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2.
Acta Biomater ; 131: 211-221, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34198010

RESUMO

Decellularized extracellular matrix (dECM) derived from natural ECM is receiving considerable interest as a promising component of tissue adhesives because of its high biocompatibility and tissue regenerative ability. However, the availability of dECM as a tissue adhesive is limited because of the lack of a gelator that can crosslink low concentrations of dECM to form hydrogels. Here, we report dECM-based tissue adhesives using a genipin gelator. Based on the pH-dependent reactivity of genipin, genipin-terminated 4 arm-poly(ethylene glycol) (GeniPEG) was synthesized. dECM-based hydrogels were formed within a few seconds of mixing GeniPEG and dECM at an optimum pH through crosslinking of dECM and self-crosslinking between GeniPEG molecules. The hydrogels crosslinked with GeniPEG exhibited greater tissue adhesive strength to porcine-derived aorta tissue than those crosslinked with genipin. Moreover, GeniPEG can be applied to various dECMs, including those from the urinary bladder, heart, liver, pancreas, and small intestine. In vivo implantation experiments demonstrated biocompatibility and biodegradability of the dECM-GeniPEG hydrogels. Therefore, this dECM-based hydrogel may extend the possibility and availability of dECM as an organ-specific tissue adhesive and contribute to successful minimally invasive surgery. STATEMENT OF SIGNIFICANCE: There is a strong need to develop highly functional tissue adhesives with high biocompatibility, tissue adhesive strength, and tissue regenerative ability. In this report, dECM-based tissue adhesives were reported using a pH-driven genipin-gelator. Focusing on the pH-dependent reactivity of genipin, genipin-based gelators were synthesized to form dECM-based hydrogels in response to pH changes. The crosslinking reaction proceeded within a few seconds to form hydrogels. The hydrogels obtained had greater tissue adhesion to aorta tissue than that of the free genipin crosslinker. This gelator can be applied to various types of dECMs. This dECM-based hydrogel had high biocompatibility and tissue adhesive properties and is useful for sealing wounds and preventing postoperative complications.


Assuntos
Adesivos Teciduais , Adesivos , Animais , Matriz Extracelular , Hidrogéis , Concentração de Íons de Hidrogênio , Iridoides , Suínos , Engenharia Tecidual
3.
Acta Biomater ; 131: 222-235, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34245891

RESUMO

Pleural and tracheal injuries remain significant problems, and an easy to use, effective pleural or tracheal sealant would be a significant advance. The major challenges are requirements for adherence, high strength and elasticity, dynamic durability, appropriate biodegradability, and lack of cell or systemic toxicity. We designed and evaluated two sealant materials comprised respectively of alginate methacrylate and of gelatin methacryloyl, each functionalized by conjugation with dopamine HCl. Both compounds are cross-linked into easily applied as pre-formed hydrogel patches or as in situ hydrogels formed at the wound site utilizing FDA-approved photo-initiators and oxidants. Material testing demonstrates appropriate adhesiveness, tensile strength, burst pressure, and elasticity with no significant cell toxicity in vitro assessments. Air-leak was absent after sealant application to experimentally-induced injuries in ex-vivo rat lung and tracheal models and in ex vivo pig lungs. Sustained repair of experimentally-induced pleural injury was observed for up to one month in vivo rat models and for up to 2 weeks in vivo rat tracheal injury models without obvious air leak or obvious toxicities. The alginate-based sealant worked best in a pre-formed hydrogel patch whereas the gelatin-based sealant worked best in an in situ formed hydrogel at the wound site thus providing two potential approaches. These studies provide a platform for further pre-clinical and potential clinical investigations. STATEMENT OF SIGNIFICANCE: Pneumothorax and pleural effusions resulting from trauma and a range of lung diseases and critical illnesses can result in lung collapse that can be immediately life-threatening or result in chronic leaking (bronchopleural fistula) that is currently difficult to manage. This leads to significantly increased morbidity, mortality, hospital stays, health care costs, and other complications. We have developed sealants originating from alginate and gelatin biomaterials, each functionalized by methacryloylation and by dopamine conjugation to have desired mechanical characteristics for use in pleural and tracheal injuries. The sealants are easily applied, non-cytotoxic, and perform well in vitro and in vivo model systems of lung and tracheal injuries. These initial proof of concept investigations provide a platform for further studies.


Assuntos
Gelatina , Adesivos Teciduais , Alginatos , Animais , Materiais Biocompatíveis , Hidrogéis , Ratos , Suínos
4.
ACS Biomater Sci Eng ; 7(8): 3908-3916, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34323468

RESUMO

Pressure-sensitive adhesives typically used for bandages are nonbiodegradable, inhibiting healing, and may cause an allergic reaction. Here, we investigated the effect of biodegradable copolymers with promising thermomechanical properties on wound healing for their eventual use as biodegradable, biocompatible adhesives. Blends of low molecular weight (LMW) and high molecular weight (HMW) poly(lactide-co-caprolactone) (PLCL) are investigated as tissue adhesives in comparison to a clinical control. Wounds treated with PLCL blend adhesives heal completely with similar vascularization, scarring, and inflammation indicators, yet require fewer dressing changes due to integration of the PLCL adhesive into the wound. A blend of LMW and HMW PLCL produces an adhesive material with significantly higher adhesive strength than either neat polymer. Wound adhesion is comparable to a polyurethane bandage, utilizing conventional nonbiodegradable adhesives designed for extremely strong adhesion.


Assuntos
Adesivos Teciduais , Adesivos , Bandagens , Poliésteres , Cicatrização
5.
Nat Commun ; 12(1): 3613, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127656

RESUMO

The development of biomedical glues is an important, yet challenging task as seemingly mutually exclusive properties need to be combined in one material, i.e. strong adhesion and adaption to remodeling processes in healing tissue. Here, we report a biocompatible and biodegradable protein-based adhesive with high adhesion strengths. The maximum strength reaches 16.5 ± 2.2 MPa on hard substrates, which is comparable to that of commercial cyanoacrylate superglue and higher than other protein-based adhesives by at least one order of magnitude. Moreover, the strong adhesion on soft tissues qualifies the adhesive as biomedical glue outperforming some commercial products. Robust mechanical properties are realized without covalent bond formation during the adhesion process. A complex consisting of cationic supercharged polypeptides and anionic aromatic surfactants with lysine to surfactant molar ratio of 1:0.9 is driven by multiple supramolecular interactions enabling such strong adhesion. We demonstrate the glue's robust performance in vitro and in vivo for cosmetic and hemostasis applications and accelerated wound healing by comparison to surgical wound closures.


Assuntos
Peptídeos/química , Peptídeos/genética , Proteínas/química , Proteínas/genética , Adesivos/química , Adulto , Animais , Cianoacrilatos/química , Modelos Animais de Doenças , Feminino , Regeneração Tecidual Guiada/métodos , Hemostasia , Humanos , Fígado/patologia , Camundongos , Ratos , Ratos Wistar , Pele/patologia , Suínos , Adesivos Teciduais/química , Cicatrização
6.
ACS Biomater Sci Eng ; 7(7): 3389-3398, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34165278

RESUMO

Isocyanate is an efficient tissue anchor for engineering of strong bioadhesives. However, isocyanate-containing adhesives were seldom manufactured due to their requirement of water-free administration and time-consuming moisture-induced solidification. To address this issue, here, a solventless dual-component bioadhesive based on thiol-isocyanate cross-linking chemistry is reported. This dual-component bioadhesive consists of a hyperbranched polymer with thiol groups (HBPTE) and an isocyanate-modified polyethylene glycol (PEGNCO). HBPTE and PEGNCO are low-viscosity fluids at room temperature and hence could be used directly as adhesive components, in the absence of a catalyst and a solvent. The thiol-isocyanate click chemistry of components provides the HBPTE-PEGNCO mixture with a gelation time of 1.8-3 min, which makes it acceptable for practical applications. The abundance of isocyanate groups in the adhesive molecule provides strong bonding strength through formation of chemical linkages with reactive groups on the tissue. Moreover, in vitro and in vivo evaluations showed excellent biocompatibility of the HBPTE-PEGNCO adhesive. This dual-component bioadhesive based on solventless thiol-isocyanate click chemistry displayed a fast gelation time and excellent bonding performance, providing a pioneering idea for engineering isocyanate-containing bioadhesives.


Assuntos
Química Click , Adesivos Teciduais , Adesivos , Isocianatos , Compostos de Sulfidrila
7.
Int J Clin Pract ; 75(10): e14560, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34155746

RESUMO

PURPOSE: To compare the efficacy, safety and recurrence rate of platelet-rich fibrin (PRF) grafts and limbal conjunctival autografts (LCAs) following pterygium excision. METHODS: A total of 108 patients (108 eyes) with primary pterygium were included in this study and were divided into group A (56 eyes) and group B (52 eyes). Patients in group A underwent excision of the pterygium followed by LCA while patients in group B underwent PRF grafts following pterygium excision. The PRF was produced using the patient's own whole-blood sample by centrifugation and extrusion. The surgery time, intraoperative complications, postoperative complications, recurrence rate, intraocular pressure (IOP) and follow-up period were recorded and evaluated between the two groups. RESULTS: The mean surgery time was significantly shorter in group B (25.0 ± 4.2 min) than in group A (36.5 ± 6.3 min) (P < .001). Recurrence was observed in two cases (3.6%) in group A while no recurrence was observed in group B. No graft loss was observed in either group. No other intra/postoperative complications such as a tear in the graft, injury to the medial rectus muscle, excessive bleeding, scleral necrosis, graft oedema, graft necrosis, pannus formation or symblepharon appeared in either group. CONCLUSIONS: This study presented with a promising outcome of PRF graft applications in primary pterygium surgery. The use of PRF following pterygium excision is a simple, easily applicable, and comfortable method for both patients and surgeons, with less time consumption, recurrence rate and complications, which could be widely used in pterygium management.


Assuntos
Fibrina Rica em Plaquetas , Pterígio , Adesivos Teciduais , Túnica Conjuntiva , Adesivo Tecidual de Fibrina/uso terapêutico , Seguimentos , Humanos , Complicações Pós-Operatórias , Pterígio/cirurgia , Recidiva , Resultado do Tratamento
8.
Adv Healthc Mater ; 10(19): e2100803, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34081412

RESUMO

Surgical sealants are widely used to prevent seepage of fluids and liquids, promote hemostasis, and close incisions. Despite the remarkable progress the field of biomaterials has undergone, the clinical uses of surgical sealants are limited because of their short persistence time in vivo, toxicity, and high production costs. Here, the development of two complementary neat (solvent-free) prepolymers, PEG4 -PLGA-NHS and PEG4 -NH2 , that harden upon mixing to yield an elastic biodegradable sealant is presented. The mechanical and rheological properties and cross-linking rate can be controlled by varying the ratio between the two prepolymers. The tested sealants show a longer persistence time compared with fibrin glue, minimal cytotoxicity in vitro, and excellent biocompatibility in vivo. The neat, multiarmed approach demonstrated here improves the mechanical and biocompatibility properties and provides a promising tissue sealant solution for wound closure in future surgical procedures.


Assuntos
Adesivos Teciduais , Materiais Biocompatíveis , Polímeros , Reologia
9.
Zhonghua Gan Zang Bing Za Zhi ; 29(5): 468-471, 2021 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-34107586

RESUMO

42 cases with gastroesophageal varices were prospectively included. The groups were treated with endoscopic band ligation or combined with tissue adhesive. The results showed that the left gastric vein internal diameter, average blood flow velocity and blood flow volume after the treatment of band ligation combined with tissue adhesive were significantly lower than that of the treatment of band ligation alone, and the differences were statistically significant (P < 0.05). Spleen and portal vein internal diameter, blood flow and average velocity, the liver and spleen size, shear wave velocity and liver function grade of the two groups after treatment did not change significantly (P > 0.05). The effective rate of band ligation combined with tissue adhesive in the treatment of esophageal and gastric varices (66.67%, 52.38%) were higher than that of band ligation alone (42.85%, 23.81%) (P > 0.05), and the re-bleeding rate of the latter was higher (9.52% and 19.05%, P > 0.05). Hence, it is suggested that the combined therapy is safe and more effective, and has no apparent effect on liver function and portal hypertension.


Assuntos
Varizes Esofágicas e Gástricas , Adesivos Teciduais , Varizes , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/terapia , Humanos , Ligadura , Veia Porta/cirurgia , Escleroterapia
10.
Int J Biol Macromol ; 183: 2142-2151, 2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34048838

RESUMO

As a kind of natural protein derived material, gelatin has been widely used in the preparation of medical hydrogels due to its good biocompatibility, non-immunogenicity and the ability of promoting cell adhesion. Functionalization of gelatin-based hydrogels is a hot topic in research and its clinic application. Herein, a novel gelatin-based adhesive hydrogel was prepared via mussel-inspired chemistry. Gelatin was firstly functionalized by dopamine to form dopamine grafted gelatin (GelDA). After the mixture with 1,4-phenylenebisboronic acid and graphene oxide (GO), the GelDA/GO hydrogels were obtained by H2O2/HRP (horseradish peroxidase) catalytic system. Based on the self-healing and tissue adhesion of the hydrogels, the hemostatic property has been exhibited in the rat hepatic hemorrhage model. Additionally, the incorporation of GO endowed conductivity and enhanced the mechanical property of GelDA/GO hydrogels. The electromyography (EMG) signals of finger movement were successfully monitored by using hydrogel as the adhesive electrodes of EMG monitor. L929 cell experiments showed that the hydrogels had good cytocompatibility. The results indicated the potential application of GelDA/GO hydrogels in tissue adhesives, wound dressings, and wearable devices.


Assuntos
Dopamina/farmacologia , Gelatina/farmacologia , Hemostasia/efeitos dos fármacos , Hemostáticos/farmacologia , Adesivos Teciduais/farmacologia , Adesividade , Animais , Ácidos Borônicos/química , Linhagem Celular , Sobrevivência Celular/efeitos dos fármacos , Dopamina/química , Dopamina/toxicidade , Condutividade Elétrica , Desenho de Equipamento , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Gelatina/química , Gelatina/toxicidade , Grafite/química , Hemostáticos/química , Hemostáticos/toxicidade , Humanos , Hidrogéis , Camundongos , Ratos , Sus scrofa , Adesivos Teciduais/química , Adesivos Teciduais/toxicidade , Dispositivos Eletrônicos Vestíveis
11.
J Mech Behav Biomed Mater ; 120: 104563, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33940485

RESUMO

The mechanical performance of the dentin-adhesive interface contributes significantly to the failure of dental composite restorations. Rational material design can lead to enhanced mechanical performance, but this requires accurate characterization of the mechanical behavior at the dentin-adhesive interface. The mechanical performance of the interface is typically characterized using bond strength tests, such as the micro-tensile test. These tests are plagued by multiple limitations including large variations in the test results. The challenges associated with conventional tensile tests limit our ability to unravel the complex relationships that affect mechanical behavior at the dentin-adhesive interface. This study used the diametral compression test to overcome the challenges inherent in conventional bond strength tests. The bovine femur cortical bone tissue was considered as a surrogate material (the mineralized tissue) for human dentin. Two different adhesive formulations, which differed by means of their self-strengthening properties, were studied. The tensile behavior of the mineralized tissue, the adhesive polymer, and the bond strength of the mineralized tissue - adhesive interface was determined using the diametral compression test. The diametral compression test improved the repeatability for both the tensile and bond strength tests. The rate dependent mechanical behavior was observed for both single material and interfacial material systems. The tensile strength and bond strength of the mineralized tissue-adhesive interface was greater for the self-strengthening formulation as compared to the control.


Assuntos
Colagem Dentária , Adesivos Teciduais , Animais , Bovinos , Resinas Compostas , Dentina , Adesivos Dentinários , Humanos , Teste de Materiais , Cimentos de Resina , Propriedades de Superfície , Resistência à Tração
12.
Adv Healthc Mater ; 10(13): e2100100, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34050621

RESUMO

The conjunctiva is a thin mucous membrane of the eye. Pterygium, a commonly appearing disease on the ocular surface, requires surgery to excise the conjunctiva to prevent visual deterioration. Recently, transplantation of the amniotic membrane (AM), which is the innermost membrane of the placenta, has been highlighted as an efficient method to cure conjunctiva defects because of its advantages of no side effects compared to mitomycin C treatment and not leaving additional scars on donor site compared to conjunctival autografting. However, to minimize additional damage to the ocular surface by suturing, AM transplantation (AMT) needs to be simplified by using a less invasive, time-saving method. In this work, a visible light-curable protein bioadhesive (named FixLight) for efficient sutureless AMT is applied. FixLight, which is based on bioengineered mussel adhesive protein (MAP), is easily applied between damaged ocular surfaces and transplanted AM, and rapidly cured by harmless blue light activation. Through in vivo evaluation using a rabbit model, the authors demonstrated that FixLight enabled facile, fast, and strong attachment of AM on sclera and promoted ocular surface reconstruction with good biocompatibility. Thus, FixLight can be successfully used as a promising clinical bioadhesive in opthalmological surgeries that require sutureless and rapid operation.


Assuntos
Âmnio , Pterígio , Adesivos Teciduais , Âmnio/transplante , Animais , Túnica Conjuntiva , Luz , Pterígio/cirurgia , Coelhos
13.
Cochrane Database Syst Rev ; 5: CD011563, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34046884

RESUMO

BACKGROUND: The use of a mesh in primary ventral or incisional hernia repair lowers the recurrence rate  and is the accepted standard of care for larger defects. In laparoscopic primary ventral or incisional hernia repair the insertion of a mesh is indispensable. Different mesh fixation techniques have been used and refined over the years. The type of fixation technique is claimed to have a major impact on recurrence rates, chronic pain, health-related quality of life (HRQOL) and complication rates. OBJECTIVES: To determine the impact of different mesh fixation techniques for primary and incisional ventral hernia repair on hernia recurrence, chronic pain, HRQOL and complications. SEARCH METHODS: On 2 October 2020 we searched CENTRAL, MEDLINE (Ovid MEDLINE(R)) Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R)), Ovid Embase, and two trials registries. We also performed handsearches, and contacted experts from the European Hernia Society (EHS). SELECTION CRITERIA: We included randomised controlled trials (RCTs) including adults with primary ventral or incisional hernia that compared different types of mesh fixation techniques (absorbable/nonabsorbable sutures, absorbable/nonabsorbable tacks, fibrin glue, and combinations of these techniques). DATA COLLECTION AND ANALYSIS: We extracted data in standardised piloted tables, or if necessary, directly into Review Manager 5. We assessed risks of bias with the Cochrane 'Risk of bias' tool. Two review authors independently selected the publications, and extracted data on results. We calculated risk ratios (RRs) for binary outcomes and mean differences (MDs) for continuous outcomes. For pooling we used an inverse-variance random-effects meta-analysis or the Peto method in the case of rare events. We prepared GRADE 'Summary of findings' tables. For laparoscopic repair we considered absorbable tacks compared to nonabsorbable tacks, and nonabsorbable tacks compared to nonabsorbable sutures as key comparisons. MAIN RESULTS: We included 10 trials with a total of 787 participants. The number of randomised participants ranged from 40 to 199 per comparison. Eight studies included participants with both primary and incisional ventral hernia. One study included only participants with umbilical hernia, and another only participants with incisional hernia. Hernia size varied between studies. We judged the risk of bias as moderate to high. Absorbable tacks compared to nonabsorbable tacks Recurrence rates in the groups were similar (RR 0.74, 95% confidence interval (CI) 0.17 to 3.22; 2 studies, 101 participants). It is uncertain whether there is a difference between absorbable tacks and nonabsorbable tacks in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Nonabsorbable tacks compared to nonabsorbable sutures At six months there was one recurrence in each group (RR 1.00, 95% CI 0.07 to 14.79; 1 study, 36 participants). It is uncertain whether there is a difference between nonabsorbable tacks and nonabsorbable sutures in recurrence because the certainty of evidence was very low. Evidence suggests that the difference between groups in early postoperative, late follow-up and chronic pain is negligible. We found no study that assessed HRQOL. Absorbable tacks compared to absorbable sutures No recurrence was observed at one year (very low certainty of evidence). Early postoperative pain was higher in the tacks group (VAS 0 - 10: MD -2.70, 95% CI -6.67 to 1.27; 1 study, 48 participants). It is uncertain whether there is a difference between absorbable tacks compared to absorbable sutures in early postoperative pain because the certainty of evidence was very low. The MD for late follow-up pain was -0.30 (95% CI -0.74 to 0.14; 1 study, 48 participants). We found no study that assessed HRQOL. Combination of different fixation types (tacks and sutures) or materials (absorbable and nonabsorbable) There were mostly negligible or only small differences between combinations (e.g. tacks plus sutures) compared to a single technique (e.g. sutures only), as well as combinations compared to other combinations (e.g. absorbable sutures combined with nonabsorbable sutures compared to absorbable tacks combined with nonabsorbable tacks) in all outcomes. It is uncertain whether there is an advantage for combining different fixation types or materials for recurrence, chronic pain, HRQOL and complications, because the evidence certainty was very low or low, or we found no study on important outcomes. Nonabsorbable tacks compared to fibrin sealant The two studies showed different directions of effects: one showed higher rates for nonabsorbable tacks, and the other showed higher rates for fibrin sealant. Low-certainty evidence suggests that the difference between groups in early postoperative, late follow-up, chronic pain and HRQOL is negligible. Absorbable tacks compared to fibrin sealant One recurrence in the tacks group and none in the fibrin sealant group were noted after one year (low certainty of evidence). Early postoperative pain might be slightly lower using tacks (VAS 0 - 100; MD -12.40, 95% CI -27.60 to, 2.80;1 study, 50 participants; low-certainty evidence). The pattern of pain and HRQOL course over time (up to 1 year) was similar in the groups (low certainty of evidence). AUTHORS' CONCLUSIONS: Currently none of the techniques can be considered superior to any other, because the certainty of evidence was low or very low for all outcomes.


Assuntos
Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Telas Cirúrgicas , Adulto , Adesivo Tecidual de Fibrina , Hérnia Umbilical/cirurgia , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/epidemiologia , Recidiva , Prevenção Secundária/métodos , Suturas , Adesivos Teciduais
14.
Medicine (Baltimore) ; 100(20): e25879, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011054

RESUMO

ABSTRACT: There might be a thick "protrusion" in the visceral surface of hepatic quadrate lobe during the laparoscopic cholecystectomy (LC), which affects the surgical fields and consequently triggers high risks of biliary tract injury. Although n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery for liver retraction, there is still no consensus on its safety and feasibility in LC. In this study, we investigated the safety, feasibility, and effectiveness of liver retraction using NBCA glue for these patients which have the thick "protrusion" on the square leaf surface of the liver during LC.Fifty-seven patients presenting thick "protrusion" hepatic quadrate lobe were included in our retrospective study. We performed LC in the presence of NBCA glue (n = 30, NBCA group) and absence of NBCA glue (n = 27, non-NBCA group), respectively. NBCA was used to fix the thick "protrusion" of the liver leaves to the hepatic viscera surface, which contributed to the revelation of the gallbladder triangle. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the 2 groups.Both the groups' patients accomplished the operation in the laparoscopy. There was no mortality and no additional incision during operation. No severe complications including bile duct injury were available after surgery and no postoperative NBCA-related complications occurred after 9- to 30 months' follow-up. The time of operation in NBCA group showed significant decrease compared with that of non-NBCA group (48.33 ±â€Š16.15 vs 65.00 ±â€Š22.15 minutes, P < .01). There were no significant differences in blood loss, postoperative hospital stays, and the preoperative and postoperative liver function between the two groups (P > .05). Besides, no significant differences were noticed in major clinical characteristics between the 2 groups (P > .05).Liver retraction using NBCA during LC for thick "protrusion" hepatic quadrate lobe patients is safe, effective, and feasible.


Assuntos
Colecistectomia Laparoscópica/métodos , Embucrilato/administração & dosagem , Complicações Intraoperatórias/prevenção & controle , Adesivos Teciduais/administração & dosagem , Adulto , Idoso , Ductos Biliares/lesões , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Colecistectomia Laparoscópica/efeitos adversos , Embucrilato/efeitos adversos , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Tempo de Internação/estatística & dados numéricos , Fígado , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 100(20): e26053, 2021 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-34011120

RESUMO

ABSTRACT: Skin adhesives are used to close clean surgical wounds. We aimed to investigate the incidence of skin adhesive-related contact dermatitis and the characteristics that differentiate it from a surgical site infection.We retrospectively analyzed patients whose surgical wound was closed using a liquid skin adhesive (Dermabond Prineo skin closure system, Ethicon, NJ) by a single surgeon between March 2018 and June 2020. Medical records were reviewed to evaluate complications indicating contact dermatitis, including wound infections and hematomas.We included 143 patients (men, 59; women, 84; mean age, 60.8 years). No patient had an early surgical site infection or wound dehiscence, but 4 (2.8%) developed postoperative contact dermatitis (week 7, 1; week 4, 2; day 9, 1). Manifestations included eczema and pruritus, without local heat or wound discharge. All cases resolved without complications, including infection.Contact dermatitis occurred in 2.8% of patients who received liquid skin adhesive, and the symptoms differed from those of surgical site infection. Patients should be informed about the risk of contact dermatitis before applying a liquid skin adhesive.


Assuntos
Cianoacrilatos/efeitos adversos , Dermatite de Contato/diagnóstico , Dermatite de Contato/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Infecção da Ferida Cirúrgica/diagnóstico , Adesivos Teciduais/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Adulto Jovem
17.
ACS Biomater Sci Eng ; 7(6): 2198-2203, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34043314

RESUMO

Biomedical adhesives have been found to be an attractive alternative to suturing in several circumstances. However, to date most of the clinically approved formulations are based on synthetic and highly reactive toxic chemicals. In this work, we aimed to combine for the first time the bioactive properties of the cationic polysaccharide chitosan and its intrinsic electrostatic binding to negatively charged tissues with the biocompatible and clinically compliant enzymatic cross-linking scheme of fibrin glue. This synergistic activity led to the generation of a transglutaminase Factor XIII cross-linkable chitosan formulation with fast gelation kinetics, tunable mechanical properties, antibacterial activity, and strong adhesion to cartilage.


Assuntos
Quitosana , Adesivos Teciduais , Adesivos , Fator XIII , Hidrogéis
18.
Br J Surg ; 108(3): 244-255, 2021 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-33793723

RESUMO

BACKGROUND: A variety of endovascular and open surgical interventions exist to treat great saphenous vein reflux. However, comparisons of treatment outcomes have been inconsistent. METHODS: A systematic review and network meta-analysis of RCTs was performed to compare rates of incomplete stripping or non-occlusion of the great saphenous vein with or without reflux (anatomical failure) at early, mid- and long-term follow-up; and secondary outcomes (reintervention and clinical recurrence) among intervention groups. The surface under the cumulative ranking curve (SUCRA) method was used to estimate the probability of the intervention with the lowest anatomical failure rates. RESULTS: Some 72 RCTs were included. Comparisons of endothermal techniques with open surgery were mostly not significantly different, except for endovenous laser ablation (EVLA), which had higher long-term anatomical failure rates (pooled risk ratio (RR) 1.87, 95 per cent c.i. 1.14 to 3.07). Mechanochemical ablation had higher anatomical failure rates than radiofrequency ablation (RFA) (pooled RR 2.77, 1.38 to 5.53), and cyanoacrylate closure (CAC) had a RR 0.56 (0.34 to 0.93) times lower than either RFA or EVLA at the early term. Ultrasound-guided foam sclerotherapy had a higher risk of anatomical failure and reintervention than open surgery, with the lowest SUCRA value, and CAC was ranked first, third and first for best intervention for anatomical failure at early, mid and long term respectively. However, clinical recurrence rates were not significantly different between all comparisons. CONCLUSION: Mechanochemical ablation and ultrasound-guided foam sclerotherapy performed poorly, with higher anatomical failure rates in the long term. The other treatment modalities had similar rates of anatomical failure in the short and mid term.


Assuntos
Veia Safena/cirurgia , Insuficiência Venosa/terapia , Cianoacrilatos , Humanos , Terapia a Laser , Metanálise em Rede , Ablação por Radiofrequência , Ensaios Clínicos Controlados Aleatórios como Assunto , Escleroterapia , Adesivos Teciduais
19.
Int J Surg ; 89: 105950, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33887492

RESUMO

BACKGROUND: Seroma is one of the most commonly encountered morbidities after inguinal lymph node dissection (ILND). It causes much nuisance to both patients and doctors and its presence can lead to many complications. This study aimed to evaluate the role and impact of using fibrin glue to decrease seroma formation in patients undergoing ILND. MATERIALS AND METHODS: Thirty-two patients underwent ILND for various reasons. The patients were randomly divided into two groups; 16 in each group. In one group, fibrin glue sealant was applied with a dosage of 2 ml per 100 cm2 surface area. Drain placement was then performed. In the control group, only drain placement was used. Preoperative, operative and postoperative data were recorded and analyzed. RESULTS: There was a significant reduction in the incidence of seroma formation favoring the fibrin glue group when compared to the control group (P = 0.022). There was also a significant reduction of total cumulative amount of serous fluid (P < 0.001), time to remove drains (P < 0.001), and hospital stay (P = 0.012). There was no significant difference between the two groups in occurrences of hematoma, infection or superficial skin edge necrosis. CONCLUSION: Fibrin glue sealant has a role to play in ILND as it significantly reduced the incidence of seroma formation. Standardization of definition of seroma as well as dosage and technique of fibrin glue have to be reached in future studies to determine the true role of fibrin glue in ILND.


Assuntos
Adesivo Tecidual de Fibrina/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Seroma/prevenção & controle , Adesivos Teciduais/administração & dosagem , Adulto , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Seroma/epidemiologia , Seroma/etiologia , Resultado do Tratamento
20.
Can Fam Physician ; 67(4): 260-262, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33853912

RESUMO

QUESTION: A 4-year-old child presented to my office recently with a 2-cm forehead laceration. The child had needle phobia and was very upset, so suturing in the office might have been very challenging. The parents were also concerned about the use of suture. Can topical skin adhesives (TSAs) be used instead of sutures, and what factors should be considered? ANSWER: Lacerations in children are common and TSAs are useful alternatives to sutures. They achieve comparable outcomes to suturing in appropriately selected wounds. Appropriate lacerations are small, superficial, appropriately cleaned, and have well approximated edges that are not under tension. Complications such as wound dehiscence and infection are rare and cosmetic outcomes are comparable to sutures. Using TSAs can also save time, minimize patient anxiety, and eliminate the need for suture removal.


Assuntos
Lacerações , Adesivos Teciduais , Adesivos , Pré-Escolar , Humanos , Lacerações/cirurgia , Pele , Suturas , Adesivos Teciduais/uso terapêutico
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