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Wang H, Huddleston S, Yang J, Ameer GA. Enabling Proregenerative Medical Devices via Citrate-Based Biomaterials: Transitioning from Inert to Regenerative Biomaterials. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2306326. [PMID: 38043945 DOI: 10.1002/adma.202306326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/03/2023] [Indexed: 12/05/2023]
Abstract
Regenerative medicine aims to restore tissue and organ function without the use of prosthetics and permanent implants. However, achieving this goal has been elusive, and the field remains mostly an academic discipline with few products widely used in clinical practice. From a materials science perspective, barriers include the lack of proregenerative biomaterials, a complex regulatory process to demonstrate safety and efficacy, and user adoption challenges. Although biomaterials, particularly biodegradable polymers, can play a major role in regenerative medicine, their suboptimal mechanical and degradation properties often limit their use, and they do not support inherent biological processes that facilitate tissue regeneration. As of 2020, nine synthetic biodegradable polymers used in medical devices are cleared or approved for use in the United States of America. Despite the limitations in the design, production, and marketing of these devices, this small number of biodegradable polymers has dominated the resorbable medical device market for the past 50 years. This perspective will review the history and applications of biodegradable polymers used in medical devices, highlight the need and requirements for regenerative biomaterials, and discuss the path behind the recent successful introduction of citrate-based biomaterials for manufacturing innovative medical products aimed at improving the outcome of musculoskeletal surgeries.
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Affiliation(s)
- Huifeng Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Samantha Huddleston
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
| | - Jian Yang
- Biomedical Engineering Program, School of Engineering, Westlake University, Hangzhou, Zhejiang, 310030, China
- Research Center for Industries of the Future, Westlake University, Hangzhou, Zhejiang, 310030, China
| | - Guillermo A Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, 60208, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, 60208, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
- Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, 60208, USA
- Simpson Querrey Institute, Northwestern University, Chicago, IL, 60611, USA
- International Institute for Nanotechnology, Northwestern University, Evanston, IL, 60208, USA
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Liu TM, Kiu KT, Yen MH, Tam KW, Chang TC. Efficacy and safety of purified starch for adhesion prevention in colorectal surgery. Heliyon 2023; 9:e21657. [PMID: 38028006 PMCID: PMC10656248 DOI: 10.1016/j.heliyon.2023.e21657] [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: 04/19/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Background Adhesions within the abdominal cavity develop in as many as 90 % of individuals following abdominal surgery. However, the true adhesive condition of patients can only be ascertained during the second surgery. Methods We conducted a prospective, non-randomized study to assess the anti-adhesion properties of purified starch in patients who had undergone colorectal surgery in the past and then needed a subsequent surgical intervention. Adhesion scores have been prospectively recorded in operation notes since January 2020 when patients underwent a second surgery. Patients who had received purified starch during their initial surgery constituted the purified starch group, while those who had not received anti-adhesion medical materials were the control group. The main objectives of the study were to evaluate the extent and severity of adhesions as primary outcomes, while secondary outcomes included measuring blood loss, operation time, and postoperative complications. Results We analyzed the data of 101 patients, with 61 in the purified starch group and 40 in the control group. In multivariate analysis, adhesion severity (Odds ratio, 0.20, 95 % confidence interval 0.08-0.54, P < 0.01) and adhesion area scores (Odds ratio, 0.13, 95 % confidence interval 0.04-0.45, P < 0.01) were significantly lower in the purified starch group than in the control group. There was no significant difference in operation times, blood loss, and postoperative complications between the two groups. Conclusion Purified starch is a safe and effective anti-adhesion material that can significantly reduce the severity and extent of adhesion after colorectal surgery.
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Affiliation(s)
- Tzu-Min Liu
- Department of General Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 112, Taiwan
| | - Kee-Thai Kiu
- Division of Colorectal Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
| | - Min-Hsuan Yen
- Division of Colorectal Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
| | - Ka-Wai Tam
- Division of General Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei City, Taiwan
| | - Tung-Cheng Chang
- Division of Colorectal Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, Number 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan
- Division of Colorectal Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
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Park HM, Park SJ, Kang MJ, Han SS, Kim SW. Postoperative Poor Oral Intake After Distal Pancreatectomy. Pancreas 2022; 51:1337-1344. [PMID: 37099776 DOI: 10.1097/mpa.0000000000002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Poor oral intake (POI) without an identifiable cause is frequently observed after distal pancreatectomy (DP). This study was designed to investigate the incidence and risk factors of POI after DP, and its impact on the length of hospital stay. METHODS The prospectively collected data of patients who received DP were retrospectively reviewed. A diet protocol after DP was followed, and POI after DP was defined as the oral intake being less than 50% of the daily requirement and parenteral calorie supply being required on postoperative day 7. RESULTS Of the 157 patients, 21.7% (34) experienced POI after DP. The multivariate analysis revealed that the remnant pancreatic margin (head; hazard ratio, 7.837; 95% confidence interval, 2.111-29.087; P = 0.002) and postoperative hyperglycemia >200 mg/dL (hazard ratio, 5.643; 95% confidence interval, 1.482-21.494; P = 0.011) were independent risk factors for POI after DP. The length of hospital stay (median [range]) of the POI group was significantly longer than that of the normal diet group (17 [9-44] vs 10 [5-44] days; P < 0.001). CONCLUSIONS Patients undergoing pancreatic resection at pancreatic head portion should follow a postoperative diet, and postoperative glucose levels should be strictly regulated.
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Affiliation(s)
- Hyeong Min Park
- From the Department of Surgery, Center for Liver and Pancreatobiliary Cancer
| | - Sang-Jae Park
- From the Department of Surgery, Center for Liver and Pancreatobiliary Cancer
| | - Mee Joo Kang
- The Korea Central Cancer Registry, National Cancer Center, Goyang-Si
| | - Sung-Sik Han
- From the Department of Surgery, Center for Liver and Pancreatobiliary Cancer
| | - Sun-Whe Kim
- Department of Surgery, Chung-Ang University Gwang-Myeong Hospital, Gwangmyeong-Si, Korea
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Żywicka B, Struszczyk MH, Paluch D, Kostanek K, Krucińska I, Kowalski K, Kopias K, Rybak Z, Szymonowicz M, Gutowska A, Kubiak P. Design of New Concept of Knitted Hernia Implant. MATERIALS 2022; 15:ma15072671. [PMID: 35408005 PMCID: PMC9000569 DOI: 10.3390/ma15072671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Abstract
A knitted implant, unilaterally modified with plasma-assisted chemical-vapor deposition (PACVD), and with a nano-layer of fluorine derivative supplementation, for reducing the risk of complications related to adhesions, and the formation of a thick postoperative scar was prepared. The biological evaluation of designed or modified medical devices is the main aspect of preclinical research. If such studies use a medical device with prolonged contact with connective tissue (more than 30 days), biocompatibility studies require a safety assessment in terms of toxicity in vitro and in vivo, allergenicity, irritation, and cancerogenicity, reproductive and developmental toxicity. The ultimate aspect of biological evaluation is biofunctionality, and evaluation of the local tissue response after implantation, resulting in the determination of all aspects of local biocompatibility with the implemented synthetic material. The implantation of PACVD-modified materials in muscle allows us to estimate the local irritation effect on the connective tissue, determining the risk of scar formation, whereas implantation of the above-mentioned knitted fabric into the abdominal wall, assists with evaluating the risk of fistula formation-the main post-surgical complications. The research aimed to evaluate the local reaction of the soft tissues after the implantation of the knitted implants modified with PACVD of the fluoropolymer in the nanostuctural form. The local effect that occurred during the implantation of the designed implants was quantitatively and qualitatively evaluated when PACVD unmodified (reference), and modified medical devices were implanted in the abdominal cavity (intra-abdominal position) for 12 or into the muscles for 56 weeks. The comparative semi-quantitative histological assessment included the severity of inflammatory cells (multinucleated cells, lymphocytes, plasma cells, macrophages, giant cells) and the tissue response (necrosis, neovascularization, fibrosis, and fat infiltration) on a five-point scale. The knitted implants modified by PACVD did not indicate cumulative tissue response when they were implanted in the muscle and intra-abdominally with direct contact with the viscera. They reduced local tissue reaction (score -2.71 after 56 weeks of the implantation) and internal organ adhesion (irritation score -2.01 and adhesion susceptibility -0.3 after 12 weeks of the implantation) compared with the reference (unmodified by PACVD) knitted implant, which had an identical structure and was made of the same source.
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Affiliation(s)
- Bogusława Żywicka
- Pre-clinical Research Center, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (D.P.); (Z.R.); (M.S.)
- Correspondence:
| | - Marcin Henryk Struszczyk
- Institute of Security Technologies “MORATEX”, Curie-Sklodowskiej 3, 90-505 Lodz, Poland; (M.H.S.); (A.G.); (P.K.)
| | - Danuta Paluch
- Pre-clinical Research Center, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (D.P.); (Z.R.); (M.S.)
| | - Krzysztof Kostanek
- Łukasiewicz Research Network—Textile Research Institute, Brzezińska 5/15, 92-103 Lodz, Poland;
| | - Izabella Krucińska
- Department of Material and Commodity Sciences and Textile Metrology, Faculty of Material Technologies and Textile Design, Technological University of Lodz, Zeromskiego 116, 90-924 Lodz, Poland;
| | - Krzysztof Kowalski
- Department of Knitting Technology, Faculty of Material Technologies and Textile Design, Technological University of Lodz, Zeromskiego 116, 90-924 Lodz, Poland; (K.K.); (K.K.)
| | - Kazimierz Kopias
- Department of Knitting Technology, Faculty of Material Technologies and Textile Design, Technological University of Lodz, Zeromskiego 116, 90-924 Lodz, Poland; (K.K.); (K.K.)
| | - Zbigniew Rybak
- Pre-clinical Research Center, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (D.P.); (Z.R.); (M.S.)
| | - Maria Szymonowicz
- Pre-clinical Research Center, Wroclaw Medical University, Pasteura 1, 50-367 Wroclaw, Poland; (D.P.); (Z.R.); (M.S.)
| | - Agnieszka Gutowska
- Institute of Security Technologies “MORATEX”, Curie-Sklodowskiej 3, 90-505 Lodz, Poland; (M.H.S.); (A.G.); (P.K.)
| | - Paweł Kubiak
- Institute of Security Technologies “MORATEX”, Curie-Sklodowskiej 3, 90-505 Lodz, Poland; (M.H.S.); (A.G.); (P.K.)
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Liu W, Xie Y, Zheng Y, He W, Qiao K, Meng H. Regulatory science for hernia mesh: Current status and future perspectives. Bioact Mater 2021; 6:420-432. [PMID: 32995670 PMCID: PMC7490592 DOI: 10.1016/j.bioactmat.2020.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022] Open
Abstract
Regulatory science for medical devices aims to develop new tools, standards and approaches to assess the safety, effectiveness, quality and performance of medical devices. In the field of biomaterials, hernia mesh is a class of implants that have been successfully translated to clinical applications. With a focus on hernia mesh and its regulatory science system, this paper collected and reviewed information on hernia mesh products and biomaterials in both Chinese and American markets. The current development of regulatory science for hernia mesh, including its regulations, standards, guidance documents and classification, and the scientific evaluation of its safety and effectiveness was first reported. Then the research prospect of regulatory science for hernia mesh was discussed. New methods for the preclinical animal study and new tools for the evaluation of the safety and effectiveness of hernia mesh, such as computational modeling, big data platform and evidence-based research, were assessed. By taking the regulatory science of hernia mesh as a case study, this review provided a research basis for developing a regulatory science system of implantable medical devices, furthering the systematic evaluation of the safety and effectiveness of medical devices for better regulatory decision-making. This was the first article reviewing the regulatory science of hernia mesh and biomaterial-based implants. It also proposed and explained the concepts of evidence-based regulatory science and technical review for the first time.
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Affiliation(s)
- Wenbo Liu
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
- Center for Medical Device Evaluation, National Medical Products Administration, Intellectual Property Publishing House Mansion, Qixiang Road, Haidian District, Beijing, China
| | - Yajie Xie
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Yudong Zheng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Wei He
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Kun Qiao
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
| | - Haoye Meng
- School of Material Science and Engineering, University of Science and Technology Beijing, 30 Xueyuan Road, Haidian District, Beijing, China
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Preparation of a cross-linked cartilage acellular matrix-poly (caprolactone-ran-lactide-ran-glycolide) film and testing its feasibility as an anti-adhesive film. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 117:111283. [DOI: 10.1016/j.msec.2020.111283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/28/2020] [Accepted: 07/19/2020] [Indexed: 12/29/2022]
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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.
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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.
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Guidelines for Perioperative Care for Pancreatoduodenectomy: Enhanced Recovery After Surgery (ERAS) Recommendations 2019. World J Surg 2020; 44:2056-2084. [DOI: 10.1007/s00268-020-05462-w] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Moon JH, Park JH, Jeong JH, Sung NS, Jeong YG, Song KC, Ahn JP, Lee NS, Han SY. Metformin-loaded Citric Acid Cross-linked Agarose Films in the Prevention of Postoperative Abdominal Adhesion. ACTA ACUST UNITED AC 2019. [DOI: 10.11637/aba.2019.32.4.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ji Hyun Moon
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Jong Ho Park
- Department of Biomedical Material, College of Medical Engineering, Konyang University, Korea
| | - Ji Heun Jeong
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Nak Song Sung
- Department of General Surgery, Konyang University Hospital, Korea
| | - Young Gil Jeong
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Ki Chang Song
- Department of Biomedical Material, College of Medical Engineering, Konyang University, Korea
| | - Jong Pil Ahn
- Korea Institute of Ceramic Engineering and Technology, Korea
| | - Nam-Seob Lee
- Department of Anatomy, College of Medicine, Konyang University, Korea
| | - Seung Yun Han
- Department of Anatomy, College of Medicine, Konyang University, Korea
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