Differently charged polypeptides in the prevention of post-surgical peritoneal adhesions

OBJECTIVE: Peritoneal adhesions develop after almost all surgical interventions in the abdomen. We have developed an efficient treatment against post-surgical adhesions consisting of a combination of positively charged poly-L-lysine and negatively charged poly-L-glutamate. The aim of the present study was to further develop the concept of applying oppositely charged polypeptides in the prevention of adhesion formation, by evaluating different doses of the peptides, alterations in the way of administration, and also testing alternative components. MATERIAL AND METHODS: Eighty-five NMRI mice were divided into six groups. A standardized peritoneal injury model was used. The groups received physiologic sodium chlorine, poly-L-lysine+poly-L-glutamate, low molecular weight poly-L-lysine+poly-L-glutamate, locally administered poly-L-lysine+poly-L-glutamate, in vitro mixed poly-L-lysine+poly-L-glutamate and poly-L-arginine+poly-L-glutamate, respectively. After 7 days, the extent of adhesion formation was determined during relaparotomy and was expressed as the mean percentage of the total wound length. RESULTS: A significant decrease (p <0.001) in the peritoneal adhesion rate was detected in all groups, with the exception of the group administered poly-L-arginine. Among those animals that received poly-L-lysine and poly-L-glutamate, the low dose of poly-L-lysine administration resulted in the most pronounced anti-adhesive effect. CONCLUSIONS: The most effective polypeptide combination was poly-L-lysine and poly-L-glutamate, also showing effectiveness when used at low doses and by local application. The differences in adhesion prevention and the possible underlying mechanisms are discussed and the key role of poly-L-lysine is elucidated.     

Novel treatment in peritoneal adhesion prevention: Protection by polypeptides

Objective. To evaluate a novel antiadhesive polypeptide complex containing a combination of poly-L-glutamate and poly-L-lysine in order to study its effectiveness and mechanisms in the prevention of postoperative abdominal adhesions in mice. Material and methods. The length of peritoneal adhesions was measured and expressed in percentage of the wound length in a standardized peritoneal injury model and evaluated 7 days and 4 weeks after adhesion induction. The test compound was administered intraperitoneally following surgery. Peritoneal swabs, including the wound area, were stained in order to determine the peritoneal location and clearance of the polypeptides. Electron microscopy was performed to analyze the wound surface and the ultra-structural changes of the phagocytes in cell culture. Moreover, flow cytometry was used to evaluate the effect on macrophage phagocytic function. Results. The poly-L-lysine and poly-L-glutamate combination significantly decreased peritoneal adhesions both at 7 days’ (p<0.001) and 4 weeks’ (p≤0.001) follow-up. From the first day, the compound was found in the wound, after which this was gradually rebuilt, and covered with mesothelial cells. The macrophages phagocytosed the test compound particles, resulting in significant cell growth, and large phagocytic vacuoles. Conclusions. The intraperitoneal administration of poly-L-lysine and poly-L-glutamate resulted in a significant decrease in experimental postoperative peritoneal adhesions.     

Prevention of peritoneal adhesions: a promising role for gene therapy

Adhesions are the most frequent complication of abdominopelvic surgery,yet the extent of the problem,and its serious consequences,has not been adequately recognized.Adhesions evolved as a life-saving mecha-nism to limit the spread of intraperitoneal inflammatory conditions.Three different pathophysiological mechanisms can independently trigger adhesion formation.Mesothelial cell injury and loss during operations,tissue hypoxia and inflammation each promotes adhesion formation separately,and potentiate the e...     

Pathophysiology and prevention of postoperative peritoneal adhesions

Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fi brin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbid...     

Novel treatment in peritoneal adhesion prevention: protection by polypeptides

OBJECTIVE: To evaluate a novel antiadhesive polypeptide complex containing a combination of poly-L-glutamate and poly-L-lysine in order to study its effectiveness and mechanisms in the prevention of postoperative abdominal adhesions in mice. MATERIAL AND METHODS: The length of peritoneal adhesions was measured and expressed in percentage of the wound length in a standardized peritoneal injury model and evaluated 7 days and 4 weeks after adhesion induction. The test compound was administered intraperitoneally following surgery. Peritoneal swabs, including the wound area, were stained in order to determine the peritoneal location and clearance of the polypeptides. Electron microscopy was performed to analyze the wound surface and the ultra-structural changes of the phagocytes in cell culture. Moreover, flow cytometry was used to evaluate the effect on macrophage phagocytic function. RESULTS: The poly-L-lysine and poly-L-glutamate combination significantly decreased peritoneal adhesions both at 7 days' (p < 0.001) and 4 weeks' (p < or = 0.001) follow-up. From the first day, the compound was found in the wound, after which this was gradually rebuilt, and covered with mesothelial cells. The macrophages phagocytosed the test compound particles, resulting in significant cell growth, and large phagocytic vacuoles. CONCLUSIONS: The intraperitoneal administration of poly-L-lysine and poly-L-glutamate resulted in a significant decrease in experimental postoperative peritoneal adhesions.     

Peritoneal adhesions after laparoscopic gastrointestinal surgery

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation,only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue.Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis.Moreover,several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact.Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration.Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2,N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum.However,these experimental data have not had a significant impact on the modification of laparoscopic instrumentation.In contrast,surgeons should train themselves to perform laparoscopy quickly,and they should complete their learning curves before testing chemical anti-adhesive agents and antiadhesion barriers.Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation,but when these agents are used alone,the concentrations needed to prevent adhesions are too high and could cause major postoperative side effects.Anti-adhesion barriers have been used mainly in open surgery,but some clinical data from laparoscopic surgeries are already available.Sprays,gels,and fluid barriers are easier to apply in laparoscopic surgery than solid barriers.Results have been encouraging with solid barriers,spray barriers,and gel barriers,but they have been ambiguous with fluid barriers.Moreover,when barriers have been used alone,the maximum protection against adhesion formation has been no greater than 60%.A recent small,randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100%effective in preventing post-operative adhesion formation.Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points,such as reduced incidences of bowel obstruction and abdominal pain and increased fertility.     

Comparison between the pathology of encapsulating sclerosis and simple sclerosis of the peritoneal membrane in chronic peritoneal dialysis

Reports analyzing the histopathological differences between encapsulating peritoneal sclerosis (EPS) and simple peritoneal sclerosis (non-EPS) and those comparing the pathology of early and late EPS are limited. We present pathological comparisons between EPS and non-EPS, also between the early and late EPS stages. We compared peritoneal membrane (PM) samples (Group B) of 12 EPS patients (Group A) and 23 non-EPS cases regarding; mesothelial loss, submesothelial compact zone degenerated layer and compact zone thicknesses, densities of total and diseased vessels, fibrin stain, new membrane formation and degenerative changes. Group A was subdivided into 7 early (group A1) and 8 late (group A2) EPS cases; we compared both subgroups in the same manner and finally compared groups A1, A2, and B. No differences were found between groups A and B in the incidences of mesothelial detachment, new membrane formation and compact zone degenerative changes between the two groups. Furthermore, there were no differences in compact zone thickness, and vascular densities in the compact zone of respective vascular grade. Whereas, fibrin deposition and thickness of the submesothelial degenerated layer were significantly higher in group A than group B (P = 0.01 and 0.05, respectively), and the thickness of the compact zone was less in group A1 than in group A2 (P = 0.03). Positive fibrin stains and thick degenerative compact zone layers are important pathological findings in EPS. Angiogenesis, vasculopathy, new membrane formation, fibrosis and degenerative changes of the compact zone are not unique characteristics for EPS. Larger size studies are recommended to verify this issue.     

腹带加压预防腹膜透析患者术后并发症的临床观察

目的探讨腹带加压对腹膜透析患者伤口拆线时间、伤口渗液、出血及隧道口炎、导管移位发生率的影响,为防治腹膜透析并发症提供新的治疗方法。方法根据腹膜透析术后是否采用腹部伤口腹带加压,将患者分为腹膜透析插管后3个月内腹带加压组(A组)和未使用腹带加压对照组(B组),观察两组患者的伤口拆线时间、伤口渗液、出血及透析管相关隧道口炎、导管移位的发生率。结果 (1)A组平均拆线时间为(11.2±0.8)d,B组平均拆线时间为(13.4±0.7)d,两组比较有统计学差异(P0.01)。(2)术后A组有1例患者发生伤口渗血,而B组有8例患者出现伤口渗血,明显高于A组(P0.05);术后A组有1例隧道口炎发生,而B组有7例患者在术后3个月发生隧道口炎,与A组比较有统计学差异(P0.05),两组患者予以规范抗感染治疗后均治愈。(3)A组有1例患者在术后第2天出现管周渗液,发生率为2.94%;B组有1例患者在术后第1天出现管周渗液,发生率为3.03%,两组比较无统计学差异(P0.05)。(4)A组有1例患者出现导管移位,发生率为2.94%;B组有1例患者出现导管移位,发生率为3.03%,两组比较无统计学差异(P0.05)。结论腹带加压可缩短手术后拆线时间,可减少术后腹部伤口渗血及隧道口炎的发生率,极大地减少了术后并发症的发生,可促进患者早日康复,能有效延长腹膜透析患者的透析时间和治疗效果,减少腹透早期退出率,提高患者生活质量。     

两种不同腹膜透析导管拔除术在老年腹膜透析患者中的临床应用

目的分析两种腹膜透析导管拔除术在老年腹膜透析患者中的应用情况。方法采用回顾性队列研究的方法, 收集2010年8月至2020年5月于山西医科大学第二医院腹膜透析中心移除腹膜透析导管的107例老年腹透患者的临床资料, 分为外科开放式拔管组(外科组)和"pull"技术拔管组(pull组), 比较两组性别、年龄、原发病、透析龄、拔管原因及术前相关化验等指标, 观察两组手术时间、术后住院时间、手术疼痛程度及术后并发症等相关情况。结果外科组的手术时间[(71.2±13.4)min和(19.3±5.6)min, t=16.933, P<0.01]、术后住院时间[(9.5±1.8)d和(2.2±0.5)d, t=10.988, P<0.01]和术中疼痛评分[(4.4±1.6)分和(1.4±1.1)分, t=6.909, P<0.01]及术后24 h的疼痛评分[(3.7±1.4)分和(0.5±0.3)分, t=9.995, P<0.01]均高于pull组, 两组术后并发症发生率(6.8%和5.0%, χ2=0.037, P>0.05)差异无统计学意义。结论外科开放式手术法和...     

Dose-dependence of the carboxymethylcellulose-papain combination in the prevention of peritoneal adhesions. Study in rats]

The action of a low volume (one drop) of sodium carboxymethylcellulose (CMC)-papain (PP) association gel to prevent peritoneal adhesions were studied in female Wistar rats. After ether anesthesia and a midline laparotomy incision, the right parietal peritoneum was pinched with a fine hemostat and the pinched peritoneal fold was then ligated. This maneuver was repeated thrice creating four points as if they were little "polyps" with a standardized size. Before closing the incision it was deposited on each point 0.05 ml (one drop) of CMC 2% (group A) or CMC + PP 0.4% (group B), with a total volume of 0.2 ml. These groups were compared with another similar group (group C) of a previous research, in which was used 7 ml/kg of body weight of CMC + PP 0.4% (1.5 ml by animal). Statistically significance was not noticed between groups A and B but it was noticed between these two groups (A and B) and group C (p < 0.001 and p < 0.01, respectively). It was concluded that the lowest effective volume (between 0.2 and 1.5 ml/animal) which can allow the desired effect is to be determined in order to diminish the quantity of substance to be deposited in the abdominal cavity.     

Talin determines the nanoscale architecture of focal adhesions

Insight into how molecular machines perform their biological functions depends on knowledge of the spatial organization of the components, their connectivity, geometry, and organizational hierarchy. However, these parameters are difficult to determine in multicomponent assemblies such as integrin-based focal adhesions (FAs). We have previously applied 3D superresolution fluorescence microscopy to probe the spatial organization of major FA components, observing a nanoscale stratification of proteins between integrins and the actin cytoskeleton. Here we combine superresolution imaging techniques with a protein engineering approach to investigate how such nanoscale architecture arises. We demonstrate that talin plays a key structural role in regulating the nanoscale architecture of FAs, akin to a molecular ruler. Talin diagonally spans the FA core, with its N terminus at the membrane and C terminus demarcating the FA/stress fiber interface. In contrast, vinculin is found to be dispensable for specification of FA nanoscale architecture. Recombinant analogs of talin with modified lengths recapitulated its polarized orientation but altered the FA/stress fiber interface in a linear manner, consistent with its modular structure, and implicating the integrin–talin–actin complex as the primary mechanical linkage in FAs. Talin was found to be ∼97 nm in length and oriented at ∼15° relative to the plasma membrane. Our results identify talin as the primary determinant of FA nanoscale organization and suggest how multiple cellular forces may be integrated at adhesion sites.Cell adhesion to the ECM is a highly coordinated process that involves ECM-specific recognition by integrin transmembrane receptors, and their aggregation with numerous cytoplasmic proteins into dense supramolecular complexes called focal adhesions (FAs) (1). Actin stress fibers terminate at FAs where actomyosin contractility is transmitted to the ECM, generating traction (2–5). Mechanical tension impinging on each FA is implicated in key steps including the elongation, reinforcement, and maintenance of the FA structures (6). FA mechanotransduction is a major aspect of cellular microenvironment sensing with wide-ranging consequences in physiological and pathological processes (7–10). However, molecular-scale spatial parameters that specify FA nanoscale organization have been difficult to access experimentally. Nevertheless, these are essential to understand how mechanosensitivity arises within such complex molecular machines (11–15).Previously 3D superresolution fluorescence microscopy has unveiled the nanoscale organization of major FA components, whereby a core region of ∼30 nm interposes between the integrin and the actin cytoskeleton along the vertical (z) axis (16). The FA core consists of a membrane-proximal layer that contains signaling proteins such as FAK (focal adhesion kinase) and paxillin, an intermediate zone that contains force-transduction proteins such as talin and vinculin, and a stress fiber interfacial zone that contains actin-associated proteins such as VASP (vasodilator-stimulated protein) and α-actinin. Although such multilaminar architecture signifies a certain degree of compartmentalization within FAs that may serve to spatially constrain protein–protein interactions and dynamics, the structural connectivity, the molecular configuration and geometry of FA proteins, and the molecular basis of their higher-order organization remain unclear.Proteomic and interactome analysis of the integrin adhesome have uncovered several direct and multitier connections between integrins and actin (17–20). This suggests that multiple highly interconnected protein–protein interactions could collectively self-organize into FA structures; such redundancy could also account for the remarkable mechanical robustness of FAs after cellular disruption or perturbation (21). Alternatively, a specific FA component may play a dominant role in regulating FA architecture. Aspects of both scenarios may also act cooperatively or function at distinct stages of FA assembly and maturation. Superresolution microscopy of cells expressing fluorescent protein (FP)-tagged FA components has revealed that talin, a large cytoskeletal adaptor protein, adopts a highly polarized orientation in FAs (16), with the N terminus residing in the membrane-proximal layer and the C terminus elevated by z ∼30 nm to the FA/stress fiber interfacial zone. This led us to hypothesize that an array of integrin–talin–actin linkages may vertically span the FA core, serving a structural role in determining FA architecture (16).To test this hypothesis, we sought to perturb FAs by substituting endogenous talin with recombinant analogs having modified lengths. These were generated by retaining both the N-terminal FERM (band 4.1/Ezrin/Radixin/Moesin) and C-terminal THATCH (Talin/HIP1R/Sla2p Actin-tethering C-terminal Homology, or R13) domains but with selective deletion of the multiple helical bundles within the central region of talin. By using a siRNA-mediated knockdown/rescue approach, we found that such talin analogs were able to support FA formation, clustering of activated integrins, and linkages to the actin cytoskeleton. By mapping the z-position of the FPs tagged at either the N or the C termini, we show that talin and its analogs are linearly extended and oriented in FAs, with their lengths regulating FA nanoscale organization. Chimeric-talin analogs with a 30-nm spacer insertion are also able to support FA assembly, facilitating the precise determination of talin geometry in FAs. Our results indicate that talin is oriented at 15° relative to the plasma membrane, measuring ∼97 nm end to end. FA nanoscale architecture in vinculin-null mouse embryonic fibroblasts (MEFs) retained its stratified organization and talin polarization similar to that in other cell types, suggesting that vinculin is dispensable for the specification of FA architecture. Our measurements demonstrate how the integrin–talin–actin module serves as the primary, and surprisingly modular, structural and tension-bearing core of FAs and geometrically define how such complexes could integrate multiple cellular forces at adhesion sites.     

Limitations of peritoneal lavage with antiseptics in prevention of recurrent colorectal cancer caused by tumor-cell seeding

PURPOSE: Exfoliated or soiled free malignant cells have serious consequences in patients undergoing gastrointestinal cancer surgery. The present study evaluates the toxicity and efficacy of cytotoxic agents in the prevention of cell seeding and tumor growth in the peritoneal cavity in an experimental model. METHODS: Mtln3 adenocarcinoma cell viability was testedin vitro using the trypan blue exclusion test after incubation with povidone-iodine or chlorhexidine.In vivo, Fischer rats were inoculated with 10⁵ or 10⁶ cells followed by peritoneal lavage with physiological saline, chlorhexidine 0.02 percent, providone-iodine low molecular weight 1 percent or povidone-iodine high molecular weight 1 and 2 percent in different quantities and incubation times. RESULTS: Chlorhexidine 0.02 percent and povidone-iodine low molecular weight 1 percent or high molecular weight 2 percent, killed over 98 percent of 10⁵ or 10⁶ tumor cellsin vitro. Povidone-iodine low molecular weight 1 percent and high molecular weight 2 percent were toxic and lethal when 5 ml were applied in the peritoneal cavity three times for five minutes. Chlorhexidine 0.02 percent applied after inoculation of 10⁵ or 10⁶ cells, reduced the tumor development only to 70 and 80 percent. Application of 5 ml povidone-iodine 1 percent low molecular weightor high molecular weight, three times for one and five minutes, after inoculation of 10⁶ cells did not change the tumor take. However, inhibition of Mtln3 cells to form metastases was observed. When povidone-iodine low molecular weight 1 percent was used three times for one minute after 10⁵ tumor cells were soiled, no toxicity was observed and the tumor take was reduced to 30 percent (P<0.05). CONCLUSIONS: Povidone-iodine toxicity proved to be a major issuein vivo. However, povidone-iodine low molecular weight 1 percent was safe when used for short periods and very effective when a limited number of tumor cells was inoculated. The use of cytotoxic agents to prevent recurrent disease caused by tumor cell seeding in patients seems to make sense only when the inoculum size of exfoliated or soiled cancer cells is limited.     

非水性固定剂对大鼠腹膜表面层固定效果的观察

目的　比较水性和非水性固定剂对腹膜表面层超微结构的影响。方法　 2 0 0 3- 0 5 2 0 0 3- 12在中山大学附属第一医院取正常SD大鼠腹膜组织 ,分别以不同固定液固定 :(1) 2 5 %戊二醛和 2 %多聚甲醛 (对照组 ) ;(2 ) 4 %四氧化锇 (OsO4) (Os组 ) ;(3) 1%OsO4的氟化碳 (FC75)固定液 (FC组 )。结果　对照组中可见腹膜间皮细胞表面的微绒毛 ,未见腹膜表面层。OS组可见腹膜表面层 ,此层质地疏松 ,平均厚度 4 μm左右。FC组间皮细胞表面可见一层连续的腹膜表面层 ,其质地较OsO4组明显致密 ,厚薄较均匀平均 4 μm左右 ,表面较光滑。 结论　正常大鼠腹膜表面覆盖着一层腹膜表面层 ,非水性的含OsO4的FC75固定液是固定该表面层的良好固定剂     

Prevention of postoperative peritoneal adhesions: Effects of lysozyme,polylysine and polyglutamate versus hyaluronic acid

Objective. Intraperitoneal adhesions are an important cause of postoperative intestinal obstruction, abdominal discomfort and infertility. In the present study we hypothesized that a combination of polypeptides with different surface properties, resulting in fine disperse low-soluble complexes, could be of benefit in the prevention of abdominal adhesions.Material and methods. Various polypeptides including lysozyme, polyglutamate, polylysine and combinations of all three were evaluated as compared to hyaluronic acid. A standard wound on the parietal peritoneum in mice was used and the evaluated agents were administered immediately postoperatively. The extent of peritoneal adhesions to the injured area was measured and expressed as a percentage of the wound length as evaluated after 7 days. Flow cytometry was performed to evaluate the effect on peritoneal macrophage survival and phagocytic function and the Pick test was used to determine peroxide production in order to estimate toxicity and potential impairment of macrophage function caused by the chemicals.Results. Significant differences were seen among the treatment groups (p<0.001). Both polyglutamate and lysozyme, and polyglutamate together with polylysine significantly decreased adhesion formation as compared to hyaluronic acid. The polylysine–polyglutamate combination was still visible macroscopically on the peritoneal surface after 1 week, though not after 1 month. The polyglutamate–lysozyme mixture was less effective than these individual components alone. The chemicals did not show any toxic effects or altered function in macrophage cell culture.Conclusions. Lysozyme, polyglutamate and, most effectively, a polyglutamate–polylysine combination significantly decreased experimental abdominal adhesion formation. A strong mechanical connection to the wound and prolonged attendance in the surface were noted. Peritoneal phagocyte function did not seem to be influenced by the chemicals.     

Melatonin prevents peritoneal adhesions in rats

Background and Aim:  Intra-abdominal adhesions are important postoperative complications following abdominal surgery. The adhesions that develop form the basis of more advanced pathology such as intestinal obstruction or infertility. Melatonin is secreted from the pineal gland in a circadian pattern; this molecule has potent antioxidant characteristics and has beneficial effects in many models of inflammation. The aim of this study was to evaluate the effects of melatonin on peritoneal adhesions created in rats.
Methods:  A total of 28 Sprague–Dawley male rats were used and divided into four groups. In the first phase of the study, pinealectomy (PINX) was performed on half the animals. An incision was made and sutured in the cecum of all experimental animals in all groups 15 days after the PINX procedure. Some animals were given melatonin orally at a dose of 5 mg/kg daily following the adhesion operation and continued for 15 days. The rats were anesthetized and the abdomen opened after the 15th day (on day 30 of the study). After adhesion scoring based on macroscopic inspection, tissue samples were obtained from the sutured region of the cecum to measure malondialdehyde and hydroxyproline.
Results:  Peritoneal adhesion density was significantly higher in the PINX group compared to the control animals; exogenously administered melatonin significantly reduced adhesion formation. The degree of adhesion was also significantly lower in the intact rats given melatonin compared to the control group.
Conclusion:  Antioxidant activity increases in the oxidative process. We conclude that melatonin may be an important molecule in preventing peritoneal adhesions.     

The efficacy of amniotic membrane-mediated sequential double-barrier therapy for the treatment of postoperative intrauterine adhesions

To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.     

Prevention of Peritoneal Adhesions by Intraperitoneal Administration of Vitamin E: An Experimental Study in Rats

PURPOSE Previous studies have shown dietary supplements of vitamin E to reduce the incidence of postoperative peritoneal adhesions. The objective of this study was to show the effect of intramuscular or intraperitoneal administration of vitamin E on peritoneal adhesions.METHODS Eighty rats were divided into four groups: Group A (control), Group B (intramuscular vitamin E), Group C (intraperitoneal olive oil, the vehicle/diluent of vitamin E), and Group D (intraperitoneal vitamin E diluted in olive oil). The same experimental method was used in all rats to produce adhesions, consisting of cecal abrasion and ligature of the adjacent parietal peritoneum. The rats were killed at 14 days to assess the adhesions occurring. The results were analyzed using a chi-squared test.RESULTS All animals in Groups A, B, and C had substantial adhesions. In Group D, 11 rats had insubstantial adhesions and only 4 had substantial adhesions. There were no significant differences between Groups A, B, and C in terms of percent formation of adhesions. A significant difference was found between Group D (vitamin E plus olive oil by the intraperitoneal route) and each of the experimental groups, A, B, and C (P < 0.0005).CONCLUSIONS Our results show that intraperitoneal administration of vitamin E just before closing the laparotomy was effective for reducing adhesion formation. By contrast, the same effect was not achieved after intramuscular administration.     

Localization and extent of peritoneal calcification in three uremic patients on continuous ambulatory peritoneal dialysis

Peritoneal calcification in three patients on continuous ambulatory peritoneal dialysis (CAPD) was reviewed, and the relation between the localization and extent of calcium deposits detected by abdominal computed tomography (CT) and clinical signs was evaluated. Case 1 was a 48-year-old man with abdominal pain, hemoperitoneum and secondary hyperparathyroidism after receiving CAPD for seven years. An abdominal CT revealed linear peritoneal calcification in the pelvic cavity and liver surface, and his symptoms resolved after switching to hemodialysis. His clinical course and pathological findings were compatible with those in progressive calcifying peritonitis. Case 2 was a 26-year-old man presenting with abdominal pain, vomiting and fullness two years after switching to hemodialysis, because of uncontrolled overhydration following 13 years of CAPD. Plaque-like calcification outlining the small intestine and parietal peritoneum was noted on CT. Case 3 was a 59-year-old man who had abdominal distention, vomiting and diarrhea three months after switching to hemodialysis due to loss of peritoneal function following 10 years of CAPD. CT revealed diffuse sheet-like calcification surrounding the bowel and mesentery, adherent dilated bowel loops and ascites. These CT findings suggested the existence of encapsulating peritoneal sclerosis (EPS) in cases 2 and 3. Findings from our three patients indicate that peritoneal calcification is not always accompanied by EPS; however, monitoring peritoneal calcification and other findings by abdominal CT, even after cessation of CAPD, is crucial to maintain vigilance on whether the subclinical signs, which are temporally diagnosed as progressive calcifying peritonitis, advance to EPS.     

乳酸盐腹膜透析液对人腹膜间皮细胞功能的影响

目的研究乳酸盐腹膜透析液(L-PDF)对人腹膜间皮细胞(HPMC)功能的影响.方法分离HPMC作体外培养,以MTT试验测定HPMC增殖程度;采用ELISA法检测细胞培养液中白细胞介素-8(IL-8)和纤维连接蛋白(FN)的蛋白质水平;逆转录多聚酶链反应检测IL-8mRNA的表达;用Lowry方法检测细胞培养液内总蛋白.结果L-PDF抑制HPMC的增殖,且呈时间依赖关系.L-PDF刺激HPMC后,培养液中IL-8和FN蛋白质水平明显增高,并上调IL-8mRNA的表达.在恢复培养期间,若加用脂多糖(10mg/L)、金黄色葡萄球菌肠毒素(10mg/L)和肿瘤坏死因子-α(TNF-α,10×10