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Head WT, Paladugu N, Kwon JH, Gerry B, Hill MA, Brennan EA, Kavarana MN, Rajab TK. Adhesion barriers in cardiac surgery: A systematic review of efficacy. J Card Surg 2021; 37:176-185. [PMID: 34661944 DOI: 10.1111/jocs.16062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/03/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Postoperative pericardial adhesions have been associated with increased morbidity, mortality, and surgical difficulty. Barriers exist to limit adhesion formation, yet little is known about their use in cardiac surgery. The study presented here provides the first major systematic review of adhesion barriers in cardiac surgery. METHODS Scopus and PubMed were assessed on November 20, 2020. Inclusion criteria were clinical studies on human subjects, and exclusion criteria were studies not published in English and case reports. Risk of bias was evaluated with the Cochrane Risk of Bias Tool. Barrier efficacy data was assessed with Excel and GraphPad Prism 5. RESULTS Twenty-five studies were identified with a total of 13 barriers and 2928 patients. Polytetrafluoroethylene (PTFE) was the most frequently evaluated barrier (13 studies, 67% of patients) with adhesion formation rate of 37.31% and standardized tenacity score of 26.50. Several barriers had improved efficacy. In particular, Cova CARD had a standardized tenacity score of 15.00. CONCLUSIONS Overall, the data varied considerably in terms of study design and reporting bias. The amount of data was also limited for the non-PTFE studies. PTFE has historically been effective in preventing adhesions. More recent barriers may be superior, yet the current data is nonconfirmatory. No ideal adhesion barrier currently exists, and future barriers must focus on the requirements unique to operating in and around the heart.
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Affiliation(s)
- William T Head
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Namrata Paladugu
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennie H Kwon
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brielle Gerry
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Morgan A Hill
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily A Brennan
- Department of Research & Education Services (Libraries), Medical University of South Carolina, Charleston, South Carolina, USA
| | - Minoo N Kavarana
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taufiek K Rajab
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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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.
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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:
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Fujita M, Policastro GM, Burdick A, Lam HT, Ungerleider JL, Braden RL, Huang D, Osborn KG, Omens JH, Madani MM, Christman KL. Preventing post-surgical cardiac adhesions with a catechol-functionalized oxime hydrogel. Nat Commun 2021; 12:3764. [PMID: 34145265 PMCID: PMC8213776 DOI: 10.1038/s41467-021-24104-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
Post-surgical cardiac adhesions represent a significant problem during routine cardiothoracic procedures. This fibrous tissue can impair heart function and inhibit surgical access in reoperation procedures. Here, we propose a hydrogel barrier composed of oxime crosslinked poly(ethylene glycol) (PEG) with the inclusion of a catechol (Cat) group to improve retention on the heart for pericardial adhesion prevention. This three component system is comprised of aldehyde (Ald), aminooxy (AO), and Cat functionalized PEG mixed to form the final gel (Ald-AO-Cat). Ald-AO-Cat has favorable mechanical properties, degradation kinetics, and minimal swelling, as well as superior tissue retention compared to an initial Ald-AO gel formulation. We show that the material is cytocompatible, resists cell adhesion, and led to a reduction in the severity of adhesions in an in vivo rat model. We further show feasibility in a pilot porcine study. The Ald-AO-Cat hydrogel barrier may therefore serve as a promising solution for preventing post-surgical cardiac adhesions.
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Affiliation(s)
- Masaki Fujita
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Gina M Policastro
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Austin Burdick
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Hillary T Lam
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jessica L Ungerleider
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Rebecca L Braden
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA
| | - Diane Huang
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Kent G Osborn
- Division of Comparative Pathology and Medicine, School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Jeffrey H Omens
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Michael M Madani
- Division of Cardiovascular and Thoracic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Karen L Christman
- Department of Bioengineering, University of California, San Diego, San Diego, CA, USA.
- Sanford Consortium for Regenerative Medicine, University of California, San Diego, San Diego, CA, USA.
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Capella-Monsonís H, Kearns S, Kelly J, Zeugolis DI. Battling adhesions: from understanding to prevention. BMC Biomed Eng 2019; 1:5. [PMID: 32903353 PMCID: PMC7412649 DOI: 10.1186/s42490-019-0005-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022] Open
Abstract
Adhesions represent a major burden in clinical practice, particularly following abdominal, intrauterine, pericardial and tendon surgical procedures. Adhesions are initiated by a disruption in the epithelial or mesothelial layer of tissue, which leads to fibrin adhesion sites due to the downregulation of fibrinolytic activity and an increase in fibrin deposition. Hence, the metabolic events involved in tissue healing, coagulation, inflammation, fibrinolysis and angiogenesis play a pivotal role in adhesion formation. Understanding these events, their interactions and their influence on the development of post-surgical adhesion is crucial for the development of effective therapies to prevent them. Mechanical barriers, antiadhesive agents and combination thereof are customarily used in the battle against adhesions. Although these systems seem to be effective at reducing adhesions in clinical procedures, their prevention remains still elusive, imposing the need for new antiadhesive strategies.
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Affiliation(s)
- Héctor Capella-Monsonís
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
| | | | - Jack Kelly
- University Hospital Galway, Galway, Ireland
| | - Dimitrios I. Zeugolis
- Regenerative, Modular and Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
- Science Foundation Ireland (SFI) Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI Galway), Galway, Ireland
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Lescan M, Al-Saidi A, Neumann B, Greiner TO, Walker T, Hierlemann H, Brochhausen C, Planck H, Wendel HP, Schlensak C, Lausberg H. Epicardial adhesion prophylaxis in swine model with a bio-absorbable polymer membrane. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:157. [PMID: 30350230 DOI: 10.1007/s10856-018-6173-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 10/12/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany.
| | - Abdulwahab Al-Saidi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Bernd Neumann
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tim-Oliver Greiner
- Department of General, Visceral and Transplant Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Tobias Walker
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | | | | | | | - Hans-Peter Wendel
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Henning Lausberg
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
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Lee CH, Kim H, Han IW, Kim SM, Kwak BS, Baik YH, Park YJ, Oh MG. Effect of polylactic film (Surgi-Wrap) on preventing postoperative ileus after major hepato-pancreato-biliary surgery. Ann Hepatobiliary Pancreat Surg 2016; 20:191-196. [PMID: 28261699 PMCID: PMC5325149 DOI: 10.14701/ahbps.2016.20.4.191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/02/2016] [Accepted: 09/26/2016] [Indexed: 01/06/2023] Open
Abstract
Backgrounds/Aims Major hepato-pancreato-biliary (HPB) surgery is usually performed via an open method rather than a laparoscopic method. Postoperative ileus (POI) is a classic complication after open surgery. The purpose of this study was to determine whether polylactic film is useful in the prevention of POI. Methods A total of 179 patients who underwent major HPB surgery between 2005 and 2014, were retrospectively reviewed. A diagnosis of POI was made by a physical examination, laboratory, and radiological findings. Surgi-Wrap® polylactic film was preferentially used intraperitoneally by surgeons, just before wound closure. Results Major HPB surgery included pancreatoduodenectomy (n=48), distal or subtotal pancreatectomy (n=24), hepatectomy (n=67), other bile duct or gallbladder operations (n=35), and others (n=5). Although patients with polylactic film showed a significantly lower incidence of POI (n=3, 4.1% vs. n=14, 13.3%, p=0.041), they showed a significantly higher complication rate (n=20, 27.0% vs. n=19, 18.1%, p=0.004), particularly intra-abdominal fluid collection (n=7, 9.4% vs. n=2, 1.9%), and wound infections (n=6, 8.1% vs. n=3, 2.9%), than those who did not receive the film, respectively. Conclusions Although the polylactic film prevented POI, more complications other than POI were observed. Well-designed randomized controlled trials, using this anti-adhesive product, are needed to evaluate its effect on POI after major HPB surgery.
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Affiliation(s)
- Chang Hyung Lee
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Hongbeom Kim
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - In Woong Han
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Suh Min Kim
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Beom Seok Kwak
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Yong Hae Baik
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Young Jin Park
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Min Gu Oh
- Department of Surgery, Dongguk University College of Medicine, Goyang, Korea
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Robinson E, Kaushal S, Alaboson J, Sharma S, Belagodu A, Watkins C, Walker B, Webster G, McCarthy P, Ho D. Combinatorial release of dexamethasone and amiodarone from a nano-structured parylene-C film to reduce perioperative inflammation and atrial fibrillation. NANOSCALE 2016; 8:4267-4275. [PMID: 26838117 DOI: 10.1039/c5nr07456h] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Suppressing perioperative inflammation and post-operative atrial fibrillation requires effective drug delivery platforms (DDP). Localized anti-inflammatory and anti-arrhythmic agent release may be more effective than intravenous treatment to improve patient outcomes. This study utilized a dexamethasone (DEX) and amiodarone (AMIO)-loaded Parylene-C (PPX) nano-structured film to inhibit inflammation and atrial fibrillation. The PPX film was tested in an established pericardial adhesion rabbit model. Following sternotomy, the anterior pericardium was resected and the epicardium was abraded. Rabbits were randomly assigned to five treatment groups: control, oxidized PPX (PPX-Oxd), PPX-Oxd infused with DEX (PPX-Oxd[DEX]), native PPX (PPX), and PPX infused with DEX and AMIO (PPX[AMIO, DEX]). 4 weeks post-sternotomy, pericardial adhesions were evaluated for gross adhesions using a 4-point grading system and histological evaluation for epicardial neotissue fibrosis (NTF). Atrial fibrillation duration and time per induction were measured. The PPX[AMIO, DEX] group had a significant reduction in mean adhesion score compared with the control group (control 2.75 ± 0.42 vs. PPX[AMIO, DEX] 0.25 ± 0.42, P < 0.001). The PPX[AMIO, DEX] group was similar to native PPX (PPX 0.38 ± 0.48 vs. PPX[AMIO, DEX] 0.25 ± 0.42, P=NS). PPX-Oxd group adhesions were indistinguishable from controls (PPX-Oxd 2.83 ± 0.41 vs. control 2.75 ± 0.42, P=NS). NTF was reduced in the PPX[AMIO, DEX] group (0.80 ± 0.10 mm) compared to control (1.78 ± 0.13 mm, P < 0.001). Total duration of atrial fibrillation was decreased in rabbits with PPX[AMIO, DEX] films compared to control (9.5 ± 6.8 s vs. 187.6 ± 174.7 s, p = 0.003). Time of atrial fibrillation per successful induction decreased among PPX[AMIO, DEX] films compared to control (2.8 ± 1.2 s vs. 103.2 ± 178 s, p = 0.004). DEX/AMIO-loaded PPX films are associated with reduced perioperative inflammation and a diminished atrial fibrillation duration. Epicardial application of AMIO, DEX films is a promising strategy to prevent post-operative cardiac complications.
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Affiliation(s)
- Erik Robinson
- Department of Mechanical Engineering, Northwestern University, Evanston, Illinois 60208, USA.
| | - Sunjay Kaushal
- Division of Pediatric Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Justice Alaboson
- Department of Material Science and Engineering, Northwestern University, Evanston, Illinois 60208, USA
| | - Sudhish Sharma
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Amogh Belagodu
- Department of Chemical & Biological Engineering, Northwestern University, Evanston, Illinois 60208, USA
| | - Claire Watkins
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Brandon Walker
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
| | - Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Patrick McCarthy
- Division of Cardiac Surgery, the Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| | - Dean Ho
- Department of Mechanical Engineering, Northwestern University, Evanston, Illinois 60208, USA. and Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, USA and Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois 60611, USA
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Sheu C, Shalumon KT, Chen CH, Kuo CY, Fong YT, Chen JP. Dual crosslinked hyaluronic acid nanofibrous membranes for prolonged prevention of post-surgical peritoneal adhesion. J Mater Chem B 2016; 4:6680-6693. [DOI: 10.1039/c6tb01376g] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A HA NFM crosslinked with FeCl3and BDDE shows prolonged degradation to prevent peritoneal adhesion.
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Affiliation(s)
- Chialin Sheu
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - K. T. Shalumon
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Chih-Hao Chen
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Chang-Yi Kuo
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
| | - Yi Teng Fong
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
- Chang Gung Memorial Hospital
- Taoyuan 33305
- Republic of China
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering
- Chang Gung University
- Taoyuan 33302
- Republic of China
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center
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Cannata A, Petrella D, Russo CF, Bruschi G, Fratto P, Gambacorta M, Martinelli L. Postsurgical Intrapericardial Adhesions: Mechanisms of Formation and Prevention. Ann Thorac Surg 2013; 95:1818-26. [DOI: 10.1016/j.athoracsur.2012.11.020] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/07/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
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Brochhausen C, Schmitt VH, Planck CNE, Rajab TK, Hollemann D, Tapprich C, Krämer B, Wallwiener C, Hierlemann H, Zehbe R, Planck H, Kirkpatrick CJ. Current strategies and future perspectives for intraperitoneal adhesion prevention. J Gastrointest Surg 2012; 16:1256-74. [PMID: 22297658 DOI: 10.1007/s11605-011-1819-9] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 12/28/2011] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The formation of peritoneal adhesions still is a relevant clinical problem after abdominal surgery. Until today, the most important clinical strategies for adhesion prevention are accurate surgical technique and the physical separation of traumatized serosal areas. Despite a variety of barriers which are available in clinical use, the optimal material has not yet been found. DISCUSSION Mesothelial cells play a crucial physiological role in friction less gliding of the serosa and the maintenance of anantiadhesive surface. The formation of postoperative adhesions results from a cascade of events and is regulated by various cellular and humoral factors. Therefore, optimization or functionalization of barrier materials by developments interacting with this cascade on a structural or pharmacological level could give an innovative input for future strategies in peritoneal adhesion prevention. For this purpose, the proper understanding of the formal pathogenesis of adhesion formation is essential. Based on the physiology of the serosa and the pathophysiology of adhesion formation, the available barriers in current clinical practice as well as new innovations are discussed in the present review.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-lab, Institute of Pathology, University Medical Centre, Johannes Gutenberg-University, Langenbeckstraße 1,55101 Mainz, Germany.
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Brochhausen C, Schmitt VH, Rajab TK, Planck CNE, Krämer B, Wallwiener M, Hierlemann H, Kirkpatrick CJ. Intraperitoneal adhesions--an ongoing challenge between biomedical engineering and the life sciences. J Biomed Mater Res A 2011; 98:143-56. [PMID: 21548063 DOI: 10.1002/jbm.a.33083] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 01/12/2011] [Accepted: 01/20/2011] [Indexed: 01/29/2023]
Abstract
Peritoneal adhesions remain a relevant clinical problem despite the currently available prophylactic barrier materials. So far, the physical separation of traumatized serosa areas using barriers represents the most important clinical strategy for adhesion prevention. However, the optimal material has not yet been found. Further optimization or pharmacological functionalization of these barriers could give an innovative input for peritoneal adhesion prevention. Therefore, a more complete understanding of pathogenesis is required. On the basis of the pathophysiology of adhesion formation the main barriers currently in clinical practice as well as new innovations are discussed in the present review. Physiologically, mesothelial cells play a decisive role in providing a frictionless gliding surface on the serosa. Adhesion formation results from a cascade of events and is regulated by a variety of cellular and humoral factors. The main clinically applied strategy for adhesion prevention is based on the use of liquid or solid adhesion barriers to separate physically any denuded tissue. Both animal and human trials have not yet been able to identify the optimal barrier to prevent adhesion formation in a sustainable way. Therefore, further developments are required for effective prevention of postoperative adhesion formation. To reach this goal the combination of structural modification and pharmacological functionalization of barrier materials should be addressed. Achieving this aim requires the interaction between basic research, materials science and clinical expertise.
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Affiliation(s)
- Christoph Brochhausen
- REPAIR-Lab, Institute of Pathology, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
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Haensig M, Mohr FW, Rastan AJ. Bioresorbable adhesion barrier for reducing the severity of postoperative cardiac adhesions: Focus on REPEL-CV(®). MEDICAL DEVICES-EVIDENCE AND RESEARCH 2011; 4:17-25. [PMID: 22915926 PMCID: PMC3417870 DOI: 10.2147/mder.s7957] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Treatment of a number of congenital heart defects often necessitates staged surgical intervention. In addition, substantial improvements in postoperative cardiac care and more liberal use of biological valve substitutes have resulted in many adult patients surviving to become potential candidates for reoperations to repair or replace valves or to undergo additional revascularization procedures. In all these scenarios, surgeons are confronted with cardiac adhesions, leading to an increased surgical risk. Thus, bioresorbable adhesion barriers had become of increasing interest because they are easy to use, and safe and effective. This review focuses on the mechanisms by which REPEL-CV® prevents adhesive processes, as well as the development, design, and materials used, and also summarizes efficacy studies, clinical data, safety, and current role in therapy.
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Affiliation(s)
- Martin Haensig
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
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14
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Ward BC, Panitch A. Abdominal Adhesions: Current and Novel Therapies. J Surg Res 2011; 165:91-111. [DOI: 10.1016/j.jss.2009.09.015] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 08/17/2009] [Accepted: 09/04/2009] [Indexed: 12/20/2022]
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Liu Z, Christensson M, Forslöw A, De Meester I, Sundqvist KG. A CD26-controlled cell surface cascade for regulation of T cell motility and chemokine signals. THE JOURNAL OF IMMUNOLOGY 2009; 183:3616-24. [PMID: 19687096 DOI: 10.4049/jimmunol.0804336] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemokines are key regulators of cell trafficking, and dipeptidyl peptidase IV/CD26 (CD26) inactivates chemokines. Here we show that the CD26-processed chemokines SDF1alpha/CXCL12 and RANTES/CCL5, in contrast to a control chemokine not processed by CD26, are potent inducers of cell surface expression of thrombospondin-1 (TSP-1) in T lymphocytes through a CD26-controlled mechanism and that TSP-1 stimulates expression of lipoprotein receptor related protein/CD91. Accordingly, intact TSP-1 and a peptide mimetic of a sequence in TSP-1 were sufficient to stimulate CD91 expression. The chemokine-induced expression of TSP-1 and CD91 was mimicked by inhibitors of CD26 and CXCL12 and CCL5 as well as inhibitors of CD26 stimulated polarized cytoplasmic spreading and migration through TSP-1. Silencing of CD26 using small interfering RNA or Ab-induced modulation of CD26 also increased TSP-1 expression and enhanced cytoplasmic spreading and T cell migration markedly. These results indicate that CD26 is an endogenous inhibitor of T cell motility through inhibition of TSP-1 expression and that chemokines stimulate cell polarity and migration through abrogation of the CD26-dependent inhibition. This suggests that T cell motility is regulated by a cascade of interacting cell surface molecules.
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Affiliation(s)
- Zhiwen Liu
- Division of Clinical Immunology, Department of Laboratory Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden
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