1
|
Ciołek L, Zaczyńska E, Krok-Borkowicz M, Biernat M, Pamuła E. Chitosan and Sodium Hyaluronate Hydrogels Supplemented with Bioglass for Bone Tissue Engineering. Gels 2024; 10:128. [PMID: 38391458 PMCID: PMC10887860 DOI: 10.3390/gels10020128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
The aim of the study was to produce biocomposites based on chitosan and sodium hyaluronate hydrogels supplemented with bioglasses obtained under different conditions (temperature, time) and to perform an in vitro evaluation of their cytocompatibility using both indirect and direct methods. Furthermore, the release of ions from the composites and the microstructure of the biocomposites before and after incubation in simulated body fluid were assessed. Tests on extracts from bioglasses and hydrogel biocomposites were performed on A549 epithelial cells, while MG63 osteoblast-like cells were tested in direct contact with the developed biomaterials. The immune response induced by the biomaterials was also evaluated. The experiments were carried out on both unstimulated and lipopolysaccharide (LPS) endotoxin-stimulated human peripheral blood cells in the presence of extracts of the biocomposites and their components. Extracts of the materials produced do not exhibit toxic effects on A549 cells, and do not increase the production of proinflammatory cytokines tumour necrosis factor alpha (TNF-α) and interleukin (IL-6) by blood cells in vitro. In direct contact with MG63 osteoblast-like cells, biocomposites containing the reference bioglass and those containing SrO are more cytocompatible than biocomposites with ZnO-doped bioglass. Using two testing approaches, the effects both of the potentially toxic agents released and of the surface of the tested materials on the cell condition were assessed. The results pave the way for the development of highly porous hydrogel-bioglass composite scaffolds for bone tissue engineering.
Collapse
Affiliation(s)
- Lidia Ciołek
- Biomaterials Research Group, Łukasiewicz Research Network-Institute of Ceramic and Building Materials, 31-983 Krakow, Poland
| | - Ewa Zaczyńska
- Hirszfeld Institute of Immunology and Experimental Therapy, Laboratory of Immunobiology, Polish Academy of Sciences, R. Weigla Str. 12, 53-114 Wroclaw, Poland
| | - Małgorzata Krok-Borkowicz
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Krakow, Al. Mickiewicza 30, 30-059 Krakow, Poland
| | - Monika Biernat
- Biomaterials Research Group, Łukasiewicz Research Network-Institute of Ceramic and Building Materials, 31-983 Krakow, Poland
| | - Elżbieta Pamuła
- Department of Biomaterials and Composites, Faculty of Materials Science and Ceramics, AGH University of Krakow, Al. Mickiewicza 30, 30-059 Krakow, Poland
| |
Collapse
|
2
|
Li Z, Liu L, Chen Y. Dual dynamically crosslinked thermosensitive hydrogel with self-fixing as a postoperative anti-adhesion barrier. Acta Biomater 2020; 110:119-128. [PMID: 32438111 DOI: 10.1016/j.actbio.2020.04.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 11/30/2022]
Abstract
Tissue adhesion is a severe postoperative complication. Various strategies have been developed to minimize postoperative adhesion, but the clinical efficacy is still far from satisfactory. Herein, we present a dual dynamically crosslinked hydrogel to serve as a physical postoperative anti-adhesion barrier. The hydrogel was generated by dynamic chemical oxime bonding from alkoxyamine-terminated Pluronic F127 (AOP127) and oxidized hyaluronic acid (OHA), as well as hydrophobic association of AOP127. Rheological analysis demonstrated that the hydrogel exhibits temperature sensitivity. At 37 °C, it shows much higher modulus and higher stability than the Pluronic F127 hydrogel. Hemolytic assays suggested that the hydrogel undergoes low hemolysis. In addition, it exhibited anti-adhesion to blood cells in blood cell adhesion tests. It also showed an anti-attachment effect to fibroblasts and biocompatibility in vitro cell studies. Macroscopic evaluation and lap-shear tests revealed that the hydrogel has a moderate adhesive capacity to tissue, which is important for self-fixation. A rat model of sidewall defect-bowel abrasion was established to evaluate the anti-adhesion effect in vivo. The gross observation and pathological analysis revealed a significant reduction in postoperative peritoneal adhesion in the AOP127/OHA hydrogel-treated group than those treated with normal saline or Pluronic F127 hydrogel. Hence, the dual dynamically crosslinked hydrogel with self-fixable capacity may be suitable as a physical barrier for postoperative adhesion prevention. STATEMENT OF SIGNIFICANCE: Despite the development of numerous postoperative anti-adhesion barriers, their anti-adhesion efficacy is still limited in clinical trials due to poor tissue adhesion and rapid clearance from injured areas. Herein, we have developed a dual dynamic crosslinked hydrogel, generated by dynamic oxime bonds and hydrophobic interactions. The hydrogel is temperature-sensitive and demonstrates moderate tissue adhesion capacity, which allows for self-fixation when applied to defects. The introduction of dynamic covalent bonds improves the stability of the hydrogel. Moreover, the hydrogel not only displays appropriate hemocompatibility, cytocompatibility and anti-adhesion of blood cells and fibroblasts, but it also effectively contributes to preventing postoperative peritoneal adhesions in vivo. Hence, this dual dynamic crosslinked hydrogel may have potential applications as a physical barrier in clinical practice.
Collapse
Affiliation(s)
- Ziyi Li
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Lixin Liu
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China
| | - Yongming Chen
- School of Materials Science and Engineering, Key Laboratory of Polymeric Composite Materials and Functional Materials of Ministry of Education, GD Research Center for Functional Biomaterials Engineering and Technology, Sun Yat-sen University, Guangzhou 510275, China.
| |
Collapse
|
3
|
Di Guardo F, Della Corte L, Vilos GA, Carugno J, Török P, Giampaolino P, Manchanda R, Vitale SG. Evaluation and treatment of infertile women with Asherman syndrome: an updated review focusing on the role of hysteroscopy. Reprod Biomed Online 2020; 41:55-61. [PMID: 32444259 DOI: 10.1016/j.rbmo.2020.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/17/2022]
Abstract
Asherman syndrome is a rare acquired clinical condition resulting in the obliteration of the uterine cavity causedby the presence of partial or complete fibrous intrauterine adhesions involving at least two-thirds of the uterine cavity potentially obstructing the internal cervical orifice. Common reported symptoms of the disease are alterations of the menstrual pattern with decreased menstrual bleeding leading up to amenorrhoea and infertility. Hysteroscopy is currently considered the gold standard diagnostic and therapeutic approach for patients with intrauterine adhesions. An integrated approach, including preoperative, intraoperative and postoperative therapeutic measures, however, are warranted owing to the complexity of the syndrome. This review aims to summarize the most recent evidence on the recommended preoperative, intraoperative and postoperative procedures to restore the uterine cavity and a functional endometrium, as well as on the concomitant use of adjuvant therapies to achieve optimal fertility outcomes.
Collapse
Affiliation(s)
- Federica Di Guardo
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - George Angelos Vilos
- The Fertility Clinic, London Health Sciences Centre, Department of Obstetrics and Gynecology, Western University, 800 Commissioners Road, London, Ontario N6A 4G5, Canada
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Science Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, 1400 NW 12th Ave, Miami, FL 33136, USA
| | - Péter Török
- Faculty of Medicine, Institute of Obstetrics and Gynaecology, University of Debrecen, 4032 Debrecen, Nagyerdei krt. 94, Hungary
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Rahul Manchanda
- Department of Gynae Endoscopy, Manchanda's Endoscopic Centre, Pushawati Singhania Research Institute, Press Enclave Marg, Sheikh Sarai II, Near Saket Court, New Delhi - 110017, India
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| |
Collapse
|
4
|
Kao HH, Kuo CY, Chen KS, Chen JP. Preparation of Gelatin and Gelatin/Hyaluronic Acid Cryogel Scaffolds for the 3D Culture of Mesothelial Cells and Mesothelium Tissue Regeneration. Int J Mol Sci 2019; 20:E4527. [PMID: 31547444 PMCID: PMC6770111 DOI: 10.3390/ijms20184527] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 08/30/2019] [Accepted: 09/07/2019] [Indexed: 12/14/2022] Open
Abstract
Mesothelial cells are specific epithelial cells that are lined in the serosal cavity and internal organs. Nonetheless, few studies have explored the possibility to culture mesothelial cells in a three-dimensional (3D) scaffold for tissue engineering applications. Towards this end, we fabricated macroporous scaffolds from gelatin and gelatin/hyaluronic acid (HA) by cryogelation, and elucidated the influence of HA on cryogel properties and the cellular phenotype of mesothelial cells cultured within the 3D scaffolds. The incorporation of HA was found not to significantly change the pore size, porosity, water uptake kinetics, and swelling ratios of the cryogel scaffolds, but led to a faster scaffold degradation in the collagenase solution. Adding 5% HA in the composite cryogels also decreased the ultimate compressive stress (strain) and toughness of the scaffold, but enhanced the elastic modulus. From the in vitro cell culture, rat mesothelial cells showed quantitative cell viability in gelatin (G) and gelatin/HA (GH) cryogels. Nonetheless, mesothelial cells cultured in GH cryogels showed a change in the cell morphology and cytoskeleton arrangement, reduced cell proliferation rate, and downregulation of the mesothelium specific maker gene expression. The production of key mesothelium proteins E-cadherin and calretinin were also reduced in the GH cryogels. Choosing the best G cryogels for in vivo studies, the cell/cryogel construct was used for the transplantation of allograft mesothelial cells for mesothelium reconstruction in rats. A mesothelium layer similar to the native mesothelium tissue could be obtained 21 days post-implantation, based on hematoxylin and eosin (H&E) and immunohistochemical staining.
Collapse
Affiliation(s)
- Hao-Hsi Kao
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
| | - Chang-Yi Kuo
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
| | - Kuo-Su Chen
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung 20401, Taiwan.
- School of Medicine, Chang Gung University, Kwei-San, Taoyuan 33303, Taiwan.
| | - Jyh-Ping Chen
- Department of Chemical and Materials Engineering, Chang Gung University, Kwei-San, Taoyuan 33302, Taiwan.
- Department of Plastic and Reconstructive Surgery and Craniofacial Research Center, Chang Gung Memorial Hospital, Linkou, Kwei-San, Taoyuan 33305, Taiwan.
- Research Center for Food and Cosmetic Safety and Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33302, Taiwan.
- Department of Materials Engineering, Ming Chi University of Technology, Tai-Shan, New Taipei City 24301, Taiwan.
| |
Collapse
|
5
|
Liu H, Xu Y, Yi N, Yi W. Efficacy and Safety of Hyaluronic Acid Gel for the Prevention of Intrauterine Adhesion: A Meta-Analysis of Randomized Clinical Trials. Gynecol Obstet Invest 2018. [PMID: 29514160 DOI: 10.1159/000486674] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study is to assess the clinical effectiveness and safety of hyaluronic acid gel for the prevention of postoperative intrauterine adhesions (IUAs). METHODS PubMed, Cochrane Library, Embase and ClinicalTrials.gov databases were searched for randomized controlled trials. RESULTS Six RCTs with a total of 564 patients met the inclusion criteria. The meta-analysis showed that, compared to no other treatment method, hyaluronic acid gel significantly reduced the rate of any IUA (risk ratio [RR] 0.68; 95% CI 0.53-0.86; p = 0.03; I2 = 64%) and adhesion score (standard mean difference = -2.90; 95% CI -4.61 to -1.49; p < 0.00001; I2 = 98%) following intraperitoneal or intrauterine surgery. Treatment lowered the rate of IUAs classified as moderate (RR 0.26; 95% CI 0.13-0.52; p = 0.13; I2 = 0%), but not those deemed mild (RR 0.86; 95% CI 0.62-1.21; p = 0.39; I2 = 3%) or severe (RR 0.33; 95% CI 0.03-3.09; p = 0.33; I2 = 0). Compliance with hyaluronic acid gel treatment was low. CONCLUSION Hyaluronic acid gel can prevent IUAs, particularly those with moderate severity and a lower adhesion score.
Collapse
|
6
|
Khorshidi HR, Kasraianfard A, Derakhshanfar A, Rahimi S, Sharifi A, Makarchian HR, Ghorbanpoor M, Javadi SMR. Evaluation of the effectiveness of sodium hyaluronate, sesame oil, honey, and silver nanoparticles in preventing postoperative surgical adhesion formation. An experimental study. Acta Cir Bras 2017; 32:626-632. [DOI: 10.1590/s0102-865020170080000004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 07/18/2017] [Indexed: 11/21/2022] Open
|
7
|
Falk P, Jonsson A, Swartling T, Ivarsson ML. Colorectal Cancer Cells Adhere to Traumatized Peritoneal Tissue in Clusters, An Experimental Study. J INVEST SURG 2017; 31:349-356. [PMID: 28541718 DOI: 10.1080/08941939.2017.1326544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Purpose/Aim: Colorectal malignity is one of the most common forms of cancer. The finding of free intraperitoneal colorectal cancer cells during surgery has been shown to be associated with poor outcome. The aim of this study was to develop an experimental model designed to investigate adhesion of colorectal cancer cells to the peritoneal surface. MATERIALS AND METHODS Two human experimental models were developed, the first using cultured mesothelial cells and the second consisting of an ex vivo model of peritoneal tissue. Both models were subjected to standardized trauma, following which labeled colorectal cancer cells (Colo205) were introduced. Adhesion of tumor cells was monitored using microscopy and detection of fluorochromes. RESULTS The mesothelial cell layers and peritoneal membranes remained viable in culture medium for several weeks. In our experimental model, the tumor cells added were seen to adhere to the edges of the traumatized area in cluster formations. CONCLUSIONS The use of human peritoneal tissue in an ex vivo model would appear to be a potentially useful tool for the study of interaction between human peritoneal membrane and free tumor cells. Experimental surgical trauma increases the ability of tumor cells to adhere to the peritoneal membrane. This ex vivo model should be useful in future studies on biological interactions between peritoneum and tumor cells in the search for novel forms of peritoneal cancer therapy.
Collapse
Affiliation(s)
- Peter Falk
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , SE-416 85 , Göteborg , Sweden
| | - Andreas Jonsson
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , SE-416 85 , Göteborg , Sweden.,b Varbergs Hospital , Region Halland, SE-432 37 , Varberg , Sweden
| | - Torbjörn Swartling
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , SE-416 85 , Göteborg , Sweden.,c Sahlgrenska University Hospital/Östra , SE-416 85 , Göteborg , Sweden
| | - Marie-Lois Ivarsson
- a Department of Surgery , Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg , SE-416 85 , Göteborg , Sweden
| |
Collapse
|
8
|
Peritoneal adhesion prevention with a biodegradable and injectable N,O-carboxymethyl chitosan-aldehyde hyaluronic acid hydrogel in a rat repeated-injury model. Sci Rep 2016; 6:37600. [PMID: 27869192 PMCID: PMC5116612 DOI: 10.1038/srep37600] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 11/01/2016] [Indexed: 02/05/2023] Open
Abstract
Postoperative peritoneal adhesion is one of the serious issues because it induces severe clinical disorders. In this study, we prepared biodegradable and injectable hydrogel composed of N,O-carboxymethyl chitosan (NOCC) and aldehyde hyaluronic acid (AHA), and assessed its anti-adhesion effect in a rigorous and severe recurrent adhesion model which is closer to clinical conditions. The flexible hydrogel, which gelated in 66 seconds at 37 °C, was cross-linked by the schiff base derived from the amino groups of NOCC and aldehyde groups in AHA. In vitro cytotoxicity test showed the hydrogel was non-toxic. In vitro and in vivo degradation examinations demonstrated the biodegradable and biocompatibility properties of the hydrogel. The hydrogel discs could prevent the invasion of fibroblasts, whereas fibroblasts encapsulated in the porous 3-dimensional hydrogels could grow and proliferate well. Furthermore, the hydrogel was applied to evaluate the anti-adhesion efficacy in a more rigorous recurrent adhesion model. Compared with normal saline group and commercial hyaluronic acid (HA) hydrogel, the NOCC-AHA hydrogel exhibited significant reduction of peritoneal adhesion. Compared to control group, the blood and abdominal lavage level of tPA was increased in NOCC-AHA hydrogel group. These findings suggested that NOCC-AHA hydrogel had a great potential to serve as an anti-adhesion candidate.
Collapse
|
9
|
Regulation of synthesis and roles of hyaluronan in peritoneal dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:427038. [PMID: 26550568 PMCID: PMC4621352 DOI: 10.1155/2015/427038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 08/16/2015] [Indexed: 12/08/2022]
Abstract
Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS) enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.
Collapse
|
10
|
Lang R, Baumann P, Schmoor C, Odermatt EK, Wente MN, Jauch KW. A-Part Gel, an adhesion prophylaxis for abdominal surgery: a randomized controlled phase I-II safety study [NCT00646412]. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2015; 9:5. [PMID: 26336510 PMCID: PMC4557926 DOI: 10.1186/s13022-015-0014-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
Background Intra-abdominal surgical intervention can cause the development of intra-peritoneal adhesions. To reduce this problem, different agents have been tested to minimize abdominal adhesions; however, the optimal adhesion prophylaxis has not been found so far. Therefore, the A-Part® Gel was developed as a barrier to diminish postsurgical adhesions; the aim of this randomized controlled study was a first evaluation of its safety and efficacy. Methods In this prospective, controlled, randomized, patient-blinded, monocenter phase I–II study, 62 patients received either the hydrogel A-Part-Gel® as an anti-adhesive barrier or were untreated after primary elective median laparotomy. Primary endpoint was the occurrence of peritonitis and/or wound healing impairment 28 ± 10 days postoperatively. As secondary endpoints anastomotic leakage until 28 days after surgery, adverse events and adhesions were assessed until 3 months postoperatively. Results A lower rate of wound healing impairment and/or peritonitis was observed in the A-Part Gel® group compared to the control group: (6.5 vs. 13.8 %). The difference between the two groups was −7.3%, 90 % confidence interval [−20.1, 5.4 %]. Both treatment groups showed similar frequency of anastomotic leakage but incidence of adverse events and serious adverse events were slightly lower in the A-Part Gel® group compared to the control. Adhesion rates were comparable in both groups. Conclusion A-Part Gel® is safe as an adhesion prophylaxis after abdominal wall surgery but no reduction of postoperative peritoneal adhesion could be found in comparison to the control group. This may at least in part be due to the small sample size as well as to the incomplete coverage of the incision due to the used application. Trial Registration: NCT00646412
Collapse
Affiliation(s)
- Reinhold Lang
- Department of Surgery, University Munich-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Petra Baumann
- Aesculap AG, Am Aesculap Platz, 78532 Tuttlingen, Germany
| | - Claudia Schmoor
- Clinical Trials Unit, University Medical Center Freiburg, Elsässer Strasse 2, 79110 Freiburg, Germany
| | | | - Moritz N Wente
- Aesculap AG, Am Aesculap Platz, 78532 Tuttlingen, Germany
| | - Karl-Walter Jauch
- Department of Surgery, University Munich-Großhadern, Marchioninistrasse 15, 81377 Munich, Germany
| |
Collapse
|
11
|
Yıldız E, Yılmaz B, Dilbaz S, Üstün Y, Kumru S. Tranexamic acid and hyaluronate/carboxymethylcellulose create cell injury. JSLS 2014; 18:JSLS-D-14-00044. [PMID: 25392658 PMCID: PMC4208894 DOI: 10.4293/jsls.2014.00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: Postoperative pelvic adhesions are associated with chronic pelvic pain, dyspareunia, and infertility. The aim of this study was to evaluate the adhesion prevention effects of tranexamic acid (TA) and hyaluronate/carboxymethylcellulose (HA/CMC) barrier in the rat uterine horn models on the basis of macroscopic and microscopic adhesion scores and histopathological as well as biochemical parameters of inflammation. Methods: Twenty-one Wistar rats were randomly divided into 3 groups. Ten lesions were created on the antimesenteric surface of both uterine horns by bipolar cautery. Three milliliters of 0.9% sodium chloride solution were administered in the control group. A single layer of 2 × 2 cm HA/CMC was plated in group 2. Two milliliters of TA was applied in the last group. All rats were sacrificed at postoperative day 21. Results: No significant difference was found among the control group, the HA/CMC group, and the TA group in terms of macro-adhesion score (P = .206) and microadhesion score (P = .056). No significant difference was found among the 3 groups in terms of inflammation score (P = .815) and inflammatory cell activity (P = .835). Malondialdehyde levels were significantly lower in the control group than in the TA group and HA/CMC group (P = .028). Superoxide dismutase and glutathione S-transferase activities were found to be higher in the control group than in the TA group (P = .005) and HA/CMC group (P = .009). Conclusions: TA and HA/CMC had no efficacy in preventing macroscopic or microscopic adhesion formation and decreasing inflammatory cell activity or inflammation score in our rat models. TA and HA/CMC increased the levels of free radicals and reduced the activities of superoxide dismutase and glutathione S-transferase enzymes, which act to reduce tissue injury.
Collapse
Affiliation(s)
- Elif Yıldız
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Bayram Yılmaz
- Department of Physiology, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Serdar Dilbaz
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Yusuf Üstün
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Selahattin Kumru
- Department of Obstetrics and Gynecology, Düzce University Faculty of Medicine, Düzce, Turkey
| |
Collapse
|
12
|
Li L, Wang N, Jin X, Deng R, Nie S, Sun L, Wu Q, Wei Y, Gong C. Biodegradable and injectable in situ cross-linking chitosan-hyaluronic acid based hydrogels for postoperative adhesion prevention. Biomaterials 2014; 35:3903-17. [DOI: 10.1016/j.biomaterials.2014.01.050] [Citation(s) in RCA: 242] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/21/2014] [Indexed: 12/22/2022]
|
13
|
Conforti A, Alviggi C, Mollo A, De Placido G, Magos A. The management of Asherman syndrome: a review of literature. Reprod Biol Endocrinol 2013; 11:118. [PMID: 24373209 PMCID: PMC3880005 DOI: 10.1186/1477-7827-11-118] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 12/19/2013] [Indexed: 12/13/2022] Open
Abstract
Asherman syndrome is a debatable topic in gynaecological field and there is no clear consensus about management and treatment. It is characterized by variable scarring inside the uterine cavity and it is also cause of menstrual disturbances, infertility and placental abnormalities. The advent of hysteroscopy has revolutionized its diagnosis and management and is therefore considered the most valuable tool in diagnosis and management. The aim of this review is to explore the most recent evidence related to this condition with regards to aetiology, diagnosis management and follow up strategies.
Collapse
Affiliation(s)
- Alessandro Conforti
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Carlo Alviggi
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Antonio Mollo
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Giuseppe De Placido
- University Department of Obstetrics, Gynaecology, Urology and Reproductive Medicine, University of Naples Federico II, Via Sergio Pansini n. 6, Naples 80100, Italy
| | - Adam Magos
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London NW3 2QG, UK
| |
Collapse
|
14
|
Falk P, Ivarsson M. Effect of a DACC dressing on the growth properties and proliferation rate of cultured fibroblasts. J Wound Care 2012; 21:327-8, 330-2. [DOI: 10.12968/jowc.2012.21.7.327] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P. Falk
- Fibrinolysis Laboratory/ Tissue Centre, Dept of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - M.L. Ivarsson
- Fibrinolysis Laboratory/ Tissue Centre, Dept of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
- Dept of Research and Development, Hallands Hospital, Sweden
| |
Collapse
|
15
|
Mais V, Cirronis MG, Peiretti M, Ferrucci G, Cossu E, Melis GB. Efficacy of auto-crosslinked hyaluronan gel for adhesion prevention in laparoscopy and hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2011; 160:1-5. [PMID: 21945572 DOI: 10.1016/j.ejogrb.2011.08.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 07/12/2011] [Accepted: 08/31/2011] [Indexed: 01/02/2023]
Abstract
Prevention of postoperative adhesions is a clinical need. We undertook a systematic review to explore the available clinical evidence of the efficacy of auto-crosslinked hyaluronan gel for postoperative adhesion prevention following endoscopic gynecological surgery. An electronic database search of MEDLINE, Cochrane Database of Systematic Reviews and EMBASE, and a comprehensive hand-search of reference lists of published and review articles were performed. No language restrictions were applied. Randomized controlled trials (RCTs) on the use of auto-crosslinked hyaluronan gel for the prevention of postoperative adhesions in gynecological surgery were included in the meta-analysis if they reported outcomes as evaluated at a blind second-look assessment. Three authors independently selected studies and extracted data on study characteristics, quality and accuracy. The Jadad scoring system was used for validity assessment. Meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The outcome was the incidence of postoperative adhesions based on a binary response (present or not present). Only five RCTs were eligible for inclusion in the meta-analysis. The incidence of postoperative adhesions in patients who received auto-crosslinked hyaluronan gel was significantly lower than in patients who underwent standard surgery only. The gel prevented both intraperitoneal adhesions after laparoscopic myomectomy (OR 0.248, 95% CI 0.098, 0.628) and intrauterine adhesions after hysteroscopic surgery (OR 0.408, 95% CI 0.217, 0.766). Further RCTs are needed to assess the efficacy of auto-crosslinked hyaluronan gel in women undergoing different laparoscopic intra-abdominal surgical procedures.
Collapse
Affiliation(s)
- Valerio Mais
- Division of Gynaecology, Obstetrics and Pathophysiology of Human Reproduction, Department of Surgery, Maternal-Fetal Medicine and Imaging, University of Cagliari, 09124 Cagliari, Italy.
| | | | | | | | | | | |
Collapse
|
16
|
A prospective, randomised, controlled, double-blind phase I-II clinical trial on the safety of A-Part Gel as adhesion prophylaxis after major abdominal surgery versus non-treated group. BMC Surg 2010; 10:20. [PMID: 20604918 PMCID: PMC2912830 DOI: 10.1186/1471-2482-10-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/06/2010] [Indexed: 11/10/2022] Open
Abstract
Background Postoperative adhesions occur when fibrous strands of internal scar tissue bind anatomical structures to one another. The most common cause of intra-abdominal adhesions is previous intra-abdominal surgical intervention. Up to 74% of intestinal obstructions are caused by post surgical adhesions. Although a variety of methods and agents have been investigated to prevent post surgical adhesions, the problem of peritoneal adhesions remains largely unsolved. Materials serving as an adhesion barrier are much needed. Methods/Design This is a prospective, randomised, controlled, patient blinded and observer blinded, single centre phase I-II trial, which evaluates the safety of A-Part® Gel as an adhesion prophylaxis after major abdominal wall surgery, in comparison to an untreated control group. 60 patients undergoing an elective median laparotomy without prior abdominal surgery are randomly allocated into two groups of a 1:1- ratio. Safety parameter and primary endpoint of the study is the occurrence of wound healing impairment or peritonitis within 28 (+10) days after surgery. The frequency of anastomotic leakage within 28 days after operation, occurrence of adverse and serious adverse events during hospital stay up to 3 months and the rate of adhesions along the scar within 3 months are defined as secondary endpoints. After hospital discharge the investigator will examine the enrolled patients at 28 (+10) days and 3 months (±14 days) after surgery. Discussion This trial aims to assess, whether the intra-peritoneal application of A-Part® Gel is safe and efficacious in the prevention of post-surgical adhesions after median laparotomy, in comparison to untreated controls. Trial registration NCT00646412
Collapse
|
17
|
Fang CC, Chou TH, Lin GS, Yen ZS, Lee CC, Chen SC. Peritoneal Infusion with Cold Saline Decreased Postoperative Intra-Abdominal Adhesion Formation. World J Surg 2010; 34:721-7. [DOI: 10.1007/s00268-009-0378-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
18
|
Saber A. Effect of honey versus intergel in intraperitoneal adhesion prevention and colonic anastomotic healing: A randomized controlled study in rats. Int J Surg 2010; 8:121-7. [DOI: 10.1016/j.ijsu.2009.11.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 10/18/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
|
19
|
Falk P, Bergström M, Palmgren I, Holmdahl L, Breimer ME, Ivarsson ML. Studies of TGF-β1-3 in Serosal Fluid During Abdominal Surgery and Their Effect on In Vitro Human Mesothelial Cell Proliferation. J Surg Res 2009; 154:312-6. [DOI: 10.1016/j.jss.2008.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 04/17/2008] [Accepted: 05/13/2008] [Indexed: 10/21/2022]
|
20
|
Guo Q, Li QF, Liu HJ, Li R, Wu CT, Wang LS. Sphingosine kinase 1 gene transfer reduces postoperative peritoneal adhesion in an experimental model. Br J Surg 2008; 95:252-8. [PMID: 18064593 DOI: 10.1002/bjs.5890] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recovery of the surgically damaged mesothelial cell layer is a major process in reducing postoperative peritoneal adhesions. Sphingosine kinase (SPK) 1 is a signalling molecule involved in the regulation of proliferation and migration of various cell types. This study determined the effect of SPK-1 gene transfer on the recovery of damaged mesothelial cells and on peritoneal adhesion formation after surgery. METHODS Rat mesothelial cells were isolated and characterized by their expression of cytokeratin and vimentin. Their migration was determined by scratch wound motility assay. Cellular SPK-1 activity was measured by [gamma-32P]adenosine 5'-triphosphate incorporation. Wistar rats underwent laparotomy with subsequent caecum or uterine horn abrasion. Rats were randomized to either SPK-1 gene (Ad-SPK-1) transfer or control groups. The animals were killed 14 days after operation and peritoneal adhesions were graded. RESULTS Adenovirus-mediated SPK-1 gene transfer increased the cellular SPK-1 activity of mesothelial cells, leading to enhanced migration. Median adhesion scores were significantly lower in the Ad-SPK-1 group than in controls in both rat caecum (0.98 versus 2.60; P < 0.001) and rat uterine horn (0.28 versus 1.83; P < 0.001) models. CONCLUSION Adenovirus-mediated SPK-1 gene transfer promotes recovery of the surgically damaged mesothelial cell layer and prevents postoperative peritoneal adhesion formation.
Collapse
Affiliation(s)
- Q Guo
- Department of General Surgery, General Hospital of People's Liberation Army, Beijing Institute of Radiation Medicine, Beijing, China
| | | | | | | | | | | |
Collapse
|
21
|
Binda MM, Molinas CR, Bastidas A, Jansen M, Koninckx PR. Efficacy of barriers and hypoxia-inducible factor inhibitors to prevent CO(2) pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. J Minim Invasive Gynecol 2007; 14:591-9. [PMID: 17848320 DOI: 10.1016/j.jmig.2007.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/23/2007] [Accepted: 04/02/2007] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVE To investigate the effects of hypoxia-inducible factor (HIF) inhibitors, flotation agents, barriers, and a surfactant on pneumoperitoneum-enhanced adhesions in a laparoscopic mouse model. DESIGN Prospective randomized trial (Canadian Task Force classification I). SETTING Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Catholic University of Leuven. SUBJECTS One hundred fourteen female BALB/c mice. INTERVENTIONS Adhesions were induced during laparoscopy in BALB/c female mice. Pneumoperitoneum was maintained for 60 minutes with humidified CO(2). In 3 experiments the effects of HIF inhibitors such as 17-allylamino 17-demethoxygeldanamycin, radicicol, rapamycin, and wortmanin, flotation agents such as Hyskon and carboxymethylcellulose, barriers such as Hyalobarrier gel and SprayGel, and surfactant such as phospholipids were evaluated. MEASUREMENTS AND MAIN RESULTS Adhesions were scored after 7 days during laparotomy. Adhesion formation decreased with the administration of wortmannin (p <.01), phospholipids (p <.01), Hyalobarrier Gel (p <.01), and SprayGel (p <.01). CONCLUSIONS These experiments confirm the efficacy of barriers and phospholipids to separate or lubricate damaged surfaces. They also confirm the role of mesothelial hypoxia in this model by the efficacy of the HIF inhibitor wortmannin.
Collapse
Affiliation(s)
- Maria Mercedes Binda
- Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | | | | |
Collapse
|
22
|
Sahin M, Cakir M, Avsar FM, Tekin A, Kucukkartallar T, Akoz M. The effects of anti-adhesion materials in preventing postoperative adhesion in abdominal cavity (anti-adhesion materials for postoperative adhesions). Inflammation 2007; 30:244-9. [PMID: 17690965 DOI: 10.1007/s10753-007-9043-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Accepted: 07/17/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to compare the effects of anti-adhesion materials in postoperative adhesions. MATERIALS AND METHODS Rats were assigned to five groups: Group 1: Control. Group 2: chitin layers were used. Group 3: Na-hyaluronate / carboxymethylcellulose layers were used. Group 4: Na-hyaluronate gel was poured into the abdomen. Group 5: methylprednisolone was injected. The adhesion frequency and grade were scored according to Granat. Blood was taken for Hb, AST, BUN and albumin levels determination. FINDINGS The adhesion frequencies (right and left) and grades were as follow in Groups; I: 82%, 91%, 2.63 +/- 1.22; II: 8.3%, 25%, 0.58 +/- 0.66; III: 17%, 33%, 1.08 +/- 1.08; IV: 50%, 58%, 1.41 +/- 1.44; V: 50%, 42%, 1.41 +/- 1.50. The adhesion phase in all study groups was found significantly low compared to control group, p < 0.05. No difference was observed among serologic and hematological parameters in all groups. CONCLUSION All the materials used significantly lowered the adhesion frequency and grade.
Collapse
Affiliation(s)
- Mustafa Sahin
- Department of General Surgery, Selcuk University Meram Medical Faculty, Konya, Turkey
| | | | | | | | | | | |
Collapse
|
23
|
Kelekci S, Uygur D, Yilmaz B, Sut N, Yesildaglar N. Comparison of human amniotic membrane and hyaluronate/carboxymethylcellulose membrane for prevention of adhesion formation in rats. Arch Gynecol Obstet 2007; 276:355-9. [PMID: 17492299 DOI: 10.1007/s00404-007-0376-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Accepted: 04/16/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the effectiveness of human amniotic membrane (HAM) in the prevention of postoperative adhesion formation and to compare it with the efficacy of hyaluronate/carboxymethylcellulose (HA/CMC) membrane in a rat model. METHODS Following pilot studies and computer-generated randomization, 23 female Wistar albino rats were operated on in the full study. One of the uterine horns with standard lesions was treated with either HAM (n = 13) or HA/CMC (n = 10) and the other uterine horn served as the control. Second look laparotomies were performed 2 weeks after the operations. Main outcome measures were extent, severity, degree, total adhesion scores and histopathologic characteristics of adhesions. RESULTS Uterine horns treated with HAM had significantly lower total adhesion scores than the controls (5.15 +/- 2.67 vs. 7.92 +/- 1.50, P < 0.05). Total adhesion scores of uterine horns treated with HA/CMC membrane were significantly lower than those of the controls (4.30 +/- 1.95 vs. 7.50 +/- 1.84, P < 0.01). There were no significant differences between the HAM and HA/CMC groups regarding any adhesion scores. CONCLUSIONS HAM and HA/CMC membrane are both effective for prevention of adhesion formation in a rat uterine horn model; however, one does not seem to be more effective than the other.
Collapse
Affiliation(s)
- Sefa Kelekci
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
24
|
Tingstedt B, Isaksson K, Andersson E, Andersson R. Prevention of Abdominal Adhesions – Present State and What’s beyond the Horizon? Eur Surg Res 2007; 39:259-68. [DOI: 10.1159/000102591] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 02/27/2007] [Indexed: 11/19/2022]
|
25
|
Sikkink CJJM, de Man B, Bleichrodt RP, van Goor H. Auto-Cross-Linked Hyaluronic Acid Gel Does Not Reduce Intra-Abdominal Adhesions or Abscess Formation in a Rat Model of Peritonitis. J Surg Res 2006; 136:255-9. [PMID: 17059836 DOI: 10.1016/j.jss.2006.06.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 06/12/2006] [Accepted: 06/22/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND Prevention of adhesion and abscess formation would decrease mortality and morbidity after peritonitis. In this study the effect of a new anti-adhesive, auto-cross-linked hyaluronic acid polysaccharide (ACP) gel, on adhesion and abscess formation was studied in a rat peritonitis model. MATERIALS AND METHODS In experiment 1, bacterial peritonitis was induced in 24 Wistar rats, using a cecal ligation and puncture model. Animals were randomized to receive 4 mL ACP gel (4%) or 4 mL phosphate buffered saline (PBS). After 2 weeks animals were killed and adhesions and abscesses were scored. In experiment 2, 72 rats underwent the same procedure but were randomized to receive 2 mL ACP gel, 4 mL ACP gel, or 4 mL PBS. After 1 and 3 weeks, respectively, half of the animals in each group were killed and adhesions and abscesses were scored. RESULTS The median total adhesion score was 12 (range, 3-20) in the ACP group and was 9 (range, 6-12) in the PBS group (not significant) in experiment 1. 91% of rats in the ACP group developed abscesses, versus 90% in the control group. There were no significant differences in abscess size or number of abscesses. In experiment 2, total adhesion scores in the 2 mL ACP group, 4 mL ACP group, and PBS group were 4 (range, 2-20), 6 (range, 1-11), and 6 (range, 1-18), respectively, (not significant) after 1 week and 3.5 (range, 1-8), 5 (range, 2-15), and 4 (range, 0-9), respectively, (not significant) after 3 weeks. All rats in the 2 mL ACP group and the PBS group and 83% of the 4 mL ACP group had developed abscesses after 1 week. After 3 weeks these percentages were 80, 75, and 73, respectively. There were no significant differences in size or number of abscesses between groups both after 1 and 3 weeks. CONCLUSION ACP does not reduce adhesion and abscess formation in a rat peritonitis model.
Collapse
Affiliation(s)
- Cornelis J J M Sikkink
- Radboud University Nijmegen Medical Center, Department of Surgery, Nijmegen, The Netherlands
| | | | | | | |
Collapse
|
26
|
Liu HJ, Wu CT, Duan HF, Wu B, Lu ZZ, Wang L. Adenoviral-mediated gene expression of hepatocyte growth factor prevents postoperative peritoneal adhesion in a rat model. Surgery 2006; 140:441-7. [PMID: 16934607 DOI: 10.1016/j.surg.2005.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 12/01/2005] [Accepted: 12/04/2005] [Indexed: 12/16/2022]
Abstract
BACKGROUND Mesothelial cell proliferation and migration play important roles in reducing formation of postoperative peritoneal adhesions. Hepatocyte growth factor (HGF) is a multifunctional cytokine that stimulates proliferation and migration of various cell types, including mesothelial cells. METHODS We investigated the effect of adenovirus-mediated HGF gene expression on the proliferation and migration of mesothelial cells and evaluated its preventive effects on postoperative formation of peritoneal adhesions. Rat mesothelial cells were isolated and characterized by expression of cytokeratin and vimentin. RESULTS Immunohistochemical staining showed that these cells expressed c-Met, the receptor for HGF. Adenoviral-mediated HGF gene transfer into mesothelial cells resulted in high expression of HGF and enhanced migration. To evaluate the preventive effects of adenoviral-mediated HGF gene transfer on the formation of postoperative peritoneal adhesion, we employed a rat model of cecum abrasion-induced adhesion formation in which 80% of the rats developed postoperative peritoneal adhesions. Local application of recombinant adenovirus carrying the HGF gene reduced adhesion formation in 16 of 20 control rats compared with 7 of 20 treated rats in this model. CONCLUSIONS These results suggest that adenoviral-mediated HGF gene transfer may be a novel strategy for preventing postoperative peritoneal adhesions.
Collapse
Affiliation(s)
- Hong-Jun Liu
- Department of Experimental Hematology, Beijing Institute of Radiation Medicine, Beijing, People's Republic of China
| | | | | | | | | | | |
Collapse
|
27
|
Sikkink CJJM, Vries de Reilingh TS, Malyar AW, Jansen JA, Bleichrodt RP, van Goor H. Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction. Hernia 2006; 10:218-22. [PMID: 16482401 DOI: 10.1007/s10029-006-0065-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2005] [Accepted: 12/19/2005] [Indexed: 12/14/2022]
Abstract
Incisional hernia is a common surgical problem, frequently requiring prosthetic mesh repair. The demands of the ideal mesh seem conflicting; ingrowth at the mesh-fascia interface, without development of adhesions at the visceral mesh surface. Various antiadhesives combined with macroporous mesh and composite meshes were studied for prevention of adhesions to mesh and ingrowth into the fascia. In 60 rats an abdominal wall defect was created and repaired with underlay mesh. Rats were divided into six groups and treated with polypropylene mesh (PPM, control), PPM with auto-cross-linked polymers (ACP) gel, PPM with fibrinogen glue (FG), polypropylene/expanded polytetrafluoroethylene (ePTFE) mesh, polypropylene/sodium hyaluronate/carboxymethylcellulose (HA/CMC) mesh, and polypropylene-collagen/polyethylene-glycol/glycerol (CPGG) mesh. Mesh infection was assessed in the postoperative period, adhesions and reherniations were scored at sacrifice 2 months after operation, and tensile strength of the mesh-tissue interface was measured. Six rats developed mesh infection, half of them were treated with PPM/ePTFE. The PPM/HA/CMC group showed a significant reduction in the amount and severity of adhesions. In animals treated with PPM/ACP and PPM/FG, severity of adhesions was reduced as well. Reherniation rate in the PPM/ACP group was 50% and significantly higher than that in other groups. Rats in the PPM/HA/CMC had the highest tensile strength. PPM/HA/CMC approaches the demands of the ideal mesh best, having superior antiadhesive properties, no reherniation and no infection in this rat model of incisional hernia.
Collapse
Affiliation(s)
- C J J M Sikkink
- Department of Surgery, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|
28
|
Sikkink CJJM, Reijnen MMPJ, Falk P, van Goor H, Holmdahl L. Influence of monocyte-like cells on the fibrinolytic activity of peritoneal mesothelial cells and the effect of sodium hyaluronate. Fertil Steril 2005; 84 Suppl 2:1072-7. [PMID: 16209995 DOI: 10.1016/j.fertnstert.2005.03.078] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2004] [Revised: 05/13/2005] [Accepted: 05/13/2005] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine whether the presence of cells of the monocyte-macrophage system affects the fibrinolytic response of peritoneal mesothelial cells to lipopolysaccharide (LPS) in the presence and absence of sodium hyaluronate. DESIGN Controlled laboratory experiment. SETTING Cell cultures in an academic laboratory research environment. PATIENT(S) Human peritoneal mesothelial cells were harvested from patients undergoing a laparotomy for noninfectious reasons and were cultured in vitro. Co-cultures were formed by adding U-937 human monocyte-like cells to a monolayer of mesothelial cells. INTERVENTION(S) After 24 hours, cultures were treated with 10 ng/mL of LPS, and sodium hyaluronate was added in a final concentration of 0.2%. Controls received medium without sodium hyaluronate. MAIN OUTCOME MEASURE(S) After 24 hours' incubation, tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), and plasminogen activator inhibitor-1 (PAI-1) levels were determined in medium and cell lysates by using ELISA techniques. RESULT(S) In medium of co-cultures, tPA and PAI-1 concentrations were statistically significantly increased compared with the case of monocultures, whereas uPA concentration was statistically significantly decreased. In cell lysates of co-cultures, PAI-1 concentration was statistically significantly increased compared with the case of monocultures, whereas tPA and uPA were unaffected. Treatment with sodium hyaluronate statistically significantly decreased PAI-1 and uPA concentrations in medium of monocultures but decreased uPA concentration only in medium of co-cultures, compared with the case of controls. CONCLUSION(S) Cells of the monocyte-macrophage system modulate the fibrinolytic capacity of LPS treated human peritoneal mesothelial cells and interfere in the hyaluronan-associated changes in mesothelial fibrinolytic capacity.
Collapse
|
29
|
Sheehan KM, DeLott LB, West RA, Bonnema JD, DeHeer DH. Hyaluronic acid of high molecular weight inhibits proliferation and induces cell death in U937 macrophage cells. Life Sci 2004; 75:3087-102. [PMID: 15488890 DOI: 10.1016/j.lfs.2004.02.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 02/17/2004] [Indexed: 11/28/2022]
Abstract
Hyaluronic acid (HA), a major glycosaminoglycan component of the extracellular matrix, has regulatory influences on cells and cellular activities. To explore the effects of a high concentration (1 mg/mL) of high molecular weight HA (500-730 kD) on U937 macrophage growth dynamics, three factors that influence overall cellular growth, namely proliferation, apoptosis, and cell death, were examined. Cells were cultured with HA and were analyzed by flow cytometry every 24 hours during a 168-hour period for proliferation and the presence of apoptotic and dead cells. These analyses demonstrated that HA inhibits U937 macrophage proliferation in a time-dependent manner. Through the first 72 hours, cells exhibited slowed proliferation. However, no evidence of cell division arrest or reduced cell viability was observed. Thereafter, HA continued to diminish proliferation, but induced apoptosis. This data is consistent with regulatory influences secondary to HA binding to CD44 and/or RHAMM cell surface receptors, both of which were shown to be expressed on U937 macrophages. This study demonstrates that a high concentration of high molecular weight HA greatly inhibits macrophage population growth by the dual actions of impeding cell proliferation and inducing apoptosis.
Collapse
Affiliation(s)
- Kyle M Sheehan
- Calvin College, Department of Biology, 3201 Burton Street, SE, Grand Rapids, MI 49546, USA
| | | | | | | | | |
Collapse
|
30
|
Eggleston RB, Mueller POE, Parviainen AK, Groover ES. Effect of carboxymethylcellulose and hyaluronate solutions on jejunal healing in horses. Am J Vet Res 2004; 65:637-43. [PMID: 15141885 DOI: 10.2460/ajvr.2004.65.637] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare a double-layer inverting anastomosis with a single-layer appositional anastomosis, coated with either 1% sodium carboxymethylcellulose (SCMC) or 0.4% sodium hyaluronate (HA) solutions, in the small intestine of horses with respect to anastomotic healing and adhesion formation. ANIMALS 18 adult horses. PROCEDURE Midline celiotomy and end-to-end jejunal anastomoses were performed. In control group horses (n = 6), a double-layer inverting anastomosis coated with sterile lactated Ringer's solution was performed. In treatment group horses, a single-layer appositional anastomosis was performed that was coated with 1% carboxymethylcellulose solution (SAA + SCMC group horses, 6) or 0.4% hyaluronate solution (SAA + HA group horses, 6). An additional 500 mL of the respective treatment solution was applied to the jejunal serosal surface, and 2 jejunal serosal abrasion sites were created. Horses were euthanatized 10 days after surgery. Anastomoses and abdominal adhesions were evaluated grossly. Anastomotic healing was evaluated on the basis of bursting wall tension. RESULTS Bursting wall tension was significantly greater in SAA + SCMC group horses, compared with control group horses. All intestinal segments failed at a point distant to the anastomosis. Significantly fewer adhesions were found at the abrasion sites of SAA + HA group horses, compared with control group horses. No differences were found in adhesion formation at the anastomotic sites among groups. CONCLUSIONS AND CLINICAL RELEVANCE Coating a single-layer appositional jejunal anastomosis with SCMC or HA solutions does not adversely affect anastomotic healing. Application of 0.4% HA solution to the serosal surface of the jejunum significantly decreases the incidence of experimentally induced intra-abdominal adhesion formation in horses.
Collapse
Affiliation(s)
- Randy B Eggleston
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602, USA
| | | | | | | |
Collapse
|
31
|
Sikkink CJJM, Postma VA, Reijnen MMPJ, De Man B, Bleichrodt RP, Van Goor H. Hyaluronan-Based Antiadhesive Membrane Has No Major Effect on Intraperitoneal Growth of Colonic Tumour Cells. Eur Surg Res 2004; 36:123-8. [PMID: 15007266 DOI: 10.1159/000076653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2003] [Accepted: 10/06/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND A relationship between post-surgical adhesion formation and peritoneal tumour implantation has been proposed. Hyaluronan (HA)-based agents reduce adhesion formation, but the effect on peritoneal tumour is not established. This study investigated the influence of a HA-containing agent on intraperitoneal tumour in an experimental model. METHODS 66 Balb/c mice underwent laparotomy and damage was inflicted to the parietal peritoneum. The animals were randomized into five groups. Groups 1 and 2 received HA-carboxymethylcellulose bioresorbable membrane and no treatment, respectively. Mice in groups 3-5 were injected intraperitoneally with 10(5) colon 26-B cells after the laparotomy. Treatment consisted of HA membrane, no HA agent and placement of HA membrane on the non-traumatized peritoneal wall, respectively. Animals were killed after 14 days; adhesions were scored in groups 1 and 2, and the tumour mass in groups 3-5. 45 Wag/Rij rats underwent the same procedures and treatment as mice in groups 3-5. In rats, 10(6) CC-531 cells were injected. Rats were killed after 3 weeks and the tumour mass was scored. RESULTS HA membrane resulted in a significant reduction of adhesions, but had no major effect on the intraperitoneal tumour mass in mice and rats. CONCLUSION HA-carboxymethylcellulose bioresorbable membrane has no major effect on intraperitoneal tumour implantation and growth in an experimental model.
Collapse
Affiliation(s)
- C J J M Sikkink
- Department of Surgery, University Medical Centre St Radboud, Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|
32
|
Reijnen MMPJ, Bleichrodt RP, van Goor H. Pathophysiology of intra-abdominal adhesion and abscess formation, and the effect of hyaluronan. Br J Surg 2003; 90:533-41. [PMID: 12734857 DOI: 10.1002/bjs.4141] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Intra-abdominal adhesions and abscesses cause significant morbidity and mortality. The formation of fibrin in the abdominal cavity is a common pathophysiological pathway for both. The aim of this review was to investigate the pathophysiology of intra-abdominal adhesions and abscesses, and to explore the possible sites of action of hyaluronan. METHODS Data were reviewed from the literature using the Medline database. RESULTS Both surgery and peritonitis disturb the equilibrium between coagulation and fibrinolysis in the abdominal cavity in favour of the coagulation system. Hyaluronan-based agents reduce adhesion formation after surgery. Moreover, hyaluronan solution reduces abscess formation in experimental peritonitis. Possible mechanisms of action include mechanical separation of wound surfaces, improvement of peritoneal healing, modulation of the inflammatory response and enhanced fibrinolysis. CONCLUSION Diminished fibrin degradation is a common pathway for the formation of adhesions and abscesses. The potential of hyaluronan-based agents to reduce intra-abdominal adhesions and abscesses in abdominal surgery and sepsis is a promising new concept. Elucidating the mechanisms involved and the clinical application of hyaluronan in peritonitis are challenges for future research.
Collapse
Affiliation(s)
- M M P J Reijnen
- Department of Surgery, University Medical Centre St Radboud, Nijmegen, The Netherlands.
| | | | | |
Collapse
|
33
|
Avsar AF, Avsar FM, Sahin M, Topaloglu S, Vatansev H, Belviranli M. Diphenhydramine and hyaluronic acid derivatives reduce adnexal adhesions and prevent tubal obstructions in rats. Eur J Obstet Gynecol Reprod Biol 2003; 106:50-4. [PMID: 12475581 DOI: 10.1016/s0301-2115(02)00213-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate the effects of diphenhydramine-HCl and Na-hyaluronate derivatives on the development of postoperative peritoneal adhesion and tubal obstruction. STUDY DESIGN Forty female rats of Sprague-Dawley type were used in the study. The rats were divided into four groups, each comprising 10 subjects. After all the rats were anaesthetized with 50mg/kg ketamine HCl, their abdomens were opened with a lower midline incision. Injury was induced on the right pelvic peritoneum and on the peritoneal surface of left uterine tube. No additional procedure was applied to the first group. 10 mg/kg diphenhydramine-HCl was given to the second group intravenously. In the third group, 0.25 mg/kg Orthovisc, a Na-hyaluronate derivative was diluted with 2 ml physiological saline and poured into the abdomen. For the fourth group, Seprafilm, a Na-hyaluronate derivative was covered in a layer of 0.7 cm x 3 cm over the left uterine tube. After 14 days, the rats were anaesthetized with ketamine HCl again, and 5 cm(3) blood sample was taken with cardiac puncture. The abdomen was opened with an incision transverse to the upper end of the midline incision, and the presence of adhesions was investigated. Detected adhesions were staged according to the Mazuji classification. Tubal patencies were inspected by injecting methylene blue from the uterine corpus into the lumen using an injector. A piece of abdominal wall of 4 cm x 4 cm was removed by extending the incision in the reverse U shape. The tensile strength and bursting pressure of the suture line were determined using the Peacock method. One gram of tissue was taken from the incision line, and hydroxyproline levels were determined by the Bergman-Loxley method. Aspartate aminotransferase (AST) levels were measured. RESULTS All of the rats completed the study. AST levels, tissue hydroxyproline levels and tensile strength and bursting pressure test results were found to be similar in all groups. While adhesion rates in the groups were 100, 40, 40 and 30%, respectively, adhesion stages were found to be, respectively as 2.1+/-1.7, 0.6+/-0.67, 0.6+/-0.67 and 0.5+/-0.85. Adhesion stages in the study groups were significantly lower (P<0.05). Tubal obstruction rates were found to be 70, 30, 30 and 20%, respectively. CONCLUSION Diphenhydramine, Orthovisc and Seprafilm significantly reduce postoperative peritoneal adhesion development, and they allow the uterine tubes to remain open.
Collapse
Affiliation(s)
- Ayse Filiz Avsar
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Maternity Training and Research Hospital, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
34
|
Reijnen MM, Skrabut EM, Postma VA, Burns JW, van Goor H. Polyanionic polysaccharides reduce intra-abdominal adhesion and abscess formation in a rat peritonitis model. J Surg Res 2001; 101:248-53. [PMID: 11735283 DOI: 10.1006/jsre.2001.6288] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Intra-abdominal infection is complicated by adhesion and abscess formation. We have assessed the adhesion- and abscess-reducing capacity of various solution volumes and concentrations of two polyanionic polysaccharides, hyaluronan (HA) and carboxymethylcellulose (CMC), in a rat peritonitis model. STUDY DESIGN In 192 male Wistar rats a bacterial peritonitis was induced using cecal ligation and puncture. After 24 h the abdomen was reopened and the ligated cecum resected. Animals were randomized into three control groups, nine groups treated with various solution volumes (1 to 8 ml) containing different HA concentrations, and four groups treated with 1.7% CMC solution. Rats were killed at day 7, postoperatively, and adhesions were scored at five abdominal sites on a scale from 0 to 4. The presence and size of intra-abdominal abscesses were noted. RESULTS Fifty-four rats (28%) prematurely died. There was no significant difference in mortality between treatment groups and controls. Treatment with CMC (P < 0.001) and low (0.2 and 0.4%) concentrations of HA (P < 0.005) significantly reduced intra-abdominal adhesion formation. High volumes of 0.2 and 0.4% HA were most effective (P = 0.01). The effect of CMC was volume independent. The incidence of abdominal abscesses was also significantly reduced by treatment with either CMC (P < 0.001) or low concentrations of HA (P < 0.001). With regard to abscess formation the effect was independent of the volume administered for HA, while low volumes of CMC were most effective (P < 0.005). CONCLUSION Intraperitoneal treatment with either CMC or low-viscosity HA solution reduced intra-abdominal adhesion and abscess formation in a rat peritonitis model. The volume-induced reduction in adhesion formation suggests a hydroflotation effect of HA solution.
Collapse
Affiliation(s)
- M M Reijnen
- Department of Surgery, University Medical Center Nijmegen, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|