This study was supported and funded by the Avenir Foundation (Fondation de l'Avenir, 255 rue de Vaugirard, 75719 Paris cedex 15, Paris, France). This study would never have been conducted without the precious help of the veterinary team of the Laboratory of Biosurgical Research from the Alain Carpentier Foundation.

所有的动物都根据动物研究伦理委员会（法国农业部的指导方针）处理。该协议获得在巴黎第五大学授权的动物experimentations当地伦理委员会的批准（注册号MESR 2035.02;医学学部巴黎笛卡尔，法国巴黎）。 1. ADSC文化和标签<ol><li>获得一个私人机构证实脂肪干细胞。在37℃和5％的CO 2与含10％胎儿小牛血清和1％抗生素（青霉素和链霉素）的α极限必需培养基培养同种异体脂肪干细胞。 </li><li>使用标准的细胞扩增程序（37℃和5％CO 2）得到每只动物约24×10 6个脂肪干细胞。收获使用标准的胰蛋白酶溶液（10毫升的T150皿）的脂肪干细胞。用血球进行细胞计数。 </li><li>执行小区使用PKH67染色PR标记移植前一天ocedure如下所述。 注:在染色过程的目标是允许移植后细胞跟踪。 <ol><li>为了标注2×10 6的脂肪干细胞，准备溶液A（2×10 6细胞用100微升稀释的C）和溶液B（PKH67 4μL用1毫升稀释液的C）。 </li><li>孵育溶液A和B为2分钟。然后，添加100μL胎儿小牛血清1分钟。 </li><li>冲洗以1500 xg离心与柠檬酸的RPMI 300微升的溶液（RPMI的298.5微升和柠檬酸1.5μL），离心5分钟。重复此操作2次。保持标记细胞，并保护他们免受光，直到板结构。 </li></ol></li></ol> 2.双击ADSC表构建<ol><li>一天移植前，准备与每细胞培养基的阱4毫升，如上所述，PKH标记之前12孔温度响应细胞培养皿。种子菜1.5×10 6 PKH-labele每孔D细胞孵育12小时（37℃和5％CO 2）。 </li><li>上移植的当天，通过温育在室温下将培养皿30分钟分离汇合细胞片。 </li><li>轻轻吸了吸取1 ADSC表和图层它的疏水纸（1.5厘米直径）。使用这种纸张作为支撑膜。 </li><li>掌握另一ADSC片，轻轻地沉积其上的另一个的顶部，以获得一个双层构建体。 </li><li>重复这些程序根据需要（4每只动物），得到尽可能多的ADSC表结构。 </li></ol> 3.食管内镜黏膜下剥离术（ESD） <ol><li>上移植的当天，用10毫克/千克肌内氯胺酮预先用药的动物，并以8毫克/公斤静脉内异丙酚诱导它们。然后，执行气管插管并保持与异氟烷2.5％吸入麻醉。 </li><li>一旦动物是在全身麻醉下，进行ESD与gastroscOPE，一个视频内窥镜，以及电外科单元。 <ol><li>使用内窥镜刀和软凝固，以获得半周背侧标记范围从40厘米到从牙弓45厘米。 </li><li>注入含有靛蓝胭脂红染料成用于粘膜层从肌肉层分离的粘膜下层甘油溶液。 </li><li>使用内窥镜刀endocut I模式来获得圆周切口。 </li><li>使用的内窥镜刀强迫凝固模式来执行粘膜解剖，从近端切口移动到远端切口。 </li></ol></li><li>在静电放电过程结束时，观察半周，5-厘米长的食管瘢痕露出肌层。 </li></ol> 4.移植内镜<ol><li>静电放电后，立即内镜移植动物4双ADSC表结构。 <ol><li>掌握内镜钳和ADSC表结构通过使用大量的，透明的内窥镜盖保护它运输到创伤部位中。 </li><li>的ADSC表构建体的整个表面施加到溃疡床。 </li><li>轻轻地应用ADSC表结构为10分钟获得一个完整的，稳定的植入。为应用程序，使用内窥镜钳子或内窥镜帽并应用ADSC的整个表面构造到食道粘膜下层。 </li></ol></li><li>重复此步骤，对每个动物四次，以获得4移栽双贴壁细胞表结构。 注:我们的目标是覆盖近似一半的受伤面积。 </li></ol> 5.术后评估及随访<ol><li>对于每个动物，确保后的ESD镇痛为0.2毫克/千克吗啡为第一天并用埃索美拉唑的28天的抗酸处理（40毫克/天），每天三次肌内注射。执行与amoxicill抗生素预防在（1克/天）7天。授权于翌日第1天的液体和固体。 </li><li>跟进动物28天。获得使用圆润平卡斯吞咽困难得分16，体重变化的测量日常临床评估。 </li><li>多式联运狭窄的评价:全身麻醉，在预定的3天，14和28下，担负狭窄发生多式联运评价。 <ol><li>执行使用瘢痕描述，狭窄测量和纸张支撑膜检测内窥镜评价。使用胃镜通过狭窄跨越测量狭窄（胃镜的直径为8毫米）。观察疤痕，关注炎性方面（粘膜红斑，粘膜水肿，和粘膜自发性出血）和瘢痕内不存在或纸张支撑膜的存在。 </li><li>通过胃镜操作者运河直接申请pCLE绿色探头插入疤痕床。搜索一个自发并组织与PKH67标记ADSC表结构植入兼容绿色信号。 </li><li>执行重晶石食管造影的2正交发生率与放射性箍（正面和左路的发生率）。保持为狭窄评价最紧密的发生率（的狭窄（％度）= [1-（狭窄下短轴长度/狭窄下正常轴）的长度×100）]）17，18。 </li></ol></li><li>动物牺牲。 <ol><li>在第28天，在随访期结束时，执行动物牺牲。虽然动物仍然是在全身麻醉下，注入100毫克/公斤静脉注射苯巴比妥。确保动物死亡利用临床检查为缺乏心跳和呼吸运动。 </li><li>胸骨切开术和器官曝光后，取出食道从每个动物处死（用10％福尔马林固定，石蜡包埋，4微米厚的部分）。染色幻灯片用苏木和藏红花15。对于数字化计算机分析幻灯片和比较动物组15。 </li></ol></li></ol>

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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Amniotic+membrane+grafts+for+the+prevention+of+esophageal+stricture+after+circumferential+endoscopic+submucosal+dissection.">Amniotic membrane grafts for the prevention of esophageal stricture after circumferential endoscopic submucosal dissection.</a> PloS One. 9 (7), 100236 (2014).</li></ol>

作者什么都没有透露。

在这种猪模型中，ADSC表移植在技术上是成功的，并允许细胞植入监测体内 pCLE评价。临床，内窥镜，放射性，和组织学评价证明增强的ESD后在食管狭窄预防的内窥镜ADSC片的有效性。 含有靛蓝胭脂红染料片的ADSC甘油溶液的内窥镜移植是在再生医学的创新方法。大木等。第一次描述了内镜移植过程。在他们的研究中，细胞表构建体组成层叠在聚偏二氟乙烯的薄片口...

浅表性食管肿瘤的管理层已与新的内镜技术的发展变化。如今，内窥镜切除是一线治疗。事实上，它是具有较低的发病率和死亡率比等于肿瘤结果1，2，3一手术相关。内窥镜粘膜切除术（EMR）和内镜黏膜下切除术（ESD）是最广泛使用的技术。在扩展浅表肿瘤的情况下，静电放电是优选的。相比EMR，ESD允许整块切除，无论病灶大小和形状4，5，6。 ESD的主要延迟并发症是食道狭窄的形成，这通常发生一周和两周之间切除后。最近公布的研究表明，狭窄形成是相关的切除的大小。日本内镜学会建议避免ESD尺寸大于¾食管周长，因为它们是在病例的90％以上与狭窄发展相关联，并且负责严重馈送麻烦和生活质量严重恶化的要大。 食管狭窄的预防仍然是具有挑战性的。参与狭窄形成机制只知道部分。狭窄的地层仿佛来自两个不同的机制，该协会导致:（1）促炎症细胞招聘和（2）过度纤维化发展7。几个预防性治疗方法已被提出。然而，结果并不令人满意，有什么好处和严重的副作用8,9。最近，日本队，大木等人。 ，提出了自体口腔粘膜细胞的单层细胞片移植到esophageal疤痕。在ESD 10,11后立即进行移植。他们证明这种创新方法的有效性，首先在犬模型，然后在病人。 脂肪组织来源的基质细胞（脂肪干细胞）是有希望在再生医学。其在几个领域中的应用已表明有趣的结果，特别是在伤口愈合过程。 ADSC疗法提供了几个优点，因为细胞是容易分离的，并具有抗炎特性，局部免疫调节作用，血管新生诱导，分化能力为间充质和非间充质系12，13，14相关联。 在先前的研究中，我们的团队表现出双ADSC表镜下移植治疗食管狭窄上一页成效在猪模型15增强的ESD后ention。在这篇文章中，ADSC板结构和内窥镜移植技术的报告介绍。

<table border="0" cellpadding="0" cellspacing="0" width="1071">
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		<col />
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		<col />
	</colgroup>
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:313px;">Transparent endoscopic cap Q180 compatible</td>
			<td style="width:159px;">Olympus Optical Co</td>
			<td style="width:107px;"></td>
			<td style="width:492px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">GIF-Q180 gastroscope&#160;</td>
			<td>Olympus Optical Co</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Videoscope System Exera II&#160;</td>
			<td>Olympus Optical Co</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Injection needle 18 G</td>
			<td>Olympus Optical Co</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Electrosurgery unit ERBE ICC 350&#160;</td>
			<td>ERBE Technology</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Indigo carmin 1%</td>
			<td>Life</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Endoscopic hybrid knife</td>
			<td>Life</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Minisonde Z pCLE green probe</td>
			<td>Mauna Kea Technology</td>
			<td></td>
			<td>You must learn how tu use the probe. The manipulation could be difficult</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Fetal bovine serum</td>
			<td>Sigma Aldrich</td>
			<td>12105C</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Trypsin</td>
			<td>Sigma Aldrich</td>
			<td>T146</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Alpha minimum essential medium</td>
			<td>Thermo Fisher</td>
			<td>22561-021</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Phosphate-Buffered Salines</td>
			<td>Thermo Fisher</td>
			<td>10010-023</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">PKH67 dye kit</td>
			<td>Sigma Aldrich</td>
			<td>Mini67-KT</td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">12-well temperature responsive cell culture dish</td>
			<td>Upcell Thermo Scientific</td>
			<td align="right">174900</td>
			<td>Feel the weel with 4 mL standard medium culture 30 minutes before seeding cells</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Esomeprazole 40 mg&#160;</td>
			<td>Biogaran</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Moprhine sulfate 50 mg/ mL</td>
			<td>Lavoisier</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Amoxicilline 1 g</td>
			<td>Biogaran</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Ketamine 250 mg/5 mL</td>
			<td>Panpharma</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Propofol 10 mg/ mL</td>
			<td>Fresenius</td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Hydrophobic paper</td>
			<td>Carrefour</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

adsc-sheet transplantation to prevent stricture after extended esophageal endoscopic submucosal dissection

在过去几年中，细胞的表结构刺激了再生医学的广泛兴趣，尤其是对重建手术程序。多样化的技术脂肪组织衍生的基质细胞（脂肪干细胞）与各种生物材料相结合的发展导致了多种类型的组织工程替代品，如骨，软骨，和从啮齿动物，猪或人脂肪干细胞的脂肪组织的结构。扩展食管内镜黏膜下剥离术（ESD）负责食管狭窄的形成。狭窄预防仍然是具有挑战性的，没有可用的有效的治疗方法。先前的研究报道了犬模型和人类中的粘膜细胞片移植的有效性。脂肪干细胞归因抗炎特性，局部免疫调节作用，血管新生诱导，分化能力为间充质和非间充质细胞谱系。这个原始的研究描述了TRA内镜一个ADSC组织工程构建的nsplantation防止食管狭窄的猪模型。在ADSC结构是由一纸支撑膜在彼此分层2同种异体ADSC表。将脂肪干细胞标记的PKH67荧光允许基于探针的共聚焦激光显微内镜（pCLE）监控。上移植当天，进行5厘米和已知诱导食管狭窄半周的ESD。动物立即用胃镜ADSC 4移植结构。温和应用的10分钟后，获得的ADSC构建体的完整的粘合。动物处死28天所有动物均成功移植。移植证实第3天以积极的pCLE的评价。相比于移植的动物，对照组动物出现严重狭窄，与主要的纤维化组织的发展，越来越频繁的消化道麻烦，减少体重增加。在我们的模型中，allogeni移植Ç脂肪干细胞，双细胞片组织，增强的ESD后成功并以较低的食管狭窄率密切相关。

脂肪干细胞并获得ADSC片的过程的培养示于图1。 图2示出了移植物的结构，在其纸载体膜在彼此层叠2 ADSC片组成。脂肪干细胞以前与PKH67荧光团标记，以便与 pCLE 体内移植监控。 图3示出了延长的食管内窥镜黏膜下层剥离术的不同步骤，从而产生一个5厘米和半周食管疤痕。 图4示出的内窥镜移植过程。移植是成...

Watch this Scientific Journal Video about ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection at JoVE.com

ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection

这项研究报告内窥镜脂肪组织的基质细胞（ADSC）的成功的方法折叠移植食管狭窄预防猪模型的扩展内镜黏膜下剥离术（ESD）之后。

ADSC表移植到扩展食管内镜黏膜下剥离术之后防止狭窄

In past years, the cell-sheet construct has spurred wide interest in regenerative medicine, especially for reconstructive surgery procedures. The ...

adsc-sheet-transplantation-to-prevent-stricture-after-extended

Research

JoVE Journal

Medicine

8.4K 次观看.  Université Paris Descartes Sorbonne Paris Cité. 这项研究报告内窥镜脂肪组织的基质细胞（ADSC）的成功的方法折叠移植食管狭窄预防猪模型的扩展内镜黏膜下剥离术（ESD）之后。 

视频: ADSC-sheet Transplantation to Prevent Stricture after Extended Esophageal Endoscopic Submucosal Dissection

Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET

The number of patients with end-stage renal disease, and the number of kidney allograft recipients continuously increases. Episodes of acute cellular allograft rejection (AR) are a negative prognostic factor for long-term allograft survival, and its timely diagnosis is crucial for allograft function 1. At present, AR can only be definitely diagnosed by core-needle biopsy, which, as an invasive method, bares significant risk of graft injury or even loss. Moreover, biopsies are not feasible in patients taking anticoagulant drugs and the limited sampling site of this technique may result in false negative results if the AR is focal or patchy. As a consequence, this gave rise to an ongoing search for new AR detection methods, which often has to be done in animals including the use of various transplantation models.
Since the early 60s rat renal transplantation is a well-established experimental method for the examination and analysis of AR 2. We herein present in addition small animal positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) to assess AR in an allogeneic uninephrectomized rat renal transplantation model and propose graft FDG-PET imaging as a new option for a non-invasive, specific and early diagnosis of AR also for the human situation 3. Further, this method can be applied for follow-up to improve monitoring of transplant rejection 4.

Non-invasive Imaging of Acute Allograft Rejection after Rat Renal Transplantation Using 18F-FDG PET

We herein present a rat renal transplantation model to non-invasively assess acute allograft rejection using positron emission tomography with 18F-fluorodeoxyglucose.

大鼠肾移植后急性排斥反应的非侵入性的成像使用<sup&gt; 18</sup&gt; F-FDG PET

The number of patients with end-stage renal  disease, and the number of kidney allograft recipients continuously increases.  Episodes of acute cellular ...

科研

医学

Intrasplenic Transplantation of Hepatocytes After Partial Hepatectomy in NOD.SCID Mice

Partial hepatectomy is a versatile and reproducible method to study liver regeneration and the effect of cell based therapeutics in various pathological conditions. Partial hepatectomy also facilitates the increased engraftment and proliferation of transplanted cells by accelerating neovascularization and cell migration towards the liver. Here, we describe a simple protocol for performing 30% hepatectomy and transplantation of cells in the spleen of a non-obese diabetic/severe combined immunodeficient NOD.SCID (NOD.CB17-Prkdcscid/J) mouse. 
In this procedure, two small incisions are made. The first incision is to expose and resect the left lobe of the liver, and another small incision is made to expose the spleen for the intrasplenic transplantation of cells. This procedure does not require any specialized surgical skills, and it can be completed in 5-7 minutes with less stress and pain, faster recovery, and better survival. We have demonstrated the transplantation of hepatocytes isolated from a green fluorescent protein (GFP) expressing mouse (Transgenic C57BL/6-Tg (UBC-GFP) 30Scha/J), as well as hepatocyte like cells of human origin (NeoHep) in partially hepatectomized NOD.SCID mice.

We have described a protocol for performing partial hepatectomy (PHx) and cell transplantation via spleen in NOD.SCID (NOD.CB17-Prkdcscid/J) mice. In this protocol, an incision is made to expose and resect the left lobe of the liver followed by another incision for the intrasplenic transplantation of cells.

肝细胞部分肝切除术后脾移植。小鼠

Partial hepatectomy is a versatile and reproducible method to study liver regeneration and the effect of cell based therapeutics in various pathological ...

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal approach to the middle ear is a minimally invasive technique sparing the bone and mucosa of the mastoid bone, since the middle ear is accessed through the external auditory canal. This emerging method has several advantages over the traditional (microscopic) approaches to the middle ear such as the panoramic wide-angle views of the anatomy, the possibility to approach and magnify tiny structures, and the possibility of looking around the corner using angled endoscopes.
The cadaveric dissection method presented here consists of an overview on the technical requirements and a precise description of a step-by-step protocol to discover the anatomy of the middle ear. Each step and anatomical structure is carefully described in order to provide a comprehensive guide to endoscopic ear anatomy. In our opinion, this is particularly important to any novice in endoscopic ear surgery as it provides thorough anatomical knowledge and may improve surgical skills.

The aim of this article is to describe the methodology of exclusively endoscopic cadaveric middle ear dissection. Moreover, we aim to provide a comprehensive guide to endoscopic middle ear anatomy.

Transcanal 内窥镜下耳部手术发现中耳解剖: 解剖手册

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

Transplantation of Adipose Tissue-Derived Stem Cell Sheet to Reduce Leakage After Partial Colectomy in A Rat Model

Anastomotic leakage is a disastrous complication after colorectal surgery. Although current methods for leakage prevention have different levels of clinical efficacy, they are until now imperfect solutions. Stem cell therapy using ASC sheets could provide a solution to this problem. ASCs are considered as promising candidates for promoting tissue healing because of their trophic and immunomodulatory properties. Here, we provide methods to produce high-density ASC sheets, that are transplanted onto a colorectal anastomosis in a rat model to reduce the leakage. ASCs formed cell sheets in thermo-responsive culture dishes that could be easily detached. On the day of the transplantation, a partial colectomy with a 5-suture colorectal anastomosis was performed. Animals were immediately transplanted with 1 ASC sheet per rat. ASC sheets adhered spontaneously to the anastomosis without any glue, suture, or any biomaterial. Animal groups were sacrificed 3 and 7 days postoperatively. Compared to transplanted animals, the incidence of anastomotic abscesses and leakage was higher in control animals. In our model, the transplantation of ASC sheets after colorectal anastomosis was successful and associated with a lower leakage rate.

The preparation and transplantation of adipose tissue derived stem cell (ASC) sheets onto insufficiently sutured colorectal anastomoses in a rat model is presented. This novel application shows that ASC sheets can reduce colorectal anastomosis leakage.

脂肪组织干细胞移植对大鼠部分结肠切除术后渗漏的减少

Anastomotic leakage is a disastrous complication after colorectal surgery. Although current methods for leakage prevention have different levels of ...

Reduced Complications after Arterial Reconnection in a Rat Model of Orthotopic Liver Transplantation

The rat orthotopic liver transplantation (OLT) model is a powerful tool to study acute and chronic rejection. However, it is not a complete representation of human liver transplantation due to the absence of arterial reconnection. Described here is a modified transplantation procedure that includes the incorporation of hepatic artery (HA) reconnection, leading to a marked improvement in transplant outcomes. With a mean anhepatic time of 12 min and 14 s, HA reconnection results in improved perfusion of the transplanted liver and an increase in long-term recipient survival from 37.5% to 88.2%. This protocol includes the use of 3D-printed cuffs and holders to connect the portal vein and infrahepatic inferior vena cava. It can be implemented for studying multiple aspects of liver transplantation, from immune response and infection to technical aspects of the procedure. By incorporating a simple and practical method for arterial reconnection using a microvascular technique, this modified rat OLT protocol closely mimics aspects of human liver transplantation and will serve as a valuable and clinically relevant research model.

The goal of this study is to modify the rat orthotopic liver transplant model to better represent human liver transplantation and improve recipient survival. The presented method reestablishes hepatic arterial inflow by connecting the donor liver&#39;s common hepatic artery to the recipient liver&#39;s proper hepatic artery.

矫形肝移植大鼠模型中动脉重联后并发症减少

The rat orthotopic liver transplantation (OLT) model is a powerful tool to study acute and chronic rejection. However, it is not a complete representation ...

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, hoarseness or asthma, which can be caused by laryngopharyngeal reflux (LPR). Due to their multifactorial origin, those symptoms can be a great diagnostic and therapeutic challenge. Esophageal pH-monitoring is commonly used to determine abnormal esophageal acid exposure and confirm the diagnosis of GERD. However, for better evaluation of acid exposure above the upper esophageal sphincter, a new laryngopharyngeal pH measurement system is now available and may lead to more reliable results in patients with predominantly extraesophageal symptoms. This article aims to present a standardized protocol for simultaneous pH measurement using esophageal and laryngopharyngeal pH probes in order to obtain acid exposure scores from both measurements.

Laryngopharyngeal pH monitoring has been specifically designed to measure acid exposure above the upper esophageal sphincter and complements diagnostic evaluation in patients that present with mainly extraesophageal reflux symptoms. Patients with suspected laryngopharyngeal reflux (LPR) were evaluated using distal esophageal and laryngopharyngeal pH testing simultaneously.

同时监测喉咽和常规食管 pH 值

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, ...

Intramyocardial Transplantation of MSC-Loading Injectable Hydrogels after Myocardial Infarction in a Murine Model

One of the major issues facing current cardiac stem cell therapies for preventing postinfarct heart failure is the low retention and survival rates of transplanted cells within the injured myocardium, limiting their therapeutic efficacy. Recently, the use of scaffolding biomaterials has gained attention for improving and maximizing stem cell therapy. The objective of this protocol is to introduce a simple and straightforward technique to transplant bone marrow-derived mesenchymal stem cells (MSCs) using injectable hydroxyphenyl propionic acid (GH) hydrogels; the hydrogels are favorable as a cell delivery platform for cardiac tissue engineering applications due to their ability to be cross-linked in situ and high biocompatibility. We present a simple method to fabricate MSC-loading GH hydrogels (MSC/hydrogels) and evaluate their survival and proliferation in three-dimensional (3D) in vitro culture. In addition, we demonstrate a technique for intramyocardial transplantation of MSC/hydrogels in mice, describing a surgical procedure to induce myocardial infarction (MI) via left anterior descending (LAD) coronary artery ligation and subsequent MSC/hydrogels transplantation.

Stem cell-based therapy has emerged as an efficient strategy to repair injured cardiac tissues after myocardial infarction. We provide an optimal in vivo application for stem cell transplantation using gelatin hydrogels that are able to be enzymatically cross-linked.

Murine 模型心肌梗塞后 MSC 加载注射水凝胶的心内移植

One of the major issues facing current cardiac stem cell therapies for preventing postinfarct heart failure is the low retention and survival rates of ...

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney transplantation and physicians. Patients provide information such as vital signs, well-being, and medication intake via smartphone apps. The information is transferred directly into a database and electronic health record at the kidney transplant center, which is used for routine patient care and research. Physicians can send an updated medication plan and laboratory data directly to the patient app via this secure platform. Other features of the app are medical messages and video consultations. Consequently, the patient is better-informed, and self-management is facilitated. In addition, the transplant center and the patient's local nephrologist automatically exchange notes, medical reports, laboratory values, and medication data via the platform. A telemedicine team reviews all incoming data on a dashboard and takes action, if necessary. Tools to identify patients at risk for complications are under development. The platform exchanges data via a standardized secure interface (Health Level 7 (HL7), Fast Healthcare Interoperability Resources (FHIR)). The standardized data exchange based on HL7 FHIR guarantees interoperability with other eHealth solutions and allows rapid scalability to other chronic diseases. The underlying data protection concept is in concordance with the latest European General Data Protection Regulation. Enrollment started in February 2020, and 131 kidney transplant recipients are actively participating as of July 2020. Two large German health insurance companies are currently funding the telemedicine services of the project. The deployment for other chronic kidney diseases and solid organ transplant recipients is planned. In conclusion, the platform is designed to enable home monitoring and automatic data exchange, empower patients, reduce hospitalizations, and improve adherence, and outcomes after kidney transplantation.

The MACCS platform&#160;is a comprehensive telemedicine concept aiming at better outcomes after kidney transplantation by sharing key medical information between patients and physicians. A telemedicine team reviews incoming data to detect potential complications and to improve adherence in kidney transplant recipients to achieve better long-term outcomes.

数字家庭-肾移植后患者的监测:MACCS平台

The MACCS (Medical Assistant for Chronic Care Service) platform enables secure sharing of key medical information between patients after kidney ...

Endoscopic Cholesteatoma Surgery

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. Compared to the microscopic approach with an excellent but straight-line view and limited illumination, the introduction of endoscopes provides a wide-angled panoramic view. Moreover, angled lenses allow the surgeon to visualize the middle ear and its hidden recesses through a transcanal, minimally-invasive approach. The endoscope enables the surgeon to remove limited cholesteatoma of the middle ear and its recesses using an exclusive endoscopic technique by taking advantage of these benefits. This reduces the rate of residual disease and sparing external incisions and excessive temporal bone drilling as in a transmastoid approach. Since transcanal endoscopic access is mainly a one-handed technique, it implies the need for specific procedures and technical refinements. This article describes a step-by-step guide as a surgical manual for endoscopic removal of epitympanic cholesteatoma. Different techniques for cholesteatoma dissection and bone removal for epitympanectomy, including curettage and powered instruments such as drills and ultrasonic devices with their outcomes, are discussed. This may offer ear surgeons insight into technical refinements and the latest technological developments and open the horizon for different techniques.

The present protocol describes a step-by-step guide for the complete endoscopic removal of epitympanic cholesteatoma with different techniques for cholesteatoma dissection and bone removal for epitympanectomy.

内窥镜胆脂瘤手术

Implementation of endoscopes in cholesteatoma surgery resulted in considerable changes in the management of cholesteatoma in the last two decades. ...

Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft failure, ongoing organ donor shortages, and the increased use of marginal grafts call for the improvement of current concepts, such as the implementation of organ machine perfusion. In order to evaluate new methods of graft reconditioning and modulation, translational models are required. With respect to anatomical and physiological similarities to humans and recent progress in the field of xenotransplantation, pigs have become the main large animal species used in transplantation models. After the initial introduction of a porcine orthotopic liver transplant model by Garnier et al. in 1965, several modifications have been published over the past 60 years.
Due to specifies-specific anatomical traits, a veno-venous bypass during the anhepatic phase is regarded as a necessity to reduce intestinal congestion and ischemia resulting in hemodynamic instability and perioperative mortality. However, the implementation of a bypass increases the technical and logistical complexity of the procedure. Furthermore, associated complications such as air embolism, hemorrhage, and the need for a simultaneous splenectomy have been reported previously.
In this protocol, we describe a model of porcine orthotopic liver transplantation without the use of a veno-venous bypass. The engraftment of donor livers after static cold storage of 20 h - simulating extended criteria donor conditions - demonstrates that this simplified approach can be performed without significant hemodynamic alterations or intraoperative mortality and with regular uptake of liver function (as defined by bile production and liver-specific CYP1A2 metabolism). The success of this approach is ensured by an optimized surgical technique and a sophisticated anesthesiologic volume and vasopressor management.
This model should be of special interest for workgroups focusing on the immediate postoperative course, ischemia-reperfusion injury, associated immunological mechanisms, and the reconditioning of extended criteria donor organs.

In this protocol, a model of porcine orthotopic liver transplantation after static cold storage of donor organs for 20 h without the use of a veno-venous bypass during engraftment is described. The approach uses a simplified surgical technique with minimization of the anhepatic phase and sophisticated volume and vasopressor management.

无静脉-静脉旁路术的猪肝移植作为扩展标准供体模型

Liver transplantation is regarded as the gold standard for the treatment of a variety of fatal hepatic diseases. However, unsolved issues of chronic graft ...