RESUMO
PURPOSE: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. MATERIALS AND METHODS: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-ß and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). RESULTS: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. CONCLUSION: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.
Assuntos
Plasma Rico em Plaquetas , Polipropilenos , Animais , Colágeno , Feminino , Coelhos , Telas Cirúrgicas , Vagina/cirurgiaRESUMO
INTRODUCTION AND HYPOTHESIS: Collagen has been proposed to be a useful biomaterial, but previous attempts to combine meshes with a collagen membrane have failed. The objective was to verify the effect of high-purified collagen gel coating in the immune-inflammatory response, host collagen metabolism, and angiogenesis around polypropylene mesh. METHODS: In 20 female Wistar rats were implanted, at one side of the abdominal wall, a monofilament polypropylene mesh (PP), and, on the other side, a mesh coated with a new highly purified collagen gel (PPC). The animals were divided into sub-groups and euthanized at 7, 14, 21, and 90 days after implantation. Immunohistochemical analysis was performed using interleukin 1 (IL-1), matrix metalloproteinases (MMP-2, MMP-3), surface antigen CD-31, and tumor necrosis factor (TNF-α). Objective analysis (percent reactive area, average density, and vessels concentration) was performed using AxioVision Software. RESULTS: Comparative analysis showed: higher vessel density in the PPC group after 14 days (p = 0.002); a decrease in the average density of MMP-2 in the PPC group after 21 and 90 days (p = 0.046); more stability in the behavior of MMP-3 in the PPC group throughout the periods with the percentage reactive area for MMP-3 showing a significant decrease just in the PP group after 14 and 90 days (p = 0.017), and also for MMP-3 average density, in which reduction was significant after 21 days in the PP group, but not until after 90 days in PPC group (p < 0.001). CONCLUSIONS: Highly purified collagen coating causes significant changes in angiogenesis and in the immune reaction of metalloproteinase around mesh implants in rats. These findings can be useful for improving mesh biocompatibility for pelvic floor surgery if such effects could be properly controlled.
Assuntos
Materiais Biocompatíveis/farmacologia , Colágeno/farmacologia , Inflamação/metabolismo , Polipropilenos/efeitos adversos , Telas Cirúrgicas/efeitos adversos , Parede Abdominal , Animais , Colágeno/metabolismo , Feminino , Géis , Imunidade Celular/efeitos dos fármacos , Inflamação/etiologia , Inflamação/prevenção & controle , Interleucina-1/análise , Metaloproteinase 2 da Matriz/análise , Metaloproteinase 3 da Matriz/análise , Neovascularização Fisiológica/efeitos dos fármacos , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise , Ratos Wistar , Fatores de Tempo , Fator de Necrose Tumoral alfa/análiseRESUMO
The use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.
Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Feminino , Humanos , Invenções , Engenharia Tecidual/métodosRESUMO
ABSTRACT Purpose: Despite high success rates in the treatment of urinary incontinence, complications related to the use of polypropylene (PP) meshes are still a concern, especially in vaginal prolapses surgeries. The objective of this study was to assess the effect of autologous platelet-rich plasma (PRP) coating on the integration of PP meshes implanted in the vaginal submucosa of rabbits. Materials and Methods: Thirty adult New Zealand rabbits were randomly divided into two groups (n=15): PP, implanted with conventional PP meshes; and PRP, implanted with autologous PRP coated PP meshes. Animals in both groups (n=5) were euthanized at 7, 30 and 90 days postoperatively, the vaginas extracted and sent to immunohistochemical analysis for the assessment of the pro-inflammatory agent TNF-α, anti-inflammatory agents TGF-β and IL-13, collagen metabolism marker MMP-2, and angiogenesis marker CD-31. AxioVision™ image analysis was used for the calculation of the immunoreactive area and density. Statistical analysis was performed with ANOVA followed by Tukey test (p <0.05). Results: Animals in the PRP group showed significantly increased expression of the angiogenesis agent CD-31 at all experimental times when compared to the PP group (p <0.0001). However, no differences concerning the expression of the other markers were observed between the groups. Conclusion: The addition of autologous PRP gel to PP meshes can be simply and safely achieved and seems to have a positive effect on implantation site angiogenesis. Further investigations are required to ascertain PPR coated meshes clinical efficacy in prolapses and stress urinary incontinence surgeries.
Assuntos
Animais , Feminino , Polipropilenos , Plasma Rico em Plaquetas , Coelhos , Telas Cirúrgicas , Vagina/cirurgia , ColágenoRESUMO
PURPOSE: To evaluate renal histological changes and renal function in single kidney rats submitted to renal ischemia-reperfusion and to immunosuppression with tacrolimus and mycophenolate-mofetil. METHODS: Experimental study with 80 Wistar rats distributed into control, Sham and six other groups treated with immunosuppressive drugs. Animals undergoing surgery, right nephrectomy and left renal clamping, killed on the 14th day and analyzed for renal histology, urea and creatinine. RESULTS: The group receiving tacrolimus at higher doses (T3) showed renal histological lesions indicative of early nephrotoxicity, and significant increase in urea and creatinine. The group M (mycophenolate-mofetil alone) and the group M2 (mycophenolate-mofetil combined with half the usual dose of tacrolimus) presented a slight rise in serum urea. The groups using mycophenolate-mofetil alone or combined with tacrolimus showed creatinine levels similar to that of the group T3. CONCLUSIONS: Histologically, the association of injury by ischemia-reperfusion with the use of tacrolimus or mycophenolate-mofetil alone demonstrated a higher rate of renal changes typical of early nephrotoxicity. In laboratory, the combination of injury by ischemia-reperfusion with tacrolimus at higher doses proved to be nephrotoxic.
Assuntos
Imunossupressores/efeitos adversos , Isquemia/complicações , Nefropatias/etiologia , Rim/irrigação sanguínea , Ácido Micofenólico/análogos & derivados , Traumatismo por Reperfusão/complicações , Tacrolimo/efeitos adversos , Animais , Inibidores de Calcineurina/efeitos adversos , Creatinina/sangue , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/sangue , Rim/patologia , Nefropatias/patologia , Nefropatias/fisiopatologia , Masculino , Ácido Micofenólico/efeitos adversos , Néfrons/efeitos dos fármacos , Distribuição Aleatória , Ratos Wistar , Tacrolimo/sangue , Fatores de Tempo , Ureia/sangueRESUMO
Obesity has become a new worldwide health problem with significant impact not only on cardiovascular diseases but also on many other related disorders, highlighting infertility. Obesity may adversely affect male reproduction by endocrinologic, thermal, genetic, and sexual mechanisms. There is good evidence that obesity can be associated with reduced sperm concentrations, but studies about sperm motility, morphology, and DNA fragmentation have been less numerous and more conflicting. Although weight loss is the cornerstone of the treatment of obesity-related infertility, with promising results in restoring fertility and normal hormonal profiles, bariatric surgery impact on male fertility is still unclear and until now there is not enough data to support the informed consent in this scenario. Physicians are encouraged to highlight possible positive and/or negative impacts concerning male capacity of fertilization when informing patients. A balanced judgment and a personalized case-by-case management with patient involvement in decisions are fundamental in this setting and indication of cryopreservation of semen samples should be considered in selected circumstances. Well-structured trials controlled for confounders including female factors and based on solid outcomes (ie, birth rates) must urgently come up to clarify this emerging scenario.
Assuntos
Cirurgia Bariátrica , Infertilidade Masculina/etiologia , Obesidade/complicações , Obesidade/cirurgia , Fragmentação do DNA , Hormônios/fisiologia , Humanos , Masculino , Obesidade/fisiopatologia , Análise do Sêmen , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Espermatozoides/ultraestrutura , Redução de PesoRESUMO
ABSTRACTThe use of meshes has become the first option for the treatment of soft tissue disorders as hernias and stress urinary incontinence and widely used in vaginal prolapse's treatment. However, complications related to mesh issues cannot be neglected. Various strategies have been used to improve tissue integration of prosthetic meshes and reduce related complications. The aim of this review is to present the state of art of mesh innovations, presenting the whole arsenal which has been studied worldwide since composite meshes, coated meshes, collagen's derived meshes and tissue engineered prostheses, with focus on its biocompatibility and technical innovations, especially for vaginal prolapse surgery.
Assuntos
Feminino , Humanos , Materiais Revestidos Biocompatíveis/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Implantes Absorvíveis , Invenções , Engenharia Tecidual/métodosRESUMO
PURPOSE: To evaluate renal histological changes and renal function in single kidney rats submitted to renal ischemia-reperfusion and to immunosuppression with tacrolimus and mycophenolate-mofetil. METHODS: Experimental study with 80 Wistar rats distributed into control, Sham and six other groups treated with immunosuppressive drugs. Animals undergoing surgery, right nephrectomy and left renal clamping, killed on the 14th day and analyzed for renal histology, urea and creatinine. RESULTS: The group receiving tacrolimus at higher doses (T3) showed renal histological lesions indicative of early nephrotoxicity, and significant increase in urea and creatinine. The group M (mycophenolate-mofetil alone) and the group M2 (mycophenolate-mofetil combined with half the usual dose of tacrolimus) presented a slight rise in serum urea. The groups using mycophenolate-mofetil alone or combined with tacrolimus showed creatinine levels similar to that of the group T3. CONCLUSIONS: Histologically, the association of injury by ischemia-reperfusion with the use of tacrolimus or mycophenolate-mofetil alone demonstrated a higher rate of renal changes typical of early nephrotoxicity. In laboratory, the combination of injury by ischemia-reperfusion with tacrolimus at higher doses proved to be nephrotoxic. .