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Lee C. The Novel Surgical Technique in the Cyanoacrylate Closure for Incompetent Great Saphenous Veins. Vasc Endovascular Surg 2024; 58:486-490. [PMID: 38155556 DOI: 10.1177/15385744231225910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
OBJECTIVE The current Instructions for Use (IFU) of cyanoacrylate closure (CAC) is to start initial injection with the catheter tip positioned 5 cm distal to the sapheno-femoral junction (SFJ) to prevent endovenous glue-induced thrombosis (EGIT). However, this defensive design is responsible for the relatively long stump length. Although clinical studies on the long-term recurrence rate are still lacking, the long stump length can predict a higher long-term recurrence rate compared to other surgical methods. The author developed a novel surgical technique that can overcome the weakness of CAC, and the initial outcomes of this technique are described in this article. METHODS This study retrospectively reviewed 25 great saphenous vein (GSV) in 20 patients who underwent CAC for incompetent GSV at our hospital. The procedure from puncturing the GSV to insertion of the catheter is the same as the conventional method. Place the catheter tip 2-3 cm below the SFJ before cyanoacrylate injection. After confirming the position of the SFJ with the longitudinal view of the ultrasound, press the GSV directly above the SFJ transversely with the second to fifth fingertips of the left hand. Then, the ultrasound probe is placed against the distal part of the fingertips, and CA injection is performed while GSV is monitored in real time. RESULTS The mean stump length immediately after surgery was 19.3 (± 7.8) mm, with a range of .0-38.4 mm. The mean stump length after 1 week was 12.3 (± 7.4) mm and the range was .1-35.4 mm. The mean stump length after 1 month was 15.4 (± 10.1) mm, and the range was .0-35.4 mm. There was no case with EGIT or recanalization. CONCLUSIONS The author confirmed the possibility of safely reducing stump length with this novel surgical technique, and expect that this method can help overcome the weakness of CAC.
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Affiliation(s)
- Changhun Lee
- Department of Vascular Surgery, Chung-Ang University H.C.S Hyundae Hospital, Gyeonggi-do, Korea
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Charters B, Foster K, Lawton B, Lee L, Byrnes J, Mihala G, Cassidy C, Schults J, Kleidon TM, McCaffery R, Van K, Funk V, Ullman A. Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction: A Randomized Clinical Trial. JAMA Pediatr 2024; 178:437-445. [PMID: 38558161 PMCID: PMC10985620 DOI: 10.1001/jamapediatrics.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/28/2023] [Indexed: 04/04/2024]
Abstract
Importance Peripheral intravenous catheters (PIVCs) facilitate essential treatment. Failure of these essential devices is frequent and new securement strategies may reduce failure and improve patient outcomes. Objective To evaluate clinical effectiveness of novel PIVC securement technologies for children to reduce catheter failure. Design, Setting, and Participants A 3-arm, parallel group, superiority randomized clinical trial was conducted at 2 regional Australian hospitals from February 5, 2020, to January 14, 2022. Children aged 6 months to 8 years who were anticipated to require admission with a PIVC for at least 24 hours of in hospital treatment were eligible. Data were analyzed from May 25, 2022, to February 20, 2024. Interventions Participants were randomly allocated in a 1:1:1 ratio to standard care, bordered polyurethane (Tegaderm [3M]), integrated securement dressing (SorbaView SHIELD [Medline]), and integrated securement dressing with tissue adhesive (Secureport IV). One catheter was studied per patient. Main Outcomes and Measures Primary outcome was PIVC failure, defined as premature cessation of PIVC function for any reason prior to completion of planned treatment. Secondary outcomes were PIVC complications (any time dislodgement, occlusion, infiltration, partial dislodgement, extravasation, device leaking, phlebitis, pain), PIVC longevity, intervention acceptability (clinicians, participants, caregivers; 0-10 scale), and pain on removal (participants and caregivers; 0-10 scale relevant to age), adverse events, and health care costs. Results A total of 383 patients (51% female; median age 36 [25th-75th percentiles, 22-72] months) were randomized 134 to standard care, 118 to integrated securement dressing, and 131 to integrated securement dressing with tissue adhesive. PIVC failure was lowest in integrated securement dressing with tissue adhesive (15 [12%]; adjusted hazard ratio [aHR], 0.47; 95% CI, 0.26-0.84) compared with integrated securement dressing (24 [21%]; aHR, 0.78; 95% CI, 0.47-1.28) and standard care (43 [34%]). Direct costs were significantly lower for integrated securement dressing with tissue adhesive (median, Australian dollars [A$], 312 [A$1 is equal to $0.65 US dollars]; IQR, A$302-A$380) and integrated securement dressing (median, A$303; IQR, A$294-A$465) compared with standard care (median, A$341; IQR, A$297-A$592; P ≤ .002) when considering the economic burden related to failure of devices. PIVC longevity and intervention acceptability were similar across all groups. Conclusions and Relevance In this study, PIVCs secured with integrated securement dressings and tissue adhesive, in comparison with standard care, bordered polyurethane dressings, were associated with significantly reduced PIVC failure, for children admitted to hospital via the emergency department. Further research should focus on implementation in inpatient units where prolonged dwell and reliable intravenous access is most needed. Trial Registration Australian New Zealand Clinical Trials Registry Identifier: ACTRN12619001026112.
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Affiliation(s)
- Brooke Charters
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Gold Coast Health, Gold Coast University Hospital, Southport, Queensland, Australia
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Kelly Foster
- University of Southern Queensland, School of Nursing and Midwifery, Ipswich, Queensland, Australia
| | - Benjamin Lawton
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Leonard Lee
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Corey Cassidy
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
- North West Regional Hospital, Cooee, Tasmania, Australia
| | - Jessica Schults
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Metro North Hospital and Health Service, Herston Infectious Disease Institute, Brisbane, Queensland, Australia
| | - Tricia M. Kleidon
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Ruth McCaffery
- West Moreton Hospital and Health Service, Ipswich Hospital, Ipswich, Queensland, Australia
| | - Kristy Van
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
| | - Vanessa Funk
- Metro South Hospital and Health Service, Logan Hospital, Brisbane, Queensland, Australia
- Central West Hospital and Health Service, Glasson House, Longreach, Queensland, Australia
| | - Amanda Ullman
- The University of Queensland, School of Nursing, Midwifery and Social Work, Saint Lucia, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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Borouman S, Sigaroodi F, Ahmadi Tafti SM, Khoshmaram K, Soleimani M, Khani MM. ECM-based bioadhesive hydrogel for sutureless repair of deep anterior corneal defects. Biomater Sci 2024; 12:2356-2368. [PMID: 38497791 DOI: 10.1039/d4bm00129j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Corneal transplantation is the gold standard treatment for corneal-related blindness; however, this strategy faces challenges such as limited donor cornea, graft rejection, suture-related complications, and the need for specialized equipment and advanced surgical skills. Development of tissue adhesives for corneal regeneration is of great clinical value. However, currently available corneal tissue sealants pose challenges, such as lack of safety, biocompatibility, and desired mechanical properties. To meet these requirements simultaneously, a bovine stromal corneal extracellular matrix (dCor) was used to design a bioadhesive photocurable hydrogel based on gelatin methacrylate (GelMA) and polyethylene glycol diacrylate (PEGDA) hydrogels (dCor/Gel-PEG). Integration of dCor into the dual networks of GelMA and PEGDA (Gel-PEG) led to a bioadhesive hydrogel for curing corneal defects, which could be crosslinked by Irgacure 2959 within 5 min ultraviolet irradiation. The viability of corneal stromal stem cells (CSSCs) was improved on the dCor/Gel-PEG hydrogel in comparison to the Gel-PEG hydrogel. The gene expression profile supported the keratocyte differentiation of CSSCs seeded on dCor/Gel-PEG via increased KERA and ALDH, with inhibited myofibroblast transdifferentiation via decreased α-SMA due to the presence of dCor. Interestingly, the dCor/Gel-PEG hydrogel exhibited favorable mechanical performance in terms of elasticity and bioadherence to the host corneal stroma. Ex vivo and in vivo examinations proved the feasibility of this hydrogel for the sutureless reconstruction of deep anterior corneal defects with promising histopathological results.
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Affiliation(s)
- Safieh Borouman
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Faraz Sigaroodi
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohsen Ahmadi Tafti
- Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran 1411713138, Iran
| | - Keyvan Khoshmaram
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran (1417935840), Tehran, Iran
| | - Masoud Soleimani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohammad-Mehdi Khani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Palai D, Ohta M, Cetnar I, Taguchi T, Nishiguchi A. Enhanced ROS scavenging and tissue adhesive abilities in injectable hydrogels by protein modification with oligoethyleneimine. Biomater Sci 2024; 12:2312-2320. [PMID: 38497434 DOI: 10.1039/d3bm02065g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Postsurgical treatment comprehensively benefits from the application of tissue-adhesive injectable hydrogels, which reduce postoperative complications by promoting wound closure and tissue regeneration. Although various hydrogels have been employed as clinical tissue adhesives, many exhibit deficiencies in adhesive strength under wet conditions or in immunomodulatory functions. Herein, we report the development of reactive oxygen species (ROS) scavenging and tissue-adhesive injectable hydrogels composed of polyamine-modified gelatin crosslinked with the 4-arm poly (ethylene glycol) crosslinker. Polyamine-modified gelatin was particularly potent in suppressing the secretion of proinflammatory cytokines from stimulated primary macrophages. This effect is attributed to its ability to scavenge ROS and inhibit the nuclear translocation of nuclear factor kappa-B. Polyamine-modified gelatin-based hydrogels exhibited ROS scavenging abilities and enhanced tissue adhesive strength on collagen casing. Notably, the hydrogel demonstrated exceptional tissue adhesive properties in a wet environment, as evidenced by its performance using porcine small intestine tissue. This approach holds significant promise for designing immunomodulatory hydrogels with superior tissue adhesion strength compared to conventional medical materials, thereby contributing to advancements in minimally invasive surgical techniques.
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Affiliation(s)
- Debabrata Palai
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Namiki 1-1, Tsukuba, Ibaraki 305-0044, Japan.
| | - Miho Ohta
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Namiki 1-1, Tsukuba, Ibaraki 305-0044, Japan.
| | - Iga Cetnar
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Namiki 1-1, Tsukuba, Ibaraki 305-0044, Japan.
- Faculty of Materials Science and Engineering, Warsaw University of Technology, Al. Waszyngtona 4/8 Warsaw, Poland
| | - Tetsushi Taguchi
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Namiki 1-1, Tsukuba, Ibaraki 305-0044, Japan.
| | - Akihiro Nishiguchi
- Research Center for Macromolecules and Biomaterials, National Institute for Materials Science, Namiki 1-1, Tsukuba, Ibaraki 305-0044, Japan.
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de Sousa CP, Carvalho C, Sousa C, Amaral R. Treatment of gastric varices with cyanoacrylate complicated by systemic embolization. Rev Gastroenterol Peru 2024; 44:67-70. [PMID: 38734914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
Acute gastric variceal bleeding is a life-threatening condition that could be effectively treated with endoscopic cyanoacrylate injection diluted with lipiodol. The mixture acts as a tissue adhesive that polymerizes when in contact with blood in a gastric varix. This work reports a patient that presented to the emergency department with upper gastrointestinal bleeding due to acute variceal bleeding, who developed systemic embolization following cyanoacrylate injection therapy. This complication culminated in cerebral, splenic and renal infarctions with a fatal outcome. Systemic embolization is a very rare, but the most severe complication associated with endoscopic cyanoacrylate injection and should be considered in patients undergoing this treatment.
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Affiliation(s)
- Cristina Peixoto de Sousa
- Department of Anesthesiology and Pain Therapy, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Catarina Carvalho
- Intensive Care Service, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - Célia Sousa
- Department of Radiology, Centro Hospitalar e Universitário Lisboa Norte, Lisboa, Portugal
| | - Ricardo Amaral
- Intensive Care Service, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
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Wang P, Zhu Y, Feng L, Wang Y, Bu Y. Rapidly Self-Deactivating and Injectable Succinyl Ester-Based Bioadhesives for Postoperative Antiadhesion. ACS Appl Mater Interfaces 2022; 14:373-382. [PMID: 34978423 DOI: 10.1021/acsami.1c21083] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Postoperative adhesion not only causes severe complications for patients but also increases their economic burden. Injectable bioadhesives with adhesiveness to tissues can cover irregular wounds and stay stable in situ, which is a promising barrier for antiadhesion. However, the potential tissue adhesion caused by bioadhesives' indiscriminate adhesiveness between normal and wounded tissue is still a problem. Herein, by using poly(ethylene glycol) succinimidyl succinate (PEG-SS) and gelatin, a succinyl ester-based bioadhesive (SEgel) was fabricated with self-deactivating properties for postoperative antiadhesion. Because N-hydroxysuccinimide esters (NHS-esters) were used as the adhesive group, the bioadhesives' side in contact with the tissue built covalent anchors quickly to maintain the stability, but the superficial layer facing outward withstood fast hydrolysis and then lost its adhesion within minutes, avoiding the indiscriminate adhesiveness. In addition, because of the specific degradation behavior of succinyl ester, the SEgel with proper in vivo retention was achieved without the worry of causing foreign body reactions and unexpected tissue adhesion. Both the cecum-sidewall adhesion and hepatic adhesion models showed that the SEgel markedly reduced the severity of tissue adhesion. These results, together with the ease of the preparation process and well-proven biocompatibility of raw materials, revealed that the SEgel might be a promising solution for postoperative antiadhesion.
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Affiliation(s)
- Pengxu Wang
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yuan Zhu
- Department of Reproductive Health, The Affiliated Maternal and Child Healthcare Hospital of Nanchang University, Jiangxi 330006, China
- Department of Reproductive Health, Jiangxi Provincial Maternal and Child Health Hospital, Nanchang, Jiangxi 330006, China
| | - Luyao Feng
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
| | - Yinghui Wang
- College of Science, Chang'an University, Xi'an 710064, China
| | - Yazhong Bu
- Institute of Medical Engineering, Department of Biophysics, School of Basic Medical Sciences, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, China
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Luo X, Xiang T, Wu J, Wang X, Zhu Y, Xi X, Yan Y, Yang J, García-Pagán JC, Yang L. Endoscopic Cyanoacrylate Injection Versus Balloon-Occluded Retrograde Transvenous Obliteration for Prevention of Gastric Variceal Bleeding: A Randomized Controlled Trial. Hepatology 2021; 74:2074-2084. [PMID: 33445218 DOI: 10.1002/hep.31718] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 12/29/2020] [Accepted: 01/05/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS The optimal treatment for gastric varices (GVs) is a topic that remains open for study. This study compared the efficacy and safety of endoscopic cyanoacrylate injection and balloon-occluded retrograde transvenous obliteration (BRTO) to prevent rebleeding in patients with cirrhosis and GVs after primary hemostasis. APPROACH AND RESULTS Patients with cirrhosis and history of bleeding from gastroesophageal varices type 2 or isolated gastric varices type 1 were randomized to cyanoacrylate injection (n = 32) or BRTO treatment (n = 32). Primary outcomes were gastric variceal rebleeding or all-cause rebleeding. Patient characteristics were well balanced between two groups. Mean follow-up time was 27.1 ± 12.0 months in a cyanoacrylate injection group and 27.6 ± 14.3 months in a BRTO group. Probability of gastric variceal rebleeding was higher in the cyanoacrylate injection group than in the BRTO group (P = 0.024). Probability of remaining free of all-cause rebleeding at 1 and 2 years for cyanoacrylate injection versus BRTO was 77% versus 96.3% and 65.2% versus 92.6% (P = 0.004). Survival rates, frequency of complications, and worsening of esophageal varices were similar in both groups. BRTO resulted in fewer hospitalizations, inpatient stays, and lower medical costs. CONCLUSIONS BRTO is more effective than cyanoacrylate injection in preventing rebleeding from GVs, with similar frequencies of complications and mortalities.
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Affiliation(s)
- Xuefeng Luo
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Tong Xiang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Junchao Wu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Yongjun Zhu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaotan Xi
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuling Yan
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Jinlin Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
| | - Juan Carlos García-Pagán
- Barcelona Hepatic Hemodynamic Laboratory Liver Unit, Hospital Clinic, IDIBAPS and CIBEREHD, Barcelona, Spain
| | - Li Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu, China
- Sichuan University-University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, China
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Jung HY, Le Thi P, HwangBo KH, Bae JW, Park KD. Tunable and high tissue adhesive properties of injectable chitosan based hydrogels through polymer architecture modulation. Carbohydr Polym 2021; 261:117810. [PMID: 33766329 DOI: 10.1016/j.carbpol.2021.117810] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/10/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022]
Abstract
Chitosan-based hydrogels have been widely used for various biomedical applications due to their versatile properties such as biocompatibility, biodegradability, muco-adhesiveness, hemostatic effect and so on. However, the inherent rigidity and brittleness of pure chitosan hydrogels are still unmanageable, which has limited their potential use in biomaterial research. In this study, we developed in situ forming chitosan/PEG hydrogels with improved mechanical properties, using the enzymatic crosslinking reaction of horseradish peroxidase (HRP). The effect of PEG on physico-chemical properties of hybrid hydrogels was thoroughly elucidated by varying the content (0-100 %), molecular weight (4, 10 and 20 kDa) and geometry (linear, 4-arm) of the PEG derivatives. The resulting hydrogels demonstrated excellent hemostatic ability and are highly biocompatible in vivo, comparable to commercially available fibrin glue. We suggest these chitosan/PEG hybrid hydrogels with tunable physicochemical and tissue adhesive properties have great potential for a wide range of biomedical applications in the near future.
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Affiliation(s)
- Ha Young Jung
- Department of Molecular Science and Technology, Ajou University, 5 Woncheon, Yeongtong, Suwon, 443-749, Republic of Korea.
| | - Phuong Le Thi
- Department of Molecular Science and Technology, Ajou University, 5 Woncheon, Yeongtong, Suwon, 443-749, Republic of Korea.
| | - Kyung-Hee HwangBo
- Department of Material Development, GENOSS, 906-5 Iuidong, Yeongtong, Suwon, Republic of Korea.
| | - Jin Woo Bae
- Department of Material Development, GENOSS, 906-5 Iuidong, Yeongtong, Suwon, Republic of Korea.
| | - Ki Dong Park
- Department of Molecular Science and Technology, Ajou University, 5 Woncheon, Yeongtong, Suwon, 443-749, Republic of Korea.
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Du G, Kong D, Shi B, Jiang Z, Aniu M, Yang J, Zhang H, Gao L, Jin B. Liver retraction using n-butyl-2-cyanoacrylate glue during laparoscopic cholecystectomy. Medicine (Baltimore) 2021; 100:e25879. [PMID: 34011054 PMCID: PMC8137017 DOI: 10.1097/md.0000000000025879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/21/2021] [Indexed: 01/05/2023] Open
Abstract
There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (n = 30, NBCA group) and absence of NBCA glue (n = 27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30 months' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33 ± 16.15 vs 65.00 ± 22.15 minutes, P < .01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (P > .05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (P > .05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.
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Choi EH, Chan AY, Brown NJ, Lien BV, Sahyouni R, Chan AK, Roufail J, Oh MY. Effectiveness of Repair Techniques for Spinal Dural Tears: A Systematic Review. World Neurosurg 2021; 149:140-147. [PMID: 33640528 DOI: 10.1016/j.wneu.2021.02.079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been introduced, but the incomplete closure is still relatively frequent and troublesome. In this study, we review current evidence on spinal dural repair strategies and evaluate their efficacy. METHODS PubMed, Web of Science, and Scopus were used to search primary studies about the repair of the spinal dura with different techniques. Of 265 articles found, 11 studies, which specified repair techniques and postoperative outcomes, were included for qualitative and quantitative analysis. The primary outcomes were CSF leakage and postoperative infection. RESULTS The outcomes of different dural repair techniques were available in 776 cases. Pooled analysis of 11 studies demonstrated that the most commonly used technique was a combination of primary closure, patch or graft, and sealant (22.7%, 176/776). A combination of primary closure and patch or graft resulted in the lowest rate of CSF leakage (5.5%, 7/128). In this study, sealants as an adjunct to primary closure (13.7%, 18/131) did not significantly reduce the rate of CSF leakage compared with primary closure alone (17.6%, 18/102). The rates of infection and postoperative neurologic deficit were similar regardless of the repair techniques. CONCLUSIONS Although the use of sealants has become prevalent, available sealants as an adjunct to primary closure did not reduce the rate of CSF leakage compared with primary closure. The combination of primary closure and patches or grafts could be effective in decreasing postoperative CSF leakage.
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Affiliation(s)
- Elliot H Choi
- Department of Neurological Surgery, University of California, Irvine, California, USA; Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Brian V Lien
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, California, USA
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - John Roufail
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Michael Y Oh
- Department of Neurological Surgery, University of California, Irvine, California, USA.
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11
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D'Orazio B, Famà F, Sciumé C, Cudia B, Corbo G, Terranova G, Calì D, Bonventre S, Vita GD, Geraci G. Effect of Fibrin Sealant on Seroma Formation Post-Incisional Hernia Repair. Chirurgia (Bucur) 2021; 115:767-774. [PMID: 33378635 DOI: 10.21614/chirurgia.115.6.767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Background: Development of seroma after incisional hernia repair is a common complication. Our study aims to compare the outcomes of sublay incisional hernia repairs with or without spray instillation of fibrin glue. Methods: We enrolled fifty patients undergoing incisional hernia repair. In all patients a suction drain was placed in the subcutaneous space. In one group (FG) 4 ml fibrin glue was instilled in the subcutaneous space. In the control group (C) patients did not receive any prevention measure. Wounds fluids were collected on post-operative day 1 (POD) and once daily until drain removal. All patients were followed up by ultrasound on POD 15, 20, 40, 60. Results: Drain fluid production, even if in significantly greater amount in the C group (p 0.01) as compared with the FG group, decreased after POD 1 in both groups. Drain was removed on POD-5 in 80% of FG patients and in 36% of C patients (p 0.01). No infective or bleeding complications were detected. In group FG average hospital stay was of 5.5 ÃÂ+- 2 days versus 7.1 +- 1.5 days in group C (p 0.01). At ultrasounds examination, seroma development was similar among two groups. Conclusions: Spray instillation of fibrin glue during the surgical repair reduces amount of drained fluid and hospital stay without increasing surgical complications. However, seroma occurrence was not significantly reduced.
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Abstract
PURPOSE OF REVIEW Gastric varices (GV) are an important complication of portal hypertension, and the current recommendation for management is beta-blocker therapy for primary prophylaxis and transjugular intrahepatic portosystemic shunt (TIPS) for active bleeding or secondary prophylaxis. Direct endoscopic injection of cyanoacrylate (CYA) glue has been investigated but has drawbacks including limited endoscopic characterization of GV and possible distal glue embolism. To this end, endoscopic ultrasound (EUS) has been pursued to help in characterization of GV, visualization of treatment in real time, and confirmation of obliteration with Doppler. RECENT FINDINGS In this paper, we review treatments for GV involving EUS, including EUS-guided injection of CYA and coils, either alone or in combination. We also discuss less common methods, including EUS-guided injection of thrombin and absorbable gelatin sponge. We then review literature comparing EUS-guided methods with direct endoscopic therapy and comparing individual EUS-guided methods with one another. We conclude by highlighting drawbacks of EUS in this field, including the unproven benefit over conventional therapy, lack of a standardized approach, and limited availability of expertise and necessary materials. Novel EUS-based methods offer a unique opportunity to directly visualize and access gastric varices for treatment and obliteration. This may provide key advantages over current endoscopic or angiographic treatments. Comparative studies investigating the benefit of EUS over conventional therapy are needed.
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Affiliation(s)
| | - Alireza Sedarat
- Division of Digestive Diseases, UCLA Vatche and Tamar Manoukian, Los Angeles, CA USA
- Santa Monica, USA
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Sugimoto S, Fuke T, Kobayashi D, Ueda K, Sawa M, Kaneko M, Fukukita K, Temma T, Nomura T, Fuwa N, Yamada H. Efficacy of polyglycolic acid sheets and fibrin glue for the prevention of post-ELPS bleeding. Auris Nasus Larynx 2020; 48:471-476. [PMID: 33067053 DOI: 10.1016/j.anl.2020.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a covering method using polyglycolic acid (PGA) sheets and fibrin glue in preventing laryngopharyngeal bleeding after endoscopic laryngopharyngeal surgery (ELPS) combined with endoscopic submucosal dissection (ESD). METHODS Twenty-one patients who underwent ELPS combined with ESD (28 resected pharyngeal carcinomas) were retrospectively evaluated. After completing ELPS combined with ESD, fibrinogen was sprayed onto the ulcer. A PGA sheet cut into 5 × 5 mm pieces that fit the size of the ELPS-induced ulcer was then placed over the ulcer and fixed in place with a fibrin glue comprising thrombin. RESULTS The resection procedure was performed for all lesions. The median long diameter of the resected specimen was 36 mm. The rate of a resected specimen diameter >30 mm, use of anticoagulant/platelet, and macroscopic classification 0-Ⅱa were 68% (19/28), 19% (5/28), and 36% (10/28), respectively. The median time required to cover ELPS-induced ulcers using PGA sheets and fibrin glue was 10 min (range: 3-22 min). No post-ELPS bleeding, subcutaneous emphysema, or aspiration pneumonia (0/28) was observed. CONCLUSION The covering method using PGA sheets and fibrin glue for ELPS-induced ulcers is considered to be sufficiently safe and effective in preventing post-ELPS laryngopharyngeal bleeding. This method could be useful in preventing post-ELPS bleeding in patients with head and neck cancer.
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Affiliation(s)
- Shinya Sugimoto
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Tomohito Fuke
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Daisuke Kobayashi
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Kohki Ueda
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Masahiro Sawa
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Mamika Kaneko
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Kohei Fukukita
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan
| | - Taishi Temma
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Tatsuma Nomura
- Divisions of Gastroenterology, Ise Red Cross Hospital, 471-2, 1, Funae, Ise, Mie 516-8512, Japan
| | - Nobukazu Fuwa
- Divisions of Radiation Oncology, Ise Red Cross Hospital, Mie, Japan
| | - Hiroyuki Yamada
- Divisions of Otolaryngology-Head and Neck Surgery, Ise Red Cross Hospital, Mie, Japan.
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14
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Roof SA, Perez ER, Villavisanis DF, Khan MN, Ferrandino RM, Chouake RJ, Pacheco CW, Yao M, Teng MS, Genden EM, Miles BA. 2-Octyl cyanoacrylate to prevent salivary fistula formation following oral cavity microvascular reconstruction: A prospective trial. Am J Otolaryngol 2020; 41:102552. [PMID: 32505990 DOI: 10.1016/j.amjoto.2020.102552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Salivary fistulas remain a significant problem in patients undergoing major head and neck reconstructive surgery. Surgical sealants have become increasingly used in cutaneous and non-cutaneous wound closure, providing a barrier to fluids/gases and promoting healing. The purpose of this study was to determine the efficacy of a common surgical sealant, 2-Octyl Cyanoacrylate (2-OCA, Dermabond®), in the prevention of salivary fistulas following free flap reconstruction of the oral cavity. METHODS In this non-randomized, single arm prospective trial, patients undergoing free flap reconstruction of gravity-dependent oral cavity defects were recruited. Application of 2-OCA was performed along flap inset suture lines at the time of surgery. Prospectively collected trial data were propensity score matched to a control cohort to compare outcomes. Data collected include demographics, medical co-morbidities, previous treatments, primary tumor site, and subsites reconstructed. The primary outcome measure was rate of salivary fistula formation. Secondary outcomes were time to development of leak and percentage of patients tolerating oral feeding at one month post-operatively. RESULTS In the 46 propensity score matched pairs, eight (17.4%) out of 46 patients in the 2-OCA prospective cohort and seven (15.2%) out of 46 patients in the control cohort developed postoperative salivary fistulas within the one-month study interval (p = 1.00). The average time to postoperative leak in the 2-OCA group was 12.5 days versus 7.1 days in the control cohort (p = 0.10). In the 2-OCA group, 30 (65.2%) patients were tolerating regular diet at one month post-operatively compared to 33 (71.7%) in the control cohort (p = 0.65). CONCLUSION Salivary fistula rates after application of a 2-OCA surgical sealant were not improved compared to a control cohort in this single institutional trial. There are several surgical sealants available, each with varying elasticity and adhesiveness. Future studies are needed to identify surgical sealants that are able to provide sufficient strength and adhesion to seal closures and combat corrosive saliva, but elastic enough to handle motion related tension during swallowing and post-operative movements in the head and neck.
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Affiliation(s)
- Scott A Roof
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA.
| | - Enrique R Perez
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | | | - Mohemmed N Khan
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Rocco M Ferrandino
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert J Chouake
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Caitlin W Pacheco
- Department of Otolaryngology Head and Neck Surgery, Kaiser Permanente Oakland, Oakland, CA, USA
| | - Mike Yao
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Marita S Teng
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Eric M Genden
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Brett A Miles
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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Daud A, Kaur B, McClure GR, Belley-Cote EP, Harlock J, Crowther M, Whitlock RP. Fibrin and Thrombin Sealants in Vascular and Cardiac Surgery: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2020; 60:469-478. [PMID: 32620348 DOI: 10.1016/j.ejvs.2020.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/18/2020] [Accepted: 05/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. DATA SOURCES Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. REVIEW METHODS Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. RESULTS Twenty-one studies (n = 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. CONCLUSION The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Results may support selective rather than routine use of fibrin and thrombin sealants in vascular and cardiac surgery.
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Affiliation(s)
- Anser Daud
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Bhagwanpreet Kaur
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Graham R McClure
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Emilie P Belley-Cote
- Department of Medicine, McMaster University and St Joseph's Hospital, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - John Harlock
- Division of Vascular Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University and St Joseph's Hospital, Hamilton, ON, Canada
| | - Richard P Whitlock
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada; Division of Cardiac Surgery, McMaster University, Hamilton, ON, Canada.
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16
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Miró I, Gutiérrez C, Carazo E, Mínguez A, Crehuet C, Costa A, Del Peral M, Diéguez I, Fonseca R, Barrios JE, Lluna J, Vila JJ. Fibrin glue treatment associated or not with diathermy for recurrent tracheoesophageal fistula: our results after more than 20 years' experience. Cir Pediatr 2020; 33:115-118. [PMID: 32657094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Recurrent tracheoesophageal fistula (RTEF) is a frequent complication (5-10%) in patients with esophageal atresia (EA). Open RTEF surgery has a high morbidity and mortality, so the endoscopic approach represents a promising alternative. We present the long-term results of fibrin glue (FG) bronchoscopic application in patients with RTEF secondary to EA, which was first used by our team in 1994. MATERIAL AND METHODS A retrospective review of all patients diagnosed with RTEF following EA repair and treated with FG bronchoscopic application from 1993 to 2019 was carried out. In most cases, diathermy was applied prior to FG sealing. The maximum number of endoscopic sessions was 5. In case of persistent RTEF following the fifth session, open surgery was performed. RESULTS 14 RTEF patients were treated with FG. In all but the first 3 cases (11 patients, 78.6%), diathermy was applied concomitantly. Mean first treatment day was day 85 of life (range: 14-770). Patients received a mean of 2.1 (1-5) endoscopic sessions. Mean follow-up was 12.1 (10-20) years. Overall success rate was 71.4%, without significant differences according to whether diathermy was concomitantly applied or not (72.7% vs. 66.6%). CONCLUSIONS Fibrin glue bronchoscopic application associated or not associated with diathermy is an excellent option for RTEF treatment in EA patients. The endoscopic approach should be considered as the first-choice treatment for RTEF.
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Affiliation(s)
- I Miró
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Gutiérrez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - E Carazo
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Mínguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Crehuet
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - A Costa
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - M Del Peral
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Diéguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Fonseca
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J E Barrios
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J Lluna
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
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17
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Ptaszek LM, Portillo Lara R, Shirzaei Sani E, Xiao C, Roh J, Yu X, Ledesma PA, Hsiang Yu C, Annabi N, Ruskin JN. Gelatin Methacryloyl Bioadhesive Improves Survival and Reduces Scar Burden in a Mouse Model of Myocardial Infarction. J Am Heart Assoc 2020; 9:e014199. [PMID: 32458746 PMCID: PMC7428984 DOI: 10.1161/jaha.119.014199] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Delivery of hydrogels to the heart is a promising strategy for mitigating the detrimental impact of myocardial infarction (MI). Challenges associated with the in vivo delivery of currently available hydrogels have limited clinical translation of this technology. Gelatin methacryloyl (GelMA) bioadhesive hydrogel could address many of the limitations of available hydrogels. The goal of this proof-of-concept study was to evaluate the cardioprotective potential of GelMA in a mouse model of MI. Methods and Results The physical properties of GelMA bioadhesive hydrogel were optimized in vitro. Impact of GelMA bioadhesive hydrogel on post-MI recovery was then assessed in vivo. In 20 mice, GelMA bioadhesive hydrogel was applied to the epicardial surface of the heart at the time of experimental MI. An additional 20 mice underwent MI but received no GelMA bioadhesive hydrogel. Survival rates were compared for GelMA-treated and untreated mice. Left ventricular function was assessed 3 weeks after experimental MI with transthoracic echocardiography. Left ventricular scar burden was measured with postmortem morphometric analysis. Survival rates at 3 weeks post-MI were 89% for GelMA-treated mice and 50% for untreated mice (P=0.011). Left ventricular contractile function was better in GelMA-treated than untreated mice (fractional shortening 37% versus 26%, P<0.001). Average scar burden in GelMA-treated mice was lower than in untreated mice (6% versus 22%, P=0.017). Conclusions Epicardial GelMA bioadhesive application at the time of experimental MI was performed safely and was associated with significantly improved post-MI survival compared with control animals. In addition, GelMA treatment was associated with significantly better preservation of left ventricular function and reduced scar burden.
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Affiliation(s)
- Leon M Ptaszek
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Roberto Portillo Lara
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
- Department of Chemical Engineering Northeastern University Boston MA
- Tecnologico de Monterrey Escuela de Ingeniera y Ciensias Zapopan Mexico
| | - Ehsan Shirzaei Sani
- Department of Chemical Engineering Northeastern University Boston MA
- Department of Chemical and Biomolecular Engineering University of California, Los Angeles CA
| | - Chunyang Xiao
- Cardiovascular Research Center Massachusetts General Hospital Boston MA
| | - Jason Roh
- Cardiovascular Research Center Massachusetts General Hospital Boston MA
| | - Xuejing Yu
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Pablo A Ledesma
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
| | - Chu Hsiang Yu
- Department of Chemical Engineering Northeastern University Boston MA
| | - Nasim Annabi
- Department of Chemical Engineering Northeastern University Boston MA
- Department of Chemical and Biomolecular Engineering University of California, Los Angeles CA
- Center for Minimally Invasive Therapeutics California NanoSystems Institute University of California, Los Angeles CA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA
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Zhu Y, Zeng Q, Zhang Q, Li K, Shi X, Liang F, Han D. Temperature/near-infrared light-responsive conductive hydrogels for controlled drug release and real-time monitoring. Nanoscale 2020; 12:8679-8686. [PMID: 32253408 DOI: 10.1039/d0nr01736a] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Stimuli-responsive hydrogels with adaptable physical properties show great potential in the biomedical field. In particular, the collection of electrical signals is essential for precision medicine. Here, a simple strategy is demonstrated for achieving controlled drug release and real-time monitoring using an interpenetrating binary network consisting of a graphene aerogel and a poly(N-isopropylacrylamide) hydrogel with incorporated polydopamine nanoparticles (PDA-NPs). Owing to the good physical properties of graphene and the embedded PDA-NPs, the hybrid hydrogel shows enhanced mechanical properties and good electrical conductivity. In addition, the hybrid hydrogel also shows dual thermo- and near-infrared light responsiveness, as revealed by the controlled release of a model drug. In addition, as the hydrogel exhibits detectable changes in resistance during drug release, the drug-release behavior of the hydrogel can be monitored in real time using electrical signals. Moreover, owing to the abundance of catechol groups on the PDA-NPs, the hybrid hydrogel shows good tissue adhesiveness, as demonstrated using in vivo experiments. Thus, the developed hybrid hydrogel exhibits considerable practical applicability for drug delivery and precision medicine.
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Affiliation(s)
- Yuting Zhu
- The State Key Laboratory for Refractories and Metallurgy, Institute of Advanced Materials and Nanotechnology, School of Chemistry and Chemical Engineering, Wuhan University of Science and Technology, Wuhan 430081, China.
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Polyakov AA, Mikhin IV, Kosivtsov OA, Ryaskov LA. [Positioning of mesh implants in endoscopic inguinal hernia repair]. Khirurgiia (Mosk) 2020:53-59. [PMID: 32573533 DOI: 10.17116/hirurgia202006153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To improve the results of endoscopic inguinal hernia repair by determining the optimal access to inguinal region and method of positioning of the mesh implant. MATERIAL AND METHODS There were 221 patients with inguinal hernia who underwent 278 operations. We formed 2 groups: the main group A consisted of 92 (41.6%) patients who underwent extraperitoneal interventions (TEP/e-TEP); the control group B - 129 (58.4%) patients after transabdominal surgery (TAPP). In each group, 3 subgroups were identified depending on the method of mesh implant positioning: subgroups A1 and B1 - stapler reduced fixation at 1-3 points, subgroups A2 and B2 - glue fixation, subgroups A3 and B3 - vacuum positioning without fixation. Acute, chronic pain syndrome and quality of life were evaluated using visual-analogue scale (VAS), Short-Form Inguinal Pain Questionnaire (sf-IPQ) and SF-36 questionnaire, respectively. RESULTS All interventions were completed in minimally invasive fashion. Regression of acute pain syndrome after 3, 24, 48, 72 hours and 7 days was as follows: in group A - from 3.39±0.37 to 0.53±0.18 scores, in group B - from 4.47±0.34 to 0.94±0.24 scores. The lowest values were observed in subgroups with non-invasive positioning (p<0.05). Chronic pain syndrome was evaluated by all patients as less than 2 scores in 6 months after surgery. SF-36 values after 6 months ranged from 78±1.5 to 92±1.0 at TEP/e-TEP and from 75±1.6 to 92±1.1 at TAPP. Between-group and within-group differences were not significant (p>0.05). Control examination within 0.5-2 years was performed in 189 (85.5%) patients. No relapses were detected. CONCLUSION E-TEP technology is a priority. Glue fixation increases the congruence of mesh implants with inguinal region due to enlarged area of immobilization. This ensures safety and reliability of hernia repair, comfort for patients.
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Affiliation(s)
- A A Polyakov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - I V Mikhin
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - O A Kosivtsov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
| | - L A Ryaskov
- Volgograd State Medical University of the Ministry of Health of Russia, Volgograd, Russia
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20
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Li J, Shao X, Cheng T. How I do it: the horizontal-bilateral unfolding method for self-gripping (Progrip™) mesh placement in laparoscopic inguinal hernia repair. Hernia 2019; 23:809-815. [PMID: 30701370 DOI: 10.1007/s10029-019-01896-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 01/18/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of the self-gripping mesh (Progrip™) during laparoscopic inguinal hernia has been proved to be effective and eliminates the need of additional fixation. However, the deployment of the self-gripping mesh is challenging due to its adhesive property. The purpose of this study was to introduce and describe an easy self-gripping mesh deployment method in laparoscopic inguinal hernia repair. METHODS The self-gripping mesh was folded bilaterally towards the center of the mesh and placed vertically to align with the inferior epigastric artery, centered on the internal defect, then unfolded in a horizontal-bilateral unfolding method, first laterally, then medially. RESULTS A total of 63 inguinal hernias were repaired laparoscopicly: 40 patients by TAPP or TEP technique with self-gripping mesh, and there were no perioperative complications. The average time of mesh placement was 186 s (45-250 s). The patients only feel minimal pain (less than VAS 3) the second postoperative morning, and most of the patients were discharged the next day postoperatively; the average postoperative hospital duration was 1 day (1-2 days). CONCLUSION The present "horizontal-bilateral unfolding" mesh deployment method is a relative easy method to implant the self-gripping mesh during laparoscopic inguinal hernia repair.
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Affiliation(s)
- J Li
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
| | - X Shao
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - T Cheng
- Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China
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Belramman A, Bootun R, Tang TY, Lane TRA, Davies AH. Mechanochemical ablation versus cyanoacrylate adhesive for the treatment of varicose veins: study protocol for a randomised controlled trial. Trials 2018; 19:428. [PMID: 30086774 PMCID: PMC6081848 DOI: 10.1186/s13063-018-2807-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thermal ablation techniques have become the first-line treatment of truncal veins in the management of chronic venous disease (CVD). Despite excellent outcomes, these methods are often associated with pain; generally due to their use of heat and the necessity of fluid infiltration around the vein. More recently, novel non-thermal techniques, such as mechanochemical ablation (MOCA) and cyanoacrylate adhesive (CAE) have been developed to overcome these unwelcome effects. So far, the novel techniques have been found to have similar efficacy to thermal methods, yet no direct comparisons between the non-thermal treatment techniques have been conducted to date, giving rise to this study. METHODS/DESIGN This is a prospective, multicentre, randomised clinical trial, recruiting patients with truncal saphenous incompetence. Patients will be randomised to undergo either MOCA or CAE truncal ablation, followed by treatment of any varicosities. All patients will be required to wear compression stockings for 4 days post intervention. The primary outcome measure is the pain score immediately following completion of truncal ablation, measured by a 100-mm Visual Analogue Scale (VAS). The secondary outcomes are entire treatment pain scores, clinical scores, quality of life scores, occlusion rates, time to return to usual activities/work at 2 weeks, 3, 6 and 12 months. Re-intervention rate will be considered from the third month. Cost-effectiveness will be assessed for each intervention at 12 months. The study is powered to detect a mean 10-mm difference in maximum pain score. Allowing for loss to follow-up, the total target recruitment is 180 patients. DISCUSSION The study will be the first study to compare MOCA against CAE and is designed to determine which method causes less pain. Completion of this study is expected to be the end of 2019. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03392753 . Registered on 17 November 2017.
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Affiliation(s)
- Amjad Belramman
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4N12A, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
| | - Roshan Bootun
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4N12A, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
- East of England Deanery, London, UK
| | - Tjun Yip Tang
- Singapore General Hospital, London, Singapore
- Sengkang General Hospital, Singapore, Republic of Singapore
| | - Tristan R. A. Lane
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4N12A, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
- London Deanery, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Alun H. Davies
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, 4N12A, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF UK
- Imperial College Healthcare NHS Trust, London, UK
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Kouritas V, Kefaloyannis E, Tcherveniakov P. Use of Bioglue™ to seal a difficult to treat air leak in a complicated empyema patient. Gen Thorac Cardiovasc Surg 2018; 66:577-580. [PMID: 29696515 DOI: 10.1007/s11748-018-0924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/09/2018] [Indexed: 11/26/2022]
Abstract
Surgical sealants have been used in thoracic surgery in an effort to reduce air leak duration, intercostal drain duration, length of stay and complications. They are instilled over a defect usually treated with other means. We herein present the technique of controlling a difficult to treat defect by directly instilling Bioglue™ alone into a crater, caused during empyema Video-assisted thoracic surgery in a 50-year-old patient with a trapped lung. This deep crater had caused a significant air leak rendering intraoperative ventilation challenging. After instillation, the dependent lung was kept blocked. With this technique, the Bioglue™ polymerized and the air leak was dramatically decreased making ventilation and eventually extubation of the patient feasible. Instillation of Bioglue™ directly into a large lung defect could be a choice of action to decrease complicated air leaks, otherwise impossible to treat with other means, in patients with trapped lung.
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Affiliation(s)
- Vasileios Kouritas
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, LS9 7TF, UK.
| | | | - Peter Tcherveniakov
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, LS9 7TF, UK
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Costales AB, Patil D, Mulya A, Kirwan JP, Michener CM. 2-Octylcyanoacrylate for the prevention of anastomotic leak. J Surg Res 2018; 226:166-172. [PMID: 29661283 DOI: 10.1016/j.jss.2018.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anastomotic leak after colorectal surgery is a significant cause of morbidity and mortality. The aim of this study was to evaluate the impact of a reinforced colo-colonic anastomosis with tissue adhesive, 2-octylcyanoacrylate (2-OCA), on the integrity of anastomotic healing as measured by anastomotic bursting pressure. METHODS Sixty-eight female Sprague-Dawley rats underwent a rectosigmoid colon transection and a sutured end-to-end anastomosis followed by randomization to receive no further intervention or reinforcement with the tissue adhesive, 2-OCA. After seven postoperative days, a macroscopic assessment of the anastomosis, mechanical assessment to determine anastomotic bursting pressure, and a detailed semi-quantitative histopathologic healing assessment were performed. RESULTS Thirty-four animals were randomized to each group. Study characteristics did not differ between the groups. There was also no difference in the degree of adhesions present postoperatively. Although there was no difference between the net proximal and distal luminal areas in the two groups (0.37 cm2versus 0.55 cm2, P = 0.26), the 2-OCA group exhibited evidence of stricture in 15% of anastomoses as compared with 3% in the suture-only group (P < 0.0001). Histologically, the presence of only fibroblasts density was statistically more evident in the 2-OCA group compared with the sutured-only anastomosis (P = 0.0183). There was not a significant increase in mechanical strength in the 2-OCA group (238.9 mm Hg) versus in the suture-only group (231.8 mm Hg). There was no difference in the rate of anastomotic leak in the 2-OCA as compared with the suture-only group (9.1 versus 8.8%). CONCLUSIONS Application of 2-OCA to reinforce a colo-colonic anastomosis clinically provides no benefit to its mechanical strength and detrimentally increases the rate of obstruction and/or stricture in this in vivo model.
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Affiliation(s)
- Anthony B Costales
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Deepa Patil
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Anny Mulya
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - John P Kirwan
- Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Chad M Michener
- Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Kern NG, Behrens AM, Srinivasan P, Rossi CT, Daristotle JL, Kofinas P, Sandler AD. Solution blow spun polymer: A novel preclinical surgical sealant for bowel anastomoses. J Pediatr Surg 2017; 52:1308-1312. [PMID: 27956071 PMCID: PMC5459684 DOI: 10.1016/j.jpedsurg.2016.11.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Solution blow spinning is a technique for depositing polymer fibers with promising potential use as a surgical sealant. This study assessed the feasibility and efficacy of solution blow spun polymer (BSP) for sealing bowel perforations in a mouse model of partial cecal transection. We then evaluated its use for reinforcing a surgical anastomosis in a preclinical piglet model. METHODS Three commercially available surgical sealants (fibrin glue, polyethylene glycol (PEG) hydrogel, and cyanoacrylate) were compared to BSP in the ability to seal partially transected cecum in mice. For anastomosis feasibility testing in a piglet model, piglets were subjected to small bowel transection with sutured anastomosis reinforced with BSP application. Outcome measures included anastomotic burst pressure, anastomotic leak rate, 14-day survival, and complication rate. RESULTS For the mouse model, the survival rates for the sealants were 30% for fibrin glue, 20% for PEG hydrogel, 78% for cyanoacrylate, and 67% for BSP. Three of 9 mice died after BSP administration because of perforation leak, failure to thrive with partial obstruction at the perforation site, and unknown causes. All other mice died of perforation leak. The mean burst pressure at 24h was significantly higher for BSP (81mm Hg) when compared to fibrin glue (6mm Hg, p=0.047) or PEG hydrogel (10mm Hg, p=0.047), and comparable to cyanoacrylate (64mm Hg, p=0.91). For piglets, 4 of 4 animals survived at 14days. Mean burst pressures at time of surgery were 37±5mm Hg for BSP and 11±9mm Hg for suture-only controls (p=0.09). CONCLUSIONS Solution blow spinning may be an effective technique as an adjunct for sealing of gastrointestinal anastomosis. Further preclinical testing is warranted to better understand BSP properties and alternative surgical applications.
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Affiliation(s)
- Nora G Kern
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA; Department of Urology, University of Virginia Health System, PO Box 800422, Charlottesville, VA 22908, USA.
| | - Adam M Behrens
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Priya Srinivasan
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - Christopher T Rossi
- Department of Pathology, Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
| | - John L Daristotle
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Peter Kofinas
- Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA
| | - Anthony D Sandler
- Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA
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Maleux G, Cornelissen S, Bonne L. New materials in embolizations. J Cardiovasc Surg (Torino) 2016; 57:750-757. [PMID: 27647339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Percutaneous, catheter-directed embolotherapy is an established interventional technique for the management of many vascular disorders. For more than three decades, typical embolization devices included macro and microcoils, polyvinyl alcohol microparticles, glue and certain liquids such as absolute alcohol. In the past decade, however, several new embolic devices and refinements of existing embolic devices have arrived on the market and a number of clinical studies have demonstrated their added value. In this review article, these new embolic devices and their typical indications will be discussed, as well as the results of studies involving the embolic devices.
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Affiliation(s)
- Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium -
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26
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Standlee AG, Rogers DJ. Novel management of an isolated comminuted cricoid cartilage fracture. Ear Nose Throat J 2016; 95:452-453. [PMID: 27792823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Laryngeal trauma is a rare occurrence that can result in significant morbidity and mortality. Isolated cricoid cartilage fractures are exceedingly rare, and their treatment is highly variable. We describe a case of an isolated comminuted, uncalcified cricoid cartilage fracture in a 34-year-old man that responded well to novel management with suture and 2-octylcyanoacrylate tissue adhesive fixation intraoperatively and topical ciprofloxacin/dexamethasone applied to the airway postoperatively. We discuss the novel application of cyanoacrylate glue in laryngeal trauma and the potential benefits of topical ciprofloxacin/dexamethasone application to the airway.
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Affiliation(s)
- Aurora G Standlee
- Department of Otolaryngology, Madigan Army Medical Center, 9040 Jackson Ave., Tacoma, WA 98431, USA
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Rokni Yazdi H, Borhani A, Rasuli B, Kianoush S, Rafieian S, Jafarian A. Percutaneous Transhepatic N-Butyl Cyanoacrylate Injection Therapy of an Isolated Bile Duct Associated with a Bronchobiliary Fistula. J Vasc Interv Radiol 2016; 27:930-2. [PMID: 27287976 DOI: 10.1016/j.jvir.2016.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hadi Rokni Yazdi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran
| | - Ali Borhani
- Departments of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahman Rasuli
- Departments of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Kianoush
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, The Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shahab Rafieian
- General Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- General Surgery, Tehran University of Medical Sciences, Tehran, Iran
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Zhou AX, Ambati BK. Sutureless Lamellar Corneoscleral Patch Graft With Fibrin Sealant for Limbal Dermoid Removal. J Pediatr Ophthalmol Strabismus 2016; 53 Online:e22-5. [PMID: 27281829 DOI: 10.3928/01913913-20160509-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/25/2016] [Indexed: 11/20/2022]
Abstract
A 2-year-old boy with Goldenhar syndrome had a limbal dermoid removed and covered with a lamellar corneoscleral patch graft that was attached with fibrin glue and no sutures. The graft healed and attached well. A sutureless technique is beneficial due to decreased scarring and chance of infection.
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Cerezal-Garrido LJ, Agudo-Bernal J, Vaquero-Puerta C. Histological Benefits of Sealants in Tracheal Lesions in Wistar Rats. Surg Technol Int 2016; 28:29-35. [PMID: 27175812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The purpose of our study was to compare the effect, on the inflammatory response and fibrosis formation, of four commercially available sealant products applied on an injured trachea in a Wistar rat population. MATERIALS AND METHODS We compared four different sealants: cyanoacrylate, fibrin/thrombin, albumin/glutaraldehyde, and polyethylene glycol-based hydrogel (PEG). Rats were organized into six groups of similar size. Four of them were experimental, one was a baseline control group (BCG), and the sixth one was a reference control group (RCG). The RCG and experimental groups underwent the same surgical intervention with tracheal puncture, but no sealant was applied in the RCG. The BCG underwent the same cervical and peritracheal dissection without tracheal puncture. Rats were euthanized after eight weeks. RESULTS The operation was performed on 54 rats, of which 12 died, leaving a final sample of 42 rats. Macroscopic analysis revealed no superficial tracheal or vascular fistulas, nor signs of local abscess. Although the groups treated with cyanoacrylate, fibrin/thrombin, and albumin/glutaraldehyde showed some degree of fibrosis, the treated area of the PEG group showed neither inflammatory nor scar signs. Microscopic assessment of the BCG and RCG showed no remarkable findings. With the exception of the PEG group, which had a light fibrosis and poor inflammatory response as did the BCG and RCG groups, the other groups showed varying degrees of fibrosis and cicatrization. CONCLUSION Our study showed that the group treated with PEG had a mild inflammatory and fibrotic response, which is useful in tracheal or tracheobronchial surgical procedures. However, groups treated with cyanoacrylate, fibrin/thrombin, and albumin/glutaraldehyde showed fibrosis and cicatrization.
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Affiliation(s)
- Luis Jorge Cerezal-Garrido
- Hospital General Universitario de Alicante, Alicante, Spain, Faculty of Medicine Universidad Miguel Hernández, Elche (Alicante), Spain
| | - Javier Agudo-Bernal
- Department of Cell Biology, Histology, and Pharmacology, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Carlos Vaquero-Puerta
- Experimental Techniques, Laboratory of Surgical Research and Experimental Techniques, Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
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Sohn JJ, Gruber TM, Zahorsky-Reeves JL, Lawson GW. Comparison of 2-Ethyl-Cyanoacrylate and 2-Butyl-Cyanoacrylate for Use on the Calvaria of CD1 Mice. J Am Assoc Lab Anim Sci 2016; 55:199-203. [PMID: 27025812 PMCID: PMC4783639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/19/2015] [Accepted: 08/05/2015] [Indexed: 06/05/2023]
Abstract
Short-chain cyanoacrylates (SCCA), such as ethyl-2-cyanoacrylate (KrazyGlue, Aron Alpha, Columbus, OH) are commonly used as commercial fast-acting glues. Although once used in clinical medicine as skin adhesives, these products caused tissue toxicity and thus their use in live tissue was discontinued. SCCA were replaced by longer-chain versions (LCCA), such as butyl-cyanoacrylate (Vetbond, 3M, St Paul, Minnesota), which were found to be less toxic than the short-chain formulations. Some researchers prefer to use SCCA due to the belief that they create a stronger bond than do the longer-chain counterparts. In survival surgeries, we compared the bone thickness, bone necrosis, fibrosis, inflammation, and bone regeneration in the calvaria of control (naïve), surgery-only, SCCA-treated, and LCCA-treated mice (n = 20 per group). At 1 and 14 d after surgery, all mice except those treated with SCCA showed statistically similar bone measurements to those of the naive control group. The SCCA group had significantly less bone regeneration than did all other groups. These results suggest that the application of SCCA causes bone damage resulting in the loss of bone regeneration. This finding may assist investigators in choosing a tissue glue for their studies and may support the IACUC in advocating the use of pharmaceutical-grade tissue glues.
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Affiliation(s)
- Joanne J Sohn
- Department of Animal and Veterinary Sciences, California State Polytechnic University, Pomona, California, USA.
| | - Theresa M Gruber
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Joanne L Zahorsky-Reeves
- Division of Lab Animal Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Greg W Lawson
- Division of Lab Animal Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Zeng N, Mignet N, Dumortier G, Olivier E, Seguin J, Maury M, Scherman D, Rat P, Boudy V. Poloxamer bioadhesive hydrogel for buccal drug delivery: Cytotoxicity and trans-epithelial permeability evaluations using TR146 human buccal epithelial cell line. Int J Pharm 2015; 495:1028-37. [PMID: 26403384 DOI: 10.1016/j.ijpharm.2015.09.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 09/18/2015] [Accepted: 09/19/2015] [Indexed: 12/11/2022]
Abstract
A salbutamol sulfate (SS)-Poloxamer bioadhesive hydrogel specially developed for buccal administration was investigated by studying interactions with TR146 human buccal epithelium cells (i.e. cellular toxicity (i) and trans-epithelial SS diffusion (ii)). The assessment of cell viability (MTT, Alamar Blue), membrane integrity (Neutral Red), and apoptosis assay (Hoechst 33342), were performed and associated to Digital Holographic Microscopy analysis. After the treatment of 2h, SS solution induced drastic cellular alterations that were prevented by hydrogels in relation with the concentrations of poloxamer and xanthan gum. The formulation containing P407 19%/P188 1%/Satiaxane 0.1% showed the best tolerance after single and multiple administrations and significantly reduced the trans-epithelial permeability from 5.00±0.29 (×10(3)) (SS solution) to 1.83±0.22 cm/h. Digital Holographic Microscopy images in good agreement with the viability data confirmed the great interest of this direct technique. In conclusion, the proposed hydrogels represent a safe and efficient buccal drug delivery platform.
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Affiliation(s)
- Ni Zeng
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France; Unither Pharmaceuticals-Unither Développement Bordeaux, ZA Tech Espace, Av. Toussaint Catros, F-33185 Le Haillan, France
| | - Nathalie Mignet
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Gilles Dumortier
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Elodie Olivier
- UMR 8638CNRS COMETE, Paris Descartes University, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Johanne Seguin
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Marc Maury
- Unither Pharmaceuticals-Unither Développement Bordeaux, ZA Tech Espace, Av. Toussaint Catros, F-33185 Le Haillan, France
| | - Daniel Scherman
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Patrice Rat
- UMR 8638CNRS COMETE, Paris Descartes University, 4, avenue de l'observatoire, F-75006 Paris, France
| | - Vincent Boudy
- CNRS UMR 8258-Inserm U1022, Paris Descartes University, Chimie-Paris Tech, 4, avenue de l'observatoire, F-75006 Paris, France; Mise au point galénique, Agence Générale des Equipements et des Produits de Santé (AGEPS), AP-HP, 7, rue du fer à moulin, F-75005 Paris, France.
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Annabi N, Yue K, Tamayol A, Khademhosseini A. Elastic sealants for surgical applications. Eur J Pharm Biopharm 2015; 95:27-39. [PMID: 26079524 PMCID: PMC4591192 DOI: 10.1016/j.ejpb.2015.05.022] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Sealants have emerged as promising candidates for replacing sutures and staples to prevent air and liquid leakages during and after the surgeries. Their physical properties and adhesion strength to seal the wound area without limiting the tissue movement and function are key factors in their successful implementation in clinical practice. In this contribution, the advances in the development of elastic sealants formed from synthetic and natural materials are critically reviewed and their shortcomings are pointed out. In addition, we highlight the applications in which elasticity of the sealant is critical and outline the limitations of the currently available sealants. This review will provide insights for the development of novel bioadhesives with advanced functionality for surgical applications.
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Affiliation(s)
- Nasim Annabi
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115-5000, USA; Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA
| | - Kan Yue
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ali Tamayol
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ali Khademhosseini
- Biomaterials Innovations Research Center, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA; Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Physics, King Abdulaziz University, Jeddah 21569, Saudi Arabia.
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Palade E, Jung CF, Ellebrecht DB, Unger L, Keck T. Lung Sealing with the Sandwich-Technique: A New Surgical Method to Deal with the Emphysematous Lung. Chirurgia (Bucur) 2015; 110:462-466. [PMID: 26531791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
UNLABELLED The persistent air leak is a common and sometimes difficult to manage complication after major pulmonary resections. Especially in cases with lung emphysema spontaneous sealing of the lung surface under conservative therapy can be prolonged or even fail and a reoperation to close the damaged visceral pleura might be necessary. An ideal surgical solution to deal with this problem is not known, all of the techniques have advantages but also limitations and additional operations should be avoided in this group of frail patients. In this paper a new surgical method to seal the lung surface is presented based on two exemplary cases and our clinical experience. Basically, two stripes of fleece bounded fibrin based sealant are put on the visceral pleura parallel to the wound, which will be then closed by multiple stitches of absorbable suture line inserted through the stripes. Afterwards, a second layer of the same sealant will be placed over it to cover the suture with a narrow overlapping in all directions to the adjacent visceral pleura (Sandwich-Technique). In our experience, this technique can be used to successfully prevent or treat persistent air leaks especially in patients with lung emphysema in whom otherwise treatment options are limited. ABBREVIATIONS VATS = video-assisted thoracoscopic surgery POD = postoperative day LVRS = lung volume reduction surgery FEV1 = forced expiratory volume in the first second DLCO = diffusing capacity of the lung for carbon monoxide.
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Linderman SW, Kormpakis I, Gelberman RH, Birman V, Wegst UGK, Genin GM, Thomopoulos S. Shear lag sutures: Improved suture repair through the use of adhesives. Acta Biomater 2015; 23:229-239. [PMID: 26022966 PMCID: PMC4522236 DOI: 10.1016/j.actbio.2015.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/27/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
Suture materials and surgical knot tying techniques have improved dramatically since their first use over five millennia ago. However, the approach remains limited by the ability of the suture to transfer load to tissue at suture anchor points. Here, we predict that adhesive-coated sutures can improve mechanical load transfer beyond the range of performance of existing suture methods, thereby strengthening repairs and decreasing the risk of failure. The mechanical properties of suitable adhesives were identified using a shear lag model. Examination of the design space for an optimal adhesive demonstrated requirements for strong adhesion and low stiffness to maximize the strength of the adhesive-coated suture repair construct. To experimentally assess the model, we evaluated single strands of sutures coated with highly flexible cyanoacrylates (Loctite 4903 and 4902), cyanoacrylate (Loctite QuickTite Instant Adhesive Gel), rubber cement, rubber/gasket adhesive (1300 Scotch-Weld Neoprene High Performance Rubber & Gasket Adhesive), an albumin-glutaraldehyde adhesive (BioGlue), or poly(dopamine). As a clinically relevant proof-of-concept, cyanoacrylate-coated sutures were then used to perform a clinically relevant flexor digitorum tendon repair in cadaver tissue. The repair performed with adhesive-coated suture had significantly higher strength compared to the standard repair without adhesive. Notably, cyanoacrylate provides strong adhesion with high stiffness and brittle behavior, and is therefore not an ideal adhesive for enhancing suture repair. Nevertheless, the improvement in repair properties in a clinically relevant setting, even using a non-ideal adhesive, demonstrates the potential for the proposed approach to improve outcomes for treatments requiring suture fixation. Further study is necessary to develop a strongly adherent, compliant adhesive within the optimal design space described by the model.
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Affiliation(s)
- Stephen W Linderman
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, United States; Department of Biomedical Engineering, Washington University, St Louis, MO 63130, United States
| | - Ioannis Kormpakis
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, United States
| | - Richard H Gelberman
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, United States
| | - Victor Birman
- Engineering Education Center, Missouri University of Science and Technology, St Louis, MO 63131, United States
| | - Ulrike G K Wegst
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, United States
| | - Guy M Genin
- Department of Mechanical Engineering and Materials Science, Washington University, St Louis, MO 63130, United States.
| | - Stavros Thomopoulos
- Department of Orthopaedic Surgery, Washington University, St Louis, MO 63110, United States; Department of Biomedical Engineering, Washington University, St Louis, MO 63130, United States; Department of Mechanical Engineering and Materials Science, Washington University, St Louis, MO 63130, United States.
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Vida VL, Barzon E, Sabiu C, De Franceschi M, Padalino MA, Stellin G. The use of "2-octyl cyanoacrylate" as skin adhesive in pediatric and congenital cardiac surgery. Minerva Pediatr 2015; 67:111-116. [PMID: 25604588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this paper was to evaluate the safety and cost-effectiveness of "2-octyl-cyanoacrylate" as skin adhesive in congenital heart surgery. METHODS From April 2010 to December 2011, we collected data from 300 patients who underwent cardiac surgery for congenital heart disease. We divided our population into 3 groups: group-1 (N.=100):"2-octyl-cyanoacrylate" has been used to replace the intra-dermal suture line; group-2 (N.=100):"2-octyl-cyanoacrylate" has been utilized as a barrier ("add-on measure") in addition to the intra-dermal suture line, group-3 (N.=100) with a standard intra-dermal suture line. RESULTS Median age of patients was 1.36 years. One-hundred and thirty-nine patients were younger than 12 months and 56 older than 16 years. There were 11 wound dehiscence (3.6%) (2 in group-1 and 9 in group-3, P=0.001) and 1 superficial wound infection (group-1). Six patients (2%) required surgical wound revision (2 in group-1 and 4 in group-3, P=NS). Wound complication was significantly associated to delayed sternal closure (3/12 patients, 25% versus 13/288 patients, 4.5%) (P=0.04). Median cost (intra-/postoperative) for wound treatment was lower in group-1 and 2 (19±5.5 and 23.9±7.4 € respectively) when compared to Group-3 (26.7±3.2) (P<0.0001). CONCLUSION The use of "2-octyl-cyanoacrylate" proved to be safe and effective; the "add-on measure" strategy provided the best cost-effective solution.
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Affiliation(s)
- V L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy -
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Abstract
Background Voluntary medical male circumcision (VMMC) is a priority HIV preventive intervention. Current adult circumcision methods need improvement. Methods Field trial in 3 primary care centres. Minimally invasive VMMC using the Unicirc instrument following topical lidocaine/prilocaine anesthetic. Men were followed up at 1 and 4 weeks. Results We circumcised 110 healthy volunteers. Two men complained of transient burning pain during circumcision, but none required injectable anaesthesia. Median blood loss was 1ml and median procedure time was 9.0 min. There were 7 (6.3%) moderate complications (5 (4.5%) post-operative bleeds requiring suture and 2 (1.8%) post-operative infections) affecting 7 men. No men experienced significant wound dehiscence. 90.4% of men were fully healed at 4 weeks of follow-up and all were highly satisfied. Conclusions Use of topical anaesthesia obviates the need for injectable anesthetic and makes the Unicirc procedure nearly painless. Unicirc is rapid, easy to learn, heals by primary intention with excellent cosmetic results, obviates the need for a return visit for device removal, and is potentially cheaper and safer than other methods. Use of this method will greatly facilitate scale-up of mass circumcision programs. Trial Registration ClinicalTrials.gov NCT02091726
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Affiliation(s)
- Peter S. Millard
- University of New England, Portland, Maine, United States of America
- * E-mail:
| | - Norman D. Goldstuck
- Faculty of Medicine and Health Sciences, Stellenbosch University and Department of Obstetrics and Gynaecology, Tygerberg Hospital, Cape Town, South Africa
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Killion EA, Hyman CH, Hatef DA, Hollier LH, Reisman NR. A systematic examination of the effect of tissue glues on rhytidectomy complications. Aesthet Surg J 2015; 35:229-34. [PMID: 25805274 DOI: 10.1093/asj/sju078] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fibrin glue has widespread use in multiple fields of surgery. There have been numerous studies on the use of fibrin glue in facelifts, with no consensus regarding differences in outcomes. OBJECTIVES This study compared the risk of hematoma, seroma, and the 24-hour drainage volume in all published prospective controlled trials. METHODS A MEDLINE search of English-language articles on fibrin glue and rhytidectomy published up to July 2013 yielded 49 citations. After screening, we examined 7 relevant controlled trials. The DerSimonian and Laird random-effects model was used to perform the meta-analysis. RESULTS Seven controlled trials measuring the outcomes of fibrin glue in facelifts were used to estimate the pooled relative risk of complications and confidence intervals. Hematoma formation was four times less likely with the use of fibrin glue (relative risk 0.25, P = .002). There was no significant reduction in seroma formation (relative risk 0.56, P = .19). There was not enough data to properly measure 24-hour drainage and ecchymoses. CONCLUSIONS This analysis suggests that fibrin glue reduces the rates of hematoma formation, but does not significantly reduce the rates of seroma development. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Elizabeth A Killion
- Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas
| | - Charles H Hyman
- Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas
| | - Daniel A Hatef
- Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas
| | - Larry H Hollier
- Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas
| | - Neal R Reisman
- Drs Killion and Hatef are Residents, Dr Hollier, Jr. is the Chief and Program Director, and Dr Reisman is a Clinical Professor, Michael E. DeBakey Department of Surgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas. Mr Hyman is a Medical Student at Baylor College of Medicine, Houston, Texas
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Furst T, Piette M, Lechanteur A, Evrard B, Piel G. Mucoadhesive cellulosic derivative sponges as drug delivery system for vaginal application. Eur J Pharm Biopharm 2015; 95:128-35. [PMID: 25660908 DOI: 10.1016/j.ejpb.2015.01.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/20/2015] [Accepted: 01/23/2015] [Indexed: 11/15/2022]
Abstract
Vaginal delivery of active drugs has been largely studied for local and systemic applications. It is well known that vagina is a complex route, due to physiological and non-physiological changes. Therefore, in order to achieve a prolonged local effect, these variations have to be considered. The aim of this study was to formulate and to characterize a solid system, called sponges, obtained by lyophilization of cellulosic derivative (HEC 250M) hydrogels. These sponges have to meet particular criteria to be adapted for vaginal application: they have to adhere to the vaginal cavity and to be rehydrated by the small amount of vaginal fluids. Moreover, they have to be easily manipulated and to be stable. Three freezing temperatures have been tested to prepare sponges (-15°C, -25°C, -35°C). By SEM analyzes, it was observed that the pores into the sponges were smaller and numerous as the freezing temperature decreases. However, this temperature did not have any influence on the rehydration speed that was rather influenced by the HEC concentration. Viscosity and mucoadhesive strength of hydrogels and corresponding sponges were also measured. It appeared that these parameters are mainly dependent on the HEC concentration. These mucoadhesive sponges can be considered as potential drug delivery systems intended for vaginal application.
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Affiliation(s)
- Tania Furst
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium.
| | - Marie Piette
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
| | - Anna Lechanteur
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
| | - Brigitte Evrard
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
| | - Géraldine Piel
- Laboratory of Pharmaceutical Technology and Biopharmacy, CIRM, University of Liège, Belgium
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Topiwala P, Bansal RK. Comparative evaluation of cyanoacrylate and fibrin glue for muscle recession in strabismus surgery. J Pediatr Ophthalmol Strabismus 2014; 51:349-54. [PMID: 25427305 DOI: 10.3928/01913913-20141021-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/24/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the safety and efficacy of fibrin glue and cyanoacrylate glue for refixating the recessed muscle to the sclera in patients undergoing strabismus surgery. METHODS In this prospective, randomized, and interventional case series, there were 15 patients in each group. Two different types of glue were used for refixating the muscle to the sclera after its recession: fibrin glue (fibrin group) and cyanoacrylate glue (cyanoacrylate group). Resection was performed as usual with a 6-0 polyglactin suture. The conjunctiva was closed with the same glue that was used for muscle recession. RESULTS Average time required per muscle attachment was 1.48±0.694 minutes in the fibrin group and 2.42±0.584 minutes in the cyanoacrylate group. There was no significant difference in pain at all postoperative visits in both groups. Significantly more chemosis was observed in the cyanoacrylate group at postoperative 3 weeks. At all other postoperative visits, there was no significant difference in chemosis in both groups. There was significantly more conjunctival reaction in the cyanoacrylate group at 1 and 3 weeks and 3 months; the difference was highly significant at 3 months (P=.00). Total inflammatory score was significantly high in the cyanoacrylate group at 1 week, 3 weeks, and 3 months. CONCLUSIONS Both fibrin and cyanoacrylate glue are equally efficacious for muscle reattachment; however, fibrin glue is more biotolerant compared to cyanoacrylate glue and results in less postoperative inflammation, and is thus recommended for recession in strabismus surgery.
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Bowen C, Bidinger J, Hivnor C, Hoover A, Henning JS. Allergic contact dermatitis to 2-octyl cyanoacrylate. Cutis 2014; 94:183-186. [PMID: 25372253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cyanoacrylates are widely used as topical skin adhesives in emergency departments, clinics, and operating rooms. We report 4 patients who developed allergic contact dermatitis (ACD) following postsurgical closure with 2-octyl cyanoacrylate. These patients were challenged with a novel method of use testing to confirm sensitivity to 2-octyl cyanoacrylate. The popularity of skin adhesives makes this emerging allergen worthy of examination. It is possible that cyanoacrylate allergy currently is underrecognized.
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Affiliation(s)
- Casey Bowen
- Department of Dermatology, San Antonio Military Medical Center South, 2200 Bergquist Dr, Ste 1, Lackland AFB, TX 78236, USA.
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Damiano G, Gioviale MC, Palumbo VD, Spinelli G, Buscemi S, Ficarella S, Bruno A, Tomasello G, Lo Monte AI. Human fibrin glue sealing versus suture polypropylene fixation in Lichtenstein inguinal herniorrhaphy: a prospective observational study. Chirurgia (Bucur) 2014; 109:660-663. [PMID: 25375054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Patients who underwent primary inguinal hernia repair still report a high rate of postoperative pain after operation due to the effect of mesh fixation by suture.An alternative is the use of human fibrin glue. We compared the two techniques. METHODS 468 patients randomly underwent primary inguinal hernia Lichtenstein repair fixing the mesh by suture or by human fibrin glue (HFG); in both cases the mesh was fixed to the posterior wall of the inguinal canal and to the inguinal ligament. RESULTS No significant differences were recorded between the two groups in terms of complications, while the sutureless technique reduces the operative time and the postoperative pain. CONCLUSIONS A widespread technique for the treatment of inguinal hernia is the application of a mesh using Lichtenstein procedure. The prosthesis can be fixed by traditional suture or using a new method of sutureless fixation with adhesive materials that shows an excellent local tolerability and lack of adverse effects and contraindications.
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Basile M, Ranieri E, Di Nicola M, Mascitelli E. Clinical comparison between wall defects surgery using conventional and low-adhesion mesh materials Preliminary results. Ann Ital Chir 2014; 85:501-506. [PMID: 25600559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE The use of prosthetic materials for hernia repair has become a standard procedure. Still the optimal material has not yet been found. Primitive hernia with loss of substance and big incisional hernia repair requires a prosthetic material which not induce, especially in the area of visceral peritoneal contact, chronic inflammation and fibrosis. The aim of this study is to clinically compare two different mesh materials: uncoated monofilament polypropylene and polypropylene- polyurethane double surface mesh. METHODS Forty eight primitive hernia and incisional hernia affected patients were included in the study. They were randomly allocated in two groups. In each group a different type of mesh was utilized, respectively uncoated monofilament polypropylene mesh and polypropylene-polyurethane double surface synthetic mesh. Lichtenstein and Rives surgical techniques were utilized. Intra-operative, early and late post-operative complications were clinically evaluated. RESULTS Uncoated monofilament polypropylene meshes treated patients showed higher abdominal pain, inflammatory diseases and hernia recurrence incidence than polypropylene-polyurethane double surface meshes. Abdominal wall hypo-mobility, discomfort and atypical sensation were the same in the two groups of treated patients. CONCLUSIONS Given the limited number of our patient's set, from our preliminary results is possible to assert that polypropylene-polyurethane double surface meshes have revealed superior bio-functional and bio-compatible efficacy.
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La Greca G, Primo S, Sofia M, Lombardo R, Puleo S, Russello D, Di Cataldo A. Combination of fibrin glue protection with microsurgical technique for duct-to-mucosa pancreatico-jejunostomy reduces the incidence of leakages after pancreaticoduodenectomy. Ann Ital Chir 2014; 85:490-494. [PMID: 25402971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Achilles' heel of pancreatic surgery is the management of the pancreatic stump. Leakage from pancreatic anastomosis with subsequent fistula, abscess formation, sepsis, or bleeding is one of the most common causes of morbidity and mortality, and it also contributes significantly to prolonged hospitalization and increased hospital expenses. Many surgical methods have been developed aimed at reducing the incidence of post-operative pancreatic fistula. However, the best technique for pancreatico-enteric reconstruction continues to be disputed. Herein, we describe an interim analysis of 35 consecutive pancreatico-duodenectomies, all with the same standardized technique that combines microsurgical technique for duct-to-mucosa pancreatico-jejunostomy with the routine use of fibrin sealant. The rate of leakage of pancreaticojejunostomy was 5,7% (n=2), all of which were grade A fistulas, treated conservatively. The increased precision of magnification instruments and microsurgical technique for duct to mucosa anastomosis, combined with routine sealing of the pancreatic anastomosis are key factors to efficiently manage the pancreatic stump. The good results obtained and especially the minimal rate of fistula suggests that this technical solution is a safe, feasible and reliable approach for pancreatic reconstruction after pancreatico-duodenectomy.
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Abstract
BACKGROUND In women undergoing in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), embryos transferred into the uterine cavity can be expelled due to many factors including uterine peristalsis and contractions, low site of deposition and negative pressure generated when removing the transfer catheter. Techniques to reduce the risk of embryo loss following embryo transfer (ET) have been described but are not standard in all centres conducting ET. OBJECTIVES To evaluate the efficacy of interventions used to prevent post-transfer embryo expulsion in women undergoing IVF and ICSI. SEARCH METHODS We searched the Menstrual Disorders and Subfertility Group Specialised Register of controlled trials to June 2014 and PubMed, MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, World Health Organization ICTRP, and trial registers from inception to June 2014, with no language restrictions. Additionally, we handsearched reference lists of relevant articles, and ESHRE and ASRM conference abstracts. SELECTION CRITERIA We included randomised controlled trials (RCTs) of interventions used to prevent post-transfer embryo expulsion in women undergoing IVF and ICSI. Two review authors independently screened titles and abstracts and reviewed the full-texts of all potentially eligible citations to determine whether they met our inclusion criteria. Disagreements were resolved by consensus. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias of included trials using standardised, piloted data extraction forms. Data were extracted to allow intention-to-treat analyses. Disagreements were resolved by consensus. The overall quality of the evidence was rated using GRADE methods. MAIN RESULTS We included four RCTs (n = 1392 women) which administered the following interventions: bed rest (two trials), fibrin sealant (one trial), and mechanical closure of the cervix (one trial). Our primary outcome, live birth rate, was not reported in any of the included trials; nor were the data available from the corresponding authors. For the ongoing pregnancy rate, two trials comparing more bed rest with less bed rest showed no evidence of a difference between groups (odds ratio (OR) 0.88; 95% confidence interval (CI) 0.60 to 1.31, 542 women, I(2) = 0%, low quality evidence). Secondary outcomes were sporadically reported with the exception of the clinical pregnancy rate, which was reported in all of the included trials. There was no evidence of a difference in clinical pregnancy rate between more bed rest and less bed rest (OR 0.88; 95% CI 0.60 to 1.31, 542 women, I(2) = 0%, low quality evidence) or between fibrin sealant and usual care (OR 0.98; 95% CI 0.54 to 1.78, 211 women, very low quality evidence). However, mechanical closure of the cervix was associated with a higher clinical pregnancy rate than usual care (OR 1.92; 95% CI 1.40 to 2.63, very low quality evidence). The quality of the evidence was rated as low or very low for all outcomes. The main limitations were failure to report live births, imprecision and risk of bias. Overall, the risk of bias of the included trials was high. The use of a proper method of randomisation and allocation concealment was fairly well reported, while only one trial clearly reported blinding. There was no evidence that any of the interventions had an effect on adverse event rates but data were too few to reach any conclusions. AUTHORS' CONCLUSIONS There is insufficient evidence to support any specific length of time for women to remain recumbent, if at all, following embryo transfer, nor is there sufficient evidence to recommend the use of fibrin sealants added to the embryo transfer fluid. There is very limited evidence to support the use of mechanical pressure to close the cervical canal following embryo transfer. Further well-designed and powered studies are required to determine the true effectiveness and safety of these interventions.
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Affiliation(s)
- Ahmed M Abou‐Setta
- University of ManitobaCentre for Healthcare InnovationGH‐714 820 Sherbrook StreetWinnipegMBCanadaR3A 1R9
| | - Leah R Peters
- University of LimerickGraduate Entry Medical SchoolLimerickIreland
| | - Arianna D'Angelo
- Cardiff University School of MedicineObstetrics and GynaecologyCardiffWalesUK
| | - Hassan N Sallam
- Alexandria UniversityObstetrics and Gynaecology22 Victor Emanuel SquareSmouhaAlexandriaEgypt21615
| | - Roger J Hart
- The University of Western Australia, King Edward Memorial Hospital and Fertility Specialists of Western AustraliaSchool of Women's and Infants' Health374 Bagot RoadSubiacoWestern AustraliaAustralia6008
| | - Hesham G Al‐Inany
- Faculty of Medicine, Cairo UniversityObstetrics & Gynaecology8 Moustapha Hassanin StManialCairoEgypt
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Cestaro G, De Rosa M, Gentile M. Treatment of fistula in ano with fibrin glue: preliminary results from a prospective study. MINERVA CHIR 2014; 69:225-228. [PMID: 24987970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM This prospective study was done to evaluate the efficacy of commercial fibrin glue application in the healing of patients with fistulas-in-ano from a short follow up period (one year). METHODS This randomized clinical trial of 26 patients was performed during the period from January 2012 to July 2012. Nineteen men and seven women were treated for a fistula-in-ano with a commercial fibrin glue injection. In the operating room, the patients underwent an anorectal examination under spinal anesthesia. The external and internal fistula tract openings were then identified and the fistula tract was accurately curetted. Fibrin glue was introduced by a loaded double-channel syringe into the external fistula opening until the fibrin glue tip could be seen emerging from the internal opening. RESULTS The initial success rate was 76.9% (20/26). Recurrence rate was 23% (6/26). Four patients underwent a re-application of fibrin glue and the fistulas of these patients closed. Total recurrence rate was 7.6% (2/26). The overall success rate was 69.2% (18/26). CONCLUSION Fibrin glue application was thus found to be an easy, safe, successful alternative treatment in the management of fistulas-in-ano. Specifically, this therapeutic option demonstrated his efficacy for simple non-ramificated transsphincteric and intersphincteric fistulas. Multicentric randomized clinical trials with more representative sample seem to be necessary to investigate the best patients to treat by fibrin glue injection and the optimal application technique to improve these results.
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Affiliation(s)
- G Cestaro
- Unit of General Specialistic and Mini‑invasive Surgery Federico II University of Naples, Naples, Italy -
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Isaksson K, Akerberg D, Posaric-Bauden M, Andersson R, Tingstedt B. In vivo toxicity and biodistribution of intraperitoneal and intravenous poly-L-lysine and poly-L-lysine/poly-L-glutamate in rats. J Mater Sci Mater Med 2014; 25:1293-1299. [PMID: 24449025 DOI: 10.1007/s10856-014-5151-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/12/2014] [Indexed: 06/03/2023]
Abstract
The combination of two differently charged polypeptides, poly-L-lysine (PL) and poly-L-glutamate (PG), has shown excellent postsurgical antiadhesive properties. However, the high molecular, positively charged PL is toxic in high doses, proposed as lysis of red blood cells. This study aims to elucidate the in vivo toxicity and biodistribution of PL and complex bound PLPG comparing intravenous and intraperitoneal administration. Fifty-six Sprague-Dawley rats were used in a model with repeated blood samples within 30 min examining blood gases and blood smears. Similarly, FITC labelled PL were used to track bio distribution and clearance of PL, given as single dose and complex bound to PG after intravenous and intraperitoneal administration. Tissue for histology and immunohistochemistry was collected. Blood gases and blood smears as well as histology points to a toxic effect of high dose PL given intravenously but not after intraperitoneal administration. The toxic effect is exerted through endothelial disruption and subsequent bleeding in the lungs, provoking sanguineous lung edema. FITC-labelled PL experiments reveal a rapid clearance with differences between routes and complex binding. This study advocates a new theory of the toxic effects in vivo of high molecular PL. PLPG complex is safe to use as antiadhesive prevention based on this toxicity study given that PL is always intraperitoneally administered in combination with PG and that the dose is adequate.
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Affiliation(s)
- K Isaksson
- Department of Surgery, Skåne University Hospital in Lund, Getingevägen 4, 221 85, Lund, Sweden
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Sabourin G. [Lacerations in the child. Treating without pain]. Perspect Infirm 2014; 11:63. [PMID: 24672929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Celis J, Mesa D, Avendaño E, González-Valle F. [Intracameral fibrin glue in spontaneous corneal perforation]. Arch Soc Esp Oftalmol 2014; 89:124-6. [PMID: 24269398 DOI: 10.1016/j.oftal.2012.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 07/31/2012] [Accepted: 09/02/2012] [Indexed: 11/17/2022]
Abstract
CASE REPORT A 70-year-old male was referred to our department due to a herpetic corneal perforation in the left eye. The perforation was healed with intracameral fibrin tissue sealant (Tissucol(®)), an amniotic membrane, and a large diameter soft contact lens. Postoperatively there were complete dissolution of the fibrin sealant and closure of the perforation without endothelial damage. DISCUSSION Intracameral fibrin glue may be effective in the closure of corneal perforations.
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Affiliation(s)
- J Celis
- Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - D Mesa
- Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | - E Avendaño
- Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - F González-Valle
- Servicio de Oftalmología, Hospital La Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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Zenteno M, Santos Franco J, Moscote-Salazar LR, Lee A. [Endovascular management of cavernous sinus dural fistulas]. Bol Asoc Med P R 2014; 106:17-24. [PMID: 24791359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Describe the outcomes of patients diagnosed with indirect carotid-cavernous fistula treated by endovascular methods. DESIGN A retrospective case series. PARTICIPANTS Twelve patients with dural cavernous sinus fistula with important ophthalmologic involvement admitted and treated at the National Institute of Neurology and Neurosurgery between February 1990 and January 2005. INTERVENTION Patients were managed by endovascular embolization for all fistulas. OUTCOME MEASURES Angiographic controls to 24 hours and at 6 and 12 months were performed. RESULTS 67 % were female and 33 % male. The mean age was 44 years. 67 % were spontaneous and 33% of traumatic origin. All patients had eye involvement with proptosis (92%) and involvement of the oculomotor nerve (67%). Headache and pulsatile tinnitus were not frequent ophthalmologic data. All were diagnosed by cerebral angiography, 33 % were type C, type D 67 %, and none of the type B classification Barrow. In 17 % of cases the distal arterial robbery showed severe. Predominance of anterior and superior venous drainage in 83 % and 42 % of cases occurred respectively. The surgical approach was arterial in 84% of cases, while in 17 % venous through the superior ophthalmic vein. Cyanoacrylate embolization material was used in 58 % of the cases, as it was associated with the use of removable ball with polyvinyl alcohol particles in 16 % in of venous approach cases. 17% detachable coils were utilized. There were no complications. After angiographic controls at 24 hours 100% occlusion was seen in patients treated with cyanoacrylate (58%) (p = 0.03). The remaining 42% were prescribed maneuver of manual compression. At 12-months angiography all patients had 100% occlusion of the carotid-cavernous fistula. CONCLSUIONS: This is the world's second largest series with indirect carotid-cavernous fistulas treated after trauma. 100 % of cases were cured with the use of a transarterial-controlled approach and N-butyl-cyanoacrylate after long-term observation.
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Abstract
PURPOSE To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo(®) ) used to close the conjunctiva in trabeculectomy. METHODS A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. RESULTS No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo(®) group. Two patients in the Tissucol Duo(®) group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. CONCLUSION The use of Tissucol Duo(®) seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.
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Affiliation(s)
- José M Martinez-de-la-Casa
- Ophthalmology Department, Clinico San Carlos Hospital, Ophthalmology Department of Medicine School, Complutense University of Madrid, Health Investigative Institute of Clinico San Carlos Hospital (IdISSC), Madrid, Spain.
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