Severe inflammatory reaction induced by peritoneal trauma is the key driving mechanism of postoperative adhesion formation

<p>Abstract</p> <p>Background</p> <p>Many factors have been put forward as a driving mechanism of surgery-triggered adhesion formation (AF). In this study, we underline the key role of specific surgical trauma related with open surgery (OS) and laparoscopic (LS) conditions in postoperative AF and we aimed to study peritoneal tissue inflammatory reaction (TIR), remodelling specific complications of open surgery (OS) versus LS and subsequently evaluating AF induced by these conditions.</p> <p>Methods</p> <p>A prospective randomized study was done in 80 anaesthetised female Wistar rats divided equally into 2 groups. Specific traumatic OS conditions were induced by midline incision line (MIL) extension and tissue drying and specific LS conditions were remodelled by intraperitoneal CO₂insufflation at the 10 cm of water. TIR was evaluated at the 24^th, 72^nd, 120^thand 168^thhour by scoring scale. Statistical analysis was performed by the non-parametric t test and two-way ANOVA using Bonferroni post-tests.</p> <p>Results</p> <p>More pronounced residual TIR was registered after OS than after LS. There were no significant TIR interactions though highly significant differences were observed between the OS and LS groups (p < 0.0001) with regard to surgical and time factors. The TIR change differences between the OS and LS groups were pronounced with postoperative time p < 0.05 at the 24^thand 72^nd; p < 0.01 - 120^thand p < 0.001 - 168^thhrs. Adhesion free wounds were observed in 20.0 and 31.0% of cases after creation of OS and LS conditions respectively; with no significant differences between these values (p > 0.05). However larger adhesion size (41.67 ± 33.63) was observed after OS in comparison with LS (20.31 ± 16.38). The upper-lower 95% confidential limits ranged from 60.29 to 23.04 and from 29.04 to 11.59 respectively after OS and LS groups with significant differences (p = 0.03). Analogous changes were observed in adhesion severity values. Subsequently, severe TIR parameters were followed by larger sizes of severe postoperative adhesions in the OS group than those observed in the LS group.</p> <p>Conclusions</p> <p>MIL extension and tissue drying seem to be the key factors in the pathogenesis of adhesion formation, triggering severe inflammatory reactions of the peritoneal tissue surrounding the MIL resulting in local and systemic consequences. CO₂insufflation however, led to moderate inflammation and less adhesion formation.</p

A possible mechanism of peritoneal pH changes during carbon dioxide pneumoperitoneum

BACKGROUND: Previous studies have documented the effect of collaboration among physicians on the effectiveness in delivering health services and in producing better patient outcomes. However, there is no systematic empirical study suggesting the underlying relationship between the collaboration network of physicians and its effect on hospitalization cost and readmission rate. In this study, we explore the effect of different attributes (i.e. degree centrality, betweenness centrality, network density and network distance) of physician collaboration network (PCN) on hospitalization cost and readmission rate. METHOD: We analyse health insurance claim data set of total hip replacement (THR) patients to construct PCN and to test the effect of its network attributes on hospitalization cost and readmission rate. We consider patient age as moderating factor, which could affect the relation of the PCN attributes with hospitalization cost and readmission rate. RESULTS: We find that degree centrality (i.e. level of involvement) and network density (i.e. level of connectedness) of PCN are negatively correlated with hospitalization cost and readmission rate. In contrast, betweenness centrality (i.e. capacity to control the flow of information) is found positively correlated with hospitalization cost and readmission rate. Distance (i.e. embeddedness of actors in a network) is found positively correlated with hospitalization cost but negatively correlated with readmission rate. We do not notice any significant impact of patient age on the relation of PCN attributes with hospitalization cost and readmission rate. CONCLUSION: The results show that the structure of PCNs is related to indicators of hospital costs and quality (readmission). In their respective hospitals, health-care managers or administrators may follow our research findings to reduce cost and improve quality

Challenging nanoparticles: a target of personalized adhesion prevention strategy

Ospan A Mynbaev,1&ndash;4 Marina Yu Eliseeva,2 Antonio Malvasi,5 Andrea Tinelli6 1International Translational Medicine and Biomodeling Research Team, MIPT Center for Human Physiology, Department of Applied Mathematics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; 2Department of Obstetrics, Gynecology and Reproductive Medicine, Peoples&rsquo; Friendship University of Russia, Moscow, Russia; 3Laboratory of Pilot Projects, Moscow State University of Medicine and Dentistry, Moscow, Russia; 4The New European Surgical Academy, Berlin, Germany; 5Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy; 6Department of&nbsp;Obstetrics and Gynaecology, Division&nbsp;of&nbsp;Experimental Endoscopic Surgery, Imaging, Minimally Invasive Therapy and Technology, Vito Fazzi Hospital, Lecce, ItalyWith great interest we have read an article by Wu et al1 recently published in the International Journal of Nanomedicine aimed to estimate cytotoxicity, toxicity, and histopathological changes, as well as the postsurgical antiadhesion potential of biodegradable and thermosensitive micelles by combining in vitro and in vivo models.Our congratulations to Wu et al1 for their new, precisely designed, and promising study of nanoparticles used in the prevention of postsurgical adhesions. Even more so when we know that in most clinical studies the adhesion prevention adjuvants have failed. Taking into account medical and financial problems associated with postsurgical adhesions worldwide in the health care system, new developments in this area are welcomed and call for further investigation.View orginal paper by Wu et a

Docetaxel-loaded solid lipid nanoparticles as a basis for a targeted and dose-sparing personalized breast cancer treatment strategy

Natalia V Danilova,1,2 Zhomart R Kalzhanov,3 Nina A Nefedova,2 Pavel G Mal&rsquo;kov,2 Ioannis P Kosmas,1,4 Marina Y Eliseeva,1,5 Ospan A Mynbaev1,5,6 1International Translational Medicine and Biomodeling Research Team, MIPT Center for Human Physiology, Laboratory of Cellular and&nbsp;Molecular Technologies, Moscow Institute of Physics and&nbsp;Technology, State University, 2Department of&nbsp;Physiology and Basic Pathology, Faculty of&nbsp;Fundamental Medicine, Lomonosov Moscow State University, Moscow, Russia; 3Department of&nbsp;Human Metabolism, Academic Unit of&nbsp;Reproductive and&nbsp;Developmental Medicine, Sheffield University, Sheffield, UK; 4Department of&nbsp;Obstetrics and&nbsp;Gynecology, Ioannina State General Hospital G Chatzikosta, Ioannina, Greece; 5Department of Obstetrics, Gynecology and Reproductive Medicine, Peoples&rsquo; Friendship University of Russia, 6Laboratory of Immunology, Moscow State University of Medicine and Dentistry named after AI Evdokimov, Moscow, Russia&nbsp;The long-term survival rate of patients with breast cancer was improved by the application of systemic adjuvant chemotherapy,1 although the primary breast cancer treatment strategy consists of mastectomy with lymphadenectomy and radiotherapy followed by breast reconstruction.2&ndash;5 Unfortunately, most adjuvant chemotherapeutic agents trigger major side effects.1,6 Therefore, we have read with great interest an article in the International Journal of Nanomedicine on the design of docetaxel-loaded solid lipid nanoparticles (DSNs) aimed at reducing the systemic toxicity of standardized docetaxel treatment.7&nbsp;Read the original article&nbsp