1。定位<ol><li>定位是一个不可分割的组成部分微血管减压术。麻醉诱导后，病人被放置在引脚而在手术室表和移动向外侧公园方所需的MVD放在替补位置。值得注意的是，JSN喜欢插入腰漏手术前，允许更大的内部运算CSF和小脑放松（漏然后取出的患者出院时，往往POD2，）排水控制。 </li><li>补齐所有的压力点放在腋下滚。病人的胸部和臀部录音牢固表允许旋转表，如有必要，以后的情况下。病人的肩膀，录音，可视化的目的。头部旋转距离约10-15度，患侧，颈部弯曲略，使手术的计划轨迹现在几乎垂直于地板。顶点倾斜略有下降。特别注意的是，以确保从头部有没有静脉异位引流的病理压缩。具体来说，应至少有两个手指之间的下颌骨和上胸部breadths的房间。头部转动不应该超过30度。 </li><li> C.人体是安全的前三点式头部固定。电生理监测（脑干听觉诱发电位和面神经监测），然后担保。隐形导航，如果使用，注册。 </li></ol> 2。切口<ol><li>在此之前预备和装饰，外部标志性建筑进行评估。它是有益的借鉴了不可磨灭的标记inion尿道外口线。 iniomeatal线是先抽出了不可磨灭的标记。这虚线代表横窦的位置表浅的代表性。接下来，一条虚线绘制覆二腹肌沟的过程中。逊色iniomeatal线这条线的一部分，代表的乙状窦的位置肤浅代表性。 </li><li>曲线切口抽出耳朵的长度大约两耳廓后面fingerbreadths。病人是prepped和身披通常的方式。 </li><li>使用手术刀，上述切口加深。夹层进行使用手术刀和单极电凝骨。自保持拉钩放置。 </li></ol> 3。开颅和硬脑膜开放<ol><li>记横向和乙状窦交界处的浅表表示，钻探启动。 </li><li> PEK喜欢钻骨而去揭露横向乙状结肠交界处。访问到CP的角度通常是创建一个3厘米的骨瓣缺损。这种方法避免了可能出现的风险造成的静脉窦附近的一个踏板演练使用，可能导致在硬脑膜窦裂伤。 </li><li> JSN喜欢使用毛刺孔放置在水平横向乙状结肠交界处的一个穿孔机钻。在此之后，一个3厘米开颅骨瓣的创建，并预留更换的情况下结束。这次演习是用来揭露，其余的横向和乙状窦。这种方法允许更换微血管减压术骨瓣。 </li><li>一旦extradurally已经暴露的横向和乙状窦，骨边缘打蜡彻底。重要的是远远不够钻横向允许适当的硬膜反射和可视化。当遇到乳突气细胞，他们大力打蜡。 </li><li>硬脑膜打开一个星状的方式。硬脑膜叶使用4-0 Nurolon和硬膜切口尽可能横向乙状结肠交界处的密切上涨。这允许直接相邻的小脑幕及颞骨岩的交界处的一条走廊的可视化。 </li></ol> 4。小脑桥脑角曝光<ol><li>得到了体现和缝合硬脑膜后，雷拉拉钩放在telfa基本牵。小脑是高架内侧轻轻地缩回。使用吸和双极电凝，CSF是不允许出口，从而在柔和的小脑放松。 </li><li>与小脑现在已从石油天幕的交界处，牵先进小脑的温柔进一步抬高。必要时采取优越的岩脉复杂。岩静脉牺牲时，用双极电凝凝其次是部分与microscissors分工。船只，然后再凝固，然后完全切断，以确保有后无出血血管结扎。 </li><li> "角落变成了"小脑桥脑角暴露，第七，第八神经复杂的可视化。在此期间接触，时刻警惕的注意的是BAER（脑脑干听觉诱发电位）和面神经监测，以防止回缩伤害。高级和内侧的第七，第八神经复杂，三叉神经，然后可视化。 </li></ol> 5。三叉神经减压<ol><li> Microscissors是用来打开的三叉神经周围的蛛网膜。锐性剥离，使神经和小脑上动脉（SCA）圆周可以检查是必要的。检查三叉神经在脑干退出和收益横向部位开始。 </li><li>三叉神经痛中最常见的船只是 1的SCA rostroventral循环。这种船只被压缩53％的患者在本系列中的施事。 </li><li>致病船只确定后，解剖，并释放，血管循环是动员远离神经。聚四氟乙烯的一个小片，然后置于下方的船只升降三叉神经。 </li><li>神经减压后，重新审视各方肯定，没有额外的压缩船舶存在。 </li></ol> 6。关闭<ol><li>伤口用盐水灌溉和所有拉钩将被删除。硬脑膜然后关闭使用4-0 Nurolon运行。 </li><li>封闭的其余步骤略有不同之间出席。对于JSN，在开始的情况下所采取的脑髓的补丁可用于协助防水封闭硬脑膜。多套结孔被放置在骨和4-0 Nurolons通过硬脑膜边缘通过套结孔和担保。 Surgicel和明胶海绵放置在顶部硬脑膜，骨瓣KLS螺钉和钢板所取代。 Norian然后用骨水泥，以关闭颅开放的其余部分，以防止以后插入到硬脑膜的肌肉。伤口，然后丰富地灌溉与杆菌肽灌溉和封闭层2-0 Vicryls多层肌肉，帽状和真皮3-0 Vicryls，和运行在皮肤4-0 Monocryl。 </li><li> PEK喜欢的封闭稍微不同的方法。 reapproximation硬脑膜，放置一块的明胶海绵覆盖硬膜切口。甲基丙烯酸甲酯，是用来填补在颅骨缺损和一个小KLS板，用于保护的甲基丙烯酸甲酯人工颅骨。如上所述覆盖杆菌肽软膏，皮肤和肌肉，然后关闭。 </li></ol> 7。代表性的成果从2006年7月使用VUMC结算部，两个功能神经外科医生在范德比尔特大学医学中心（VUMC）（JSN或PEK）的一段时间进行微血管减压术的59例患者的病历获得的彩管代码审查至2009年7月在一项回顾性的方式进行了评估。研究的数据收集和管理使用REDCap电子数据采集tools2（REDCap是一个设在美国范德比尔特大学的安全，基于Web的应用，旨在支持数据采集研究）。这一患者人群的人口统计数据摘要表1可见。 至于病人的人口统计（见表1），约66％的患者为女性。 10％的多发性硬化症的历史和19％TGN以前的手术程序（见表2）历史。关于手术结果（见表3），93％的患者经历了显着改善面部疼痛或全分辨率从6个星期至2年不等的后续行动。我们后续的方法，包括一个电子病历的回顾性分析。 64％的患者无痛苦报道，在其最近的诊所下列程序访问。 约15％的患者在系列遭受了脑脊液漏6例患者（10％）;需要插入脑室 - 腹腔分流（VPSI）。值得注意的是，在患者​​群中脑脊液漏率明显较高的前骨瓣或甲基丙烯酸甲酯（MM）的封buttressing的日常使用。具体来说，25％的患者无骨皮瓣或甲基丙烯酸甲酯假肢瓣关闭开发了脑脊液漏。相比之下，只有8％的患者封闭后皮瓣骨或MM安置了手术后脑脊液漏的证据。除了上面所述的结果，两组患者（3％）出现伤口感染。有没有实例小脑损害。两组患者（3％）报告了一些手术后听力损失的程度。 <table border="1"><tbody><tr><td colspan="2"> 病人的人口统计 </td></tr><tr><td>性别（男/女） </td><td>三十九分之二十〇 </td></tr><tr><td>多发性硬化症的历史（是/否） </td><td> 6 / 53 </td></tr><tr><td> TGN以前的外科手术史（是/否） </td><td>四十八分之一十一</td></tr></tbody></table> 表1病人的人口统计摘要。 <table border="1"><tbody><tr><td colspan="3"> 以前的程序（五十九分之一十一） </td></tr><tr><td> 类型 </td><td> 数 </td><td> 结果:无痛苦（PF）与显着改善（SI）与无改善（NI） </td></tr><tr><td>伽玛刀</td><td> 5（8％） </td><td> 3犯规，2 SI </td></tr><tr><td> MVD </td><td> 2（3％） </td><td> 2助攻</td></tr><tr><td> RFL </td><td> 1（2％） </td><td>犯规</td></tr><tr><td>多个程序</td><td> 2（3％） </td><td> PF，SI </td></tr></tbody></table> 表2。经历了前面的过程发生在当前一系列微血管减压术（MVD），前病人的手术结果。患者是事先特定程序分层。 RFL =射频lesioning。 <table border="1"><tbody><tr><td colspan="2"> 手术结果和并发症 </td></tr><tr><td>后续的平均长度</td><td> 4个月</td></tr><tr><td>疼痛明显好转或完全解决</td><td> 55（93％） </td></tr><tr><td>脑脊液漏</td><td> 9（15％） </td></tr><tr><td>无菌性脑膜炎</td><td> 8（14％） </td></tr><tr><td>伤口感染</td><td> 2（3％） </td></tr><tr><td>小脑损害</td><td> 0（0％） </td></tr><tr><td>听力损失</td><td> 2（3％） </td></tr></tbody></table> 表3。手术结果和并发症的总结。 <img alt="图1" src="/files/ftp_upload/2590/2590fig1.jpg" /> 图1手术结果:手术后脑脊液漏率发现大量被关闭与否与挟着骨瓣更换或安置的甲基丙烯酸甲酯（MM）瓣的影响。因此，去骨瓣缺损的皮瓣更换骨/ MM现在是结束这些程序的标准协议。 <img alt="图2" src="/files/ftp_upload/2590/2590fig2.jpg" /> 图2。分层描述手术后疼痛改善的结果。

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彼得康拉德博士和博士约瑟夫Neimat收取咨询费和授予美敦力公司的支持，没有数据的报道利益相关的冲突。

三叉神经痛是激烈抽痛，痛在三叉神经分布发作的疾病。这种疼痛的严重程度，可能会导致显着的病人的焦虑，营养不良，甚至抑郁3。虽然这种情况可能近端病因是多种多样的，包括肿瘤或脱髓鞘，80-90％的病例是由三叉神经受压有关相邻的船只 4,5 。在许多情况下，三叉神经痛，药物治疗是足够足够的控制症状。然而，多数患者需要更明确的手术measures6。微血管减压术（MVD）和烧蚀程序（例如，放射治疗，经皮射频lesioning，气球压缩，或甘油rhizolysis）已被证明是有效控制三叉神经痛症状敏锐，但是，MVD已证明是防止长的优势长期复发7。 首次报道使用Janetta的MVD在20世纪60年代以来，适应的过程，改善患者预后。术中听觉脑干诱发电位的使用，特别是通过监测，已减少手术发病早期刺激脑干和颅神经损害的预防协助这些结构8。最近的报告估计在77-94％9,10,11范围内的三叉神经痛MVD积极成果率。然而，严重的术后并发症，即小脑损伤和听力损失 9,10，脑脊液漏，仍时有发生的程序。此外，症状复发，有报道发生在多达39％的患者此过程10,11。除了 ​​与术中的变量，如神经的位置，血管，类型和症状持续时间 6,7相关，复发率也已与经验的外科医生和医院在执行MVD 12 。适当的技术，可以最大化和病人的结果可以减少不良后果的。 这项研究的范德比尔特大学神经外科医生进行手术的MVD技术的有效性。我们测量（93％）取得的积极成果率在高，一般在文献 9,10报道的范围。虽然在本系列后续的平均时间是小，患者经常没有看到在临床上的6周的访问，如果他们仍然无痛苦和无症状。鉴于64％的患者报告自己下面的过程完全无痛苦，这并不奇怪，在这项研究中的后续的平均持续时间短。在我们现有的机构，并发症发生率与由他人报告的。最初，MVDs枕下没有更换骨瓣开颅。改变后的数据，这些数据表明25％升高脑脊液泄漏的内部审查，该协议包括甲基丙烯酸甲酯皮瓣或更换前的骨瓣伤口缝合buttressing。这段时间以来，我们的脑脊液漏率近似与其他速率（2.4 - 12％）的8％在7,13文献报道的一致。听力损失（3％）报告的患者比例也接近文献（0.8-2.8％），1,2,12,13，报告的数字。在任何情况下，我们有证据小脑损伤的病人。 我们的经验表明，监测BAERs和骨瓣更换，微血管减压术是值得选择。范德比尔特大学利用其显着的手术原则和技术的细微差别已提交的视频格式。此外，这个视频杂志格式独特的介绍，许多医生不经常看到手术室外的血管病变。结果表明，微血管减压术是一个非常有效的执行过程与病人的发病率较低。

<ul><li>梅菲尔德引脚</li><li>豆袋</li><li>显微镜</li><li>钻与"火柴棍"和/或"craniotome的"附件</li><li>格林伯格牵</li><li>颅microdissectors </li><li>聚四氟乙烯</li></ul>

microvascular decompression: salient surgical principles and technical nuances

三叉神经痛是抽痛，痛在三叉神经分布的严重事件相关的疾病。以前的报告表明，有80-90％的病例是由相邻的船只相关三叉神经受压。多数三叉神经痛患者最终需要手术治疗，以达到缓解症状。手术方案管理包括烧蚀程序（例如，放射治疗，经皮射频lesioning，气球压缩，rhizolysis甘油等）和微血管减压术。烧蚀程序未能解决的无序的根源和防止复发症状比微血管减压术的长期，效果较差。然而，微血管减压术是天生就比烧蚀程序侵入，增加手术的风险。以往的研究表明微血管减压术的外科医生的经验和患者预后之间的关系。在这一系列由两个神经外科（JSN和PEK）自2006年以来的59例患者中，93％的患者表现出显着改善他们的三叉神经痛，下面的程序与后续从6个星期至2年不等。此外，66例患者（约64％）41个已完全无痛苦以下操作。 在本出版物，视频格式是利用这种疾病的显微病理审查。在手术过程中的步骤进行审查和讨论了突出的原则和技术的细微差别，在最大限度地减少并发症，最大限度地提高疗效的有用。

Watch this Scientific Journal Video about Microvascular Decompression: Salient Surgical Principles and Technical Nuances at JoVE.com

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

三叉神经痛病人的管理有许多可用的选项。微血管减压术，所有的选项，而最侵入，也是最有效的实现长短期缓解症状。如何最大限度地提高疗效和减少并发症此过程的视频指令描述。

微血管减压:突出的手术原则和技术的细微差别

Trigeminal neuralgia is a disorder associated with severe episodes of lancinating pain in the distribution of the trigeminal nerve. Previous reports ...

microvascular-decompression-salient-surgical-principles-technical

Research

JoVE Journal

Medicine

46.2K 次观看.  Vanderbilt University Medical Center. 三叉神经痛病人的管理有许多可用的选项。微血管减压术，所有的选项，而最侵入，也是最有效的实现长短期缓解症状。如何最大限度地提高疗效和减少并发症此过程的视频指令描述。

视频: Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Multispectral Real-time Fluorescence Imaging for Intraoperative Detection of the Sentinel Lymph Node in Gynecologic Oncology

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical excision of the tumor with a full lymphadenectomy in the drainage area of the tumor. However, removal of lymph nodes is associated with increased morbidity due to infection, wound breakdown and lymphedema.4,5 As an alternative, the sentinel lymph node procedure (SLN) was developed several decades ago to detect the first draining lymph node from the tumor.6 In case of lymphogenic dissemination, the SLN is the first lymph node that is affected (Figure 1). Hence, if the SLN does not contain metastases, downstream lymph nodes will also be free from tumor metastases and need not to be removed. The SLN procedure is part of the treatment for many tumor types, like breast cancer and melanoma, but also for cancer of the vulva and cervix.7 The current standard methodology for SLN-detection is by peritumoral injection of radiocolloid one day prior to surgery, and a colored dye intraoperatively. Disadvantages of the procedure in cervical and vulvar cancer are multiple injections in the genital area, leading to increased psychological distress for the patient, and the use of radioactive colloid.
Multispectral fluorescence imaging is an emerging imaging modality that can be applied intraoperatively without the need for injection of radiocolloid. For intraoperative fluorescence imaging, two components are needed: a fluorescent agent and a quantitative optical system for intraoperative imaging. As a fluorophore we have used indocyanine green (ICG). ICG has been used for many decades to assess cardiac function, cerebral perfusion and liver perfusion.8 It is an inert drug with a safe pharmaco-biological profile. When excited at around 750 nm, it emits light in the near-infrared spectrum around 800 nm. A custom-made multispectral fluorescence imaging camera system was used.9.
The aim of this video article is to demonstrate the detection of the SLN using intraoperative fluorescence imaging in patients with cervical and vulvar cancer. Fluorescence imaging is used in conjunction with the standard procedure, consisting of radiocolloid and a blue dye. In the future, intraoperative fluorescence imaging might replace the current method and is also easily transferable to other indications like breast cancer and melanoma.

Fluorescence imaging is a promising innovative modality for image-guided surgery in surgical oncology. In this video we describe the technical procedure for detection of the sentinel lymph node using fluorescence imaging as showcased in gynecologic oncologicy. A multispectral fluorescence camera system, together with the fluorescent agent indocyanine green, is applied.

多光谱实时荧光成像术在妇科肿瘤前哨淋巴结的检测

The prognosis in virtually all solid tumors depends on the presence or absence of lymph node metastases.1-3 Surgical treatment most often combines radical ...

科研

医学

Non-invasive Assessment of Microvascular and Endothelial Function

The authors have utilized capillaroscopy and forearm blood flow techniques to investigate the role of microvascular dysfunction in pathogenesis of cardiovascular disease. Capillaroscopy is a non-invasive, relatively inexpensive methodology for directly visualizing the microcirculation. Percent capillary recruitment is assessed by dividing the increase in capillary density induced by postocclusive reactive hyperemia (postocclusive reactive hyperemia capillary density minus baseline capillary density), by the maximal capillary density (observed during passive venous occlusion). Percent perfused capillaries represents the proportion of all capillaries present that are perfused (functionally active), and is calculated by dividing postocclusive reactive hyperemia capillary density by the maximal capillary density. Both percent capillary recruitment and percent perfused capillaries reflect the number of functional capillaries. The forearm blood flow (FBF) technique provides accepted non-invasive measures of endothelial function: The ratio FBFmax/FBFbase is computed as an estimate of vasodilation, by dividing the mean of the four FBFmax values by the mean of the four FBFbase values. Forearm vascular resistance at maximal vasodilation (FVRmax) is calculated as the mean arterial pressure (MAP) divided by FBFmax. Both the capillaroscopy and forearm techniques are readily acceptable to patients and can be learned quickly.
The microvascular and endothelial function measures obtained using the methodologies described in this paper may have future utility in clinical patient cardiovascular risk-reduction strategies. As we have published reports demonstrating that microvascular and endothelial dysfunction are found in initial stages of hypertension including prehypertension, microvascular and endothelial function measures may eventually aid in early identification, risk-stratification and prevention of end-stage vascular pathology, with its potentially fatal consequences.

Capillaroscopy is a non-invasive, relatively inexpensive methodology for directly visualizing the microcirculation. The forearm blood flow technique provides accepted non-invasive measures of endothelial function.

非侵入性的评估微血管和内皮功能

The authors have utilized capillaroscopy and forearm blood flow techniques to investigate the role of microvascular dysfunction in pathogenesis of ...

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

Intravital Microscopy of Tumor-associated Vasculature Using Advanced Dorsal Skinfold Window Chambers on Transgenic Fluorescent Mice

Tumor and tumor vessel development, as well as tumor response to therapeutics, are highly dynamic biological processes. Histology provides static information and is often not sufficient for a correct interpretation. Intravital evaluation, in which a process is followed in time, provides extra and often unexpected information. With the creation of transgenic animals expressing cell-specific markers and live cell tracers, improvements to imaging equipment, and the development of several imaging chambers, intravital microscopy has become an important tool to better understand biological processes. This paper describes an experimental design for the investigation of tumor vessel development and of therapeutic effects in a spatial and temporal manner. Using this setup, the stage of vessel development, tip cell and lumen formation, blood flow, extravasation, an established vascular bed, and vascular destruction can be visualized and followed. Furthermore, therapeutic effects, intratumoral fate, and the localization of chemotherapeutic compounds can also be followed.

This protocol describes the intravital imaging of transgenic mice expressing cell-specific fluorescent markers. Intravital imaging provides a non-invasive method for high-resolution observations in living animals using implantable windows through which the microscopic visualization of processes is possible. This method is especially useful to study longitudinal processes.

应用先进的背皮窗室对转基因荧光小鼠肿瘤相关血管的活体显微镜观察

Tumor and tumor vessel development, as well as tumor response to therapeutics, are highly dynamic biological processes. Histology provides static ...

Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic options have significant risk of failure and substantial morbidity.
Use of bone vascularized composite allotransplantation (VCA) would offer both a close match of resected bone size and shape and the healing and remodeling potential of living bone. At present, life-long drug immunosuppression (IS) is required. Organ toxicity, opportunistic infection and neoplasm risks are of concern to treat such non-lethal indications.
We have previously demonstrated that bone and joint VCA viability may be maintained in rats and rabbits without the need of long-term-immunosuppression by implantation of recipient derived vessels within the VCA. It generates an autogenous, neoangiogenic circulation with measurable flow and active bone remodeling, requiring only 2 weeks of IS. As small animals differ from man substantially in anatomy, bone physiology and immunology, we have developed a porcine bone VCA model to evaluate this technique before clinical application is undertaken. Miniature swine are currently widely used for allotransplantation research, given their immunologic, anatomic, physiologic and size similarities to man. Here, we describe a new porcine orthotopic tibial bone VCA model to test the role of autogenous surgical angiogenesis to maintain VCA viability.
The model reconstructs segmental tibial bone defects using size- and shape-matched allogeneic tibial bone segments, transplanted across a major swine leukocyte antigen (SLA) mismatch in Yucatan miniature swine. Nutrient vessel repair and implantation of recipient derived autogenous vessels into the medullary canal of allogeneic tibial bone segments is performed in combination with simultaneous short-term IS. This permits a neoangiogenic autogenous circulation to develop from the implanted tissue, maintaining flow through the allogeneic nutrient vessels for a short time. Once established, the new autogenous circulation maintains bone viability following cessation of drug therapy and subsequent nutrient vessel thrombosis.

Currently any kind of vascularized composite allotransplantation depends on long-term-immunosuppression, difficult to support for non-life-critical indications. We present a new porcine tibial VCA model that can be used to study bone VCA and demonstrate the use of surgical angiogenesis to maintain bone viability without the need of long-term immune-modulation.

猪胫骨移植术后血管生成的动物模型

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic ...

Using In Vitro Live-cell Imaging to Explore Chemotherapeutics Delivered by Lipid-based Nanoparticles

Conventional imaging techniques can provide detailed information about cellular processes. However, this information is based on static images in an otherwise dynamic system, and successive phases are easily overlooked or misinterpreted. Live-cell imaging and time-lapse microscopy, in which living cells can be followed for hours or even days in a more or less continuous fashion, are therefore very informative. The protocol described here allows for the investigation of the fate of chemotherapeutic nanoparticles after the delivery of doxorubicin (dox) in living cells. Dox is an intercalating agent that must be released from its nanocarrier to become biologically active. In spite of its clinical registration for more than two decades, its uptake, breakdown, and drug release are still not fully understood. This article explores the hypothesis that lipid-based nanoparticles are taken up by the tumor cells and are slowly degraded. Released dox is then translocated to the nucleus. To prevent fixation artifacts, live-cell imaging and time-lapse microscopy, described in this experimental procedure, can be applied.

Using In Vitro Live-cell Imaging to Explore Chemotherapeutics Delivered by Lipid-based Nanoparticles

Live-cell imaging is a powerful tool to visualize dynamic processes. The examination of fixed cells provides only static pictures, which can lead to misinterpretation and confusion about the process. This work presents a method to study uptake, drug release, and intracellular localization of liposomal nanoparticles in living cells.

使用体外活体细胞成像技术研究脂纳米粒子化疗

Conventional imaging techniques can provide detailed information about cellular processes. However, this information is based on static images in an ...

Technical Detail for Robot Assisted Pancreaticoduodenectomy

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic platform, including three-dimensional vision, wristed instruments, and improved ergonomics, allow the surgeon to recapitulate the principles of open pancreatoduodenectomy allowing safe oncologic dissection, hemostasis, and meticulous reconstruction. Over the course of the past decade, significant strides have been achieved in outlining the safety, feasibility, and learning curve of the robotic Whipple. When performed by high volume pancreatic surgeons experienced in RPD, recent comparative effectiveness studies show potential advantages compared to the open technique, including reductions in hospital stay and morbidity. National data also show reductions in conversion rates compared to its laparoscopic counterpart. Although long-term oncologic data are still needed, short-term oncologic surrogates of margin resection and lymph node harvest suggest no compromise in oncologic outcomes. As pancreatic surgeons increasingly integrate robotics into their practice, proficiency-based training and credentialing will be necessary for the safe application and dissemination of RPD. Here, we provide the detailed steps of a robotic pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.&#160;

The following manuscript details a stepwise approach to the robot-assisted pancreaticoduodenectomy performed at the University of Pittsburgh Medical Center.

机器人辅助胰腺切除术的技术细节

Since its first report in 2003, robotic pancreaticoduodenectomy (RPD) has gained popularity among pancreatic surgeons. Inherent advantages of the robotic ...

Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.
To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

增强现实导航引导的股骨头坏死核心减压

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For ...

人工耳蜗植入期间的实时遥测阻抗测量

Performing Repeated Intraoperative Impedance Telemetry Measurements during Cochlear Implantation

Impedance measurements are routinely performed during cochlear implantation (CI) after finalized electrode insertion. They may allow conclusions on the electrode's and implant's function. In the postoperative setting, the analysis of impedance changes enables the identification of scarring or inflammation processes around the electrode. Recent studies report associations between impedance telemetry and the site of stimulation. Consequently, repeated impedance measurements during cochlear implant electrode insertion may enable objective feedback on whether the electrode is positioned inside the perilymph or outside the inner ear. With the presented novel method, impedances can be measured in real-time during cochlear implantation. This protocol systematically explains how to perform repeated impedance recordings during CI surgery. These repeated measurements are challenging since they depend on multiple intraoperative methodological factors starting with the draping of the patient. Thus, for successful recordings, a standardized procedure is mandatory. In this article, we comprehensively illustrate the system setup and procedure of performing intraoperative measurements during CI surgery.

作者聚焦:人工耳蜗手术阻抗监测的进展

Here we present a protocol to conduct repeated impedance telemetry measurements during cochlear implantation (CI). They may allow conclusions on the electrode's and implant's function. Repeated impedance measurements enable objective feedback on whether the electrode is positioned inside the perilymph or outside the inner ear.

在人工耳蜗植入过程中进行重复的术中阻抗遥测测量

Impedance measurements are routinely performed during cochlear implantation (CI) after finalized electrode insertion. They may allow conclusions on the ...