title: Attenuation in peripheral endothelial function after continuous flow left ventricular assist device therapy is associated with cardiovascular adverse events. The efficacy of a hyaluronate/carboxymethylcellulose membrane in prevention of postoperative adhesion in a rat uterine horn model. Reduction of epidural scar adhesion by topical application of simvastatin after laminectomy in rats. Prevention of post-surgical adhesion formation using aspirin in a rodent model: a preliminary report. Simvastatin inhibits tissue factor and plasminogen activator inhibitor-1 expression of glomerular mesangial cells in hypercholesterolemic rabbits. The effect of oral simvastatin on fibrinolytic activity after colorectal surgery-a pilot study. Effects of Intraperitoneal Administration of Simvastatin in Prevention of Postoperative Intra-abdominal Adhesion Formation in Animal Model of Rat. Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study. Analysis of Peridural Scar Formation and Its Prevention After Lumbar Laminotomy and Discectomy in Dogs Metformin and atorvastatin reduce adhesion formation in a rat uterine horn model. Evaluation of topical application and systemic administration of rosuvastatin in preventing epidural fibrosis in rats. Influence of time on risk of bowel resection in complete small bowel obstruction. AbobotulinumtoxinA: A New Therapy for Hip Osteoarthritis. A Prospective Randomized Double-Blind Multicenter Study
abstract: BACKGROUND Patients with heart failure ( HF ) have abnormal endothelial function . Although use of a continuous flow left ventricular assist device ( CF-LVAD ) results in significant hemodynamic improvement , the effects on systemic endothelial function are unclear . METHODS AND RESULTS Eighteen HF patients with CF-LVAD implantation were included in this prospect i ve observational study . We measured  reactive hyperemia index ( RHI ) before and after CF-LVAD implantation to evaluate sequential changes in endothelial function . Patients were followed clinical ly for the occurrence of adverse cardiovascular events , a composite of death , thrombosis , bleeding , HF , renal failure , and arrhythmia . Preoperative RHI was 1.77±0.39 . Early in the postoperative period ( 7 - 14 days after operation ) RHI significantly decreased to 1.19±0.31 ( P<0.001 , compared with preoperative RHI ) . At first and second follow-up ( 4 - 6 weeks and 3 - 7 months after operation ) RHI remained lower at 1.48±0.50 ( P=0.030 ) and 1.26±0.37 ( P=0.002 ) , respectively , compared with preoperative RHI . The decrease in early postoperative RHI relative to preoperative RHI was significantly associated with adverse cardiovascular events  after CF-LVAD ( age-adjusted risk ratio for 0.25 decrease in RHI , 1.35 ; 95 % confidence interval : 1.13 - 1.62 , P=0.001 ) . CONCLUSIONS Peripheral endothelial function had a significant and persistent decline up to 5 months following implantation of CF-LVAD , and this decline was associated with adverse cardiovascular events . These findings may provide insight into some of the vascular complications following CF-LVAD in HF patients The current study was design ed to investigate the efficacy of a hyaluronate/carboxymethylcellulose membrane for the prevention of post-operative adhesion in a rat uterine horn model . This is a prospect i ve double-blinded controlled study . Nineteen injured uterine horns were treated with a hyaluronate/carboxymethylcellulose membrane as a barrier and 19 injured uterine horns without any treatment served as a control group . Two weeks later , second look laparotomies were performed in order to assess the degree of the adhesion . Total adhesion scores , histopathological analysis of inflammation process and vascularization of adhesions were compared with control group . P values of 5 % or less were considered statistically significant . Animals treated with a hyaluronate/carboxymethylcellulose membrane had significantly reduced post-surgical adhesion scores when compared with control group . In histopathological examination , there was less vascularization in the treatment group . The types and extent of inflammation were similar in two groups . Clinical ly and histopathologically , a hyaluronate/carboxymethylcellulose membrane is effective in reducing postoperative adhesion formation in the rat uterine horn model OBJECTIVE Epidural scar adhesion is one of the major causes of the failed back surgery syndrome after laminectomy . Recent studies have shown that simvastatin has potent anti-fibrotic and anti-inflammatory properties . This study evaluates the effect of the topical application of simvastatin on reducing epidural scar adhesion after laminectomy in rats . MATERIAL S AND METHODS Thirty-six male Sprague-Dawley rats were r and omly divided into three groups : control , chitosan and simvastatin group . After laminectomy was performed at L1 level , simvastatin and chitosan were applied to the laminectomy sites . The control group received no additional treatment . Four weeks later , the rats were killed and the epidural adhesion was evaluated by macroscopic assessment , hydroxyproline content analysis and histological analysis . The number of fibroblasts and the optical density of the collagen were also determined . RESULTS The results showed that simvastatin could reduce epidural scar adhesion in rats . Little epidural adhesions were seen in the laminectomy sites treated with simvastatin . The hydroxyproline content , the number of fibroblasts and the optical density of the collagen in the simvastatin group were significantly less than those of the chitosan and control group . However , dense epidural adhesion was found in control group . CONCLUSIONS Topical application of simvastatin could reduce epidural scar adhesion after laminectomy in rats . Further research is necessary to determine the optimal dosage and the safety of simvastatin Pelvic adhesions are one of the major factors which significantly and adversely affect surgery outcome due to intra- and postoperative morbidity and reduce future female fertility . Using a rodent model , we evaluated the efficacy of aspirin , a non-steroidal anti-inflammatory drug , in the prevention of adhesion formation . A total of 72 female Wistar rats received a st and ardized primary traumatic lesion to the right uterine horn . They were r and omly divided into eight groups : group I ( control ) had no treatment and group II received a single pre-operative 0.70 mg aspirin . All the succeeding groups ( III-VIII ) received aspirin in doses of 0.35 , 0.70 , or 1.40 mg every 6 h for either 48 or 96 h in addition to the pre-operative aspirin ( 0.70 mg ) . All animals were killed 4 weeks later and adhesions were assessed using a modified adhesion scoring scale . The lowest adhesion score was found in the group treated with 0.35 mg of aspirin for 96 h , and the highest was found among the groups treated with either 0.70 or 1.40 mg for 48 - 96 h respectively ( P < 0.05 ) . These results are in line with the hypothesis that administration of a low dose of aspirin selectively inhibits the production of thromboxane A2 , whereas basal prostacyclin bio synthesis is preserved . This phenomenon might contribute to reducing postoperative adhesion formation in a rat model . Thus , future studies into the prevention of adhesion formation may require the additional use of a non-steroidal anti-inflammatory drug , for which aspirin deserves further attention , before extrapolation into human therapy Tissue factor ( TF ) and plasminogen activator inhibitor-1 ( PAI-1 ) activity and /or expression are upregulated in hypercholesterolemia . Despite extensive research on anti-thrombotic effect of statins , little is known about their effects on TF and PAI-1 expression in glomerular mesangial cells under hypercholesterolemic condition . Male rabbits were fed on either normal or high-cholesterol diet for 8 weeks . Then cholesterol-fed rabbits were r and omly assigned to simvastatin or starch . At the end of 12 weeks , glomerular mesangial cells were collected . The concentrations of TF and PAI-1 mRNA were detected by RT-PCR . The plasma activities of TF and PAI-1 were determined with enzyme linked immunosorbent assay ( ELISA ) and chromogenic substrate method , respectively . The atherogenic diet caused a consistent increase in serum concentrations of total cholesterol ( TC ) and serum triglyceride ( TG ) ( p < 0.05 ) , increased TF and PAI-1 mRNA expression in glomerular mesangial cells and plasma activities as compared to the normal diet ( p < 0.01 ) . Four-week simvastatin treatment result ed in significant decrease of mesangial TF and PAI-1 mRNA ( p < 0.01 ) , and also of the plasma activities of TF ( p < 0.05 ) and PAI-1 ( p < 0.01 ) . These results suggest that simvastatin might protect kidney from the formation of microthrombus under hypercholesterolemic condition and might be a possible pathogenesis of obesity-related glomerulopathy BACKGROUND Studies conducted in animal models have shown that statins ( 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors ) reduce adhesion formation by upregulating fibrinolysis . The aim of this study was to determine the effect of orally administered statins on the promoters and inhibitors of the fibrinolytic pathway . METHODS In a previously described double-blinded clinical trial , 144 patients undergoing elective colorectal resection , or reversal of Hartmann 's procedure were r and omized to receive 40 mg once daily oral simvastatin 3 - 7 d before surgery or placebo . For the purpose s of the present study , peritoneal drain fluid was collected postoperatively from patients to measure active tissue plasminogen activator ( tPA ) , tissue plasminogen activator total antigen , active plasminogen activator inhibitor-1 ( PAI-1 ) , plasminogen activator inhibitor total antigen ( PAI-1TA ) , plasminogen activator inhibitor-1 and tissue plasminogen activator complex ( PAI-1/tPA ) . These were analyzed using ELISA . The number of hospitalizations and complications related to small bowel obstruction ( SBO ) were recorded at 2 y after surgery . RESULTS A total of 95 patients ( 72 % ) had sufficient peritoneal drain fluid suitable for ELISA analysis . Of them , 46 patients ( 48 % ) were from the oral simvastatin group . Mean tPA and tPA total antigen concentrations in peritoneal fluid were similar between the two groups . Mean PAI-1 and PAI-1 TA concentrations in the statin and placebo group were also similar . Mean PAI-1/tPA complex concentration was similar between the two groups . The number of hospitalizations from SBOs were 5 and 4 in the statin and placebo groups respectively ( P = 0.46 ) . The overall mortality at 2-year post-surgery was similar between the two groups ( P = 0.59 ) . CONCLUSIONS In this pilot study involving humans , oral simvastatin had no measured effect on the peritoneal fibrinolytic pathway in the first 24 h after colorectal surgery . Analysis of clinical outcomes also showed that oral simvastatin did not reduce hospitalizations for SBO in the 2 y after surgery . Further studies may be useful to evaluate whether fibrinolytic pathways beyond 24 h are altered after systemic administration of statins and to evaluate the use of higher doses of statins , perhaps used intraperitoneally rather than systemically OBJECTIVE To determine the preventive effects of local administration of simvastatin for postoperative intra-abdominal adhesion formation in animal model of rat . METHODS In this experimental study , 32 Wistar albino rats as the animal model of intra-abdominal adhesion formation were included . Adhesions were induced in all the animals via abrasion of the peritoneal and intestinal surface during laparotomy . Afterwards , the rats were r and omly assigned to receive simvastatin ( 30 mg/kg body weight ) as a single intraperitoneal dose at the time of laparotomy ( n=16 ) or normal saline in same volume at the same time ( n=16 ) . At the day 21 , animals were euthanized and the adhesions were quantified clinical ly ( via repeated laparotomy ) and pathologically and compared between the two groups . RESULTS The baseline characteristics of the animals were comparable between two study groups . Clinical ly , in simvastatin group , 10 rats ( 62.5 % ) did not develop any adhesion and 6 ( 37.5 % ) had first- grade adhesion ; whereas in the control group , 11 ( 68.8 % ) rats had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . Pathologically , in simvastatin group , 6 rats ( 37.5 % ) had first- grade adhesion , while in control group , 11 rats ( 68.8 % ) had first- and 5 ( 31.2 % ) had second- grade adhesions ( p<0.001 ) . CONCLUSION Our findings suggest that intraperitoneal administration of simvastatin is an effective method for prevention of postoperative intra-abdominal adhesion formation in animal model of rat BACKGROUND Postoperative abdominal adhesions are associated with numerous complications , including small bowel obstruction , difficult and dangerous reoperations , and infertility . A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane ( HA membrane ) was developed to reduce formation of postoperative adhesions . The objectives of our prospect i ve study were to assess the incidence of adhesions that recurred after a st and ardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions . STUDY DESIGN Eleven centers enrolled 183 patients with ulcerative colitis or familial polyposis who were scheduled for colectomy and ileal pouch-anal anastomosis with diverting-loop ileostomy .  Before abdominal closure , patients were r and omly assigned to receive or not receive HA membrane placed under the midline incision . At ileostomy closure eight to 12 weeks later , laparoscopy was used to evaluate the incidence , extent , and severity of adhesion formation to the midline incision . RESULTS Data were analyzed for 175 assessable patients . While only five ( 6 percent ) of 90 control patients had no adhesions , 43 ( 51 percent ) of 85 patients receiving HA membrane were free of adhesions ( p < 0.00000000001 ) . The mean percent of the incision length involved was 63 percent in the control group , significantly greater than the 23 percent observed in patients who received HA membrane ( p < 0.001 ) . Dense adhesions were observed in 52 ( 58 percent ) of the 90 control patients , but in only 13 ( 15 percent ) of the 85 receiving HA membrane ( P < 0.0001 ) . Comparison of the incidence of specific adverse events between the groups did not identify a difference ( P > 0.05 ) . CONCLUSIONS This study represents the first controlled , prospect i ve evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using st and ardized , direct peritoneal visualization . In this study , HA membrane was safe and significantly reduced the incidence , extent , and severity of postoperative abdominal adhesions Study Design Peridural fibrosis after lumbar laminectomy and discectomy has been implicated ( not proven ) as one of the factors that contribute to continuing or recurrent radicular and /or low back pain . This animal experimental study was design ed to unequivocally show the stages in the development of scar tissue and to what extent , if any , scar tissue development is influenced by interposing fat grafts and Na hyaluronate of different molecular weights . Methods A four-level unilateral lumbar laminotomy , anular fenestration , and nucleotomy was performed in 11 dogs . In each dog , levels were selected at r and om : one to serve as an empty control and three to insert the following : a fat graft , a viscous ( 1.9 % ) solution of Na hyaluronate , and a 1 % high molecular weight solution of Na hyaluronate solution . The animals were killed at 1 day , 2 days , and 1 , 2 , 4 , and 12 weeks postoperatively . Immediately after the dogs were killed , the lumbar spines were frozen in situ with dry ice , the lumbar spines were harvested and sectioned with a cryomicrotome . Close-up photographs taken at su bmi llimeter intervals at each level were digitized and postprocessed with a computer . Results In the early postoperative period a hematoma was found in the pathway of the surgical dissection . During a 2 - 4-week period , this hematoma was replaced by a thick , white fibrotic tissue mass . Fibrosis was markedly less pronounced at the hyaluronate levels , especially the high molecular weight subset . Twoway statistical analysis of variance without replications revealed significantly less scar formation at the 0.05 level in the hyaluronate vs. the control segments . Dunnett 's test , comparing each group individually with the control , revealed no difference between the fat groups and the control subjects . There was a significant difference between 1.9 % Na hyaluronate and control . Conclusions Viscous hyaluronate solution with its semifluid properties coats the nerve roots and dura anteriorly and posteriorly and reduces peridural fibrosis in the critical anterior region where adhesions form between the nerve root and anulus fibrosus The aim of the present study was to determine whether atorvastatin and metformin are effective in preventing adhesions in a rat uterine horn model . A total of 40 non-pregnant , female Wistar albino rats , weighing 180 - 210 g , were used as a model for post-operative adhesion formation . The rats were r and omized into four groups after seven st and ard lesions were inflicted in each uterine horn and lower abdominal sidewall using bipolar cauterization . The rats were given atorvastatin 2.5 mg/kg/day , p.o . ( 10 rats ) , atorvastatin 30 mg/kg/day , p.o . ( 10 rats ) , metformin 50 mg/kg/day , p.o . ( 10 rats ) and no treatment was applied in the control group ( 10 rats ) . The animals were killed 2 weeks later and adhesions were scored both clinical ly and pathologically by authors blinded to groups . One rat in the control group died before the end of the 2 week period . Total clinical adhesion scores regarding extent , severity and degree of adhesions and histopathological findings including inflammation and fibrosis were significantly lower in the metformin ( P < 0.001 and P < 0.01 , respectively ) and atorvastatin 30 mg/kg/day ( P < 0.001 and P < 0.01 , respectively ) groups when compared with control group . Metformin and atorvastatin are both effective for prevention of adhesion formation in a rat uterine horn model BACKGROUND CONTEXT Epidural fibrosis is a major challenge in spine surgery , with some patients having recurrent symptoms secondary to excessive formation of scar tissue result ing in neurologic compression . One of the most important factors initiating the epidural fibrosis is assumed to be the transforming growth factor-1β ( TGF-1β ) . Rosuvastatin ( ROS ) has shown to demonstrate preventive effects over fibrosis via inhibiting the TGF-1β . PURPOSE We hypothesized that ROS might have preventive effects over epidural fibrosis through the inhibition of TGF-1β pathways . STUDY DESIGN Experimental animal study . METHODS Forty-eight adult male Wistar Albino rats were equally and r and omly divided into four groups ( laminectomy , spongostan , topical ROS , and systemic ROS ) . Laminectomy was performed at the L3 level in all rats . Four weeks later , the extent of epidural fibrosis was assessed both macroscopically and histopathologically . RESULTS Our data revealed that topical application and systemic administration of ROS both were effective in reducing epidural fibrosis formation . Furthermore , the systemic administration of ROS yielded better results than topical application . CONCLUSIONS Both topical application and systemic administration of ROS show meaningful preventive effects over epidural fibrosis through multiple mechanisms . The results of our study provide the first experimental evidence of the preventive effects of ROS over epidural fibrosis BACKGROUND Little is known about the effect of passing time on risk of resection among patients with complete small bowel obstruction . We sought to provide a benchmark of the relationship of time from symptom onset to surgical treatment on the need for resection in patients with complete small bowel obstruction . STUDY DESIGN We performed an observational study of patients with surgically treated complete small bowel obstruction at an inner-city urban tertiary referral center and a municipal hospital . Patients were sample d r and omly retrospectively ( n=60 ) , and prospect ively ( n=81 ) , for a final sample of 141 . Detailed clinical and time data were abstract ed from medical records including out-of-hospital examinations . Risk of resection  was calculated using actuarial life table methods . Linear regression was used to determine factors affecting time to treatment . RESULTS All patients were treated surgically for obstruction ; 45 % underwent resection . Resected patients had longer ( 11 days versus 8 days ; p=0.01 ) and more complicated ( 31 % versus 14 % in ICU ; p=0.01 ) hospital stays . The risk of resection  was 4 % among patients with 24 hours of unresponsive symptoms ; it increased to 10 % to 14 % through 96 hours , then dropped slightly but did not disappear . Patients treated first with a tube had longer times between first examination and operation , system-time ( 40.6 hours versus 10.2 hours ; p=0.0007 ) , but this was not associated with an increased resection risk . System-times were shorter among patients seen first in the emergency department ( median : 25.7 hours versus 59.7 hours ; p=0.0001 ) . CONCLUSIONS Physicians should be cautious in postponing surgery beyond 24 hours in patients with unresponsive symptoms from complete obstruction . The risk of resection  rises dramatically , remains elevated through 96 hours of unresolved symptoms , then declines but does not disappear Hip Osteoarthritis ( OA ) causes pain and disability . Here we evaluate abobotulinumtoxinA ( Dysport ® ) ( AboBoNT-A ) injections versus placebo as a novel treatment option to improve hip range of motion , pain and quality of life . This prospect i ve r and omized double-blind multicenter study ( EudraCT # 2012 - 004890 - 25 ) recruited 46 out patients with hip OA who were r and omized 2:1 to the Treatment Group ( TG ; 31 subjects ) , or the Placebo Group ( PG ; 15 subjects ) . The TG received 400 U of AboBoNT-A injected into the adductor muscles , and the PG received placebo solution . The primary endpoints were the difference in Harris Hip Score ( HHS ) and Visual Analogic Scale for pain ( VAS ) at Week 4 between groups ( TG vs. PG ) . Secondary endpoints were the change from baseline in HHS , VAS pain , Medical Research Council scale for muscle strength ( MRC ) and Short Form scale ( SF-36 ) scores . In TG at Week 4 , the HHS and VAS score were significantly improved compared to PG , and pairwise assessment s showed significant improvements in HSS and VAS pain at each time point compared to baseline for TG . No significant changes were observed in MRC and SF-36 over time , though SF-36 showed a positive trend . There were no significant differences from baseline in the PG . No adverse events were detected in either treatment group . AboBoNT-A injections in hip OA improve range of motion and pain without any significant side effects
target: In conclusion , statins were effective in preventing postoperative adhesion , as assessed based on gross and microscopic adhesion scores in rats
background: Adhesion is a significant concern after surgery .
  Many research ers studied the anti-adhesive effect of statin , of which results were inconsistent .
  Thus , we purpose d to perform a systematic review and meta- analysis to evaluate the effect of statins on postoperative adhesion in an experimental study .