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1.
Khirurgiia (Mosk) ; (3): 26-35, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33710823

RESUMO

OBJECTIVE: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (AASBO). MATERIAL AND METHODS: A retrospective multiple-center study included 143 (85.6%) patients with AASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups. RESULTS: AASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (n=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (n=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (p=0.287), early and late surgery in patients with strangulation (p=0.940), early and late surgery in patients without strangulation (p=0.76). Patients died (n=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (n=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p=0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p=0.061), bowel resection (95% CI 33.3-14.0, p=0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613). CONCLUSION: Delayed surgery may be advisable in patients with AASBO and no obvious signs of strangulation due to less mortality.


Assuntos
Obstrução Intestinal , Intestino Delgado/cirurgia , Isquemia/cirurgia , Aderências Teciduais/cirurgia , Doença Aguda , Tratamento Conservador , Humanos , Obstrução Intestinal/mortalidade , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/terapia , Intestino Delgado/irrigação sanguínea , Intestino Delgado/patologia , Isquemia/etiologia , Isquemia/mortalidade , Isquemia/terapia , Estimativa de Kaplan-Meier , Estudos Retrospectivos , Fatores de Risco , Tempo para o Tratamento , Aderências Teciduais/complicações , Aderências Teciduais/terapia , Resultado do Tratamento
2.
Mol Med Rep ; 23(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33179074

RESUMO

Estrogen is a commonly used hormone in the adjuvant treatment of intrauterine adhesion (IUA), which can promote endometrial growth. Stem cell transplantation has also been reported to promote endometrial regeneration in IUA due to its potential differentiative capacity. Human Wharton's jelly mesenchymal stem cells (WJ­MSCs) are isolated from the umbilical cord, possess strong self­renewal and proliferative abilities, and are hypo­immunogenic and non­tumorigenic. Therefore, the present study aimed to investigate the therapeutic effects and underlying mechanism of WJ­MSCs transplantation with estrogen treatment, separately or as a combined therapy, on IUA. The IUA model was established using the ethanol damage method. A total of 50 Sprague­Dawley female rats were randomly divided into the control, IUA model, WJ­MSCs treatment, estrogen treatment and WJ­MSCs+ estrogen treatment groups (n=10/group). WJ­MSCs were injected three times at 5­day intervals. IUA rats in the estrogen group received 0.2 mg/kg estrogen through intragastric administration, once every 2 days for 8 weeks. Morphological changes were evaluated by hematoxylin­eosin staining. Immunohistochemical evaluations of pan­keratin, vimentin, transforming growth factor (TGF)­ß1, RhoA, RhoB, RhoC, Rho­associated coiled­coil­containing protein kinase (ROCK)I, and ROCKII expression were performed in uterine tissue. After treatment, the uterine specimens were observed to have increased uterine thickness and gland numbers in all treatment groups compared with the IUA group; however, the degree of restoration in the independent WJ­MSCs and estrogen treatment groups was better than in the combined treatment group. Immunohistochemical analysis demonstrated that pan­keratin expression was increased, and RhoA, ROCKI and TGF­ß1 expression was significantly inhibited in the WJ­MSCs and WJ­MSCs + estrogen treatment groups compared with the IUA group; however, the expression levels of these proteins were similar among all treatment groups. No change in vimentin expression was detected in any treatment group. The expression levels of RhoB, RhoC and ROCKII were clearly not affected by WJ­MSCs intervention alone. In conclusion, transplantation of WJ­MSCs may repair endometrial damage in IUA rats via TGF­ß1­mediated inhibition of RhoA/ROCKI signaling.


Assuntos
Estrogênios/administração & dosagem , Células-Tronco Mesenquimais/citologia , Aderências Teciduais/terapia , Fator de Crescimento Transformador beta1/metabolismo , Doenças Uterinas/terapia , Animais , Diferenciação Celular , Terapia Combinada , Modelos Animais de Doenças , Regulação para Baixo , Estrogênios/farmacologia , Etanol/efeitos adversos , Feminino , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/metabolismo , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Transdução de Sinais , Aderências Teciduais/induzido quimicamente , Aderências Teciduais/metabolismo , Resultado do Tratamento , Doenças Uterinas/induzido quimicamente , Doenças Uterinas/metabolismo , Proteínas rho de Ligação ao GTP/metabolismo , Quinases Associadas a rho/metabolismo
3.
Medicine (Baltimore) ; 99(29): e21103, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702858

RESUMO

RATIONALE: Lymphadenectomy for tongue cancer in the neck region is often accompanied by local impaired mobility, gland damage, difficult in swallowing, and postoperative complication and seriously affects patients life quality. We reported a case of subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy for tongue lesions accompanied by impaired neck mobility and difficult in swallowing was treated using Fu's subcutaneous needling (FSN) treatment. PATIENT CONCERNS: A 55-year-old male with tongue cancer received surgical intervention with lymphadenectomy 8 years ago was revealed a 15 cm-long curved surgical incision in the neck region and surrounded by numerous scar tissues. DIAGNOSIS: Post-operation subcutaneous adhesions and scar hyperplasia in the neck region after lymphadenectomy was diagnosed. INTERVENTIONS: FSN treatment was performed 2 to 3 times per week for 1 month to sway the affected tightened muscle and dissociate the superficial fascia beneath the scar resulted in a considerable improvement in neck movement. OUTCOMES: The Vancouver Scar Scale (VSS) was as follows: color (M) - 1; vascular distribution (V) - 0, thickness (H) - 2, and flexibility (P) - 4, with a total of 7 points before FSN treatment. The VSS after 1 month of FSN treatment was as follows: M1, V0, H2, and P2, with a total of 5 points. Neck mobility in different directions, i.e., stretching to the back of the neck and laterally bending the neck to the left and/or right side, was improved (P < .05). LESSONS: At present, treatment of chronic scar hyperplasia has certain side effects and limitations. FSN is safe and convenient, with minimal destruction of the superficial fascia, having evident effects of dissociating tissue adhesion under scars and compensating for deficiencies in scar hyperplasia treatment. It can provide new ideas for future treatments.


Assuntos
Hiperplasia/terapia , Pescoço/anormalidades , Tela Subcutânea/anormalidades , Aderências Teciduais/terapia , Humanos , Hiperplasia/patologia , Hiperplasia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pescoço/fisiopatologia , Tela Subcutânea/patologia , Tela Subcutânea/fisiopatologia , Aderências Teciduais/patologia , Aderências Teciduais/fisiopatologia , Neoplasias da Língua/complicações , Neoplasias da Língua/fisiopatologia , Neoplasias da Língua/cirurgia
4.
Gynecol Obstet Invest ; 85(3): 267-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32289792

RESUMO

BACKGROUND: Intrauterine adhesion (IUA) is the second leading cause of secondary infertility in women. Research has shown that stem cells can promote endometrial regeneration and that biomaterials are also helpful in tissue regeneration. Therefore, we compared the efficacy of a collagen scaffold combined with either human umbilical cord mesenchymal stem cells (hUCMSC) or estrogen for the treatment of IUA. METHODS: The IUA-induced rats were injected with hUCMSCs or estrogen, and with a collagen scaffold. The endometrial glands and amount of fibrosis were assessed using hematoxylin and eosin and Masson staining. The extent of fibrosis and levels of regeneration-related cytokines were examined by real-time quantitative PCR, and the expression levels of the estrogen receptor, KI67 and cytokeratin were analyzed using an immunochemistry assay. In addition, human nuclear antigen (HuNu) and vimentin were examined by immunofluorescence microscopy. RESULTS: The collagen scaffold administered with hUCMSCs markedly increased the number of endometrial glands and reduced the area of fibrosis compared with either the collagen scaffold or hUCMSCs alone. In addition, the collagen scaffold with hUCMSCs significantly regulated the expression levels of fibrosis, estrogen, and differentiation-related genes relative to the collagen scaffold or hUCMSCs alone. Furthermore, the hUCMSCs alone or in combination with the collagen scaffold increased the expression of HuNu and vimentin in the IUA-induced rat model. In addition, protein levels of the p-transcriptional co-activator with PDZ-binding motif, stromal cell-derived factor-1, and C-X-C chemokine receptor type 4 were upregulated in the group that received the collagen scaffold in combination with -hUCMSCs. CONCLUSION: Our results suggest that the combination of the collagen scaffold with hUCMSCs may be an alternative approach for treating IUA.


Assuntos
Regeneração Tecidual Guiada/métodos , Transplante de Células-Tronco Mesenquimais , Aderências Teciduais/terapia , Tecidos Suporte/química , Doenças Uterinas/terapia , Animais , Colágeno/farmacologia , Modelos Animais de Doenças , Endométrio/fisiologia , Feminino , Humanos , Células-Tronco Mesenquimais/citologia , Ratos , Cordão Umbilical/citologia
6.
World J Surg ; 43(12): 3027-3034, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31555867

RESUMO

BACKGROUND: Adhesive small bowel obstruction (ASBO) severity has been associated with important clinical outcomes. However, the impact of ASBO severity on hospitalization cost is unknown. The American Association for the Surgery of Trauma (AAST) developed an Emergency General Surgery (EGS) disease severity grading system for ASBO. We stratified patients' ASBO severity and captured hospitalization costs hypothesizing that increased disease severity would correlate with greater costs. METHODS: This was a single-center study of hospitalized adult patients with SBO during 2015-2017. Clinical data and estimated total cost (direct + indirect) were abstracted. AAST EGS grades (I-IV) stratified disease severity. Costs were normalized to the median grade I cost. Univariate and multivariate analyses evaluated the relationship between normalized cost and AAST EGS grade, length of hospital and ICU stay, operative time, and Charlson comorbidity index. RESULTS: There were 214 patients; 119 (56%) were female. AAST EGS grades included: I (62%, n = 132), II (23%, n = 49), III (7%, n = 16), and IV (8%, n = 17). Relative to grade I, median normalized cost increased by 1.4-fold for grade II, 1.6-fold for grade III, and 4.3-fold for grade IV disease. No considerable differences in patient comorbidity between grades were observed. Pair-wise comparisons demonstrated that grade I disease cost less than higher grades (corrected p < 0.001). Non-operative management was associated with lower normalized cost compared to operative management (1.1 vs. 4.5, p < 0.0001). In patients who failed non-operative management, normalized cost was increased 7.2-fold. Collectively, the AAST EGS grade correlated well with cost (Spearman's p = 0.7, p < 0.0001). After adjustment for covariates, AAST EGS grade maintained a persistent relationship with cost. CONCLUSION: Increasing ASBO severity is independently associated with greater costs. Efforts to identify and mitigate costs associated with this burdensome disease are warranted. LEVEL OF EVIDENCE: III, economic/decision.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Obstrução Intestinal/economia , Intestino Delgado/cirurgia , Aderências Teciduais/economia , Idoso , Emergências , Serviço Hospitalar de Emergência , Feminino , Hospitalização/economia , Humanos , Obstrução Intestinal/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Aderências Teciduais/terapia , Estados Unidos
7.
Stem Cell Res Ther ; 10(1): 257, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412924

RESUMO

BACKGROUND: Intrauterine adhesion (IUA) is an adhesion of the uterine cavity or cervical canal resulting from damage to the basal layer of the endometrium; this condition is usually accompanied by fibrosis of the endometrium. Previous studies have demonstrated that human amniotic epithelial cells (hAECs) have stem cell characteristics; however, it is unclear whether hAECs have the therapeutic potential to restore fertility after IUA. METHODS: A murine IUA model was established by mechanical injury to the uterus. Then, 106 hAECs were transplanted by intraperitoneal injection. The endometrium thickness, number of glands, and fibrosis area were measured by hematoxylin and eosin (H&E) staining and Masson staining. Molecules (including vWF, VEGF, PCNA, ER, PR, LC3, and p62) related to endometrial angiogenesis, cell proliferation, and autophagy were assayed by IHC staining. Pregnancy outcomes were also evaluated. Finally, hAECs were cocultured with human endometrial mesenchymal stem cells (hEnSCs) damaged by H2O2 to verify the paracrine effect on endometrial stromal cells in vitro. RESULTS: The IUA uterine cavity presented with adhesion and even atresia, accompanied by a thinner endometrium, fewer glands, increased fibrosis area, and fewer microvessels. However, hAECs significantly improved the uterine structure after IUA. After hAEC treatment, the endometrium was thicker, the number of endometrial glands was increased, fibrosis was reduced, and more microvessels were generated. The expression levels of VEGF, PCNA, and ER were increased in the hAEC-treated endometrium, indicating improvements in angiogenesis and stromal cell proliferation. hAECs also increased pregnancy outcomes in IUA mice, and the pregnancy rate and fetus number increased. Furthermore, we observed altered autophagy in the IUA uterine model, and hAEC transplantation upregulated autophagy. An in vitro study showed that hAECs activated autophagy in (hEnSCs) treated with H2O2 in a paracrine manner. CONCLUSIONS: Our results demonstrated that hAECs have the potential to repair the uterus after injury, providing a new strategy for the prevention and treatment of Asherman syndrome.


Assuntos
Âmnio/citologia , Modelos Animais de Doenças , Endométrio/citologia , Células Epiteliais/citologia , Infertilidade/prevenção & controle , Aderências Teciduais/terapia , Doenças Uterinas/terapia , Animais , Feminino , Humanos , Camundongos , Camundongos Endogâmicos BALB C , Gravidez , Regeneração , Aderências Teciduais/patologia , Doenças Uterinas/patologia
8.
Zygote ; 27(6): 367-374, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31452481

RESUMO

Endometrial injury is an important cause of intrauterine adhesion (IUA), amenorrhea and infertility in women, with limited effective therapies. Recently, stem cells have been used in animal experiments to repair and improve injured endometrium. To date, our understanding of adipose-derived stem cells (ADSCs) in endometrial injury repair and their further therapeutic mechanisms is incomplete. Here, we examined the benefit of ADSCs in restoration of injured endometrium by applying a rat endometrial injury model. The results revealed by immunofluorescence showed that green fluorescent protein (GFP)-labelled ADSCs can differentiate into endometrial epithelial cells in vivo. At 30 days after ADSCs transplantation, injured endometrium was significantly improved, with increased microvessel density, endometrial thickness and glands when compared with the model group. Furthermore, the fertility of rats with injured endometrium in ADSCs group was improved and had a higher conception rate (60% vs 20%, P = 0.014) compared with the control phosphate-buffered saline (PBS) group. However, there was no difference in the control group compared with the sham group. In addition, expression levels of the oestrogen receptor Eα/ß (ERα, ERß) and progesterone receptor (PR) detected by western blot and enzyme-linked immunosorbent assay (ELISA) were higher in the ADSCs group than in the PBS group. Taken together, these results suggested that ADSC transplantation could improve endometrial injury as a novel therapy for IUA.


Assuntos
Tecido Adiposo/citologia , Endométrio/lesões , Transplante de Células-Tronco/métodos , Células-Tronco/citologia , Aderências Teciduais/terapia , Doenças Uterinas/terapia , Ferimentos e Lesões/terapia , Animais , Células Cultivadas , Endométrio/metabolismo , Feminino , Humanos , Infertilidade/etiologia , Infertilidade/terapia , Ratos Sprague-Dawley , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Aderências Teciduais/etiologia , Doenças Uterinas/etiologia , Ferimentos e Lesões/complicações
9.
Pain Physician ; 22(4): 307-322, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31337160

RESUMO

BACKGROUND: Post lumbar surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis are often contemplated in managing post lumbar surgery syndrome. Multiple previous systematic reviews have reached discordant conclusions about the level of evidence for the effectiveness of percutaneous adhesiolysis in managing post lumbar surgery syndrome and other conditions. STUDY DESIGN: A systematic review of previously published systematic reviews assessing efficacy of percutaneous adhesiolysis in managing post lumbar surgery syndrome. OBJECTIVE: To evaluate the value and validity of previous systematic reviews performed after 2015 on effectiveness of percutaneous adhesiolysis in managing chronic refractory low back and lower extremity pain secondary to post lumbar surgery syndrome. METHODS: Previous systematic reviews on percutaneous adhesiolysis were evaluated. The quality of each systematic review was assessed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews (AMSTAR).The randomized trials included in the available systematic reviews were assessed by Cochrane review criteria and Interventional Pain Management techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for methodologic quality.Data sources included relevant systematic reviews and the randomized trials included in those systematic reviews published since 2015 with searches of PubMed, Cochrane reviews, and Google Scholar through February 2019. OUTCOME MEASURES: Outcome measures were significant improvement defined as 50% pain relief and improvement in functional status. Short-term efficacy was defined as improvement of 6 months or less, whereas long-term efficacy was defined as more than 6 months. RESULTS: Three systematic reviews and 4 randomized controlled trials (RCTs) of post lumbar surgery syndrome with chronic refractory low back and lower extremity pain showed notable evidence of significant pain relief. Only one systematic review, which was of low quality with inappropriate analysis, showed lack of evidence. CONCLUSION: Overall, the present analysis shows Level I evidence for percutaneous adhesiolysis based on significant evidence from published RCTs and 3 of the 4 systematic reviews. KEY WORDS: Post lumbar surgery syndrome, epidural fibrosis, percutaneous adhesiolysis, systematic reviews, randomized controlled trials.


Assuntos
Síndrome Pós-Laminectomia/terapia , Aderências Teciduais/terapia , Dor Crônica/terapia , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Região Lombossacral , Manejo da Dor/métodos , Reprodutibilidade dos Testes , Revisões Sistemáticas como Assunto , Resultado do Tratamento
10.
Mol Med Rep ; 20(1): 205-215, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31115522

RESUMO

Tendon adhesion is a substantial challenge for tendon repair. Thermal pretreatment (TP) may decrease inflammation by upregulating heat shock proteins (HSPs). The present study intends to identify the function that TP serves when combined with HSP70 overexpression in tendon healing and adhesion in rats. Sprague­Dawley male rats were used to establish a surgically ablative tendon postoperative suture model, and the positive expression of the HSP70 protein was measured using immunohistochemistry. Changes to the blood vessels and collagenous fiber, in addition to the maximum tensile strength and the tendon sliding distance, were detected under a microscope. Finally, HSP70, tumor growth factor ß (TGF­ß), and insulin­like growth factor 1 (IGF­1) mRNA and protein levels were all determined by employing reverse transcription­quantitative polymerase chain reaction and western blot analysis methods. The positive expression of the HSP70 protein increased following TP. Furthermore, TP reduced the infiltration of inflammatory cells and improved the collagenous arrangement, accompanied by an increased maximum tensile force and tendon gliding distance following surgery. In addition, TP increased the mRNA and protein expression levels of HSP70, TGF­ß and IGF­1. Altogether, TP increases HSP70 expression, thereby reducing postoperative traumatic inflammation and establishing tendon adhesion and promoting tendon healing. Thus, TP may be a potential strategy for the treatment of tendon adhesion.


Assuntos
Proteínas de Choque Térmico HSP70/genética , Tendões/cirurgia , Aderências Teciduais/terapia , Animais , Vasos Sanguíneos/metabolismo , Vasos Sanguíneos/patologia , Regulação da Expressão Gênica/genética , Temperatura Alta/uso terapêutico , Fator de Crescimento Insulin-Like I/genética , Masculino , RNA Mensageiro/genética , Ratos , Técnicas de Sutura , Tendões/metabolismo , Tendões/patologia , Resistência à Tração , Aderências Teciduais/genética , Aderências Teciduais/patologia , Fator de Crescimento Transformador beta/genética
11.
Orthopedics ; 42(3): 163-167, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31099882

RESUMO

Arthrofibrosis following total knee arthroplasty (TKA) is a debilitating complication. Treatment options include physical therapy, manipulation under anesthesia (MUA), and arthroscopic lysis of adhesions (ALOA) with or without MUA. The authors studied 70 patients with arthrofibrosis after TKA treated with MUA or ALOA plus MUA. In this matched cohort study, 35 patients were treated with MUA and 35 patients were treated with ALOA plus MUA. Total knee arthroplasty followed by MUA was performed by 2 surgeons and TKA followed by MUA plus ALOA was performed by 1 surgeon at 1 institution. Electronic records were used to collect information and match cohorts based on age, sex, body mass index, diabetes mellitus, perioperative range of motion (ROM), and timing of the procedure for arthrofibrosis. The combination of MUA and ALOA yielded changes in ROM: a 72.7% increase 4 to 12 weeks after index TKA (P=.032), a 50.0% increase 12+ weeks after TKA (P=.032), and a 99.8% increase in patients with a pre-manipulation ROM of 0° to 60° (P=.001). Manipulation under anesthesia yielded a 49.2% increase 4 to 12 weeks after TKA (P=.161), a 27.0% increase 12+ weeks after TKA (P=.161), and a 68.8% increase in patients with pre-manipulation ROM of 0° to 60° (P=.084). Patients treated with ALOA plus MUA had greater increases in ROM (P=.026) and final knee flexion (P=.028) compared with those treated with MUA alone. Arthrofibrosis following TKA is a complication that often requires additional procedures. Traditionally, ALOA is added 3+ months from index TKA, when abundant scar formation has occurred. This study found a benefit to ALOA plus MUA compared with MUA alone, with the largest benefit in patients whose pre-manipulation ROM was 0° to 60°. [Orthopedics. 2019; 42(3):163-167.].


Assuntos
Artroplastia do Joelho/efeitos adversos , Artroscopia , Fibrose/terapia , Manipulação Ortopédica , Aderências Teciduais/terapia , Estudos de Coortes , Feminino , Fibrose/etiologia , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Amplitude de Movimento Articular
12.
J Bodyw Mov Ther ; 23(2): 262-269, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31103106

RESUMO

OBJECTIVE: To systematically review the effects of soft tissue mobilization (STM) on both surgical and non-surgical abdominal adhesion-related symptoms. STUDY DESIGN: Systematic Review. BACKGROUND: It is known that abdominal adhesions can cause a variety of symptoms with one of the most common being abdominal pain. To date, there is no known systematic review that documents the effects of STM on adhesion-related abdominal symptoms. METHODS AND MEASURES: A systematic review of literature was indexed in the following databases: PubMed, Cochrane, Google Scholar, OVID, and EBSCO. The quality of the studies was assessed using the MINORS scale. RESULTS: Nine studies satisfied the eligibility criteria for this systematic review. The studies' population age ranged from 10.7 to 89.4 years. Four articles were nonrandomized and had scores ranging from 3 to 14 out of 16 total on the MINORS scale. Five articles were randomized controlled trials or comparative studies and scores ranged from 16 to 23 out of 24 total on the MINORS scale. There were five articles that used pain as an objective measure and all of them reported a decrease in pain after treatment. Two studies looked at quality of life and function and both saw objective improvements following abdominal adhesion treatment. Collectively, there were also improvements seen in scar mobility, infertility, posture, a reduction in medication, increased pressure tolerance and decreased postoperative ileus. CONCLUSION: The results of this review indicate preliminary strong evidence for the benefits of STM on symptoms relating to acute post-surgical adhesions, preliminary moderate evidence for the benefits of STM on symptoms relating to chronic non-surgical related adhesions (fertility and SBO) and moderate evidence for the benefits of STM on symptoms relating to chronic post-surgical adhesions.


Assuntos
Abdome , Manejo da Dor/métodos , Terapia de Tecidos Moles/métodos , Aderências Teciduais/terapia , Cicatriz/terapia , Humanos , Qualidade de Vida
13.
Biomed Res Int ; 2019: 2354325, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31073521

RESUMO

Introduction: Tendon adhesion to surrounding tissues is the most common complication reported after tendon repair. To date, effective solutions to prevent tendon injury are still lacking. Materials and Methods: A total of 89 patients with flexor tendon injury in zone II were recruited. The patients were divided into a control group, a poly-DL-lactic acid (PDLLA) group, and an amnion group according to the different tendon treatments applied. The control group was not subjected to other treatments. PDLLA and bioamniotic membranes were, respectively, used to wrap broken ends in the PDLLA and amnion membrane groups. The patients were followed at 1, 2, 3, 6, and 12 months after surgery and the ranges of active flexion and extension lag in the proximal and distal interphalangeal joints were evaluated. Results: The means of total active ranges of motion of the interphalangeal joints (excluding rupture cases) in the PDLLA and amnion groups did not significantly differ between each other but significantly differed from that of the control group. Statistical analysis showed a significant difference in the clinical grades of the outcomes among the control, PDLLA, and amnion groups. The incidence of complications in the control and PDLLA groups was found to be significantly higher than that in the amniotic membrane group; no significant difference was observed between the control and PDLLA groups. Conclusion: In this study, freeze-dried amniotic membrane transplantation was applied to promote healing of the flexor tendon in zone II and prevent adhesion. This technique presents a new method to solve the issue of tendon adhesion after repair. Clinical Trial Registration: The trial was registered by identifier ChiCTR1900021769.


Assuntos
Âmnio/transplante , Ruptura/terapia , Traumatismos dos Tendões/terapia , Aderências Teciduais/terapia , Dedo em Gatilho/terapia , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/administração & dosagem , Amplitude de Movimento Articular/fisiologia , Ruptura/fisiopatologia , Traumatismos dos Tendões/fisiopatologia , Tendões/efeitos dos fármacos , Tendões/fisiopatologia , Aderências Teciduais/fisiopatologia , Dedo em Gatilho/fisiopatologia
14.
J Biomed Mater Res A ; 107(8): 1814-1823, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31008569

RESUMO

Formation of peritoneal adhesions is common complication after abdominal and pelvic surgery. They bear a significant health problem with an influence to quality of life and health care expenses. Promising approach for their prevention is using of biodegradable barrier films for physical separation of peritoneal surfaces. In the present study, highly porous pectin-based three-dimensional (3D) scaffolds were obtained by freeze-drying technique. Physico-chemical properties of the formed materials, including their morphology, porosity, density, and stability, have been studied. The evaluation of their biocompatibility, biodegradation, and potential antiadhesion effect was studied by in vivo experiment. To reinforce the scaffolds structure and improve their stability in physiological solutions, pectin chains were cross-linked with divalent cations. We determined optimal cross-linking conditions, which allow obtaining scaffolds with desired biodegradation rate. These cross-linked scaffolds fully dissolved within 8 days in the peritoneal cavity with low presence of complications and some antiadhesive effect. It has also been determined that mesenchymal stem cells from adipose tissue could effectively adhere to the scaffolds with preservation of their viability. Our results show that obtained materials can be suggested as mechanical scaffold for delivery of the stem cells culture to peritoneal surfaces as a part of complex antiadhesive barrier system.


Assuntos
Pectinas/química , Peritônio/patologia , Aderências Teciduais/terapia , Tecidos Suporte/química , Animais , Adesão Celular , Agregação Celular , Reagentes para Ligações Cruzadas/química , Células-Tronco Mesenquimais/citologia , Porosidade , Ratos Wistar , Espectroscopia de Infravermelho com Transformada de Fourier , Aderências Teciduais/patologia
15.
J Gynecol Obstet Hum Reprod ; 48(6): 413-417, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30910760

RESUMO

OBJECTIVE: To evaluate the benefits of second-look laparoscopy (SLL) in pelvic inflammatory disease (PID). STUDY DESIGN: A 5- year retrospective study conducted at Clermont-Ferrand University Hospital and included all patients who had undergone SLL following a PID. Data collection comprised patient and disease characteristics, type of initial medical or surgical treatment, adhesion (AFS) and tubal (MAGE) scores recorded during SLL and outcomes following subsequent pregnancies. RESULTS: 76 patients who had received SLL were included. A higher rate of severe adhesions was recorded during SLL in patients with stage 3 PID, than for women with stage 1 and 2 (63.6% versus 25%, p = 0.01). A higher rate of Mage scores of 4 were also found in patients with stage 3 PID (25.8% versus 0%, p = 0.001). Multivariate analysis revealed that women at stage 3 are 17 times more likely to have a high level of adhesions than patients at stage 1 (OR [95% CI] = 17.4 [1.7; 1]). A Mage score of 1was found to be associated with higher pregnancy and live birth rates. CONCLUSION(S): SLL seems presents benefits for the preservation of fertility in cases of severe PID with tubo ovarian abcess and may be proposed to patients with stage 3 salpingitis and desire for pregnancy. Further prospective randomized study should be done to confirm these results.


Assuntos
Laparoscopia , Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/terapia , Cirurgia de Second-Look , Adulto , Antibacterianos/uso terapêutico , Infecções Bacterianas/complicações , Infecções Bacterianas/tratamento farmacológico , Feminino , Fertilidade , Preservação da Fertilidade , França , Humanos , Doença Inflamatória Pélvica/etiologia , Dor Pélvica , Gravidez , Estudos Retrospectivos , Salpingite/microbiologia , Salpingite/terapia , Aderências Teciduais/complicações , Aderências Teciduais/terapia
16.
J Trauma Acute Care Surg ; 86(4): 651-657, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30907786

RESUMO

BACKGROUND: Although adhesive small-bowel obstruction (ASBO) is frequently managed nonoperatively, little is known regarding outcomes on readmission following this approach. Using a large population-based dataset, we evaluated risk factors for operative intervention and mortality at readmission in patients with ASBO who were initially managed nonoperatively. METHODS: The ASBO patients were identified in the California Office of Statewide Health Planning and Development 2007 to 2014 patient discharge database. Patients who were managed operatively at index admission or had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for nonadhesive obstructive small bowel disease were excluded. Associations between risk factors and both operative intervention and death following readmission were evaluated using survival analysis. RESULTS: Among 15,963 ASBO patients, 3,103 (19.4%) had at least one readmission. The 1,069 (34.5%) who received an operation during their first readmission presented sooner (175 days vs. 316 days, p < 0.001) and were more likely to die during that readmission (5.2% vs. 0.7%, p < 0.001). Operative management at first readmission was associated with younger age, fewer comorbidities, and shorter times to readmission. Patients operatively managed at first readmission had longer times to second readmission compared with nonoperative patients. Stratified analyses using nonoperative patients as the reference over the study period revealed that patients who underwent lysis of adhesions and bowel resection were 5.04 times (95% confidence interval [CI], 2.82-9.00) as likely to die while those who underwent lysis only were 2.09 times (95% CI, 1.14-3.85) as likely to die. Patients with bowel resection only were at an increased risk for subsequent interventions beyond the first readmission (hazard ratio, 1.79; 95% CI, 1.11-2.87). CONCLUSION: In a large cohort readmitted for ASBO and initially managed nonoperatively, subsequent operative intervention conferred a greater risk of death and a longer time to readmission among survivors. Prospective research is needed to further delineate outcomes associated with initial nonoperative management of ASBO. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III.


Assuntos
Obstrução Intestinal/terapia , Intestino Delgado , Resultado do Tratamento , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , California , Bases de Dados Factuais , Feminino , Humanos , Obstrução Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Análise de Sobrevida , Aderências Teciduais/terapia
17.
Turk J Med Sci ; 49(1): 249-257, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30761878

RESUMO

Background/aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing treatment protocol. Materials and methods: Eighty-two patients with FBSS symptoms were included. Two groups were composed as group I (stabilized) and group II (nonstabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the patient satisfaction scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were 7.8 and 3.28 points in group I (P < 0.001) and 7.51 and 2.74 points in group II (P < 0.001) at the beginning and at 12 months, respectively. Mean ODI scores were 34.05 and 22.16 points in group I (P < 0.001) and 30.74 and 19.46 points in group II (P < 0.001) at the beginning and at 12 months. VAS and ODI scores decreased significantly in both groups, but were more significant in the nonstabilized group (P < 0.001). Moderate or severe fibrous tissue was observed in 86.58% of the patients and patient satisfaction scores were very good or good in 78.06% of the patients. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the nonstabilization group; however, none of these patients developed a spinal headache and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase, and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis, and the possible course of the present findings and may be more effective in nonstabilized patients


Assuntos
Síndrome Pós-Laminectomia/cirurgia , Hialuronoglucosaminidase/uso terapêutico , Aderências Teciduais/terapia , Adulto , Estudos de Coortes , Feminino , Humanos , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Dor Pós-Operatória/terapia , Reoperação , Aderências Teciduais/etiologia , Resultado do Tratamento
18.
FEBS Lett ; 593(4): 386-394, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30609020

RESUMO

Mesothelial cells, which cover the surface of visceral organs and serous cavities in mammals, play a crucial role in preventing adhesion. We previously reported that primary mesothelial progenitor cells (MPCs) can not only prevent postoperative adhesion but also promote liver regeneration after hepatectomy. Induced pluripotent stem cells (iPSCs) have the potential to be used for regenerative medicine. Here, we have established a differentiation protocol for mouse iPSC-derived MPCs (miMPCs) via the exposure to defined factors, as well as purification using MPC-specific cell surface antigens. Furthermore, the miMPCs had the ability to suppress postoperative adhesion and facilitate liver regeneration. This is the first report highlighting the generation of functional miMPCs, which may offer potential for de novo cell therapy.


Assuntos
Células Epiteliais/citologia , Células-Tronco Pluripotentes Induzidas/citologia , Regeneração Hepática/efeitos dos fármacos , Células-Tronco/citologia , Aderências Teciduais/terapia , Animais , Antígenos de Superfície/metabolismo , Técnicas de Cultura de Células , Diferenciação Celular , Células Cultivadas , Modelos Animais de Doenças , Células Epiteliais/imunologia , Epitélio/imunologia , Células-Tronco Pluripotentes Induzidas/imunologia , Masculino , Camundongos , Transplante de Células-Tronco , Células-Tronco/imunologia
19.
JAMA Surg ; 154(5): 413-420, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30698610

RESUMO

Importance: Adhesive small-bowel obstruction (aSBO) is a potentially chronic, recurring surgical illness. Although guidelines suggest trials of nonoperative management, the long-term association of this approach with recurrence is poorly understood. Objective: To compare the incidence of recurrence of aSBO in patients undergoing operative management at their first admission compared with nonoperative management. Design, Setting, and Participants: This longitudinal, propensity-matched, retrospective cohort study used health administrative data for the province of Ontario, Canada, for patients treated from April 1, 2005, through March 31, 2014. The study population included adults aged 18 to 80 years who were admitted for their first episode of aSBO. Patients with nonadhesive causes of SBO were excluded. A total of 27 904 patients were included and matched 1:1 by their propensity to undergo surgery. Factors used to calculate propensity included patient age, sex, comorbidity burden, socioeconomic status, and rurality of home residence. Data were analyzed from September 10, 2017, through October 4, 2018. Exposures: Operative vs nonoperative management for aSBO. Main Outcomes and Measures: The primary outcome was the rate of recurrence of aSBO among those with operative vs nonoperative management. Time-to-event analyses were used to estimate hazard ratios of recurrence while accounting for the competing risk of death. Results: Of 27 904 patients admitted with their first episode of aSBO, 6186 (22.2%) underwent operative management. Mean (SD) patient age was 61.2 (13.6) years, and 51.1% (14 228 of 27 904) were female. Patients undergoing operative management were younger (mean [SD] age, 60.2 [14.3] vs 61.5 [13.4] years) with fewer comorbidities (low burden, 382 [6.2%] vs 912 [4.2%]). After matching, those with operative management had a lower risk of recurrence (13.0% vs 21.3%; hazard ratio, 0.62; 95% CI, 0.56-0.68; P < .001). The 5-year probability of experiencing another recurrence increased with each episode until surgical intervention, at which point the risk of subsequent recurrence decreased by approximately 50%. Conclusions and Relevance: According to this study, operative management of the first episode of aSBO is associated with significantly reduced risk of recurrence. Guidelines advocating trials of nonoperative management for aSBO may assume that surgery increases the risk of recurrence putatively through the formation of additional adhesions. The long-term risk of recurrence of aSBO should be considered in the management of this patient population.


Assuntos
Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Aderências Teciduais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Risco , Aderências Teciduais/complicações , Aderências Teciduais/terapia , Adulto Jovem
20.
J Surg Res ; 233: 408-412, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502278

RESUMO

BACKGROUND: Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. METHODS: A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. RESULTS: Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P < 0.05; 0.478 [0.240-0.952], P < 0.036). CONCLUSIONS: A significant proportion of patients at 48 h (29%) "failed" the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. LEVEL OF EVIDENCE: Level II.


Assuntos
Tratamento Conservador/métodos , Meios de Contraste/administração & dosagem , Diatrizoato de Meglumina/administração & dosagem , Obstrução Intestinal/terapia , Idoso , Idoso de 80 Anos ou mais , Conjuntos de Dados como Assunto , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Intubação Gastrointestinal , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estudos Retrospectivos , Fatores de Tempo , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/terapia , Resultado do Tratamento
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