Development Of Postoperative Adhesions Research Articles

Biosafe Polydopamine-Decorated MnO2 Nanoparticles with Hemostasis and Antioxidative Properties for Postoperative Adhesion Prevention.

Surgical bleeding and cumulative oxidative stress are significant factors in the development of postoperative adhesions, which are always associated with adverse patient outcomes. However, effective strategies for adhesion prevention are currently lacking in clinical practice. In this study, we propose a solution using polydopamine-decorated manganese dioxide nanoparticles (MnO2@PDA) with rapid hemostasis and remarkable antioxidant properties to prevent postsurgical adhesion. The PDA modification provides MnO2@PDA with enhanced tissue adhesiveness and hemocompatibility with negligible hemolysis. Furthermore, MnO2@PDA exhibits impressive antioxidant and free radical scavenging properties, protecting cells from the negative effects of oxidative stress. The hemostatic activity of MnO2@PDA is evaluated in a mouse truncated tail model and a liver injury model, with results demonstrating reduced bleeding time and volume. The in vivo test on a mouse cecal abrasion model shows that MnO2@PDA exhibits excellent antiadhesion properties coupled with alleviated inflammation around the damaged tissue. Therefore, MnO2@PDA, which exhibits high biosafety, rapid hemostasis, and beneficial antioxidant capacity, displays exceptional antiadhesion performance, holding great potential for clinical applications to prevent postoperative adhesion.

Shielding the Nerve: A Systematic Review of Nerve Wrapping to Prevent Adhesions in the Rat Sciatic Nerve Model.

Peripheral nerve pathology is frequently encountered in clinical practice among peripheral nerve and extremity surgeons. One major factor limiting nerve regeneration and possibly leading to revision surgeries is the development of traumatic or postoperative adhesions and scarring around nerves. In experimental models, different materials have been studied to limit scar tissue formation when wrapped around nerves. A systematic review of studies describing nerve-wrapping materials in a non-transectional rat sciatic nerve model was performed following the PRISMA guidelines. Literature describing nerve-wrapping methods for the prevention of peripheral nerve scarring in rat sciatic nerve models was identified using PubMed and Web of Science, scanned for relevance and analyzed. A total of 15 original articles describing 23 different materials or material combinations for nerve wrapping were included. The heterogeneity of the methods used did not allow a meta-analysis, thus, a systematic review was performed. Out of 28 intervention groups, 21 demonstrated a preventive effect on scar tissue formation in at least one qualitative or quantitative assessment method. The analyzed literature describes a variety of materials from different origins to limit peripheral nerve scarring and adhesions. Thus, a scar-preventive effect by wrapping peripheral nerves as adhesion prophylaxis seems likely. However, a quantitative comparison of the studies to identify the optimal material or technique is not possible with the diversity of used models and study designs. Therefore, further research needs to be performed to identify the optimal nerve wraps to be used routinely in clinical practice.

Оценка эффективности современного противоспаечного барьера в программе хирургического лечения пациенток с бесплодием трубного происхождения

Study Objective: To evaluate the effectiveness of the Reform antiadhesion gel in preventing the development of postoperative adhesions of the pelvic organs and maintaining the patency of the fallopian tubes after laparoscopic treatment in case of tubal infertility. Study Design: Continuous longitudinal clinical and epidemiological study. Materials and methods. The article presents a prospective analysis of 60 laparoscopic operations for female tubal infertility. The main group consisted of 30 patients who, in order to prevent postoperative adhesions in the pelvic area, were treated with Reform antiadhesion gel. The control group also consisted of 30 patients who did not use this gel. Study Results. The indicator of the onset of uterine pregnancy is one of the criteria for the effectiveness of the proposed method. Within 12 months after endosurgical operations, uterine pregnancies occurred in 9 (30%) patients of the main group and 4 (13.3%) patients in the control group (p < 0.05). Conclusion. The results of the study showed that the use of Reform antiadhesion gel in laparoscopic operations for female infertility of tubal origin in the case of adhesions of the pelvic organs has a positive effect on the dynamics of restoring the patency of the fallopian tubes while maintaining the reproductive function of women. Keywords: tubal infertility, antiadhesion gel, adhesive process, laparoscopy.

Epigenetics: new insights into postoperative adhesion development.

The link between post-operative adhesion development and epigenetic modifications is important in understanding the mechanism behind their formation. The purpose of this study was to determine whether epigenetic differences exist between primary fibroblasts of normal peritoneum and adhesion tissues isolated from the same patient(s). DNA from fibroblasts isolated from normal peritoneum and adhesion tissues was isolated using Qiagen's EZ1 Advanced Kit. Methylation patterns of genes were quantified and compared in both cell lines using the Infinium Human Methylation 27 Beadchip system. A total of 7364 genes had been found to manifest significantly different DNA methylation levels in adhesion fibroblasts as compared to normal peritoneal fibroblasts (p<0.01). A total of 1685 genes were found to have increased DNA methylation by 50% in adhesion compared to peritoneal fibroblasts, and were enriched in Gene Ontology categories, Glycoprotein, and Defense Response. Furthermore, 1287 genes were found to have decreased DNA methylation patterns with enriched Gene Ontology categories, "Homeobox", and Transcription Factor Activity in adhesion fibroblasts. Epigenetic differences in fibroblasts isolated from normal peritoneum and adhesion tissues were observed. Future studies focusing on the precise role of these genes in the development of post operative adhesions will allow us to more fully appreciate regulatory mechanisms leading to adhesion development, thereby establishing targets for therapeutic interventions to prevent or limit adhesion development.

Lipid emulsions prevent postoperative abdominal adhesions

IntroductionAdhesions are the most common cause of long-term morbidity after abdominal surgery and most often cause various forms of intestinal passage disorders ranging from partial obstruction to complete, life-threatening intestinal obstruction. The aim of the present study was to evaluate the protective effect of intraperitoneally administered lipid emulsions on the formation of adhesions in larger animal model, as the lubricating effect of phospholipids and the mechanical barrier of the lipid component are combined with the anti-inflammatory effect of fish oil. MethodsThirty-one female domestic pigs were randomly divided into three groups. At the end of the surgical procedure, a lipid emulsion or saline solution was applied intraperitoneally. After 14 days, an independent macroscopic, histological and immunohistochemical evaluation of the adhesions were performed. ResultsIntraperitoneal administration of lipid emulsions significantly reduced the incidence of intra-abdominal adhesions. Microscopic examination demonstrated a significant reduction in the number of inflammatory elements and the amount of collagen in the adhesions, especially after administration of the fish oil-based emulsion. A simultaneous decrease in neovascularization was observed in the adhesions. Evaluation of the intestinal anastomosis did not reveal significant differences in healing between the groups. ConclusionIntraperitoneal administration of lipid emulsions can reduce the development of postoperative intra-abdominal adhesions by the combined action of phospholipids as important lubricants and lipids as a mechanical barrier. Their effect is caused by a reduction in proinflammatory and profibrotic mediators. At the same time, intraperitoneal administration of lipid emulsions does not impair healing of the anastomosis in larger animal model.

Histopathological changes in extraocular muscles of rabbits following injection of Bupivacaine 5mg/ml versus 7.5mg/ml.

: Purpose To compare the histopathological effects of injecting 2 concentrations of Bupivacaine (5mg/ml and 7.5mg/ml) in the superior rectus muscle of rabbits, and to compare these to conventional extraocular muscle surgery in previous studies. Methods Eighteen albino rabbits’ eyes were used. The superior rectus muscles were injected with Bupivacaine 5mg/ml (Group B5, 10 eyes) or 7.5mg/ml (Group B7, 8 eyes). The rabbits were sacrificed and eyes enucleated 6 weeks later for histopathological evaluation. Results were compared to the average of those obtained, by 3 previous studies, after conventional superior rectus resection in rabbits. Results Foreign body reaction was absent in all specimens. Conjunctival and scleral inflammation, perimuscular adhesions, intramuscular fibrosis, conjunctival and scleral oedema and muscle atrophy were higher in group B7, while conjunctival hyperaemia and muscle hypertrophy were higher in group B5 (p > .05). On comparison to conventional surgery, conjunctival inflammation and hyperaemia, foreign body reaction, and adhesions were less after bupivacaine injection (p >.05 for all except for intensity of conjunctival inflammation in B5 versus conventional surgery). Scleral inflammation was more frequent after bupivacaine injection (p <.05). Muscle fibrosis was more frequent in group B7 and conventional surgery than in group B5 (p >.05). Conclusions Both Bupivacaine concentrations effectively produced the desired muscle hypertrophy and fibrosis, so the lower concentration may be used for muscle strengthening to correct strabismus. Bupivacaine injection, although produced no foreign body reaction, did not significantly lower the development of undesired postoperative adhesions and caused more scleral inflammation.

An Injectable Asymmetric‐Adhesive Hydrogel as a GATA6+ Cavity Macrophage Trap to Prevent the Formation of Postoperative Adhesions after Minimally Invasive Surgery

AbstractAntiadhesive hydrogels have been developed for preventing the formation of postoperative adhesions. However, it is challenging to design an injectable hydrogel with superior tissue retention properties that can be easily administered during minimally invasive surgical procedures to prevent the development of postsurgical adhesions. In this study, an injectable asymmetric‐adhesive hydrogel is fabricated using photocurable catechol‐grafted hyaluronic acid (HAD) for use during minimally invasive procedures to prevent the development of postoperative adhesions. The hydrogel exhibits superior tissue retention properties and favorably inhibits postoperative adhesion formation. This is the first time that an injectable hydrogel is designed via photocrosslinking to control asymmetric‐adhesive capability. The results show that laparoscopically delivered HAD precursor acts as a wet adhesive on the injured cecum, while its outward‐facing side is nonadherent after photocrosslinking. Intriguingly, the HAD acts as a physical barrier and polyanion trap to neutralize scavenger receptors, thereby inhibiting collagen deposition and uncontrolled recruitment of GATA6+ cavity macrophages. Furthermore, the HAD significantly downregulates the expression of fibrosis‐related and proinflammatory cytokines and promotes macrophage polarization. These results demonstrate that injection of the hydrogel can be readily integrated into laparoscopic surgery. Moreover, the HAD may be suitable for preventing adhesion formation after minimally invasive surgical procedures.

Cataract surgery in patients with uveitis

AbstractCataract surgery in patients with uveitis requires special considerations. Active inflammation, particularly anterior or intermediate uveitis, increases the risk for postoperative complications. Other problems include the development of postoperative adhesions between the iris and lens capsule postoperatively, membrane formation, IOL deposits, zonular problems, and cystoid macular edema (CME). Inflammation should be inactive or controlled as much as possible prior to elective surgery, minimum 3 months prior to surgery, as this reduces the risk of posteoperative CME. Collaboration with the physicians treating the patient's uveitis prior to cataract surgery will help to provide for appropriate prophylactic anti‐inflammatory therapy and improve postsurgical outcomes. Surgical planning should include the possible need for other procedures, such as managing pre‐existing posterior synechiae, pupillary membranes, zonular compromise, and fibrotic scarring of the pupillary margin. Current evidence supports a superior effect of hydrophobic acrylic lenses over silicone lenses, specifically for posterior synechiae outcome. Periocular or intraocular corticosteroids at the time of surgery should be considered. Posteoperatively the use of short‐acting topical mydriatic agents and greater frequency and duration of topical anti‐inflammatory treatment is recommended.

A comparative study of different amniotic membrane orientations during extraocular muscle surgery in rabbits

ABSTRACTPurpose: To histopathologically compare the effect of different orientations of cryopreserved human amniotic membrane (AM) transplant during extraocular muscle surgery in rabbits.Methods: Fifty-two albino rabbit eyes underwent 4-mm resection of the superior rectus. Eyes were randomly divided into four groups. In Group C (Control group, 16 eyes) the muscle was not wrapped with amniotic membrane. In the three AM groups, cryopreserved AM was wrapped around the muscle, oriented with either its stroma (Group S, 15 eyes) or epithelium (Group E, nine eyes) towards the muscle, or folded on itself with the epithelium externally (Group F, 12 eyes). The rabbits were sacrificed and the eyes were enucleated 6 weeks after surgery. Histopathological examination was conducted for periamniotic, foreign body, scleral, and conjunctival inflammation, conjunctival vascularity, adhesions and muscle fibrosis.Results: In all AM eyes, the AM was surrounded by periamniotic inflammation, with no adhesions detected between the muscle and surrounding tissues in the segment where the AM was present, but detected elsewhere. Adhesions were detected in all group C eyes. Foreign body inflammation was significantly less in Group C than in each of the AM groups (p < .05), but was insignificantly different among the three AM groups (p > .05). Scleral inflammation was absent in all specimens. No significant differences were noted among all groups in terms of conjunctival vascularity, conjunctival inflammation, or muscle fibrosis (p > .05).Conclusions: All AM orientations were equally effective in preventing the development of postoperative adhesions between the extraocular muscle and surrounding tissues.

ВЫСОКИЙ УРОВЕНЬ ГЛИКОЗАМИНОГЛИКАНОВ СЫВОРОТКИ КРОВИ КАК НЕЗАВИСИМЫЙ ПРЕДИКТОР РАЗВИТИЯ СПАЕЧНОЙ БОЛЕЗНИ БРЮШИНЫ

Peritoneal commissures is the phenomenon of adhesions formation with apparent symptom group of violations in functioning of the gastrointestinal tract and small pelvis. Unlike other postoperative complications adhesive disease is characterized by high risk for life manifestations in the form of intestinal obstruction, infertility and chronic pain. It is known that in the process of restoring the integrity of the peritoneum the decisive role is given to makrophages, peritoneal immune system, processes of angiogenesis, increasing fibroblasts and collagen production. However, the biochemical processes taking place in the intercellular matrix of connective tissue, particularly, the exchange of glycosaminoglycans in the formation of peritoneal adhesions have not been studied. In this context, the main objective of this work was to study levels of glycosaminoglycans of the blood in the development of adhesive disease and justification of the use of indicators to exchange connective tissue as additional prognostic criteria for the development of postoperative adhesions. An open prospective randomized trial analyzed the data of 67 patients that were admitted for the planned reconstructive surgery on the anterior abdominal wall to eliminate postoperative ventral hernia, at the surgery department of State Clinical Hospital No. 8, city ofUFAduring the period of 2005-2008. The severity of adhesions was assessed and contrasted to the results of determination of glycosaminoglycans in blood serum. The total content of glycosaminoglycans, hyaluronic acid, chondroitin sulfates and heparan sulfates was determined. Postoperative monitoring stages of the studied indicators -3, 5 and 7 day after herniotomy. The group of patients with adhesive peritoneum desease showed total content of glycosaminoglycans by 19.2% (p < 0.0001) higher than reference values. It should be noted that there was continuous growth of all factions of glycosaminoglycans during all seven days of the postoperative monitoring. The growth of the overall content of the glycosaminoglycans made 261% (p < 0.0001) compared with the control group. Method of ROC-analysis established that the area under the ROC curve is a common glycosaminoglycans is equal 0.824 ± 0.055, 95% confidence interval-0.906 0.711. Sensitivity-70.4% (54.8 -86.0), specificity is 97.5% (82.4 -98.6). The optimum point for the division amounted to 30 μmol/l. Positive predicting level amounted to 96.8%, negative 75.1%. Thus, the assessment of the level of glycosaminoglycans can serve as an additional prognostic test to diagnose disturbance in intercellular matrix that can be used in the diagnosis of commissural process and in monitoring the effectiveness of preventive measures.

The Creation of a Model for Ex Vivo Development of Postoperative Adhesions.

Postoperative adhesions occur in the overwhelming majority of patients after laparotomy and laparoscopy. The clinical consequences of adhesions can be devastating. Adhesions are believed to contribute to infertility and are the most common cause of small bowel obstruction and abdominal pelvic pain. Our objective is to develop a model for ex vivo development of postoperative adhesions. Peritoneal tissue strips were obtained from Sprague Dawley rats and were abraded by scraping the tissue surface with a scalpel. Tissues were incubated in a special medium, and visible adhesion bands were assessed. Experiments were performed in a university setting. Adhesion bands were observed as early as 24 hours after abrasion. No adhesion bands were observed in the control tissue strips. This is a model system for the creation of actual adhesive bands utilizing an ex vivo culture of peritoneal strips.

Adhesion phenotype manifests an altered metabolic profile favoring glycolysis

To determine whether metabolic markers are differentially expressed in normal and adhesion fibroblasts with and without hypoxia exposure. Prospective experimental study. University research laboratory. Fibroblasts established from normal peritoneum and adhesion tissues from the same patients. Invitro experiments on normal peritoneal and adhesion fibroblasts under normal and hypoxic (2% O2) conditions. Expression of metabolic markers, glyceraldehyde 3-phosphate dehydrogenase (GAPDH), glucose transporter 1 (GLUT1), hypoxia inducible factor (HIF)-1α, hexokinase 2 (HK2), lactose dehydrogenase A (LDHA), and pyruvate dehydrogenase alpha 1 (PDHA1) were measured using real-time reverse transcription polymerase chain reaction; adenosine triphosphate (ATP), HIF-1α, and lactate levels were assessed with ELISAs. Baseline mRNA levels of GAPDH and HIF-1α were increased, while GLUT1 and PDHA1 were decreased in adhesion as compared with in normal peritoneal fibroblasts. There was no change in baseline levels of HK2 or LDHA between the cell lines. Hypoxia increased protein levels of HIF-1α and mRNA levels of GAPDH, GLUT1, and HK2 and decreased levels of PDHA1 in both cell lines. Hypoxia increased LDHA mRNA levels in normal peritoneal fibroblasts. Baseline levels of lactate and ATP were lower in adhesion as compared with in normal peritoneal fibroblasts. In response to hypoxia, there was an increase in lactate in both cell lines and a decrease in ATP in normal fibroblasts. Adhesion fibroblasts manifested an altered metabolic profile, which favors the glycolytic pathway, and is further altered by hypoxia. Targeting these specific metabolic markers during surgery can be an important therapeutic intervention minimizing the development of postoperative adhesions.

Evaluation of breviscapine on prevention of experimentally induced abdominal adhesions in rats

BackgroundAdhesion formation, which results from mechanical peritoneal damage, tissue ischemia, or the presence of foreign materials, is a complicated process. The formation of adhesions is associated with inflammatory response and extracellular matrix deposition in response to injury. Although the pathophysiology of adhesion formation is widely understood, an absolute solution to this problem does not exist yet. As a main component of Erigeron breviscapus, breviscapine has exhibited the ability of anti-inflammatory and antifibrosis on many diseases. The purpose of this study was to investigate the effect of breviscapine on the development of postoperative intra-abdominal adhesions in Wistar rats. MethodsAbdominal adhesions were induced by scraping the cecum in rats. Various dosages of breviscapine drugs were administered for 10 days after surgery. On the 11th day after surgery, the levels of interleukin (IL) 18, IL-6, tumor necrosis factor α in blood serum and transforming growth factor β1 (TGF-β1), connective tissue growth factor, tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1) in peritoneal fluid were determined by enzyme linked immunosorbent assay. The expression of Smad7 and TGF-β1 in rat cecum tissue was evaluated by Western blot analysis. Grades of intestinal adhesion were ranked by macroscopic observation. ResultsThe intraperitoneal administration of breviscapine is effective on the prevention of the formation of postoperative adhesions in rats. Breviscapine decreased the levels of IL-18, IL-6, and tumor necrosis factor-α in blood serum and TGF-β1, connective tissue growth factor, PAI-1 in peritoneal fluid. But the levels of tPA and the ratio of tPA and PAI-1 in peritoneal fluid were increased. In addition, breviscapine significantly inhibited the expression of TGF-β1 and increased the level of Smad7 in the rat cecum tissue. ConclusionsThese results suggested that intraperitoneal administration of breviscapine was effective in preventing intra-abdominal adhesion formation in rats. Breviscapine appears to have synergetic effects which could decrease fibrosis by inhibiting inflammation, upregulating peritoneal fibrinolytic activity and regulating the TGF and/or Smad signaling pathway. These data indicated a potential new therapeutic use of breviscapine on adhesion prevention.

Nicotinamide Adenine Dinucleotide Phosphate Oxidase Expression Is Differentially Regulated to Favor a Pro-oxidant State That Contributes to Postoperative Adhesion Development

We have previously reported that superoxide (O2•-) contributes to the development of postoperative adhesions. In this study, we determined whether O2•- generating nicotinamide adenine dinucleotide phosphate oxidase (NOX) is differentially expressed in normal peritoneal and adhesion fibroblasts and tissues. The NOX isoforms were measured utilizing Western blot, immunohistochemistry, high-performance liquid chromatography, and real-time reverse transcription polymerase chain reaction. Expression and activity of NOX were found to be significantly higher in adhesion tissues and cells than that in normal peritoneal tissues and cells (P < .05). Levels of NOX2, NOX4, NOX activating protein 1, DUOX1, p47phox, and p22phox messenger RNA increased in adhesion fibroblasts when compared to normal peritoneal and increased in response to hypoxia in normal peritoneal fibroblasts. Thus, adhesion fibroblasts are characterized by a unique NOX expression profile, which maintains a pro-oxidant state that may be responsible for the persistence of the adhesion phenotype. Decreasing the activity of NOX by targeting these isoforms may be beneficial for future therapeutic interventions of postoperative adhesions.

Effects of experimental mechanical manipulations on local inflammation in the jejunum of horses

To determine characteristics of the inflammatory reaction in the jejunum of horses in response to various mechanical manipulations. 12 adult warm blood horses without gastrointestinal tract disorders. The proximal aspect of the jejunum in each horse was divided into 5 segments, and the following manipulations were performed: manual emptying, placement of Doyen forceps, enterotomy alone, enterotomy with mucosal abrasion, and serosal abrasion. Jejunum samples were collected before (control), immediately after, and 30 minutes after the end of manipulations and histologically evaluated to determine distribution of neutrophils and eosinophils. Macroscopically, all manipulations resulted in jejunal hemorrhage and edema. Compared with control samples, neutrophil numbers were significantly higher after manipulations in the serosa (after all manipulation types), circular muscle layer (after manual emptying), submucosa (after placement of Doyen forceps), and mucosa (after all manipulations except enterotomy alone). Eosinophil numbers were significantly higher in the submucosa after mechanical abrasion of the serosa and manual emptying versus control samples. Results indicated mechanical manipulation of the jejunum resulted in local inflammatory reactions characterized predominantly by infiltration of neutrophils. This could contribute to the development of postoperative ileus or adhesions in horses without macroscopically detectable injury of the jejunum during surgery.

Lycopene, a powerful antioxidant, significantly reduces the development of the adhesion phenotype

Postoperative adhesions are a common medical complication of gynecologic and other pelvic surgeries resulting in persistent pelvic pain, obstruction of the intestines, and even infertility. The molecular mechanisms of postoperative adhesion development remain to be elucidated. We have recently described a role for reactive oxygen species, specifically superoxide, in the development of postoperative adhesions. In this study, we sought to determine whether lycopene, a potent antioxidant, reduces markers characteristic of the adhesion phenotype. Primary fibroblast cultures from normal peritoneum and adhesion tissues were utilized to determine mRNA levels of adhesion phenotype markers type I collagen, transforming growth factor-beta 1 (TGF-β1), and vascular endothelial growth factor (VEGF) in response to lycopene (24 hours, 10 μM) treatment. There was a 2 (p < 0.003), 4.7 (p < 0.004), and 1.6 fold (p < 0.004) increase in mRNA levels of type I collagen, TGF-β1, and VEGF, respectively, in adhesion as compared to normal peritoneal fibroblasts. Lycopene treatment led to a 6.8 and a 12.4 fold decrease in type I collagen mRNA levels, in normal peritoneal and adhesion fibroblasts, respectively (p < 0.005). Lycopene treatment led to a 4.2 (p < 0.03) and a 4.6 (p < 0.05) fold decrease in VEGF mRNA levels, in normal peritoneal and adhesion fibroblasts, respectively. Lycopene treatment led to a 7.0 fold decrease in TGF-β1 mRNA levels, in adhesion fibroblasts (p < 0.03). A 1.9 fold decrease in TGF-β1 mRNA was observed in normal peritoneal fibroblasts in response to treatment, although it was not significant. Lycopene substantially reduced levels of adhesion phenotype markers in normal peritoneal and adhesion fibroblasts and whether it will reduce postoperative adhesions needs to be further investigated.

Effects of Parecoxib on The Prevention of Postoperative Peritoneal Adhesions in Rats

ABSTRACTBackground: No systemic preventive therapy has been successful in inhibiting the development of postoperative peritoneal adhesions (PPAs). Objective: The aim of this study was to evaluate the potential effects of 5 day administration of parecoxib, on PPA prevention and on suture or wound healing in rats. Methods: In a model of PPAs induced by peritoneal electrical burn, 30 rats were randomized into 3 groups according to parecoxib administration route (control; intraperitoneal (IP); intramuscular (IM)). Plasma and peritoneal levels of PAI-1 and tPA were measured at T0, after 90 min of surgery (T90), and on postoperative day 10 (D10). In a cecum resection model, 20 rats were randomized into two groups (control and IP parecoxib), and abdominal wound healing and suture leakage were assessed at D10. In both models, PPAs were evaluated quantitatively and qualitatively on D10. Results: Administration of parecoxib significantly decreased the quantity (p < .05) and the severity (p < .01) of PPAs in both models. In addition, parecoxib administration did not cause healing defects or infectious complications in the two models. In the peritoneal burn model, IP or IM parecoxib administration inhibited the increase of postoperative plasma and peritoneum PAI-1 levels, an increase that was observed in the control group (p < .01). No anastomosis leakage could be demonstrated in both groups in the cecum resection model. Conclusion: This study showed that, in these rat models, parecoxib might reduce PPA formation. Confirmation of the safety of parecoxib on intestinal anastomoses is required and should be investigated in further animal models.

Effect of cryopreserved amniotic membrane on the development of adhesions and fibrosis after extraocular muscle surgery in rabbits

To histopathologically evaluate the effect of cryopreserved human amniotic membrane (AM) transplant on preventing the development of postoperative adhesions after extraocular muscle surgery. Ten albino rabbits were used. The superior rectus muscles were bilaterally resected. In right eyes, the muscle was wrapped with cryopreserved human AM (group AM). In left eyes, the muscle was not wrapped with AM and served as a control group (group C). The rabbits were killed, and the eyes were enucleated 6 weeks after surgery to perform histopathological examination. On histopathological examination, the AM was present in eight eyes, surrounded by periamniotic inflammation, with no adhesions detected between rectus muscle and sclera, conjunctiva and Tenon's capsule in the segment where the AM was present, but detected elsewhere. Adhesions were detected in the other two eyes of group AM, in which the AM was absent, and in all group C eyes. When comparing eye pairs of each rabbit, AM eyes showed significantly less adhesions between the muscle and sclera (p = 0.009) and between the muscle and Tenon's capsule and conjunctiva (p = 0.008), in the region of AM application, and significantly more foreign body inflammation (p = 0.031), than C eyes. The differences between AM and C eye pairs, in terms of conjunctival inflammation and vascularity and muscle fibrosis, were insignificant (p > 0.05). Cryopreserved AM is effective in reducing postoperative extraocular muscle adhesions. Its application is, therefore, recommended during strabismus reoperations.

Evaluation of curcumin effects on post-operative peritoneal adhesion in rats.

The purpose of this study holds, for the first time, an evaluation of the intraperitoneal curcumin lavage on the development of post-operative intra-abdominal adhesions. Thirty male Wistar rats were randomized into five groups. The rats were administered anesthesia and underwent surgery in order to create intra-abdominal adhesions. Before the abdomen was closed, five lavage solutions of normal saline (control group), curcumin 1, 3, and 5% and hydrocortisone 1% were used for 1 min. After five days, the rats underwent laparatomy. Based on a histopathology evaluation and serum levels of hs-CRP, TNFα and Isoprostane, peritoneal adhesion severity were compared in different groups. The groups that received curcumin 3% and 5% showed a significant decrease in TNFα, hs-CRP and Isoprostane serum concentrations compared to the normal saline group, however, these differences were not significant, between the other groups. The intensity of adhesions in the different groups of curcumin 1, 3 and 5% concentrations and hydrocortisone 1% were compared to the normal saline control group and no significant statistical difference was recorded. Curcumin was not effective in post-operative peritoneal adhesion; however, further studies on curcumin lavage in higher concentrations are recommended.

Effects of hypoxia on the expression of inflammatory markers IL-6 and TNF-a in human normal peritoneal and adhesion fibroblasts

Inflammation is known to be involved in the postoperative adhesion development. Interleukin (IL)-6 and tumor necrosis factor (TNF)-α are cytokines that stimulate the acute-phase reaction, which leads to a systemic reaction including inflammation, fever, and activation of the complement and clotting cascades. The goal of this study was to examine the expression of these inflammatory markers, under normal and hypoxic conditions, in normal and adhesion fibroblasts. Primary cultures of fibroblasts were established from normal peritoneum and adhesion tissues from the same patient(s) and cultured under 20% O2 or hypoxic 2% O2 conditions for 24 hours. Cells were harvested and total RNA was isolated. Complimentary DNA was generated by reverse transcription and subjected to real-time RT-PCR using specific primers for IL-6 and TNF-α. Both normal peritoneal and adhesion fibroblasts expressed IL-6 and TNF-α. Adhesion fibroblasts exhibited significantly higher levels of IL-6 and TNF-α mRNA as compared to normal peritoneal fibroblasts (p < 0.05). Both IL-6 and TNF-α mRNA levels were upregulated in response to hypoxia in both normal peritoneal and adhesion fibroblasts. The increase in IL-6 and TNF-α mRNA levels of normal fibroblasts reached the levels observed in adhesion fibroblasts. Our results suggest that hypoxia promotes the development of the adhesion phenotype by the induction of inflammatory markers, which may contribute to the development of postoperative adhesions. The inhibition of inflammation may be a potential therapeutic approach in the prevention and/or reduction of postoperative adhesion development.