Ce travail a été financé par R21CA134819 (CH), T32CA009035 (SD), et P30CA006927 (Cancer Center de base de subvention). Les auteurs tiennent à remercier Elizabeth Culnan pour son aide au recrutement des participants, Lia Boyle, Eva Panigrahi et Kate Menezes pour leur aide dans l&#39;élaboration de procédures et Jeanne Pomenti avec son aide à la préparation du manuscrit. Nous remercions également les examinateurs revue pour leurs suggestions utiles.

1. Préparation à l&#39;exposition aux UV <ol><li> Expliquez aux participants comment les tests MED fonctionne (&quot;Je vais exposer un peu de peau sur votre bras à la lumière UV au cours d&#39;environ 20 min, et demain, nous allons vérifier que la section de votre peau afin de déterminer combien vous êtes sensibles à la lumière. Vous pouvez rencontrer un coup de soleil dans les petites zones que nous exposons aux UV. Si le coup de soleil est douloureux ou vous dérange, vous pouvez le traiter comme vous le feriez pour tout autre coup de soleil. &quot;) </li><li> Le personnel et les participants doivent porter des lunettes de protection UV. </li><li> Le participant doit être vêtu d&#39;une chemise à manches courtes ou rouler jusqu&#39;à sa manche. </li><li> Vous avez le participant a mis sur un gant pour protéger la peau sur sa main. </li><li> Retirer le patch 1 soutien Daavlin sur les côtés gauche et droit de la pièce, et placez-le sur le bras inférieur intérieur juste à côté du gant, en évitant les imperfections de la peau existants. </li><li> Couvrir toute la peau supplémentaire sur le wi brase la chemise du participant ou tout autre matériau. </li><li> Placer le bras de telle sorte que les trous dans le patch seront exposés à la source de lumière UV. Aucun autre peau doit être exposé à la lumière UV. </li><li> Informer le participant se sentira la chaleur, mais son bras ne sera pas brûlé pendant le test. </li></ol> 2. Mener exposition aux UV <ol><li> Patch trous (par exemple 6) devraient être exposés aux UV, à intervalles tout au long de la période d&#39;exposition. </li><li> Commencez par le trou 1 ouverte. </li><li> Sélectionnez la durée totale de l&#39;exposition sur la base des spécifications du fabricant pour la source de lumière et Fitzpatrick type de peau du participant I-VI (très juste de très sombre; Fitzpatrick, 1988). 2 juste la peau est plus susceptible de brûler. </li><li> Réglez une minuterie pour la durée totale de l&#39;exposition (par exemple, 20 min). Un deuxième minuterie de sauvegarde peut également être utilisé. Démarrer le minuteur (s). </li><li> Par exemple, ouvrez le trou 2 après 2 min, 3 trou ouvert après 4min, trou ouvert 4 après 8 min, trou ouvert 5 après 12 min, et le trou ouvert 6 après 16 min. Ainsi, les temps d&#39;exposition aux UV de la peau sera de 20 min pour le trou 1, 18 min pour le trou 2, 16 min pour le trou 3, 12 min pour le trou 4, 8 min pour le trou 5, et 4 min pour le trou 6. </li><li> Afin d&#39;identifier plus facilement les zones exposées, après 24 à 48 h, de marquer la peau exposée sur le bord le plus éloigné du premier et du dernier trou de la pastille, et demander au participant de ne pas rincer les marques qu&#39;après la peau est examinée. </li><li> Avez participant enlever le gant et patch. </li><li> Réitérer au participant que la peau doit être réexaminée en 24-48 heures. </li></ol> 3. L&#39;évaluation de la MED <ol><li> Après 24-48 heures, examiner les zones exposées de la peau. Peau rouge ou rose indique érythème ou de brûlure. Erythemetous peau exposée à la durée la plus courte d&#39;UV est définie comme étant la dose minimale d&#39;érythème ou de MED. </li><li> Futures expositions aux rayons UV doit être pour des durées plus courtes que til MED pour éviter de brûler. </li><li> Si les zones d&#39;exposition sont difficiles à identifier, vous voudrez peut-être mettre le patch de retour sur l&#39;utilisation des marques de s&#39;aligner sur la peau exposée. Ceci est également utile en cas d&#39;utilisation d&#39;un dispositif de mesure de la couleur de la peau tel qu&#39;un spectrophotomètre. </li><li> Spectrophotomètres fournissent des mesures de L * (obscurité) et b * (teinte). a * désigne la rougeur de la peau. A une plus grande valeur * indique peau rouge. </li><li> Si l&#39;on utilise un dispositif de mesure de la couleur de la peau tel qu&#39;un spectrophotomètre, placer l&#39;ouverture du spectrophotomètre dans le centre de l&#39;alésage à mesurer. </li><li> Mesurer chacune des zones d&#39;exposition 6 dans l&#39;ordre numérique, et une zone non exposée à proximité des autres pour comparaison. Essayez de mesurer le centre de chaque trou, mais pas une tache de rousseur ou grain de beauté ou d&#39;autres décolorations non-UV. Étiqueter chacune des mesures. La mesure de la zone non exposée doit être étiqueté 0 min et être inscrite à côté de la zone 6 (la zone d&#39;exposition plus courte - 4 min). </li><li> L&#39;augmentation des valeurs de a * doivent correspondre à des augmentations de la durée d&#39;exposition aux UV. Essayez des valeurs re-mesure qui ne sont pas dans le même ordre. </li><li> Une différence de 2,5 point dans l&#39;une * de la peau non exposée par rapport à la peau exposée indique une différence significative dans rougeur, suggérant feu potentiel. </li><li> Ajouter 2,5 pour la plus faible valeur de a *. Tout ce qui égale ou supérieure à cette valeur serait considérée comme potentiellement brûlant. Le temps d&#39;exposition plus faible au-dessus de cette valeur est considérée comme la MED. </li></ol>

<ol>
	<li>Fitzpatrick, T. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+validity+and+practicality+of+sun-reactive+skin+types+I+through+VI.">The validity and practicality of sun-reactive skin types I through VI.</a> Archives of Dermatology. 124, 869-871 (1988).</li><li>Bodekaer, M., Akerstrom, U., Wulf, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Accumulation+of+sunscreen+in+human+skin+after+daily+applications:+a+study+of+sunscreens+with+different+ultraviolet+radiation+filters.">Accumulation of sunscreen in human skin after daily applications: a study of sunscreens with different ultraviolet radiation filters.</a> Photodermatol. Photoimmunol. Photomed. 28, 127-132 (2012).</li><li>Kwon, I. H., Kwon, H. H., Na, S. J., Youn, J. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Could+colorimetric+method+replace+the+individual+minimal+erythemal+dose+(MED)+measurements+in+determining+the+initial+dose+of+narrow-band+UVB+treatment+for+psoriasis+patients+with+skin+phototype+III-V?.">Could colorimetric method replace the individual minimal erythemal dose (MED) measurements in determining the initial dose of narrow-band UVB treatment for psoriasis patients with skin phototype III-V?.</a> J. Eur. Acad. Dermatol. Venereol. , (2012).</li><li>Youn, J. I., Park, J. Y., Jo, S. J., Rim, J. H., Choe, Y. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+the+usefulness+of+skin+phototype+and+skin+color+as+the+parameter+of+cutaneous+narrow+band+UVB+sensitivity+in+psoriasis+patients.">Assessment of the usefulness of skin phototype and skin color as the parameter of cutaneous narrow band UVB sensitivity in psoriasis patients.</a> Photodermatol. Photoimmunol. Photomed. 19, 261-264 (2003).</li><li>Henriksen, M., Na, R., Agren, M. S., Wulf, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Minimal+erythema+dose+after+multiple+UV+exposures+depends+on+pre-exposure+skin+pigmentation.">Minimal erythema dose after multiple UV exposures depends on pre-exposure skin pigmentation.</a> Photodermatol. Photoimmunol. Photomed. 20, 163-169 (2004).</li><li>Kraemer, C. K., Menegon, D. B., Cestari, T. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Determination+of+the+minimal+phototoxic+dose+and+colorimetry+in+psoralen+plus+ultraviolet+A+radiation+therapy.">Determination of the minimal phototoxic dose and colorimetry in psoralen plus ultraviolet A radiation therapy.</a> Photodermatol. Photoimmunol. Photomed. 21, 242-248 (2005).</li><li>Sachdeva, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fitzpatrick+skin+typing:+applications+in+dermatology.">Fitzpatrick skin typing: applications in dermatology.</a> Indian J. Dermatol. Venereol. Leprol. 75, 93-96 (2009).</li><li>Webb, A. R., Kift, R., Berry, J. L., Rhodes, L. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+vitamin+D+debate:+translating+controlled+experiments+into+reality+for+human+sun+exposure+times.">The vitamin D debate: translating controlled experiments into reality for human sun exposure times.</a> Photochem. Photobiol. 87, 741-745 (2011).</li><li>Otman, S. G., Edwards, C., Gambles, B., Anstey, A. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+a+semiautomated+method+of+minimal+erythema+dose+testing+for+narrowband+ultraviolet+B+phototherapy.">Validation of a semiautomated method of minimal erythema dose testing for narrowband ultraviolet B phototherapy.</a> Br. J. Dermatol. 155, 416-421 (2006).</li><li>Taylor, D. K., Anstey, A. V., Coleman, A. J., Diffey, B. L., Farr, P. M., Ferguson, S., 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=Guidelines+for+dosimetry+and+calibration+in+ultraviolet+radiation+therapy:+a+report+of+a+British+Photodermatology+Group+workshop.">Guidelines for dosimetry and calibration in ultraviolet radiation therapy: a report of a British Photodermatology Group workshop.</a> Br. J. Dermatol. 146, 755-763 (2002).</li></ol>

Nous n&#39;avons rien à révéler.

Le rayonnement ultraviolet (UV) thérapie est parfois utilisé comme traitement de diverses affections cutanées courantes, y compris le psoriasis, l&#39;acné et l&#39;eczéma. Le dosage de la lumière UV est prescrit en fonction de la sensibilité de la peau d&#39;un individu, qui est déterminé en fonction de Fitzpatrick peau du type de l&#39;individu I à VI (très juste de très sombre). 2 La peau humaine varie dans sa sensibilité au rayonnement UV en raison de divers degrés de pigmentation de la peau...

minimal erythema dose (med) testing

Le rayonnement ultraviolet (UV) thérapie est parfois utilisé comme traitement de diverses affections cutanées courantes, y compris le psoriasis, l&#39;acné et l&#39;eczéma. Le dosage de la lumière UV est prescrit en fonction de la sensibilité de la peau d&#39;un individu. Ainsi, pour établir le bon dosage de la lumière UV à administrer à un patient, le patient est parfois projeté afin de déterminer une dose érythémateuse minimale (MED), qui est la quantité de rayons UV qui va produire un érythème minime (coup de soleil ou une rougeur causée par l&#39;engorgement des capillaires) de la peau d&#39;un individu à l&#39;intérieur de quelques heures suivant l&#39;exposition. Cet article explique comment effectuer des tests de dose érythémateuse minimale (MED). Il n&#39;existe actuellement aucun moyen facile de déterminer une dose d&#39;UV approprié à des fins cliniques ou de recherche sans procéder à des tests formels MED, nécessitant heures d&#39;observation après le test, essai ou informel et les tests d&#39;erreur avec les risques de sur-ou sous-dosage. Toutefois, certaines méthodes alternatives sont discutées.

<img alt="Figure 1" fo:content-width="4in" fo:src="/files/ftp_upload/50175/50175fig1highres.jpg" src="/files/ftp_upload/50175/50175fig1.jpg" /> Figure 1 Les quatre étapes de la réalisation d&#39;essais MED:. Préparation de l&#39;exposition aux UV, la conduite exposition aux rayons UV, l&#39;évaluation de la MED, et la détermination de la MED. <img alt="Figure 2" src="/files/...

Watch this Scientific Journal Video about Minimal Erythema Dose MED Testing at JoVE.com

Minimal Erythema Dose MED Testing

Cet article explique comment effectuer des tests de dose érythémateuse minimale (MED) afin de déterminer la plus faible dose de rayonnement ultraviolet qui va provoquer un érythème (combustion) lorsqu&#39;il est administré à un individu.

Erythème Dose (MED) des tests minimaux

Ultraviolet radiation (UV) therapy is  sometimes used as a treatment for various common skin conditions, including  psoriasis, acne, and eczema. The ...

Research

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Medicine

Minimal Erythema Dose (MED) Testing

41.2K vues.  Fox Chase Cancer Center. Cet article explique comment effectuer des tests de dose érythémateuse minimale (MED) afin de déterminer la plus faible dose de rayonnement ultraviolet qui va provoquer un érythème (combustion) lorsqu'il est administré à un individu.

Vidéo: Minimal Erythema Dose MED Testing

Quantitative Autonomic Testing

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be invaluable tool for evaluation of these disorders, both in clinic and research. There are number of autonomic tests, however, only few were validated clinically or are quantitative. Here, fully quantitative and clinically validated protocol for testing of autonomic functions is presented. As a bare minimum the clinical autonomic laboratory should have a tilt table, ECG monitor, continuous noninvasive blood pressure monitor, respiratory monitor and a mean for evaluation of sudomotor domain. The software for recording and evaluation of autonomic tests is critical for correct evaluation of data. The presented protocol evaluates 3 major autonomic domains: cardiovagal, adrenergic and sudomotor. The tests include deep breathing, Valsalva maneuver, head-up tilt, and quantitative sudomotor axon test (QSART). The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores (CASS). Detailed protocol is provided highlighting essential aspects of testing with emphasis on proper data acquisition, obtaining the relevant parameters and unbiased evaluation of autonomic signals. The normative data and CASS algorithm for interpretation of results are provided as well.

Standardized, comprehensive and fully quantitative testing of autonomic functions is described. The autonomic tests consist of evaluation of all three major autonomic domains including cardiovagal, adrenergic and sudomotor. The severity and distribution of dysautonomia is quantitated using Composite Autonomic Severity Scores.

Des tests quantitatifs Autonomic

Disorders associated with dysfunction of autonomic nervous system are quite common yet frequently unrecognized. Quantitative autonomic testing can be ...

Recherche

Médecine

X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a significant concern, particularly in pediatric applications. Pediatrics procedures are in general much more complex than those performed on adults and thus are on average four to eight times longer1. Furthermore, children can undergo up to 10 fluoroscopic procedures by the age of 10, and have been shown to have a three-fold higher risk of developing fatal cancer throughout their life than the general population2,3.
We have shown that radiation dose can be significantly reduced in adult cardiac procedures by using our scanning beam digital x-ray (SBDX) system4-- a fluoroscopic imaging system that employs an inverse imaging geometry5,6 (Figure 1, Movie 1 and Figure 2). Instead of a single focal spot and an extended detector as used in conventional systems, our approach utilizes an extended X-ray source with multiple focal spots focused on a small detector. Our X-ray source consists of a scanning electron beam sequentially illuminating up to 9,000 focal spot positions. Each focal spot projects a small portion of the imaging volume onto the detector. In contrast to a conventional system where the final image is directly projected onto the detector, the SBDX uses a dedicated algorithm to reconstruct the final image from the 9,000 detector images.
For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our current implementation, the adaptive exposure requires user interaction (Figure 3). However, in the future, the adaptive exposure will be real time and fully automatic.
We have performed experiments with an anthropomorphic phantom and compared measured radiation dose with and without adaptive exposure using a dose area product (DAP) meter. In the experiment presented here, we find a dose reduction of 30%.

We are developing a dynamic adaptive exposure technique using our scanning beam digital X-ray system. Rather than exposing an object uniformly, the exposure is adapted depending on the opacity of the object. Here we show an experiment on an anthropomorphic phantom that resulted in a dose saving of 30%.

Réduction des doses de rayons X à travers l&#39;exposition d&#39;adaptation dans l&#39;imagerie radioscopique

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a ...

Preparation and Pathogen Inactivation of Double Dose Buffy Coat Platelet Products using the INTERCEPT Blood System

Blood centers are faced with many challenges including maximizing production yield from the blood product donations they receive as well as ensuring the highest possible level of safety for transfusion patients, including protection from transfusion transmitted diseases. This must be accomplished in a fiscally responsible manner which minimizes operating expenses including consumables, equipment, waste, and personnel costs, among others.
Several methods are available to produce platelet concentrates for transfusion. One of the most common is the buffy coat method in which a single therapeutic platelet unit (&ge; 2.0 x1011 platelets per unit or per local regulations) is prepared by pooling the buffy coat layer from up to six whole blood donations. A procedure for producing "double dose" whole blood derived platelets has only recently been developed.
Presented here is a novel method for preparing double dose whole blood derived platelet concentrates from pools of 7 buffy coats and subsequently treating the double dose units with the INTERCEPT Blood System for pathogen inactivation. INTERCEPT was developed to inactivate viruses, bacteria, parasites, and contaminating donor white cells which may be present in donated blood. Pairing INTERCEPT with the double dose buffy coat method by utilizing the INTERCEPT Processing Set with Dual Storage Containers (the "DS set"), allows blood centers to treat each of their double dose units in a single pathogen inactivation processing set, thereby maximizing patient safety while minimizing costs. The double dose buffy coat method requires fewer buffy coats and reduces the use of consumables by up to 50% (e.g. pooling sets, filter sets, platelet additive solution, and sterile connection wafers) compared to preparation and treatment of single dose buffy coat platelet units. Other cost savings include less waste, less equipment maintenance, lower power requirements, reduced personnel time, and lower collection cost compared to the apheresis technique.

This article describes the process used by &#214;rebro University Hospital to produce double dose buffy coat platelet concentrates prepared from whole blood donations and treated with the INTERCEPT Blood System for pathogen inactivation. The in vitro quality of the final platelet units are evaluated over 7 days of storage.

Préparation et inactivation des agents pathogènes des doubles produits Buffy Coat dose de plaquettes à l&#39;aide du système sanguin INTERCEPT

Blood centers are faced with many challenges including maximizing production yield from the blood product donations they receive as well as ensuring the ...

A Novel Application of Musculoskeletal Ultrasound Imaging

Ultrasound is an attractive modality for imaging muscle and tendon motion during dynamic tasks and can provide a complementary methodological approach for biomechanical studies in a clinical or laboratory setting. Towards this goal, methods for quantification of muscle kinematics from ultrasound imagery are being developed based on image processing. The temporal resolution of these methods is typically not sufficient for highly dynamic tasks, such as drop-landing. We propose a new approach that utilizes a Doppler method for quantifying muscle kinematics. We have developed a novel vector tissue Doppler imaging (vTDI) technique that can be used to measure musculoskeletal contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities using ultrasound. The goal of this preliminary study was to investigate the repeatability and potential applicability of the vTDI technique in measuring musculoskeletal velocities during a drop-landing task, in healthy subjects. The vTDI measurements can be performed concurrently with other biomechanical techniques, such as 3D motion capture for joint kinematics and kinetics, electromyography for timing of muscle activation and force plates for ground reaction force. Integration of these complementary techniques could lead to a better understanding of dynamic muscle function and dysfunction underlying the pathogenesis and pathophysiology of musculoskeletal disorders.

We describe a new ultrasound-based vector tissue Doppler imaging technique to measure muscle contraction velocity, strain and strain rate with sub-millisecond temporal resolution during dynamic activities. This approach provides complementary measurements of dynamic muscle function and could lead to a better understanding of mechanisms underlying musculoskeletal disorders.

Une application roman de l&#39;appareil locomoteur imagerie par ultrasons

Ultrasound is an attractive modality for imaging muscle and tendon  motion during dynamic tasks and can provide a complementary methodological  approach ...

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery.

The current priority in breast cancer radiotherapy is to reduce cardiac doses without compromising target tissue coverage. The voluntary breath-hold technique described here is a simple, inexpensive solution to this problem and capable of being instituted widely without the need for specialized equipment.

Volontaire Technique apnée pour la réduction de coeur dose en radiothérapie du sein gauche

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

Minimal Invasive Surgical Procedure of Inducing Myocardial Infarction in Mice

Myocardial infarction still remains the main cause of death in western countries, despite considerable progress in the stent development area in the last decades. For clarification of the underlying mechanisms and the development of new therapeutic strategies, the availability of valid animal models are mandatory. Since we need new insights into pathomechanisms of cardiovascular diseases under in vivo conditions to combat myocardial infarction, the validity of the animal model is a crucial aspect. However, protection of animals are highly relevant in this context. Therefore, we establish a minimally invasive and simple model of myocardial infarction in mice, which assures a high reproducibility and survival rate of animals. Thus, this models fulfils the requirements of the 3R principle (Replacement, Refinement and Reduction) for animal experiments and assure the scientific information needed for further developing of therapeutical strategies for cardiovascular diseases.

A highly reproducible model for myocardial infarction in mice with minimal invasive manipulations is described. The model can be easily performed, resulting in a high reproducibility and survival rate. Thus, the described model will reduce the number of required animals as requested by the 3R principle (Replacement, Refinement and Reduction).

Minimal intervention chirurgicale invasive d&#39;induire un infarctus du myocarde chez des souris

Myocardial infarction still remains the main cause of death in western countries, despite considerable progress in the stent development area in the last ...

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The incidence of the pathology increases with growing age after 65 years. Conventional surgical aortic valve replacement through median sternotomy has been the gold standard of patient care for symptomatic aortic valve stenosis. However, as the risk profile of patients worsens, other therapeutic strategies have been introduced in an attempt to maintain the excellent results obtained by the established surgical treatment. One of these approaches is represented by transcatheter aortic valve implantation. Although the outcomes of high-risk patients undergoing treatment for symptomatic aortic valve stenosis have improved with transcatheter aortic valve replacement, many patients with this condition remain candidates for surgical aortic valve replacement. In order to reduce the surgical trauma in patients who are candidates for surgical aortic valve replacement, minimally invasive approaches have garnered interest during the past decade. Since the introduction of right anterior thoracotomy for aortic valve replacement in 1993, right anterior mini-thoracotomy and upper hemi-sternotomy have become the predominant incisional approaches among cardiac surgeons performing minimal access aortic valve replacement. Beside the location of the incision, the arterial cannulation site represents the second major landmark of minimal access techniques for aortic valve replacement. The two most frequently used arterial cannulation sites include central aortic and peripheral femoral approaches. With the purpose of reducing surgical trauma in these patients, we have opted for a right anterior mini-thoracotomy approach with a central aortic cannulation site. This protocol describes in detail a technique for minimally invasive aortic valve replacement and provides recommendations for patient selection criteria, including cardiac computer tomography measurements. The indications and limitations of this technique, as well as its alternatives, are discussed.

The goal of this protocol is to describe in detail the technique of minimally invasive aortic valve replacement through a right anterior mini-thoracotomy and central aortic cannulation. This technique can potentially enhance patients&#39; comfort and, by reducing post-operative morbidity, promote lowering the length of stay and global costs.

Technique et critères de sélection des patients du droit antérieur mini thoracotomie pour un remplacement valvulaire aortique accès Minimal

Aortic valve stenosis has become the most prevalent valvular heart disease in developed countries, and is due to the aging of these populations. The ...

Precision Implementation of Minimal Erythema Dose (MED) Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary to produce erythema (inflammatory reddening) on the surface of the skin. In this context, the MED is regarded as a key factor in determining starting doses for UV phototherapy for common skin conditions such as psoriasis and eczema. In research settings, MED testing also has potential to be a powerful tool for assessing within- and between-persons variation in inflammatory responses. However, MED testing has not been widely adopted for use in research settings, likely owing to a lack of published guidelines, which is a barrier to obtaining reproducible results from this assay. Also, protocols and equipment for establishing MED vary widely, making it difficult to compare results across laboratories. Here, we describe a precise and reproducible method to induce and measure superficial erythema using newly designed protocols and methods that can easily be adapted to other equipment and laboratory environments. The method described here includes detail on procedures that will allow extrapolation of a standardized dosage schedule to other equipment so that this protocol can be adapted to any UV radiation source.

Precision Implementation of Minimal Erythema Dose MED Testing to Assess Individual Variation in Human Inflammatory Response

Minimal erythema dose (MED) testing is used to establish dosage schedules for ultraviolet radiation phototherapy. It can assess individual variation in inflammatory response but lacks methodology for achieving reproducible results. Here, we present a precision implementation of MED and demonstrate its ability to capture individual variation in inflammatory response.

Mise en œuvre avec précision des tests de dose minimale d'érythème (MED) pour évaluer la variation individuelle de la réponse inflammatoire humaine

Minimal erythema dose (MED) testing is frequently used in clinical settings for determining the smallest amount of ultraviolet (UV) irradiation necessary ...

Semi-Minimal Invasive Method to Induce Myocardial Infarction in Rats and the Assessment of Cardiac Function by an Isolated Working Heart System

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily and highly reproducible MI induction procedure is required to obtain further insight and better understanding of the underlying pathological changes. This procedure can also be used to evaluate the effects or potency of new and promising treatments (as drugs or interventions) in acute MI, subsequent remodeling and heart failure (HF). After intubation and pre-operative preparation of the animal, an anesthetic protocol with isoflurane was performed, and the surgical procedure was conducted&#160;quickly. Using a minimally invasive approach, the left anterior descending artery (LAD) was located and occluded by a ligature. The occlusion can be performed acutely for subsequent reperfusion (ischemia/reperfusion injury). Alternatively, the vessel can be ligated permanently to investigate the development of chronic MI, remodeling or HF. Despite common pitfalls, the drop-out rates are minimal. Various treatments such as remote ischemic conditioning can be examined for their cardioprotective potential pre-, peri- and post-operatively. The post-operative recovery was quick as the anesthesia was precisely controlled and the duration of the operation was short. Post-operative analgesia was administered for three days. The minimally invasive procedure reduces the risk of infection and inflammation. Furthermore, it facilitates rapid recovery. The &#8220;working heart&#8221; measurements were performed ex vivo and enabled precise control of preload, afterload and flow. This procedure requires specific equipment and training for adequate performance. This manuscript provides a detailed step-by-step introduction for conducting these measurements.

This article presents an efficient method to perform myocardial ischemia and subsequent chronic reperfusion in rats using a minimally invasive approach. In addition, left ventricular hemodynamic function of rats is assessed by echocardiography and isolated working heart methods.&#160;

Méthode invasive semi-minimale pour induire l’infarctus du myocarde chez les rats et l’évaluation de la fonction cardiaque par un système cardiaque de travail isolé

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily ...

Robot-assisted Total Mesorectal Excision and Lateral Pelvic Lymph Node Dissection for Locally Advanced Middle-low Rectal Cancer

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex procedures. The high-quality 3-D visual, multijoint arm and natural tremor filtration allow the surgeon to expose and dissect more accurately with minimal invasion. Total mesorectal excision is the standard surgical technique for the treatment of resectable rectal cancer. To reduce the lateral recurrence rate, lateral pelvic lymph node dissection can be performed, as it is a safe and feasible procedure for locally advanced middle-low rectal cancer with a high possibility of metastasis to the lateral lymph nodes. However, the complexity of the anatomic structures and the high postoperative complication rate limit its application. Recently, several surgeons have increasingly used robotic techniques for total mesorectal excision and lateral pelvic lymph node dissection. Compared with open and laparoscopic surgery, the robotic technique has several advantages, such as less blood loss, fewer blood transfusions, minimal trauma, shorter postoperative hospitalization, and quicker recovery. A robotic approach is generally regarded as a reasonable alternative for complicated procedures such as lateral pelvic lymph node dissection, although there are a limited number of high-quality prospective randomized controlled studies reporting direct evidence. Here, we provide the detailed steps of robot-assisted total mesorectal excision and lateral pelvic lymph node dissection performed at the First Affiliated Hospital of Xi&#39;an Jiaotong University.

The robotic technique described herein aims to detail a stepwise approach to robot-assisted total mesorectal excision and lateral pelvic lymph node dissection for locally advanced (T3/T4) rectal cancer located below the peritoneal reflection.

Excision mésorectale totale assistée par robot et curage ganglionnaire pelvien latéral pour le cancer du rectum localement avancé de moyenne à basse température

Since their approval for clinical use, da Vinci surgical robots have shown great advantages in gastrointestinal surgical operations, especially in complex ...