Research Progress of Antibacterial Biliary Stent / 中国医疗器械杂志

Biliary stent has been widely used in the treatment of biliary stricture and obstruction, it can relieve the pain of patients effectively, but bacterial infection and stent obstruction are still troublesome after surgery. We introduce the mechanism of infection and stent blockage caused by bacterial invasion after biliary stent implantation, and expound the formation mechanism of bacterial biofilm and bile sludge in this review. Antibacterial biliary stent is an effective way to inhibit biliary tract infection, the literatures on antibacterial modification of biliary stent with different antibacterial methods in domestic and abroad are reviewed, and the research prospect of antibacterial biliary stent is summarized and prospected.

Clinical Results of Anti-adhesion Adjuvants after Endonasal Dacryocystorhinostomy

PURPOSE: Various absorbable anti-adhesion agents have been used to prevent postoperative synechia formation after endonasal surgery. The purpose of this study was to evaluate the anti-adhesion effects of HyFence and Mediclore after endonasal dacryocystorhinostomy (DCR) compared to a mixed solution of hyaluronic acid and sodium carboxymethylcellulose (Guardix-Sol). METHODS: In this retrospective study, endonasal DCR and silicone tube intubation were performed on 198 eyes of 151 patients. Three different anti-adhesion adjuvants were applied to the osteotomy site in the nasal cavity after standard endonasal DCR procedures. The subjects were classified into three respective groups: group A (71 eyes, Guardix-Sol 1.5 g), group B (89 eyes, HyFence 1.5 mL), and group C (38 eyes, Mediclore 1 cc). The three groups were evaluated by asking patients about subjective symptoms and by performing lacrimal irrigation tests and endoscopic examinations. RESULTS: There were no statistically significant differences in age, sex, timing of tube removal, or follow-up period among the three groups. There were no statistically significant differences in success rates among the three groups (p = 0.990, 91.5% [65 / 71], 92.1% [82 / 89], and 92.1% [35 / 38], respectively). CONCLUSIONS: HyFence and Mediclore are safe and effective adjunctive modalities following endonasal DCR compared to Guardix-Sol. Therefore, these agents can be considered good alternatives to Guardix-Sol to increase the success rate of endonasal DCR in treating patients with poor prognosis.

Clinical effect of polylactic acid membrane in the surgery of lumbar disc herniation / 中国综合临床

Objective To investigate whether the polylactic acid(PLA)membrane can reduce the scar size and or improve the clinical outcome of the patients after lumbar disc herniation surgery,and the association between peridural scarring and recurrent pain after lumbar disc herniation surgery.Methods Seventy-two patients treated with lumbar disc herniation surgery were collected and randomly divided into two groups, including 38 cases were treated with PLA membrane,and 34 cases as the control group.All patients underwent MRI at 12 months after surgery for grading the size,location and development of the scar.NRS was used to assess the severity of lower limb pain before and 12 months after surgery.The modified Macnab scale was used to assess the clinical outcomes of the patients.Results For 9 cases(23.7%)in the PLA membrane group,the scar tissue had an effect on the nerve root,while 16 cases(47.1%)in the control group experienced the same,the difference was statistically sigificant(χ2=4.326,P=0.038).There was significant difference in scar score between the two groups(Z=2.340,P=0.019),but there was no significant difference in leg pain degree between the two groups(t=0.687,1.014,0.426,0.000,P=0.532,0.324,0.675,1.000).There was no significant difference between the two groups in modified Macnab classification grading(χ2=1.202,P=0.273).Conclusion PLA membranes used in lumbar disc herniation surgery could reduce peridural scar formation,but it does not significantly improve the clinical results.

Effect of anti-adhesion products on the healing of abdominal muscle / 医用生物力学

Objective To evaluate the effect of commonly used anti-adhesion products on the healing of abdominal muscles, and to provide guidance for surgeons to use anti-adhesion products in their clinical practice. Methods Adult SD rats were used. Except the sham group, surgical traumas were created on the serosal layer of the cecum and the underlying muscles of the abdominal wall. The wounds were covered without (Adhesion group) or with anti-adhesion products. Fourteen days after the surgery, the mechanical properties and histology of abdominal muscles were investigated to evaluate the healing of injured muscles. Results The ultimate tensile force and stiffness of the healing abdominal muscles in the groups of Polylactic acid membrane and Medical polyethylene glycol berberis lye were the same as those of normal muscles (P>0.05). The ultimate tensile force of the healing muscle in the groups of Chitosan gel and Seprafilm was significantly smaller than that of normal muscles (P0.05). The significant losses of mechanical properties of the healing muscles occurred in the Adhesion and Medical sodium hyaluronate gel group (P<0.05). HE staining indicated that more capillaries were found in Medical sodium hyaluronate gel, Polylactic acid membrane and Medical polyethylene glycol berberis lye group. The wound in Medical sodium hyaluronate gel group had less fibroblasts and fewer inflammatory cells, while the inflammatory cells were fully infiltrated with dense fibers in the other product groups. Conclusions Polylactic acid membrane and Medical polyethylene glycol berberis lye can promote abdominal muscle healing and are superior to Medical sodium hyaluronate gel, Chitosan gel and Seprefilm.

Efficacy and Safety of Sodium Hyaluronate with 1,4-Butanediol Diglycidyl Ether Compared to Sodium Carboxymethylcellulose in Preventing Adhesion Formation after Lumbar Discectomy

OBJECTIVE: Epidural injection of hyaluronic acid may prevent adhesion formation after spine surgery, but the compounds used to stabilize hyaluronidase could interfere with its anti-adhesion effects. The present study was conducted as a clinical trial to evaluate the efficacy and safety of an experimental medical gel in preventing adhesion formation. METHODS: This study was designed as a multicenter, randomized, double-blind, and comparative controlled clinical trial with an observation period of 6 weeks. Subjects were randomly assigned into two groups: group A with sodium hyaluronate + 1,4-butanediol diglycidyl ether (BDDE) and group B with sodium hyaluronate + sodium carboxymethylcellulose (CMC). Visual analogue scale (VAS) of back and leg pain and the Oswestry disability index (ODI) and scar score ratings were assessed after surgery. RESULTS: Mean scar grade was 2.37+/-1.13 in group A and 2.75+/-0.97 in group B, a statistically significant difference (p=0.012). VAS of back and leg pain and ODI scores decreased significantly from baseline to 3 and 6 weeks postoperatively in both groups (p0.3). The number of adverse reactions related to the anti-adhesion gels was not statistically different (p=0.569), but subsequent analysis of nervous adverse reactions showed group B was superior with a statistically difference (p=0.027). CONCLUSION: Sodium hyaluronate with BDDE demonstrated similar anti-adhesion properties to sodium hyaluronate with CMC. But, care should be used to nervous adverse reactions by using sodium hyaluronate with BDDE.

A Randomized, Multi-Center, Single Blind, Active-Controlled, Matched Pairs Clinical Study to Evaluate Prevention of Adhesion Formation and Safety of HyFence in Patients After Endoscopic Sinus Surgery

OBJECTIVES: Recurrent mucosal disease and anatomic obstruction are commonly cited causes of failed endoscopic sinus surgery (ESS). Hyaluronic acid (HA) has been reported to reduce scarring and to promote wound healing in sinonasal surgery. HyFence is HA stabilized by 1, 4-butandiol diglycidyl ether, which makes it less-water-soluble and highly viscoelastic. The purpose of this study is to examine the anti-adhesion effect of HyFence after ESS compared to that of HA-CMC (Guardix-Sol). METHODS: Seventy-four patients with chronic rhinosinusitis who underwent ESS were included in the study. After the ESS procedure, Merocel was placed in the ethmoidectomized areas of the both sides. Five milliliters of Guardix-Sol was then applied to the Merocel of one side and HyFence LV was applied to the other side. The effect of the agents was evaluated at one, two, and four weeks after surgery by endoscopic examination. The severity of adhesion, edema, infection and complications were evaluated. RESULTS: There was no significant difference in the incidence of postoperative adhesion between the HyFence group and the Guardix-Sol group (P>0.05). Mean postoperative grades of edema and infection showed no significant difference between groups (P>0.05). There was no significant postoperative complications associated with either anti-adhesion agent (P>0.05). CONCLUSION: HyFence has equivalent anti-adhesion effect compared to Guardix-Sol following ESS.

Adhesions after Gynecologic Surgery in Postmenopausal Women / 대한폐경학회지

Adhesions represent a significant cause of morbidity for post-operative patients. Most gynecologic surgical procedures are associated with pelvic adhesions that may cause small bowel obstruction, infertility, chronic pelvic pain, and difficulties in post-operative treatment. Gynecologic surgical procedures in elderly women are more risky because of post-operative morbidity and mortality due to pre-existing diseases. Menopause marks the onset of the senile stage. After menopause, hormonal changes occur. This article will review the current issues about adjunctive methods to prevent post-operative adhesion formation and the correlation between hormone changes and adhesion formation.

The Effect of Alloderm on Prevention of Adhesions following Tenorrhaphy in the Rabbits

PURPOSE: Peritendinous adhesion is one of the most notorious complication after the flexor tendon injury. In this study, Alloderm(R)(LifeCell Corp., Branchburg, N.J.), which is the decellularized human dermal analogue with its intact native basement membrane components, was used for the prevention of peritendinous adhesions following flexor tendon repair. METHODS: Thirty New Zealand white male rabbits were divided equally into 3 groups. In all groups, the flexor digitorum profundus of the third finger of the right back foot was cut totally and repaired by modified Kessler suture technique. Following tendon repair, Alloderm(R) was wrapt around the repaired tendon in the first group and sodium hyaluronate gel was sprayed to the operation field in the second group. In the control group, no external material was applied. The right back foot were immobilized for 6 weeks to optimize the formation of adhesion ingrowth. After death, the third finger that repaired tendons and sheaths was removed en bloc. We checked range of motion. and studied histologically for all groups. RESULTS: The experimental groups had better range of motion than the control group. We checked that the range of motion was 73.5 degrees in Alloderm(R) group, 55.9 degrees in the hyaluronic acid group, and 38.3 degrees in the control group. in the histological study, the experimental group had less adhesions compared with the control group. CONCLUSION: This study concludes that Alloderm(R) can decrease peritendinous adhesions following flexor tendon repairs in rabbits. We think the method could be used in clinical cases.