首先，我们衷心感谢参与这个项目的母亲。接下来，我们承认协助和促进抽样程序的所有人员，麻醉医师，护士麻醉师和外科护士。如果没有挪威东南部挪威地区卫生局和挪威妇女健康问题咨询组，奥斯陆大学以及奥斯陆大学医院提供的当地资金，该项目就不可能实现。

该研究由奥斯陆大学医院数据保护官员和挪威南部卫生研究伦理学区域委员会2419/2011批准。所有参与者签署书面知情同意书。 准备工作注意:程序的时间表如图1所示 。 <img alt="图1" class="xfigimg" src="/files/ftp_upload/55847/55847fig1.jpg" /> 图1 : 描述涉及4血管采样程序的时间和人员的流程图。 一种颜色代表一个人。该方法的详细说明在协议中给出。 <a href="http://ecsource.jove.com/files/ftp_upload/55847/55847fig1large.jpg" target="_blank">请点击此处查看此图的较大版本。</a> <ol><li> 员工 <ol><li&gt;确保所有必需的人员可用:高级技术的进行超声测量的胎儿医学专家，两名产科医生进行手术，其中一名产科医生和两名护士收集样品，一名助理处理血气分析和一名助理处理其他样品连续并立即收集。 注意:如果更高级的胎盘组织收集，需要额外的人。 </li></ol></li><li> 设备 <ol><li>准备设备，冷冻冷冻的1M冰磷酸缓冲盐水（PBS），25mL冷RNA稳定溶液和5×0.5mL最佳切割温度化合物（OCT）。标记出真空管和管子。见临时设备清单。 </li></ol></li></ol> 2.产妇特征<ol><li>记录产妇的临床和非临床特征，并重复相关问题和我发货时包括重量，包括重量。记录剖宫产前的禁食期，以及手术期间发生的任何低血压事件。 注意:包括最近在全球妊娠合并实验室（COLAB）出版的报告中提供的最小母亲临床数据。本文还包括选择学习人群的一些非常重要的方面，在规划研究时应予以解决18 。 </li><li>考虑记录父系特征，包括种族，年龄和体重指数（BMI）。 </li></ol>超声波<ol><li>在交付当天进行多普勒超声检查，女性处于禁食状态。在胎儿静止期间进行检查，女性处于半仰卧位，与感兴趣区域稍微横向倾斜，以避免压迫主动脉和腔静脉。监视输出显示器上的机械和热指数的张力。 </li><li> 脐静脉 <ol><li>在脐静脉中可以观察到胎腹的矢状或斜向横断。在任何可见的分支之前测量腹内脐静脉直线部分的内部血管直径。使用常规B模式，并以直径测量的垂直角度观察容器，并保留几个最佳框架用于以后的测量，以最小化脉动直径变化的影响。 <ol><li>重复测量五到十次19 。 </li></ol></li><li>在同一个位置，使用多普勒超声，并调整探头以获得尽可能低的声压角（始终&lt;30°），以测量时间平均最大速度（TAMX）。在3 - 5秒（非脉动流量）的时间内获得速度。 </li></ol></li><li> 子宫动脉 <ol><li>使用多普勒超声显示子宫动脉穿过髂外动脉后立即从髂内动脉分支。调整此位置的探头以获得较低的角度（始终&lt;30°）并测量TAMX。获取速度为三个心脏周期的平均速度。 </li><li>由于在与TAMX测量相同的位置处不太可能获得垂直的角度，所以沿着容器向远侧方向，以获得直径测量值的正确角度，使其尽可能接近直径测量点。如果任何可见的血管在该位置之前分支，则通过彩色多普勒超声评估，排除直径测量。 <ol><li>使用常规B模式，并以直径测量的垂直角度观察容器，并保留几个最佳框架用于以后的测量，以最小化脉动直径变化的影响。 </li><li>重复测量五到十次19 。 </li></ol></<html> LI&gt; </ol></li><li>注意胎盘的位置。 </li></ol> 4血管采血注意: 图1中概述了程序的时间表， 图2中显示了样品的概述。 <img alt="图2" class="xfigimg" src="/files/ftp_upload/55847/55847fig2.jpg" /> 图2 : 胎盘脉管系统和采样部位的示意图。 在4血管采样方法中，血液样品从子宫静脉，桡动脉（作为子宫动脉的代理）和脐动脉和静脉抽取。通过超声测量子宫动脉和脐静脉血流量。收集来自胎盘的组织样品。插图:奥斯陆大学ØysteinH. Horgmo。5847fig2large.jpg"target ="_ blank"&gt;请点击此处查看此图的较大版本。 <ol><li> 安全程序 <ol><li>向操作剧院的所有人员提供手套，手术擦洗套装，口罩和头饰。 </li><li>提供外科医生和研究人员与手术护理套装，口罩，头饰，长袍和双手套接触手术领域。眼镜是可选的。 </li><li>提供用手套处理血液样本的人员。 </li><li>提供使用手套和手术口罩处理胎盘样品的人员。均质化需要使用罩。 </li></ol></li><li> 准备在手术室 <ol><li>给予介绍，并将设备交给所有在手术开始前协助取样的人员。 </li><li>解决麻醉师和麻醉护士谁将协助进行必要的外周动脉和静脉通路，并确保取样前不得静脉注射液体。 </li><li>给辅助肘前静脉样本的人和两个注射器（一个20 mL和一个10 mL）和一个血液注射器（含肝素）的三个注射器（10 mL）无针对辅助桡动脉的人。 </li><li>准备两个无菌注射器（20 mL），五个无菌注射器（10 mL），三个"蝴蝶针"和两个血液注射器进行操作。 </li></ol></li><li> 进入血管。 <ol><li>按照剖宫产前的标准程序，以确保外周静脉（iv）进入。 注意:由于更容易从本地抽取样品，因此优选肘前静脉。 </li><li>通过超声或触诊定位手腕上的桡动脉。在0.5mL皮下利多卡因镇痛后，将动脉线置于桡动脉。如果三次插入失败，请放弃此网站的抽样，或如果女人在插入期间经历疼痛。 注意:按照标准程序进行剖宫产手术。以下仅列出了抽样程序所需的调整。 </li></ol></li><li> 产妇血液样本 注意:在子宫切口之前同时获得所有三种母体血液样本（子宫静脉，桡动脉和肘前静脉）。 <ol><li>对于子宫静脉，打开腹腔后，使用牵开器抬起腹壁，将子宫静脉的主要分支暴露在子宫的前外侧。如果胎盘位于子宫中线，请尽可能在与胎盘同侧的子宫静脉分支处获取血液，或使用最突出的静脉丛。 <ol><li>在大约30度的角度将蝴蝶针插入子宫静脉血气注射器，并通过温和抽吸收集血液，以避免溶血。在小心地固定蝴蝶针的静脉位置的同时，将填充的血气注射器用20 mL和10 mL注射器连续更换。 注意:当站在所选子宫静脉的对侧时，最佳保证最佳。 </li></ol></li><li>对于桡动脉，从动脉内线吸出。弃去前5 mL，然后在肝素注射器中抽吸3 mL进行血气分析，然后在两个注射器（20 + 10 mL）中3 mL。 </li><li>对于肘静脉，从静脉导管轻轻吸出。弃去前5 mL，然后在三只注射器（10 mL）中抽取30 mL。 </li><li>在开始关闭腹部之前，先对子宫静脉采样点进行最终检查。 </li></ol></li><li> 胎儿血样 <ol><li>当孩子出生时，立即从脐动脉吸出血液，而不夹紧脐带或输送胎盘。开始机智h用于血气分析的注射器，如果可能的话，使用三个10mL注射器。 </li><li>当固定动脉样本时，夹住绳索，并将脐带静脉（血气和20 + 10 mL注射器）取样前将儿童送到助产士。 注意:在分娩的几秒钟内和胎盘原位获得所有脐带样品，除非自发分离。 </li><li>按照挪威关于延迟钳夹的建议。如果遇到困难的孩子，请立即夹紧并切断绳索，并将小孩的手交给助产士和新生儿学家。 </li></ol></li><li> 处理血液样本 <ol><li>将血气注射器放在冰上，同时准备其余的血液样品，并在5分钟内在血气分析仪中分析。 </li><li>将血液样品立即转移到真空器中，并将等离子管放置在摇杆上1-2分钟，然后放在冰上。离开血液管上的劳动atory长凳定居30分钟。 注意:这是程序中的关键步骤，需要额外的关注，因为所有五个站点的样品必须同时准备以确保良好的质量。 </li><li>尽快离心血浆样品，30分钟内，6℃，2500×g离心20分钟。 </li><li> 30分钟后，将血清样品在室温下以2500×g离心10分钟。 </li><li>将上清液小心地分装到2 mL冷冻管中，将0.5 mL上清液放在颗粒上方，以确保无血小板血浆。 </li><li>将样品储存在-80°C。 </li></ol></li></ol> 5.胎盘组织收集<ol><li>交付后，将胎盘平放在冰冷的夹层托盘上。拍摄并测量最长直径和直径在90度。 </li><li>称重胎盘。 </li><li>记录重量，两个直径，任何gross病理学，绳索中的血管数量以及从胎盘放置在冰上的时间间隔。 注意:如果临床指示，请将胎盘发送到病理检查。 </li><li>将胎盘放置在母体表面上，并确定随机位于胎盘每个象限中的4 - 5个采样点，避免坦克病理区域。用剪刀取下蜕膜，从母体表面切出3-5毫米。从每个位点收集1 - 2 cm 3的绒毛组织。 </li><li>将收集的组织轻轻洗涤在50mL冷1M PBS中。从每个采样点分割成几片，并分装。 注意:胎盘的尺寸将取决于计划的分析。 </li><li>将0.1 - 0.5 cm 3组织样品的等分试样添加到5个低温管中，并在液氮中快速冷冻。 </li><li>使用25 mL RNA稳定溶液将0.1〜0.2 cm 3的小块加入管中。存放于46; C 24小时，丢弃RNA稳定溶液并更换。冻结。 </li><li>将0.5cm 3的片加入5个冷冻管中，加入0.5mL OCT，充满OCT，混合并冷冻。 </li><li>将样品储存在-80°C直到分析。 注意:Burton et al。根据计划分析，对胎盘采样的实际情况进行了很好的概述。 20考虑到制备的剩余组织为微绒毛和基膜的分离，并收集通过真空抽吸技术蜕膜组织。 21,22 </li></ol> 6.新生儿特征<ol><li>记录新生儿特征，包括Apgar评分（1,5和10分钟），性别，体重，体重，胎龄和新生儿重症监护病房入院时间（住院时间和结局）。 </li><li>考虑通过人体测量测量新生儿身体组成，进行排气体积描记法或双重X线吸收测定法。 23，24 </li></ol> 7.计算<ol><li>假设在径向和子宫动脉中血液成分相似，并计算子宫胎盘动静脉的浓度差异。 胎盘动静脉血压浓度差= C A - C V 脐静脉 - 动脉浓度差= C v -C a 其中C为下标浓度:A，桡动脉; V，子宫静脉;脐静脉和脐动脉。 </li><li>计算体积血流量，mL / min（Q）: <img alt="公式1" src="/files/ftp_upload/55847/55847eq1.jpg" /> 其中D是血管直径（cm），TAMX是时间平均最大速度，h是空间血液速度分布的系数。使用0.5作为脐静脉的系数0.6子宫动脉25，26。 </li><li>根据Fick的原理计算胎盘摄取和释放: 子宫胎盘摄取 =（ C A - C V ）× Qm 胎儿吸收= （ C v -C a ） x Q f 下标:m，母亲和f，胎儿。 </li></ol>

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J., 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=Optimising+sample+collection+for+placental+research.">Optimising sample collection for placental research.</a> Placenta. 35 (1), 9-22 (2014).</li><li>Illsley, N. P., Wang, Z. Q., Gray, A., Sellers, M. C., Jacobs, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simultaneous+preparation+of+paired,+syncytial,+microvillous+and+basal+membranes+from+human+placenta.">Simultaneous preparation of paired, syncytial, microvillous and basal membranes from human placenta.</a> Biochim Biophys Acta. 1029 (2), 218-226 (1990).</li><li>Staff, A. C., Ranheim, T., Khoury, J., Henriksen, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+contents+of+phospholipids,+cholesterol,+and+lipid+peroxides+in+decidua+basalis+in+women+with+preeclampsia.">Increased contents of phospholipids, cholesterol, and lipid peroxides in decidua basalis in women with preeclampsia.</a> Am J Obstet Gynecol. 180 (3), 587-592 (1999).</li><li>Catalano, P. M., Thomas, A. J., Avallone, D. A., Amini, S. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anthropometric+estimation+of+neonatal+body+composition.">Anthropometric estimation of neonatal body composition.</a> Am J Obstet Gynecol. 173 (4), 1176-1181 (1995).</li><li>Ellis, K. J., 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=Body-composition+assessment+in+infancy:+air-displacement+plethysmography+compared+with+a+reference+4-compartment+model.">Body-composition assessment in infancy: air-displacement plethysmography compared with a reference 4-compartment model.</a> Am J Clin Nutr. 85 (1), 90-95 (2007).</li><li>Haugen, G., Kiserud, T., Godfrey, K., Crozier, S., Hanson, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Portal+and+umbilical+venous+blood+supply+to+the+liver+in+the+human+fetus+near+term.">Portal and umbilical venous blood supply to the liver in the human fetus near term.</a> Ultrasound Obstet Gynecol. 24 (6), 599-605 (2004).</li><li>Acharya, G., 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=Experimental+validation+of+uterine+artery+volume+blood+flow+measurement+by+Doppler+ultrasonography+in+pregnant+sheep.">Experimental validation of uterine artery volume blood flow measurement by Doppler ultrasonography in pregnant sheep.</a> Ultrasound Obstet Gynecol. 29 (4), 401-406 (2007).</li><li>Wu, X., 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=Glutamate-glutamine+cycle+and+exchange+in+the+placenta-fetus+unit+during+late+pregnancy.">Glutamate-glutamine cycle and exchange in the placenta-fetus unit during late pregnancy.</a> Amino Acids. 47 (1), 45-53 (2015).</li><li>Tuckey, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progesterone+synthesis+by+the+human+placenta.">Progesterone synthesis by the human placenta.</a> Placenta. 26 (4), 273-281 (2005).</li><li>Simmons, M. A., Meschia, G., Makowski, E. L., Battaglia, F. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fetal+metabolic+response+to+maternal+starvation.">Fetal metabolic response to maternal starvation.</a> Pediatr Res. 8 (10), 830-836 (1974).</li><li>Simmons, M. A., Jones, M. D., Battaglia, F. C., Meschia, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Insulin+effect+on+fetal+glucose+utilization.">Insulin effect on fetal glucose utilization.</a> Pediatr Res. 12 (2), 90-92 (1978).</li><li>Bujold, E., 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=Evidence+supporting+that+the+excess+of+the+sVEGFR-1+concentration+in+maternal+plasma+in+preeclampsia+has+a+uterine+origin.">Evidence supporting that the excess of the sVEGFR-1 concentration in maternal plasma in preeclampsia has a uterine origin.</a> J Matern Fetal Neonatal Med. 18 (1), 9-16 (2005).</li><li>Jansson, T., Aye, I. L., Goberdhan, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+emerging+role+of+mTORC1+signaling+in+placental+nutrient-sensing.">The emerging role of mTORC1 signaling in placental nutrient-sensing.</a> Placenta. 33, 23-29 (2012).</li><li>Cetin, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+transport+of+amino+acids+in+normal+and+growth-restricted+pregnancies.">Placental transport of amino acids in normal and growth-restricted pregnancies.</a> Eur J Obstet Gynecol Reprod Biol. 110, 50-54 (2003).</li></ol>

作者没有什么可以披露的。

<html>胎盘4血管采样方法有三个主要目的。首先，我们的葡萄糖和氨基酸研究证明，它可以用于研究胎盘在母体一侧如何摄取特定物质，并可能转移到脐带循环和胎儿。第二，该方法与研究胎盘产生的物质高度相关，并释放到母体或胎儿循环中，如黄体酮结果所示。第三，研究胎儿体内如何在快速生长和组织重塑过程中消除废物可能是有用的。 4血管方法的关键步...

根据卫生，美国全国学院，胎盘是在人体1，2，3中的至少理解器官。 在体内不易对正在进行的怀孕造成不道德的风险进行人体胎盘的访问和研究是困难的。因此，人体胎盘功能的研究主要是基于体外和离体模型。多数在胎盘转运和代谢的体内研究以前已经在动物4,5被执行，6。然而，由于胎盘结构和功能在物种间有很大差异，所以必须谨慎地将动物的结果外推至人体。只有少数较小的人体内研究已经调查了在正常生理学下的胎盘和胎儿摄取和运输人的条件下，并且没有已经探索几种化合物7，8，9，10，11，12，13的集成传输。这些基础研究表明，人胎盘的体内研究是可行的，并且它们可以用于多种目的。首先，主要来自体外 ， 体外和动物研究的胎盘功能的现有概念可以在人的环境中进行测试，从而提供对人胎盘的新颖和更具体的洞察。其次，与异常胎儿生长，先兆子痫，母亲糖尿病，代谢综合征和其他母体代谢紊乱相关的功能障碍性胎盘的性质可以更好地表征。第三，人体内研究提供了开发诊断的机会tic和胎盘功能的预测工具。 在这个背景下，我们旨在建立一个全面的生理数据收集，以调查体内人胎盘功能。在计划剖宫产期间，我们利用腹腔内进入子宫静脉从胎盘的母胎和胎侧的进出血管收集血液样品（4血管采样方法）。这些样品用于计算营养物质和其他物质的成对动静脉浓度差异14 。此外，我们通过超声测量胎盘两侧的体积血流量。因此，可以量化任何化合物的胎盘和胎儿摄取。此外，能够确定由胎盘释放到母体和胎儿循环15，16，17的物质。结合时20d与母亲和儿童的临床参数，以及胎盘的分析和其他相关组织，这种方法具有令人兴奋的潜力，在同一个母亲，胎儿对胎盘功能的许多方面集成在体内 。

<table border="0" cellpadding="0" cellspacing="0" width="1323">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="20">
			<td height="20" style="height:20px;width:557px;">Maternal body composition</td>
			<td style="width:173px;"></td>
			<td style="width:107px;"></td>
			<td style="width:487px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Impedance scale</td>
			<td>Tanita</td>
			<td></td>
			<td>or similar</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Ultrasound measurements&#160;</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Sequoia 512 ultrasound machine</td>
			<td>Acuson</td>
			<td></td>
			<td>equipped with a curved transducer with colour and pulsewave Doppler (frequency bandwidth 2-6 MHz)</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Blood samples</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Arerial cannula</td>
			<td>BD Medical</td>
			<td>682245</td>
			<td>or similar</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">20cc Eccentric Luer Tip Syringe without Needle</td>
			<td>Termo</td>
			<td>SS-20ES</td>
			<td>or similar. 3 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">10cc Eccentric Luer Tip Syringe without Needle</td>
			<td>Termo</td>
			<td>SS-10ES</td>
			<td>or similar. 9 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">5cc 6% Luer Syringe without Needle</td>
			<td>Termo</td>
			<td>SS-05S1</td>
			<td>or similar. 2 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Arterial blood gas syringe&#160;</td>
			<td>Radiometer Medical</td>
			<td></td>
			<td>or similar. 4 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Sterile winged needle connected to flexible tubing, 21 gauge</td>
			<td>Greiner Bio-One</td>
			<td>450081</td>
			<td>(intended for single use).3 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Vacutainer tube 6 mL EDTA&#160;</td>
			<td>Greiner Bio-One</td>
			<td>456043</td>
			<td>or similar. Label with sample site. 10 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Vacutainer tube 5 ml LH Lithium Heparin Separator</td>
			<td>Greiner Bio-One</td>
			<td>456305</td>
			<td>or similar. Label with sample site. 5 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Vacutainer tube 6 mL Serum Clot Activator&#160;</td>
			<td>Greiner Bio-One</td>
			<td>456089</td>
			<td>or similar. Label with sample site. 5 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;width:557px;">Vacutainer tube 3 ml&#160; 9NC Coagulation sodium citrate 3,2%</td>
			<td>Greiner Bio-One</td>
			<td>454334</td>
			<td>or similar. Label with sample site. 5 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Cryogenic vials, 2.0 mL</td>
			<td>Corning</td>
			<td>430488</td>
			<td>or similar. Label with sample site, serum/type of plasma and ID. 90 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Marked trays to transport the syringes</td>
			<td></td>
			<td></td>
			<td>to transport the blood samples in the operation theatre</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Rocker</td>
			<td></td>
			<td></td>
			<td>for gentle mixing of the samples</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Ice</td>
			<td></td>
			<td></td>
			<td>in styrofoam box</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Liquid nitrogen</td>
			<td></td>
			<td></td>
			<td>in appropriate container</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Placenta samples</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Metal tray</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Ice</td>
			<td></td>
			<td></td>
			<td>in styrofoam box</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Calibrated scale</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Metal ruler</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">1 M Phosphate buffered saline</td>
			<td>Sigma</td>
			<td>D1408</td>
			<td>or similar. Dilute 10 M to&#160; 1M before use</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">RNA stabilization solution</td>
			<td>Sigma</td>
			<td>R0901-500ML&#160;</td>
			<td>or similar</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Optimal Cutting Temperature (O.C.T.) compound</td>
			<td>vwr</td>
			<td>361603E</td>
			<td>or similar</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Cryogenic vials, 2.0 mL</td>
			<td>Corning</td>
			<td>430488</td>
			<td>or similar. Label with sample site. content and ID. 10 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Centrifuge tubes, conical bottom 50 mL</td>
			<td>Greiner Bio-One</td>
			<td>227,285</td>
			<td>or similar. Label with &#34;RNA later&#34;, sample site and ID. 2 needed.</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Liquid nitrogen</td>
			<td></td>
			<td></td>
			<td>in appropriate container</td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Fetal body composition</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Calibrated scale</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;">Measuring tape</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

the 4-vessel sampling approach to integrative studies of human placental physiology in vivo

人胎盘在子宫内仍然无法进行研究。因此，目前对人类胎盘生理学的了解在很大程度上取决于动物研究，尽管胎盘解剖学中物种的多样性，血液动力学和妊娠持续时间。绝大多数人胎盘研究是离体灌注研究或体外滋养层研究。虽然体外研究和动物模型是必不可少的，但是将这些研究结果外推到体内的人类胎盘是不确定的。我们的目的是在体内研究人胎盘生理学，并提出该方法的详细方案。在计划剖宫产期间，利用子宫内膜的子宫静脉进入子宫静脉，我们从胎盘母体和胎侧的进出血管中收集血样。组合时从体积血流测量的血液样本中心测量，我们能够量化胎盘和胎儿摄取和任何化合物的释放。此外，来自相同母胎胎系的胎盘组织样本可以提供运动员密度和活性以及体内胎盘功能的其它方面的测量。通过这种4血管采样方法的综合使用，我们能够在正常和病理性怀孕中测试体内胎盘营养转移和代谢的一些现有概念。此外，该方法能够将胎盘分泌的物质鉴定为母体循环，这可能是对胎盘功能障碍生物标志物的检索的重要贡献。

4血管采样方法适用于临床实践，我们成功获得了209例母亲/婴儿对的血液样本。其中128个我们也实现了测量体积血流量。在70个母胎胎系中获得了完整的4血管采样和母体和胎儿血管的良好质量流量测量（ 图3 ）。此外，我们迄今已收集了30名先兆子痫患者的血液和胎盘样品。之前我们已经发表了关于营养成分的人胎盘转移，以及血管活性胎盘因素释?...

Watch this Scientific Journal Video about The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo at JoVE.com

The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

我们提出了一种在体内研究人胎盘生理学的详细方法。该方法将来自胎盘和母胎侧的进出血管的血液采样与体积血流和胎盘组织取样的超声测量相结合。

人体胎盘生理学综合研究的4血管取样方法<em&gt;体内</em

The human placenta is highly inaccessible for research while still in utero. The current understanding of human placental physiology in vivo is therefore ...

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The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

10.5K 次观看.  Oslo University Hospital. 我们提出了一种在体内研究人胎盘生理学的详细方法。该方法将来自胎盘和母胎侧的进出血管的血液采样与体积血流和胎盘组织取样的超声测量相结合。 

视频: The 4-vessel Sampling Approach to Integrative Studies of Human Placental Physiology In Vivo

Roux-en-Y Gastric Bypass Operation in Rats

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality benefit is bariatric surgery1,2. Consequently, there has been a steady rise in the number of bariatric operations done worldwide in recent years with the Roux-en-Y gastric bypass (gastric bypass) being the most commonly performed operation3. Against this background, it is important to understand the physiological mechanisms by which gastric bypass induces and maintains body weight loss. These mechanisms are yet not fully understood, but may include reduced hunger and increased satiation4,5, increased energy expenditure6,7, altered preference for food high in fat and sugar8,9, altered salt and water handling of the kidney10 as well as alterations in gut microbiota11. Such changes seen after gastric bypass may at least partly stem from how the surgery alters the hormonal milieu because gastric bypass increases the postprandial release of peptide-YY (PYY) and glucagon-like-peptide-1 (GLP-1), hormones that are released by the gut in the presence of nutrients and that reduce eating12.
During the last two decades numerous studies using rats have been carried out to further investigate physiological changes after gastric bypass. The gastric bypass rat model has proven to be a valuable experimental tool not least as it closely mimics the time profile and magnitude of human weight loss, but also allows researchers to control and manipulate critical anatomic and physiologic factors including the use of appropriate controls. Consequently, there is a wide array of rat gastric bypass models available in the literature reviewed elsewhere in more detail 13-15. The description of the exact surgical technique of these models varies widely and differs e.g. in terms of pouch size, limb lengths, and the preservation of the vagal nerve. If reported, mortality rates seem to range from 0 to 35%15. Furthermore, surgery has been carried out almost exclusively in male rats of different strains and ages. Pre- and postoperative diets also varied significantly.
Technical and experimental variations in published gastric bypass rat models complicate the comparison and identification of potential physiological mechanisms involved in gastric bypass. There is no clear evidence that any of these models is superior, but there is an emerging need for standardization of the procedure to achieve consistent and comparable data. This article therefore aims to summarize and discuss technical and experimental details of our previously validated and published gastric bypass rat model.

Numerous studies using gastric bypass rat models have been recently conducted to uncover the underlying physiological mechanisms of Roux-en-Y gastric bypass operations. This article aims to demonstrate and discuss the technical and experimental details of our published gastric bypass rat model to understand advantages and limitations of this experimental tool.

空肠Roux-en-Y胃搭桥手术大鼠

Currently, the most effective therapy for the treatment of morbid obesity to induce significant and maintained body weight loss with a proven mortality ...

科研

医学

Depletion of Mouse Cells from Human Tumor Xenografts Significantly Improves Downstream Analysis of Target Cells

The use of in vitro cell line models for cancer research has been a useful tool. However, it has been shown that these models fail to reliably mimic patient tumors in different assays1. Human tumor xenografts represent the gold standard with respect to tumor biology, drug discovery, and metastasis research 2-4. Tumor xenografts can be derived from different types of material like tumor cell lines, tumor tissue from primary patient tumors4 or serially transplanted tumors. When propagated in vivo, xenografted tissue is infiltrated and vascularized by cells of mouse origin. Multiple factors such as the tumor entity, the origin of xenografted material, growth rate and region of transplantation influence the composition and the amount of mouse cells present in tumor xenografts. However, even when these factors are kept constant, the degree of mouse cell contamination is highly variable.
Contaminating mouse cells significantly impair downstream analyses of human tumor xenografts. As mouse fibroblasts show high plating efficacies and proliferation rates, they tend to overgrow cultures of human tumor cells, especially slowly proliferating subpopulations. Mouse cell derived DNA, mRNA, and protein components can bias downstream gene expression analysis, next-generation sequencing, as well as proteome analysis 5. To overcome these limitations, we have developed a fast and easy method to isolate untouched human tumor cells from xenografted tumor tissue. This procedure is based on the comprehensive depletion of cells of mouse origin by combining automated tissue dissociation with the benchtop tissue dissociator and magnetic cell sorting. Here, we demonstrate that human target cells can be can be obtained with purities higher than 96% within less than 20 min independent of the tumor type.

Human tumor xenografts are vascularized and infiltrated by cells of mouse origin during the growth phase in vivo. To circumvent the bias caused by these contaminating cells during downstream analysis, we developed a method allowing for comprehensive depletion of all mouse cells by magnetic cell sorting.

从人类肿瘤异种移植的小鼠细胞的消耗显着改善靶细胞下游分析

The use of in vitro cell line models for cancer research has been a useful tool. However, it has been shown that these models fail to reliably mimic ...

Phosphorus-31 Magnetic Resonance Spectroscopy: A Tool for Measuring In Vivo Mitochondrial Oxidative Phosphorylation Capacity in Human Skeletal Muscle

Skeletal muscle mitochondrial oxidative phosphorylation (OXPHOS) capacity, which is critically important in health and disease, can be measured in vivo and noninvasively in humans via phosphorus-31 magnetic resonance spectroscopy (31PMRS). However, the approach has not been widely adopted in translational and clinical research, with variations in methodology and limited guidance from the literature. Increased optimization, standardization, and dissemination of methods for in vivo 31PMRS would facilitate the development of targeted therapies to improve OXPHOS capacity and could ultimately favorably impact cardiovascular health. 31PMRS produces a noninvasive, in vivo measure of OXPHOS capacity in human skeletal muscle, as opposed to alternative measures obtained from explanted and potentially altered mitochondria via muscle biopsy. It relies upon only modest additional instrumentation beyond what is already in place on magnetic resonance scanners available for clinical and translational research at most institutions. In this work, we outline a method to measure in vivo skeletal muscle OXPHOS. The technique is demonstrated using a 1.5 Tesla whole-body MR scanner equipped with the suitable hardware and software for 31PMRS, and we explain a simple and robust protocol for in-magnet resistive exercise to rapidly fatigue the quadriceps muscle. Reproducibility and feasibility are demonstrated in volunteers as well as subjects over a wide range of functional capacities.

Phosphorus-31 Magnetic Resonance Spectroscopy: A Tool for Measuring In Vivo Mitochondrial Oxidative Phosphorylation Capacity in Human Skeletal Muscle

This work demonstrates the feasibility of an in vivo phosphorus-31 magnetic resonance spectroscopy (31PMRS) technique to quantify mitochondrial oxidative phosphorylation (OXPHOS) capacity in human skeletal muscle.

磷31磁共振波谱分析:一种测量工具<em&gt;在体内</em&gt;线粒体氧化磷酸化能力人骨骼肌

Skeletal muscle mitochondrial oxidative phosphorylation (OXPHOS) capacity, which is critically important in health and disease, can be measured in vivo ...

Analyzing Beneficial Effects of Nutritional Supplements on Intestinal Epithelial Barrier Functions During Experimental Colitis

Inflammatory bowel diseases (IBD), including Crohn&#39;s disease and ulcerative colitis, are chronic relapsing disorders of the intestines. They cause severe problems, such as abdominal cramping, bloody diarrhea, and weight loss, in affected individuals. Unfortunately, there is no cure yet, and treatments only aim to alleviate symptoms. Current treatments include anti-inflammatory and immunosuppressive drugs that may cause severe side effects. This warrants the search for alternative treatment options, such as nutritional supplements, that do not cause side effects. Before their application in clinical studies, such compounds must be rigorously tested for effectiveness and security in animal models. A reliable experimental model is the dextran sulfate sodium (DSS) colitis model in mice, which reproduces many of the clinical signs of ulcerative colitis in humans. We recently applied this model to test the beneficial effects of a nutritional supplement containing vitamins C and E, L-arginine, and &#969;3-polyunsaturated fatty acids (PUFA). We analyzed various disease parameters and found that this supplement was able to ameliorate edema formation, tissue damage, leukocyte infiltration, oxidative stress, and the production of pro-inflammatory cytokines, leading to an overall improvement in the disease activity index. In this article, we explain in detail the correct application of nutritional supplements using the DSS colitis model in C57Bl/6 mice, as well as how disease parameters such as histology, oxidative stress, and inflammation are assessed. Analyzing the beneficial effects of different diet supplements may then eventually open new avenues for the development of alternative treatment strategies that alleviate IBD symptoms and/or that prolong the phases of remission without causing severe side effects.

Current treatments of inflammatory bowel diseases (IBD) aim at alleviating disease symptoms but may cause severe side effects. Thus, alternative strategies are being investigated in animal colitis models. Here, we explain how the beneficial effects of diet supplements on clinical IBD signs are analyzed in such a colitis model.

分析营养补充剂的有益作用于肠上皮屏障功能在实验性结肠炎

Inflammatory bowel diseases (IBD), including Crohn&#39;s disease and ulcerative colitis, are chronic relapsing disorders of the intestines. They cause ...

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ischemia and infarction in children. If left untreated, it results in a 90% mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic subendocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. The average age of life-threatening presentation is 33 years and of sudden cardiac death 31 years. Therefore, surgical correction is highly recommended as soon as the diagnosis is made, regardless of age. In adult-type ALCAPA originating from the right-facing sinus of the pulmonary artery, direct re-implantation of the ALCAPA into the aorta is the more physiologically sound repair technique to re-establish the dual-coronary perfusion system and is recommended. This protocol describes the technique of direct re-implantation of adult-type ALCAPA into the aorta.

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Surgical correction of ALCAPA is highly recommended, regardless of age or the degree of intercoronary collateralization. This protocol presents a technique for the direct re-implantation of adult-type ALCAPA into the aorta to re-establish the dual-coronary perfusion. Whenever feasible, direct re-implantation is preferred to other surgical correction techniques.

左冠状动脉直接再注入与从肺动脉左冠状动脉起源异常成人主动脉（ALCAPA）

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial valve might not meet the functional needs. The implantation of a too-small stented pericardial valve, leading to an effective orifice area indexed to a body surface area less than 0.85 cm2/m2, is regarded as prosthesis-patient mismatch (PPM). A PPM negatively affects the regression of left ventricular hypertrophy and thus the normalization of left ventricular function and the alleviation of symptoms. Persistent left ventricular hypertrophy is associated with an increased risk of arrhythmias and sudden cardiac death. In the case of predictable PPM, there are three options: 1) accept the PPM resulting from the implantation of a stented pericardial valve when comorbidities of the patient forbid the more technically demanding operative technique of implanting a larger prosthesis, 2) enlarge the aortic root to accommodate a larger stented valve substitute, or 3) implant a stentless biological valve or a homograft. Compared to classical aortic valve replacement with stented pericardial valves, the full-root implantation of stentless aortic xenografts offers the possibility of implanting a 3-4 mm larger valve in a given patient, thus allowing significant reduction in transvalvular gradients. However, a number of cardiac surgeons are reluctant to transform a classical aortic valve replacement with stented pericardial valves into the more technically challenging full-root implantation of stentless aortic xenografts. Given the potential hemodynamic advantages of stentless aortic xenografts, we have adopted full-root implantation to avoid PPM in patients with small aortic roots necessitating an aortic valve replacement. Here, we describe in detail a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses. Limitations of this technique and alternative options are discussed.

Full-root aortic valve replacement by stentless aortic xenograft is a viable option in patients with small aortic roots. We describe, a technique for the full-root implantation of stentless aortic xenografts, with emphasis on the management of the proximal suture line and coronary anastomoses, and discuss its limitations and alternative options.

全根主动脉瓣置换主动脉瓣狭窄主动脉异种移植患者小主动脉根

In patients with small aortic roots who need an aortic valve replacement with biological valve substitutes, the implantation of the stented pericardial ...

Preparation of Herbal Medicine: Er-Xian Decoction and Er-Xian-containing Serum for In Vivo and In Vitro Experiments

Traditional herbal medicine, an alternative medicine in the clinical setting, has received increased attention in recent years. Before delivery to the body, an additional extraction procedure is commonly required to release the active constituents from raw herbs. Water decoction is a classical extraction procedure that is still broadly used in the clinical settings. Here, we propose a detailed protocol for er-xian decoction (EXD) in order to apply herbal decoctions to experimental studies. The calculation of an animal-appropriate dose is described, as well as the four main steps of EXD: soaking, water decoction, filtration, and concentration. In addition, serum-containing EXD is introduced to rats as a means of in vitro validation. Here, rats were orally administered EXD for three days. Blood samples were then collected, inactivated, centrifuged, and filtered. The serum, diluted with the culture medium, can be utilized to treat cells or tissues in vitro. For example, EXD was applied to both in vivo and in vitro studies and demonstrated that EXD enhances osteogenesis. This protocol can be used as a reference for the preparation and application of herbal medicines.

Preparation of Herbal Medicine: Er-Xian Decoction and Er-Xian-containing Serum for In Vivo and In Vitro Experiments

Here, we present the preparation of an er-xian decoction (EXD) in four steps&#8212;soaking, decoction, filtration, and concentration&#8212;and demonstrate the administration of a prepared EXD-containing serum to rats. These methods are applicable to the in vivo and in vitro study of herbal decoctions such as traditional Chinese medicines.

草药的制备:洱西汤和含茜素的血清<em&gt;体内</em&gt;和<em&gt;体外</em&gt;实验

Traditional herbal medicine, an alternative medicine in the clinical setting, has received increased attention in recent years. Before delivery to the ...

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) Procedure

Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver metastases, the amount of liver tissue left behind after liver resection has become the main limiting factor of resectability of large or multiple liver tumors. A minimal amount of functional tissue is required to avoid the severe complication of post-hepatectomy liver failure, which has high morbidity and mortality. Inducing liver growth of the prospective remnant prior to resection has become more established in liver surgery, either in the form of portal vein embolization by interventional radiologists or in the form of portal vein ligation several weeks prior to resection. Recently, it was shown that liver regeneration is more extensive and rapid, when the parenchymal transection is added to portal vein ligation in a first stage and then, after only one week of waiting, resection performed in a second stage (Associating Liver Partition and Portal vein ligation for Staged hepatectomy = ALPPS). ALPPS has rapidly become popular across the world, but has been criticized for its high perioperative mortality. The mechanism of accelerated and extensive growth induced by this procedure has not been well understood. Animal models have been developed to explore both the physiological and molecular mechanisms of accelerated liver regeneration in ALPPS. This protocol presents a rat model that allows mechanistic exploration of accelerated regeneration.

Rat Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy ALPPS Procedure

Inducing rapid liver hypertrophy using Associating Liver Partition and Portal vein ligation for a Staged hepatectomy (ALPPS) has been proposed for resection of borderline resectable liver tumors. This model may elucidate mechanisms involved in rapid hypertrophy and allows testing of drugs that promote or block the acceleration of regeneration.

肝分型与门静脉结扎大鼠分期肝切除 (ALPPS) 手术模型的建立

Recent clinical data support an aggressive surgical approach to both primary and metastatic liver tumors. For some indications, like colorectal liver ...

Technique of Minimally Invasive Transverse Aortic Constriction in Mice for Induction of Left Ventricular Hypertrophy

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure overload-induced left ventricular hypertrophy (LVH) and its progression to heart failure. In the majority of the reported investigations, this procedure is performed with intubation and ventilation of the animal which renders it demanding and time-consuming and adds to the surgical burden to the animal. The aim of this protocol is to describe a simplified technique of minimally invasive TAC without intubation and ventilation of mice. Critical steps of the technique are emphasized in order to achieve low mortality and high efficiency in inducing LVH.
Male C57BL/6 mice (10-week-old, 25-30 g, n=60) were anesthetized with a single intraperitoneal injection of a mixture of ketamine and xylazine. In a spontaneously breathing animal following a 3-4 mm upper partial sternotomy, a segment of 6/0 silk suture threaded through the eye of a ligation aid was passed under the aortic arch and tied over a blunted 27-gauge needle. Sham-operated animals underwent the same surgical preparation but without aortic constriction. The efficacy of the procedure in inducing LVH is attested by a significant increase in the heart/body weight ratio. This ratio is obtained at days 3, 7, 14 and 28 after surgery (n = 6 - 10 in each group and each time point). Using our technique, LVH is observed in TAC compared to sham animals from day 7 through day 28. Operative and late (over 28 days) mortalities are both very low at 1.7%.
In conclusion, our cost-effective technique of minimally invasive TAC in mice carries very low operative and post-operative mortalities and is highly efficient in inducing LVH. It simplifies the operative procedure and reduces the strain put on the animal. It can be easily performed by following the critical steps described in this protocol.

The aim of this protocol is to describe step-by-step the technique of minimally invasive transverse aortic constriction (TAC) in mice. By elimination of intubation and ventilation which are mandatory for the commonly used standard procedure, minimally invasive TAC simplifies the operative procedure and reduces the strain put on the animal.

小鼠横主动脉狭窄诱导左心室肥厚的技术研究

Transverse aortic constriction (TAC) in mice is one of the most commonly used surgical techniques for experimental investigation of pressure ...

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures prevents a number of cardiac surgeons from incorporating them into their practice. The aim of this protocol is to describe a simplified and user-friendly technique of an aortic valve-sparing root replacement (VSRR) procedure by re-implantation of the aortic valve. Proper selection of patients and limitations of the technique are discussed.
In 54 consecutive patients, normal appearing aortic valves were re-implanted in a commercially available polyester prosthesis with pre-shaped sinuses by a simplified and standardized technique. Placement of the first row of the proximal suture line, choice of the prosthesis size, and adjustment of the height of the commissures of the patient to the fixed height of the sinus portion of the prosthesis were slightly modified from the reference techniques with the aim of increasing its feasibility for use by other cardiac surgeons. Early mortality and morbidity as well as 5-year survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were collected in all patients.
Thirty-day mortality, re-sternotomy for bleeding, re-sternotomy for mediastinitis, and the incidence of stroke were very low, 1.8% for each (1 of 54). No patient required permanent pace-maker implantation. At 5 years, survival, freedom from aortic valve reoperation, and freedom from recurrent moderate regurgitation were 97.5%, 95.2%, and 91.6%, respectively.
Mid-term results of our standardized technique of re-implantation of the aortic valve for valve-sparing aortic root replacement are very good and compare with more complex techniques reported by experienced surgeons. By following the present protocol of the standardized re-implantation technique, a greater number of cardiac surgeons can perform this procedure with comparable good results.

Valve-sparing aortic root replacement has the advantage of preserving the patient&#39;s own aortic valve. The complexity of the reported techniques to date restricts their use to a limited number of cardiac surgeons. This protocol describes step-by-step a standardized technique reproducible by a greater number of cardiac surgeons.

主动脉瓣重置术治疗瓣膜备用主动脉根置换的规范化技术

Despite the obvious advantages of the preservation of a normal aortic valve during aortic root replacement, the complexity of valve sparing procedures ...

人体胎盘生理学综合研究的4血管取样方法

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