Benefits and biosafety of use of buckypaper for surgical applications. A pilot study in a rabbit clinical trial model

Background: One of the main problems related to prosthetic abdominal surgery is mesh fixation. Suture line tension, mesh separation, displacement, or improper application of stitches are the leading causes of complications, including seroma, postoperative pain, and recurrence. A surface able to adhere firmly to living tissue represents an effective alternative to conventional perforating fixations. As a bio-adhesive tape, we report experimental evidence on the potential applicability of the BuckyPaper (BP), a felt composed of entangled multi-walled carbon nanotubes. Matherial and methods: BP is implanted to assess its biosafety and effectiveness as an adhesive prosthetic device. Results: During 35 days we observed no rabbit behavioral alteration, BP stability in the implantation site, good adhesion, and integration of the device with the surrounding tissue, and no adverse reactions. Conclusions: BP could be used as an adhesive to secure the prostheses to tissues in abdominal wall prosthetic surgery, but large-size animal studies are needed

Gel piastrinico. Trattamento del piede diabetico e dell’osteomielite fistolizzata. Revisione della letteratura e nostra esperienza in 61 casi clinici

GEL PIASTRINICO: TRATTAMENTO DEL PIEDE DIABETICO E DELL’OSTEOMIELITE FISTOLIZZATA. REVISIONE DELLA LETTERATURA E NOSTRA ESPERIENZA IN 61 CASI CLINICI Introduzione: la nostra esperienza evidenzia l’utilità del gel piastrinico (GP) nel trattamento ambulatoriale delle piaghe torpide della pianta del piede in paziente diabetico e delle ulcerazioni torpide che richiedevano periodi lunghissimi di medicazioni complesse, senza raggiungere il risultato atteso. Materiali e Metodi: la metodica personale prevede il curettage dopo disinfezione e debridement della piaga, l’inoculazione di 1-4 UI di insulina pronta alla base del cratere ulcerativo e quindi l’applicazione di 5 ml di GP con 1 ml di Trombina autologa attivata. L’applicazione si esegue facendo gocciolare il concentrato piastrinico su Hyalofill-F Fidia® Italia sul quale si fa, quindi, gocciolare l’attivatore ottenendo un panno morbido, elastico-gelatinoso, pronto a riempire la cavità da trattare. Il supporto inerte riassorbibile in acido ialuronico impedisce la dispersione della parte liquida o non completamente gelificata, ricca dei fattori di crescita (PDGF, TGF, EGF) che stimolano la moltiplicazione dei fibroblasti i quali aumentano di numero e depositano matrice connettivale, trasformando la piaga torpida con la fioritura dei bottoni di granulazione. In caso di ferite più piccole o man mano che l’ampiezza della ferita si riduce, il prodotto può essere aliquotato e congelato per successive somministrazioni. Nel caso di paziente affetto da ulcerazione da osteomielite occorre un lungo periodo di terapia antibiotica parenterale con Ampicillina-Sulbactam o Piperacillina-Tazobactam o Ertapenem o Meropenem associata a Vancomicina, oppure, alternativamente Daptomicina. Discussione: in generale, la terapia deve essere mirata sulla base dell’isolamento del germe patogeno, ma spesso l’infezione è polimicrobica e quindi si somministra una terapia empirica ad ampio spettro. Principio guida nella terapia empirica è la somministrazione di antibiotici contro lo Staphylococcus aureus meticillino resistente (MRSA). Nei pazienti ambulatoriali è essenziale tenere in considerazione la presenza di germi meticillino resistente associati alla comunità di appartenenza (CA-MRSA) e quindi occorrono colture batteriche ripetute. Conclusioni: l’approccio multidisciplinare tra chirurgo, immunotrasfusionista, infettivologo, dermatologo, ortopedico, diabetologo e cardiologo, risolve brillantemente la problematica. Lo stretto coordinamento tra ambulatorio chirurgico ed il centro trasfusionale, evita inutili attese al Paziente, accorcia i tempi di esecuzione della medicazione, abbatte i costi per l’impiego di materiali e diventa conveniente rispetto al trattamento tradizionale.Our study proves the usefulness of platelet gel in the treatment of the diabetic foot. We started in January 2006 to treat diabetic wounds of the foot in the outpatients’ surgical department with encouraging results. Despite its expensive and complex preparation, the platelet gel is useful and convenient because it succeeds in shortening the ambulatory treatment period. Besides, in our opinion, the multidisciplinary approach of this treatment is rather important: actually, it implies the cooperation of dermatologist, surgeon, orthopaedist, immunologist, diabetologist and, if necessary, the cardiologist. That is why it reduces wastes of work-time and the expenses for consultants, medications and dressing material

ABSORBABLE ADHESIVE FOR LAPAROSCOPIC APPLICATIONS

One of the main problems of abdominal prosthetic surgery is the mesh fixation. Surfaces able to adhere promptly and strongly on wet biological tissue may represent an effective alternative to the conventional prosthesis fixation. Our VIDEO proposes the application of the nature inspired micro- or nano-patterned adhesive surfaces. We realized the intervention with 2 trocar in treated group vs 3 trocar in control group on pig model and operating time in the treated was 10’vs 60’in control group.ClinicalTrials.gov Identifier: NCT02137018 https://register.clinicaltrials.gov prot. C26A10HCNR, founding of 35000€ Prof Lucio D'Ilario, Prof. Andrea Martinelli, Dott. Massimo Chiaretti , prot letter 0003306 project n° 304P25, interfaculty Chemistry Dep, General Surgery Paride Stefanini Dep. http://www.uniroma1.it Location National Health Institute (ISS Istituto Superiore di Sanità), Viale Regina Elena 299 Rome, Roma, Italy, 00161 "BP as a New Device for Surgery and Solid Cancer and Hematopoietic System Tumors Treatment. Effects of BP Implantation" (DM159) ClinicalTrials.gov Protocol and Results Registration System (PRS) Receipt Release Date: 12/30/2014 The objective of this project is to obtain results that can direct the search for the ultimate realization of a prosthetic device for use in abdominal surgery. Will be conducted systematic experiments in 30 New Zealand female rabbits (R1-R30), weighting about 3000 g (Harlan Laboratories)

New fixing method for open and laparoscopic surgical prosthetic materials tested on animal models

Abstract text Introduction: the abdominal wall defects surgery needs of prosthetic light, resistant, biocompatible and economic materials, to reduce recurrence risks, shorten recovery length and improve the patients postoperative comfort. The Ideal prosthesis would be simply implantable, biocompatible and usable both in open and laparoscopic surgery. The material we tested is also bioadhesive. Methods&Materials: we studied a new material, the Buchypaper of Carbon Nanotubes (BP). About BP we observed that it can be tailored with scissors, it can be sterilized, it is superlight, flexible, bioadhesive and biocompatible. The BP can be linked to any kind of prosthetic material and employed to fix the prosthesis to biological alive tissues. We tested on Sprague Dawley rat model and bench tests on New Zeeland female rabbits. The measurement of the bioadhesivity was realized by peeling test at 90° with INSTRON 4502. Results: we compared BP Fmax=4.1 N versus Parietene Progrip® “self gripping” Fmax=0.01 N. Infinity GORE Fmax=0,3 N, were fixed to the biological support with fibrin glue Tissucol® Baxter. Test show the adhesion strength of new dry BP sample applied on biological support. As peel force is applied we measure the displacement of self-gripping BP from fascia and muscular layer. For the samples of BP tested on the smooth surface (BPs), BP tested on the rough surface. We compared these results with the peeling test of Parietene Progrip® “self gripping”. The bio-adhesiveness of the side coated with polyglactin is very low, showing maximum peel strength of only 0.001 N/mm, 100 times lower than that recorded for BPr sample. Conclusions: the tests showed a significant performance difference among the prosthetic samples. At the light of our experience we think that the BP can replace any kind of suture and biologic glues in the fixing prosthesis materials in the alive tissues, avoiding theoretically but possible infections and chronic pain due to nerve “entrapment”. The BP showed a bioadhesivity 100 times bigger than the best self gripping actually marketed prosthetic material. We believe that the modifiable BP bioadhesivity, if largely employed, can radically change the fixing surgical technique.URL LAVORO: https://link.springer.com/article/10.1007/s00464-012-2198-3#citeas GRANT_NUMBER: ERDF DI9_20 2011-2013 URL: http://www.regione.abruzzo.it/xEuropa/docs/beneficiariPor/beneficiari23022016.pdf GRANT_NUMBER: C26A10HCNR/2010, Project 349/2012 URL: http://www.uniroma1.it/sites/default/files/PROGETTI_UNIVERSITà_1.pd

DOLORE CRONICO, DONAZIONE, TRASFUSIONE, TRAPIANTO, ELABORAZIONE DEL LUTTO, ABORTO: PROBLEMATICHE RELIGIOSE

DOLORE CRONICO, DONAZIONE, TRASFUSIONE, TRAPIANTO, ELABORAZIONE DEL LUTTO, ABORTO: PROBLEMATICHE RELIGIOSEDOLORE CRONICO, DONAZIONE, TRASFUSIONE, TRAPIANTO, ELABORAZIONE DEL LUTTO, ABORTO: PROBLEMATICHE RELIGIOS