1。胎盤の準備<ol><li>胎盤は出産後に血栓形成、乾燥及び組織の全体的な劣化を最小限に抑えるために、できるだけ早く分娩室から取得しておく必要があります。 </li><li>ケアは、胎盤がホルマリンまたは他の固定液にさらされないように注意してください。 </li><li>ヒトの組織のための標準BSL2予防措置は維持されるべきであると担当者は、マスク、ガウン、手袋と靴カバーを着用してください。 </li><li>流体の排水を可能にするためにプレカットの穴を持つ大規模なプラスチックや金属製のボウルに胎盤を置きます。このボウルは、こぼれを防ぐために大きなステンレス製のボウルの内側に配置する必要があります。 </li><li>温かい生理食塩水で胎盤を洗ってください。 </li><li>良い胎盤可視化のため、消費税に胎盤自身を傷つけないよう確認してから間双子の羊膜をMetzenbaumのはさみを使用してください。場所の間ツイン膜の½のcmのカフを残す。 （図1A）。 </li></ol> 2。胎盤血管のカテーテル検査<ol><li>それぞれの双子のコードを識別します。産科医は、通常、各コードの上に置かれたクランプの数によってそれぞれ双子を識別します。提示ツイン（ツインA）を供給するどの電源コードを確認してください。 </li><li>一度に1つ、コードだけでクランプ（図1B）の下にそれぞれのコードをトランセクトいる、ある追跡するという。ゆっくりと船（図1C）から血栓を搾り出す。脊髄の切断端に一つ静脈および通常少なくとも一つ、二つ、動脈が存在します。動脈は、比較的小さな直径（静脈に比べて）と周囲の筋肉のカフ（図1D）によって識別されます。 </li><li>双子の脊髄の切断端面（図1E）上動脈口へのアクセスを得るためにソフトチップで、標準放射状動脈ラインのガイドワイヤ、0.46 mm径と80 cmの長さを使用して（矢印、PAを読む、米国）。 </li><li>ガイドワイヤは、容器に3cmの最小値を配置する必要があります。ケリーのクランプを使用してコードのカットエッジのnonvascular部分で穏やかなカウンター緊張は大幅にワイヤの進歩を促進する。蛇行血管をまっすぐにするコードのマイナーな回転は、ワイヤーの進歩に役立つことがあります。ケアは、偽の通路を避けるために注意する必要があります。 </li><li>動脈（図1F）にネットワーク経由でぶっきらぼうに面取り先端でSeldinger法、スレッド20センチ0.6〜1.19ミリメートル、内径のポリエチレンカテーテルを（Intramedic、バタビアIL、米国）を使用する。ケアは、カテーテルを進めながら線が剥がれないよう注意する必要があります。カテーテルが血管内に3cm以上を装着した後、ワイヤーを取り外します。 </li><li>また、一部のグループは、臍動脈カテーテルを挿入している臍帯血管のガイドワイヤーとの直接カニュレーションを使用せずに成功を収めている。 、このテクニックは私たちの手でうまく動作しますがガイドワイヤの使用は、手順を完了するために私達にかかる時間を減少している。 </li><li>チューブの近位端に18 G鈍先端の針（BD Biosciences社、Franlik湖、ニュージャージー州、米国）を取り付けます。容器に生理食塩水を少量注入し、遠位動脈のクリアを観察することにより、カテーテルの適切な配置を確認してください。生理食塩水を注入しながら血管にやさしいフィンガースイープは、残存血栓の移動を容易に助けるかもしれない。 </li><li>慎重に動脈カテーテルを外れを避けるために注意して双子の静脈は2.6手順2.3を繰り返します。 </li><li>コー​​ドとカテーテルの周りの面取り部から遠位の臍テープ1cmの部分を接続します。逆流を防ぐためにタイトなシールを確認してください。 </li><li>各双子の臍動脈と静脈臍テープで固定し、両方の循環を生理食塩水（図2）を注入されているのカテーテルが存在するような（ツイン非提示）ツインBのコードのために2.9にステップ2.3を繰り返します。 </li></ol> 3。胎盤の血管に着色された染料の注入<ol><li>病理染料、バリウム懸濁液、ゼラチンまたは他の粘性着色染料は胎盤血管を可視化するために使用することができます。各双子のための動脈と静脈の色は容易に区別すべき双子AとBの動脈と静脈を注入するためで4つの対照的な色を選択してください。表面的な吻合は、色素を混合し、別の（ブレンド）を簡単に検出可能な色を形成することによって検出可能でなければなりません。 </li><li>手に低い圧力で染料とツインAの動脈を注入3ミリリットル注射器を使用してください。ゆっくりと全体の血管樹の充填を確実に染料の流れの方向に血管に沿って1つまたは2つの指で掃く。表面的な血管吻合が識別されている場合は、給餌容器の取扱説明書閉塞が（図3A）より高い抵抗血管床の残りの部分は記入できるようにすることができる。 </li><li>ツインBの動脈（図3B）を注入する手に、別の3ミリリットル注射器を使用してください。 </li><li>静脈注射のためのステップ3.2と3.3を繰り返します。 </li><li>損傷した血管から染料漏れている場合、修復は細い縫合糸と針のドライバで実行する必要があります。全体ヴェスを連結縫合しないように注意してくださいエル。 </li><li>高解像度のデジタルカメラを使用すると、それぞれの注入後の画像を取る。すべての注射が完了したら、色中立背景と再イメージ（図4）に対して、ボウルから場所を標本を削除します。双子の循環の間に見られる接続の数と種類を文書化する。 </li></ol> 4。代表的な結果： 動脈吻合（AAS）の動脈は、それらがTTTSの重要なリスクの減少とし、両方の双子5の改善の成果と関連しているとして&quot;保護&quot;であることが示されている。図4は、注入されたMC双子の胎盤を示しています。 AAは、プロスペクティブに子宮内ドップラー超音波検査のことで同定されていた。この発見は、双子の動脈（黄色）と通信して動脈構造（緑、矢印）のツインB動脈（青）色素の混合により確認された。ツインB（オレンジ）からツイン（黄色）から動脈と静脈とのAV吻合も（矢頭）が示されている。図5と図6は、我々は、注入二つの胎盤の標本の写真を表しています。 <img src="/files/ftp_upload/2837/2837fig1.jpg" alt="図1"/> 図1。 （A）羊膜を慎重にMetzenbaumのはさみと共有MC胎盤の胎児の表面から除去される。（B）ツインの臍帯のきれいなエッジがMetzenbaumのはさみと近位切除によって公開される。（C）血栓が搾乳されマニュアル圧縮によるコードから。（D）双子の臍帯動脈（矢頭）と静脈（矢印）が同定されています。（E）牽引のためのコードの切断面の無血管部分でケリーのクランプの配置後、ガイドワイヤは、ツインと曲がりくねった血管を通じて、優しく高度の臍動脈に配置されます。（F）小さなカテーテルは、Seldinger法を用いて血管内腔にガイドワイヤー上の高度です。 <img src="/files/ftp_upload/2837/2837fig2.jpg" alt="図2"/> 図2。カテーテルは、1つの臍動脈と各双子の臍静脈に配置されています。これらのカテーテルは、全体のコードの周り臍テープタイで所定位置に固定されています。各カテーテルの正確な位置決めが確認され、管腔内血栓を温めた生理食塩水の注射によってクリアされています。 <img src="/files/ftp_upload/2837/2837fig3.jpg" alt="図3"/> 図3。 （A）双子の動脈循環は、黄色の色素を注入されます。コントラストがはっきりと（B）ツインBの動脈循環が青色色素を注入されたツインBの動脈循環に血管の赤道越えて渡されます。黄色の染料と実証AA吻合（矢印）内の緑の色素で青色色素結果を混合すること。 <img src="/files/ftp_upload/2837/2837fig4.jpg" alt="図4"/> 図4の静脈ツイン（赤）とツインB（オレンジ）が注入されたの静脈。 AA吻合（矢印）とAV吻合は、流れとツインBに向かってツインからの指示、（矢じり）区切られています。 <img src="/files/ftp_upload/2837/2837fig5.jpg" alt="図5"/> 図5。出生後の注射後にレーザー治療を受けたMC双子の胎盤の例。ドナーの双子の動脈と静脈はそれぞれ黄色と緑色になります。受信者の動脈と静脈がそれぞれ青とオレンジ色になります。循環の間に残留接続が検出されなかった。 <img src="/files/ftp_upload/2837/2837fig6.jpg" alt="図6"/> 図6。注入後のMCツイン胎盤の例。左サイド双子の動脈と静脈はそれぞれ黄色と赤色になります。右サイドツインの動脈と静脈がそれぞれ青とオレンジ色になります。 AA（矢じり）とVV（矢印）が胎盤表面上に表示されます。

<ol>
	<li>Rand, L., Lee, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complicated+monochorionic+twin+pregnancies:+updates+in+fetal+diagnosis+and+treatment.">Complicated monochorionic twin pregnancies: updates in fetal diagnosis and treatment.</a> Clin Perinatol. 36, 417-430 (2009).</li><li>Sebire, N., Talbert, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Twin-to-twin+transfusion+syndrome+results+from+dynamic+asymmetrical+reduction+in+placental+anastomoses:+a+hypothesis.">Twin-to-twin transfusion syndrome results from dynamic asymmetrical reduction in placental anastomoses: a hypothesis.</a> in Placenta. , (2001).</li><li>Machin, G. A., Keith, L. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> An atlas of multiple pregnancy: biology and pathology. , (1999).</li><li>Machin, G. A., Feldstein, V. A., van Gemert, M. J., Keith, L. G., Hecher, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Doppler+sonographic+demonstration+of+arterio-venous+anastomosis+in+monochorionic+twin+gestation.">Doppler sonographic demonstration of arterio-venous anastomosis in monochorionic twin gestation.</a> Ultrasound Obstet Gynecol. 16, 214-217 (2000).</li><li>Denbow, M. L., Cox, P., Taylor, M., Hammal, D. M., Fisk, N. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+angioarchitecture+in+monochorionic+twin+pregnancies:+Relationship+to+fetal+growth,+fetofetal+transfusion+syndrome,+and+pregnancy+outcome.">Placental angioarchitecture in monochorionic twin pregnancies: Relationship to fetal growth, fetofetal transfusion syndrome, and pregnancy outcome.</a> American Journal of Obstetrics and Gynecology. 182, 417-426 (2000).</li><li>Taylor, M. J. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Doppler+detection+of+arterio-arterial+anastomoses+in+monochorionic+twins:+feasibility+and+clinical+application.">Doppler detection of arterio-arterial anastomoses in monochorionic twins: feasibility and clinical application.</a> Human Reproduction. 15, 1632-1636 (2000).</li><li>Berm&#250;dez, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+types+and+twin-twin+transfusion+syndrome.">Placental types and twin-twin transfusion syndrome.</a> American Journal of Obstetrics and Gynecology. 187, 489-494 (2002).</li><li>Lewi, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intertwin+anastomoses+in+monochorionic+placentas+after+fetoscopic+laser+coagulation+for+twin-to-twin+transfusion+syndrome:+is+there+more+than+meets+the+eye.">Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye.</a> Am J Obstet Gynecol. 194, 790-795 (2006).</li><li>Wee, L. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterisation+of+deep+arterio-venous+anastomoses+within+monochorionic+placentae+by+vascular+casting.">Characterisation of deep arterio-venous anastomoses within monochorionic placentae by vascular casting.</a> Placenta. 26, 19-24 (2005).</li><li>Paepe, M. E. D. e., Burke, S., Luks, F. I., Pinar, H., Singer, D. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Demonstration+of+placental+vascular+anatomy+in+monochorionic+twin+gestations.">Demonstration of placental vascular anatomy in monochorionic twin gestations.</a> Pediatr Dev Pathol. 5, 37-44 (2002).</li></ol>

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色素注入によるMCツイン胎盤の血管マッピングは複雑な、臨床的に処理されたケースを評価するための、さらにMCの姉妹の我々の理解を高めるための重要な手続きです。無傷胎盤試料の迅速な取得を確保するために産科チームとの連携が不可欠です。乾燥や注射の前に組織の長期保管は、色素の血管損傷および溢出する可能性があります。架橋血栓が血管内色素の血流を遮断するため、胎盤の...

<table border="1"><tbody><tr><th>試薬の名前</th><th>会社</th><th>カタログ番号</th><th>コメント（省略可能） </th></tr><tr><td>穴あきプラスチックボウル</td><td> QuickMedical医療機器と消耗品</td><td> Polarware PA75 </td><td>穿孔は、ドリルで行うことができます。 </td></tr><tr><td>ステンレス製ボウル</td><td>ナランメディカル株式会社</td><td> HH517 </td><td></td></tr><tr><td>生理食塩水</td><td>フィッシャー</td><td> 50983204 </td><td></td></tr><tr><td> 0.6〜1.9ミリメートルのIDのポリエチレンチューブ</td><td> Intramedic </td><td> 7436 </td><td></td></tr><tr><td>動脈ラインのガイドワイヤー（0.46 mm）の</td><td>アローインターナショナル</td><td> PW - 18080 </td><td>ソフトチップ</td></tr><tr><td> 18 Gブラント針</td><td> BDバイオサイエンス</td><td> 305180 </td><td></td></tr><tr><td>臍テープ</td><td> QCの供給</td><td> 140895 </td><td></td></tr><tr><td> Metzenbaumはさみ</td><td>コー​​ル - パーマー</td><td> EW - 10921〜04 </td><td></td></tr><tr><td>ケリー鉗子</td><td>コー​​ルパーマー</td><td> EW - 10918〜20 </td><td></td></tr><tr><td> 3 mlの注射器</td><td> Covidien社</td><td> 1180300555 </td><td></td></tr><tr><td>病理学ダイ</td><td>ブラッドリー製品</td><td> 7365 - X </td><td></td></tr><tr><td>デジタルカメラ</td><td>パナソニック</td><td> LUMIX - TZ50 </td><td></td></tr></tbody></table>

guide wire assisted catheterization and colored dye injection for vascular mapping of monochorionic twin placentas

単一絨毛膜性の（MC）ツイン妊娠はdichorionic双子よりも有意に高い罹患率と死亡率に関連付けられています。 MC双子の妊娠の約50％は、共有胎盤とそれに関連する血管の接続1に起因する合併症を開発する。重度のツインからツイン症候群（TTTS）は、これらの合併症2,3の約20％を占めると報告されている。インターツイン血管の接続は、ほぼすべてのMCの胎盤で発生し、これらのリスクの高い双子妊娠の予後や転帰に関連している。接続の数、サイズと種類は、TTTSや他のMCツイン条件の開発に関与している。胎盤葉に胎盤とダイブの胎児の表面に沿って1つのツインコースから脱酸素血液を運ぶの枝の動脈静脈の接続（AVS）1）動脈を：インターツイン血管3つのタイプの接続が発生します。血液は、胎盤の胎児の表面に現れると、他の双子に向かって酸素を豊富に含んだ血液をもたらす流出静脈への深い実質内毛細血管網を経由して流れます。遠心性静脈を受けて双子に向かって求心性の動脈を供給ツインからの一方向の流れがある場合2）動脈の接続への動脈は（AAS）は、各双子からの分岐動脈は拍動双方向で容器内に生じる表面的な胎盤の表面に直接に適合フロー、およびそれぞれの双子からの分岐静脈が直接低圧双方向のフローを可能にする表面的な胎盤表面に適合する静脈の接続（VVS）〜3）静脈。 子宮産科超音波検査の対象となるドップラー尋問では、AVの存在を識別するために使用されていますとAAの接続4。出生後の胎盤注射の研究によって確認されている出生前に検出されたAAをは双生児5の両方のための改良予後と関連していることが示されている。さらに、共有胎盤の胎児の表面の間ツイン血管接続のfetoscopicレーザーアブレーションは現在、早期、厳しいTTTSのための好ましい治療法です。 出生後の胎盤注射の研究は、出生前のドップラー超音波所見の正確さと胎児のレーザー治療6の有効性を確認するために貴重な方法を提供する。色の染料を使用して個別に手作業で注入された各双子の動脈と静脈の循環、技術のハイライトと群を区別視聴覚資料、AAS、およびVVSに。 MC胎盤血管の解剖学のこの決定的なデモンストレーションは、MCの姉妹とその後遺症の病態生理の理解を高めるためにドップラー超音波所見と新生児予後と相関することができます。ここで我々は胎盤注射のテクニックを示しています。

Watch this Scientific Journal Video about Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas at JoVE.com

Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas

出産後の単一絨毛膜性の（MC）ツイン胎盤の血管マッピングは、双子の循環の間に血管の接続の詳細なデモンストレーションのための手段を提供します。これらの接続の不均衡は、双胎児間輸血症候群を含むMC双晶の合併症の発症に極めて重要な役割を果たすと考えられている。

単一絨毛膜性のツイン胎盤の血管のマッピングのためのガイドワイヤ補助カテーテルと有色色素注入

Monochorionic (MC) twin pregnancies are associated with significantly higher morbidity and mortality rates than dichorionic twins. Approximately 50% of MC ...

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14.8K ビュー.  University of California, San Francisco. 出産後の単一絨毛膜性の（MC）ツイン胎盤の血管マッピングは、双子の循環の間に血管の接続の詳細なデモンストレーションのための手段を提供します。これらの接続の不均衡は、双胎児間輸血症候群を含むMC双晶の合併症の発症に極めて重要な役割を果たすと考えられている。

ビデオ: Guide Wire Assisted Catheterization and Colored Dye Injection for Vascular Mapping of Monochorionic Twin Placentas

Mesenteric Artery Contraction and Relaxation Studies Using Automated Wire Myography

Proximal resistance vessels, such as the mesenteric arteries, contribute substantially to the peripheral resistance. These small vessels of between 100-400 &mu;m in diameter function primarily in directing blood flow to various organs according to the overall requirements of the body. The rat mesenteric artery has a diameter greater than 100 &mu;m. The myography technique, first described by Mulvay and Halpern1, was based on the method proposed by Bevan and Osher2. The technique provides information about small vessels under isometric conditions, where substantial shortening of the muscle preparation is prevented. Since force production and sensitivity of vessels to different agonists is dependent on the extent of stretch, according to active tension-length relation, it is essential to conduct contraction studies under isometric conditions to prevent compliance of the mounting wires. Stainless steel wires are preferred to tungsten wires because of oxidation of the latter, which affects recorded responses3.The technique allows for the comparison of agonist-induced contractions of mounted vessels to obtain evidence for normal function of vascular smooth muscle cell receptors.
We have shown in several studies that isolated mesenteric arteries that are contracted with phenylyephrine relax upon addition of cumulative concentrations of extracellular calcium (Ca2+e). The findings led us to conclude that perivascular sensory nerves, which express the G protein-coupled Ca2+-sensing receptor (CaR), mediate this vasorelaxation response. Using an automated wire myography method, we show here that mesenteric arteries from Wistar, Dahl salt-sensitive(DS) and Dahl salt-resistant (DR) rats respond differently to Ca2+e. Tissues from Wistar rats showed higher Ca2+-sensitivity compared to those from DR and DS. Reduced CaR expression in mesenteric arteries from DS rats correlates with reduced Ca2+e-induced relaxation of isolated, pre-contracted arteries. The data suggest that the CaR is required for relaxation of mesenteric arteries under increased adrenergic tone, as occurs in hypertension, and indicate an inherent defect in the CaR signaling pathway in Dahl animals, which is much more severe in DS.
The method is useful in determining vascular reactivity ex vivo in mesenteric resistance arteries and similar small blood vessels and comparisons between different agonists and/or antagonists can be easily and consistently assessed side-by-side6,7,8.

An automated myography method for force measurements in isolated mesenteric arteries is described. It employs a Mulvany-Halpern Auto Dual Wire Myograph 510A to determine responses to phenylephrine and extracellular calcium. The method allows consistent determination of isometric responses to agonists in small vessels of diameters of 60 - 300 &mu;m, independently.

自動ワイヤの筋運動記録法を用いた腸間膜動脈の収縮と弛緩の研究

Proximal resistance vessels, such as the mesenteric arteries, contribute substantially to the peripheral resistance. These small vessels of between ...

医学

Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia polycythemia sequence (TAPS)1,2. Injection studies of twin placentas have shown that such anastomoses are almost invariably present in monochorionic twins and extremely rare in dichorionic twins1. Three types of anastomoses have been documented: from artery to artery, from vein to vein and from artery to vein. Arterio-venous (AV) anastomoses are unidirectional and are referred to as "deep" anastomoses since they proceed through a shared placental cotyledon, whereas arterio-arterial (AA) and veno-venous (VV) anastomoses are bi-directional and are referred to as "superficial" since they lie on the chorionic plate. Both TTTS and TAPS are caused by net imbalance of blood flow between the twins due to AV anastomoses. Blood from one twin (the donor) is pumped through an artery into the shared placental cotyledon and then drained through a vein into the circulation of the other twin (the recipient). Unless blood is pumped back from the recipient to the donor through oppositely directed deep AV anastomoses or through superficial anastomoses, an imbalance of blood volumes occurs, gradually leading to the development of TTTS or TAPS. The presence of an AA anastomosis has been shown to protect against the development of TTTS and TAPS by compensating for the circulatory imbalance caused by the uni-directional AV anastomoses1,2. 
Injection of monochorionic placentas soon after birth is a useful mean to understand the etiology of various (hematological) complications in monochorionic twins and is a required test to reach the diagnosis of TAPS2. In addition, injection of TTTS placentas treated with fetoscopic laser surgery allows identification of possible residual anastomoses3-5. This additional information is of paramount importance for all perinatologists involved in the management and care of monochorionic twins with TTTS or TAPS. Several placental injection techniques are currently being used. We provide a simple protocol to accurately evaluate the presence of (residual) vascular anastomoses using colored dye injection.

Twin-to-twin transfusion syndrome and twin anemia polycythemia sequence are two potentially devastating problems in perinatal medicine. Both disorders occur only in monochorionic twins and result from unbalanced blood flow through placental vascular anastomoses. We provide a simple protocol to accurately evaluate the presence of vascular anastomoses using colored dye injection of placental vessels after birth.

カラー染料を使用して単一絨毛膜性の胎盤における血管吻合の正確かつ簡単に評価

The presence of placental vascular anastomoses is a conditio sine qua non for the development of twin-to-twin transfusion syndrome (TTTS) and twin anemia ...

Accuracy in Dental Medicine, A New Way to Measure Trueness and Precision

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base for dental restorations. The current limitation of many reference scanners is the lack of accuracy scanning large objects like full dental arches, or the limited possibility to assess detailed tooth surfaces. A new reference scanner, based on focus variation scanning technique, was evaluated with regards to highest local and general accuracy. A specific scanning protocol was tested to scan original tooth surface from dental impressions. Also, different model materials were verified. The results showed a high scanning accuracy of the reference scanner with a mean deviation of 5.3 &#177; 1.1 &#181;m for trueness and 1.6 &#177; 0.6 &#181;m for precision in case of full arch scans. Current dental impression methods showed much higher deviations (trueness: 20.4 &#177; 2.2 &#181;m, precision: 12.5 &#177; 2.5 &#181;m) than the internal scanning accuracy of the reference scanner. Smaller objects like single tooth surface can be scanned with an even higher accuracy, enabling the system to assess erosive and abrasive tooth surface loss. The reference scanner can be used to measure differences for a lot of dental research fields. The different magnification levels combined with a high local and general accuracy can be used to assess changes of single teeth or restorations up to full arch changes.

Accuracy is a major demand in dental medicine. To verify accuracy, reference scanners are needed. This article presents a new reference scanner with an adjusted scanning method to acquire a broad variety of dental morphologies with high trueness and precision.

歯科医学、真度と精度を測定するための新しい方法の精度

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base ...

A Murine Model of Arterial Restenosis: Technical Aspects of Femoral Wire Injury

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to atherosclerotic plaque development or the rupturing of established plaques, interrupts normal blood flow leading to various morbidities such as myocardial infarction and stroke. In the clinic endovascular procedures such as angioplasty are commonly performed to reopen the lumen. However, these treatments inevitably damage the vessel wall as well as the vascular endothelium, triggering an excessive healing response and the development of a neointimal plaque that extends into the lumen causing vessel restenosis (re-narrowing). Restenosis remains a major cause of failure of endovascular treatments for atherosclerosis. Thus, preclinical animal models of restenosis are vitally important for investigating the pathophysiological mechanisms as well as translational approaches to vascular interventions. Among several murine experimental models, femoral artery wire injury is widely accepted as the most suitable for studies of post-angioplasty restenosis because it closely resembles the angioplasty procedure that injures both endothelium and vessel wall. However, many researchers have difficulty utilizing this model due to its high degree of technical difficulty. This is primarily because a metal wire needs to be inserted into the femoral artery, which is approximately three times thinner than the wire, to generate sufficient injury to induce prominent neointima. Here, we describe the essential surgical details to effectively overcome the major technical difficulties of this model. By following the presented procedures, performing the mouse femoral artery wire injury becomes easier. Once familiarized, the whole procedure can be completed within 20 min.

The mouse femoral artery wire injury model of restenosis is technically challenging. In this protocol we show the key technical details essential for successfully performing wire injury to induce consistent&#160;neointima for studies of restenosis.

動脈再狭窄のマウスモデル：大腿ワイヤー傷害の技術的な側面

Cardiovascular disease caused by atherosclerosis is the leading cause of death in the developed world. Narrowing of the vessel lumen, due to ...

Induction of Accelerated Atherosclerosis in Mice: The "Wire-Injury" Model

Atherosclerosis is a proliferative fibro-inflammatory disease developing in the arterial wall, inducing a deficient blood flow or a lack of blood flow. Moreover, by rupture of the defective vascular wall, atherosclerosis induces occlusive thrombus formation, which represents the main cause of myocardial infarction or stroke and the most frequent cause of death. Despite the advances in the cardiovascular field, many questions remain unanswered, and additional basic research is essential to improve our understanding of the molecular mechanisms during atherosclerosis and its effects. Due to limited clinical studies, there is a need for representative animal models recreating atherosclerotic conditions such as neointima formation after stent implantation, balloon angioplasty, or endarterectomy. Since the mouse presents many advantages and is the most frequently used model for studying molecular processes, the current study proposes an invasive procedure of endothelial denudation, also known as the wire-injury model, which is representative of the human condition of neointima formation in arteries after revascularization procedures.

Induction of Accelerated Atherosclerosis in Mice: The &quot;Wire-Injury&quot; Model

This study describes an invasive procedure for the induction of accelerated atherosclerosis in mice. In comparison to other methods using electric- or cryo-induced injury, mechanical-induced injury mimics the human condition of restenosis after revascularization therapies and is ideal for the study of the molecular mechanisms involved.

マウスにおける加速アテローム性動脈硬化症の誘導:ワイヤー傷害モデル

Atherosclerosis is a proliferative fibro-inflammatory disease developing in the arterial wall, inducing a deficient blood flow or a lack of blood flow. ...

Shunt Surgery, Right Heart Catheterization, and Vascular Morphometry in a Rat Model for Flow-induced Pulmonary Arterial Hypertension

In this protocol, PAH is induced by combining a 60 mg/kg monocrotalin (MCT) injection with increased pulmonary blood flow through an aorto-caval shunt (MCT+Flow). The shunt is created by inserting an 18-G needle from the abdominal aorta into the adjacent caval vein. Increased pulmonary flow has been demonstrated as an essential trigger for a severe form of PAH with distinct phases of disease progression, characterized by early medial hypertrophy followed by neointimal lesions and the progressive occlusion of the small pulmonary vessels. To measure the right heart and pulmonary hemodynamics in this model, right heart catheterization is performed by inserting a rigid cannula containing a flexible ball-tip catheter via the right jugular vein into the right ventricle. The catheter is then advanced into the main and the more distal pulmonary arteries. The histopathology of the pulmonary vasculature is assessed qualitatively, by scoring the pre- and intra-acinar vessels on the degree of muscularization and the presence of a neointima, and quantitatively, by measuring the wall thickness, the wall-lumen ratios, and the occlusion score.

This protocol describes a surgical procedure to create a model for flow-induced pulmonary arterial hypertension (PAH) in rats and the procedures to analyze the principle hemodynamic and histological end-points in this model.

流れ誘導性の肺動脈性肺高血圧症のためのラットモデルにおけるシャント手術、右心カテーテル、および血管形態計測

In this protocol, PAH is induced by combining a 60 mg/kg monocrotalin (MCT) injection with increased pulmonary blood flow through an aorto-caval shunt ...

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously. Here we describe realistic simulators designed to allow the user familiarity with the equipment and specific steps required in the surgical treatment of TTTS, including fetoscopic handling, approaches to anterior and posterior placenta, recognition of anastomoses, and efficient coagulation of vessels. We describe the skills that are especially important in conducting placental laser coagulation that the surgeon can practice on the model and apply in a clinical case. These models can be adapted easily depending on the availability of materials and require standard fetoscopy equipment. Such training systems are complementary to traditional surgical apprenticeships and can be useful aids for fetal medicine units that provide this clinical service.

Practicing the specific skills required for fetoscopic laser coagulation of monochorionic placental anastomoses on realistic models can aid less experienced surgeons in overcoming the steep learning curve associated with this procedure that is now regarded as the standard of care for twin-twin transfusion syndrome.

リアルなシミュレータを使用した Monochorionic Diamniotic ツイン胎盤の胎児レーザー光凝固でモデル手術トレーニング: スキルの習得

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome ...

Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin

Nephrotic syndrome is the most extreme manifestation of proteinuric kidney disease and characterized by heavy proteinuria, hypoalbuminemia, and edema due to sodium retention and hyperlipidemia. To study the pathophysiology of this syndrome, rodent models have been developed based on the injection of toxic substances such as doxorubicin causing podocyte damage. In mice, only few strains are susceptible to this model. In wildtype 129S1/SvImJ mice, the administration of doxorubicin by rapid intravenous injection to the retrobulbar sinus induces experimental nephrotic syndrome that features all the symptoms of human disease including sodium retention and edema. After the onset of proteinuria, mice exhibit increased urinary serine protease activity that leads to the activation of the epithelial sodium channel (ENaC) and sodium retention. Pharmacological inhibition of urinary serine proteases by the treatment with sustained release aprotinin abrogates ENaC activation and prevents sodium retention. This model is ideal to study the pathophysiology of proteasuria, i.e., the excretion of active serine proteases that cause ENaC activation by the proteolysis of its &#947;-subunit. This can be regarded as the primary mechanism of ENaC activation and sodium retention in proteinuric kidney disease.

Here, we describe the induction of experimental nephrotic syndrome in 129S1/SvImJ mice by rapid retrobulbar injection of doxorubicin. We also treat nephrotic mice with sustained release pellets containing aprotinin to inhibit urinary serine protease activity and prevent sodium retention.

ドキソルビシンの球後注射と徐放性アプロチニンによるボリューム保持の予防によるマウスのネフローゼ症候群の誘導

Nephrotic syndrome is the most extreme manifestation of proteinuric kidney disease and characterized by heavy proteinuria, hypoalbuminemia, and edema due ...

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty (PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The accuracy of PVP mainly depends on the surgeons&#39; experience and multiple fluoroscopes during a traditional procedure. Puncture related complications were reported all over the world. To make the surgical procedure more precise and decrease the rate of puncture-related complications, our team applied a three-dimensional printing guide template to PVP to modify the traditional procedure. This protocol introduces how to model target vertebrae DICOM imaging data into three-dimensions in the software, how to simulate operation in this 3-D model, and how to use all of the surgical data to reconstruct a patient specific template for application. Using this template, surgeons can identify suitable puncture points accurately to improve the accuracy of the operation. The whole protocol includes: 1) diagnosis of the osteoporotic vertebral compression fracture; 2) acquisition of CT imaging of the target vertebra; 3) simulation of the operation in the software; 4) design and fabrication of the 3-D printing guide template; and 5) application of the template into an operation procedure.

Three-Dimensional Printing Guide Template Assisted Percutaneous Vertebroplasty PVP

Herein, we present a three-dimensional printing guide template for percutaneous vertebraplasty. A patient with a T11 vertebral compression fracture was selected as a case study.

3次元印刷ガイドテンプレートアシスト経皮椎形成術(PVP)

Percutaneous vertebroplasty (PVP) is considered an effective treatment for the back pain caused by osteoporotic vertebral compression fracture. The ...

OP-IVM: Combining In vitro Maturation after Oocyte Retrieval with Gynecological Surgery

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte retrieval with routine gynecological surgery. OP-IVM is suitable for patients undergoing benign gynecological surgery who have the need for fertility preservation (FP) or infertility treatments such as in vitro fertilization and embryo transfer (IVF-ET). In the operating room, patients undergoing benign gynecological surgery are first anesthetized and receive ultrasound-guided immature follicle aspiration (IMFA) treatment. As the subsequent gynecological surgery is performed, the cumulus-oocyte complexes (COCs) are examined, and the immature COCs are transferred into the IVM medium and cultured for 28-32 hours in the IVF laboratory. After assessment, mature oocytes in the MII stage will be selected and cryopreserved in liquid nitrogen for FP or fertilized by intracytoplasmic sperm injection (ICSI) for IVF-ET. By combining IVM with gynecological surgery, immature oocytes that would have been discarded can be saved and used for assisted reproductive technology (ART). The procedure, significance and critical aspects of OP-IVM are described in this article.

In vitro maturation (IVM) before gynecological operation (OP-IVM) combines IVM following oocyte retrieval with routine gynecological surgery and serves as an extension of conventional IVM applications for fertility preservation.

OP-IVM:卵母細胞検索後の体外成熟と婦人科手術の組み合わせ

The use of in vitro maturation (IVM) before gynecological operation (OP-IVM) is an extension of conventional IVM that combines IVM following oocyte ...