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

Combined condylomatosis and Buschke-Loewenstein tumor: case report & systematic review

Objectives: An undesired manifestation of HPV is the transformation of infected cells into neoplastic cells, with the subsequent development of precancerous intraepithelial lesions and in some instances cancer. The generally benign manifestations of HPV include asymptomatic and subclinical disease as well as anogenital condyloma acuminatum, warts and verruccosis. Certain HPV manifestations are however associated with poor outcome for the patient, and these include giant and multiple condylomas such as Buschke- Löwenstein tumor (BLT), and respiratory papillomatosis and their relapses. These conditions decrease the patient’s life quality, and have the potential to progress to malignancy, and are a particular problem for practitioners. Management of these patients is complicated due to the absence of therapies that can eliminate HPV and prevent wart recurrence, or medication that can cure genital warts and condylomas. Indeed, although there are many clinical reports describing the aggressive manifestation of genital warts in immune compromised individuals, the triggering mechanisms for such atypical lesions is not yet understood. Our objective here is to present a case report of combined condylomatosis and BLT in a patient with Henoch-Schönlein purpura and simultaneously infected with six HPV genotypes (6, 11, 18, 31, 43 & 56), and to systematicly review the literature in order to provide a better insight into these conditions. Methods: Clinical and laboratory parameters as well as a video of surgery of female patient (30 ys) with combined condylomatosis and BLT (the informed consent was obtained). Clinical and research literature over the last 15 years focusing on the immunological aspects of papillomavirus interaction with the innate and adaptive immune systems, and interference with the cellular and humoral host responses. Particular attention is given to the nature of papillomavirus clearance and persistence. Conclusions: Atypical manifestation of HPV was in our case related to systemic disease involving an autoimmune host response and long-term glucocorticoid treatment. Our review confirms that such atypical manifestations and the long-term persistence of HPV are often linked to disturbances in the hosts immune system. More specifically these comprise changes in the content of lymphocyte subsets (helper, cytotoxic and regulatory T-cells), NK cells and macrophages at HPV infected sites and in the blood, as well as changes in lymphocyte function related to the expression of INF-<& ®, IL-2; IL-4, IL-10, TGF®‚ and other cytokines

Low power field generation for magneto-optic fiber-based interferometric switches

A new fiber-based, magneto-optic switch is proposed with a novel approach for low power and efficient operation. The switch, with reasonable switching speed compared to competitive designs, operates at considerably reduced power levels, which makes it a practical deployable solution. The basic switch setup consists of a Faraday rotator in a Sagnac fiber-optic interferometer in which optical switching is controlled by an electronic driving circuit. The electronic system generates a magnetic field through the Faraday rotator by driving current through a specially designed two-coil system. The new coil system allows for sufficient field generation at low quiescent power levels while maintaining very short optical rise and fall times. The design and considerations as well as the effect of mutual inductance between the two coils and its influence on switching times are investigated. The optical system consists of a Sagnac interferometer with a Faraday rotator within the Sagnac loop. Appropriate phase shift for interference is achieved by the proposed field generating system designed for the magneto-optical element. The theory of operation, design, experimental results, and optical and electronic setup are presented and analyzed

Can trans resveratrol plus d-chiro-inositol and myo-inositol improve maternal metabolic profile in overweight pregnant patients?

Objective. To investigate the effect of trans-resveratrol from Polygonum cuspidatum/magnesium hydroxide complex, trademark Revifast®, plus D-chiro-inositol (DCI) and Myo-inositol (MI) during spontaneous pregnancies in overweight patients in a pilot study. Study design. A one-year, prospective, randomized, doubleblinded, placebo-controlled single center clinical study was carried out on overweight pregnant women. 110 patients were randomized in 3 groups to receive: Revifast® with DCI/MI (group I), DCI/MI alone (group II) or control group (group III) for 30 and 60 days. The main outcomes were to explore the lipid profile (total cholesterol, LDL, HDL, TG) and glucose levels, after 30 and 60 days of therapy. Results. No difference in systolic and diastolic parameters among 3 groups during study. All blood chemistry parameters improved compared to placebo at 30 days already, but significantly to 60 days, respect placebo. By comparing the two treatment groups, group I demonstrates significantly improved lipid and glucose parameters than group II, which are at 30 to 60 days of treatment. Conclusion. The supplementation of Trans-resveratrol, Revifast® in addition to DCI/MI in overweight pregnant woman with an elevated fasting glucose improves glucose levels, Total Cholesterol, LDL and TG

T136

To study the impact of oxidative stress acute hypoxia and reperfusion on HeLa cervical cancer cell attachment, survival and invasion capacities. Summary background data: Many hypotheses have been proposed to explain the mechanism of port-site metastases (PSM). We presumed that CO2 exposure results in hypoxia and reperfusion with subsequent oxidative stress of cancer cells being a triggering mechanism of PSM. Methods: Two CO2-pneumoperitoneum conditions were created: the hypoxic standard model (HSM) and oxidative stress model (OSM) upon CO2 insufflation and reperfusion by means of in vitro cell culture tools and non-exposed cells were served as intact control. HeLa cervical cancer cells were exposed under these CO2 insufflation conditions. Subsequently, HeLa cell attachment, viability and proliferation capacities were evaluated in duplicate samples as series I and II by the MTT and SRB assays and invasion by the Matrigel invasion assay and repeated in triplicate experiments. The impact of different CO2-pneumoperitoneum conditions on cancer cell attachment was evaluated immediately after exposure, whereas invasion capacity after 48 h of incubation and survival and proliferation every 24 h for 72 h. Results: Both CO2 insufflation models significantly affected HeLa cell attachment activity (p < 0.001) in comparison with that of non-exposed cells. CO2 insufflation by HSM resulted in significantly pronounced weakening of HeLa cell attachment as compared to exposure of these cells to insufflation by OSM (p < 0.001). Both pneumoperitoneum regimes significantly weakened HeLa cell invasion capacity in comparison with those of controls (p < 0.001 and p < 0.05), whereas HSM profoundly decreased HeLa cell invasion capacity in comparison with that of OSM (p < 0.05). Conclusion: An in vitro model of oxidative stress during CO2-pneumoperitoneum increased HeLa cancer cell invasion capacity in comparison with standard CO2-pneumoperitoneum condition with continuous CO2 insufflation. Oxidative stress followed by acute hypoxia and reperfusions during deflations can increase cancer cell attachment and survival capacity, and may trigger cancer cell invasion and metastasis. These data suggest that a regime of laparoscopic procedures may affect attachment and invasion of cancer cells and hence can explain the occurrence of port-site cancer metastasis