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

全ての動物は、動物実験倫理委員会（農業のフランスの省のガイドライン）に従って処理しました。プロトコルは、パリデカルト大学の動物実験法のために公認の地元の倫理委員会の承認を受けた（登録番号MESR 2035.02を、医学パリデカルト、パリ、フランスの学部）。 1. ADSC文化とラベリング<ol><li>民間金融機関から確認されたADSCを取得します。 10％胎児仔牛血清および1％抗生物質（ペニシリンおよびストレプトマイシン）を含むアルファ最小必須培地で37℃、5％CO 2で培養同種のADSC。 </li><li>標準的な細胞増殖手順を用いて、動物あたり約24×10 6のADSC（37℃、5％CO 2）を取得します。標準のトリプシン溶液（T150皿のための10ミリリットル）を使用したADSCを収穫。血球計数器を用いて細胞計数を行います。 </li><li>セルPKH67染色PRを使用して、移植前日にラベル付けを行いますocedure以下に説明しました。 注：染色手順の目標は、移植後の細胞追跡を可能にすることです。 <ol><li> 2×10 6のADSCを標識するためには、溶液Aを調製し、B液（希釈液Cを1mLとPKH67の4μL）（100希釈液CのμLで2×10 6細胞）。 </li><li> 2分間溶液AとBをインキュベートします。その後、1分間の胎児仔牛血清の100μLを追加します。 </li><li> 5分間1500×gで300クエン酸RPMIのμL（RPMIとクエン酸の1.5μLの298.5μL）、遠心分離で溶液を洗浄します。この操作を2回繰り返します。標識細胞を維持し、シート建設まで光から保護。 </li></ol></li></ol> 2.ダブルADSCシート構築物<ol><li>当日は、移植前に、PKH標識の前に、上記の細胞培養培地のウェル当たり4 mLを、12ウェルの温度応答性細胞培養皿を準備します。 1.5×10 6 PKH-labeleで皿をシードウェルD細胞と12時間（37℃、5％CO 2）インキュベートします。 </li><li>移植の日に、30分間室温で皿をインキュベートすることにより集密細胞シートを取り外します。 </li><li>静かにピペットで1 ADSCシートを吸引し、疎水性紙（1.5 cmの直径）の上に層。支持膜として、この用紙を使用してください。 </li><li>別のADSCシートをつかみ、静かに二層構造物を得るために、他の1の上に堆積させます。 </li><li> （動物当たり4）必要な数のADSC-シート構造を得るために、これらの手順を繰り返します。 </li></ol> 3.食道内視鏡的粘膜下層切開（ESD） <ol><li>移植の日に、10 mgを筋肉内ケタミン/ kgので動物を事前に薬で治療および静脈内プロポフォールの8ミリグラム/キログラムでそれらを誘導します。その後、気管内挿管を行い、イソフルラン2.5％の吸入で麻酔を維持します。 </li><li>動物は全身麻酔下になると、gastroscでESDを行いますOPE、ビデオスコープ、および電気手術装置。 <ol><li> 40センチメートルから歯列弓〜45 cmの範囲の半周背マークを取得するために、内視鏡ナイフとソフト凝固を使用してください。 </li><li>筋層から粘膜層の分離のための粘膜下層へのインジゴカルミン染料を含有するグリセロール溶液を注入します。 </li><li>周切開を得るためにendocutのIモードで内視鏡ナイフを使用してください。 </li><li>遠位の切り込みに近位切開部から移動し、粘膜下層剥離術を実行するために強制凝固モードでの内視鏡ナイフを使用してください。 </li></ol></li><li> ESD手順の最後に、筋層を露出させる半周、5センチメートル長食道の傷を観察します。 </li></ol> 4.内視鏡移植<ol><li>すぐにESD後、内視鏡4の二重ADSC-シート構築物で動物を移植。 <ol><li>内視鏡鉗子でADSC-シート構造体をつかみ、大規模な、透明な内視鏡のキャップを使用することにより、創傷部位への輸送中にそれを保護します。 </li><li>潰瘍床にADSC-シート構築物の表面全体に適用します。 </li><li>静かに完全かつ安定した生着を得るために10分間ADSC-シート構造体を適用します。アプリケーションでは、内視鏡鉗子または内視鏡のキャップを使用して、ADSCの表面全体が食道粘膜下層の上に構築適用されます。 </li></ol></li><li> 4移植し、接着性二重セルシート構築物を得るために、この手順を各動物の4回繰り返します。 注：目標は、創傷領域の近似的半分をカバーするものです。 </li></ol> 5.術後評価とフォローアップ<ol><li>各動物について、0.2 mgのモルヒネ/ kgの一日三回最初の日のために及びエソメプラゾールの28日間の抗酸処理（40 mg /日）での筋肉内注射でESD後の鎮痛を確保します。 amoxicillで抗生物質の予防的投与を行います7日間（1グラム/日）インチ翌日の1日目の液体と固体を承認。 </li><li> 28日間の動物とフォローアップ。メロウピンカスの嚥下障害スコア16と重量変化の測定値を使用して、毎日の臨床評価を得ます。 </li><li>マルチモーダル狭窄の評価：全身麻酔下で、スケジュールされた日3、14、および28に、狭窄の発生のマルチモーダル評価を行います。 <ol><li>瘢痕説明、狭窄の測定、および紙支持体膜の検出を使用して内視鏡評価を行います。 （胃カメラの直径は8mmである）狭窄を介して交差するように胃カメラを使用して狭窄を測定します。炎症アスペクト（粘膜紅斑、粘膜の浮腫、および粘膜自然出血）および瘢痕内の紙支持体膜の有無に注意を払って、傷跡を確認します。 </li><li>瘢痕床に直接胃内視鏡オペレータ運河を通じてPCLE緑のプローブを適用します。自発的な検索そして、PKH67標識ADSC-シート構造体の生着と互換性のある緑色の信号を組織しました。 </li><li>放射線フープ（前面と左側の発生率）でバライト食道造影の2直交発生率を実行します。 18、17）（[×100狭窄下の垂直軸の狭窄/長さの下で短軸の1-（長さ）狭窄度（％）=）]最も厳しい狭窄評価のための発生率を保管してください。 </li></ol></li><li>動物の犠牲。 <ol><li> 28日目に、フォローアップ期間の終了時に、動物の犠牲を行います。動物は全身麻酔下にある間に、静脈内フェノバルビタール100mgの/キロを注入。心拍の呼吸運動の不在のために臨床検査を用いた動物の死を確認してください。 </li><li>胸骨切開と臓器露光後、それぞれから食道を削除（10％緩衝ホルマリン固定、パラフィン包埋し、4μmの厚さのセクションで）動物を犠牲にしました。スライドを染色ヘマトキシリンとサフラン15で。コンピュータ分析のためのスライドをデジタル化し、動物群15を比較します。 </li></ol></li></ol>

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

著者らは、開示することは何もありません。

このブタモデルでは、ADSC-シート移植は技術的に成功し、in vivoで PCLE評価は、細胞移植のモニタリングを可能にしました。臨床内視鏡的、放射線、および組織学的評価は、拡張ESD後食道狭窄予防に内視鏡ADSCシートの有効性を実証しました。 インジゴカルミン色素シートを含むADSCグリセロール溶液の内視鏡移植は、再生医療における革新的なアプローチです。大木<...

表在食道腫瘍の管理は、新しい内視鏡技術の開発と変更されました。今日では、内視鏡的切除が第一選択治療です。実際に、同等の腫瘍学的結果を1、2、3で手術より低い罹患率および死亡率と関連しています。内視鏡的粘膜切除術（EMR）と内視鏡的粘膜下層切除（ESD）は、最も広く使用されている技術です。拡張された表在性腫瘍の場合には、ESDが好ましいです。 EMRに比べて、ESDに関わらず、病変の大きさの、 ブロック切除専用でき、4、5、6を形作ります。 ESDの主な遅延合併症は、一般的切除後1および2週間の間に発生する食道狭窄形成、です。最近公表された研究は、狭窄形成が相関することを示しています切除のサイズ。日本内視鏡学会は、それらが例の90％以上に狭窄の開発に関連付けられており、厳しい送りトラブルや生活の質の主要な劣化を担当されているので、食道周囲の3/4よりも大きなサイズのESDを回避することをお勧めします。 食道狭窄の予防は依然として厳しいです。狭窄の形成に関与する機構は、部分的にしか知られています。狭窄形成つの異なるメカニズムの会合に起因すると思われる：（1）プロ炎症性細胞の動員、（2）過剰な線維症の開発7。いくつかの予防的治療法が提案されています。しかし、結果は、ほとんど利益と重篤な副作用8,9と、不十分でした。最近、日本のチーム、大木ら。 、esophに自己口腔粘膜細胞の単層細胞シートを移植することを提案ageal傷跡。移植はESD 10、11の直後に行きました。彼らは、最初のイヌのモデルにした後、患者に、この革新的なアプローチの有効性を実証しました。 脂肪組織由来間質細胞（ADSCを）は、再生医療に期待されています。いくつかの分野におけるそれらのアプリケーションは、特に創傷治癒過程で、興味深い結果を示しています。細胞は、容易に分離され、間葉系と非間葉系統12、13、14への抗炎症性、局所免疫調節作用、血管新生の誘導、および分化能力に関連付けられているためADSC療法は、いくつかの利点を提供しています。 以前の研究では、我々のチームは、食道狭窄prevをダブルADSC-シート内視鏡移植の有効性を実証しました豚モデル15内の拡張ESD後ention。この記事では、ADSC-枚構成と内視鏡的移植技術のレポートが提示されています。

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

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

過去数年間において、細胞シート構築物は、特に再建手術の手順については、再生医療の幅広い関心に拍車をかけました。様々な生体材料と脂肪組織由来間質細胞（ADSCを）を組み合わせ多様な技術の開発は、骨、軟骨、およびげっ歯類、ブタ、またはヒトのADSCからの脂肪組織などの組織工学代用、多数のタイプの建設につながっています。拡張食道内視鏡的粘膜下層剥離術（ESD）は、食道狭窄形成を担当しています。狭窄の予防は利用できませ効率的な治療法と、依然として厳しいです。以前の研究では、イヌのモデルおよびヒトにおいて粘膜細胞シート移植の有効性を報告しました。 ADSCを間葉系と非間葉系統に抗炎症性、局所免疫調節作用、血管新生の誘導、および分化能力を起因しています。この最初の研究では、内視鏡TRAを説明します豚のモデルに食道狭窄を防ぐために、ADSCの組織工学構築物のnsplantation。 ADSC構築物は、紙支持膜上に互いの上に積層2同種ADSCシートから構成されました。 ADSCを、プローブベースの共焦点レーザーendomicroscopy（PCLE）監視できるようにPKH67蛍光色素で標識しました。移植の日に、5-CMおよび食道狭窄を誘導することが知られている半円周ESDを行いました。動物はすぐに内視鏡4 ADSC構築物で移植しました。 ADSC構築物の完全な接着が穏やかアプリケーションの10分後に得ました。動物は、すべての動物が正常に移植された28日目に屠殺しました。移植は正PCLE評価で3日目に確認されました。移植された動物と比較して、対照動物には、主要な線維性組織の発達と、より頻繁に消化トラブル重度狭窄を発症し、体重増加を減少させました。 allogeniの我々のモデルでは、移植C二重細胞シートで組織のADSCは、拡張ESD後に成功したと強く下部食道狭窄率に関連付けられていました。

ADSCシートを得るためのADSCの培養及び手順は、図1に示されています。 図2はその紙支持体膜上に互いの上に層状に2 ADSCシートで構成され、移植片の構成を示しています。 ADSCをは、以前PCLEと生体内移植片の監視にできるようにPKH67蛍光色素で標識しました。 図3は、5-cmであり、半周食道傷跡が得られ、拡張された食?...

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

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

この研究は、ブタモデルに拡張された内視鏡的粘膜下層剥離術（ESD）後の食道狭窄予防のためのβシート移植の内視鏡的脂肪組織由来間質細胞（ADSC）の成功した方法を報告します。

拡張食道内視鏡的粘膜下層切開後に狭窄を防止するためのADSC-シート移植

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

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

Research

JoVE Journal

Medicine

8.4K ビュー.  Université Paris Descartes Sorbonne Paris Cité. この研究は、ブタモデルに拡張された内視鏡的粘膜下層剥離術（ESD）後の食道狭窄予防のためのβシート移植の内視鏡的脂肪組織由来間質細胞（ADSC）の成功した方法を報告します。 

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

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

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

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

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

使用したラット腎移植後の急性拒絶反応の非侵襲的イメージング<sup&gt; 18</sup&gt; F-FDG PET

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

医学

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

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

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

うなずくにおける肝切除後肝脾内移植。SCID マウス

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

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

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

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

Transcanal 内視鏡下耳の手術による中耳解剖学の発見: 解剖マニュアル

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

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

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

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

ラットモデルにおける部分的な術後後の漏れを減らすために脂肪組織由来幹細胞シートの移植

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

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

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

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

ラット型異形肝移植モデルにおける動脈リコネクション後の合併症の減少

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

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

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

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

喉頭咽頭と従来の食道pHモニタリングの同時

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

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

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

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

マウスモデルにおける心筋梗塞後のMSC負荷注入性ヒドロゲルの筋内移植

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

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

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

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

腎臓移植後の患者のデジタルホームモニタリング:MACCSプラットフォーム

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

Endoscopic Cholesteatoma Surgery

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

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

内視鏡的胆汁うっ滞症手術

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

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

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

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

拡張基準ドナーモデルとしての静脈バイパスなしのブタ肝移植

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