Dr. Eisenhardt is funded by the German Research Foundation (DFG) # EI 866/1-1 and #EI 866/2-1.

<ol>
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The authors have nothing to disclose.

Even though different surgical techniques have been described to regain a dynamic smile in patients with long standing facial paralysis, the two-stage repair with initial cross facial nerve grafting and consecutive free gracilis muscle transfer is seen as the &#8220;criterion standard&#8221;.
Although a two-stage procedure, the technique allows for spontaneity of the smile which is seen as a crucial factor to overcome the social handicap associated with facial palsy13.In cases of bi...

وتشارك العصب الوجهي في حماية العين، التعبير، والزهد عن طريق الفم ويؤثر بشكل كبير على المظهر الجمالي للوجه. لذا يرتبط انخفاض قيمة هذا العصب مع قسط كبير من المراضة والانسحاب الاجتماعي. وعلى الرغم من التقدم الكبير في العلاج، والعديد من المشاكل المرتبطة الوجه مشلولة لا يمكن إلا أن تكون مستهدفة مع مجموعة واسعة من إجراءات إضافية. مشتركة بين جميع التقنيات الجراحية هو الحاجة إلى المعرفة التشريحية الدقيقة. الوجه تشريح الأعصاب يتكون العصب الوجهي عنصر محرك الخيشومي من أجل السيطرة الطوعية المحرك للعضلات الوجه وعنصر محرك الحشوية من أجل السيطرة الحركية من الدمعية، تحت الفك السفلي والغدد تحت اللسان. الى جانب ذلك، هناك نوعان من المكونات الحسية للتعصيب من القناة السمعية الخارجية وللطعم في الأمامي ثلثي اللسان. مسار العصب الوجهي يمكن بالبريد تنقسم إلى ثلاثة أجزاء: داخل الجمجمة، intratemporal، وextratemporal. في هذا الجزء داخل الجمجمة، والمجموعة العليا من الخلايا العصبية التي يعصب العضلة الجبهية والمنطقة محيط بالأذن تتلقى مدخلات القشرية الثنائي. الخلايا العصبية التي يعصب عضلات الوجه المتبقية تتلقى مدخلات القشرية المقابل حصرا. ونتيجة لذلك، يتم الحفاظ وظيفة الجبهي في الآفات فوق النووي المماثل. ويمكن تقسيم الجزء intratemporal الى مزيد من ثلاثة أجزاء. في هذا الجزء يشبه المتاهة، والعصب الصخري أكبر يترك جذع لتزويد الغدة الدمعية مع ألياف غير المتجانسة 1. في هذا الجزء الخشاء، والركابية العصبية رقيقة يمتد إلى العضلات مراسل. فروع السمبتاوي يعصب تحت الفك السفلي، تحت اللسان والغدد اللغات الأمامي، في حين يتم تزويد الأمامية ثلثي اللسان مع الألياف الذوقية (حبل الطبل). الجذع الرئيسي للعصب الوجه مخارج القناة العظميةمن خلال الثقبة الإبرية الخشائية. هذا هو بداية الجزء extratemporal، ومع ذلك لم يبدأ arborisation قبل الدخول الغدة النكفية. وينقسم العصب لأول مرة في 3 إلى 4 أقسام السيارات التي تشكل الضفيرة intraparotid وإعطاء في نهاية المطاف إلى ظهور الزمني، الوجني، الشدق، الفك السفلي وفروع سرطان عنق الرحم 2. التشخيص التفريقي من شلل في الوجه كما المسببات من شلل في الوجه واسع ويصعب تصنيفها، ينبغي النظر في التقسيم الذي يتأثر أولا. يمكن أن يكون سبب شلل في الوجه داخل الجمجمة بواسطة عوائق جوبية أو أورام تجويف داخل الجمجمة. الالتهابات البكتيرية والفيروسية، كوليستيرولي وشلل بيل يمكن أن يكون أسباب تلف الأعصاب intratemporal. الأورام الخبيثة الأورام والعلاج الجراحي يرتبط بها هي الأسباب الغالبة للشلل في الوجه extratemporal. وعلى الرغم من شلل بيل يمثل التشخيص الأكثر شيوعافي المرضى الذين يعانون من شلل في الوجه، ومعظم الحالات تشفى تماما دون عقابيل ولست بحاجة لعملية جراحية 3. السبب الثاني الأكثر شيوعا من الشلل في الوجه هو الصدمة. هنا، بكسور في العظم الصدغي هي آلية الصدمة السائدة 4. أنواع علاج الشلل الوجهي وتوجد العديد من الخيارات الجراحية لعلاج شلل في الوجه، وأنها يمكن تصنيفها إلى عودة التعصيب، وإعادة الإعمار وإعادة البناء ثابت ديناميكي. عادة، تعتبر عامين لتكون هذه المرة من الاصابة التي وظيفة بعد عودة التعصيب يمكن استعاد مرضية مع reinnervating إجراءات 5. في وقت لاحق، وضمور إزالة التعصيب عضلات الوجه يمنع فائدتها لمزيد من إعادة الإعمار. ويمكن الحصول على عودة التعصيب بواسطة إصلاح الأساسي العصبية، الطعوم العصبية بين المواقع، عبر الوجه تطعيم العصب أو نقل العصب القحفي. وتوجه تقنيات إعادة الإعمار ثابتة لتصحيحالإعاقة الوظيفية، (حماية القرنية، وتحسين تدفق الهواء عن طريق الأنف، والوقاية من سيلان اللعاب) وتحسين التماثل في بقية. وbrowlift إجراءات نموذجية لإطراق الحاجب، أو رأب الموق لانخفاض الشتر الخارجي غطاء. ويفضل إعادة الإعمار ثابت في المرضى المسنين مع التواكب المرضي كبيرة أو العيوب في الوجه ضخمة الثانوية للصدمات أو استئصال السرطان. ويمكن تقسيم التقنيات الجراحية لإعادة الإعمار الحيوية في نقل العضلات الإقليمي ونقل العضلات microneurovascular الحرة مع إما تلئيم إلى فرع الماضغة المحرك أو عبر ترقيع الوجه العصبية. يمثل هذا الأخير المعيار معيار لإعادة إعمار الابتسامة في شلل في الوجه، كما لا خيار العلاج الآخر يحقق ابتسامة عفوية وحيوي لتحسين عائق اجتماعي موثوق بها. تلئيم إلى فرع الماضغة المحرك هو طريقة العلاج الأمثل لمرضى الشلل الثنائي، ومع ذلك مؤشرات لديهم تحويلةانتهى، والمرضى المسنين أو المرضى الذين يعانون من أمراض المصاحبة كبيرة عادة ما يفضلون إجراء مرحلة واحدة (6). الناحلة رفرف التشريح الناحي العضلة الناحلة هي العضلات السطحية بدلا من الفخذ وسطي، وهو ما يمثل اطول عضلة من عضلات المقربة. كان مصدره من أقل الارتفاق والفرع السفلي من العانة. تشغيل بشكل أقصى، وتصبح العضلات الضيقة وإدراج البعيدة لمفصل الركبة في الساق التي تسمح التقريب ليس فقط من الفخذ ولكن أيضا انثناء الركبة. العضلة الناحلة لديها نوع II نمط الدورة الدموية بعد Mathes وNahai مع وجود العرض الشرايين من المهيمنة وبعض السويقات الصغيرة الأوعية الدموية 7. الشريان المهيمن مخارج العضلات في نقير لبالطبع أفقيا وتنتهي في الشريان المنعطف وسطي عادة. نادرا، الشريان المهيمن إنهاء مباشرة في الشريان الفخذي العميق. العرض الوريدي من الجرانيتوعادة ما يتحقق العضلات cilis من خلال اثنين المرافقة للوريد، التي بالطبع عميق في العضلات المقربة الطويلة لمتابعة الشريان المهيمن. ويتحقق تعصيب العضلات من خلال فرع الأمامي للعصب المسد الذي يدخل العضلات 1-2 سم متفوق إلى نقير. الاستخدام السريري العضلة الناحلة هي العضلات المانحة قيمة لجراحة الترميمية وأصبحت العضلات المفضل لكثير من الجراحين لنقل العضلات الحرة وظيفية. ويعود ذلك إلى حقيقة أن هناك القليل الموقع المانحة الاعتلال ويظهر رفرف النسب المثلى فيما يتعلق رحلة من العضلات والأوعية الدموية أبعاد عنيق على التوالي. وهناك واحد طويل معصب العصب المحرك يخفف رفرف وظيفية الحصاد 8. نحن هنا لشرح حالة امرأة عمرها 49 سنة، الذي قدم في البداية مع صورة كاملة من شلل في الوجه المحيطي غادر التالية استئصال لالصوتيةالعصب (شفاني الدهليزي) في وقت سابق من 2 سنة. وكان المريض الأكثر تعاني من عدم تناسق الوجه، وخاصة عندما يبتسم. لم يتم توثيقها التواكب المرضي الموجودة مسبقا الأخرى. على الفحص السريري، وأظهر المريض شلل جزئي الكامل للعضلة الجبهي، ولكن التماثل الجبين مرضية في بقية. كان إغلاق غطاء كاف على اليسار مع عين أرنبية من 5 ملم وظاهرة بيل. كانت علامات تهيج القرنية والشتر الخارجي غائبة. في بقية، أظهر المريض عدم التماثل المعتدل في زاوية الفم مع مسافة الزنمة-عماد القوقعة من 11 سم على اليمين و 11.5 سم على اليسار في بقية. على الابتسام، وبعد المسافة الزنمة-عماد القوقعة تقليصها إلى 9 سم على اليمين وعلى اليسار ممدود إلى 12 سم. بعد تقديم المشورة واسعة، تمنى المريض لإعادة الإعمار ديناميكي واحد قام من الابتسامة مع نقل الناحلة وظيفية مجانا باستخدام الماضغة كما العصبية المانحة. وأبلغت المريض أيضا حول مختلف الشركة المصرية للاتصالاتchniques الشركة من إعادة الإعمار إغلاق الغطاء، ومع ذلك رفض العلاج الجراحي في هذه المرحلة. وكانت الدورة من العلاج غير معقدة. وقد لاحظت علامات عودة التعصيب أول ثلاثة أشهر بعد العمل الجراحي. بعد أربعة أشهر من الجراحة، والمريض قدم مع تندب عادي على طول خط المعدلة وتجميل شق السابق. التماثل في بقية ومدروسة يبتسم كانت ممتازة مع تعريف مرض تجعد الأنفية الشفوية. أظهر المريض أيضا ابتسامة عفوية تماما. وقد تم توثيق قبل و9 أشهر بعد العملية الجراحية مجموعة من رحلة من زاوية الفم من قبل بالفيديو.

<table border="0" cellpadding="0" cellspacing="0" width="612">
	<tbody>
		<tr height="43">
			<td height="43" style="height:43px;width:216px;">Name of Material/ Equipment</td>
			<td style="width:111px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:167px;">Comments/Description</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Nylon Suture, 9-0</td>
			<td>Serag Weissner</td>
			<td>Z0039490</td>
			<td>&#176;</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Polypropylene Suture&#160;</td>
			<td>Ethicon</td>
			<td>-</td>
			<td>Multiple thread sizes</td>
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			<td height="20" style="height:20px;">Microsurgical instruments lab set</td>
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			<td>Diener</td>
			<td>64,562</td>
			<td>&#176;</td>
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			<td height="20" style="height:20px;">Applying forceps</td>
			<td>Diener</td>
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			<td>for Biemer vessel clip</td>
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			<td height="20" style="height:20px;">Cefuroxim 1500mg</td>
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			<td height="20" style="height:20px;">Braunoderm</td>
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			<td height="21" style="height:21px;">Myacyne Ointment</td>
			<td>Schur Pharma</td>
			<td>-</td>
			<td></td>
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single-stage dynamic reanimation of the smile in irreversible facial paralysis by free functional muscle transfer

Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic facial paralysis (Bell&#8217;s palsy) is the most common diagnosis, patients can also present with a history of physical trauma, infectious disease, tumor, or iatrogenic facial paralysis. Early repair within one year of injury can be achieved by direct nerve repair, cross-face nerve grafting or regional nerve transfer. It is due to muscle atrophy that in long lasting facial paralysis complex reconstructive methods have to be applied. Instead of one single procedure, different surgical approaches have to be considered to alleviate the various components of the paralysis.
The reconstruction of a spontaneous dynamic smile with a symmetric resting tone is a crucial factor to overcome the functional deficits and the social handicap that are associated with facial paralysis. Although numerous surgical techniques have been described, a two-stage approach with an initial cross-facial nerve grafting followed by a free functional muscle transfer is most frequently applied. In selected patients however, a single-stage reconstruction using the motor nerve to the masseter as donor nerve is superior to a two-stage repair. The gracilis muscle is most commonly used for reconstruction, as it presents with a constant anatomy, a simple dissection and minimal donor site morbidity.
Here we demonstrate the pre-operative work-up, the post-operative management, and precisely describe the surgical procedure of single-stage microsurgical reconstruction of the smile by free functional gracilis muscle transfer in a step by step protocol. We further illustrate common pitfalls and provide useful tips which should enable the reader to truly comprehend the procedure. We further discuss indications and limitations of the technique and demonstrate representative results.

<html> تم تقييم استخدام العصب الماضغي لعودة التعصيب من الكسب غير المشروع العضلات في 5 مرضى (الجدول 1). من بينها، كان العصب السمعي استئصال السبب الرئيسي لشلل في الوجه. يفضل 3 مرشحين الإجراء مرحلة واحدة بدلا من &quot;المعيار الذهبي&quot; نهج مرحلتين. في اثنين من المرضى، و...

Watch this Scientific Journal Video about Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer at JoVE.com

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

The use of the masseteric nerve as donor nerve represents a single-stage alternative to the criterion standard two-stage procedure of cross-facial nerve grafting and free muscle transfer in facial paralysis. We provide a detailed description to safely perform this technique with a gracilis muscle transfer and discuss indications and limitations.

مرحلة واحدة الديناميكي الإنعاش للابتسامة في الوجه لا رجعة فيه الشلل التي كتبها مجاني نقل العضلات الوظيفي

Unilateral facial paralysis is a common disease that is associated with significant functional, aesthetic and psychological issues. Though idiopathic ...

single-stage-dynamic-reanimation-smile-irreversible-facial-paralysis

Research

JoVE Journal

Medicine

105.8K Views.  University of Freiburg Medical Centre. The use of the masseteric nerve as donor nerve represents a single-stage alternative to the criterion standard two-stage procedure of cross-facial nerve grafting and free muscle transfer in facial paralysis. We provide a detailed description to safely perform this technique with a gracilis muscle transfer and discuss indications and limitations.

Video: Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer

In Vivo Canine Muscle Function Assay

We describe a minimally-invasive and reproducible method to measure canine pelvic limb muscle strength and muscle response to repeated eccentric 
contractions. The pelvic limb of an anesthetized dog is immobilized in a stereotactic frame to align the tibia at a right angle to the femur. Adhesive wrap affixes the 
paw to a pedal mounted on the shaft of a servomotor to measure torque. Percutaneous nerve stimulation activates pelvic limb muscles of the paw to either push (extend) or 
pull (flex) against the pedal to generate isometric torque. Percutaneous tibial nerve stimulation activates tibiotarsal extensor muscles. Repeated eccentric (lengthening) 
contractions are induced in the tibiotarsal flexor muscles by percutaneous peroneal nerve stimulation. The eccentric protocol consists of an initial isometric contraction 
followed by a forced stretch imposed by the servomotor. The rotation effectively lengthens the muscle while it contracts, e.g., an eccentric contraction. During 
stimulation flexor muscles are subjected to an 800 msec isometric and 200 msec eccentric contraction. This procedure is repeated every 5 sec. To avoid fatigue, 4 min rest 
follows every 10 contractions with a total of 30 contractions performed.

In Vivo Canine Muscle Function Assay

We describe a minimally-invasive and painless method to measure canine hindlimb muscle strength and muscle response to repeated eccentric contractions.

فيفو الناب في العضلات وظيفة الفحص

We describe a minimally-invasive and reproducible method to measure canine pelvic limb muscle strength and muscle response to repeated eccentric 
...

Quantitative Visualization and Detection of Skin Cancer Using Dynamic Thermal Imaging

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment for melanoma remains surgical excision, therefore, the key to extended survival is early detection 2,3. Considering the large numbers of patients diagnosed every year and the limitations in accessing specialized care quickly, the development of objective in vivo diagnostic instruments to aid the diagnosis is essential. New techniques to detect skin cancer, especially non-invasive diagnostic tools, are being explored in numerous laboratories. Along with the surgical methods, techniques such as digital photography, dermoscopy, multispectral imaging systems (MelaFind), laser-based systems (confocal scanning laser microscopy, laser doppler perfusion imaging, optical coherence tomography), ultrasound, magnetic resonance imaging, are being tested. Each technique offers unique advantages and disadvantages, many of which pose a compromise between effectiveness and accuracy versus ease of use and cost considerations. Details about these techniques and comparisons are available in the literature 4.
Infrared (IR) imaging was shown to be a useful method to diagnose the signs of certain diseases by measuring the local skin temperature. There is a large body of evidence showing that disease or deviation from normal functioning are accompanied by changes of the temperature of the body, which again affect the temperature of the skin 5,6. Accurate data about the temperature of the human body and skin can provide a wealth of information on the processes responsible for heat generation and thermoregulation, in particular the deviation from normal conditions, often caused by disease. However, IR imaging has not been widely recognized in medicine due to the premature use of the technology 7,8 several decades ago, when temperature measurement accuracy and the spatial resolution were inadequate and sophisticated image processing tools were unavailable. This situation changed dramatically in the late 1990s-2000s. Advances in IR instrumentation, implementation of digital image processing algorithms and dynamic IR imaging, which enables scientists to analyze not only the spatial, but also the temporal thermal behavior of the skin 9, allowed breakthroughs in the field.
In our research, we explore the feasibility of IR imaging, combined with theoretical and experimental studies, as a cost effective, non-invasive, in vivo optical measurement technique for tumor detection, with emphasis on the screening and early detection of melanoma 10-13. In this study, we show data obtained in a patient study in which patients that possess a pigmented lesion with a clinical indication for biopsy are selected for imaging. We compared the difference in thermal responses between healthy and malignant tissue and compared our data with biopsy results. We concluded that the increased metabolic activity of the melanoma lesion can be detected by dynamic infrared imaging.

We demonstrated that malignant pigmented lesions with increased metabolic activity generate quantifiable amounts of heat and the measurement of the transient thermal response of the skin to a cooling excitation allows quantitative identification of melanoma and other skin cancers (vs. non-proliferative nevi) at an early stage of the disease.

الكمية التصور والكشف عن سرطان الجلد باستخدام التصوير الحراري الديناميكي

In 2010 approximately 68,720 melanomas will be diagnosed in the US alone, with around 8,650 resulting in death 1. To date, the only effective treatment ...

The Use of Primary Human Fibroblasts for Monitoring Mitochondrial Phenotypes in the Field of Parkinson's Disease

Parkinson's disease (PD) is the second most common movement disorder and affects 1% of people over the age of 60 1. Because ageing is the most important risk factor, cases of PD will increase during the next decades 2. Next to pathological protein folding and impaired protein degradation pathways, alterations of mitochondrial function and morphology were pointed out as further hallmark of neurodegeneration in PD 3-11.
After years of research in murine and human cancer cells as in vitro models to dissect molecular pathways of Parkinsonism, the use of human fibroblasts from patients and appropriate controls as ex vivo models has become a valuable research tool, if potential caveats are considered. Other than immortalized, rather artificial cell models, primary fibroblasts from patients carrying disease-associated mutations apparently reflect important pathological features of the human disease.
Here we delineate the procedure of taking skin biopsies, culturing human fibroblasts and using detailed protocols for essential microscopic techniques to define mitochondrial phenotypes. These were used to investigate different features associated with PD that are relevant to mitochondrial function and dynamics. Ex vivo, mitochondria can be analyzed in terms of their function, morphology, colocalization with lysosomes (the organelles degrading dysfunctional mitochondria) and degradation via the lysosomal pathway. These phenotypes are highly relevant for the identification of early signs of PD and may precede clinical motor symptoms in human disease-gene carriers. Hence, the assays presented here can be utilized as valuable tools to identify pathological features of neurodegeneration and help to define new therapeutic strategies in PD.

The Use of Primary Human Fibroblasts for Monitoring Mitochondrial Phenotypes in the Field of Parkinson&#039;s Disease

Fibroblasts from patients carrying mutations in Parkinson's disease-causing genes represent an easily accessible ex vivo model to study disease-associated phenotypes. Live cell imaging gives the opportunity to study morphological and functional parameters in living cells. Here we describe the preparation of human fibroblasts and subsequent monitoring of mitochondrial phenotypes.

استخدام الخلايا الليفية الإنسان الأساسية لرصد نمط ظاهري الميتوكوندريا في مجال مرض باركنسون

Parkinson's disease (PD) is the second most  common movement disorder and affects 1% of people over the age of 60 1. Because ageing is  the most important ...

Patient Derived Cell Culture and Isolation of CD133+ Putative Cancer Stem Cells from Melanoma

Despite improved treatments options for melanoma available today, patients with advanced malignant melanoma still have a poor prognosis for progression-free and overall survival. Therefore, translational research needs to provide further molecular evidence to improve targeted therapies for malignant melanomas. In the past, oncogenic mechanisms related to melanoma were extensively studied in established cell lines. On the way to more personalized treatment regimens based on individual genetic profiles, we propose to use patient-derived cell lines instead of generic cell lines. Together with high quality clinical data, especially on patient follow-up, these cells will be instrumental to better understand the molecular mechanisms behind melanoma progression.
Here, we report the establishment of primary melanoma cultures from dissected fresh tumor tissue. This procedure includes mincing and dissociation of the tissue into single cells, removal of contaminations with erythrocytes and fibroblasts as well as primary culture and reliable verification of the cells' melanoma origin.
Recent reports revealed that melanomas, like the majority of tumors, harbor a small subpopulation of cancer stem cells (CSCs), which seem to exclusively fuel tumor initiation and progression towards the metastatic state. One of the key markers for CSC identification and isolation in melanoma is CD133. To isolate CD133+ CSCs from primary melanoma cultures, we have modified and optimized the Magnetic-Activated Cell Sorting (MACS) procedure from Miltenyi resulting in high sorting purity and viability of CD133+ CSCs and CD133- bulk, which can be cultivated and functionally analyzed thereafter.

Patient Derived Cell Culture and Isolation of CD133+ Putative Cancer Stem Cells from Melanoma

This article describes the preparation of freshly obtained melanoma tissue into primary cell cultures, and how to remove contaminations of erythrocytes and fibroblasts from the tumor cells. Finally, we describe how CD133+ putative melanoma stem cells are sorted from the CD133- bulk using Magnetic Activated Cell Sorting (MACS).

زراعة الخلايا المشتقة المريض وعزل CD133<sup&gt; +</sup&gt; خلايا الجذعية السرطانية المزعومين من الميلانوما

Despite improved treatments options for melanoma available today, patients with advanced malignant melanoma still have a poor prognosis for ...

High-throughput Flow Cytometry Cell-based Assay to Detect Antibodies to N-Methyl-D-aspartate Receptor or Dopamine-2 Receptor in Human Serum

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases in children and adults. These antibodies have been used to guide diagnosis and treatment. Cell-based assays have improved the detection of antibodies in patient serum. They are based on the surface expression of brain antigens on eukaryotic cells, which are then incubated with diluted patient sera followed by fluorochrome-conjugated secondary antibodies. After washing, secondary antibody binding is then analyzed by flow cytometry. Our group has developed a high-throughput flow cytometry live cell-based assay to reliably detect antibodies against specific neurotransmitter receptors. This flow cytometry method is straight forward, quantitative, efficient, and the use of a high-throughput sampler system allows for large patient cohorts to be easily assayed in a short space of time. Additionally, this cell-based assay can be easily adapted to detect antibodies to many different antigenic targets, both from the central nervous system and periphery. Discovering additional novel antibody biomarkers will enable prompt and accurate diagnosis and improve treatment of immune-mediated disorders.

Over the recent years, live cell-based assays have been used successfully to detect antibodies against surface and conformational antigens. Here, we describe a method using high-throughput flow cytometry enabling the analysis of large cohorts of patients. Detection of novel antibodies will improve diagnosis and treatment of immune-mediated disorders.

الإنتاجية العالية التدفق الخلوي القائم على الفحص لكشف خلية أضداد N-ميثيل مد اسبارتاتي مستقبلات الدوبامين-2 أو مستقبلات في مصل الإنسان

Over the recent years, antibodies against surface and conformational proteins involved in neurotransmission have been detected in autoimmune CNS diseases ...

Assessment of Right Ventricular Structure and Function in Mouse Model of Pulmonary Artery Constriction by Transthoracic Echocardiography

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, the RV is significantly affected in pulmonary diseases such as pulmonary artery hypertension (PAH). In addition, the RV is remarkably sensitive to cardiac pathologies, including left ventricular (LV) dysfunction, valvular disease or RV infarction4. To understand the role of RV in the pathogenesis of cardiac diseases, a reliable and noninvasive method to access the RV structurally and functionally is essential.
A noninvasive trans-thoracic echocardiography (TTE) based methodology was established and validated for monitoring dynamic changes in RV structure and function in adult mice. To impose RV stress, we employed a surgical model of pulmonary artery constriction (PAC) and measured the RV response over a 7-day period using a high-frequency ultrasound microimaging system. Sham operated mice were used as controls. Images were acquired in lightly anesthetized mice at baseline (before surgery), day 0 (immediately post-surgery), day 3, and day 7 (post-surgery). Data was analyzed offline using software.
Several acoustic windows (B, M, and Color Doppler modes), which can be consistently obtained in mice, allowed for reliable and reproducible measurement of RV structure (including RV wall thickness, end-diastolic&#160;and end-systolic dimensions), and function (fractional area change, fractional shortening, PA peak velocity, and peak pressure gradient) in normal mice and following PAC.
Using this method, the pressure-gradient resulting from PAC was accurately measured in real-time using Color Doppler mode and was comparable to direct pressure measurements performed with a Millar high-fidelity microtip catheter. Taken together, these data demonstrate that RV measurements obtained from various complimentary views using echocardiography are reliable, reproducible and can provide insights regarding RV structure and function. This method will enable a better understanding of the role of RV cardiac dysfunction.

Right ventricle (RV) dysfunction is critical to the pathogenesis of cardiovascular disease, yet limited methodologies are available for its evaluation. Recent advances in ultrasound imaging provide a noninvasive and accurate option for longitudinal RV study. Herein, we detail a step-by-step echocardiographic method using a murine model of RV pressure overload.

تقييم البطين الأيمن هيكل وظيفة في نموذج الفأر من الشريان الرئوي عبر الصدر عن طريق انقباض ضربات القلب

Emerging clinical data support the notion that RV dysfunction is critical to the pathogenesis of cardiovascular disease and heart failure1-3. Moreover, ...

Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow reserve (CFR) in humans. Reduced CFR is accompanied by marked intramyocardial and pericoronary fibrosis and is used as an indication of the severity of dysfunction. This study explores, step-by-step, the real-time changes measured in the coronary flow velocity, CFR and systolic to diastolic peak velocity (S/D) ratio in the setting of an aortic banding model in mice. By using a Doppler transthoracic imaging technique that yields reproducible and reliable data, the method assesses changes in flow in the septal coronary artery (SCA), for a period of over two weeks in mice, that previously either underwent aortic banding or thoracotomy. 
During imaging, hyperemia in all mice was induced by isoflurane, an anesthetic that increased coronary flow velocity when compared with resting flow. All images were acquired by a single imager. Two ratios, (1) CFR, the ratio between hyperemic and baseline flow velocities, and (2) systolic (S) to diastolic (D) flow were determined, using a proprietary software and by two independent observers. Importantly, the observed changes in coronary flow preceded LV dysfunction as evidenced by normal LV mass and fractional shortening (FS). 
The method was benchmarked against the current gold standard of coronary assessment, histopathology. The latter technique showed clear pathologic changes in the coronary artery in the form of peri-coronary fibrosis that correlated to the flow changes as assessed by echocardiography. 
The study underscores the value of using a non-invasive technique to monitor coronary circulation in mouse hearts. The method minimizes redundant use of research animals and demonstrates that advanced ultrasound-based indices, such as CFR and S/D ratios, can serve as viable diagnostic tools in a variety of investigational protocols including drug studies and the study of genetically modified strains.

Coronary flow reserve (CFR) is useful for assessment of myocardial oxygen demand and evaluation of cardiovascular risk. This study establishes a step-by-step transthoracic Doppler echocardiographic (TTDE) method for longitudinal monitoring of the changes in CFR, as measured from coronary artery in mice, under the experimental pressure overload of aortic banding.

تقييم الموجات فوق الصوتية وبناء من الشريان التاجي تدفق وتدفق التاجي الاحتياطي باستخدام نموذج الزائد الضغط في الفئران

Transthoracic Doppler echocardiography (TTDE) is a clinically useful, noninvasive tool for studying coronary artery flow velocity and coronary flow ...

Functional Human Liver Preservation and Recovery by Means of Subnormothermic Machine Perfusion

There is currently a severe shortage of liver grafts available for transplantation. Novel organ preservation techniques are needed to expand the pool of donor livers. Machine perfusion of donor liver grafts is an alternative to traditional cold storage of livers and holds much promise as a modality to expand the donor organ pool. We have recently described the potential benefit of subnormothermic machine perfusion of human livers. Machine perfused livers showed improving function and restoration of tissue ATP levels. Additionally, machine perfusion of liver grafts at subnormothermic temperatures allows for objective assessment of the functionality and suitability of a liver for transplantation. In these ways a great many livers that were previously discarded due to their suboptimal quality can be rescued via the restorative effects of machine perfusion and utilized for transplantation. Here we describe this technique of subnormothermic machine perfusion in detail. Human liver grafts allocated for research are perfused via the hepatic artery and portal vein with an acellular oxygenated perfusate at 21 &#176;C.

We describe a method of ex vivo machine perfusion of human liver grafts at subnormothermic temperature (21 &#176;C).

المحافظة على الكبد وظيفية الإنسان والاسترداد من قبل وسائل Subnormothermic آلة الإرواء

There is currently a severe shortage of liver grafts available for transplantation.  Novel organ preservation techniques are needed to expand the pool of ...

Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases

Remodeling of the brain vasculature is a common trait of brain pathologies. In vivo imaging techniques are fundamental to detect cerebrovascular plasticity or damage occurring overtime and in relation to neuronal activity or blood flow. In vivo two-photon microscopy allows the study of the structural and functional plasticity of large cellular units in the living brain. In particular, the thinned-skull window preparation allows the visualization of cortical regions of interest (ROI) without inducing significant brain inflammation. Repetitive imaging sessions of cortical ROI are feasible, providing the characterization of disease hallmarks over time during the progression of numerous CNS diseases. This technique accessing the pial structures within 250 &#956;m of the brain relies on the detection of fluorescent probes encoded by genetic cellular markers and/or vital dyes. The latter (e.g., fluorescent dextrans) are used to map the luminal compartment of cerebrovascular structures. Germane to the protocol described herein is the use of an in vivo marker of amyloid deposits, Methoxy-O4, to assess Alzheimer&#39;s disease (AD) progression. We also describe the post-acquisition image processing used to track vascular changes and amyloid depositions. While focusing presently on a model of AD, the described protocol is relevant to other CNS disorders where pathological cerebrovascular changes occur.

Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases

This manuscript describes a procedure to track the remodeling of the cerebrovasculature during amyloid plaque accumulation in vivo using longitudinal two-photon microscopy. A thinned-skull preparation enables the visualization of fluorescent dyes to assess the progression of cerebrovascular damage in a mouse model of Alzheimer&#39;s disease.

طولي<em&gt; في فيفو</em&gt; التصوير من Cerebrovasculature: الأقرب للأمراض الجهاز العصبي المركزي

Remodeling of the brain vasculature is a common trait of brain pathologies. In vivo imaging techniques are fundamental to detect cerebrovascular ...

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects resulting from tumor extirpation, trauma, infections, malformations or burns. Free flaps are particularly useful for reconstructing highly complex anatomical regions, like those of the head and neck, the hand, the foot and the perineum. Moreover, basic and translational research in the area of free tissue transfer is of great clinical potential. Notwithstanding, surgical trainees and researchers are frequently deterred from using microsurgical models of tissue transfer, due to lack of information regarding the technical aspects involved in the operative procedures. The aim of this paper is to present the steps required to transfer a fasciocutaneous epigastric free flap to the neck in the rat.
This flap is based on the superficial epigastric artery and vein, which originates from and drain into the femoral artery and vein, respectively. On average the caliber of the superficial epigastric vein is 0.6 to 0.8 mm, contrasting with the 0.3 to 0.5 mm of the superficial epigastric artery. Histologically, the flap is a composite block of tissues, containing skin (epidermis and dermis), a layer of fat tissue (panniculus adiposus), a layer of striated muscle (panniculus carnosus), and a layer of loose areolar tissue.
Succinctly, the epigastric flap is raised on its pedicle vessels that are then anastomosed to the external jugular vein and to the carotid artery on the ventral surface of the rat's neck. According to our experience, this model guarantees the complete survival of approximately 70 to 80% of epigastric flaps transferred to the neck region. The flap can be evaluated whenever needed by visual inspection. Hence, the authors believe this is a good experimental model for microsurgical research and training.

This paper describes the steps required to raise a fasciocutaneous epigastric free flap and transfer it to the neck in the rat.

نموذج من حر نقل الأنسجة: الجرذ شرسوفي الحرة رفرف

Free tissue transfer has been increasingly used in clinical practice since the 1970s, allowing reconstruction of complex and otherwise untreatable defects ...