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Martins RS, Fatimi AS, Ansari AI, Raheel H, Poulikidis K, Latif MJ, Razi SS, Bhora FY. Factors associated with safe and successful postoperative day 1 discharge after lung operations: a systematic review and meta-analysis. J Cardiothorac Surg 2024; 19:91. [PMID: 38350950 PMCID: PMC10865531 DOI: 10.1186/s13019-024-02505-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/17/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND A shorter length of stay (LOS) is associated with fewer hospital-acquired adverse conditions and decreased utilization of hospital resources. While modern perioperative care protocols have enabled some ambitious surgical teams to achieve discharge as early as within postoperative day 1 (POD1), most other teams remain cautious about such an approach due to the perceived risk of missing postoperative complications and increased readmission rates. We aimed to identify factors that would help guide surgical teams aiming for safe and successful POD1 discharge after lung resection. METHODS We searched the PubMed, Embase, Scopus, Web of Science and CENTRAL databases for articles comparing perioperative characteristics in patients discharged within POD1 (DWPOD1) and after POD1 (DAPOD1) following lung resection. Meta-analysis was performed using a random-effects model. RESULTS We included eight retrospective cohort studies with a total of 216,887 patients, of which 22,250 (10.3%) patients were DWPOD1. Our meta-analysis showed that younger patients, those without cardiovascular and respiratory comorbidities, and those with better preoperative pulmonary function are more likely to qualify for DWPOD1. Certain operative factors, such as a minimally invasive approach, shorter operations, and sublobar resections, also favor DWPOD1. DWPOD1 appears to be safe, with comparable 30-day mortality and readmission rates, and significantly less postoperative morbidity than DAPOD1. CONCLUSIONS In select patients with a favorable preoperative profile, DWPOD1 after lung resection can be achieved successfully and without increased risk of adverse outcomes such as postoperative morbidity, mortality, or readmissions.
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Affiliation(s)
- Russell Seth Martins
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network-Central Region, 65 James Street, Edison, NJ, 08820, USA
| | | | - Amna Irfan Ansari
- Medical College, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Hamna Raheel
- Dow Medical College, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Kostantinos Poulikidis
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network-Central Region, 65 James Street, Edison, NJ, 08820, USA
| | - M Jawad Latif
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network-Central Region, 65 James Street, Edison, NJ, 08820, USA
| | - Syed Shahzad Razi
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network-Central Region, 65 James Street, Edison, NJ, 08820, USA
| | - Faiz Y Bhora
- Division of Thoracic Surgery, Department of Surgery, Hackensack Meridian School of Medicine, Hackensack Meridian Health (HMH) Network-Central Region, 65 James Street, Edison, NJ, 08820, USA.
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Williams J, Prey B, Francis A, Weykamp M, Liu B, Parsons M, Vu M, Franko J, Roedel E, Horton J, Bingham J, Mentzer S, Kuckelman J. Bioadhesive patch as a parenchymal sparing treatment of acute traumatic pulmonary air leaks. J Trauma Acute Care Surg 2023; 95:679-684. [PMID: 36973876 DOI: 10.1097/ta.0000000000003956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Traumatic pulmonary injuries are common in chest trauma. Persistent air leaks occur in up to 46% of patients depending on injury severity. Prolonged leaks are associated with increased morbidity and cost. Prior work from our first-generation pectin patches successfully sealed pulmonary leaks in a cadaveric swine model. We now test the next-generation pectin patch against wedge resection in the management of air leaks in anesthetized swine. METHODS A continuous air leak of 10% to 20% percent was created to the anterior surface of the lung in intubated and sedated swine. Animals were treated with a two-ply pectin patch or stapled wedge resection (SW). Tidal volumes (TVs) were recorded preinjury and postinjury. Following repair, TVs were recorded, a chest tube was placed, and animals were observed for presence air leak at closure and for an additional 90 minutes while on positive pressure ventilation. Mann-Whitney U test and Fisher's exact test used to compare continuous and categorical data between groups. RESULTS Thirty-one animals underwent either SW (15) or pectin patch repair (PPR, 16). Baseline characteristics were similar between animals excepting baseline TV (SW, 10.3 mL/kg vs. PPR, 10.9 mL/kg; p = 0.03). There was no difference between groups for severity of injury based on percent of TV loss (SW, 15% vs. PPR, 14%; p = 0.5). There was no difference in TV between groups following repair (SW, 10.2 mL/kg vs. PPR, 10.2 mL/kg; p = 1) or at the end of observation (SW, 9.8 mL/kg vs. PPR, 10.2 mL/kg; p = 0.4). One-chamber intermittent air leaks were observed in three of the PPR animals, versus one in the SW group ( p = 0.6). CONCLUSION Pectin patches effectively sealed the lung following injury and were noninferior when compared with wedge resection for the management of acute traumatic air leaks. Pectin patches may offer a parenchymal sparing option for managing such injuries, although studies evaluating biodurability are needed.
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Affiliation(s)
- James Williams
- From the Madigan Army Medical Center (J.W., B.P., A.F., M.W., M.P., M.V., J.F., E.R., J.H., J.B., J.K.), Tacoma, Washington; and Laboratory of Adaptive and Regenerative Biology (B.L., S.M., J.K.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Erdi M, Sandler A, Kofinas P. Polymer nanomaterials for use as adjuvant surgical tools. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1889. [PMID: 37044114 PMCID: PMC10524211 DOI: 10.1002/wnan.1889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 03/03/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
Materials employed in the treatment of conditions encountered in surgical and clinical practice frequently face barriers in translation to application. Shortcomings can be generalized through their reduced mechanical stability, difficulty in handling, and inability to conform or adhere to complex tissue surfaces. To overcome an amalgam of challenges, research has sought the utilization of polymer-derived nanomaterials deposited in various fashions and formulations to improve the application and outcomes of surgical and clinical interventions. Clinically prevalent applications include topical wound dressings, tissue adhesives, surgical sealants, hemostats, and adhesion barriers, all of which have displayed the potential to act as superior alternatives to current materials used in surgical procedures. In this review, emphasis will be placed not only on applications, but also on various design strategies employed in fabrication. This review is designed to provide a broad and thought-provoking understanding of nanomaterials as adjuvant tools for the assisted treatment of pathologies prevalent in surgery. This article is categorized under: Implantable Materials and Surgical Technologies > Nanomaterials and Implants Implantable Materials and Surgical Technologies > Nanoscale Tools and Techniques in Surgery.
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Affiliation(s)
- Metecan Erdi
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
| | - Anthony Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Joseph E. Robert Jr. Center for Surgical Care, Children's National Medical Center, Washington, DC, USA
| | - Peter Kofinas
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, Maryland, USA
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Williams J, Prey B, Francis A, Weykamp M, Liu B, Parsons M, Vu M, Franko J, Roedel E, Lallemand M, Bingham J, Mentzer S, Kuckelman J. Pectin based biologic Velcro effectively seals traumatic solid organ and small bowel injuries. J Trauma Acute Care Surg 2023; 95:55-61. [PMID: 36872522 DOI: 10.1097/ta.0000000000003910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Injuries to the liver and small bowel are common in multiple injuries. While there are currently a variety of accepted damage-control techniques to expeditiously manage such injuries, morbidity and mortality remain high. Pectin polymers have previously been shown to effectively seal visceral organ injuries ex vivo through physiochemical entanglement with the glycocalyx. We sought to compare the standard of care for the management of penetrating liver and small bowel injuries with a pectin-based bioadhesive patch in a live animal model. METHODS Fifteen adult male swine underwent a laparotomy with standardized laceration to the liver. Animals were randomized to one of three treatment arms: packing with laparotomy pads (n = 5), suture repair (n = 5), or pectin patch repair (n = 5). Following 2 hours of observation, fluid was evacuated from the abdominal cavity and weighed. Next, a full-thickness small bowel injury was created, and animals were randomized to either a sutured repair (n = 7) or pectin patch repair (n = 8). The segment of bowel was then pressurized with saline, and the burst pressure was recorded. RESULTS All animals survived the protocol to completion. There were no clinically significant differences between groups regarding baseline vitals or laboratory studies. On one-way analysis of variance, there was a statistically significant difference between groups regarding blood loss after liver repair (26 mL suture vs. 33 mL pectin vs. 142 mL packing, p < 0.01). On post hoc analysis, there was no statistically significant difference between suture and pectin ( p = 0.9). After repair, small bowel burst pressures were similar between pectin and suture repair (234 vs. 224 mm Hg, p = 0.7). CONCLUSION Pectin-based bioadhesive patches performed similarly to the standard of care for the management of liver lacerations and full-thickness bowel injuries. Further testing is warranted to assess the biodurability of a pectin patch repair, as it may offer a simple option to effectively temporize traumatic intra-abdominal injuries.
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Affiliation(s)
- James Williams
- From the Madigan Army Medical Center (J.W., B.P., A.F., M.W., M.P., M.V., J.F., E.R., M.L., J.B., J.K.), Tacoma, Washington; and Laboratory of Adaptive and Regenerative Biology (B.L., S.M., J.K.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Han GY, Hwang SK, Cho KH, Kim HJ, Cho CS. Progress of tissue adhesives based on proteins and synthetic polymers. Biomater Res 2023; 27:57. [PMID: 37287042 DOI: 10.1186/s40824-023-00397-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
In recent years, polymer-based tissue adhesives (TAs) have been developed as an alternative to sutures to close and seal incisions or wounds owing to their ease of use, rapid application time, low cost, and minimal tissue damage. Although significant research is being conducted to develop new TAs with improved performances using different strategies, the applications of TAs are limited by several factors, such as weak adhesion strength and poor mechanical properties. Therefore, the next-generation advanced TAs with biomimetic and multifunctional properties should be developed. Herein, we review the requirements, adhesive performances, characteristics, adhesive mechanisms, applications, commercial products, and advantages and disadvantages of proteins- and synthetic polymer-based TAs. Furthermore, future perspectives in the field of TA-based research have been discussed.
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Affiliation(s)
- Gi-Yeon Han
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Korea
| | - Soo-Kyung Hwang
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea
| | - Ki-Hyun Cho
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, 03080, Korea
| | - Hyun-Joong Kim
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Korea.
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea.
| | - Chong-Su Cho
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea.
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Kong F, Mehwish N, Lee BH. Emerging albumin hydrogels as personalized biomaterials. Acta Biomater 2023; 157:67-90. [PMID: 36509399 DOI: 10.1016/j.actbio.2022.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
Developing biomaterials-based tissue engineering scaffolds with personalized features and intrinsic biocompatibility is appealing and urgent. Through utilizing various strategies, albumin, as the most abundant protein in plasma, could be fabricated into sustainable, cost-effective, and potentially personalized hydrogels that would display enormous biological applications. To date, much of the albumin-based research is primarily engrossed in using albumin as a therapeutic molecule or a drug carrier, not much as a scaffold for tissue engineering. For this reason, we have come up with a detailed and insightful review of recent progress in albumin-based hydrogels having an emphasis on production techniques, material characteristics, and biological uses. It is envisioned that albumin-based scaffolds would be appealing and useful platforms to meet current tissue engineering needs and achieve the goal of clinical translation to benefit patients. STATEMENT OF SIGNIFICANCE: The creation of autologous material-based scaffolds is a potential method for preventing immunological reactions and obtaining the best therapeutic results. Patient-derived albumin hydrogels may consequently provide improved opportunities for personalized treatment due to their abundant supply and minimal immunogenicity. To provide a detailed and insightful summary on albumin-based hydrogels, this review includes latest comprehensive information on their preparation procedures, features, and applications in 3D printing and other biomedical applications. The challenges, along with the future potential for implementing albumin-based hydrogels in clinics, have also been addressed.
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Affiliation(s)
- Fanhui Kong
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou, Guangdong, 510006, China
| | - Nabila Mehwish
- Engineering Research Center of Clinical Functional Materials and Diagnosis & Treatment Devices of Zhejiang Province, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China.
| | - Bae Hoon Lee
- Engineering Research Center of Clinical Functional Materials and Diagnosis & Treatment Devices of Zhejiang Province, Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang 325011, China; Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision and Brain Health), Wenzhou, Zhejiang, 325000, China.
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7
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Cardillo G, Nosotti M, Scarci M, Torre M, Alloisio M, Benvenuti MR, Bertani A, Cagini L, Casablanca G, Cavallesco G, Cherchi R, Crucitti P, Curcio C, Denegri A, Droghetti A, Guggino G, Imperatori A, Infante MV, Lucchi M, Macrì P, Marulli G, Melloni G, Paci M, Paladini P, Pariscenti GL, Potenza E, Rea F, Refai M, Rena O, Ricciardi S, Rusca M, Sollitto F, Taurchini M, Terzi A, Voltolini L, Crisci R. Air leak and intraoperative bleeding in thoracic surgery: a Delphi consensus among the members of Italian society of thoracic surgery. J Thorac Dis 2022; 14:3842-3853. [PMID: 36389328 PMCID: PMC9641338 DOI: 10.21037/jtd-22-619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
Background Persistent air leak and the management of intraoperative blood loss are common threats in thoracic surgical practice. The availability of new procedures, technology and materials is constantly evolving topical hemostats and surgical sealants must be added to this toolkit. Topical hemostats and surgical sealants differ according to their chemical nature and physical characteristics, to their origin and mechanism of action, regulatory/registration and vigilance paths. A Delphi consensus was set to highlight the different points of view on the use of topical haemostatic products and sealants among the members of Italian Society of thoracic surgery. Methods The board was formed by a group of five Italian experts; in the first phase after a careful review of the scientific literature and two rounds, the board finally generated 16 consensus statements for testing across a wider audience. During the second phase, the statements were collated into a questionnaire, which was electronically sent to a panel of 46 Italian surgeons, experts in the field. Results Out of 46 Italian surgeons, 33 (72%) panel members responded to the Delphi questionnaire. All the items reached a positive consensus, with elevated levels of agreement, as demonstrated by the presence of a 100% consensus for nine items. For the remaining 7 statements the minimum level of consent was 88% (29 participants approved the statement and 4 disagreed) and the maximum was 97% (32 participants approved the statement and 1 was in disagreement). Conclusions The present Delphi analysis shows that air leak and intraoperative bleeding are clinical problems well known among thoracic surgeons. Nevertheless, the aim of the scientific societies and of the group of experts is to execute the education activities in the surgery community. This Delphi survey suggest the need of wider and updated scientific information about technical and registration characteristics of most recent technologic solutions, such as the of topical hemostats and surgical sealants to provide healthcare and administrative staff with the opportunity to work and interact through a common and shared language and eventually to guarantee minimal requirements of assistance.
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Affiliation(s)
- Giuseppe Cardillo
- Department of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus - Saint Camillus International University of Health Sciences, Rome, Italy
| | - Mario Nosotti
- University of Milan, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Scarci
- Imperial College Healthcare NHS Trust, London, UK
| | - Massimo Torre
- Department of Thoracic Surgery, ASST GOM Niguarda, Milan, Italy
| | - Marco Alloisio
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Alessandro Bertani
- Thoracic Surgery and Lung Transplant Division, IRCCS ISMETT – UPMC, Palermo, Italy
| | - Lucio Cagini
- Department of Thoracic Surgery, University of Perugia, Perugia, Italy
- Thoracic Surgery Department, Ospedale del Mare, Naples, Italy
| | | | - Giorgio Cavallesco
- Department of Surgery 1 Thoracic, Hospital Unit University of Ferrara, Ferrara, Italy
| | - Roberto Cherchi
- Department of Thoracic Surgery, U.O.C A.R.N.A.S. -Brotzu, Cagliari, Italy
| | - Pierfilippo Crucitti
- Department of Thoracic Surgery, Fondazione Policlinico Campus Bio-Medico of Rome, Rome, Italy
| | - Carlo Curcio
- UOC Thoracic Surgery, AORN dei Colli. Monaldi Hospital, Naples, Italy
| | - Andrea Denegri
- Department of Thoracic Surgery, UOC Azienda Ospedaliera SS Annunziata Cosenza, Cosenza, Italy
| | | | - Gianluca Guggino
- Department of Thoracic Surgery, UOC Azienda Ospedaliera Rilievo Nazionale “A. Cardarelli”, Naples, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Marco Lucchi
- Division of Thoracic Surgery, University of Pisa, Pisa, Italy
| | - Paolo Macrì
- Department of Thoracic Surgery, Humanitas Istituto Clinico Catanese, Misterbianco, Italy
| | - Giuseppe Marulli
- Thoracic Surgery Unit, Department of Emergency and Organ Transplantation, University Hospital of Bari, Bari, Italy
| | - Giulio Melloni
- Department of Thoracic Surgery, S.Croce e Carle General Hospital, Cuneo, Italy
| | - Massimiliano Paci
- Department of Thoracic Surgery, Azienda Unità Sanitaria Locale–IRCCS, Reggio Emilia, Italy
| | - Piero Paladini
- Department of Thoracic Surgery, University of Siena, Siena, Italy
| | - Gian Luca Pariscenti
- Department of Thoracic Surgery, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Enrico Potenza
- Department of Thoracic Surgery, U.O.C. A.O.R.N.A.S. Garibaldi Nesima, Catania, Italy
| | - Federico Rea
- Unit of Thoracic Surgery and Lung Transplantation, Department of Cardio-Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Majed Refai
- Department of Thoracic Surgery, AOU Ospedali Riuniti, Ancona, Italy
| | - Ottavio Rena
- Thoracic Surgery Unit, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Sara Ricciardi
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
- PhD Program, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | | | - Marco Taurchini
- Department of Thoracic Surgery, UOC Policlinico SS Annunziata Asl Taranto, Taranto, Italy
| | - Alberto Terzi
- IRCCS Sacro Cuore-Don Calabria, Hospital Negrar di Valpolicella, Valpolicella, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, University Hospital Careggi, Florence, Italy
| | - Roberto Crisci
- Department of Thoracic Surgery, MeSVA Department University of L’Aquila, L’Aquila, Italy
- Division of Thoracic Surgery, “Mazzini” Hospital, Teramo, Italy
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8
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Sharifi S, Saei AA, Gharibi H, Mahmoud NN, Harkins S, Dararatana N, Lisabeth EM, Serpooshan V, Végvári Á, Moore A, Mahmoudi M. Mass Spectrometry, Structural Analysis, and Anti-Inflammatory Properties of Photo-Cross-Linked Human Albumin Hydrogels. ACS APPLIED BIO MATERIALS 2022; 5:2643-2663. [PMID: 35544705 DOI: 10.1021/acsabm.2c00109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Albumin-based hydrogels offer unique benefits such as biodegradability and high binding affinity to various biomolecules, which make them suitable candidates for biomedical applications. Here, we report a non-immunogenic photocurable human serum-based (HSA) hydrogel synthesized by methacryloylation of human serum albumin by methacrylic anhydride (MAA). We used matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, liquid chromatography-tandem mass spectrometry, as well as size exclusion chromatography to evaluate the extent of modification, hydrolytic and enzymatic degradation of methacrylated albumin macromer and its cross-linked hydrogels. The impacts of methacryloylation and cross-linking on alteration of inflammatory response and toxicity were evaluated in vitro using brain-derived HMC3 macrophages and Ex-Ovo chick chorioallantoic membrane assay. Results revealed that the lysines in HSA were the primary targets reacting with MAA, though modification of cysteine, threonine, serine, and tyrosine, with MAA was also confirmed. Both methacrylated HSA and its derived hydrogels were nontoxic and did not induce inflammatory pathways, while significantly reducing macrophage adhesion to the hydrogels; one of the key steps in the process of foreign body reaction to biomaterials. Cytokine and growth factor analysis showed that albumin-based hydrogels demonstrated anti-inflammatory response modulating cellular events in HMC3 macrophages. Ex-Ovo results also confirmed the biocompatibility of HSA macromer and hydrogels along with slight angiogenesis-modulating effects. Photocurable albumin hydrogels may be used as a non-immunogenic platform for various biomedical applications including passivation coatings.
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Affiliation(s)
- Shahriar Sharifi
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - Amir Ata Saei
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17 177 Stockholm, Sweden.,Department of Cell Biology, Harvard Medical School, Boston, Massachusetts 02115, United States
| | - Hassan Gharibi
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17 177 Stockholm, Sweden
| | - Nouf N Mahmoud
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States.,Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman 11733, Jordan.,Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
| | - Shannon Harkins
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - Naruphorn Dararatana
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - Erika M Lisabeth
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan 48824, United States
| | - Vahid Serpooshan
- Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, Georgia 30322, United States.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia 30322, United States.,Children's Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - Ákos Végvári
- Division of Physiological Chemistry I, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-17 177 Stockholm, Sweden.,Proteomics Biomedicum, Division of Physiological Chemistry I, Department of Medical Biochemistry, Karolinska Institutet, SE-17 177 Stockholm, Sweden
| | - Anna Moore
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States
| | - Morteza Mahmoudi
- Department of Radiology and Precision Health Program, Michigan State University, East Lansing, Michigan 48824, United States
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Elucidating the degradation mechanism of a self-degradable dextran-based medical adhesive. Carbohydr Polym 2022; 278:118949. [PMID: 34973767 DOI: 10.1016/j.carbpol.2021.118949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022]
Abstract
We developed a self-degradable medical adhesive, LYDEX, consisting of periodate-oxidized aldehyde-functionalized dextran (AD) and succinic anhydride-treated ε-poly-l-lysine (SAPL). After gelation and adhesion of LYDEX by Schiff base bond formation between the AD aldehyde groups and SAPL amino groups, molecular degradation associated with the Maillard reaction is initiated, but the detailed degradation mechanism remains unknown. Herein, we elucidated the degradation mechanism of LYDEX by analyzing the main degradation products under typical solution conditions in vitro. The degradation of the LYDEX gel with a sodium periodate/dextran content of 2.5/20 was observed using gel permeation chromatography and infrared and 1H NMR spectroscopy. The AD ratio in the AD-SAPL mixture increased as the molecular weight decreased with the degradation time. This discovery of LYDEX self-degradability is useful for clarifying other polysaccharide hydrogel degradation mechanisms, and valuable for the use of LYDEX in medical applications, such as hemostatic or sealant materials.
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Baghdasarian S, Saleh B, Baidya A, Kim H, Ghovvati M, Sani ES, Haghniaz R, Madhu S, Kanelli M, Noshadi I, Annabi N. Engineering a naturally derived hemostatic sealant for sealing internal organs. Mater Today Bio 2022; 13:100199. [PMID: 35028556 PMCID: PMC8741525 DOI: 10.1016/j.mtbio.2021.100199] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 12/28/2021] [Indexed: 12/26/2022] Open
Abstract
Controlling bleeding from a raptured tissue, especially during the surgeries, is essentially important. Particularly for soft and dynamic internal organs where use of sutures, staples, or wires is limited, treatments with hemostatic adhesives have proven to be beneficial. However, major drawbacks with clinically used hemostats include lack of adhesion to wet tissue and poor mechanics. In view of these, herein, we engineered a double-crosslinked sealant which showed excellent hemostasis (comparable to existing commercial hemostat) without compromising its wet tissue adhesion. Mechanistically, the engineered hydrogel controlled the bleeding through its wound-sealing capability and inherent chemical activity. This mussel-inspired hemostatic adhesive hydrogel, named gelatin methacryloyl-catechol (GelMAC), contained covalently functionalized catechol and methacrylate moieties and showed excellent biocompatibility both in vitro and in vivo. Hemostatic property of GelMAC hydrogel was initially demonstrated with an in vitro blood clotting assay, which showed significantly reduced clotting time compared to the clinically used hemostat, Surgicel®. This was further assessed with an in vivo liver bleeding test in rats where GelMAC hydrogel closed the incision rapidly and initiated blood coagulation even faster than Surgicel®. The engineered GelMAC hydrogel-based seaalant with excellent hemostatic property and tissue adhesion can be utilized for controlling bleeding and sealing of soft internal organs.
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Affiliation(s)
- Sevana Baghdasarian
- Department of Chemical and Biomolecular Engineering, University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Bahram Saleh
- Department of Chemical Engineering Northeastern University, Boston, MA, 02115, USA
| | - Avijit Baidya
- Department of Chemical and Biomolecular Engineering, University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Hanjun Kim
- Center for Minimally Invasive Therapeutics (C-MIT), California NanoSystems Institute (CNSI), University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Mahsa Ghovvati
- Department of Chemical and Biomolecular Engineering, University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Ehsan Shirzaei Sani
- Department of Chemical and Biomolecular Engineering, University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Reihaneh Haghniaz
- Center for Minimally Invasive Therapeutics (C-MIT), California NanoSystems Institute (CNSI), University of California - Los Angeles, Los Angeles, CA, 90095, USA
| | - Shashank Madhu
- Department of Chemical Engineering Northeastern University, Boston, MA, 02115, USA
| | - Maria Kanelli
- School of Chemical Engineering, National Technical University of Athens, Zografou Campus, Athens, 15780, Greece
| | - Iman Noshadi
- Department of Bioengineering, University of California, Riverside, 92507, USA
| | - Nasim Annabi
- Department of Chemical and Biomolecular Engineering, University of California - Los Angeles, Los Angeles, CA, 90095, USA
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11
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Joglekar MM, Slebos DJ, Leijten J, Burgess JK, Pouwels SD. Crosslink bio-adhesives for bronchoscopic lung volume reduction: current status and future direction. Eur Respir Rev 2021; 30:30/162/210142. [PMID: 34853096 DOI: 10.1183/16000617.0142-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Several bronchoscopic lung volume reduction (BLVR) treatments have been developed to reduce hyperinflation in emphysema patients. Lung bio-adhesives are among the most promising new BLVR treatment options, as they potentially provide a permanent solution for emphysematous patients after only a single application. To date, bio-adhesives have mainly been used as haemostats and tissue sealants, while their application in permanently contracting and sealing hyperinflated lung tissue has recently been identified as a novel and enticing opportunity. However, a major drawback of the current adhesive technology is the induction of severe inflammatory responses and adverse events upon administration. In our review, we distinguish between and discuss various natural, semi-synthetic and synthetic tissue haemostats and sealants that have been used for pulmonary applications such as sealing air/fluid leaks. Furthermore, we present an overview of the different materials including AeriSeal and autologous blood that have been used to achieve lung volume reduction and discuss their respective advantages and drawbacks. In conclusion, we describe the key biological (therapeutic benefit and biocompatibility) and biomechanical (degradability, adhesive strength, stiffness, viscoelasticity, tunability and self-healing capacity) characteristics that are essential for an ideal lung bio-adhesive material with the potential to overcome the concerns related to current adhesives.
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Affiliation(s)
- Mugdha M Joglekar
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Dirk-Jan Slebos
- University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
| | - Jeroen Leijten
- Dept of BioEngineering, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Janette K Burgess
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands
| | - Simon D Pouwels
- University of Groningen, University Medical Center Groningen, Dept of Pathology and Medical Biology, Groningen, The Netherlands .,University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, The Netherlands.,University of Groningen, University Medical Center Groningen, Dept of Pulmonary Diseases, Groningen, The Netherlands
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12
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Li J, Yu X, Martinez EE, Zhu J, Wang T, Shi S, Shin SR, Hassan S, Guo C. Emerging Biopolymer-Based Bioadhesives. Macromol Biosci 2021; 22:e2100340. [PMID: 34957668 DOI: 10.1002/mabi.202100340] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/23/2021] [Indexed: 12/13/2022]
Abstract
Bioadhesives have been widely used in healthcare and biomedical applications due to their ease-of-operation for wound closure and repair compared to conventional suturing and stapling. However, several challenges remain for developing ideal bioadhesives, such as unsatisfied mechanical properties, non-tunable biodegradability, and limited biological functions. Considering these concerns, naturally derived biopolymers have been considered good candidates for making bioadhesives owing to their ready availability, facile modification, tunable mechanical properties, and desired biocompatibility and biodegradability. Over the past several years, remarkable progress has been made on biopolymer-based adhesives, covering topics from novel materials designs and advanced processing to clinical translation. The developed bioadhesives have been applied for diverse applications, including tissue adhesion, hemostasis, antimicrobial, wound repair/tissue regeneration, and skin-interfaced bioelectronics. Here in this comprehensive review, recent progress on biopolymer-based bioadhesives is summarized with focuses on clinical translations and multifunctional bioadhesives. Furthermore, challenges and opportunities such as weak adhesion strength at the hydrated state, mechanical mismatch with tissues, and unfavorable immune responses are discussed with an aim to facilitate the future development of high-performance biopolymer-based bioadhesives.
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Affiliation(s)
- Jinghang Li
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China.,School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Xin Yu
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China
| | | | - Jiaqing Zhu
- School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Ting Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, 210029, China
| | - Shengwei Shi
- School of Materials Science and Engineering, Wuhan Institute of Technology, Wuhan, Hubei Province, 430205, China
| | - Su Ryon Shin
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Shabir Hassan
- Division of Engineering in Medicine, Department of Medicine, Harvard Medical School, and Brigham and Women's Hospital, Cambridge, MA, 02139, USA
| | - Chengchen Guo
- School of Engineering, Westlake University, Hangzhou, Zhejiang Province, 310024, China
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13
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Dhandapani V, Saseedharan P, Groleau D, Vermette P. Overview of approval procedures for bioadhesives in the United States of America and Canada. J Biomed Mater Res B Appl Biomater 2021; 110:950-966. [PMID: 34676966 DOI: 10.1002/jbm.b.34956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/16/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022]
Abstract
Bioadhesives are useful medical devices to help reduce postoperative complications and as adjuncts to sutures and staples in sealing wounds. Biomedical companies have been promoting research and development into new bioadhesives. As for other medical devices, translating promising candidates to market involves the need to pass through several regulatory steps, wherein their safety and effectiveness are evaluated and the proper reimbursements from payors are assessed. The regulatory procedures involve classification based on the risk factors, support studies, submission of applications to relevant authorities, procurement of certification, and finally commercialization, while keeping a track record of the post-market data. The importance of real-world data has been recently realized. The aim of this review is to focus on the translational goals, expectations, and necessities of medical devices focusing on the bioadhesives to be commercialized. It should aid researchers inspired to discover and market new bioadhesives in understanding the need for basic regulatory procedures behind their commercialization for medical usage, most importantly for internal medicine specifically in the United States of America, Canada, and Europe, in part. The key differences in the regulatory aspects among those are highlighted. Regulations keep changing with the introduction of new products and governmental laws. They are updated in this manuscript till March 2021.
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Affiliation(s)
- Vignesh Dhandapani
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de recherche du CHUS, Faculté de médecine et des sciences de la santé, Sherbrooke, Québec, Canada
| | - Prashanth Saseedharan
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de recherche du CHUS, Faculté de médecine et des sciences de la santé, Sherbrooke, Québec, Canada
| | - Denis Groleau
- Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Patrick Vermette
- Laboratoire de bio-ingénierie et de biophysique de l'Université de Sherbrooke, Department of Chemical and Biotechnological Engineering, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Centre de recherche du CHUS, Faculté de médecine et des sciences de la santé, Sherbrooke, Québec, Canada
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14
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Gasek N, Park HE, Uriarte JJ, Uhl FE, Pouliot RA, Riveron A, Moss T, Phillips Z, Louie J, Sharma I, Mohammed B, Dearborn J, Lee PC, Jensen T, Garner J, Finck C, Weiss DJ. Development of alginate and gelatin-based pleural and tracheal sealants. Acta Biomater 2021; 131:222-235. [PMID: 34245891 DOI: 10.1016/j.actbio.2021.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 01/11/2023]
Abstract
Pleural and tracheal injuries remain significant problems, and an easy to use, effective pleural or tracheal sealant would be a significant advance. The major challenges are requirements for adherence, high strength and elasticity, dynamic durability, appropriate biodegradability, and lack of cell or systemic toxicity. We designed and evaluated two sealant materials comprised respectively of alginate methacrylate and of gelatin methacryloyl, each functionalized by conjugation with dopamine HCl. Both compounds are cross-linked into easily applied as pre-formed hydrogel patches or as in situ hydrogels formed at the wound site utilizing FDA-approved photo-initiators and oxidants. Material testing demonstrates appropriate adhesiveness, tensile strength, burst pressure, and elasticity with no significant cell toxicity in vitro assessments. Air-leak was absent after sealant application to experimentally-induced injuries in ex-vivo rat lung and tracheal models and in ex vivo pig lungs. Sustained repair of experimentally-induced pleural injury was observed for up to one month in vivo rat models and for up to 2 weeks in vivo rat tracheal injury models without obvious air leak or obvious toxicities. The alginate-based sealant worked best in a pre-formed hydrogel patch whereas the gelatin-based sealant worked best in an in situ formed hydrogel at the wound site thus providing two potential approaches. These studies provide a platform for further pre-clinical and potential clinical investigations. STATEMENT OF SIGNIFICANCE: Pneumothorax and pleural effusions resulting from trauma and a range of lung diseases and critical illnesses can result in lung collapse that can be immediately life-threatening or result in chronic leaking (bronchopleural fistula) that is currently difficult to manage. This leads to significantly increased morbidity, mortality, hospital stays, health care costs, and other complications. We have developed sealants originating from alginate and gelatin biomaterials, each functionalized by methacryloylation and by dopamine conjugation to have desired mechanical characteristics for use in pleural and tracheal injuries. The sealants are easily applied, non-cytotoxic, and perform well in vitro and in vivo model systems of lung and tracheal injuries. These initial proof of concept investigations provide a platform for further studies.
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Affiliation(s)
- Nathan Gasek
- Department of Medicine, University of Vermont, Burlington, VT, USA; University of Connecticut School of Medicine, Farmington CT, USA
| | - Heon E Park
- Department of Medicine, University of Vermont, Burlington, VT, USA; Department of Mechanical Engineering, University of Vermont, Burlington VT, USA; Department of Chemical and Process Engineering, University of Canterbury, Christchurch, New Zealand
| | - Juan J Uriarte
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Franziska E Uhl
- Department of Medicine, University of Vermont, Burlington, VT, USA; Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Robert A Pouliot
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Tovah Moss
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Zachary Phillips
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Jessica Louie
- Department of Experimental Medical Sciences, Lund University, Lund, Sweden
| | - Ishna Sharma
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | | | - Jacob Dearborn
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Patrick C Lee
- Department of Mechanical Engineering, University of Vermont, Burlington VT, USA; Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Canada
| | - Todd Jensen
- Department of Surgery, Connecticut Children's Hospital, Hartford, CT, Department of Pediatrics, University of Connecticut School of Medicine, Farmington CT, USA
| | | | - Christine Finck
- Department of Surgery, Connecticut Children's Hospital, Hartford, CT, Department of Pediatrics, University of Connecticut School of Medicine, Farmington CT, USA
| | - Daniel J Weiss
- Department of Medicine, University of Vermont, Burlington, VT, USA.
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15
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Brunelli A, Bölükbas S, Falcoz PE, Hansen H, Jimenez MF, Lardinois D, Scarci M, Viti A, Walker I, Warren T. Exploring consensus for the optimal sealant use to prevent air leak following lung surgery: a modified Delphi survey from The European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2021; 59:1265-1271. [PMID: 33337471 DOI: 10.1093/ejcts/ezaa428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The use of sealants is one of the methods available to reduce the occurrence of intraoperative air leaks. The objective of this modified Delphi survey among ESTS members is to understand the attitudes of clinicians to the optimal use of sealants in air leak management. METHODS To understand the attitudes of a wider sample of clinicians, a questionnaire was developed highlighting key issues through 37 statements. Respondents were invited to score their level of agreement with each. A modified Delphi methodology was used to review responses with a threshold of agreement for consensus of 75%. RESULTS A total of 258 responses were received (response rate 17%). Respondents agreed that prolonged air leaks are a common complication in thoracic surgery presenting a burden to the patient and increasing the costs of care. There is clear support for the use of sealants to reduce costs and improve the efficiency of healthcare provision and duration of chest tube use in selected high-risk patients with intraoperative air leak at the end of the lung surgery. Respondents also agreed that, due to often complex nature of thoracic surgery, sealants should be developed specifically for this application. CONCLUSION There is a clear role for sealants in the management of air leaks and certain surgical procedures demand their use (i.e. lung volume reduction surgery, decortication). This opinion-based consensus review helps to raise the debate about the burden of air leaks in thoracic surgery in order that this issue is recognized in practice and informs the optimal use of sealants in lung surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrea Viti
- IRCCS Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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16
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Gao Y, Peng K, Mitragotri S. Covalently Crosslinked Hydrogels via Step-Growth Reactions: Crosslinking Chemistries, Polymers, and Clinical Impact. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2006362. [PMID: 33988273 DOI: 10.1002/adma.202006362] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/24/2020] [Indexed: 06/12/2023]
Abstract
Hydrogels are an important class of biomaterials with the unique property of high-water content in a crosslinked polymer network. In particular, chemically crosslinked hydrogels have made a great clinical impact in past years because of their desirable mechanical properties and tunability of structural and chemical properties. Various polymers and step-growth crosslinking chemistries are harnessed for fabricating such covalently crosslinked hydrogels for translational research. However, selecting appropriate crosslinking chemistries and polymers for the intended clinical application is time-consuming and challenging. It requires the integration of polymer chemistry knowledge with thoughtful crosslinking reaction design. This task becomes even more challenging when other factors such as the biological mechanisms of the pathology, practical administration routes, and regulatory requirements add additional constraints. In this review, key features of crosslinking chemistries and polymers commonly used for preparing translatable hydrogels are outlined and their performance in biological systems is summarized. The examples of effective polymer/crosslinking chemistry combinations that have yielded clinically approved hydrogel products are specifically highlighted. These hydrogel design parameters in the context of the regulatory process and clinical translation barriers, providing a guideline for the rational selection of polymer/crosslinking chemistry combinations to construct hydrogels with high translational potential are further considered.
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Affiliation(s)
- Yongsheng Gao
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Kevin Peng
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
| | - Samir Mitragotri
- School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Boston, MA, 02115, USA
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17
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Parmar A, Ansari NA, Parmar G, Krishnakumar A. Evaluation of cell viability of Human Dental Pulp Stem Cells in Two dimensional and Three dimensional Fibrin Glue Scaffold. J Conserv Dent 2021; 23:479-483. [PMID: 33911357 PMCID: PMC8066662 DOI: 10.4103/jcd.jcd_439_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/28/2020] [Accepted: 12/05/2020] [Indexed: 11/11/2022] Open
Abstract
Context: Regenerative endodontics uses the concept of tissue engineering to restore the diseased immature tooth, allowing for continued development of the root to a healthy state. For regenerative endodontics, the use of human dental pulp stem cells (HDPSCs) with appropriate scaffolds and growth factors is imperative. Aims: The aim of the study was to evaluate the human dental pulp cell viability in two-dimensional (2D) and 3D fibrin glue scaffold to be used in regenerative endodontics. Subjects and Methods: Regenerative potential of HDPSCs was comparatively assessed usings 2D and 3D fibrin glue scaffold. 3D scaffold was made with different concentrations of fibrinogen. Cell morphology was studied under inverted phase-contrast microscopy, and cell proliferation was assessed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay at various time intervals. Statistical Analysis Used: Collected data underwent a two-way ANOVA test. The P value of the study was kept 0.05 according to the sample size. Results: Study revealed a significant increase in the proliferation of HDPSCs in fibrin glue precoated wells of 2D fibrin glue compared to preseeded cells on day 1 and day 3. The concentration of fibrinogen has a major role in cell viability in 3D fibrin glue scaffold. Homing of HDPSCs in the 3D scaffold improves with time. Conclusions: This study concludes that the concentration of fibrin glue has a significant role in HDPSC Viability in 3D scaffold.
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Affiliation(s)
- Abhishek Parmar
- Department of Conservative Dentistry and Endodontics, Government Dental College, Ahmedabad, Gujarat, India
| | - Needa A Ansari
- Department of Conservative Dentistry and Endodontics, Government Dental College, Ahmedabad, Gujarat, India
| | - Girish Parmar
- Department of Conservative Dentistry and Endodontics, Government Dental College, Ahmedabad, Gujarat, India
| | - Amee Krishnakumar
- Department of Biotechnology, Institute of Science, Nirma University, Ahmedabad, Gujarat, India
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18
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Abstract
Polymeric tissue adhesives provide versatile materials for wound management and are widely used in a variety of medical settings ranging from minor to life-threatening tissue injuries. Compared to the traditional methods of wound closure (i.e., suturing and stapling), they are relatively easy to use, enable rapid application, and introduce minimal tissue damage. Furthermore, they can act as hemostats to control bleeding and provide a tissue-healing environment at the wound site. Despite their numerous current applications, tissue adhesives still face several limitations and unresolved challenges (e.g., weak adhesion strength and poor mechanical properties) that limit their use, leaving ample room for future improvements. Successful development of next-generation adhesives will likely require a holistic understanding of the chemical and physical properties of the tissue-adhesive interface, fundamental mechanisms of tissue adhesion, and requirements for specific clinical applications. In this review, we discuss a set of rational guidelines for design of adhesives, recent progress in the field along with examples of commercially available adhesives and those under development, tissue-specific considerations, and finally potential functions for future adhesives. Advances in tissue adhesives will open new avenues for wound care and potentially provide potent therapeutics for various medical applications.
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Affiliation(s)
- Sungmin Nam
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02134, United States.,Wyss Institute for Biologically Inspired Engineering, Cambridge, Massachusetts 02115, United States
| | - David Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts 02134, United States.,Wyss Institute for Biologically Inspired Engineering, Cambridge, Massachusetts 02115, United States
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19
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Wang T, Li Y, Wang J, Xu Y, Chen Y, Lu Z, Wang W, Xue B, Li Y, Cao Y. Smart Adhesive Peptide Nanofibers for Cell Capture and Release. ACS Biomater Sci Eng 2020; 6:6800-6807. [DOI: 10.1021/acsbiomaterials.0c01485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Tiankuo Wang
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Yiran Li
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Juan Wang
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Ying Xu
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Yifang Chen
- Institute of Advanced Materials and Flexible Electronics (IAMFE), School of Chemistry and Materials Science, Nanjing University of Information Science & Technology, 210044 Nanjing, China
- Reading Academy, Nanjing University of Information Science & Technology, Nanjing 210044, China
| | - Zilin Lu
- Institute of Advanced Materials and Flexible Electronics (IAMFE), School of Chemistry and Materials Science, Nanjing University of Information Science & Technology, 210044 Nanjing, China
- Reading Academy, Nanjing University of Information Science & Technology, Nanjing 210044, China
| | - Wei Wang
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Bin Xue
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
| | - Ying Li
- Institute of Advanced Materials and Flexible Electronics (IAMFE), School of Chemistry and Materials Science, Nanjing University of Information Science & Technology, 210044 Nanjing, China
- Reading Academy, Nanjing University of Information Science & Technology, Nanjing 210044, China
| | - Yi Cao
- Collaborative Innovation Center of Advanced Microstructures, National Laboratory of Solid State Microstructure, Key Laboratory of Intelligent Optical Sensing and Manipulation, Ministry of Education, Department of Physics, Nanjing University, Nanjing 210093, China
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20
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Tarafder S, Park GY, Felix J, Lee CH. Bioadhesives for musculoskeletal tissue regeneration. Acta Biomater 2020; 117:77-92. [PMID: 33031966 DOI: 10.1016/j.actbio.2020.09.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
Natural or synthetic materials designed to adhere to biological components, bioadhesives, have received significant attention in clinics and surgeries. As a result, there are several commercially available, FDA-approved bioadhesives used for skin wound closure, hemostasis, and sealing tissue gaps or cracks in soft tissues. Recently, the application of bioadhesives has been expanded to various areas including musculoskeletal tissue engineering and regenerative medicine. The instant establishment of a strong adhesion force on tissue surfaces has shown potential to augment repair of connective tissues. Bioadhesives have also been applied to secure tissue grafts to host bodies and to fill or seal gaps in musculoskeletal tissues caused by injuries or degenerative diseases. In addition, the injectability equipped with the instant adhesion formation may provide the great potential of bioadhesives as vehicles for localized delivery of cells, growth factors, and small molecules to facilitate tissue healing and regeneration. This review covers recent research progress in bioadhesives as focused on their applications in musculoskeletal tissue repair and regeneration. We also discuss the advantages and outstanding challenges of bioadhesives, as well as the future perspective toward regeneration of connective tissues with high mechanical demand.
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21
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Photocurable platelet rich plasma bioadhesives. Acta Biomater 2020; 117:133-141. [PMID: 32966923 DOI: 10.1016/j.actbio.2020.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Closure of wounds with tissue adhesives has many advantages over sutures, but existing synthetic adhesives are toxic and have poor workability. Blood-derived adhesives display complete resorption but have adhesion too weak for reliable wound dressings. We propose a semi-synthetic design that combines the positive attributes of synthetic and blood-derived tissue adhesives. PAMAM-g-diazirine (PDz) is a rapidly gelling bioadhesive miscible in both aqueous and organic solvents. PDz blended with platelet-rich plasma (PRP) forms PDz/PRP composite, a semi-synthetic formulation that combines PDz's wet tissue adhesion with PRP's potent wound healing properties. Light-activated PDz/PRP bioadhesive composite has similar elasticity to soft tissues and behaves as an induced hemostat-an unmet clinical need for rapid wound dressings. PDz/PRP composite applied to in-vivo full-thickness wounds observed a 25% reduction in inflammation, as assessed by the host-cell response.
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22
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A comprehensive review of topical hemostatic agents: The good, the bad, and the novel. J Trauma Acute Care Surg 2020; 88:e1-e21. [PMID: 31626024 DOI: 10.1097/ta.0000000000002508] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Uncontrolled exsanguination remains the leading cause of death for trauma patients, many of whom die in the pre-hospital setting. Without expedient intervention, trauma-associated hemorrhage induces a host of systemic responses and acute coagulopathy of trauma. For this reason, health care providers and prehospital personal face the challenge of swift and effective hemorrhage control. The utilization of adjuncts to facilitate hemostasis was first recorded in 1886. Commercially available products haves since expanded to include topical hemostats, surgical sealants, and adhesives. The ideal product balances efficacy, with safety practicality and cost-effectiveness. This review of hemostasis provides a guide for successful implementation and simultaneously highlights future opportunities.
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Geraci TC, Sasankan P, Luria B, Cerfolio RJ. Intraoperative Anesthetic and Surgical Concerns for Robotic Thoracic Surgery. Thorac Surg Clin 2020; 30:293-304. [PMID: 32593362 DOI: 10.1016/j.thorsurg.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Robotic thoracic surgery continues to gain momentum and is emerging as the optimal method for minimally invasive thoracic surgery. As a rapidly advancing field, continued review of the surgical and anesthetic concerns unique to robotic thoracic operations is necessary to maintain safe and efficient practice. In this review, we discuss the intraoperative concerns as they pertain to pulmonary, esophageal, and mediastinal thoracic robotic operations.
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Affiliation(s)
- Travis C Geraci
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA.
| | - Prabhu Sasankan
- New York University School of Medicine, NYU Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Brent Luria
- Department of Anesthesiology, New York University Langone Health, 550 1st Avenue, 15th Floor, New York, NY 10016, USA
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
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Aljehani Y, Alshamekh A, AlQatari AA. Radiologically Guided Management of Secondary Spontaneous Pneumothorax. Radiol Case Rep 2020; 15:1115-1118. [PMID: 32547671 PMCID: PMC7283950 DOI: 10.1016/j.radcr.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 11/10/2022] Open
Abstract
Secondary spontaneous pneumothorax is a serious medical condition that typically occurs in patients with an underlying lung pathology such as chronic obstructive pulmonary disease. Those patients are usually compromised and more amenable to higher morbidity and mortality rates. Moreover, they are poor candidates for general anesthesia and mechanical ventilation due to their poor health condition. We report a case of an 86-year-old male, who presented with a non-ST-elevation myocardial infarction and was incidentally found to have secondary spontaneous pneumothorax on a routine chest x-ray. The results of his blood work, international normalized ratio and liver function test were abnormal. Therefore, a novel intervention was introduced to control the air-leak by injecting a sealant material (Progel™, Warwick, Rhode Island, USA) through a thoracostomy tube guided by computed tomography fluoroscopy. The procedure was demonstrated to be a successful method of air-leak repair with minimal complications; as the patient was followed for two and a half years without any evidence of recurrence.
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Affiliation(s)
- Yasser Aljehani
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Alshamekh
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah A AlQatari
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Gillman N, Lloyd D, Bindra R, Ruan R, Zheng M. Surgical applications of intracorporal tissue adhesive agents: current evidence and future development. Expert Rev Med Devices 2020; 17:443-460. [PMID: 32176853 DOI: 10.1080/17434440.2020.1743682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Traditional mechanical closure techniques pose many challenges including the risk of infection, tissue reaction, and injury to both patients and clinicians. There is an urgent need to develop tissue adhesive agents to reform closure technique. This review examined a variety of tissue adhesive agents available in the market in an attempt to gain a better understanding of intracorporal tissue adhesive agents as medical devices.Areas covered: Fundamental principles and clinical determinants of the tissue adhesives were summarized. The available tissue adhesives for intracorporal use and their relevant clinical evidence were then presented. Lastly, the perspective of future development for intracorporal tissue adhesive were discussed. Clinical evidence shows current agents are efficacious as adjunctive measures to mechanical closure and these agents have been trialed outside of clinical indications with varied results.Expert opinion: Despite some advancements in the development of tissue adhesives, there is still a demand to develop novel technologies in order to address unmet clinical needs, including low tensile strength in wet conditions, non-controllable polimerization and sub-optimal biocompatibility. Research trends focus on producing novel adhesive agents to remit these challenges. Examples include the development of biomimetic adhesives, externally activated adhesives, and multiple crosslinking strategies. Economic feasibility and biosafety are limiting factors for clinical implementation.
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Affiliation(s)
- Nicholas Gillman
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - David Lloyd
- Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Randy Bindra
- School of Medicine, Griffith University School of Medicine, Gold Coast, QLD, Australia.,Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Southport, QLD, Australia
| | - Rui Ruan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Griffith Centre for Orthopaedic Research and Engineering, Menzies Health Institute, Gold Coast, QLD, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, 6009, Australia
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26
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Escudero-Duch C, Martin-Saavedra F, Prieto M, Sanchez-Casanova S, Lopez D, Sebastian V, Arruebo M, Santamaria J, Vilaboa N. Gold nanoparticles for the in situ polymerization of near-infrared responsive hydrogels based on fibrin. Acta Biomater 2019; 100:306-315. [PMID: 31568875 DOI: 10.1016/j.actbio.2019.09.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/16/2019] [Accepted: 09/26/2019] [Indexed: 12/01/2022]
Abstract
Non-invasiveness and relative safety of photothermal therapy, which enables local hyperthermia of target tissues using a near infrared (NIR) laser, has attracted increasing interest. Due to their biocompatibility, amenability of synthesis and functionalization, gold nanoparticles have been investigated as therapeutic photothermal agents. In this work, hollow gold nanoparticles (HGNP) were coated with poly-l-lysine through the use of COOH-Poly(ethylene glycol)-SH as a covalent linker. The functionalized HGNP, which peak their surface plasmon resonance at 800 nm, can bind thrombin. Thrombin-conjugated HGNP conduct in situ fibrin polymerization, facilitating the process of generating photothermal matrices. Interestingly, the metallic core of thrombin-loaded HGNP fragmentates at physiological temperature. During polymerization process, matrices prepared with thrombin-loaded HGNP were loaded with genetically-modified stem cells that harbour a heat-activated and ligand-dependent gene switch for regulating transgene expression. NIR laser irradiation of resulting cell constructs in the presence of ligand successfully triggered transgene expression in vitro and in vivo. STATEMENT OF SIGNIFICANCE: Current technological development allows synthesis of gold nanoparticles (GNP) in a wide range of shapes and sizes, consistently and at scale. GNP, stable and easily functionalized, show low cytotoxicity and high biocompatibility. Allied to that, GNP present optoelectronic properties that have been exploited in a range of biomedical applications. Following a layer-by-layer functionalization approach, we prepared hollow GNP coated with a positively charged copolymer that enabled thrombin conjugation. The resulting nanomaterial efficiently catalyzed the formation of fibrin hydrogels which convert energy of the near infrared (NIR) into heat. The resulting NIR-responsive hydrogels can function as scaffolding for cells capable of controlled gene expression triggered by optical hyperthermia, thus allowing the deployment of therapeutic gene products in desired spatiotemporal frameworks.
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Affiliation(s)
- Clara Escudero-Duch
- Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain
| | - Francisco Martin-Saavedra
- Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain.
| | - Martin Prieto
- Departmento de Ingenieria Quimica, Instituto de Nanociencia de Aragon (INA), Universidad de Zaragoza, Campus Rio Ebro. Edificio I+D. C/ Mariano Esquillor s/n, Zaragoza 50018 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain; Instituto de Ciencia de Materiales de Aragon, Consejo Superior de Investigaciones Cientificas (ICMA-CSIC), Universidad de Zaragoza, Zaragoza 50009 Spain
| | - Silvia Sanchez-Casanova
- Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain
| | - Daniel Lopez
- Instituto de Ciencia y Tecnologia de Polimeros, Consejo Superior de Investigaciones Cientificas (ICTP-CSIC), C/ Juan de la Cierva 3, Madrid 28006 Spain
| | - Victor Sebastian
- Departmento de Ingenieria Quimica, Instituto de Nanociencia de Aragon (INA), Universidad de Zaragoza, Campus Rio Ebro. Edificio I+D. C/ Mariano Esquillor s/n, Zaragoza 50018 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain; Instituto de Ciencia de Materiales de Aragon, Consejo Superior de Investigaciones Cientificas (ICMA-CSIC), Universidad de Zaragoza, Zaragoza 50009 Spain
| | - Manuel Arruebo
- Departmento de Ingenieria Quimica, Instituto de Nanociencia de Aragon (INA), Universidad de Zaragoza, Campus Rio Ebro. Edificio I+D. C/ Mariano Esquillor s/n, Zaragoza 50018 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain; Instituto de Ciencia de Materiales de Aragon, Consejo Superior de Investigaciones Cientificas (ICMA-CSIC), Universidad de Zaragoza, Zaragoza 50009 Spain
| | - Jesus Santamaria
- Departmento de Ingenieria Quimica, Instituto de Nanociencia de Aragon (INA), Universidad de Zaragoza, Campus Rio Ebro. Edificio I+D. C/ Mariano Esquillor s/n, Zaragoza 50018 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain; Instituto de Ciencia de Materiales de Aragon, Consejo Superior de Investigaciones Cientificas (ICMA-CSIC), Universidad de Zaragoza, Zaragoza 50009 Spain
| | - Nuria Vilaboa
- Hospital Universitario La Paz-IdiPAZ, Paseo de la Castellana 261, Madrid 28046 Spain; CIBER de Bioingenieria, Biomateriales y Nanomedicina, CIBER-BBN, Spain.
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Jalalvandi E, Charron P, Floreani RA. Physico-mechanical Characterization of Liquid versus Solid Applications of Visible Light Cross-Linked Tissue Sealants. ACS APPLIED BIO MATERIALS 2019; 2:1204-1212. [PMID: 35021369 DOI: 10.1021/acsabm.8b00785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The limitations of commercially available tissue sealants have resulted in the need for a new tissue adhesives with adequate adhesion, improved mechanical properties, and innocuous degradation products. To address current limitations, a visible light cross-linking method for the preparation of hydrogel tissue sealants, based on natural polymers (chitosan or alginate), is presented. Water-soluble chitosan was generated via modification with vinyl groups. To form hydrogels, alginate and chitosan were cross-linked by green light illumination, with or without the use of a bifunctional cross-linker. Evaluation of the mechanical properties through rheological characterization demonstrated an increased viscosity of polymer blends, and differences in shear moduli despite similar gelation points upon photo-cross-linking. A comparative study on the burst pressure properties of liquid versus solid material applications was performed to determine if the tissue sealants can perform under physiological lung pressures and beyond using different application methods. Higher burst pressure values were obtained for the sealants applied as a liquid compared to the solid application. The hydrogel tissue sealants revealed no cytotoxic effects toward primary human mesenchymal stem cells. This is the first report of a direct comparison between hydrogel tissue sealants of the same formulation applied in liquid versus solid form.
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28
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Kazi GA, Yamamoto O. Effectiveness of the sodium alginate as surgical sealant materials. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.wndm.2019.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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29
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Shamskhou EA, Kratochvil MJ, Orcholski ME, Nagy N, Kaber G, Steen E, Balaji S, Yuan K, Keswani S, Danielson B, Gao M, Medina C, Nathan A, Chakraborty A, Bollyky PL, De Jesus Perez VA. Hydrogel-based delivery of Il-10 improves treatment of bleomycin-induced lung fibrosis in mice. Biomaterials 2019; 203:52-62. [PMID: 30852423 DOI: 10.1016/j.biomaterials.2019.02.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 02/06/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a life-threatening progressive lung disorder with limited therapeutic options. While interleukin-10 (IL-10) is a potent anti-inflammatory and anti-fibrotic cytokine, its utility in treating lung fibrosis has been limited by its short half-life. We describe an innovative hydrogel-based approach to deliver recombinant IL-10 to the lung for the prevention and reversal of pulmonary fibrosis in a mouse model of bleomycin-induced lung injury. Our studies show that a hyaluronan and heparin-based hydrogel system locally delivers IL-10 by capitalizing on the ability of heparin to reversibly bind IL-10 without bleeding or other complications. This formulation is significantly more effective than soluble IL-10 for both preventing and reducing collagen deposition in the lung parenchyma after 7 days of intratracheal administration. The anti-fibrotic effect of IL-10 in this system is dependent on suppression of TGF-β driven collagen production by lung fibroblasts and myofibroblasts. We conclude that hydrogel-based delivery of IL-10 to the lung is a promising therapy for fibrotic lung disorders.
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Affiliation(s)
- Elya A Shamskhou
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Michael J Kratochvil
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, 94305, USA; Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Mark E Orcholski
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Nadine Nagy
- Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Gernot Kaber
- Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Emily Steen
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Swathi Balaji
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Ke Yuan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Sundeep Keswani
- Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, 77030, USA
| | - Ben Danielson
- Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Max Gao
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Carlos Medina
- Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Abinaya Nathan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Ananya Chakraborty
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA
| | - Paul L Bollyky
- Department of Medicine, Division of Infectious Disease, Stanford University, Stanford, CA, 94305, USA
| | - Vinicio A De Jesus Perez
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA, 94305, USA.
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30
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Heher P, Ferguson J, Redl H, Slezak P. An overview of surgical sealant devices: current approaches and future trends. Expert Rev Med Devices 2018; 15:747-755. [DOI: 10.1080/17434440.2018.1526672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Philipp Heher
- Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Vienna, Austria
| | - James Ferguson
- Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Vienna, Austria
| | - Heinz Redl
- Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Vienna, Austria
| | - Paul Slezak
- Austrian Cluster for Tissue Regeneration, Ludwig Boltzmann Institute for Experimental and Clinical Traumatology/AUVA Research Center, Vienna, Austria
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31
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Mortman KD, Corral M, Zhang X, Berhane I, Soleas IM, Ferko NC. Length of stay and hospitalization costs for patients undergoing lung surgery with Progel pleural air leak sealant. J Med Econ 2018; 21:1016-1022. [PMID: 29999435 DOI: 10.1080/13696998.2018.1499519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
AIM Progel Pleural Air Leak Sealant (Progel) is currently the only sealant approved by the FDA for the treatment of air leaks during lung surgery. This study was performed to determine whether Progel use improves hospital length of stay (LOS) and hospitalization costs compared with other synthetic/fibrin sealants in patients undergoing lung surgery. METHODS The US Premier hospital database was used to identify lung surgery discharges from January 1, 2010 to June 30, 2015. Eligible discharges were categorized as "Progel Sealant" or "other sealants" using hospital billing data. Propensity score matching (PSM) was performed to control for hospital and patient differences between study groups. Primary outcomes were hospital LOS and all-cause hospitalization costs. Clinical outcomes, hospital re-admissions, and sealant product use were also described. RESULTS After PSM, a total of 2,670 discharges were included in each study group; baseline characteristics were balanced between groups. The hospital LOS (mean days ± standard deviation, median) was significantly shorter for the Progel group (9.9 ± 9.6, 7.0) compared with the other sealants group (11.3 ± 12.8, 8.0; p < .001). Patients receiving Progel incurred significantly lower all-cause hospitalization costs ($31,954 ± $29,696, $23,904) compared with patients receiving other sealants ($36,147 ± $42,888, $24,702; p < .001). LIMITATIONS It is not possible to say that sealant type alone was responsible for the findings of this study, and analysis was restricted to the data available in the Premier database. CONCLUSIONS Among hospital discharges for lung surgery, Progel use was associated with significantly shorter hospital LOS and lower hospitalization costs compared with other synthetic/fibrin sealants, without compromising clinical outcomes.
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Affiliation(s)
- Keith D Mortman
- a Division of Thoracic Surgery , The George Washington University Hospital , Washington , DC , USA
| | | | | | | | - Ireena M Soleas
- c Cornerstone Research Group Inc. , Burlington , ON , Canada
| | - Nicole C Ferko
- c Cornerstone Research Group Inc. , Burlington , ON , Canada
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Zhou Y, Gao L, Peng J, Xing M, Han Y, Wang X, Xu Y, Chang J. Bioglass Activated Albumin Hydrogels for Wound Healing. Adv Healthc Mater 2018; 7:e1800144. [PMID: 29845777 DOI: 10.1002/adhm.201800144] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/01/2018] [Indexed: 12/22/2022]
Abstract
In this study, a novel Bioglass/albumin composite hydrogel with controllable injectability, good adhesiveness, and bioactivity, is developed by utilizing dual-functional bioactive ions released from Bioglass, which on one side controls the gelling time by creating an alkaline environment to regulate the cross-linking reaction between human serum albumin and succinimidyl succinate modified poly(ethylene glycol), and on the other side stimulates wound healing. The composite hydrogel exhibits adhesive property that is superior to clinically used fibrin and cyanoacrylate glues. The gelation time of the composite hydrogel could be regulated via changing the amounts of Bioglass which endows the hydrogel with good injectability. The in vivo experiment confirms that this composite hydrogel has good bioactivity to stimulate angiogenesis and enhance chronic wound healing. Moreover, for the first time, the concentrations of the bioactive ions released from the composite hydrogel in situ are quantified during wound healing using a microdialysis technique, and a correlation of the in vitro and in vivo concentration of ions released from the hydrogel is determined, which is extremely important for understanding the bioactivity mechanisms of Bioglass/bioceramic-based biomaterials and designing biomaterials for tissue regeneration.
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Affiliation(s)
- Yanling Zhou
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
| | - Long Gao
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
| | - Jinliang Peng
- School of Pharmacy; Shanghai Jiao Tong University; 800 Dongchuan Road Shanghai 200240 China
| | - Min Xing
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
| | - Yan Han
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
| | - Xiaoya Wang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
| | - Yuhong Xu
- School of Pharmacy; Shanghai Jiao Tong University; 800 Dongchuan Road Shanghai 200240 China
| | - Jiang Chang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure; Shanghai Institute of Ceramics; Chinese Academy of Sciences; 1295 Dingxi Road Shanghai 200050 China
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Servais AB, Valenzuela CD, Kienzle A, Ysasi AB, Wagner WL, Tsuda A, Ackermann M, Mentzer SJ. Functional Mechanics of a Pectin-Based Pleural Sealant after Lung Injury. Tissue Eng Part A 2018; 24:695-702. [PMID: 28920559 PMCID: PMC5963544 DOI: 10.1089/ten.tea.2017.0299] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/23/2017] [Indexed: 01/08/2023] Open
Abstract
Pleural injury and associated air leaks are a major influence on patient morbidity and healthcare costs after lung surgery. Pectin, a plant-derived heteropolysaccharide, has recently demonstrated potential as an adhesive binding to the glycocalyx of visceral mesothelium. Since bioadhesion is a process likely involving the interpenetration of the pectin-based polymer with the glycocalyx, we predicted that the pectin-based polymer may also be an effective sealant for pleural injury. To explore the potential role of an equal (weight%) mixture of high-methoxyl pectin and carboxymethylcellulose as a pleural sealant, we compared the yield strength of the pectin-based polymer to commonly available surgical products. The pectin-based polymer demonstrated significantly greater adhesion to the lung pleura than the comparison products (p < 0.001). In a 25 g needle-induced lung injury model, pleural injury resulted in an air leak and a loss of airway pressures. After application of the pectin-based polymer, there was a restoration of airway pressure and no measurable air leak. Despite the application of large sheets (50 mm2) of the pectin-based polymer, multifrequency lung impedance studies demonstrated no significant increase in tissue damping (G) or hysteresivity (η)(p > 0.05). In 7-day survival experiments, the application of the pectin-based polymer after pleural injury was associated with no observable toxicity, 100% survival (N = 5), and restored lung function. We conclude that this pectin-based polymer is a strong and nontoxic bioadhesive with the potential for clinical application in the treatment of pleural injuries.
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Affiliation(s)
- Andrew B. Servais
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristian D. Valenzuela
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arne Kienzle
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra B. Ysasi
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Willi L. Wagner
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Akira Tsuda
- Molecular and Integrative Physiological Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Servais AB, Kienzle A, Valenzuela CD, Ysasi AB, Wagner WL, Tsuda A, Ackermann M, Mentzer SJ. Structural Heteropolysaccharide Adhesion to the Glycocalyx of Visceral Mesothelium. Tissue Eng Part A 2018; 24:199-206. [PMID: 28467734 PMCID: PMC5792244 DOI: 10.1089/ten.tea.2017.0042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/25/2017] [Indexed: 12/25/2022] Open
Abstract
Bioadhesives are biopolymers with potential applications in wound healing, drug delivery, and tissue engineering. Pectin, a plant-based heteropolysaccharide, has recently demonstrated potential as a mucoadhesive in the gut. Since mucoadhesion is a process likely involving the interpenetration of the pectin polymer with mucin chains, we hypothesized that pectin may also be effective at targeting the glycocalyx of the visceral mesothelium. To explore the potential role of pectin as a mesothelial bioadhesive, we studied the interaction of various pectin formulations with the mesothelium of the lung, liver, bowel, and heart. Tensile strength, peel strength, and shear resistance of the bioadhesive-mesothelial interaction were measured by load/displacement measurements. In both high-methoxyl pectins (HMP) and low-methoxyl pectins, bioadhesion was greatest with an equal weight % formulation with carboxymethylcellulose (CMC). The tensile strength of the high-methoxyl pectin was consistently greater than low-methoxyl or amidated low-methoxyl formulations (p < 0.05). Consistent with a mechanism of polymer-glycocalyx interpenetration, the HMP adhesion to tissue mesothelium was reversed with hydration and limited by enzyme treatment (hyaluronidase, pronase, and neuraminidase). Peel and shear forces applied to the lung/pectin adhesion resulted in a near-interface structural failure and the efficient isolation of intact en face pleural mesothelium. These data indicate that HMP, in an equal weight % mixture with CMC, is a promising mesothelial bioadhesive for use in experimental and therapeutic applications.
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Affiliation(s)
- Andrew B. Servais
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Arne Kienzle
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cristian D. Valenzuela
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alexandra B. Ysasi
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Willi L. Wagner
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Akira Tsuda
- Molecular and Integrative Physiological Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Maximilian Ackermann
- Institute of Functional and Clinical Anatomy, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Steven J. Mentzer
- Laboratory of Adaptive and Regenerative Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Reduction of Pulmonary Air Leaks with a Combination of Polyglycolic Acid Sheet and Alginate Gel in Rats. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3808675. [PMID: 29487867 PMCID: PMC5816875 DOI: 10.1155/2018/3808675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022]
Abstract
Postoperative air leaks remain a major cause of morbidity after lung resection. This study evaluated the effect of a combination of polyglycolic acid (PGA) sheet and alginate gel on pulmonary air leaks in rats. Four pulmonary sealing materials were evaluated in lung injury: fibrin glue, combination of PGA sheet and fibrin glue, alginate gel, and combination of PGA sheet and alginate gel. With the airway pressure maintained at 20 cmH2O, a 2 mm deep puncture wound was created on the lung surface using a needle. Lowering the airway pressure to 5 cmH2O, each sealing material was applied. The lowest airway pressure that broke the seal was measured. The seal-breaking pressure in each experimental group was fibrin, 10.4 ± 6.8 cmH2O; PGA + fibrin, 13.5 ± 6.5 cmH2O; alginate gel, 10.3 ± 4.9 cmH2O; and PGA + alginate, 35.8 ± 11.9 cmH2O, respectively. The seal-breaking pressure was significantly greater in the PGA + alginate gel group than in the other groups (p < 0.01). There were no significant differences among the other three groups. Alginate gel combined with a PGA sheet is a promising alternative to fibrin glue as a safe and low-cost material for air leak prevention in pulmonary surgery.
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Annabi N, Zhang YN, Assmann A, Sani ES, Cheng G, Lassaletta AD, Vegh A, Dehghani B, Ruiz-Esparza GU, Wang X, Gangadharan S, Weiss AS, Khademhosseini A. Engineering a highly elastic human protein-based sealant for surgical applications. Sci Transl Med 2017; 9:eaai7466. [PMID: 28978753 PMCID: PMC11186511 DOI: 10.1126/scitranslmed.aai7466] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/11/2017] [Accepted: 08/17/2017] [Indexed: 04/28/2024]
Abstract
Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments. To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin. The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation. All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage. In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up. The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.
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Affiliation(s)
- Nasim Annabi
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA.
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Yi-Nan Zhang
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander Assmann
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
- Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf 40225, Germany
| | - Ehsan Shirzaei Sani
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA
| | - George Cheng
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Antonio D Lassaletta
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Andrea Vegh
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Bijan Dehghani
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Guillermo U Ruiz-Esparza
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xichi Wang
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sidhu Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Anthony S Weiss
- School of Life and Environmental Sciences, University of Sydney, Sydney, New South Wales 2006, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales 2006, Australia
- Bosch Institute, University of Sydney, Sydney, New South Wales 2006, Australia
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02139, USA.
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
- Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
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Assmann A, Vegh A, Ghasemi-Rad M, Bagherifard S, Cheng G, Sani ES, Ruiz-Esparza GU, Noshadi I, Lassaletta AD, Gangadharan S, Tamayol A, Khademhosseini A, Annabi N. A highly adhesive and naturally derived sealant. Biomaterials 2017; 140:115-127. [PMID: 28646685 PMCID: PMC5993547 DOI: 10.1016/j.biomaterials.2017.06.004] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 05/28/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
Abstract
Conventional surgical techniques to seal and repair defects in highly stressed elastic tissues are insufficient. Therefore, this study aimed to engineer an inexpensive, highly adhesive, biocompatible, and biodegradable sealant based on a modified and naturally derived biopolymer, gelatin methacryloyl (GelMA). We tuned the degree of gelatin modification, prepolymer concentration, photoinitiator concentration, and crosslinking conditions to optimize the physical properties and adhesion of the photocrosslinked GelMA sealants. Following ASTM standard tests that target wound closure strength, shear resistance, and burst pressure, GelMA sealant was shown to exhibit adhesive properties that were superior to clinically used fibrin- and poly(ethylene glycol)-based glues. Chronic in vivo experiments in small as well as translational large animal models proved GelMA to effectively seal large lung leakages without the need for sutures or staples, presenting improved performance as compared to fibrin glue, poly(ethylene glycol) glue and sutures only. Furthermore, high biocompatibility of GelMA sealant was observed, as evidenced by a low inflammatory host response and fast in vivo degradation while allowing for adequate wound healing at the same time. Combining these results with the low costs, ease of synthesis and application of the material, GelMA sealant is envisioned to be commercialized not only as a sealant to stop air leakages, but also as a biocompatible and biodegradable hydrogel to support lung tissue regeneration.
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Affiliation(s)
- Alexander Assmann
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA; Department of Cardiovascular Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, 40225, Duesseldorf, Germany
| | - Andrea Vegh
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Materials Science and Engineering, University of Toronto, Toronto, Ontario, M5S1A4, Canada
| | - Mohammad Ghasemi-Rad
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Sara Bagherifard
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Mechanical Engineering, Politecnico di Milano, Milan, 20156, Italy
| | - George Cheng
- Division of Pulmonary, Allergy, and Critical Care, Duke University Medical Center, Durham, NC, 27710, USA; Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Ehsan Shirzaei Sani
- Department of Chemical Engineering, Northeastern University, Boston, MA, 02115-5000, USA
| | - Guillermo U Ruiz-Esparza
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Iman Noshadi
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA; Department of Chemical Engineering, Northeastern University, Boston, MA, 02115-5000, USA
| | - Antonio D Lassaletta
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Sidhu Gangadharan
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Ali Tamayol
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - Ali Khademhosseini
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA; Department of Physics, King Abdulaziz University, Jeddah, 21569, Saudi Arabia; Department of Bioindustrial Technologies, College of Animal Bioscience and Technology, Konkuk University, Hwayang-dong, Gwangjin-gu, Seoul, 05029, Republic of Korea.
| | - Nasim Annabi
- Biomaterials Innovation Research Center, Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne Street, Cambridge, MA, 02139, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA; Department of Chemical Engineering, Northeastern University, Boston, MA, 02115-5000, USA.
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Fenn SL, Charron PN, Oldinski RA. Anticancer Therapeutic Alginate-Based Tissue Sealants for Lung Repair. ACS APPLIED MATERIALS & INTERFACES 2017; 9:23409-23419. [PMID: 28648052 PMCID: PMC5546308 DOI: 10.1021/acsami.7b04932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Injury to the connective tissue that lines the lung, the pleura, or the lung itself can occur from many causes including trauma or surgery, as well as lung diseases or cancers. To address current limitations for patching lung injuries, to stop air or fluid leaks, an adherent hydrogel sealant patch system was developed, based on methacrylated alginate (AMA) and AMA dialdehyde (AMA-DA) blends, which is capable of sealing damaged tissues and sustaining physiological pressures. Methacrylation of alginate hydroxyl groups rendered the polysaccharide capable of photo-cross-linking when mixed with an eosin Y-based photoinitiator system and exposed to visible green light. Oxidation of alginate yields functional aldehyde groups capable of imine bond formation with proteins found in many tissues. The alginate-based patch system was rigorously tested on a custom burst pressure testing device. Blending of nonoxidized material with oxidized (aldehyde modified) alginates yielded patches with improved burst pressure performance and decreased delamination as compared with pure AMA. Human mesothelial cell (MeT-5A) viability and cytotoxicity were retained when cultured with the hydrogel patches. The release and bioactivity of doxorubicin-encapsulated submicrospheres enabled the fabrication of drug-eluting adhesive patches and were effective in decreasing human lung cancer cell (A549) viability.
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Affiliation(s)
- Spencer L. Fenn
- Department of Biomedical Engineering, Tufts University, Medford, MA, 02155
- Bioengineering Program, College of Engineering and Mathematical Sciences, and Larner College of Medicine, University of Vermont, Burlington, VT, 05405
| | - Patrick N. Charron
- Department of Mechanical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
| | - Rachael A. Oldinski
- Bioengineering Program, College of Engineering and Mathematical Sciences, and Larner College of Medicine, University of Vermont, Burlington, VT, 05405
- Department of Mechanical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
- Department of Electrical and Biomedical Engineering, College of Engineering and Mathematical Sciences, University of Vermont, Burlington, VT, 05405
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, VT, 05405
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Tsilimigras DI, Antonopoulou A, Ntanasis-Stathopoulos I, Patrini D, Papagiannopoulos K, Lawrence D, Panagiotopoulos N. The role of BioGlue in thoracic surgery: a systematic review. J Thorac Dis 2017; 9:568-576. [PMID: 28449464 DOI: 10.21037/jtd.2017.02.57] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND BioGlue is a commonly used sealant in thoracic surgery. Prolonged air leak and presence of bronchopleural fistulae (BPF) are often encountered in clinical practice. We therefore, investigated the role and the efficacy of BioGlue in these scenarios. METHODS A systematic review was conducted by searching Medline [1966-2016] and Cochrane Central Register of Controlled Trials (CENTRAL) [1999-2016] along with reference lists of the included studies. Included studies reported on thoracic surgery operations and use of BioGlue in thoracic surgical procedures, whereas excluded studies met at least one of the following criteria: non-English language studies, non-human population, studies on surgical specialties other than Thoracic surgery, reviews and meta-analyses and sealants other than BioGlue. RESULTS Twelve studies with a total number of 194 patients were included. Amongst them, 178 were treated for alveolar air leaks (AAL), 14 for BPF and 2 for lymphatic leaks. BioGlue was utilized at the time of initial operation in 172 (96.7%) patients for AAL, while at secondary intervention in 13 (92.9%) for BPF and 1 (50%) for lymphatic leak. In terms of AAL, only 2 out of 4 studies showed statistically significant reduction in duration of air leak, duration of intercostal drainage and length of stay (LOS) when BioGlue was applied. No complications were encountered after using BioGlue in sealing BPF, apart from the re-application of BioGlue in 3 cases. CONCLUSIONS Although BioGlue has been shown to be efficient in treating AAL, it should be used with caution against BPF, despite encouraging preliminary results. Potential adverse effects must always be taken into consideration. Future randomized controlled trials are warranted in an attempt to establish its benefit in current clinical practice.
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Affiliation(s)
- Diamantis I Tsilimigras
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aspasia Antonopoulou
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK.,School of Medicine, University of Patras, Patras, Greece
| | | | - Davide Patrini
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
| | | | - David Lawrence
- Department of Thoracic Surgery, University College London Hospitals (UCLH), London, UK
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Ibrahim M, Pindozzi F, Menna C, Rendina EA. Intraoperative bronchial stump air leak control by Progel® application after pulmonary lobectomy. Interact Cardiovasc Thorac Surg 2015; 22:222-4. [PMID: 26541960 DOI: 10.1093/icvts/ivv307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/30/2015] [Indexed: 11/12/2022] Open
Abstract
Diffuse tracheobronchial calcification is a physiological condition associated with advanced age, especially in women. A calcified bronchus can be fractured during major lung resections (lobectomy, bilobectomy, and pneumonectomy), exposing patients to intraoperative air leakage and broncho-pleural fistula (BPF) occurrence. We retrospectively evaluated the use of Progel® application on the suture line of bronchial stump after pulmonary lobectomy analysing the intraoperative air leak and BPF occurrence. Between January 2014 and December 2014, Progel® was applied in 11 patients who presented intraoperative bronchial fractures after suture resection by mechanical staplers and air leak from bronchial stump, in order to treat air leakage. Patients were 7 men and 4 women, aged between 56 and 81 years (mean age 71.2 ± 12.1 years). Surgical procedures included 6 upper lobectomies (4 right, 2 left), 1 bilobectomy and 4 lower lobectomies (3 right, 1 left). Mean hospital stay was 4.5 ± 2.6 days (2-8 days). None of the patients had postoperative air leakage. No Progel® application-related complications occurred. No other major complications occurred. No mortality occurred. Progel® proved to be useful in treating intraoperative air leakage during major lung resections, particularly those occurring as a result of fracture of the bronchus from a mechanical stapler.
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Affiliation(s)
- Mohsen Ibrahim
- Division of Thoracic Surgery, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Fioralba Pindozzi
- Division of General Surgery, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - Cecilia Menna
- Division of Thoracic Surgery, G. Mazzini Hospital of Teramo, University of L'Aquila, L'Aquila, Italy
| | - Erino A Rendina
- Division of Thoracic Surgery, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
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Annabi N, Yue K, Tamayol A, Khademhosseini A. Elastic sealants for surgical applications. Eur J Pharm Biopharm 2015; 95:27-39. [PMID: 26079524 PMCID: PMC4591192 DOI: 10.1016/j.ejpb.2015.05.022] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Sealants have emerged as promising candidates for replacing sutures and staples to prevent air and liquid leakages during and after the surgeries. Their physical properties and adhesion strength to seal the wound area without limiting the tissue movement and function are key factors in their successful implementation in clinical practice. In this contribution, the advances in the development of elastic sealants formed from synthetic and natural materials are critically reviewed and their shortcomings are pointed out. In addition, we highlight the applications in which elasticity of the sealant is critical and outline the limitations of the currently available sealants. This review will provide insights for the development of novel bioadhesives with advanced functionality for surgical applications.
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Affiliation(s)
- Nasim Annabi
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA; Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Kan Yue
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ali Tamayol
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ali Khademhosseini
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA; Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia.
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Abstract
In the United States and Europe, the number of topical adhesives, surgical sealants, and hemostats approved for use in the surgical setting is ever expanding although no single device fills all medical and surgical needs to replace sutures. As more surgical procedures are performed through laparoscopic and robotic approaches, these devices are becoming more important, and current research is focused on solving the limitations of conventional wound treatments. This review article discusses clinical applications of various biologically derived and synthetic products that are currently available to surgeons and those that are in development.
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Affiliation(s)
- Lindsey Sanders
- Department of Bioengineering, Clemson University, Clemson, South Carolina
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Li Y, Meng H, Liu Y, Lee BP. Fibrin gel as an injectable biodegradable scaffold and cell carrier for tissue engineering. ScientificWorldJournal 2015; 2015:685690. [PMID: 25853146 PMCID: PMC4380102 DOI: 10.1155/2015/685690] [Citation(s) in RCA: 156] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/27/2015] [Indexed: 12/28/2022] Open
Abstract
Due to the increasing needs for organ transplantation and a universal shortage of donated tissues, tissue engineering emerges as a useful approach to engineer functional tissues. Although different synthetic materials have been used to fabricate tissue engineering scaffolds, they have many limitations such as the biocompatibility concerns, the inability to support cell attachment, and undesirable degradation rate. Fibrin gel, a biopolymeric material, provides numerous advantages over synthetic materials in functioning as a tissue engineering scaffold and a cell carrier. Fibrin gel exhibits excellent biocompatibility, promotes cell attachment, and can degrade in a controllable manner. Additionally, fibrin gel mimics the natural blood-clotting process and self-assembles into a polymer network. The ability for fibrin to cure in situ has been exploited to develop injectable scaffolds for the repair of damaged cardiac and cartilage tissues. Additionally, fibrin gel has been utilized as a cell carrier to protect cells from the forces during the application and cell delivery processes while enhancing the cell viability and tissue regeneration. Here, we review the recent advancement in developing fibrin-based biomaterials for the development of injectable tissue engineering scaffold and cell carriers.
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Affiliation(s)
- Yuting Li
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Hao Meng
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Yuan Liu
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Bruce P. Lee
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
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Ghobril C, Grinstaff MW. The chemistry and engineering of polymeric hydrogel adhesives for wound closure: a tutorial. Chem Soc Rev 2015; 44:1820-35. [DOI: 10.1039/c4cs00332b] [Citation(s) in RCA: 508] [Impact Index Per Article: 56.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Thistutorial reviewhighlights the key features and design requirements for the use of polymeric hydrogel adhesives in the clinic.
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Affiliation(s)
- C. Ghobril
- Departments of Biomedical Engineering and Chemistry
- Metcalf Center for Science and Engineering
- Boston University
- Boston
- USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering and Chemistry
- Metcalf Center for Science and Engineering
- Boston University
- Boston
- USA
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Annabi N, Tamayol A, Shin SR, Ghaemmaghami AM, Peppas NA, Khademhosseini A. Surgical Materials: Current Challenges and Nano-enabled Solutions. NANO TODAY 2014; 9:574-589. [PMID: 25530795 PMCID: PMC4266934 DOI: 10.1016/j.nantod.2014.09.006] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Surgical adhesive biomaterials have emerged as substitutes to sutures and staples in many clinical applications. Nano-enabled materials containing nanoparticles or having a distinct nanotopography have been utilized for generation of a new class of surgical materials with enhanced functionality. In this review, the state of the art in the development of conventional surgical adhesive biomaterials is critically reviewed and their shortcomings are outlined. Recent advancements in generation of nano-enabled surgical materials with their potential future applications are discussed. This review will open new avenues for the innovative development of the next generation of tissue adhesives, hemostats, and sealants with enhanced functionality for various surgical applications.
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Affiliation(s)
- Nasim Annabi
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Ali Tamayol
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Su Ryon Shin
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Amir M Ghaemmaghami
- Division of Immunology, School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, United Kingdom
| | - Nicholas A Peppas
- Department of Biomedical Engineering, Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Ali Khademhosseini
- Center for Biomaterials Innovation, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA ; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA ; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA ; Department of Biomedical Engineering, Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA ; Department of Maxillofacial Biomedical Engineering and Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul 130-701, Republic of Korea ; Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia
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Bipolar sealing of lung parenchyma: tests in an ex vivo model. Surg Endosc 2014; 29:127-32. [PMID: 25027470 DOI: 10.1007/s00464-014-3664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Almost every pulmonary lobe resection requires cutting the lung parenchyma in the area of a lung fissure. A monopolar cutter or stapler is often used for this purpose. The seal should be absolutely airtight to prevent post-operative pulmonary fistulas. In the present study, the bipolar sealing technique was evaluated regarding air tightness of the seals during normal ventilation and its burst pressure in an ex vivo animal model. MATERIALS AND METHODS The investigations were carried out on paracardial lung lobes obtained from heart-lung preparations taken from freshly killed pigs at a slaughter house. In the laboratory, each individual lobe was perfused with Ringer's solution at body temperature and protectively ventilated through a tube (frequency: 20 1/min, p insp = 20 mbar, PEEP +5 mbar). Non-anatomic resection was carried out in the periphery of the lung lobe. The two control groups (12 lobes per group; Group 1-stapler, Group 2-parenchyma suture) were compared to three groups in which different bipolar sealing instruments were used. They were Group 3-MARSEAL(®) 10 mm (KLS Martin, Tuttlingen); Group 4-MARSEAL(®) 5 mm; and Group 5-MARCLAMP(®) (KLS Martin, Tuttlingen). The SealSafe(®) G3 electric current was used in all cases. Ventilation was continued for 20 min following parenchymal resection. Parenchymal sealing was then judged visually in a water bath and given a score (0-3). Burst pressure (mbar) was measured by increasing the inspiration pressure stepwise. Group mean values were compared (nonparametric Mann-Whitney U test, p < 0.005). RESULTS Parenchymal seals were airtight under ventilation throughout the observation period in all groups. Mean burst pressures were as follows: Group 1: 47.1 ± 6.2 mbar; Group 2: 32.9 ± 3.9 mbar; Group 3: 38.8 ± 2.2 mbar; Group 4: 25.0 ± 6.4 mbar; and Group 5: 32.9 ± 5.8 mbar. Group 1, the stapler group, thus exhibited the highest burst pressures. Burst pressures for Group 3 were significantly greater than those for Group 2 (p < 0.006). Burst pressures for groups 2 and 5 were similar (p = 0.97). However, the burst pressures for Group 4 were significantly lower than those for Group 2 (p < 0.001). CONCLUSION MARSEAL(®) 10 mm and MARCLAMP(®) achieved adequate burst pressures compared to the two control groups and thus might be suitable for clinical use.
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Andrade CF, Fontena E, Cardoso PF, Pereira RB, Grun G, Forgiarini LF, Moreira JS, Felicetti JC. Peritoneal Free Autologous Fat Graft for the Control of Pulmonary Air Leaks in Emphysematous Rat Lungs. Ann Thorac Surg 2014; 98:271-6. [DOI: 10.1016/j.athoracsur.2014.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 11/24/2022]
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