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Dai Y, Inagaki NF, Ueki R, Sando S, Hasegawa K, Ito T. Hepatocyte Growth Factor DNA Aptamer for Prevention of Postoperative Peritoneal Adhesion via Enhancement of Fibrinolysis and Inhibition of Mesothelial Mesenchymal Transition. ACS APPLIED BIO MATERIALS 2024; 7:4679-4689. [PMID: 38963794 DOI: 10.1021/acsabm.4c00507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Postoperative peritoneal adhesion (PPA) is a prevalent complication of abdominal surgery, posing a significant hindrance to postsurgical recovery. Although several strategies have been developed to alleviate and prevent adhesions, their efficacy remains unsatisfactory. For the first time, we studied the therapeutic effect and mechanism of our recently developed thermally stable oligonucleotide-based mimetics of hepatocyte growth factor (HGF DNA aptamer) to prevent PPA. The HGF DNA aptamer effectively inhibited canonical TGF-β1 signaling transduction, partially suppressing mesothelial mesenchymal transition. Additionally, the aptamer, respectively, upregulated and downregulated the expression of tissue plasminogen activator and plasminogen activator inhibitor 1, thereby enhancing fibrinolytic activity. As a pleiotropic factor, the HGF DNA aptamer also enhanced the migratory and proliferative capacities of mesothelial cells. Finally, the aptamer demonstrated a higher level of effectiveness in preventing PPAs than the commercially available antiperitoneal adhesion barrier, Seprafilm. Due to its therapeutic benefits, excellent stability, biosafety, cost-effectiveness, and versatility, the HGF DNA aptamer demonstrates promise for preventing PPA in future clinical settings.
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Affiliation(s)
- Yizhou Dai
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Natsuko F Inagaki
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Department of Radiology and Biomedical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Ryosuke Ueki
- Department of Chemistry & Biotechnology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Shinsuke Sando
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Department of Chemistry & Biotechnology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Taichi Ito
- Department of Chemical System Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Department of Bioengineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan
- Department of Radiology and Biomedical Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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Lu Y, Elrod J, Herrmann M, Knopf J, Boettcher M. Neutrophil Extracellular Traps: A Crucial Factor in Post-Surgical Abdominal Adhesion Formation. Cells 2024; 13:991. [PMID: 38891123 PMCID: PMC11171752 DOI: 10.3390/cells13110991] [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: 04/07/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Post-surgical abdominal adhesions, although poorly understood, are highly prevalent. The molecular processes underlying their formation remain elusive. This review aims to assess the relationship between neutrophil extracellular traps (NETs) and the generation of postoperative peritoneal adhesions and to discuss methods for mitigating peritoneal adhesions. A keyword or medical subject heading (MeSH) search for all original articles and reviews was performed in PubMed and Google Scholar. It included studies assessing peritoneal adhesion reformation after abdominal surgery from 2003 to 2023. After assessing for eligibility, the selected articles were evaluated using the Critical Appraisal Skills Programme checklist for qualitative research. The search yielded 127 full-text articles for assessment of eligibility, of which 7 studies met our criteria and were subjected to a detailed quality review using the Critical Appraisal Skills Programme (CASP) checklist. The selected studies offer a comprehensive analysis of adhesion pathogenesis with a special focus on the role of neutrophil extracellular traps (NETs) in the development of peritoneal adhesions. Current interventional strategies are examined, including the use of mechanical barriers, advances in regenerative medicine, and targeted molecular therapies. In particular, this review emphasizes the potential of NET-targeted interventions as promising strategies to mitigate postoperative adhesion development. Evidence suggests that in addition to their role in innate defense against infections and autoimmune diseases, NETs also play a crucial role in the formation of peritoneal adhesions after surgery. Therefore, therapeutic strategies that target NETs are emerging as significant considerations for researchers. Continued research is vital to fully elucidate the relationship between NETs and post-surgical adhesion formation to develop effective treatments.
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Affiliation(s)
- Yuqing Lu
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Julia Elrod
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Martin Herrmann
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Department of Internal Medicine 3—Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Jasmin Knopf
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Ren Y, Li G, Li E, Deng K, Lian J, Gao Q, Wang H, Wang X, Wang Z, Shen T, Jiang Z, Li X, Qiu G. Luteolin blocks the ROS/PI3K/AKT pathway to inhibit mesothelial-mesenchymal transition and reduce abdominal adhesions. Eur J Pharmacol 2024; 964:176272. [PMID: 38110140 DOI: 10.1016/j.ejphar.2023.176272] [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: 07/26/2023] [Revised: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Postoperative abdominal adhesion (PAA) is a common postoperative complication. Clinically, various methods have been used to prevent the occurrence of PAA, such as drugs and physiotherapy; however, no satisfactory results have been obtained. Luteolin (LUT) is a natural flavonoid that reduces inflammation and acts as an antioxidant. This research aimed to examine the impact and mechanism of LUT in reducing PAA. METHODS C57/BL6 mice were used in vivo experiments. PAA model was established using a brush friction method. Visual scoring and hematoxylin and eosin staining were used to score the severity of adhesions. Network pharmacology was used to infer potential targets and core pathways of LUT. Hydrogen peroxide (H2O2) was used to induce oxidative stress in vitro, while the reactive oxygen species (ROS) assay kit was used to evaluate oxidative stress levels. Western blotting, cell immunofluorescence, and multiple immunofluorescence assays were used to detect α-SMA, vimentin, E-cadherin, collagen I, or AKT phosphorylation level. Scratch assay was used to detect cell migration. RESULTS LUT reduced the degree of PAA in mice. It attenuated H2O2-induced ROS production and reversed mesothelial-mesenchymal transition (MMT) in HMrSV5 cells. Network pharmacology analysis showed that LUT likely exerted anti-adhesion activity by regulating the PI3K-Akt signaling pathway. Phosphorylated Akt levels were significantly reduced in LUT-treated HMrSV5 cells. LUT also significantly reduced the expression of vimentin and collagen I in adherent tissues and upregulated E-cadherin expression. CONCLUSION LUT blocks the ROS/PI3K/AKT pathway, thereby inhibiting MMT and reducing PAA. To this end, LUT has potential in PAA therapy.
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Affiliation(s)
- Yiwei Ren
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Gan Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Enmeng Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Kai Deng
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Jie Lian
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Qi Gao
- Department of General Surgery, Shaanxi Provincial People's Hospital, Xi'an Medical University, 710061 Xi'an, Shaanxi, China
| | - Huijun Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xingjie Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Zijun Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Tianli Shen
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Zhengdong Jiang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China; Department of Talent Highland, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
| | - Guanglin Qiu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China.
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Wintjens AGWE, Fransen PPKH, Lenaerts K, Liu H, van Almen GC, van Steensel S, Gijbels MJ, de Hingh IHJT, Dankers PYW, Bouvy ND. Development of a Supramolecular Hydrogel for Intraperitoneal Injections. Macromol Biosci 2024; 24:e2300005. [PMID: 36934315 DOI: 10.1002/mabi.202300005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/22/2023] [Indexed: 03/20/2023]
Abstract
Local intraperitoneal drug administration is considered a challenging drug delivery route. The therapeutic efficiency is low, mainly due to rapid clearance of drugs. To increase the intraperitoneal retention time of specific drugs, a pH-sensitive supramolecular hydrogel that can act as a drug delivery vehicle is developed. To establish the optimal formulation of the hydrogel and to study its feasibility, safety, and tissue compatibility, in vitro, postmortem, and in vivo experiments are performed. In vitro tests reveal that a hydrogelator formulation with pH ≥ 9 results in a constant viscosity of 0.1 Pa·s. After administration postmortem, the hydrogel covers the parietal and visceral peritoneum with a thin, soft layer. In the subsequent in vivo experiments, 14 healthy rats are subjected to intraperitoneal injection with the hydrogel. Fourteen and 28 days after implantation, the animals are euthanized. Intraperitoneal exposure to the hydrogel is not resulted in significant weight loss or discomfort. Moreover, no macroscopic adverse effects or signs of organ damage are detected. In several intra-abdominal tissues, vacuolated macrophages are found indicating a physiological degradation of the synthetic hydrogel. This study demonstrates that the supramolecular hydrogel is safe for intraperitoneal application and that the hydrogel shows good tissue compatibility in rats.
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Affiliation(s)
- Anne G W E Wintjens
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
- NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6211LK, The Netherlands
| | | | - Kaatje Lenaerts
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
- NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6211LK, The Netherlands
| | - Hong Liu
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
- NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6211LK, The Netherlands
| | | | - Sebastiaan van Steensel
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
| | - Marion J Gijbels
- NUTRIM - School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, 6211LK, The Netherlands
- Department of Pathology, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
| | - Ignace H J T de Hingh
- GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, 6211LK, The Netherlands
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, 5623EJ, The Netherlands
| | - Patricia Y W Dankers
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612AE, The Netherlands
- Department of Biomedical Engineering, Laboratory of Chemical Biology, Eindhoven University of Technology, Eindhoven, 5612AE, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6202AZ, The Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam University Medical Center, Amsterdam, 1081HV, The Netherlands
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Pires AARD, Takiya CM, Silva PC, Manso JEF. Gastrotomy followed by gastrorrhaphy as a reliable and more physiologic technique for inducing peritoneal adhesion in rats. Rev Col Bras Cir 2023; 50:e20233453. [PMID: 37531501 PMCID: PMC10508687 DOI: 10.1590/0100-6991e-20233453-en] [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: 08/18/2022] [Accepted: 03/15/2023] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVE this research objective was to develop a new peritoneal adhesion animal model that would lead to adhesions formation in all operated animals, simple and reproducible, associated with maintenance the animal's health. METHODS eighteen adult male Wistar rats (Rattus norvegicus) were randomly distributed into three groups: Control Group (anatomical and clinical parameters), Sham Group (delicate manipulation of the stomach and exposure of the peritoneal cavity to ambient air) and Surgery Group (gastrotomy followed by gastrorrhaphy). The animals were analyzed and classificated macroscopically according to two adhesion classification models and differences between groups were considered significant when p<0.05. RESULTS the six animals in the control group had no peritoneal adhesions, three of the six animals in the sham group had focal peritoneal adhesions, and all animals in the surgery group (gastrotomy followed by gastrorraphy) had firm peritoneal adhesions. All adhesions found were macroscopically quantified and microscopically confirmed, without carrying out a microscopic classification of the adhesions. CONCLUSION the new model developed of gastrotomy followed by gastrorrhaphy, proved to be safe and efficient to induce and study peritoneal adhesions.
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Affiliation(s)
- Antonio Augusto Ribeiro Dias Pires
- - Universidade Federal do Rio de Janeiro, Departamento de Cirurgia Experimental - Rio de Janeiro - RJ - Brasil
- - Hospital Naval Marcílio Dias - Rio de Janeiro - RJ - Brasil
| | - Christina Maeda Takiya
- - Universidade Federal do Rio de Janeiro, Departamento de Cirurgia Experimental - Rio de Janeiro - RJ - Brasil
| | - Paulo Cesar Silva
- - Universidade Federal do Rio de Janeiro, Departamento de Cirurgia Experimental - Rio de Janeiro - RJ - Brasil
| | - José Eduardo Ferreira Manso
- - Universidade Federal do Rio de Janeiro, Departamento de Cirurgia Experimental - Rio de Janeiro - RJ - Brasil
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Akkurt Yıldırım M, Demirbilek M, Kızılbey K, Kaplan E, Türkoğlu N. Evaluation of triacetin on mechanical strength and free surface energy of PHBHHx: The prevention of intra-abdominal adhesion. J BIOACT COMPAT POL 2023. [DOI: 10.1177/08839115221149726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Several polymers are used for the preparation of biomaterials as membranes and films for tissue engineering applications. The most common plasticizer is PEG to obtain polymer-based biomaterials. On the other hand, triacetin is a non-toxic, FDA-approved plasticizer mostly used in the food industry. In this study, we used triacetin as a plasticizer to obtain hydrophobic membranes for the prevention of intra-abdominal adhesion. We selected a well-known polymer named PHBHHx which is a bacterial polyester generally used as supporting material for cell attachments in regenerative tissue applications. We evaluated the triacetin as a plasticizer and its effect on mechanical, thermal, surface area, pore size, and surface energy. The hydrophobic/hydrophilic contrast of a biomaterial surface determines the biological response. Surface hydrophobicity is critical for the cellular response. The contact angle tests of PHBHHx revealed that the hydrophilicity of the membrane was decreased following triacetin blending. Modification of the PHBHHx membrane by blending with triacetin caused a significant decrease in cell adhesion. The cell attachment rates of PHBHHx membranes were as 95 ± 5% on the first day, 34.5 ± 0.9% on third day, and 23 ± 1.5% on the fifth day, respectively. The rates of cell attachments on PHBHHx/triacetin membranes were determined as 79 ± 2.5% for the first day, 33 ± 2.7% for the third day, and 13 ± 2.1% for the fifth day, respectively. Besides, triacetin blending decreased the surface area from 38.790 to 32.379 m2/g. The elongation at breaks was observed as 128% for PHBHHx and 171% for PHBHHx/triacetin. Graphical abstract [Formula: see text]
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Affiliation(s)
- Meryem Akkurt Yıldırım
- Department of Molecular Biology and Genetics, Yıldız Technical University, Istanbul, Turkey
| | - Murat Demirbilek
- Advanced Technologies Application and Research Center, Hacettepe University, Ankara, Turkey
| | - Kadriye Kızılbey
- Biomedical Engineering Department, İstanbul Yeni Yüzyıl University, İstanbul, Turkey
| | - Engin Kaplan
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, Istanbul University-Cerrahpasa, İstanbul, Turkey
| | - Nelisa Türkoğlu
- Department of Molecular Biology and Genetics, Yıldız Technical University, Istanbul, Turkey
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Oral Administration Evaluation of the Hydro-Ethanolic Extract of Ginger (Rhizome of Zingiber officinale) against Postoperative-Induced Peritoneal Adhesion: Investigating the Role of Anti-Inflammatory and Antioxidative Effects. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2023; 2023:4086631. [PMID: 36865747 PMCID: PMC9974257 DOI: 10.1155/2023/4086631] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/10/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023]
Abstract
Peritoneal adhesions (PAs) occur and develop after abdominal surgery. Abdominal adhesions are common and often develop after abdominal surgery. Currently, there are no effective targeted pharmacotherapies for treating adhesive disease. In this regard, ginger is wildly used in traditional medicine because of its anti-inflammatory and antioxidant effects and has been investigated for peritoneal adhesion treatment. This study analyzed ginger ethanolic extraction via HPLC to have a 6-gingerol concentration. Four groups induced peritoneal adhesion to evaluate ginger's effects on peritoneal adhesion. Then, ginger extract (50, 150, and 450 mg/kg) was administered by gavage in various groups of male Wistar rats (220 ± 20 g, 6-8 weeks). After scarifying the animals for biological assessment, macroscopic and microscopic parameters were determined via scoring systems and immunoassays in the peritoneal lavage fluid. Next, the adhesion scores and interleukin IL-6, IL-10, tumor necrosis factor-(TNF-) α, transforming growth factor-(TGF-) β1, vascular endothelial growth factor (VEGF), and malondialdehyde (MDA) were elevated in the control group. The results showed that ginger extract (450 mg/kg) notably decreased inflammatory (IL-6 and TNF-α), fibrosis (TGF-β1), anti-inflammatory cytokine (IL-10), angiogenesis (VEGF), and oxidative (MDA) factors, while increased antioxidant factor glutathione (GSH), compared to the control group. These findings suggest that a hydro-alcoholic extract of ginger is a potentially novel therapeutic strategy for inhibiting adhesion formation. Also, it might be considered a beneficial anti-inflammatory or antifibrosis herbal medicine in clinical trials. However, further clinical studies are required to approve the effectiveness of ginger.
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Kazemi K, Hosseinzadeh A, Shahriarirad R, Nikeghbalian S, Kamran H, Hosseinpour P, Tanideh N, Jamshidi K. Comparison of Oral Sirolimus, Prednisolone, and Combination of Both in Experimentally Induced Peritoneal Adhesion. J Surg Res 2022; 276:168-173. [PMID: 35344743 DOI: 10.1016/j.jss.2022.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Peritoneal adhesion formation is a challenging postoperative complication. We aim to evaluate the effect of orally administered sirolimus, prednisolone, and their combination to prevent this entity. METHODS Eighty female albino underwent intraperitoneal injection of 3 mL of 10% sterile talc solution to induce peritoneal adhesion, and were subsequently and randomly divided into four groups (each n = 20); including a control group; 1 mg/kg oral prednisolone daily in the morning; 0.1 mg/kg oral sirolimus daily; and a combination group which received both drugs, with the same dosage. On the 29th day, abdominal cavities were explored, and classification was done based on Nair classification. RESULTS All rats were healthy on the 29th day, in which exploration was performed. The rats in the control group had extensive intra-abdominal adhesions, while 17 (85%) rats in the control group had substantial adhesion; however, the prednisolone, sirolimus, and combination group had lesser adhesion formation. Also, 14 (70%) rats of prednisolone group, 13 (65%) of sirolimus group, and 16 (80%) of combination group had insubstantial adhesion. The decrease in the grade of peritoneal adhesion bands was highly significant in the combination group (P > 0.001). CONCLUSIONS The combination of sirolimus and prednisolone was effective for preventing peritoneal adhesions in rats.
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Affiliation(s)
- Kourosh Kazemi
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Hosseinzadeh
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran.
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Saman Nikeghbalian
- Shiraz Transplant Center, Abu Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Science, Shiraz, Iran; Students Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Hosseinpour
- School of Medicine, Islamic Azad University, Kazeroun branch, Kazeroun, Iran
| | - Nader Tanideh
- Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Pharmacology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Jamshidi
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Gholami A, Abdoluosefi HE, Riazimontazer E, Azarpira N, Behnam M, Emami F, Omidifar N. Prevention of Postsurgical Abdominal Adhesion Using Electrospun TPU Nanofibers in Rat Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9977142. [PMID: 34993249 PMCID: PMC8727164 DOI: 10.1155/2021/9977142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 10/29/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Abstract
Intra-abdominal adhesions following surgery are a challenging problem in surgical practice. This study fabricated different thermoplastic polyurethane (TPU) nanofibers with different average diameters using the electrospinning method. The conditions were evaluated by scanning electron microscopy (SEM), atomic force microscope (AFM), and Fourier transform infrared spectrometer (FTIR) analysis. A static tensile test was applied using a strength testing device to assess the mechanical properties of the electrospun scaffolds. By changing the effective electrospinning parameters, the best quality of nanofibers could be achieved with the lowest bead numbers. The electrospun nanofibers were evaluated in vivo using a rat cecal abrasion model. The macroscopic evaluation and the microscopic study, including the degree of adhesion and inflammation, were investigated after three and five weeks. The resultant electrospun TPU nanofibers had diameters ranging from about 200 to 1000 nm. The diameters and morphology of the nanofibers were significantly affected by the concentration of polymer. Uniform TPU nanofibers without beads could be prepared by electrospinning through reasonable control of the process concentration. These nanofibers' biodegradability and antibacterial properties were investigated by weight loss measurement and microdilution methods, respectively. The purpose of this study was to provide electrospun nanofibers having biodegradability and antibacterial properties that prevent any adhesions or inflammation after pelvic and abdominal surgeries. The in vivo experiments revealed that electrospun TPU nanofibers reduced the degree of abdominal adhesions. The histopathological study confirmed only a small extent of inflammatory cell infiltration in the 8% and 10% TPU. Conclusively, nanofibers containing 8% TPU significantly decreased the incidence and severity of postsurgical adhesions, and it is expected to be used in clinical applications in the future.
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Affiliation(s)
- Ahmad Gholami
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Elham Riazimontazer
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medicinal Chemistry, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Organ Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohamadali Behnam
- Nano Opto-Electronic Research Center, Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Farzin Emami
- Nano Opto-Electronic Research Center, Electrical and Electronics Engineering Department, Shiraz University of Technology, Shiraz, Iran
| | - Navid Omidifar
- Biotechnology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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ShaykhoIslami A, Ghasemian M, Zardast M, Farzad M. Effect of intra-abdominal administration of ascites fluid on postoperative peritoneal adhesion in rat model: A randomized controlled trail. Ann Med Surg (Lond) 2021; 71:102928. [PMID: 34659745 PMCID: PMC8503846 DOI: 10.1016/j.amsu.2021.102928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Intra-abdominal adhesions are typically found after the most surgical procedures. Normally, most adhesions are asymptomatic; however, few individuals experience postoperative adhesion-related problems such as small bowel obstruction, pelvic pain, infertility, or other complications. We aimed to evaluate the preventive effect of the ascites fluid for postoperative peritoneal adhesions in rat models. Material and methods This experimental trial was conducted in Sixty Syrian male rat randomly assigned to six groups of 10 animals each as follows: control (group 1&4); normal saline (group 2&5): 2 mL of normal saline was poured into the peritoneal cavity; and case (group 3&6): 2 mL ascites fluid was poured into the peritoneal cavity. All animals in the six groups underwent laparotomy and measurable serosal injury were created with a standard technique. 10 and 30 days after initial surgery, the rats underwent another laparotomy in groups 1, 2, 3 and 4, 5, 6, respectively to assess macroscopic and microscopic adhesions, which were scored by an examiner who was blind to the animals̕ group assignment. Data analyzed by SPSS version 18, using the kruskal Wallis and Bonferroni-corrected Mann-Whitney U tests. P-values of less than 0.05 were considered significant. Results The mean scores of both microscopic and macroscopic adhesion were significantly different between all the groups (P < 0.05). Total macroscopic and microscopic adhesion scores were significantly lower in the ascites fluid treatment than in the control (P = 0.0001) or the normal saline (P < 0.001) group. There was no significant difference between adhesion intensity 10 and 30 days after laparotomy (P > 0.05). Conclusions Ascites fluid can decrease the possibility of post-operative intraperitoneal adhesion formation. Ascites fluid decreases post-operative adhesion formation. The intensity of adhesion did not differ over time. Ideal adhesion-reducing substances are still under investigation.
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Affiliation(s)
- Ali ShaykhoIslami
- Surgical Resident, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Mohammadreza Ghasemian
- Cardiovascular Diseases Research Center, Department of Surgery, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.,Imamreza Clinical Research Development Unit, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahmoud Zardast
- Department of Pathology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Marjan Farzad
- Cardiovascular Diseases Research Center, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran.,Clinical Research Development Unit of Razi Hospital, Birjand University of Medical Sciences, Birjand, Iran
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Parolini F, Boroni G, Betalli P, Cheli M, Pinelli D, Colledan M, Alberti D. Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia. CHILDREN-BASEL 2021; 8:children8090820. [PMID: 34572252 PMCID: PMC8470555 DOI: 10.3390/children8090820] [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: 08/15/2021] [Revised: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022]
Abstract
Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE.
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Affiliation(s)
- Filippo Parolini
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Correspondence: ; Tel.: +39-0303996201; Fax: +39-0303996154
| | - Giovanni Boroni
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
| | - Pietro Betalli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Maurizio Cheli
- Department of Paediatric Surgery, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (P.B.); (M.C.)
| | - Domenico Pinelli
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Michele Colledan
- Department of Surgery III, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Daniele Alberti
- Department of Paediatric Surgery, “Spedali Civili” Children’s Hospital, 25123 Brescia, Italy; (G.B.); (D.A.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
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Khanal N, Thapa A, Raut A, Ghimire B, Pradhan S, Shrestha S. Intra-abdominal propylene suture fragment leading to complete small bowel obstruction: A case report. Int J Surg Case Rep 2021; 85:106174. [PMID: 34274756 PMCID: PMC8319363 DOI: 10.1016/j.ijscr.2021.106174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Propylene sutures are non-absorbable sterile surgical sutures, which when present intra-abdominally act as a foreign body leading to adhesion formation. Post-operative adhesions are a common cause of bowel obstruction, with complete closed loop obstruction presenting as a surgical emergency. CASE DETAILS A 66-year-old man who had undergone a laparotomy for bowel obstruction two years back, presented to our emergency department with features of complete bowel obstruction. Midline laparotomy revealed propylene suture and intra peritoneal adhesions acting as a constricting band around the jejunum to be the cause. DISCUSSION Adhesions are common perturbing problem after surgeries. The presence of a foreign body further incites the process of adhesion formation by causing hindrance to the fibrinolysis process. In this case, the adhesive bands acted synergistically with the encircling prolene suture material from the previous surgery in causing a complete loop obstruction. CONCLUSION Propylene sutures used in routine surgical procedures can migrate intra-abdominally, and lead to adhesion formation. Adhesions along with the non-absorbable suture can cause complete bowel obstruction.
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Affiliation(s)
- Niharika Khanal
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Anjila Thapa
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal.
| | - Akash Raut
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Bikal Ghimire
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Susan Pradhan
- Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
| | - Sujan Shrestha
- Surgical Gastroenterology, Department of GI and General Surgery, MMC, IOM, Tribhuvan University, Nepal
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Zeng X, Lu B, Wang F, Mao J, Deng L, Li Y, Hou L. The effect of Smad2- and Smad3-targeting RNA interference on extracellular matrix synthesis in rat fibroblasts of peritoneal adhesion tissues. Am J Transl Res 2020; 12:7420-7429. [PMID: 33312378 PMCID: PMC7724320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Abstract
Fibroblasts migrating to peritoneum injuries play an important role in the development of postoperative peritoneal adhesions due to the excessive synthesis and deposition of extracellular matrix (ECM). This effect is mainly induced by the transforming growth factor-β (TGF-β). Studies indicate that elevated TGF-β1 levels and TGF-β1/Smad signaling are both implicated in the formation of peritoneal adhesions. To confirm the effect of TGF-β1/Smad signaling interference in regulating excessive ECM synthesis, a total of four different R-Smad-targeting small interference RNA (siRNA) duplexes (Smad2-500, Smad2-956, Smad3-378, Smad3-1385) were tested in this study using a TGF-β1-stimulated adhesion tissue fibroblasts (ATFs) cell model. The in vitro assessments show that all proposed siRNAs are capable of significantly downregulating the mRNA and protein levels of Smad2 and Smad3 in ATFs. They also inhibit the phosphorylation of both Smads, which confirms their effect in blocking the TGF-β1/Smad signaling pathway. Moreover, the siRNA duplexes can appreciably lower the elevated levels of fibronectin and collagen 3 alpha 1 (COL3A1) in TGF-β1-stimulated ATFs, and the Smad3-378 siRNA can actually restore both molecules (fibronectin and COL3A1) to normal levels. Therefore, the Smad3-378 siRNA is suitable for both adhesion prevention and wound healing. Overall, our results indicate that postoperative adhesion prophylaxis may be achieved by temporarily blocking TGF-β1/Smad signaling transduction.
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Affiliation(s)
- Xuxin Zeng
- Department of Pharmaceutical Science, School of Medical Engineering, Foshan UniversityFoshan, Guangdong, China
| | - Bin Lu
- Department of Pharmaceutical Science, Medical College of Shaoguan UniversityShaoguan, Guangdong, China
| | - Fang Wang
- Department of Traditional Chinese Pharmaceutics, School of Traditional Chinese Medicine, Guangdong Pharmaceutical UniversityGuangzhou, Guangdong, China
| | - Jianwen Mao
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances and School of Basic Medicine, Guangdong Pharmaceutical UniversityGuangzhou, Guangdong, China
| | - Lulu Deng
- Guangdong Provincial Key Laboratory of Pharmaceutical Bioactive Substances and School of Basic Medicine, Guangdong Pharmaceutical UniversityGuangzhou, Guangdong, China
| | - Yanping Li
- Department of Pharmaceutical Science, School of Medical Engineering, Foshan UniversityFoshan, Guangdong, China
| | - Lianbing Hou
- Department of Pharmacy, Nanfang Hospital, Southern Medical UniversityGuangzhou, Guangdong, China
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Syahputra DA, Mashudy A, Dasrul. The effect of addition of dexamethasone into normal saline irrigation solution on Prevention of Intraperitoneal Adhesion Post Laparotomy in wistar rats (Rattus norvegicus). Ann Med Surg (Lond) 2020. [DOI: https:/doi.org/10.1016/j.amsu.2020.08.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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15
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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: 81] [Impact Index Per Article: 20.3] [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.
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The effect of addition of dexamethasone into normal saline irrigation solution on Prevention of Intraperitoneal Adhesion Post Laparotomy in wistar rats (Rattus norvegicus). Ann Med Surg (Lond) 2020; 59:57-63. [PMID: 32994984 PMCID: PMC7501407 DOI: 10.1016/j.amsu.2020.08.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Intraperitoneal adhesion is a pathological condition of adhesion between the omentum, intestine and abdominal wall. The purpose of this study was to determine the effect of adding dexamethasone into normal saline fluid to prevent intra peritoneal adhesion. Materials and methods This study used experimental post-test only control group design. There were four treatment groups using six white rats in each group: group I without administration of normal saline and dexamethasone, group II with administration of normal saline irrigation, group III by adding dexamethasone dose 0.2 mg/BW into 5 cc normal saline, and group IV by adding 0.5 mg/BW into 5 cc normal saline. Laparotomy was performed to all samples followed by excoriation and abrasion in cecum and terminal ileum using gauze. Intra peritoneal adhesion assessment was carried out on the 10th day post laparotomy. Macroscopic and microscopic assessments were performed to evaluate formation of collagen, fibrin and the spread of inflammatory cells of each group. Results From macroscopic observations, it was found that the average adhesion that occurred was 3.333; 2.333; 0.666; 0.333 by using statistical calculations with one-way ANOVA with P value of 0.000. Post-Hoc analysis showed that the administration of dexamethasone 0.5 mg/BW is proven to minimize the occurrence of adhesion between the 3 groups. Microscopic assessment of the formation of collagen, fibrin and the spread of inflammatory cells by one-way ANOVA produced P 0.000 in all three parameters, but the dose of dexamethasone administration between 0.2 mg/BW and 0.5 kg/BW did not prove significant in either group. Conclusion There is evidence that the addition of dexamethasone to normal saline as an irrigation liquid during laparotomy can reduce the occurrence of adhesion. However, the dose difference was not proven to be better in this study. Further studies are suggested to use more experimental animals. Administration of dexamethasone was proven to reduce the amount of the three parameters. Addition of dexamethasone to normal saline as an irrigation liquid during laparotomy can reduce the occurrence of adhesion. Administration of normal saline can reduce inflammatory cells in the intraperitoneal adhesion tissue.
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The Selective Angiotensin II Type 2 Receptor Agonist Compound 21 Reduces Abdominal Adhesions in Mice. J Surg Res 2020; 256:231-242. [PMID: 32711180 DOI: 10.1016/j.jss.2020.06.051] [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] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Abdominal adhesions (AAs) are post-traumatic fibrous bands that connect visceral and/or peritoneal surfaces, leading to possible long-term complications. The effect of a novel antifibrotic selective angiotensin II type 2 receptor agonist, compound 21 (C21) on AA formation was assessed in a murine model. METHODS Female BALB/c mice were laparotomized and the cecum and overlying parietal peritoneum abraded. C21 (10 μg/kg) or saline (vehicle) were administered orally or intraperitoneally daily. Mice were sacrificed 8 days after surgery, adhesions graded, and peritoneal fluid collected for transforming growth factor (TGF)-β levels. Laparotomy incisions were excised for immunohistochemistry. In vitro, scratch assays were performed using primary parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21 (10 μM), angiotensin II (1 μM), or both. Western blot analysis of primary cell lysates was performed for total and phosphorylated SMAD 2/3. RESULTS Oral and intraperitoneal C21 reduced AA formation and TGF-β levels in peritoneal fluid. Surgical incisions demonstrated decreased α-smooth muscle actin expression in C21-treated animals, but no difference in vascularity, macrophage infiltration, collagen I/III distribution and density, and dermal thickness. Migration and expression of phosphorylated SMAD 2/3 was reduced in parietal peritoneal fibroblasts and visceral mesothelial cells treated with C21. CONCLUSIONS Local and systemic C21 administration reduced or completely prevented AA formation. These findings may be attributed to decreased intraperitoneal TGF-β in vivo and decreased migration of peritoneal fibroblasts and visceral mesothelial cells. Importantly, C21 did not have histologically quantifiable effects on laparotomy wounds, suggesting C21 could reduce AA formation without compromising laparotomy healing.
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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.
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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.)
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Mahmoudieh M, Keleidari B, Nasr Esfahani F, Zolfaghari B, Melali H, Davarpanah Jazi AH, Mehdinezhad N, Mokhtari M. The effect of Punica granatum L. flower extract on post-surgical peritoneal adhesions in a rat model. Eur J Obstet Gynecol Reprod Biol 2019; 246:113-116. [PMID: 32004879 DOI: 10.1016/j.ejogrb.2019.12.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Peritoneal adhesions may develop after every abdominopelvic surgery. Many agents and technical modifications have been investigated to minimize adhesions. Punica granatum (pomegranate) flower has some anti-inflammatory and antioxidative effects that would reduce the formation of peritoneal adhesions. In the present study, the effects of different doses of oral Punica granatum flower extract on postoperative peritoneal adhesions were evaluated in a rat model. STUDY DESIGN Thirty-two female Wistar rats were divided into four groups: one control group (CG) and three experimental groups, treated with 100 (EG100), 200 (EG200), and 400 (EG400) mg/kg/day Punica granatum extract orally for eight days. Induction of peritoneal adhesions was done in all groups using the same method. Two weeks after the first surgery, all rats re-operated and adhesions were evaluated via both macroscopic and microscopic changes. RESULTS We observed that rats in the control group had statistically higher adhesion area and more severe adhesions when compared to all experimental groups. Besides, those in the EG-400 group had a significantly lower rate of foreign body reaction in serosal layer when compared to the other three study groups. Other microscopic findings were comparable between the four groups. CONCLUSION Administration of the oral Punica granatum flower extract was associated with a decreased quantity and quality of the adhesions in the animal model of rat in this study. This therapy might be an effective and safe strategy to reduce intraperitoneal adhesion after abdominal surgeries in animal models.
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Affiliation(s)
- Mohsen Mahmoudieh
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Behrouz Keleidari
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Farid Nasr Esfahani
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of Medicine, University of Medical Sciences, Isfahan, Iran.
| | - Behzad Zolfaghari
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Iran.
| | - Hamid Melali
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Amir Hosein Davarpanah Jazi
- Minimally Invasive Surgery Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Minimally Invasive Surgery, Al Zahra Hospital, Isfahan, Iran.
| | - Negin Mehdinezhad
- Department of Pharmacognosy, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Iran.
| | - Mojgan Mokhtari
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran.
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Darge HF, Andrgie AT, Tsai HC, Lai JY. Polysaccharide and polypeptide based injectable thermo-sensitive hydrogels for local biomedical applications. Int J Biol Macromol 2019; 133:545-563. [DOI: 10.1016/j.ijbiomac.2019.04.131] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 01/19/2023]
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Gökçelli U, Ercan UK, İlhan E, Argon A, Çukur E, Üreyen O. Prevention of Peritoneal Adhesions by Non-Thermal Dielectric Barrier Discharge Plasma Treatment on Mouse Model: A Proof of Concept Study. J INVEST SURG 2019; 33:605-614. [PMID: 30644787 DOI: 10.1080/08941939.2018.1550542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purposes: Formation of peritoneal adhesions is a common consequence of abdominopelvic surgeries and remarkably increases the mortality and morbidity. Moreover, peritoneal adhesions linked to chronic abdominopelvic pain and infertility in women. Various attempts for prevention of peritoneal adhesions were reported. However, these methods either remain insufficient to prevent formation of peritoneal adhesions or carry some practical limitations and thus, there is a need for novel techniques that could effectively decrease the formation of peritoneal adhesions. The aim of the present prospective, randomized, controlled, and single blinded study was to evaluate the effect of non-thermal atmospheric plasma (NTAP) treatment on prevention of peritoneal adhesions. Materials and Methods: Sixteen male CD-1 mice were randomly divided into two groups: control and plasma. Excisional and abrasion adhesion models were generated on the peritoneal side wall and cecum, respectively. Ten days after creating adhesion models, mice were sacrificed and adhesion formations were evaluated macroscopically using Knightly's and Linsky's grading systems to assess the intensity and extent of adhesions, respectively. Zühlke's grading system was used for microscopic assessment of adhesions. Results: The mean scores for peritoneum and cecum in control group according to Knightly's grading system were determined as 3.3 and 2.6, respectively. In NTAP-treated group, Knightly's score was determined as 1.6 and 0.5 for peritoneum and cecum, respectively. NTAP treatment reduced Linsky's score from 3.8 to 1.3 and 2.1 to 1.1 on peritoneum and cecum. Finally, in microscopic evaluation, NTAP treatment reduced Zühlke's score from 3.4 to 1.5 and 2.6 to 1.3 for peritoneum and cecum, respectively. Conclusions: The results of the present proof of concept study suggest that NTAP could be a novel method to reduce and/or prevent the formation of peritoneal adhesions after abdominopelvic surgeries.
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Affiliation(s)
- Uğur Gökçelli
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Utku Kürşat Ercan
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - Enver İlhan
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Asuman Argon
- Department of Pathology, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
| | - Elif Çukur
- Department of Biomedical Engineering, İzmir Katip Çelebi University, İzmir, Turkey
| | - Orhan Üreyen
- Department of General Surgery, İzmir Bozyaka Research and Training Hospital, University of Health Sciences, İzmir, Turkey
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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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Mesothelial to mesenchyme transition as a major developmental and pathological player in trunk organs and their cavities. Commun Biol 2018; 1:170. [PMID: 30345394 PMCID: PMC6191446 DOI: 10.1038/s42003-018-0180-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/28/2018] [Indexed: 12/18/2022] Open
Abstract
The internal organs embedded in the cavities are lined by an epithelial monolayer termed the mesothelium. The mesothelium is increasingly implicated in driving various internal organ pathologies, as many of the normal embryonic developmental pathways acting in mesothelial cells, such as those regulating epithelial-to-mesenchymal transition, also drive disease progression in adult life. Here, we summarize observations from different animal models and organ systems that collectively point toward a central role of epithelial-to-mesenchymal transition in driving tissue fibrosis, acute scarring, and cancer metastasis. Thus, drugs targeting pathways of mesothelium’s transition may have broad therapeutic benefits in patients suffering from these diseases. Tim Koopmans and Yuval Rinkevich review recent findings linking the mesothelium’s embryonic programs that drive epithelial-to-mesenchyme transition with adult pathologies, such as fibrosis, acute scarring, and cancer metastasis. They highlight new avenues for drug development that would target pathways of the mesothelium’s mesenchymal transition.
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