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Lu Z, Chen Y, Xiao C, Hua K, Hu C. Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons' initial experience. BMC Surg 2024; 24:25. [PMID: 38229131 DOI: 10.1186/s12893-023-02304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/26/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND To introduce a novel technique of transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy (ESLS) for apical prolapse and to evaluate the feasibility and short-term outcomes of this technique. METHODS Sixteen patients were enrolled to undergo ESLS between January 2020 and May 2021. Perioperative outcomes were included. Short-term results were assessed by Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Organ Prolapse Quantification (POP-Q) scores, mesh exposure and prolapse recurrence. RESULTS A total of 14/16 cases (87.5%) were successfully completed. The mean operation time was 118 min (range 85-160), and the mean blood loss was 68 ml (range 20-100). The mean postoperative visual analog scale (VAS) pain score at 24 h was 0.7. No intraoperative complications occurred except for one patient who developed subcutaneous emphysema. All patients gained a significant improvement in both physical prolapse and quality of life at 12 months after surgery, and there was no mesh exposure or prolapse recurrence. CONCLUSIONS Our experience showed that transvaginal ESLS is a feasible and effective technique for apical prolapse with a previous hysterectomy. However, this technique should be performed by surgeons with extensive experience both in vaginal surgery and laparoscopic single-port surgery.
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Affiliation(s)
- Zhiying Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang RD, Shanghai, 200090, China
| | - Yisong Chen
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang RD, Shanghai, 200090, China
| | - Chengzhen Xiao
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang RD, Shanghai, 200090, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang RD, Shanghai, 200090, China.
| | - Changdong Hu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang RD, Shanghai, 200090, China.
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Lang P, Liu T, Huang S, Zhou Z, Zhang M, Lin Y, He Q, Yao Y, Liu Z, Zhang L. Degradable Temperature-Sensitive Hydrogel Loaded with Heparin Effectively Prevents Post-Operative Tissue Adhesions. ACS Biomater Sci Eng 2023. [PMID: 37179492 DOI: 10.1021/acsbiomaterials.3c00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Tissue adhesions could occur following surgeries, and severe tissue adhesions can lead to serious complications. Medical hydrogels could be applied at surgical sites as a physical barrier to prevent tissue adhesion. For practical reasons, spreadable, degradable, and self-healable gels are highly demanded. To meet these requirements, we applied carboxymethyl chitosan (CMCS) to poloxamer-based hydrogels to generate low Poloxamer338 (P338) content gels displaying low viscosity at refrigerator temperature and improved mechanical strength at body temperature. Heparin, an effective adhesion inhibitor, was also added to construct P338/CMCS-heparin composite hydrogel (PCHgel). PCHgel presents as a flowable liquid below 20 °C and could rapidly transform into gel when spread on the surface of damaged tissue due to temperature change. The introduction of CMCS enabled hydrogels to form a stable self-healable barrier at injured positions and slowly release heparin during the wound healing period before being degraded after ∼14 days. Ultimately, PCHgel significantly reduced tissue adhesion in model rats and displayed higher efficiency than P338/CMCS gel without heparin. Its adhesion suppression mechanism was verified, and it also displayed good biosafety. Therefore, PCHgel showed good clinical transformation potential with high efficacy, good safety, and ease of use.
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Affiliation(s)
- Puxin Lang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Tiantian Liu
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Shiqi Huang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Zhaojie Zhou
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Mengxing Zhang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
| | - Yunzhu Lin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610000, P. R. China
| | - Qin He
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan 610000, P. R. China
| | - Yuqin Yao
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
| | - Zhenmi Liu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
| | - Ling Zhang
- College of Polymer Science and Engineering, Sichuan University, Chengdu, Sichuan 610000, China
- Med-X Center for Materials, Sichuan University, Chengdu, Sichuan 610000, China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610000, China
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Xiang L, Liang J, Wang Z, Lin F, Zhuang Y, Saiding Q, Wang F, Deng L, Cui W. Motion lubrication suppressed mechanical activation via hydrated fibrous gene patch for tendon healing. SCIENCE ADVANCES 2023; 9:eadc9375. [PMID: 36763658 PMCID: PMC9917012 DOI: 10.1126/sciadv.adc9375] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Mechanical activation of fibroblasts, caused by friction and transforming growth factor-β1 recognition, is one of the main causes of tissue adhesions. In this study, we developed a lubricated gene-hydrogel patch, which provides both a motion lubrication microenvironment and gene therapy. The patch's outer layer is composed of polyethylene glycol polyester hydrogel. The hydrogel forms hydrogen bonds with water molecules to create the motion lubrication layer, and it also serves as a gene delivery library for long-term gene silencing. Under the motion lubricated microenvironment, extracellular signal-regulated kinase-small interfering RNA can silence fibroblasts and enhance the blocking effect against fibroblast activation. In vitro, the proposed patch effectively inhibits fibroblast activation and reduces the coefficient of friction. In vivo, this patch reduces the expression of vimentin and α-smooth muscle actin in fibroblasts. Therefore, the lubricated gene-hydrogel patch can inhibit the mechanical activation of fibroblasts to promote tendon healing.
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Unveil the pain of endometriosis: from the perspective of the nervous system. Expert Rev Mol Med 2022; 24:e36. [PMID: 36059111 DOI: 10.1017/erm.2022.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endometriosis is a chronic inflammatory disease with pelvic pain and uncharacteristic accompanying symptoms. Endometriosis-associated pain often persists despite treatment of the disease, thus it brings a deleterious impact on their personal lives as well as imposing a substantial economic burden on them. At present, mechanisms underlie endometriosis-associated pain including inflammatory reaction, injury, aberrant blood vessels and the morphological and functional anomaly of the peripheral and central nervous systems. The nerve endings are influenced by the physical and chemical factors surrounding the lesion, via afferent nerve to the posterior root of the spinal nerve, then to the specific cerebral cortex involved in nociception. However, our understanding of the aetiology and mechanism of this complex pain process caused by endometriosis remains incomplete. Identifying the pathogenesis of endometriosis is crucial to disease management, offering proper treatment, and helping patients to seek novel targets for the maintenance and contributors of chronic pain. The main aim of this review is to focus on every possible mechanism of pain related to endometriosis in both peripheral and central nervous systems, and to present related mechanisms of action from the interaction between peripheral lesions and nerves to the changes in transmission of pain, resulting in hyperalgesia and the corresponding alterations in cerebral cortex and brain metabolism.
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Wang Z, Xiang L, Lin F, Tang Y, Deng L, Cui W. A Biomaterial-Based Hedging Immune Strategy for Scarless Tendon Healing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2200789. [PMID: 35267215 DOI: 10.1002/adma.202200789] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Indexed: 06/14/2023]
Abstract
Scarring rather than regeneration, is an inevitable outcome of unbalanced amplifications of inflammation-destructive signals and atresia of the regenerative niche. However, identifying and effectively hedging against the risk of scarring and realizing the conversion of regenerative cues remain difficult. In this work, a hedging immune strategy based microfibrous membrane (Him-MFM), by tethering distearoyl phosphoethanolamine layer-supported copoly(lactic/glycolic acid) electrospun fibers with identified CD11b+ /CD68+ scarring subpopulation membranes in the immune landscape after tendon injury to counterweigh tissue damage, is reported. Him-MFM, carrying relevant risk receptors is shown to shift high type I biased polarization, alleviate apoptosis and metabolic stress, and mitigate inflammatory tenocyte response. Remarkably, the hedging immune strategy reverses the damaged tendon sheath barrier to the innate IL-33 secretory phenotype by 4.36 times and initiates the mucous-IL-33-Th2 axis, directly supplying a transient but obligate regenerative niche for sheath stem cell proliferation. In murine flexor tendon injury, the wrapping of Him-MFM alleviates pathological responses, protects tenocytes in situ, and restores hierarchically arranged collagen fibers covered with basement membrane, and is structurally and functionally comparable to mature tendons, demonstrating that the hedging immunity is a promising strategy to yield regenerative responses not scarring.
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Affiliation(s)
- Zhen Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Lei Xiang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Feng Lin
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Yunkai Tang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Lianfu Deng
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, P. R. China
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Effects of Icodextrin Solution (Adept®) on Ovarian Cancer Cell Proliferation in an In Vitro Model. Medicina (B Aires) 2022; 58:medicina58030386. [PMID: 35334562 PMCID: PMC8950810 DOI: 10.3390/medicina58030386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objective: Anti-adhesion barriers are currently used during ovarian cancer surgery to decrease adhesion-related morbidity. Adept® (4% icodextrin) solution, a liquid anti-adhesion material, has been widely used during gynecologic surgeries, though the risk of this barrier for oncologic surgery is controversial. The aim of this study was to determine the effect of Adept® solution on the proliferation of ovarian cancer cells. Materials and methods: We assessed the dose- and time-dependent effects of icodextrin on the growth and proliferation of OVCAR-3 and A2780 human ovarian tumor cell lines in vitro. Cell growth was determined by cell number counting. Expressions of cell cycle-regulation proteins (cyclin D1 and cyclin B1) were determined using Western blot analysis. Results: Adept® did not significantly increase ovarian cancer cell growth when tested at various concentrations (0, 1, 5, 10, 15, and 20%, equal to 0, 0.04, 0.2, 0.4, 0.6 and 0.8% icodextrin) and different time points (1–3 days) compared to control cells. Moreover, the protein levels of cyclin D1 and B1 were not overexpression-elevated in icodextrin-treated ovarian cancer cells, either with an increasing concentration or with an increasing treated time. These results demonstrated that Adept® does not activate the growth or proliferation of ovarian cancer cells in either a dose- or time-dependent manner. Conclusions: This study supports the use of Adept® solution as a safe anti-adhesion barrier for ovarian cancer surgery, though further in vivo studies are necessary.
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Chemically Modified Hyaluronic Acid for Prevention of Post-Surgical Adhesions: New Aspects of Gel Barriers Physical Profiles. J Clin Med 2022; 11:jcm11040931. [PMID: 35207204 PMCID: PMC8874822 DOI: 10.3390/jcm11040931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/27/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to provide information regarding the chemistry—including structure, synthesis, formulation, and mechanical properties—of two types of chemically modified anti-adhesion gels made of hyaluronic acid. Gel A (Hyalobarrier®) and gels B and C (HyaRegen® and MetaRegen®) that are used in postsurgical adhesion prevention. To date, little information is available on their physicochemical attributes. This information is necessary in order to understand the differences in their in vivo behavior. Methods: Comparative analyses were conducted under laboratory-controlled conditions, including measuring the shear viscosity, storage modulus G’, peel strength, and extrusion forces. Results: All polymers exhibited viscoelastic behavior. Polymer A showed a shear viscosity approximately three times larger than both polymers B and C (114 Pa.s−1 vs. 36–38 Pa.s−1) over the shear-rate range measured, indicating a possible better ability to resist flows and potentially remain in place at the site of application in vivo. The results of storage modulus (G’) measurements showed 100 Pa for polymer A and 16 Pa and 20 Pa for polymers B and C, respectively. This translated into a weaker elastic behavior for gels B and C, and a lower ability to resist sudden deformation. The peel test results showed a rupture strength of 72 mN (0.016 lbf) for polymer A, 39.6 mN (0.0089 lbf) for polymer B, and 38.3 mN (0.0086 lbf) for polymers C, indicating possible higher adhesive properties for polymer A. Tests measuring the extrudability of the hyaluronic acid gels in their commercial syringes showed an average extrusion force of 20 N (4.5 lbf) for polymer A, 28 N (6.33 lbf) for polymer B, and 17 N (3.79 lbf) for polymer C. Conclusions: Modified anti-adhesion gels made of hyaluronic acid differed in mechanical properties and concentration. Further clinical studies are needed to confirm whether these differences make one polymer easier to apply during surgery and more likely to stay in place longer after in vivo application, and to determine which is potentially superior in terms of preventing adhesions.
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Noh JJ, Kim MS, Jeong SY, Kang JH, Park BK, Kim TJ. The prevention of postoperative port-site adhesion following single-port access (SPA) laparoscopic surgeries. Medicine (Baltimore) 2021; 100:e27441. [PMID: 34622860 PMCID: PMC8500635 DOI: 10.1097/md.0000000000027441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/18/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT No studies have examined the issue of intraabdominal port-site adhesion following single-port access (SPA) laparoscopic surgeries. The purpose of the present study was to investigate the clinical effects of temperature-sensitive adhesion barrier solution in preventing periumbilical adhesion in SPA laparoscopy. This was a prospective, single-arm study in which patients were given GUARDIX-SGTM after SPA laparoscopic surgery for benign gynecologic diseases. One gram of GUARDIX-SGTM was applied on the abdominal viscera just below the umbilical port site and adjacent abdominal wall prior to fascia closure. The primary endpoint was the incidence of postoperative adhesion evaluated by visceral sliding technique through transabdominal sonography after three months. Between June 2019 and March 2020, a total of 37 healthy patients without any history of previous abdominal surgery received SPA laparoscopic surgery by a single surgeon. No postoperative complications such as wound dehiscence or surgical site infection occurred during the follow-up period of three months. No postoperative adhesion around the umbilicus was noted in all 37 patients. The mean visceral movement measured by transabdominal sonography during maximal respiration was 4.9 cm (4.9 ± 1.9 cm). Using an adhesion barrier around the port site prior to fascia closure prevents postoperative adhesion in benign SPA laparoscopic gynecologic surgery.
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Affiliation(s)
- Joseph J Noh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Myeong-Seon Kim
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, Catholic University of Korea, Suwon, South Korea
| | - Soo-Young Jeong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Hyeok Kang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Joong Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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The pro-inflammatory and anti-inflammatory role of hyaluronic acid in endometriosis. Taiwan J Obstet Gynecol 2021; 60:711-717. [PMID: 34247812 DOI: 10.1016/j.tjog.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Endometriosis is a bothersome disease affected women worldwide, the mechanism of disease development is still under investigation. Several inflammatory responses after clinical hyaluronic acid (HA) use were reported. Cyclooxygenase (COX)-2 mediated inflammation pathway is involved in the pathogenesis of endometriosis. Thus, we tried to investigate the inflammatory role of hyaluronic acid in endometriosis. MATERIALS AND METHODS Peritoneal fluid was collected in endometriosis and disease-free patients for the measurement of HA. Endometriotic stromal cells were treated with IL-1β and HA and expression of COX-2 was evaluated. Mice model of endometriosis was established and treated with fluid or gel form of HA. Endometriotic lesion size and weight were recorded and level of COX-2 was evaluated by immunohistochemistry staining. RESULTS The level of HA in the peritoneal fluid had no statistically significant difference between normal, early and advanced stage endometriosis patients. The overexpression of COX-2 protein was detected when treating endometriotic stromal cell with HA in the presence of IL-1β (P < 0.001). The endometriotic lesion size was reduced in mice model when treated with higher concentration gel form HA. It further showed less proportion of strong COX-2 expression compare of gel form HA to fluid form treatment in COX-2 expression score of endometriosis lesion. CONCLUSION Both proinflammatory evidence, elevated COX-2 expression, and anti-inflammatory result, reduced endometriosis lesion size and COX-2 expression score, were noted in our study after treating HA in in vivo and in vitro models. We hypothesized it is possible that HA may induce an acute proinflammatory response followed by chronic anti-inflammatory reaction in the formation of endometriosis.
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Huberlant S, Leprince S, Allegre L, Warembourg S, Leteuff I, Taillades H, Garric X, de Tayrac R, Letouzey V. In Vivo Evaluation of the Efficacy and Safety of a Novel Degradable Polymeric Film for the Prevention of Intrauterine Adhesions. J Minim Invasive Gynecol 2020; 28:1384-1390. [PMID: 33152532 DOI: 10.1016/j.jmig.2020.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To study the safety of a degradable polymeric film (DPF) and its efficacy on reducing the risk of intrauterine-adhesion (IUA) formation in a rat model. DESIGN A series of case-control studies relying on random allocation, where feasible. SETTING University and good practice animal laboratories. ANIMALS The animal models comprised female and male Oncins France Strain A and female Wistar rats. INTERVENTION(S) AND MEASUREMENTS The Oncins France Strain A rats were used for in vivo evaluation of the impact of the DPF on endometrial thickness and its effect on fertility. For in vivo evaluation of the biologic response, 40 Wistar rats were randomly allocated to intervention and control groups, with matched sampling time after surgery. Finally, for the in vivo evaluation of the DPF's efficacy on IUA prevention, a total of 24 Wistar rats were divided into 3 groups: 1 treated with the DPF, 1 treated with hyaluronic acid gel, and a sham group. MAIN RESULTS The DPF did not have a significant impact on endometrial thickness, and there were no significant differences in the number of conceived or prematurely terminated pregnancies, confirming its noninferiority to no treatment. The DPF did not induce irritation at 5 days and 28 days. Finally, the DPF significantly reduced the likelihood of complete IUA formation compared with hyaluronic acid gel- and sham-implanted animals, where only 27% of the animals had their uterine cavity obliterated compared with 80% and 100%, respectively. CONCLUSION The DPF is a safe film that is effective in preventing IUA formation after intrauterine curettage in rats.
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Affiliation(s)
- Stéphanie Huberlant
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France.
| | - Salome Leprince
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Lucie Allegre
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Sophie Warembourg
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Isabelle Leteuff
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Hubert Taillades
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Xavier Garric
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Renaud de Tayrac
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
| | - Vincent Letouzey
- Institut des Biomolécules Max Mousseron, UMR 5247, CNRS, Université Montpellier, ENSCM (Drs. Huberlant, Leprince, Allegre, Warembourg, Leteuff, Garric, de Tayrac, and Letouzey); Experimental Department, University of Montpellier (Mr. Taillades), Montpellier; Department of Gynecology and Obstetrics, CHU Nîmes, University of Montpellier, Nîmes (Drs. Huberlant, Allegre, de Tayrac, and Letouzey); Gynecology Department, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon (Dr. Warembourg), France
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Schönthal AH, Swenson SD, Chen TC, Markland FS. Preclinical studies of a novel snake venom-derived recombinant disintegrin with antitumor activity: A review. Biochem Pharmacol 2020; 181:114149. [PMID: 32663453 DOI: 10.1016/j.bcp.2020.114149] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022]
Abstract
Snake venoms consist of a complex mixture of many bioactive molecules. Among them are disintegrins, which are peptides without enzymatic activity, but with high binding affinity for integrins, transmembrane receptors that function to connect cells with components of the extracellular matrix. Integrin-mediated cell attachment is critical for cell migration and dissemination, as well as for signal transduction pathways involved in cell growth. During tumor development, integrins play key roles by supporting cancer cell proliferation, angiogenesis, and metastasis. The recognition that snake venom disintegrins can block integrin functions has spawned a number of studies to explore their cancer therapeutic potential. While dozens of different disintegrins have been isolated, none of them as yet has undergone clinical evaluation in cancer patients. Among the best-characterized and preclinically most advanced disintegrins is vicrostatin (VCN), a recombinant disintegrin that was rationally designed by fusing 62 N-terminal amino acids derived from the disintegrin contortrostatin with 6 C-terminal amino acids from echistatin, the disintegrins from another snake species. Bacterially produced VCN was shown to target multiple tumor-associated integrins, achieving potent anti-tumor and anti-angiogenic effects in in vitro and in vivo models in the absence of noticeable toxicity. This review will introduce the field of snake venom disintegrins as potential anticancer agents and illustrate the translational development and cancer-therapeutic potential of VCN as an example.
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Affiliation(s)
- Axel H Schönthal
- Department of Molecular Microbiology and Immunology, Keck School of Medicine (KSOM), University of Southern California (USC), Los Angeles, CA 90089, USA
| | - Stephen D Swenson
- Department of Neurological Surgery, KSOM, USC, Los Angeles, CA 90089, USA; Department of Biochemistry and Molecular Medicine, KSOM, USC, Los Angeles, CA 90089, USA
| | - Thomas C Chen
- Department of Neurological Surgery, KSOM, USC, Los Angeles, CA 90089, USA
| | - Francis S Markland
- Department of Biochemistry and Molecular Medicine, KSOM, USC, Los Angeles, CA 90089, USA.
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12
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Effects of heparin and prednisolone on postoperative intra-abdominal adhesions in Wistar rats. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.714575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Al-Husban N, Elayyan Y, El-Qudah M, Aloran B, Batayneh R. Surgical adhesions among women undergoing laparoscopic gynecological surgery with or without adhesiolysis - prevalence, severity, and implications: retrospective cohort study at a University Hospital. Ther Adv Reprod Health 2020; 14:2633494120906010. [PMID: 32518913 PMCID: PMC7254590 DOI: 10.1177/2633494120906010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/18/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To find out the prevalence of adhesions, severity, and their relation to the current clinical scenario and to the type of previous surgery. Methods and Materials: A retrospective study of patients who already had different previous abdominopelvic surgery and subsequently underwent gynecological laparoscopic surgery for various indications. The patients’ clinical and operative notes were reviewed and analyzed. Results: There were 654 procedures performed. The most common indication for the laparoscopic surgery was secondary infertility 23.5%, followed by adnexal lesions 22.0% and primary infertility 19.6%. Intraoperative adhesions were found in 45.3%. Adhesions were deemed relevant to the clinical scenario in 21.3%. Patients who had a previous history of open (traditional) surgery were more likely to be found with adhesions in comparison with patients with history of laparoscopic surgery (odds ratio: 2.7, 95% confidence interval: 1.4–5.3, p = 0.0025). The presence of adhesions was found to be strongly associated with previous abdominopelvic surgery than non-abdominopelvic surgery (odds ratio: 4.3, p = 0.0078, 95% confidence interval: 1.5–12.5). The most common location of the adhesions was abdominal (36.1%), mixed abdominal and pelvic (35.1%), and pelvic adhesions (28.1%). Severe adhesions were found in 36.1%; 13.6% of converted laparoscopy to open surgery was due to adhesions. Cesarean sections were significantly associated with adhesions. Patients who had cesarean sections were more likely to have adhesions than those who had not (odds ratio: 5.7, 95% confidence interval: 3.8–8.6, p < 0.0001). Adhesiolysis was done without complications in 19.6% of patients with adhesions. Conclusion: Adhesions were prevalent in gynecological patients with previous abdominopelvic surgery. They were a significant contributor to the gynecological and reproductive issues. To minimize the risk of postoperative adhesions, laparoscopic approach should be encouraged instead of traditional surgery and rates of cesarean section should be reduced. Further high-quality studies are needed to establish conclusion and practical guidance toward the use of adhesion barriers.
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Affiliation(s)
- Naser Al-Husban
- Assistant Professor, Faculty of Medicine, The University of Jordan, P.O. Box 2194, Amman 11941, Jordan
| | - Yousef Elayyan
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Malab El-Qudah
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Bayan Aloran
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
| | - Rima Batayneh
- Department of Obstetrics and Gynecology, Jordan University Hospital, Amman, Jordan
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14
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Hooper-Isoul M, Gaudet-Chardonnet A, Chapron C, Pirot F. [How I do… Resection of the uterosacral ligament by laparoscopy with nerve sparing in 6 steps]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2020; 48:453-456. [PMID: 31991174 DOI: 10.1016/j.gofs.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Indexed: 06/10/2023]
Affiliation(s)
- M Hooper-Isoul
- Department of Gynecology Obstetrics and Reproductive Medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France.
| | - A Gaudet-Chardonnet
- Department of Gynecology Obstetrics and Reproductive Medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - C Chapron
- Department of Gynecology Obstetrics and Reproductive Medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France
| | - F Pirot
- Department of Gynecology Obstetrics and Reproductive Medicine, hôpital universitaire Paris Centre (HUPC), CHU de Cochin, AP-HP, Paris, France; Faculté de médecine, Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
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Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery. Wideochir Inne Tech Maloinwazyjne 2019; 15:351-357. [PMID: 32489497 PMCID: PMC7233162 DOI: 10.5114/wiitm.2019.89653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release. Aim To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain. Material and methods In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1% and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO2 gas, the position change, depletion of CO2, and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery). Results Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05). Conclusions Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period.
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Affiliation(s)
| | - Annette Settnes
- Department of Obstetrics and Gynecology, North Zealand University Hospital, Hilleroed, Denmark
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17
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Prevention and management of bowel injury during gynecologic laparoscopy: an update. Curr Opin Obstet Gynecol 2019; 31:245-250. [PMID: 31045654 DOI: 10.1097/gco.0000000000000552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article aims to briefly review recent literature on bowel injury in gynecologic surgery with a focus on minimally invasive techniques, strategies for prevention, and management of injury. RECENT FINDINGS Recent reviews describe a low incidence of bowel injury that is likely affected by low rates of reporting and inconsistent definitions. The major risk factor for bowel injury is adhesive disease, and assessment and prevention techniques for the presence of adhesive disease are evolving. When bowel injury occurs, prompt diagnosis and intraoperative repair yields more favorable outcomes than delayed diagnosis. Repair can be performed by a gynecologic surgeon, with or without the help of a consultant depending on the extent of the injury and surgeon comfort. SUMMARY Bowel injury is a potentially catastrophic complication in gynecologic surgery, but its rarity presents a challenge in research. A high index of suspicion and meticulous surgical technique are the cornerstones of managing a bowel injury.
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Allègre L, Le Teuff I, Leprince S, Warembourg S, Taillades H, Garric X, Letouzey V, Huberlant S. A new bioabsorbable polymer film to prevent peritoneal adhesions validated in a post-surgical animal model. PLoS One 2018; 13:e0202285. [PMID: 30395571 PMCID: PMC6218020 DOI: 10.1371/journal.pone.0202285] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022] Open
Abstract
Background Peritoneal adhesions are a serious surgical postoperative complication. The aim of this study is to investigate, in a rat model, the anti-adhesive effects of a bioabsorbable film of polymer combining polyethylene glycol and polylactic acid. Materials and methods Sixty-three animals were randomized into five groups according to the anti-adhesion treatment: Hyalobarrier®, Seprafilm®, Polymer A (PA), Polymer B (PB), and control. The rats were euthanized on days 5 and 12 to evaluate the extent, severity and degree of adhesions and histopathological changes. Three animals were euthanized at day 2 in PA, PB and control groups to observe the in vivo elimination. Results Macroscopic adhesion formation was significantly lower in the PA group than in the control group at day 5 (median adhesion score 0±0 vs 9.6 ±0.5 p = 0.002) and at day 12 (0±0 vs 7.3±4 p = 0.02). Furthermore, median adhesion score at day 5 was significantly lower in the PA group than in the Seprafilm group (0±0 vs 4.2± 3.9 p = 0.03). Residence time of PA seems longer than PB. Conclusion The PA bioabsorbable film seems efficient in preventing the formation of peritoneal adhesions.
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Affiliation(s)
- Lucie Allègre
- Department of gynecology and obstetrics, University Hospital of Nîmes, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
- * E-mail:
| | - Isabelle Le Teuff
- Department of gynecology and obstetrics, University Hospital of Nîmes, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Salomé Leprince
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Sophie Warembourg
- Department of gynecology and obstetrics, University Hospital of Nîmes, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Hubert Taillades
- Surgical and Experimental Department, University of Montpellier, Montpellier, France
| | - Xavier Garric
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Vincent Letouzey
- Department of gynecology and obstetrics, University Hospital of Nîmes, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
| | - Stephanie Huberlant
- Department of gynecology and obstetrics, University Hospital of Nîmes, Nîmes, France
- Department of Artificial Polymers, Max Mousseron Institute of Biomolecules, CNRS UMR 5247, University of Montpellier 1, Montpellier, France
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