Use of intranasal submucosal fillers as a transient implant to alter upper airway aerodynamics: implications for the assessment of empty nose syndrome.

BACKGROUND: Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease-specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients. METHODS: Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6-Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22-item Sino-Nasal Outcome Test (SNOT-22), Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). RESULTS: Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward-trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT-22 scores significantly decreased at 1 week (p = 0.01) and 1 month (p = 0.04), mean GAD-7 at 1 month (p = 0.02) and 3 months (p = 0.02), and mean PHQ-9 at 1 week (p = 0.01) and 1 month (p = 0.004) postinjection. CONCLUSION: Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms.

Evaluación del gel antiadherencial post quirúrgico: hialuronato de sodio más carboximetilcelulosa y alginato / Evaluation of post-surgical antiadherence gel: sodium hyaluronate plus carboxymethylcellulose and alginate

INTRODUCCIÓN: Antecedentes: Las adherencias son bandas de tejido similar el tejido cicatricial que se forman entre superfícies dentro del organismo y hacen que estas se unan. Se forman más frecuentemente en el abdomen y pelvis después de cirugias intestinales o de los órganos femeninos, estas producen diversar molestias como distención o hinchazón abdominal, estreñimiento, náuseas y vomitos, incluso dolor pélvico intenso y crónico. Las adherencias son parte de un proceso fisiopatológico desencadenado o en respuesta al corte, isquemia, abrasión del peritoneo durante la cirugia. Las zonas alteradas sufren de regeneración mesotelial y fibrosis resultando en la formación de adherencias entre los tejidos serosos dañados. Las adherencias pueden tener un efecto beneficioso, ya que permite neovscularización de zonas isquémicas del intestino, tales como en las anastomosis, pero generalmente ocasionan probelmas cuando se vuelven excesivas. Las adherencias son la principal causa de obstrucción intestinal que causa el 70% de readmisiones hospitalarias. El hialuronato de sodio más carboximetilcelulosa, es descrito como un agente antiadherente no tóxico, no inmunogénico y biocompatible que reduce la incidencia y extensión de las adherencias postoperatorias. Compuesto de hialuronato de sodio y carboximetilcelulosa está modificado químicamente para retardar su tasa de degradación y deputación después de entrar en contato con el organismo. METODOLOGÍA: Se realizó una búsqueda bibliográfica de la literatura con respecto a la eficacia y seguridad del uso del Gel Antiadherencial Post quirúrgico. Se seleccionaron artículos científicos: evaluación de tecnologías santiarias, revisiones sistemáticas, met-análisis y ensayos clínicos. Se realizó una búsqueda dentro de la información generada por grupos que realizan revisiones sistemáticas, evaluación de tencologías sanitarias y guías de práctica clínica, tales como The Cochrane Library y The National Institute for Health and Care Excelence (NICE). Además, se hizo una búsqueda en www.clinicaltrials.gov, para poder identificar ensayos aún en elaboración o que no hayan sido publicados. CONCLUSIONES: Las investigaciones publicadas hasta marzo del 2016 son insuficientes para poder determinar la eficacia y seguridad del gel antiadherencial postquirúrgico (hialuronato de sodio más carboximetilcelulosa). Los resultados de los estudios preclínicos son discordantes con los ensayos clínicos realizados posteriomente. El Instituto de Tecnologías en Salud e Investigación-IETSI, no aprueba el uso del gel antiadherencial en sus presentaciones: (hialuronato de sodio más carboximetilcelulosa, alginato o la combinación de hialuronato de sodio más carboximetilcelulosa y alginato; para la reducción de adherencias abdominlaes y pélvicas.

Efectividad y seguridad de carboximetil celulosa tópica para el tratamiento sintomático del ojo seco / Effectiveness and safety of topical carboxymethyl cellulose for the symptomatic treatment of dry eye

Antecedentes: Descripción de la condición de salud de interés: El síndrome de ojo seco se define como una enfermedad multifactorial de las lágrimas y de la superficie ocular que resulta en síntomas de disconfort, alteraciones visuales e inestabilidad de la capa acuosa del ojo con un daño potencial a la superficie ocular. La comparación de datos estratificados por edad acerca de la prevalencia de la enfermedad en estudios epidemiológicos de gran tamaño, dan cuenta de una prevalencia del 5 al 35%, una afectación mayor de los hispanos y de los asiáticos cuando son comparados contra los caucásicos. Descripción de la tecnolo\r\ngía: El tratamiento más común para la condiciónde Ojo Seco, es el uso de lágrimas artificiales en forma de colírios o gotas, se administran con el fin de complementar la producción de lágrimas naturales. Las lágrimas naturales constan de siete elementos básicos: agua, solución salina, sustancias que mejoran su permanencia en el ojo y conservantes. Contienen diferentes tipos de polímeros que actúan como ingredientes activos que buscan proteger la superficie de la mucosa ocular. Evaluación de efectividad y seguridad: Pregunta de investigación: En pacientes con síndrome de ojo seco ¿es más efectiva y segura la caroboximetilcelulosa comparado con no hacer nada? La pregunta de investigación fue validada teniendo en cuenta las siguientes fuentes de información: registro sanitario INVIMA, Acuerdo 029 de 2011, guías de práctica clínica, reportes de evaluación de tecnologías, revisiones sistemáticas y narrativas de la literatura, estudios de prevalencia/incidencia y carga de enfermedad, consulta con expertos temáticos, y otros actores clave. Población: Pacientes con síndrome de ojo seco. Tecnología de interés: Carboximetilcelulosa. Metodología: Búsqueda de literatura, Búsqueda en bases de datos electrónicas. Conclusiones: Con el protocolo de búsqueda establecido no se halló evidencia que permita establecer la efectividad y la seguridad de la carboximetilcelulosa para el tratamiento de pacientes con síndrome de ojo seco.

Clinical assessment of a CMC/PEO gel to inhibit postoperative epidural adhesion formation after lumbar discectomy: a randomized, control study.

PURPOSE: To evaluate effectiveness of carboxymethylcellulose/polyethylene oxide (CMC/PEO) gel in improving clinical outcomes after the first-time lumbar discectomy. METHOD: Ninety-three patients with herniated lumbar disc at L4-L5 or L5-S1 were enrolled and randomized into two groups: CMC/PEO gel treatment group and control group. All the patients underwent laminotomy and discectomy by posterior approach. The preoperative and postoperative Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores for lower-back pain and leg pain were analyzed and compared between two groups at 30- and 60-day time points. RESULTS: No patient presented with any clinically measurable adverse event during surgery. There were no significant differences between the treated group and the control group on the preoperative ODI and VAS scores. In general, the ODI and VAS scores decreased in both groups at all the time points. At the 30-day time point, the VAS scores for back pain and leg pain and the ODI scores in treatment group were lower by 9.9 % (P = 0.0302), 27.0 % (P = 0.0002) and 16.3 % (P = 0.0007) than those in control group. And at the 60-day time point, the ODI and VAS scores further decreased in both groups. The VAS scores for leg pain in treatment group were lower by 4.5 % than that in the control group (P = 0.0149). However, no significant difference was detected between two groups on the ODI and VAS scores for back pain. CONCLUSIONS: The results demonstrated that CMC/PEO gel is effective in reducing posterior dural adhesions in the spine with no apparent safety issues. It can improve patients' postoperative clinical outcome.

Synthesis, characterization and in vitro assessment of the magnetic chitosan-carboxymethylcellulose biocomposite interactions with the prokaryotic and eukaryotic cells.

Preparation and characterization of CS/Fe(3)O(4)/CMC composite scaffolds including the morphology, crystallinity, and the in vitro efficacy as antibiotic delivery vehicles as well as their influence on the eukaryotic cells are reported. The results demonstrated that the magnetic polymeric composite scaffolds are exhibiting structural and functional properties that recommend them for further applications in the biomedical field. They improve the activity of currently used antibiotics belonging to penicillins, macrolides, aminoglycosides, rifampicines and quinolones classes, representing potential macromolecular carriers for these antimicrobial substances, to achieve extracellular and intracellular targets. The obtained systems are not cytotoxic and do not influence the eukaryotic HCT8 cell cycle, representing potential tools for the delivery of drugs in a safe, effective and less expensive manner.

Voluntary ingestion of antiparasitic drugs emulsified in honey represents an alternative to gavage in mice.

The oral route is the most frequently used method of drug intake in humans. Oral administration of drugs to laboratory animals such as mice typically is achieved through gavage, in which a feeding needle is introduced into the esophagus and the drug is delivered directly into the stomach. This method requires technical skill, is stressful for animals, and introduces risk of injury, pain and morbidity. Here we investigated another method of drug administration. The benzimidazole derivative albendazole was emulsified in commercially available honey and administered to mice by voluntary feeding or gavage. Mice that received albendazole by either gavage or honey ingestion had virtually identical levels of serum albendazole sulfoxide, indicating that uptake and metabolism of albendazole was similar for both administration techniques. In addition, dosing mice with the albendazole-honey mixture for 8 wk had antiparasitic activity comparable to earlier studies using gavage for drug administration. Compared with gavage, voluntary ingestion of a drug in honey is more rapid, less stressful to the animal, and less technically demanding for the administrator. Because of its low cost and ready availability, honey presents a viable vehicle for drug delivery.

Imaging assessment of the modified double contrast barium enema using carboxymethylcellulose on radiography and ultrasonography in dogs.

A modified double contrast barium enema using carboxymethylcellulose was evaluated in beagle dogs and compared with dogs receiving a conventional barium enema. The experimental group was divided into three groups (1, 2, and 3) and given 30 ml/kg of different volume ratios of a barium vs. carboxymethylcellulose mixture. Each group underwent sonography following radiography. The volume ratio of one part barium to three parts carboxymethylcellulose was judged to be the optimal mixture, resulting in a general distribution of contrast and bowel radiolucency on radiographs and adequate postradiography sonography. The modified barium enema using carboxymethylcellulose is useful for assessing the general morphology and mucosal layers of the colon simultaneously on radiographs and ultrasonographs.

A comparative assessment of the efficacy of carbomer gel and carboxymethyl cellulose containing artificial tears in dry eyes.

The present study aimed to compare the clinical efficacy of a 0.4% carbomer gel and 1% carboxymethyl cellulose (CMC) containing artificial tears in treatment of dry eye patients. Sixty subjects with mean age of 45.89 years who had symptoms and signs of dry eye were enrolled in this prospective, investigator-masked and stratified random sampling study. The subjects were divided into two parallel groups with 30 subjects (60 eyes) in each group. One group received carbomer gel, and the other group received 1% CMC containing artificial tears. Subjects received the drops 3 to 4 times or more per day for 3 months. At the first visit time, the precorneal residence time of these two drops was measured. The efficacy was assessed by comparing the subjective symptoms (ocular dryness, foreign body sensation, burning sensation and pain), and the objective test results of tears breakup time, Schirmer's test and corneal fluorescein staining prior to the study and after the treatment. As a result, the ocular residence time of carbomer gel was significantly longer than that of 1% CMC (P<0.001). Most of the primary subjective symptoms and objective test results were improved after treatment in both carbomer gel group and 1% CMC group. As to the improvement of each symptom and objective test result, carbomer gel was more effective than 1% CMC group (P<0.01). In conclusion, carbomer gel had longer precorneal residence time and was more effective than 1% CMC in the treatment of patients with dry eyes.

A silver-impregnated antimicrobial dressing reduces hospital costs for pediatric burn patients.

PURPOSE: Since using a novel silver-impregnated antimicrobial dressing (Aquacel Ag, ConvaTec, Princeton, NJ) in our pediatric patients with partial-thickness burns, hospital LOS has been significantly reduced. Here we investigated whether there was concomitant cost-effectiveness of this approach. METHODS: We retrospectively reviewed Burn Registry Data from a large Children's Hospital Burn Unit from January 2005 through August 2005 for inpatients with partial-thickness burns treated with Aquacel Ag. A comparison group was composed of patients from the same period the previous year treated with silver sulfadiazine cream (SSD, Par Pharmaceuticals, Woodcliff, NJ) and matched for age and %TBSA burned. Patients with inhalation injury or full-thickness burns were excluded. Intent-to-treat analysis was limited to patients with less than 22% TBSA burn. Direct costs and total charges were compared statistically after log transformation due to the skewedness of the data. RESULTS: Total charges and direct costs were significantly lower for Aquacel Ag-treated patients (n = 38) than for SSD-treated patients (n = 39) (P = .004 and P < .001, respectively). In addition, Aquacel Ag-treated patients had a shorter LOS than SSD-treated patients. DISCUSSION: These data strongly support our findings that the application of Aquacel Ag reduces hospital LOS which results in a significant cost savings in the care of pediatric patients with partial-thickness burns.

Prevention of adhesion formation after radical hysterectomy using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier: a cost-effectiveness analysis.

OBJECTIVE: To evaluate the cost-effectiveness of an adhesion prevention strategy compared to routine care, in which no adhesion prevention measures are taken, through a decision analysis model in the clinical setting of patients undergoing radical hysterectomy and pelvic lymphadenectomy for Stage IB cervical cancer. METHODS: A decision analysis model compared two strategies to manage the risk of adhesion-related morbidity following radical hysterectomy for Stage IB cervical cancer: (1) routine care with no adhesion prevention measures, and (2) the intervention strategy with a HA-CMC anti-adhesion barrier. The cost-effectiveness of each strategy was evaluated from the perspective of society and that of a third party payer. RESULTS: From the perspective of society, the HA-CMC strategy had an overall cost per patient of $1932 and effectiveness of 7.901 QALYs and dominated the routine care strategy, which had a cost per patient of $3043 and effectiveness of 7.805 QALYs. From the perspective of a third party payer, the HA-CMC strategy had an overall cost per patient of $1247 and effectiveness of 7.987 QALYs and dominated the routine care strategy, which had a cost per patient of $1629 and effectiveness of 7.970 QALYs. A series of one-way sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: Under a conservative set of clinical and economic assumptions, an adhesion prevention strategy utilizing a HA-CMC barrier in patients undergoing radical hysterectomy for Stage IB cervical cancer is cost-effective from both the perspective of society as a whole and that of a third party payer.

In vitro assessment of bioadhesion for periodontal and buccal drug delivery.

Bioadhesion could significantly improve oral therapeutics for periodontal diseases and mucosal lesions. This project was designed to examine the factors important to prolonged adhesion (adhesion time) in organ culture under standardized conditions. A wide variety of bioadhesives were tested in the model and the effect of mucin was also examined. Whilst many gels adhered for 1-5 h, others (chitosan and Eudispert) showed no retention loss over 4 d. Histologically, chitosan also showed excellent tissue wetting properties. For most materials, however, mucin significantly reduced adhesion times (P < 0.05). In conclusion, the absence of mucin, the control of gel hydration and swelling, and wetting characteristics were identified as key factors for prolonged adhesion.

Assessment of carboxymethylcellulose and 32% dextran 70 for prevention of adhesions in a rabbit uterine horn model.

The ability of solutions of carboxymethylcellulose (CMC) and 32% dextran 70 to reduce postoperative adhesion formation was examined using a rabbit uterine-horn scrape model. Utilization of 50 mL of 32% dextran 70 did not reduce adhesion formation compared with control rabbits. However, intraperitoneal instillation of CMC significantly reduced postoperative adhesion formation. An inverse correlation was established between either the concentration of CMC employed (1%, 2%, and 3%) or the volume of 2% CMC employed (20, 30, 40, and 50 mL) and the extent of adhesion formation. It is concluded that in this animal model CMC, but not 32% dextran 70, was able to retard postoperative adhesion formation.