sup> postoperative day and any adhesions were scored. Tissue samples and blood samples were taken for histopathological and biochemical analysis.</br> <br><b>Results:</b> None of the rats that were administered omega-3 fish oil developed macroscopic postoperative peritoneal adhesions (P = 0.005). The omega-3 fish oil formed an anti-adhesive lipid barrier on the injured tissue surfaces. Microscopic evaluation revealed diffuse inflammation with excessive connective tissue and fibroblastic activity in the control group rats, while foreign body reactions were common in the omega-3 rats. The mean amount of hydroxyproline in samples from injured tissues was significantly lower in the omega-3 rats than in the control rats (P = 0.004).</br> <br><b>Conclusion:</b> Intraperitoneal application of omega-3 fish oil prevents postoperative peritoneal adhesions by forming an anti-adhesive lipid barrier on injured tissue surfaces. However, further studies are needed to determine whether this adipose layer is permanent or will be resorbed over time.</br>.
Collapse
Affiliation(s)
- Kerem Karaman
- Department of Gastroenterology Surgery, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Hüseyin Çakıroğlu
- Department of Experimental Medicine Research and Application Centre, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Fatıma Betül Tuncer
- Department of Biochemistry, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | | | - Fahri Yılmaz
- Department of Pathology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| |
Collapse
|
9
|
Cai J, Guo J, Wang S. Application of Polymer Hydrogels in the Prevention of Postoperative Adhesion: A Review. Gels 2023; 9:gels9020098. [PMID: 36826268 PMCID: PMC9957106 DOI: 10.3390/gels9020098] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Postoperative adhesion is a common post-surgery complication formed between the surface of the body cavity, ranging from a layer of connective tissue to a fibrous bridge containing blood vessels and nerve tissue. Despite achieving a lot of progress, the mechanisms of adhesion formation still need to be further studied. In addition, few current treatments are consistently effective in the prevention of postoperative adhesion. Hydrogel is a kind of water-expanding crosslinked hydrophilic polymer network generated by a simple reaction of one or more monomers. Due to the porous structure, hydrogels can load different drugs and control the drug release kinetics. Evidence from existing studies has confirmed the feasibility and superiority of using hydrogels to counter postoperative adhesions, primarily due to their outstanding antifouling ability. In this review, the current research status of hydrogels as anti-adhesion barriers is summarized, the character of hydrogels in the prevention of postoperative adhesion is briefly introduced, and future research directions are discussed.
Collapse
Affiliation(s)
- Jie Cai
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, China
| | - Jiaming Guo
- Department of Radiation Medicine, College of Naval Medicine, Naval Medical University, No. 800 Xiangyin Road, Shanghai 200433, China
| | - Shige Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, No. 516 Jungong Road, Shanghai 200093, China
- Correspondence:
| |
Collapse
|
10
|
Song BR, Park IS, Park DY, Kim YJ, Kim MS, Lee KB, Park SR, Choi BH, Min BH. Anti-adhesive effect of chondrocyte-derived extracellular matrix surface-modified with poly-L-lysine (PLL). J Tissue Eng Regen Med 2021; 16:279-289. [PMID: 34788485 DOI: 10.1002/term.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 12/08/2022]
Abstract
After an injury, soft tissue structures in the body undergo a natural healing process through specific phases of healing. Adhesions occur as abnormal attachments between tissues and organs through the formation of blood vessels and/or fibrinous adhesions during the regenerative repair process. In this study, we developed an adhesion-preventing membrane with an improved physical protection function by modifying the surface of chondrocyte-derived extracellular matrices (CECM) with anti-adhesion function. We attempted to change the negative charge of the CECM surface to neutral using poly-L-lysine (PLL) and investigated whether it blocked fibroblast adhesion to it and showed an improved anti-adhesion effect in animal models of tissue adhesion. The surface of the membrane was modified with PLL coating (PLL 10), which neutralized the surface charge. We confirmed that the surface characteristics except for the potential difference were maintained after the modification and tested cell attachment in vitro. Adhesion inhibition was identified in a peritoneal adhesion animal model at 1 week and in a subcutaneous adhesion model for 4 weeks. N-CECM suppressed fibroblast and endothelial cell adhesion in vitro and inhibited abdominal adhesions in vivo. The CECM appeared to actively inhibit the infiltration of endothelial cells into the injured site, thereby suppressing adhesion formation, which differed from conventional adhesion barriers in the mode of action. Furthermore, the N-CECM remained intact without degradation for more than four weeks in vivo and exerted anti-adhesion effects for a long time. This study demonstrated that PLL10 surface modification rendered a neutral charge to the polymer on the extracellular matrix surface, thereby inhibiting cell and tissue adhesion. Furthermore, this study suggests a means to modify extracellular matrix surfaces to meet the specific requirements of the target tissue in preventing post-surgical adhesions. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Bo Ram Song
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea.,Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
| | - In Su Park
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Do Young Park
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Young Jick Kim
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea
| | - Moon Suk Kim
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea
| | - Kyi Beom Lee
- Department of Pathology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - So Ra Park
- Department of Physiology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Byung Hyune Choi
- Department of Biomedical Sciences, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Byoung-Hyun Min
- Cell Therapy Center, Ajou University Medical Center, Suwon, Republic of Korea.,Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Republic of Korea.,Department of Molecular Science & Technology, Ajou University, Suwon, Republic of Korea
| |
Collapse
|
11
|
Shin YH, Yun HW, Park SY, Choi SJ, Park IS, Min BH, Kim JK. Effect of glutaraldehyde-crosslinked cartilage acellular matrix film on anti-adhesion and nerve regeneration in a rat sciatic nerve injury model. J Tissue Eng Regen Med 2021; 15:1023-1036. [PMID: 34591344 DOI: 10.1002/term.3249] [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: 10/22/2020] [Accepted: 09/01/2021] [Indexed: 01/16/2023]
Abstract
Decellularized extra-cellular matrix (ECM) has been studied as an alternative to anti-adhesive biomaterials and cartilage acellular matrix (CAM) has been shown to inhibit postoperative adhesion in several organs. This study aimed to evaluate the suitability of glutaraldehyde (GA) crosslinked CAM-films as anti-adhesion barriers for peripheral nerve injury. The films were successfully fabricated and showed improved physical properties such as mechanical strength, swelling ratio, and lengthened degradation period while maintaining the microstructure and chemical composition after GA crosslinking. In the in vitro study of CAM-film, the dsDNA content met the recommended limit of decellularization and more than 70% of the major ECM components were preserved after decellularization. The adhesion and proliferation of seeded human umbilical vein endothelial cells and fibroblasts were significantly lower in CAM-film than in control, but similar with Seprafilm. However, the CAM-film extract did not show cytotoxicity. In the in vivo study, the peri-neural fibrosis was thicker, adhesion score higher, and peri-neural collagen fibers more abundant in the control group than in the CAM-film group. The total number of myelinated axons was significantly higher in the CAM-film group than in the control group. The inflammatory marker decreased with time in the CAM-film group compared to that in the control group, whereas the nerve regenerative marker expression was maintained. Moreover, the ankle angles at contracture and toe-off were higher in the CAM film-treated rats than in the control rats. GA-crosslinked CAM films may be used during peripheral nerve surgery to prevent peri-neural adhesion and enhance nerve functional recovery.
Collapse
Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Woong Yun
- Cell Therapy Center, Ajou Medical Center, Suwon, Korea
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Suk Young Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Jin Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In-Su Park
- Cell Therapy Center, Ajou Medical Center, Suwon, Korea
| | - Byoung-Hyun Min
- Cell Therapy Center, Ajou Medical Center, Suwon, Korea
- Department of Orthopedic Surgery, School of Medicine, Ajou University, Suwon, Korea
| | - Jae Kwang Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Head WT, Paladugu N, Kwon JH, Gerry B, Hill MA, Brennan EA, Kavarana MN, Rajab TK. Adhesion barriers in cardiac surgery: A systematic review of efficacy. J Card Surg 2021; 37:176-185. [PMID: 34661944 DOI: 10.1111/jocs.16062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac surgery. The study presented here provides the first major systematic review of adhesion barriers in cardiac surgery. METHODS Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria were clinical studies on human subjects, and exclusion criteria were studies not published in English and case reports. Risk of bias was evaluated with the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with Excel and GraphPad Prism 5. RESULTS Twenty-five studies were identified with a total of 13 barriers and 2928 patients. Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier (13 studies, 67% of patients) with adhesion formation rate of 37.31% and standardized tenacity score of 26.50. Several barriers had improved efficacy. In particular, Cova CARD had a standardized tenacity score of 15.00. CONCLUSIONS Overall, the data varied considerably in terms of study design and reporting bias. The amount of data was also limited for the non-PTFE studies. PTFE has historically been effective in preventing adhesions. More recent barriers may be superior, yet the current data is nonconfirmatory. No ideal adhesion barrier currently exists, and future barriers must focus on the requirements unique to operating in and around the heart.
Collapse
Affiliation(s)
- William T Head
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Namrata Paladugu
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennie H Kwon
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brielle Gerry
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Morgan A Hill
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- Department of Research & Education Services (Libraries), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minoo N Kavarana
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taufiek K Rajab
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
13
|
Correa S, Grosskopf AK, Lopez Hernandez H, Chan D, Yu AC, Stapleton LM, Appel EA. Translational Applications of Hydrogels. Chem Rev 2021; 121:11385-11457. [PMID: 33938724 PMCID: PMC8461619 DOI: 10.1021/acs.chemrev.0c01177] [Citation(s) in RCA: 366] [Impact Index Per Article: 122.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/17/2022]
Abstract
Advances in hydrogel technology have unlocked unique and valuable capabilities that are being applied to a diverse set of translational applications. Hydrogels perform functions relevant to a range of biomedical purposes-they can deliver drugs or cells, regenerate hard and soft tissues, adhere to wet tissues, prevent bleeding, provide contrast during imaging, protect tissues or organs during radiotherapy, and improve the biocompatibility of medical implants. These capabilities make hydrogels useful for many distinct and pressing diseases and medical conditions and even for less conventional areas such as environmental engineering. In this review, we cover the major capabilities of hydrogels, with a focus on the novel benefits of injectable hydrogels, and how they relate to translational applications in medicine and the environment. We pay close attention to how the development of contemporary hydrogels requires extensive interdisciplinary collaboration to accomplish highly specific and complex biological tasks that range from cancer immunotherapy to tissue engineering to vaccination. We complement our discussion of preclinical and clinical development of hydrogels with mechanical design considerations needed for scaling injectable hydrogel technologies for clinical application. We anticipate that readers will gain a more complete picture of the expansive possibilities for hydrogels to make practical and impactful differences across numerous fields and biomedical applications.
Collapse
Affiliation(s)
- Santiago Correa
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | - Abigail K. Grosskopf
- Chemical
Engineering, Stanford University, Stanford, California 94305, United States
| | - Hector Lopez Hernandez
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | - Doreen Chan
- Chemistry, Stanford University, Stanford, California 94305, United States
| | - Anthony C. Yu
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
| | | | - Eric A. Appel
- Materials
Science & Engineering, Stanford University, Stanford, California 94305, United States
- Bioengineering, Stanford University, Stanford, California 94305, United States
- Pediatric
Endocrinology, Stanford University School
of Medicine, Stanford, California 94305, United States
- ChEM-H Institute, Stanford
University, Stanford, California 94305, United States
- Woods
Institute for the Environment, Stanford
University, Stanford, California 94305, United States
| |
Collapse
|
14
|
Fatehi Hassanabad A, Zarzycki AN, Jeon K, Deniset JF, Fedak PWM. Post-Operative Adhesions: A Comprehensive Review of Mechanisms. Biomedicines 2021; 9:biomedicines9080867. [PMID: 34440071 PMCID: PMC8389678 DOI: 10.3390/biomedicines9080867] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/27/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Post-surgical adhesions are common in almost all surgical areas and are associated with significant rates of morbidity, mortality, and increased healthcare costs, especially when a patient requires repeat operative interventions. Many groups have studied the mechanisms driving post-surgical adhesion formation. Despite continued advancements, we are yet to identify a prevailing mechanism. It is highly likely that post-operative adhesions have a multifactorial etiology. This complex pathophysiology, coupled with our incomplete understanding of the underlying pathways, has resulted in therapeutic options that have failed to demonstrate safety and efficacy on a consistent basis. The translation of findings from basic and preclinical research into robust clinical trials has also remained elusive. Herein, we present and contextualize the latest findings surrounding mechanisms that have been implicated in post-surgical adhesion formation.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.F.D.)
- Correspondence:
| |
Collapse
|
15
|
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.
Collapse
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:
| |
Collapse
|
16
|
Ito T, Shintani Y, Fields L, Shiraishi M, Podaru MN, Kainuma S, Yamashita K, Kobayashi K, Perretti M, Lewis-McDougall F, Suzuki K. Cell barrier function of resident peritoneal macrophages in post-operative adhesions. Nat Commun 2021; 12:2232. [PMID: 33854051 PMCID: PMC8046819 DOI: 10.1038/s41467-021-22536-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/15/2021] [Indexed: 12/20/2022] Open
Abstract
Post-operative adhesions are a leading cause of abdominal surgery-associated morbidity. Exposed fibrin clots on the damaged peritoneum, in which the mesothelial barrier is disrupted, readily adhere to surrounding tissues, resulting in adhesion formation. Here we show that resident F4/80HighCD206− peritoneal macrophages promptly accumulate on the lesion and form a ‘macrophage barrier’ to shield fibrin clots in place of the lost mesothelium in mice. Depletion of this macrophage subset or blockage of CD11b impairs the macrophage barrier and exacerbates adhesions. The macrophage barrier is usually insufficient to fully preclude the adhesion formation; however, it could be augmented by IL-4-based treatment or adoptive transfer of this macrophage subset, resulting in robust prevention of adhesions. By contrast, monocyte-derived recruited peritoneal macrophages are not involved in the macrophage barrier. These results highlight a previously unidentified cell barrier function of a specific macrophage subset, also proposing an innovative approach to prevent post-operative adhesions. Peritoneal adhesions are a major cause of complications after abdominal surgery. Here the authors use a post-operative abdominal adhesion model in mice to show that resident F4/80HighCD206− macrophages form a protective barrier that can be enhanced by IL-4 administration or adoptive transfer of these cells.
Collapse
Affiliation(s)
- Tomoya Ito
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Yusuke Shintani
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Laura Fields
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Manabu Shiraishi
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mihai-Nicolae Podaru
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Satoshi Kainuma
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kizuku Yamashita
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kazuya Kobayashi
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mauro Perretti
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Fiona Lewis-McDougall
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Ken Suzuki
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| |
Collapse
|
17
|
Stapleton LM, Lucian HJ, Grosskopf AK, Smith AAA, Totherow KP, Woo YJ, Appel EA. Dynamic Hydrogels for Prevention of Post‐Operative Peritoneal Adhesions. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | - Haley J. Lucian
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Abigail K. Grosskopf
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | - Anton A. A. Smith
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
| | | | - Y. Joseph Woo
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Cardiothoracic Surgery Stanford University School of Medicine Stanford CA 94305 USA
| | - Eric A. Appel
- Department of Bioengineering Stanford University Stanford CA 94305 USA
- Department of Materials Science and Engineering Stanford University Stanford CA 94305 USA
- ChEM‐H Institute Stanford University Stanford CA 94305 USA
- Department of Pediatrics (Endocrinology) Stanford University School of Medicine Stanford CA 94305 USA
| |
Collapse
|
18
|
Kuşaslan R, Ercan G, Ağcaoğlu O, Altınay S, Binboğa S, Altınel Y. A novel coenzyme-Q approach for the prevention of postsurgical adhesion. Turk J Surg 2020; 36:202-208. [PMID: 33015565 DOI: 10.5578/turkjsurg.4398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 12/30/2019] [Indexed: 11/15/2022]
Abstract
Objectives Postoperative intraperitoneal adhesions are an unsolved and important problem in abdominal surgery. In the present study, the probable preventive role of coenzyme-Q in the development of peritoneal adhesions was investigated. Material and Methods Sixteen Wistar Hannover male rats weighing 300-350 g were randomly separated into two groups of 8 rats each. The cecum was abraded with a sterile gauze until sub-serosal hemorrhage developed. A patch of peritoneum located opposite to the cecal abrasion was completely dissected. No treatment was given to Group 1. Group 2 received 30 mg/kg coenzyme-Q, which was injected 2 mL intraperitoneally. All the rats were sacrificed on the postoperative 21st day, and after adhesions were scored macroscopically, tissue specimens of the peritoneum and bowel were subjected to histopathological investigation. Tissue and blood specimens were also taken for biochemical analysis to investigate antioxidant efficiency. Results Adhesion scores were significantly different between the control group and the coenzyme-Q group (p= 0.001). According to the tissue levels of GSH-Px, MDA, and SOD levels, there was no significant difference between the study groups (p= 0.074, p= 0.208, p= 0.526). According to the plasma GSH-Px and SOD levels, there was significant difference between the groups (p= 0.002, p= 0.001), but the difference was not significant at MDA levels (p= 0.793). The differences between the pathological scores of the control and coenzyme-Q (p= 0.028 for fibrosis; p= 0.025 for inflammation) groups were statistically significant. Conclusion This study confirms that coenzyme-Q is the potential application in the prevention of early postoperative adhesions.
Collapse
Affiliation(s)
- Ramazan Kuşaslan
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Gülçin Ercan
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Orhan Ağcaoğlu
- Department of General Surgery, Koc University School of Medicine Hospital, Istanbul, Turkey
| | - Serdar Altınay
- Department of Pathology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sinan Binboğa
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Yüksel Altınel
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
19
|
Russo Serafini M, Medeiros Savi F, Ren J, Bas O, O'Rourke N, Maher C, Hutmacher DW. The Patenting and Technological Trends in Hernia Mesh Implants. TISSUE ENGINEERING PART B-REVIEWS 2020; 27:48-73. [PMID: 32403989 DOI: 10.1089/ten.teb.2019.0245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Described as a projection (prolapse) of tissue through a fascial defect in the abdominal wall, hernias are associated with significant rates of complications, recurrence, and reoperations. This literature review is aimed at providing an overview of the prosthetic surgical meshes used for the repairing of hernia defects. The review was carried out using two specialized online databases: Espacenet, from the European Patent Office (EPO), and WIPO from the World Intellectual Property Organization. Of the 56 patents selected from 2008 to 2018, China was the largest contributor with 55% (31 patents) of the total patent applicant filings, followed by the United States of America (US), with 29% (16 patents). Although the majority of patent applications (39 documents) had at least one company (industry) assigned to the patent application, 4 patents were solely from academic research. Our data showed that only 13 industry applicants have had their products included in the market, and the majority of meshes available on the market are still made from polypropylene. Chemical, physical, and mesh surface modifications have been implemented, and a few reviews describing mesh design, composition, and mechanical properties are available. However, to date, the ideal mesh implant from a clinical point of view has not been developed.
Collapse
Affiliation(s)
- Mairim Russo Serafini
- Department of Pharmacy, Universidade Federal de Sergipe, São Cristóvão, Brazil.,Institute of Health and Biomedical Innovation, School of Mechanical, Medical and Process Engineering, and Queensland University of Technology (QUT), Queensland, Australia
| | - Flavia Medeiros Savi
- Institute of Health and Biomedical Innovation, School of Mechanical, Medical and Process Engineering, and Queensland University of Technology (QUT), Queensland, Australia
| | - Jiongyu Ren
- Institute of Health and Biomedical Innovation, School of Mechanical, Medical and Process Engineering, and Queensland University of Technology (QUT), Queensland, Australia
| | - Onur Bas
- Institute of Health and Biomedical Innovation, School of Mechanical, Medical and Process Engineering, and Queensland University of Technology (QUT), Queensland, Australia.,Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology (QUT), Queensland, Australia
| | - Nicholas O'Rourke
- University of Queensland, Queensland, Australia.,Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Christopher Maher
- University of Queensland, Queensland, Australia.,Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Dietmar W Hutmacher
- Institute of Health and Biomedical Innovation, School of Mechanical, Medical and Process Engineering, and Queensland University of Technology (QUT), Queensland, Australia.,Australian Research Council Industrial Transformation Training Centre in Additive Biomanufacturing, Queensland University of Technology (QUT), Queensland, Australia
| |
Collapse
|
20
|
Azadi H, Davoodabadi A, Akbari H, Benafsheh HR, Norroddini M, Hajian A. Effect of pimecrolimus on postoperative peritoneal adhesions in rat: An experimental study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Stapleton LM, Steele AN, Wang H, Lopez Hernandez H, Yu AC, Paulsen MJ, Smith AAA, Roth GA, Thakore AD, Lucian HJ, Totherow KP, Baker SW, Tada Y, Farry JM, Eskandari A, Hironaka CE, Jaatinen KJ, Williams KM, Bergamasco H, Marschel C, Chadwick B, Grady F, Ma M, Appel EA, Woo YJ. Use of a supramolecular polymeric hydrogel as an effective post-operative pericardial adhesion barrier. Nat Biomed Eng 2019; 3:611-620. [DOI: 10.1038/s41551-019-0442-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/08/2019] [Indexed: 01/24/2023]
|
22
|
Taokaew S, Alghunaim A, Newby BMZ. Zosteric Acid, a Bioactive Component in Eelgrass Zostera marina, Reduced Collagen I Expression in a Repaired Mouse Fibroblast Scratch. Nat Prod Commun 2019. [DOI: 10.1177/1934578x19850713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Zosteric acid (ZA), a bioactive component in Zostera marina eelgrass, was applied to assess closure of normal mouse fibroblast scratch and collagen I expression. The cytotoxicity of ZA on the fibroblast at different ZA concentrations was evaluated. ZA showed low toxicity with ~80% of cell viability at a concentration of ~1600 ppm. A single scratch (~1500 μm) was made on a layer of fibroblast, and collagen expression was determined after 72 hours when the scratch fully closed for both ZA-treated and untreated samples. Compared to control, the ZA-treated cells were slightly less dense and randomly oriented in the closure region and had lower actin and vinculin expressions. The total collagen expressions were comparable to the control, whereas collagen I expression of the mouse fibroblast treated with 1600 ppm of ZA was significantly lower than untreated fibroblasts.
Collapse
Affiliation(s)
- Siriporn Taokaew
- Department of Chemical and Biomolecular Engineering, The University of Akron, OH, USA
- Department of Materials Science and Technology, School of Engineering, Nagaoka University of Technology, Kamitomioka, Niigata, Japan
| | - Abdullah Alghunaim
- Department of Chemical and Biomolecular Engineering, The University of Akron, OH, USA
| | - Bi-min Zhang Newby
- Department of Chemical and Biomolecular Engineering, The University of Akron, OH, USA
| |
Collapse
|
23
|
Biocompatible, drug-loaded anti-adhesion barrier using visible-light curable furfuryl gelatin derivative. Int J Biol Macromol 2018; 120:915-920. [DOI: 10.1016/j.ijbiomac.2018.07.180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 07/11/2018] [Accepted: 07/29/2018] [Indexed: 11/23/2022]
|
24
|
Sebastian A, Stupart D, Watters DA. Loop ileostomy reversal after laparoscopic versus open rectal resection. ANZ J Surg 2018; 89:E52-E55. [DOI: 10.1111/ans.14879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/23/2018] [Accepted: 08/25/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Arie Sebastian
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
| | - Douglas Stupart
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
- Department of Surgery, Deakin University; Geelong Victoria Australia
| | - David A. Watters
- Department of Surgery; University Hospital Geelong; Geelong Victoria Australia
- Department of Surgery, Deakin University; Geelong Victoria Australia
| |
Collapse
|
25
|
Bento SV, Nunes TA, Araújo ID, Silva RCOE, Vidigal PVT, Carvalhais RM. Hyperbaric oxygenation on adhesions prevention after laparotomy in rats. Acta Cir Bras 2018; 33:824-833. [DOI: 10.1590/s0102-865020180090000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/26/2018] [Indexed: 03/09/2023] Open
|
26
|
Rice AD, Patterson K, Reed ED, Wurn BF, Robles K, Klingenberg B, Weinstock LB, Pratt JSA, King CR, Wurn LJ. Decreasing recurrent bowel obstructions, improving quality of life with physiotherapy: Controlled study. World J Gastroenterol 2018; 24:2108-2119. [PMID: 29785079 PMCID: PMC5960816 DOI: 10.3748/wjg.v24.i19.2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare (1) quality of life and (2) rate of recurrent small bowel obstructions (SBO) for patients treated with novel manual physiotherapy vs no treatment.
METHODS One hundred and three subjects (age 19-89) with a history of recurrent adhesive SBO were treated with a manual physiotherapy called the Clear Passage Approach (CPA) which focused on decreasing adhesive crosslinking in abdominopelvic viscera. Pre- and post-therapy data measured recurring obstructions and quality of life, using a validated test sent 90 d after therapy. Results were compared to 136 untreated control subjects who underwent the same measurements for subjects who did not receive any therapy, which is the normal course for patients with recurring SBO. Comparison of the groups allowed us to assess changes when the physiotherapy was added as an adjunct treatment for patients with recurring SBO.
RESULTS Despite histories of more prior hospitalizations, obstructions, surgeries, and years impacted by bowel issues, the 103 CPA-treated subjects reported a significantly lower rate of repeat SBO than 136 untreated controls (total obstructions P = 0.0003; partial obstructions P = 0.0076). Subjects treated with the therapy demonstrated significant improvements in five of six total domains in the validated Small Bowel Obstruction Questionnaire (SBO-Q). Domains of diet, pain, gastrointestinal symptoms, quality of life (QOL) and pain severity when compared to post CPA treatment were significantly improved (P < 0.0001). The medication domain was not changed in the CPA treated group (P = 0.176).
CONCLUSION CPA physical therapy was effective for patients with adhesive SBO with significantly lower recurrence rate, improvement in reported symptoms and overall quality of life of subjects.
Collapse
Affiliation(s)
- Amanda D Rice
- Department of Internal Medicine, College of Medicine-Phoenix, University of Arizona, Phoenix, AZ 85004, United States
| | | | - Evette D Reed
- Clear Passage Therapies, Gainesville, FL 32606, United States
| | - Belinda F Wurn
- Clear Passage Therapies, Gainesville, FL 32606, United States
| | - Kristen Robles
- Clear Passage Therapies, Gainesville, FL 32606, United States
| | - Bernhard Klingenberg
- Department of Mathematics and Statistics, Williams College, Williamstown, MA 01267, United States
| | - Leonard B Weinstock
- Clinical Medicine and Surgery, Washington University School of Medicine, Specialists in Gastroenterology, LLC, St. Louis, MO 63141, United States
| | - Janey SA Pratt
- Department of Surgery, Stanford University School of Medicine, Palo Alto, CA 94035, United States
| | - C Richard King
- College of Medicine, University of Florida, Gainesville, FL 32607, United States
| | - Lawrence J Wurn
- Clear Passage Therapies, Gainesville, FL 32606, United States
| |
Collapse
|
27
|
Park JY, Tenjimbayashi M, Muto J, Shiratori S. Antiadhesion Function between a Biological Surface and a Metallic Device Interface at High Temperature by Wettability Control. ACS Biomater Sci Eng 2018; 4:1891-1899. [DOI: 10.1021/acsbiomaterials.8b00387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jun-Yong Park
- Center for Material Design Science, School of Integrated Design Engineering, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Mizuki Tenjimbayashi
- Center for Material Design Science, School of Integrated Design Engineering, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| | - Jun Muto
- Department of Neurosurgical Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Seimei Shiratori
- Center for Material Design Science, School of Integrated Design Engineering, Keio University, 3-14-1 Hiyoshi, Yokohama 223-8522, Japan
| |
Collapse
|
28
|
Chen Z, Zhao Y, He T, Chen K, Jiang L, Zhang J, Wan H, Li R. [Study on the prevention of postoperative intraperitoneal adhesion of rat with PLGA/PEG electrospun polymer membrane]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:999-1005. [PMID: 29806441 PMCID: PMC8458602 DOI: 10.7507/1002-1892.201703083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/26/2017] [Indexed: 11/03/2022]
Abstract
Objective Adopting poly- L-lactic/glycolic acid (PLGA) and polyethylene glycol (PEG) as the material to fabricate PLGA/PEG electrospun polymer membrane by electrospinning technology. And to study its preventive effect on postoperative intraperitoneal adhesion of rat. Methods PLGA and PEG were mixed at the ratio of 19∶1( M/M), then dissolved in organic solvent. The PLGA/PEG electrospun polymer membrane was prepared by electrospinning technology, and then the gross observation and scanning electron microscope observation were taken. Fifty-four Sprague Dawley rats (weighing, 180-200 g), were randomly divided into 3 groups. The rats in control group ( n=6) were left intact. The rats in model group ( n=24) and PLGA/PEG group ( n=24) were treated with the method of mechanical injury of the cecal serosa in order to establish the intraperitoneal adhesion models; then the PLGA/PEG electrospun polymer membrane was used to cover the wound in PLGA/PEG group, but was not in the model group. The intraperitoneal adhesion in PLGA/PEG group and model group were observed at 3 days, 1 week, 2 weeks, and 8 weeks after operation, and the adhesion degree was assessed according to the self-generated standard. The degradation of PLGA/PEG electrospun polymer membrane was also observed in PLGA/PEG group. At each time point, the rats were harvested for histological observation. All the above indexes were compared with the control group. Results Using the electrospinning technology, PLGA/PEG electrospun polymer membrane was prepared successfully. PLGA/PEG electrospun polymer membrane was white and opaque, with soft texture. Scanning electron microscopy observation showed that PLGA/PEG electrospun polymer membrane was mainly composed of disorderly staggered fibers, with microporous structure. All rats survived to the end of the experiment. Gross observation showed that PLGA/PEG electrospun polymer membrane gradually degraded after implantation in vivo, and the adhesion degree in PLGA/PEG group was significantly lower than that in model group ( P<0.05), but it had not yet reached to the level of the control group ( P<0.05). Histological observation showed that the proliferation of cecal fibrous connective tissue was slower in PLGA/PEG group than in model group, and adhesion severity significantly decreased, only with a small amount of inflammatory cell infiltration. Nevertheless, it was not up to the level of the control group. Conclusion PLGA/PEG electrospun polymer membrane can effectively prevent postoperative intraperitoneal adhesion of rat, and has good biodegradability.
Collapse
Affiliation(s)
- Zaomei Chen
- Pharmaceutical college of Guangdong Pharmaceutical University, Guangzhou Guangdong, 510006, P.R.China;Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P.R.China
| | - Yue Zhao
- Pharmaceutical college of Guangdong Pharmaceutical University, Guangzhou Guangdong, 510006, P.R.China;Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P.R.China
| | - Ting He
- Guangzhou Electrospinning Biological Technology Co.Ltd., Guangzhou Guangdong, 510604, P.R.China
| | - Kejun Chen
- Pharmaceutical college of Guangdong Pharmaceutical University, Guangzhou Guangdong, 510006, P.R.China;Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P.R.China
| | - Li Jiang
- Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010, P.R.China
| | - Junhui Zhang
- Guangzhou Electrospinning Biological Technology Co.Ltd., Guangzhou Guangdong, 510604, P.R.China
| | - Huayin Wan
- Guangzhou Electrospinning Biological Technology Co.Ltd., Guangzhou Guangdong, 510604, P.R.China
| | - Rubing Li
- Pharmaceutical college of Guangdong Pharmaceutical University, Guangzhou Guangdong, 510006, P.R.China;Department of Pharmacy, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou Guangdong, 510010,
| |
Collapse
|
29
|
Popov SV, Popova GY, Nikitina IR, Markov PA, Latkin DS, Golovchenko VV, Patova OA, Krachkovsky N, Smirnov VV, Istomina EA, Shumikhin KV, Burkov AA, Martinson EA, Litvinets SG. Injectable hydrogel from plum pectin as a barrier for prevention of postoperative adhesion. J BIOACT COMPAT POL 2016. [DOI: 10.1177/0883911516637374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
An injectable hydrogel was obtained from the high methyl-esterified plum Prunus domestica L. (PD) pectin and calcium ions (Ca2+). PD hydrogel showed a weak gel-like behavior and could be squeezed out of the syringe with an injection force of ca. 9 N. PD hydrogel was not suitable for the NIH/3T3 fibroblast cell adhesion in vitro. The live/dead fluorescence and MTT (3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide) assays indicated that the PD hydrogel had a low cytotoxicity in relation to both the adhered and gel surrounding fibroblasts. PD hydrogel was found to inhibit adhesion formation in the sidewall defect-cecum abrasion rat model. In the control group, the occurrence of adhesion of the cecum to the peritoneal wall was found in seven of the total seven rats operated. Only four of the seven animals that were treated with the PD hydrogel were noted to have any adhesions. These adhesions were of a minimum grade of 1, 2, and 3 and were represented by a thin film that could be easily broken. The protective effect of PD hydrogel was found to be comparable with that of hyaluronic acid hydrogel used as a positive control. PD hydrogel appeared to possess enhanced in vivo residence stability on the injury sites compared to hyaluronic acid hydrogel as measured by staining of healing tissue with periodic acid-Schiff reagent. The data obtained offered the prospect for the development of the pectin-based gels as new barrier materials for surgery.
Collapse
Affiliation(s)
- Sergey V Popov
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Galina Yu Popova
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Ida R Nikitina
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Pavel A Markov
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Dmitry S Latkin
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Victoria V Golovchenko
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Ol’ga A Patova
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Nikita Krachkovsky
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Vasily V Smirnov
- Institute of Physiology, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | - Elena A Istomina
- Institute of Chemistry, Komi Science Centre, The Urals Branch of the Russian Academy of Sciences, Syktyvkar, Russia
| | | | - Andrey A Burkov
- Department of Biotechnology, Vyatka State University, Kirov, Russia
| | | | | |
Collapse
|
30
|
Treating Small Bowel Obstruction with a Manual Physical Therapy: A Prospective Efficacy Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7610387. [PMID: 26989690 PMCID: PMC4775771 DOI: 10.1155/2016/7610387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
Small bowel obstructions (SBOs) caused by adhesions are a common, often life-threatening postsurgical complication with few treatment options available for patients. This study examines the efficacy of a manual physical therapy treatment regimen on the pain and quality of life of subjects with a history of bowel obstructions due to adhesions in a prospective, controlled survey based study. Changes in six domains of quality of life were measured via ratings reported before and after treatment using the validated Small Bowel Obstruction Questionnaire (SBO-Q). Improvements in the domains for pain (p = 0.0087), overall quality of life (p = 0.0016), and pain severity (p = 0.0006) were significant when average scores before treatment were compared with scores after treatment. The gastrointestinal symptoms (p = 0.0258) domain was marginally significant. There was no statistically significant improvement identified in the diet or medication domains in the SBO-Q for this population. Significant improvements in range of motion in the trunk (p ≤ 0.001), often limited by adhesions, were also observed for all measures. This study demonstrates in a small number of subjects that this manual physical therapy protocol is an effective treatment option for patients with adhesive small bowel obstructions as measured by subject reported symptoms and quality of life.
Collapse
|
31
|
Sheu C, Shalumon KT, Chen CH, Kuo CY, Fong YT, Chen JP. Dual crosslinked hyaluronic acid nanofibrous membranes for prolonged prevention of post-surgical peritoneal adhesion. J Mater Chem B 2016; 4:6680-6693. [DOI: 10.1039/c6tb01376g] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A HA NFM crosslinked with FeCl3and BDDE shows prolonged degradation to prevent peritoneal adhesion.
Collapse
Affiliation(s)
- Chialin Sheu
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - K. T. Shalumon
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Chang-Yi Kuo
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Yi Teng Fong
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
| |
Collapse
|
32
|
Dag A, Colak T, Koc O, Ayaz L, Comelekoglu U, Serinsoz-Pfeiffer E. Soybean oil prevents peritoneal adhesions without impairing colonic anastomotic healing. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12120] [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]
Affiliation(s)
- Ahmet Dag
- Department of General Surgery; Mersin University; Mersin Turkey
| | - Tahsin Colak
- Department of General Surgery; Mersin University; Mersin Turkey
| | - Okay Koc
- Department of General Surgery; Mersin University; Mersin Turkey
| | - Lokman Ayaz
- Department of Biochemistry; Trakya University; Edirne Turkey
| | | | | |
Collapse
|
33
|
A new poly(1,3-trimethylene carbonate) film provides effective adhesion reduction after major abdominal surgery in a rat model. Surgery 2015; 157:1113-20. [DOI: 10.1016/j.surg.2015.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 02/04/2015] [Accepted: 02/13/2015] [Indexed: 12/08/2022]
|
34
|
|
35
|
Trehalose solution protects mesothelium and reduces bowel adhesions. J Surg Res 2014; 191:224-30. [DOI: 10.1016/j.jss.2014.03.077] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022]
|
36
|
Koeneman MM, Koek GH, Bemelmans M, Peeters LL. Perihepatic adhesions: An unusual complication of hemolysis, elevated liver enzymes and low platelet syndrome. World J Gastroenterol 2014; 20:8726-8728. [PMID: 25024632 PMCID: PMC4093727 DOI: 10.3748/wjg.v20.i26.8726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023] Open
Abstract
We present a case of symptomatic perihepatic adhesions, which developed after a pregnancy complicated by hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome, in which a subcapsular liver hematoma occurred. Our patient presented with complaints of persistent, severe right-sided upper abdominal pain. The complaints developed gradually, one year after a pregnancy that had been complicated by HELLP syndrome with a subcapsular liver hematoma. The hematoma had resolved spontaneously. An upper-abdominal magnetic resonance imaging revealed a density between liver and diaphragm at the site of the former subcapsular hematoma, suspect of perihepatic adhesions. The presence of perihepatic adhesions was confirmed during a laparoscopy and treated by adhesiolysis in the same session. The adhesions may have developed in response to the degradation process of the subcapsular liver hematoma during conservative treatment. This case of perihepatic adhesions may therefor be the first presentation of a long term sequel of subcapsular liver hematoma in HELLP syndrome.
Collapse
|
37
|
Zhang Y, Li X, Zhang Q, Li J, Ju J, Du N, Liu X, Chen X, Cheng F, Yang L, Xu C, Bilal MU, Wei Y, Lu Y, Yang B. Berberine hydrochloride prevents postsurgery intestinal adhesion and inflammation in rats. J Pharmacol Exp Ther 2014; 349:417-26. [PMID: 24676878 DOI: 10.1124/jpet.114.212795] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Intestinal adhesion, characterized by connection of the loops of the intestine with other abdominal organs by fibrous tissue bands, remains an inevitable event of abdominal operations and can cause a number of complications. Berberine hydrochloride (berberine), a natural plant alkaloid derived from Chinese herbal medicine, is characterized by diverse pharmacological effects, such as anticancer and lower elevated blood glucose. This study is designed to investigate the effects of berberine on adhesion and inflammation after abdominal surgeries and the underlying molecular mechanisms. Adhesion severity grades and collagen deposition were assessed 14 days after surgery. We evaluated the levels of intercellular adhesion molecule-1 (ICAM-1) and inflammatory cytokines interleukin-1β (IL-1β), IL-6, transforming growth factor β (TGF-β), tumor necrosis factor-α (TNF-α), and examined transforming growth factor-activated kinase 1 (TAK1)/c-Jun N-terminal kinase (JNK) and TAK1/nuclear factor κB (NF-κB) signaling. The surgery group experienced the most severe adhesions, and berberine strikingly reduced the density and severity of adhesion. Results showed significant lower expression of IL-1β, IL-6, TGF-β, TNF-α, and ICAM-1, in berberine groups compared with the operation group. Activities of phosphorylated JNK and phosphorylated NF-κB were inhibited in the berberine groups compared with the surgery group. Our novel findings identified berberine hydrochloride as a promising strategy to prevent adhesion by downregulating ICAM-1 and reduce inflammation by inhibiting the TAK1/JNK and TAK1/NF-κB signaling after abdominal surgery, which brought out a good therapeutic approach for the development of clinical application for postoperative abdominal adhesion and inflammation.
Collapse
Affiliation(s)
- Yong Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education) (Y.Z., X.Li, Q.Z., J.L., J.J., N.D., X.Liu, X.C., F.C., C.X., M.U.B., Y.L., B.Y.), and Institute of Cardiovascular Research (Y.Z., Y.L., B.Y.), Harbin Medical University, Harbin, Heilongjiang, China; and Department of Bone Surgery (L.Y.) and Department of General Surgery (Y.W.), the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Alonso JDM, Alves ALG, Watanabe MJ, Rodrigues CA, Hussni CA. Peritoneal response to abdominal surgery: the role of equine abdominal adhesions and current prophylactic strategies. Vet Med Int 2014; 2014:279730. [PMID: 24587939 PMCID: PMC3918701 DOI: 10.1155/2014/279730] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/22/2013] [Indexed: 12/27/2022] Open
Abstract
Intra-abdominal adhesions constitute a significant clinical and surgical problem that can lead to complications such as pain and bowel occlusion or subocclusion. These adhesions are frustrating and potentially fatal, representing a major postoperative complication in abdominal surgery. It is estimated that 32% of horses undergoing laparotomy will present clinical symptoms due to adhesions, but the true prevalence is not known because a large proportion of animals with postoperative recurrent colics are medically treated or submitted to euthanasia without necropsy. Adhesions are highly cellular, vascularized, dynamic structures that are influenced by complex signaling mechanisms. Understanding their pathogenesis could assist in applying better therapeutic strategies and in developing more effective antiadhesion products. Currently, there are no definitive strategies that prevent adhesion formation, and it is difficult to interpret the results of existing studies due to nonstandardization of an induction model and evaluation of their severity. The best clinical results have been obtained from using minimally traumatic surgical techniques, anti-inflammatory agents, antimicrobials, anticoagulants, and mechanical separation of serosal surfaces by viscous intraperitoneal solutions or physical barriers. This paper aims to review adhesion formation pathogenesis, guide the understanding of major products and drugs used to inhibit adhesion formation, and address their effectiveness in the equine species.
Collapse
Affiliation(s)
- Juliana de Moura Alonso
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Ana Liz Garcia Alves
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Marcos Jun Watanabe
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Celso Antonio Rodrigues
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| | - Carlos Alberto Hussni
- School of Veterinary Medicine and Animal Science, UNESP, University Estadual Paulista, Botucatu, São Paulo, Brazil
| |
Collapse
|
39
|
Affiliation(s)
- Markus Trochsler
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia
| | - Guy J Maddern
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
| |
Collapse
|
40
|
Sprayable powder of hyaluronate embedded in mildly cross-linked alginate as a post-surgical tissue adhesion barrier. Macromol Res 2013. [DOI: 10.1007/s13233-013-1163-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
41
|
Takagi K, Araki M, Fukuoka H, Takeshita H, Hidaka S, Nanashima A, Sawai T, Nagayasu T, Hyon SH, Nakajima N. Novel powdered anti-adhesion material: preventing postoperative intra-abdominal adhesions in a rat model. Int J Med Sci 2013; 10:467-74. [PMID: 23470962 PMCID: PMC3590608 DOI: 10.7150/ijms.5607] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 02/28/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Although laparoscopic surgery has decreased postoperative adhesions, complications induced by adhesions are still of great concern. The aim of this study was to investigate the anti-adhesive effects of a novel powdered anti-adhesion material that can be applied during laparoscopic surgery in comparison with other anti-adhesion materials. METHODS Our novel powdered anti-adhesion material is composed of aldehyde dextran and ε-poly(L-lysine). In 40 male rats, a 2.5×2.0-cm abdominal wall resection and cecum abrasion were performed. The rats were randomized into four groups based on the anti-adhesion treatments: normal saline; Seprafilm(®); Interceed(®); and novel powdered anti-adhesion material. The animals were euthanized on days 7 and 28 to evaluate the adhesion severity, area of adhesion formation, gross appearance, and pathological changes. RESULTS The adhesion severities on both days 7 and 28 were significantly lower for all anti-adhesion material groups compared with the normal saline group (p<0.05). Pathologically, all groups showed inflammatory cell infiltration on day 7 and complete regeneration of the peritoneum on day 28. CONCLUSIONS Our novel powdered anti-adhesion material was found to be effective for reducing postoperative intra-abdominal adhesions and showed equivalent efficacy to commercial anti-adhesion materials.
Collapse
Affiliation(s)
- Katsunori Takagi
- Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg 2012; 49:642-717. [PMID: 23057861 DOI: 10.1067/j.cpsurg.2012.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Merril T Dayton
- Department of Surgery, SUNY Buffalo, Kaleida Health System, Buffalo, NY, USA
| | | | | | | |
Collapse
|
43
|
|
44
|
Abstract
Abdominal adhesions, whether caused by peritoneal trauma, radiation, infection, or a congenital condition, are associated with a wide range of complications. These complications include chronic abdominal or pelvic pain, infertility, and adhesive small bowel obstruction. Such adhesions render re-operation difficult, with attendant risks of inadvertent enterostomy and increased operation time. The purpose of this study was to investigate the potential of hyperbaric oxygen (HBO) therapy in the prevention of abdominal adhesions in an experimental animal study. A laparotomy was performed on Wistar rats to induce the formation of adhesions on the cecum and the intra-abdominal area (1 × 2 cm). A superficial layer of the underlying muscle from the right abdominal wall was also shaved and prepared for aseptic surgery. The rats were divided into four groups according to the duration of HBO therapy; five additional groups were designated according to the conditions of HBO therapy. When the rats were evaluated according to adhesion area and grade, a statistically significant difference was observed between the control and HBO treatment groups (p < 0.005). Results from this study suggest that HBO treatment could reduce adhesion formation; and further suggest that HBO therapy may have therapeutic potential in the treatment of postoperative peritoneal adhesion.
Collapse
|
45
|
Na SY, Oh SH, Song KS, Lee JH. Hyaluronic acid/mildly crosslinked alginate hydrogel as an injectable tissue adhesion barrier. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2012; 23:2303-13. [PMID: 22661246 DOI: 10.1007/s10856-012-4689-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/21/2012] [Indexed: 05/25/2023]
Abstract
Although hyaluronic acid (HA) has been conventionally utilized as a tissue adhesion barrier material, its rapid clearance in the body still remains as a big challenge in the clinical practice. In this study, we prepared a hydrogel of HA embedded in mildly crosslinked alginate (HA/mcALG hydrogel), which is injectable, easily covers injured tissues, and remains stably at the applied site during wound healing (by muco-adhesive HA embedded in the network structure of the mcALG hydrogel). The HA/mcALG hydrogel was highly effective for the prevention of peritoneal tissue adhesion compared to HA and mcALG hydrogels, and did not lead to any abnormal tissue responses during wound healing. The HA/mcALG hydrogel can be a good candidate as an injectable tissue adhesion barrier for clinical applications.
Collapse
Affiliation(s)
- Seung Yeon Na
- Department of Advanced Materials, Hannam University, 461-6 Jeonmin Dong, Yuseong Gu, Daejeon, 305-811, Republic of Korea
| | | | | | | |
Collapse
|
46
|
Involvement of the ubiquitin-proteasome system in the formation of experimental postsurgical peritoneal adhesions. Mediators Inflamm 2012; 2012:194723. [PMID: 22496598 PMCID: PMC3306991 DOI: 10.1155/2012/194723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 10/31/2011] [Accepted: 11/05/2011] [Indexed: 11/17/2022] Open
Abstract
We investigated the Ubiquitin-Proteasome System (UPS), major nonlysosomal intracellular protein degradation system, in the genesis of experimental postsurgical peritoneal adhesions. We assayed the levels of UPS within the adhered tissue along with the development of peritoneal adhesions and used the specific UPS inhibitor bortezomib in order to assess the effect of the UPS blockade on the peritoneal adhesions.
We found a number of severe postsurgical peritoneal adhesions at day 5 after surgery increasing until day 10. In the adhered tissue an increased values of ubiquitin and the 20S proteasome subunit, NFkB, IL-6, TNF-α and decreased values of IkB-beta were found. In contrast, bortezomib-treated rats showed a decreased number of peritoneal adhesions, decreased values of ubiquitin and the 20S proteasome, NFkB, IL-6, TNF-α, and increased levels of IkB-beta in the adhered peritoneal tissue.
The UPS system, therefore, is primarily involved in the formation of post-surgical peritoneal adhesions in rats.
Collapse
|
47
|
A sprayable hyaluronate/carboxymethylcellulose adhesion barrier exhibits regional adhesion reduction efficacy and does not impair intestinal healing. J Gastrointest Surg 2012; 16:325-33. [PMID: 21983948 DOI: 10.1007/s11605-011-1709-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 09/20/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND While bioresorbable solid barriers such as Seprafilm® prevent adhesions, their efficacy is limited to sites of application. The aim of this study was to assess the effectiveness of the sprayable adhesion barrier Sepraspray® in preventing adhesions to sites of direct application and to remote sites. METHODS Intraabdominal adhesions were induced in 30 rats by creating three ischemic buttons on each side of a midline incision. To assess efficacy, Sepraspray (5 mg/button) or Seprafilm (1 cm(2)/button) was applied over three buttons on one side of the peritoneum. Operated control animals received no treatment. On day 7, adhesions were scored as percent of buttons with adhesions. To assess safety, 81 rats underwent a colonic transection repaired with an end-to-end anastomosis. Both barriers were applied circumferentially to anastomoses. Controls received no product. The integrity of healing anastomosed colonic wounds was assessed by burst pressure and tensile strength at days 3, 5, and 7 postoperatively. RESULTS The direct application of both Sepraspray and Seprafilm significantly (p < 0.001) reduced adhesion formation compared to controls. While Seprafilm had no remote effect on adhesion formation, Sepraspray significantly (p < 0.001) reduced adhesion formation to contralateral ischemic buttons. Neither barrier affected anastomotic integrity at any time point. CONCLUSIONS Sepraspray has widespread efficacy throughout the peritoneum in reducing adhesions without compromising intestinal healing. Furthermore, this sprayable alternative offers the potential for easier intraabdominal application.
Collapse
|
48
|
Hull TL, Joyce MR, Geisler DP, Coffey JC. Adhesions after laparoscopic and open ileal pouch-anal anastomosis surgery for ulcerative colitis. Br J Surg 2011; 99:270-5. [PMID: 22095139 DOI: 10.1002/bjs.7759] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Emerging evidence suggests that a laparoscopic approach to colorectal procedures generates fewer adhesions. Even though laparoscopic ileal pouch-anal anastomosis (IPAA) is a lengthy procedure, the prospect of fewer adhesions may justify this approach. The aim of this study was to assess abdominal and adnexal adhesion formation following laparoscopic versus open IPAA in patients with ulcerative colitis. METHODS A diagnostic laparoscopy was performed at time of ileostomy closure. All abdominal quadrants and the pelvis were video recorded systematically and graded offline. The incisional adhesion score (IAS; range 0-6) and total abdominal adhesion score (TAS; range 0-10) were calculated, based on the grade and extent of adhesions. Adnexal adhesions were classified by the American Fertility Society (AFS) adhesion score. RESULTS A total of 43 patients consented to participate, of whom 40 could be included in the study (laparoscopic 28, open 12). Median age was 38 (range 20-61) years. There was no difference in age, sex, body mass index, American Society of Anesthesiologists grade and time to ileostomy closure between groups. The IAS was significantly lower after laparoscopic IPAA than following an open procedure: median (range) 0 (0-5) versus 4 (2-6) respectively (P = 0·004). The TAS was also significantly lower in the laparoscopic group: 2 (0-6) versus 8 (2-10) (P = 0·002). Applying the AFS score, women undergoing laparoscopic IPAA had a significantly lower mean(s.d.) prognostic classification score than those in the open group: 5·2(3·7) versus 20·0(5·6) (P = 0·023). CONCLUSION Laparoscopic IPAA was associated with significantly fewer incisional, abdominal and adnexal adhesions in comparison with open IPAA.
Collapse
Affiliation(s)
- T L Hull
- Digestive Disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avene/A30, Cleveland, Ohio 44195, USA.
| | | | | | | |
Collapse
|
49
|
Intraperitoneal oxygen/ozone treatment decreases the formation of experimental postsurgical peritoneal adhesions and the levels/activity of the local ubiquitin-proteasome system. Mediators Inflamm 2011; 2011:606718. [PMID: 21969768 PMCID: PMC3182568 DOI: 10.1155/2011/606718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/01/2011] [Accepted: 08/03/2011] [Indexed: 12/31/2022] Open
Abstract
We have investigated whether an oxygen/ozone (95%O2/5%O3) mixture would have potential against the formation of experimental postsurgical peritoneal adhesions. In two groups of rats, one control intraperitoneally injected with 3 mL/rat of O2 and one intraperitoneally injected with oxygen/ozone mixture (3 mL/rat equivalent to 300 μg/kg ozone), we induced a midline laparotomy and an enterotomy at the level of the ileum to encourage the formation of peritoneal adhesions. Samples were taken from the parietal peritoneal tissue to assess the formation of adhesions 0 and 10 days after the surgical procedure and to assess the levels of ubiquitin and 20S proteasome. We found decreased formation of postsurgical peritoneal adhesions after treatment of the rats with 300 μg/kg ozone associated with a decreased levels of ubiquitin and 20S proteasome subunit within the adhered tissue. Oxygen/ozone mixture is potentially useful for approaching the post-surgical peritoneal adhesions, and the UPS system is involved in this.
Collapse
|