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Premkumar A, Anatone A, Illescas A, Memtsoudis S, Cross MB, Sculco PK, Gonzalez Della Valle A. Perioperative Use of Antifibrotic Medications Associated With Lower Rate of Manipulation After Primary TKA: An Analysis of 101,366 Patients. J Arthroplasty 2022; 37:S1010-S1015.e1. [PMID: 35283229 DOI: 10.1016/j.arth.2022.03.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/28/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Several commonly prescribed medications have known antifibrotic properties and have been shown to reduce postoperative scar formation in other clinical areas, but it is unknown whether the use of such medications perioperatively in patients undergoing TKA may improve rates of postoperative stiffness. METHODS A large US employer-sponsored healthcare database (Truven Marketscan) was queried for patients who underwent elective primary TKA for primary osteoarthritis between 2015-2019. Demographic information and comorbidities were recorded, along with whether patients were prescribed one of several medications with known antifibrotic properties during the three months before or after surgery. RESULTS Complete data were available for 101,366 patients undergoing TKA, of which 4,536 underwent MUA (4.5%). Perioperative use of any antifibrotic medication was associated with a lower likelihood of undergoing MUA (P < .001). When controlling for age, sex, comorbidities, opioid use, length of stay, among other variables, perioperative use of specific ACE inhibitors (OR 0.91, CI 0.84-1, P = .042), COX-2 inhibitors (OR 0.88, CI 0.81-0.96, P = .002), and angiotensin II receptor blockers, specifically losartan (OR 0.80, CI 0.70-0.91, P = .007) all remained significantly associated with lower rates of MUA. CONCLUSION This study, spanning over a hundred thousand primary TKA procedures over a recent five-year period, demonstrates an association between perioperative use of specific medications with antifibrotic properties and a decreased rate of MUA. These data will help inform future studies aimed to prospectively evaluate the potential of antifibrotic medications in preventing postoperative stiffness in high-risk patients undergoing knee arthroplasty.
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Affiliation(s)
- Ajay Premkumar
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Alex Anatone
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Alex Illescas
- Hospital for Special Surgery, Biostatistics Core, New York, NY
| | - Stavros Memtsoudis
- Hospital for Special Surgery, Department of Anesthesiology, Critical Care, and Pain Management, New York, NY
| | - Michael B Cross
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
| | - Peter K Sculco
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, NY
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Fuentes-Orozco C, Agredano-Jiménez R, Alvarez-Villaseñor AS, Mares-País R, Barbosa-Camacho FJ, Cortés-Flores AO, Reyes-Elizalde EA, Guzmán-Ramírez BG, Flores-Becerril P, Guzmán-Barba JA, Chejfec-Ciociano JM, Ibarrola-Peña JC, Brancaccio-Pérez IV, González-Ojeda A. Effects of Oral Zafirlukast, Sildenafil, or Pirfenidone on the Formation of Postsurgical Intra-abdominal Adhesions in an Experimental Rat Model. Eur Surg Res 2021; 63:145-154. [PMID: 34818645 DOI: 10.1159/000521036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intra-abdominal adhesions' main etiology is surgical procedures that commonly require reintervention. Oral treatments with Sildenafil, Zafirlukast, and Pirfenidone have yielded decreased severity of fibrotic phenomena secondary to the introduction of foreign material. This study aimed to evaluate the efficacy of oral Zafirlukast, Sildenafil or Pirfenidone treatment on reducing or preventing intra-abdominal adhesions in an experimental rat model. METHODS Four groups, each of 10 male Wistar rats weighing 250-300 g, were used. A midline laparotomy was used to excise an area of 1.5´1.5cm and reconstructed with polypropylene mesh fixed to the abdominal wall. After 12 h, oral doses of Zafirlukast (1.25 mg/kg, group B), Sildenafil (15 mg/kg, group C), or Pirfenidone (500 mg/kg, group D) were given every day for eight days. The control group, A, received no treatment. At day nine, animals were reoperated. The implant was resected after ethically approved euthanasia and specimens were fixed in 10% formaldehyde for histopathology. RESULTS Control group A yielded adhesions with greater fibrovascular density and neighboring organ involvement than the other groups (P = 0.001), as well as intense inflammatory infiltrates and numerous granulomas (P = 0.04). Adhesions in group C had less fibrovascular density (P = 0.03) with decreased serosal injuries (P = 0.001) and less organ involvement. Group D had reduced adhesions without organ involvement (P < 0.01), and less inflammatory infiltrates, collagen fibers, and foreign body granulomas than groups B or C (P < 0.01). CONCLUSIONS Oral administration of these agents did not prevent adhesions but ameliorated them. Oral Pirfenidone offered the best performance and could be recommended for human use.
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Affiliation(s)
- Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Ruben Agredano-Jiménez
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Roberto Mares-País
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | | | - Emilio Alberto Reyes-Elizalde
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Paola Flores-Becerril
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - José Aldo Guzmán-Barba
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | | | - Juan Carlos Ibarrola-Peña
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Irma Valeria Brancaccio-Pérez
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Western National Medical Center, Social Security Mexican Institute, Guadalajara, Mexico
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Yan S, Yue Y, Zeng L, Jiang C, Li W, Li H, Qian Y. Ligustrazine nanoparticles nano spray's activation on Nrf2/ARE pathway in oxidative stress injury in rats with postoperative abdominal adhesion. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:379. [PMID: 31555693 DOI: 10.21037/atm.2019.07.72] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Postoperative abdominal adhesions formation is considered a significant clinical entity implicating the healing process following major pelvic and abdominal surgery, with serious clinical complications and need for substantial health care expenditures. However, setting a physical barrier between the damage site and the neighboring tissues is a convenient and highly valid way to minimize or prevent peritoneal adhesions. The present experimental study evaluated the preventive effect of ligustrazine nanoparticles nano spray (LNNS) on postoperative abdominal adhesion in rats and explored its mechanism. Methods Sixty male Sprague Dawley (SD) rats were randomly divided into sham operation group, control group, sodium hyaluronate group and low, medium, and high dose LNNS groups. All groups were prepared with abdominal adhesion models except for the sham operation group. The models were made by opening the abdominal cavity to and filing the serosa in ileocecal junction. The abdominal cavity of rats in the sham operation group were only opened and sutured. The wound surface of rats in the sodium hyaluronate group, low, medium, and high dose LNNS groups were sprayed with sodium hyaluronate gel (0.5 mL/kg) and LNNS (2.5, 5, and 10 mL/kg). Rats in each group were sacrificed 7 days later. Degree of adhesion was evaluated by naked eyes and the pathological sections were scored afterwards. The collagen synthesis in adhesion tissues was detected by Masson's trichrome stain, and the activities of reactive oxygen species (ROS), nitric oxide (NO), superoxide dismutase (SOD) and malondialdehyde (MDA) in peritoneal fluid were detected with the method of chromogenic substrate. Levels of TNF-α and IL-1β in serum, and the protein levels of MCP-1 and MMP-9 in adhesion tissues were detected by ELISA and. immunohistochemistry respectively. RT-PCR and Western blot were utilized to identify the expression levels of Nrf2, heme-oxygenase-1, NQO1 mRNA and protein in adherent intestinal tissues. Results Compared with the control group, the incidence of postoperative abdominal adhesions decreased in the low, medium and high dose LNNS groups, while the expression of SOD in the peritoneal fluid significantly increased. The expression levels of ROS, MDA and NO were reduced remarkably (P<0.05), so were the expression levels of serum TNF-α and IL-1β (P<0.01) and the expression of MCP-1 protein in adhesion tissues. The MMP-9 protein expression, and Nrf2, heme-oxygenase-1, NQO1 mRNA and protein expressions increased. Conclusions LNNS with medium or high dose can significantly reduce the incidence of postoperative abdominal adhesions, the mechanism of which may be the activation of Nrf2/ARE pathway, resulting in the up-regulation of Nrf2, heme-oxygenase-1, NQO1 and mRNA expression, as well as the levels of TNF-α and IL-1β in peripheral blood and the expression of MCP-1 protein in adhesion tissues. Meanwhile, the content of MMP-9 protein in adhesion tissues were raised, and oxidative stress and inflammatory response are released.
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Affiliation(s)
- Shuai Yan
- Department of Anorectal Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, China.,School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yinzi Yue
- Department of Anorectal Surgery, Suzhou Hospital of Traditional Chinese Medicine, Suzhou 215009, China.,First Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Li Zeng
- First Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Chenxue Jiang
- School of Foreign Languages, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Wenlin Li
- Jingwen Library, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Huan Li
- First Clinical Medical College, Henan University of Traditional Chinese Medicine, Zhengzhou 450000, China
| | - Yifei Qian
- Crosspoint High School at Suzhou No. 3 High School, Suzhou 215001, China
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Xia Y, Zhu YZ, Xu C. Hydrogen sulfide prevents postoperative adhesion in a rat uterine horn model. Taiwan J Obstet Gynecol 2017; 56:46-50. [PMID: 28254225 DOI: 10.1016/j.tjog.2016.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Abdominal adhesions are primarily severe postoperative complications that can cause gynecological problems such as infertility and chronic pelvic pain. Inflammatory mediators are significantly related to adhesion formation, and hydrogen sulfide plays a significant anti-inflammatory role in multiple physiological processes. Therefore, the effect of NaHS, a hydrogen sulfide donor, on postoperative adhesion formation was examined in a rat uterine horn model. MATERIALS AND METHODS A rat uterine horn model was created to evaluate whether NaHS, a hydrogen sulfide donor, could decrease postoperative adhesion formation. Rats were randomly grouped and administrated with different doses of NaHS, where DL-propargylglycine and low-molecular-weight heparin acted as negative and positive controls, respectively. The extent and severity of adhesions were assessed on the 14th postoperative day. Serum of rats was sampled for the determination of 27 cytokines using a chip. RESULTS The severity and total scores of adhesion in rats given 112μM/kg and 56μM/kg NaHS were significantly less compared with those of the control group (p<0.01). Scores for the extent of adhesion re-formation in the DL-propargylglycine and control groups did not differ (p>0.05). At least six cytokines were involved in the procedures for the prevention of adhesion formation, as they varied significantly among different groups. CONCLUSION Administration of NaHS could apparently reduce postoperative adhesion in the rat uterine horn model. This preventive effect may be associated with the variation of cytokine that is related to inflammatory.
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Affiliation(s)
- Ye Xia
- Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Yi Zhun Zhu
- Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China; Department of Pharmacology, School of Pharmacy, Fudan University, Shanghai, China; Institute of Biomedical Sciences, Fudan University, Shanghai, China
| | - Congjian Xu
- Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China; Institute of Biomedical Sciences, Fudan University, Shanghai, China; Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China.
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Güney G, Kaya C, Oto G, Yıldırım S, Özdemir H, Tokmak A. Effects of quercetin and surgicel for preventing adhesions after gynecological surgery: A rat uterine horn model. J Obstet Gynaecol Res 2016; 43:179-184. [PMID: 27943594 DOI: 10.1111/jog.13185] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/23/2016] [Indexed: 11/28/2022]
Abstract
AIM Postoperative pelvic adhesions are significant health care problems causing chronic pelvic pain, infertility and intestinal obstruction after abdominal or pelvic surgery. We investigated the effects of quercetin and Surgicel for the prevention of adhesions after gynecological surgery. METHODS A double blind, randomized, controlled experimental study was designed. Forty female Wistar Hannover rats were divided into five groups: control, sham operated, quercetin, Surgicel, and quercetin + Surgicel. The control group received medication used for the surgical procedure only. The sham group received a laparotomy only. The quercetin group received 15 mg/kg quercetin in addition to undergoing the standard surgical procedure, and the injuries in the surgical group were covered with a single, 1 cm2 layer of Surgicel (oxidized regenerated cellulose). The quercetin + Surgicel group received both 15 mg/kg quercetin and a single, 1 cm2 layer of Surgicel. Adhesions were scored 14 days after the first surgical procedure. RESULTS The extent, severity, degree, total adhesion, inflammation and fibrosis scores of the control group were significantly higher than those of the quercetin, Surgicel, and quercetin + Surgicel groups. There was no significant difference between the Surgicel and quercetin groups in degree, but all other parameters were significantly higher in the Surgicel than in the quercetin group. The quercetin + Surgicel group had lower adhesion scores than the quercetin group. CONCLUSIONS Quercetin, Surgicel and quercetin + Surgicel treatment may be useful for preventing pelvic adhesions.
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Affiliation(s)
- Gürhan Güney
- Department of Obstetrics and Gynecology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Cihan Kaya
- Department of Obstetrics and Gynecology, Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Gökhan Oto
- Department of Pharmacology, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey
| | - Serkan Yıldırım
- Department of Pathology, Ataturk University, Faculty of Veterinary Medicine, Erzurum, Turkey
| | - Hülya Özdemir
- Department of Pharmacology, Yuzuncu Yıl University, Faculty of Medicine, Van, Turkey
| | - Aytekin Tokmak
- Zekai Tahir Burak Training and Research Hospital, Ankara, Turkey
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Zhang Y, Liu Q, Yang N, Zhang X. Hyaluronic acid and oxidized regenerated cellulose prevent adhesion reformation after adhesiolysis in rat models. DRUG DESIGN DEVELOPMENT AND THERAPY 2016; 10:3501-3507. [PMID: 27822014 PMCID: PMC5087760 DOI: 10.2147/dddt.s103824] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Postsurgical adhesion formation is the most common complication in abdominal and pelvic surgery. Adhesiolysis is the most commonly applied treatment for adhesion formation but is often followed by adhesion reformation. Therefore, an efficient strategy should be adopted to solve these problems. This study aimed to explore whether hyaluronic acid and oxidized regenerated cellulose (ORC) could prevent adhesion formation and reformation. Thirty female Sprague Dawley rats were randomly divided into three groups (n=10 each) and subjected to different treatments during the first and second surgery. The control group was treated with isotonic sodium chloride, the ORC group was treated with ORC (1.5×1 cm), and the medical sodium hyaluronate (MSH) group was treated with 1% MSH (0.5 mL). At 2 weeks after the first surgery, adhesion scores in the MSH group (1.90±0.99) and the ORC group (1.40±0.97) were significantly lower than those in the control group (3.00±0.82) (P=0.005). Similarly, 2 weeks after the second surgery, adhesion scores in the MSH group (2.00±0.82) and the ORC group (1.50±1.27) were significantly lower than those in the control group (3.50±0.53) (P=0.001). In addition, body weights in the MSH group and the ORC group did not change significantly, whereas the control group showed a consistent decrease in body weight during the experiment. Histological examination revealed that inflammatory infiltration was involved in both adhesion formation and reformation. In conclusion, hyaluronic acid and ORC were both efficient in reducing adhesion formation and reformation in the rat model.
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Affiliation(s)
- Yan Zhang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Qin Liu
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Ning Yang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
| | - Xuegang Zhang
- Department of Gynecology, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, People's Republic of China
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Oz M, Cetinkaya N, Bas S, Korkmaz E, Ozgu E, Terzioglu GS, Buyukkagnici U, Akbay S, Caydere M, Gungor T. A randomized controlled experimental study of the efficacy of platelet-rich plasma and hyaluronic acid for the prevention of adhesion formation in a rat uterine horn model. Arch Gynecol Obstet 2016; 294:533-40. [DOI: 10.1007/s00404-016-4079-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/17/2016] [Indexed: 11/28/2022]
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