PDF(Pubmed)
Abstract：
BACKGROUND: Congenital diaphragmatic hernia (CDH) repair is an area of active research. Large defects requiring patches have a hernia recurrence rate of up to 50%. We designed a biodegradable polyurethane (PU)-based elastic patch that matches the mechanical properties of native diaphragm muscle. We compared the PU patch to a non-biodegradable Gore-Tex™ (polytetrafluoroethylene) patch.
METHODS: The biodegradable polyurethane was synthesized from polycaprolactone, hexadiisocyanate and putrescine, and then processed into fibrous PU patches by electrospinning. Rats underwent 4 mm diaphragmatic hernia (DH) creation via laparotomy followed by immediate repair with Gore-Tex™ (n = 6) or PU (n = 6) patches. Six rats underwent sham laparotomy without DH creation/repair. Diaphragm function was evaluated by fluoroscopy at 1 and 4 weeks. At 4 weeks, animals underwent gross inspection for recurrence and histologic evaluation for inflammatory reaction to the patch materials.
RESULTS: There were no hernia recurrences in either cohort. Gore-Tex™ had limited diaphragm rise compared to sham at 4 weeks (1.3 mm vs 2.9 mm, p = 0.003), but no difference was found between PU and sham (1.7 mm vs 2.9 mm, p = 0.09). There were no differences between PU and Gore-Tex™ at any time point. Both patches formed an inflammatory capsule, with similar thicknesses between cohorts on the abdominal (Gore-Tex™ 0.07 mm vs. PU 0.13 mm, p = 0.39) and thoracic (Gore-Tex™ 0.3 mm vs. PU 0.6 mm, p = 0.09) sides.
CONCLUSIONS: The biodegradable PU patch allowed for similar diaphragmatic excursion compared to control animals. There were similar inflammatory responses to both patches. Further work is needed to evaluate long-term functional outcomes and further optimize the properties of the novel PU patch in vitro and in vivo.
METHODS: Level II, Prospective Comparative Study.
METHODS: The biodegradable polyurethane was synthesized from polycaprolactone, hexadiisocyanate and putrescine, and then processed into fibrous PU patches by electrospinning. Rats underwent 4 mm diaphragmatic hernia (DH) creation via laparotomy followed by immediate repair with Gore-Tex™ (n = 6) or PU (n = 6) patches. Six rats underwent sham laparotomy without DH creation/repair. Diaphragm function was evaluated by fluoroscopy at 1 and 4 weeks. At 4 weeks, animals underwent gross inspection for recurrence and histologic evaluation for inflammatory reaction to the patch materials.
RESULTS: There were no hernia recurrences in either cohort. Gore-Tex™ had limited diaphragm rise compared to sham at 4 weeks (1.3 mm vs 2.9 mm, p = 0.003), but no difference was found between PU and sham (1.7 mm vs 2.9 mm, p = 0.09). There were no differences between PU and Gore-Tex™ at any time point. Both patches formed an inflammatory capsule, with similar thicknesses between cohorts on the abdominal (Gore-Tex™ 0.07 mm vs. PU 0.13 mm, p = 0.39) and thoracic (Gore-Tex™ 0.3 mm vs. PU 0.6 mm, p = 0.09) sides.
CONCLUSIONS: The biodegradable PU patch allowed for similar diaphragmatic excursion compared to control animals. There were similar inflammatory responses to both patches. Further work is needed to evaluate long-term functional outcomes and further optimize the properties of the novel PU patch in vitro and in vivo.
METHODS: Level II, Prospective Comparative Study.
摘要：
背景：先天性膈疝（CDH）修复是一个活跃的研究领域。需要补片的大缺陷具有高达50%的疝复发率。我们设计了一种基于可生物降解的聚氨酯（PU）的弹性贴片，该贴片与天然diaphragm肌的机械性能相匹配。我们将PU贴片与不可生物降解的Gore-Tex™(聚四氟乙烯)贴片进行了比较。
方法：以聚己内酯为原料合成可生物降解聚氨酯，六异氰酸酯和腐胺，然后通过静电纺丝加工成纤维状PU贴片。大鼠通过剖腹手术进行4毫米膈疝（DH）产生，然后立即用Gore-Tex™（n=6）或PU（n=6）补片进行修复。六只大鼠进行了假剖腹手术，没有DH产生/修复。在第1周和第4周通过透视检查评估膈肌功能。4周时,对动物进行了总体检查以了解其复发情况,并进行了组织学评估以了解对贴片材料的炎性反应.
结果：两组均无疝气复发。与4周时的假手术相比，Gore-Tex™的隔膜上升有限（1.3mmvs2.9mm，p=0.003),但PU和Sham之间没有发现差异(1.7毫米vs2.9毫米，p=0.09)。在任何时间点,PU和Gore-Tex™之间没有差异。两片都形成了炎症包膜，腹部队列之间的厚度相似(Gore-Tex™0.07mmvs.PU0.13mm,p=0.39)和胸部(Gore-Tex™0.3mmvs.PU0.6mm,p=0.09)边。
结论:与对照动物相比,可生物降解的PU贴剂允许类似的膈偏移。两种斑块都有相似的炎症反应。需要进一步的工作来评估长期功能结果并进一步优化新型PU贴片在体外和体内的特性。
方法：二级，前瞻性比较研究。
方法：以聚己内酯为原料合成可生物降解聚氨酯，六异氰酸酯和腐胺，然后通过静电纺丝加工成纤维状PU贴片。大鼠通过剖腹手术进行4毫米膈疝（DH）产生，然后立即用Gore-Tex™（n=6）或PU（n=6）补片进行修复。六只大鼠进行了假剖腹手术，没有DH产生/修复。在第1周和第4周通过透视检查评估膈肌功能。4周时,对动物进行了总体检查以了解其复发情况,并进行了组织学评估以了解对贴片材料的炎性反应.
结果：两组均无疝气复发。与4周时的假手术相比，Gore-Tex™的隔膜上升有限（1.3mmvs2.9mm，p=0.003),但PU和Sham之间没有发现差异(1.7毫米vs2.9毫米，p=0.09)。在任何时间点,PU和Gore-Tex™之间没有差异。两片都形成了炎症包膜，腹部队列之间的厚度相似(Gore-Tex™0.07mmvs.PU0.13mm,p=0.39)和胸部(Gore-Tex™0.3mmvs.PU0.6mm,p=0.09)边。
结论:与对照动物相比,可生物降解的PU贴剂允许类似的膈偏移。两种斑块都有相似的炎症反应。需要进一步的工作来评估长期功能结果并进一步优化新型PU贴片在体外和体内的特性。
方法：二级，前瞻性比较研究。
