1
|
Dallaev R. Advances in Materials with Self-Healing Properties: A Brief Review. MATERIALS (BASEL, SWITZERLAND) 2024; 17:2464. [PMID: 38793530 PMCID: PMC11123491 DOI: 10.3390/ma17102464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/17/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
The development of materials with self-healing capabilities has garnered considerable attention due to their potential to enhance the durability and longevity of various engineering and structural applications. In this review, we provide an overview of recent advances in materials with self-healing properties, encompassing polymers, ceramics, metals, and composites. We outline future research directions and potential applications of self-healing materials (SHMs) in diverse fields. This review aims to provide insights into the current state-of-the-art in SHM research and guide future efforts towards the development of innovative and sustainable materials with enhanced self-repair capabilities. Each material type showcases unique self-repair mechanisms tailored to address specific challenges. Furthermore, this review investigates crack healing processes, shedding light on the latest developments in this critical aspect of self-healing materials. Through an extensive exploration of these topics, this review aims to provide a comprehensive understanding of the current landscape and future directions in self-healing materials research.
Collapse
Affiliation(s)
- Rashid Dallaev
- Department of Physics, Faculty of Electrical Engineering and Communication, Brno University of Technology, Technická 2848/8, 61600 Brno, Czech Republic
| |
Collapse
|
2
|
Liang Y, Wang J, Liu X, Chen S, He G, Fang X, Yang J, Teng Z, Liu HB. Anti-adhesion multifunctional poly(lactic-co-glycolic acid)/polydimethylsiloxane wound dressing for bacterial infection monitoring and photodynamic antimicrobial therapy. Int J Biol Macromol 2024; 260:129501. [PMID: 38224803 DOI: 10.1016/j.ijbiomac.2024.129501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
Wound infection and adhesion are important factors affecting wound healing. Early detection of pathogen infection and reduction of wound-to-dressing adhesion are critical for improving wound healing. Herein, Ester-J, which can rapidly respond to lipase secreted by bacteria, was designed and synthesized. Then, Ester-J was co-spun with poly(lactic-co-glycolic acid) (PLGA) and polydimethylsiloxane (PDMS) to prepare a PP-EsJ hydrophobic anti-adhesion dressing with a contact angle of 140.7°. When the PP-EsJ membrane came into contact with the bacteria, the loaded Ester-J was hydrolyzed to Tph-TSF-OH, releasing bright cyan-blue fluorescence, thus providing a fluorescence switch for an early warning of infection. The detection limits of PP-EsJ for Pseudomonas aeruginosa and Staphylococcus aureus were 1.0 × 105 and 1.0 × 106 CFU/mL, respectively. Subsequently, Tph-TSF-OH released 1O2 through light irradiation, which rapidly killed P. aeruginosa and S. aureus, and accelerated wound healing. Compared with the control group, enhanced wound closure (up to 99.80 ± 1.10 %) was observed in mice treated with the PP-EsJ membrane. The PP-EsJ membrane not only effectively reduced the risk of external infection but also reduced adhesions to the skin during dressing changes. These characteristics make PP-EsJ membranes potentially useful for clinical treatment.
Collapse
Affiliation(s)
- Yuehui Liang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Jing Wang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Xu Liu
- Medical College of Guangxi University, Guangxi University, Nanning 53004, PR China
| | - Shirong Chen
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Guangpeng He
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Xiru Fang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Jiaying Yang
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Zhongshan Teng
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China
| | - Hai-Bo Liu
- School of Chemistry and Chemical Engineering, Guangxi University, Nanning 53004, PR China.
| |
Collapse
|
3
|
Kargozar S, Gorgani S, Nazarnezhad S, Wang AZ. Biocompatible Nanocomposites for Postoperative Adhesion: A State-of-the-Art Review. NANOMATERIALS (BASEL, SWITZERLAND) 2023; 14:4. [PMID: 38202459 PMCID: PMC10780749 DOI: 10.3390/nano14010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
To reduce and prevent postsurgical adhesions, a variety of scientific approaches have been suggested and applied. This includes the use of advanced therapies like tissue-engineered (TE) biomaterials and scaffolds. Currently, biocompatible antiadhesive constructs play a pivotal role in managing postoperative adhesions and several biopolymer-based products, namely hyaluronic acid (HA) and polyethylene glycol (PEG), are available on the market in different forms (e.g., sprays, hydrogels). TE polymeric constructs are usually associated with critical limitations like poor biocompatibility and mechanical properties. Hence, biocompatible nanocomposites have emerged as an advanced therapy for postoperative adhesion treatment, with hydrogels and electrospun nanofibers among the most utilized antiadhesive nanocomposites for in vitro and in vivo experiments. Recent studies have revealed that nanocomposites can be engineered to generate smart three-dimensional (3D) scaffolds that can respond to different stimuli, such as pH changes. Additionally, nanocomposites can act as multifunctional materials for the prevention of adhesions and bacterial infections, as well as tissue healing acceleration. Still, more research is needed to reveal the clinical potential of nanocomposite constructs and the possible success of nanocomposite-based products in the biomedical market.
Collapse
Affiliation(s)
- Saeid Kargozar
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Sara Gorgani
- Tissue Engineering Research Group (TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran; (S.G.); (S.N.)
| | - Simin Nazarnezhad
- Tissue Engineering Research Group (TERG), Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 917794-8564, Iran; (S.G.); (S.N.)
| | - Andrew Z. Wang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX 75390, USA;
| |
Collapse
|
4
|
Lang P, Liu T, Huang S, Zhou Z, Zhang M, Lin Y, He Q, Yao Y, Liu Z, Zhang L. Degradable Temperature-Sensitive Hydrogel Loaded with Heparin Effectively Prevents Post-Operative Tissue Adhesions. ACS Biomater Sci Eng 2023. [PMID: 37179492 DOI: 10.1021/acsbiomaterials.3c00017] [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: 05/15/2023]
Abstract
Tissue adhesions could occur following surgeries, and severe tissue adhesions can lead to serious complications. Medical hydrogels could be applied at surgical sites as a physical barrier to prevent tissue adhesion. For practical reasons, spreadable, degradable, and self-healable gels are highly demanded. To meet these requirements, we applied carboxymethyl chitosan (CMCS) to poloxamer-based hydrogels to generate low Poloxamer338 (P338) content gels displaying low viscosity at refrigerator temperature and improved mechanical strength at body temperature. Heparin, an effective adhesion inhibitor, was also added to construct P338/CMCS-heparin composite hydrogel (PCHgel). PCHgel presents as a flowable liquid below 20 °C and could rapidly transform into gel when spread on the surface of damaged tissue due to temperature change. The introduction of CMCS enabled hydrogels to form a stable self-healable barrier at injured positions and slowly release heparin during the wound healing period before being degraded after ∼14 days. Ultimately, PCHgel significantly reduced tissue adhesion in model rats and displayed higher efficiency than P338/CMCS gel without heparin. Its adhesion suppression mechanism was verified, and it also displayed good biosafety. Therefore, PCHgel showed good clinical transformation potential with high efficacy, good safety, and ease of use.
Collapse
Affiliation(s)
- Puxin Lang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Tiantian Liu
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Shiqi Huang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Zhaojie Zhou
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Mengxing Zhang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Yunzhu Lin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610000, P. R. China
| | - Qin He
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610000, P. R. China
| | - Yuqin Yao
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Ling Zhang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| |
Collapse
|
5
|
Ensan B, Bathaei P, Nassiri M, Khazaei M, Hassanian SM, Abdollahi A, Ghorbani HR, Aliakbarian M, Ferns GA, Avan A. The Therapeutic Potential of Targeting Key Signaling Pathways as a Novel Approach to Ameliorating Post-Surgical Adhesions. Curr Pharm Des 2022; 28:3592-3617. [PMID: 35466868 DOI: 10.2174/1381612828666220422090238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/24/2022] [Accepted: 02/04/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Peritoneal adhesions (PA) are a common complication of abdominal operations. A growing body of evidence shows that inhibition of inflammation and fibrosis at sites of peritoneal damaging could prevent the development of intra-abdominal adhesions. METHODS A search of PubMed, Medline, CINAHL and Embase databases was performed using the keywords 'postsurgical adhesion', 'post-operative adhesion', 'peritoneal adhesion', 'surgery-induced adhesion' and 'abdominal adhesion'. Studies detailing the use of pharmacological and non-pharmacological agents for peritoneal adhesion prevention were identified, and their bibliographies were thoroughly reviewed to identify further related articles. RESULTS Several signaling pathways, such as tumor necrosis factor-alpha, tissue plasminogen activator, and type 1 plasminogen activator inhibitor, macrophages, fibroblasts, and mesothelial cells play a key part in the development of plasminogen activator. Several therapeutic approaches based on anti-PA drug barriers and traditional herbal medicines have been developed to prevent and treat adhesion formation. In recent years, the most promising method to prevent PA is treatment using biomaterial-based barriers. CONCLUSION In this review, we provide an overview of the pathophysiology of adhesion formation and various agents targeting different pathways, including chemical agents, herbal agents, physical barriers, and clinical trials concerning this matter.
Collapse
Affiliation(s)
- Behzad Ensan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Parsa Bathaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Nassiri
- Recombinant Proteins Research Group, The Research Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Majid Khazaei
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Mahdi Hassanian
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Abdollahi
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Ghorbani
- Orology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Aliakbarian
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Amir Avan
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Basic Sciences Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Medical Genetics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
6
|
Wang R, Guo T, Li J. Mechanisms of Peritoneal Mesothelial Cells in Peritoneal Adhesion. Biomolecules 2022; 12:biom12101498. [PMID: 36291710 PMCID: PMC9599397 DOI: 10.3390/biom12101498] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022] Open
Abstract
A peritoneal adhesion (PA) is a fibrotic tissue connecting the abdominal or visceral organs to the peritoneum. The formation of PAs can induce a variety of clinical diseases. However, there is currently no effective strategy for the prevention and treatment of PAs. Damage to peritoneal mesothelial cells (PMCs) is believed to cause PAs by promoting inflammation, fibrin deposition, and fibrosis formation. In the early stages of PA formation, PMCs undergo mesothelial–mesenchymal transition and have the ability to produce an extracellular matrix. The PMCs may transdifferentiate into myofibroblasts and accelerate the formation of PAs. Therefore, the aim of this review was to understand the mechanism of action of PMCs in PAs, and to offer a theoretical foundation for the treatment and prevention of PAs.
Collapse
Affiliation(s)
- Ruipeng Wang
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730030, China
| | - Tiankang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730030, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730030, China
| | - Junliang Li
- The First School of Clinical Medical, Gansu University of Chinese Medicine, Lanzhou 730030, China
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730030, China
- The First School of Clinical Medicine, Lanzhou University, Lanzhou 730030, China
- Correspondence:
| |
Collapse
|
7
|
Akhlaghi S, Rabbani S, Karimi H, Haeri A. Hyaluronic acid gel incorporating curcumin-phospholipid complex nanoparticles prevents postoperative peritoneal adhesion. J Pharm Sci 2022. [DOI: 10.1016/j.xphs.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Intraperitoneal Lavage with Crocus sativus Prevents Postoperative-Induced Peritoneal Adhesion in a Rat Model: Evidence from Animal and Cellular Studies. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:5945101. [PMID: 34956439 PMCID: PMC8702342 DOI: 10.1155/2021/5945101] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 12/31/2022]
Abstract
Postoperative peritoneal adhesions are considered the major complication following abdominal surgeries. The primary clinical complications of peritoneal adhesion are intestinal obstruction, infertility, pelvic pain, and postoperative mortality. In this study, regarding the anti-inflammatory and antioxidant activities of Crocus sativus, we aimed to evaluate the effects of Crocus sativus on the prevention of postsurgical-induced peritoneal adhesion. Male Wistar-Albino rats were used to investigate the preventive effects of C. sativus extract (0.5%, 0.25% and 0.125% w/v) against postsurgical-induced peritoneal adhesion compared to pirfenidone (PFD, 7.5% w/v). We also investigated the protective effects of PFD (100 μg/ml) and C. sativus extract (100, 200, and 400 μg/ml) in TGF-β1-induced fibrotic macrophage polarization. The levels of cell proliferation and oxidative, antioxidative, inflammatory and anti-inflammatory, fibrosis, and angiogenesis biomarkers were evaluated both in vivo and in vitro models. C. sativus extract ameliorates postoperational-induced peritoneal adhesion development by attenuating oxidative stress [malondialdehyde (MDA)]; inflammatory mediators [interleukin- (IL-) 6, tumour necrosis factor- (TNF-) α, and prostaglandin E2 (PGE2)]; fibrosis [transforming growth factor- (TGF-) β1, IL-4, and plasminogen activator inhibitor (PAI)]; and angiogenesis [vascular endothelial growth factor (VEGF)] markers, while propagating antioxidant [glutathione (GSH)], anti-inflammatory (IL-10), and fibrinolytic [tissue plasminogen activator (tPA)] markers and tPA/PAI ratio. In a cellular model, we revealed that the extract, without any toxicity, regulated the levels of cell proliferation and inflammatory (TNF-α), angiogenesis (VEGF), anti-inflammatory (IL-10), M1 [inducible nitric oxide synthase (iNOS)] and M2 [arginase-1 (Arg 1)] biomarkers, and iNOS/Arg-1 ratio towards antifibrotic M1 phenotype of macrophage, in a concentration-dependent manner. Taken together, the current study indicated that C. sativus reduces peritoneal adhesion formation by modulating the macrophage polarization from M2 towards M1 cells.
Collapse
|
9
|
Weyers S, Capmas P, Huberlant S, Dijkstra JR, Hooker AB, Hamerlynck T, Debras E, De Tayrac R, Thurkow AL, Fernandez H. Safety and Efficacy of a Novel Barrier Film to Prevent Intrauterine Adhesion Formation after Hysteroscopic Myomectomy: The PREG1 Clinical Trial. J Minim Invasive Gynecol 2021; 29:151-157. [PMID: 34343712 DOI: 10.1016/j.jmig.2021.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To evaluate the safety and potential efficacy of a novel degradable polymer film (DPF) designed to act as a 7-day barrier to prevent intrauterine adhesions (IUAs) after hysteroscopic myomectomy. DESIGN A prospective single-arm, first-in-human clinical study. SETTING Multicenter study involving 6 centers in France, Belgium, and the Netherlands. PATIENTS Women aged 40 years or older with no plans to conceive who qualified for hysteroscopic myomectomy (at least 1 10-mm type 0, 1, or 2 myoma) and had a sounded length of the uterine cavity (fundus to exocervix) ranging between 6 cm and 9 cm were considered eligible for the study. INTERVENTIONS The DPF was inserted after hysteroscopic transcervical myoma resection. The women were followed up by a telephone call at 30 days and second-look hysteroscopy 4 to 8 weeks after the procedure. MEASUREMENTS AND MAIN RESULTS The chosen safety outcome measures were uterine perforation or cervical trauma at the time of the DPF insertion and unexpected fever, pain, or bleeding beyond 48 hours and up to 30 days after insertion, whereas the outcome measure for efficacy was the absence of IUAs on second-look hysteroscopy. A total of 23 women participated in the study. There were no incidents of uterine perforation or cervical trauma at the time of the DPF insertion. There were no reported adverse effects attributable to the DPF. On second-look hysteroscopy, 20 (87%) of the 23 women had no IUAs. CONCLUSION The DPF is a novel, easy-to-apply, and acceptable device to prevent IUAs, with very promising initial safety and efficacy data.
Collapse
Affiliation(s)
- Steven Weyers
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium (Drs. Weyers and Hamerlynck).
| | - Perrine Capmas
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, Le Kremlin-Bicêtre (Drs. Capmas, Debras, and Fernandez)
| | - Stephanie Huberlant
- Department of Gynecology and Obstetrics, Nîmes University Hospital, Nîmes (Drs. Huberlant and De Tayrac), France
| | - Jeroen R Dijkstra
- Department of Obstetrics and Gynaecology, Isala Hospital, Zwolle (Mr. Dijkstra)
| | - Angelo B Hooker
- Department of Obstetrics and Gynaecology, Zaans Medical Center, Zaandam (Dr. Hooker)
| | - Tjalina Hamerlynck
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium (Drs. Weyers and Hamerlynck)
| | - Elodie Debras
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, Le Kremlin-Bicêtre (Drs. Capmas, Debras, and Fernandez)
| | - Renaud De Tayrac
- Department of Gynecology and Obstetrics, Nîmes University Hospital, Nîmes (Drs. Huberlant and De Tayrac), France
| | - Andreas L Thurkow
- Department of Gynaecology, Bergman Clinics Amsterdam and Amsterdam University Medical Centres, Amsterdam (Dr. Thurkow), The Netherlands
| | - Herve Fernandez
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, Le Kremlin-Bicêtre (Drs. Capmas, Debras, and Fernandez)
| |
Collapse
|
10
|
Fatehi Hassanabad A, Zarzycki AN, Jeon K, Dundas JA, Vasanthan V, Deniset JF, Fedak PWM. Prevention of Post-Operative Adhesions: A Comprehensive Review of Present and Emerging Strategies. Biomolecules 2021; 11:biom11071027. [PMID: 34356652 PMCID: PMC8301806 DOI: 10.3390/biom11071027] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
Post-operative adhesions affect patients undergoing all types of surgeries. They are associated with serious complications, including higher risk of morbidity and mortality. Given increased hospitalization, longer operative times, and longer length of hospital stay, post-surgical adhesions also pose a great financial burden. Although our knowledge of some of the underlying mechanisms driving adhesion formation has significantly improved over the past two decades, literature has yet to fully explain the pathogenesis and etiology of post-surgical adhesions. As a result, finding an ideal preventative strategy and leveraging appropriate tissue engineering strategies has proven to be difficult. Different products have been developed and enjoyed various levels of success along the translational tissue engineering research spectrum, but their clinical translation has been limited. Herein, we comprehensively review the agents and products that have been developed to mitigate post-operative adhesion formation. We also assess emerging strategies that aid in facilitating precision and personalized medicine to improve outcomes for patients and our healthcare system.
Collapse
Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Anna N. Zarzycki
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Kristina Jeon
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R7, Canada;
| | - Jameson A. Dundas
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Vishnu Vasanthan
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
| | - Justin F. Deniset
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 2N9, Canada; (A.F.H.); (A.N.Z.); (J.A.D.); (V.V.); (J.F.D.)
- Correspondence:
| |
Collapse
|
11
|
Kheilnezhad B, Hadjizadeh A. A review: progress in preventing tissue adhesions from a biomaterial perspective. Biomater Sci 2021; 9:2850-2873. [PMID: 33710194 DOI: 10.1039/d0bm02023k] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Postoperative adhesions (POA) are one of the main problems suffered by patients and are a common complaint. It is considered to be closely associated with the healing mechanism of damaged tissues. Tissue adhesions accompany other symptoms such as inflammation, pain, and even dyskinesia under certain conditions, compromising the patients' quality of life. On the other hand, common treatments involve high costs, re-surgery or long-term hospital stays. Therefore, alternative approaches need to be formulated so that aforementioned problems can be resolved. To this end, a review of recent advances in this context is imperative. In this review, we have highlighted the mechanism of adhesion formation, advances in common therapeutic approaches, and prospective treatments in preventing tissue adhesions. Based on the literature, it can be determined that the disadvantages of available commercial products in the treatment of tissue adhesion have led researchers to utilize alternative methods for designing anti-adhesive products with different structures such as electrospun fibrous mats, hydrogels, and nanospheres. These studies are on the fast track in producing optimal anti-adhesion materials. We hope that this article can attract attention by showing various mechanisms and solutions involved in adhesion problems and inspire the further development of anti-adhesion biomaterials.
Collapse
Affiliation(s)
| | - Afra Hadjizadeh
- Department of Biomedical Engineering, Amirkabir University, Tehran, Iran.
| |
Collapse
|
12
|
Huberlant S, Leprince S, Allegre L, Warembourg S, Leteuff I, Taillades H, Garric X, de Tayrac R, Letouzey V. In Vivo Evaluation of the Efficacy and Safety of a Novel Degradable Polymeric Film for the Prevention of Intrauterine Adhesions. J Minim Invasive Gynecol 2020; 28:1384-1390. [PMID: 33152532 DOI: 10.1016/j.jmig.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To study the safety of a degradable polymeric film (DPF) and its efficacy on reducing the risk of intrauterine-adhesion (IUA) formation in a rat model. DESIGN A series of case-control studies relying on random allocation, where feasible. SETTING University and good practice animal laboratories. ANIMALS The animal models comprised female and male Oncins France Strain A and female Wistar rats. INTERVENTION(S) AND MEASUREMENTS The Oncins France Strain A rats were used for in vivo evaluation of the impact of the DPF on endometrial thickness and its effect on fertility. For in vivo evaluation of the biologic response, 40 Wistar rats were randomly allocated to intervention and control groups, with matched sampling time after surgery. Finally, for the in vivo evaluation of the DPF's efficacy on IUA prevention, a total of 24 Wistar rats were divided into 3 groups: 1 treated with the DPF, 1 treated with hyaluronic acid gel, and a sham group. MAIN RESULTS The DPF did not have a significant impact on endometrial thickness, and there were no significant differences in the number of conceived or prematurely terminated pregnancies, confirming its noninferiority to no treatment. The DPF did not induce irritation at 5 days and 28 days. Finally, the DPF significantly reduced the likelihood of complete IUA formation compared with hyaluronic acid gel- and sham-implanted animals, where only 27% of the animals had their uterine cavity obliterated compared with 80% and 100%, respectively. CONCLUSION The DPF is a safe film that is effective in preventing IUA formation after intrauterine curettage in rats.
Collapse
Affiliation(s)
- Stéphanie Huberlant
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France.
| | - Salome Leprince
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Lucie Allegre
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Sophie Warembourg
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Isabelle Leteuff
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Hubert Taillades
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Xavier Garric
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Renaud de Tayrac
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Vincent Letouzey
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| |
Collapse
|
13
|
Peritoneal adhesions: Occurrence, prevention and experimental models. Acta Biomater 2020; 116:84-104. [PMID: 32871282 DOI: 10.1016/j.actbio.2020.08.036] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/20/2022]
Abstract
Peritoneal adhesions (PA) are a postoperative syndrome with high incidence rate, which can cause chronic abdominal pain, intestinal obstruction, and female infertility. Previous studies have identified that PA are caused by a disordered feedback of blood coagulation, inflammation, and fibrinolysis. Monocytes, macrophages, fibroblasts, and mesothelial cells are involved in this process, and secreted signaling molecules, such as tumor necrosis factor alpha (TNF-α), interleukin-10 (IL-10), tissue plasminogen activator (tPA), and type 1 plasminogen activator inhibitor (PAI-1), play a key role in PA development. There have been many attempts to prevent PA formation by anti-PA drugs, barriers, and other therapeutic methods, but their effectiveness has not been widely accepted. Treatment by biomaterial-based barriers is believed to be the most promising method to prevent PA formation in recent years. In this review, the pathogenesis, treatment approaches, and animal models of PA are summarized and discussed to understand the challenges faced in the biomaterial-based anti-PA treatments.
Collapse
|
14
|
The Effect of Extractum Cepae, Heparin Sodium, and Allantoin in Experimental Peritoneal Adhesion. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
15
|
Wang Z, Cui W. Two Sides of Electrospun Fiber in Promoting and Inhibiting Biomedical Processes. ADVANCED THERAPEUTICS 2020. [DOI: 10.1002/adtp.202000096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Zhen Wang
- Shanghai Institute of Traumatology and Orthopaedics Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| | - Wenguo Cui
- Shanghai Institute of Traumatology and Orthopaedics Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases Ruijin Hospital Shanghai Jiao Tong University School of Medicine 197 Ruijin 2nd Road Shanghai 200025 P. R. China
| |
Collapse
|
16
|
Park H, Baek S, Kang H, Lee D. Biomaterials to Prevent Post-Operative Adhesion. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E3056. [PMID: 32650529 PMCID: PMC7412384 DOI: 10.3390/ma13143056] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023]
Abstract
Surgery is performed to treat various diseases. During the process, the surgical site is healed through self-healing after surgery. Post-operative or tissue adhesion caused by unnecessary contact with the surgical site occurs during the normal healing process. In addition, it has been frequently found in patients who have undergone surgery, and severe adhesion can cause chronic pain and various complications. Therefore, anti-adhesion barriers have been developed using multiple biomaterials to prevent post-operative adhesion. Typically, anti-adhesion barriers are manufactured and sold in numerous forms, such as gels, solutions, and films, but there are no products that can completely prevent post-operative adhesion. These products are generally applied over the surgical site to physically block adhesion to other sites (organs). Many studies have recently been conducted to increase the anti-adhesion effects through various strategies. This article reviews recent research trends in anti-adhesion barriers.
Collapse
Affiliation(s)
- Heekyung Park
- Department of Biomedical Engineering, School of Integrative Engineering, Chung-Ang University, 221 Heukseok-Dong, Dongjak-Gu, Seoul 06974, Korea; (H.P.); (S.B.)
| | - Seungho Baek
- Department of Biomedical Engineering, School of Integrative Engineering, Chung-Ang University, 221 Heukseok-Dong, Dongjak-Gu, Seoul 06974, Korea; (H.P.); (S.B.)
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine and Graduate School of Medicine, Seoul 06973, Korea
| | - Donghyun Lee
- Department of Biomedical Engineering, School of Integrative Engineering, Chung-Ang University, 221 Heukseok-Dong, Dongjak-Gu, Seoul 06974, Korea; (H.P.); (S.B.)
| |
Collapse
|
17
|
Mayes SM, Davis J, Scott J, Aguilar V, Zawko SA, Swinnea S, Peterson DL, Hardy JG, Schmidt CE. Polysaccharide-based films for the prevention of unwanted postoperative adhesions at biological interfaces. Acta Biomater 2020; 106:92-101. [PMID: 32097711 PMCID: PMC8552357 DOI: 10.1016/j.actbio.2020.02.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 01/05/2023]
Abstract
Postoperative adhesions protect, repair, and supply nutrients to injured tissues; however, such adhesions often remain permanent and complicate otherwise successful surgeries by tethering tissues together that are normally separated. An ideal adhesion barrier should not only effectively prevent unwanted adhesions but should be easy to use, however, those that are currently available have inconsistent efficacy and are difficult to handle or to apply. A robust hydrogel film composed of alginate and a photo-crosslinkable hyaluronic acid (HA) derivative (glycidyl methacrylate functionalized hyaluronic acid (GMHA)) represents a solution to this problem. A sacrificial porogen (urea) was used in the film manufacture process to impart macropores that yield films that are more malleable and tougher than equivalent films produced without the sacrificial porogen. The robust mechanical behavior of these templated alginate/GMHA films directly facilitated handling characteristics of the barrier film. In a rat peritoneal abrasion model for adhesion formation, the polysaccharide films successfully prevented adhesions with statistical equivalence to the leading anti-adhesion technology on the market, Seprafilm®. STATEMENT OF SIGNIFICANCE: Postoperative adhesions often remain permanent and complicate otherwise successful surgeries by tethering tissues together that are normally separated and pose potentially significant challenges to patients. Therefore, the generation of adhesion barriers that are easy to deploy during surgery and effectively prevent unwanted adhesions is a big challenge. In this study robust hydrogel films composed of alginate and a photo-crosslinkable hyaluronic acid (HA) derivative (glycidyl methacrylate functionalized HA, GMHA) were fabricated and investigated for their potential to act as a solution to this problem using a rat peritoneal abrasion model for adhesion formation. We observed the polysaccharide films successfully prevented adhesions with statistical equivalence to the leading anti-adhesion technology on the market, Seprafilm®, suggesting that such films represent a promising strategy for the prevention of postoperative adhesions.
Collapse
Affiliation(s)
- Sarah M Mayes
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Jessica Davis
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Jessica Scott
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - Vanessa Aguilar
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA
| | - Scott A Zawko
- Department of Chemical Engineering, University of Texas at Austin, 200 E Dean Keeton St, Austin, TX 78712, USA
| | - Steve Swinnea
- Department of Chemical Engineering, University of Texas at Austin, 200 E Dean Keeton St, Austin, TX 78712, USA.
| | - Daniel L Peterson
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA.
| | - John G Hardy
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-53, P.O. Box 116131, Gainesville, FL 32611-6131, USA.
| | - Christine E Schmidt
- Department of Biomedical Engineering, University of Texas at Austin, 107W Dean Keeton St, Austin, TX 78712, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Biomedical Sciences Building JG-53, P.O. Box 116131, Gainesville, FL 32611-6131, USA.
| |
Collapse
|
18
|
Zavradashvili N, Puiggali J, Katsarava R. Artificial Polymers made of α-amino Acids - Poly(Amino Acid)s, Pseudo-Poly(Amino Acid)s, Poly(Depsipeptide)s, and Pseudo-Proteins. Curr Pharm Des 2020; 26:566-593. [DOI: 10.2174/1381612826666200203122110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/21/2019] [Indexed: 01/01/2023]
Abstract
Degradable polymers (DPs) - “green materials” of the future, have an innumerable use in biomedicine,
particularly in the fields of tissue engineering and drug delivery. Among these kind of materials naturally occurring
polymers - proteins which constituted one of the most important “bricks of life” - α-amino acids (AAs) are
highly suitable. A wide biomedical applicability of proteins is due to special properties such as a high affinity
with tissues and releasing AAs upon biodegradation that means a nutritive potential for cells. Along with these
positive characteristics proteins as biomedical materials they have some shortcomings, such as batch-to-batch
variation, risk of disease transmission, and immune rejection. The last limitation is connected with the molecular
architecture of proteins. Furthermore, the content of only peptide bonds in protein molecules significantly restricts
their material properties. Artificial polymers with the composition of AAs are by far more promising as degradable
biomaterials since they are free from the limitations of proteins retaining at the same time their positive
features - a high tissue compatibility and nutritive potential. The present review deals with a brief description of
different families of AA-based artificial polymers, such as poly(amino acid)s, pseudo-poly(amino acid)s, polydepsipeptides,
and pseudo-proteins - relatively new and broad family of artificial AA-based DPs. Most of these
polymers have a different macromolecular architecture than proteins and contain various types of chemical links
along with NH-CO bonds that substantially expands properties of materials destined for sophisticated biomedical
applications.
Collapse
Affiliation(s)
- Nino Zavradashvili
- Institute of Chemistry and Molecular Engineering, Agricultural University of Georgia, Kakha Bendukidze University Campus, # 240 David Aghmashenebeli Alley, Tbilisi 0131, Georgia
| | - Jordi Puiggali
- Departament d’Enginyeria Quimica, EEBE, Universitat Politecnica de Catalunya, Edifici I.2, C/Eduard Maristany, 10-14, Barcelona 08019, Spain
| | - Ramaz Katsarava
- Institute of Chemistry and Molecular Engineering, Agricultural University of Georgia, Kakha Bendukidze University Campus, # 240 David Aghmashenebeli Alley, Tbilisi 0131, Georgia
| |
Collapse
|