この作品は、若手研究者 (No. 81300810) 中国の国家自然科学基金、上海の若い医師の研修 (第 20141057)、上海自然科学基金 (第 16ZR1405100)、上海市によって賄われていた健康と家族計画 (ナンバー 201740187) の委員会。我々 はこの原稿の準備の間に言語の援助を提供するため LetPub (www.letpub.com) に感謝を思います。

ヒトを対象に関与、この手順は、眼耳鼻咽喉科病院、復旦大学、中国の制度上の審査委員会によって承認されました。提供されているすべての登録患者には、インフォームド コンセントが書き込まれます。
1. 手術のための準備
<ol><li>術前に、患者の鼻腔前方 rhinoscopy、内視鏡検査、コンピューター断層撮影 (CT) スキャンして確認し、偏差を見つけると15の兆候を識別するためとを調べます。</li>
	<li>全体として彼らの鼻の開存性を評価するために、手術前に視覚アナログ スケール (VAS) にこれを示すために患者をお願いします。 注: スケールの合計の長さが 10 cm、1 つの極端が、完全に明確な鼻 (すなわち、0 cm 得点 0%)、他の極端な鼻が完全につまって (10 cm の 100% を獲得)、センター 50% 閉塞と鼻。</li>
	<li>両方の鼻ホール 1 日手術前に、で上唇を削除します。</li>
	<li>手術の日、動作表16にそれらを配置した後、患者に全身麻酔を管理します。 注: は、麻酔とプロポ フォール、sulfentanyl、0.2 μ g/kg、0.6 mg/kg ロクロニウムの 2 〜 2.5 mg/kg を誘発します。0.1 μ g/kg/min のレミフェンタニルの持続静脈内投与とセボフルラン (0.8 最小肺胞濃度) の吸入麻酔を維持します。</li>
	<li>オペレーティング テーブル (背の高い位置) に 30 ° の傾斜し、(どちらも曲げても拡張) 中立的な立場で患者の頭部を置きます。</li>
</ol>2. 手術
注: は、全体の操作中に 0 度の内視鏡を使用します。
<ol><li>急勾配の 1% テトラカインと 0.1% エピネフリン 4 mL 20 mL の混合液とガーゼ (6 cm × 60 cm) を 8 個。鼻の粘膜を縮小に 5 分間、各鼻腔に 1 浸したガーゼの部分を置きます。</li>
	<li>手順の最後でエレベーターのある鼻腔の外側壁に向かって鼻甲介下を置きます。</li>
	<li>0.9 の 20 mL の混合液の数ミリリットルで 5 mL 注射器の針を用いて中隔に潜入 % 食塩水と、subperichondrial で 0.1% エピネフリン 0.05 mL と隔壁の両側の骨膜下面。 注: 場合両側に鼻中隔偏位していた、我々 定義凸側前方偏差の側として。</li>
	<li>第 15 刃隔軟骨の最大偏差 (すなわち、凸側) の同側側粘膜皮膚接合部でキリアン切開を確認します。中隔、鼻腔の床に続きをできるだけ高く、鼻腔の床に達した時点で後方に曲線の縦切開を開始します。 注: 切開は、鼻中隔の粘膜軟骨膜に浸透する必要があります。</li>
	<li>出血の場合は、吸引のエレベーターの subperichondrial 面の粘膜フラップを上げます。出血、なし 2 mm または 5 mm のエレベーターとフラップを上げます。上向きと下向きに凸の側の軟骨性と骨質の中隔を完全に公開鼻腔の床には、可能な限り高い標高を拡張します。</li>
	<li>背と四角形の軟骨の接合部と篩骨の垂直板の前方下軟骨に 2 mm エレベーターや数 15 刃の鋭い端を使用して縦切開をする (すなわちの最初の行、2LoRs). 同様に、四角形の軟骨、鼻中骨および上顎クレスト (つまり、2 番目の行) の接合部に優れた軟骨の横切開を行う (図 2 a)。 注: この方法で骨の中隔にその後方と下の添付ファイルから動員は中隔の軟骨と前部と優れた添付ファイルはそのまま残ります。</li>
	<li>吸引のエレベーターを持つ二国間骨の中隔を公開する側の口蓋を昇格させます。</li>
	<li>中隔の軟骨と (図 1 b) 隣接する骨の中隔の後部と下余白の 2 つのストリップを切除します。<ol>
<li>1/4、1/3 (時折 1/3、1/2) の最初の行 (図 2 b) 前後の寸法で軟骨の元の幅を切除します。</li>
		<li>1/4、1/3 (時折 1/3、1/2) (図 2) の 2 番目の行に垂直方向に軟骨の元の高さを切除します。</li>
	</ol>
</li>
	<li>肥厚骨中隔偏差を削除し、偏差を正中線に移動する部分的な破壊の変位を実行します。 注: 後部と下骨の中隔の豊富な除去は、すべての厚さとこの地域での奇形をオフにです。</li>
	<li>電気焼灼で、術中の出血を制御します。</li>
	<li>吸収性材料 (図 2 D) と二つの縫合による粘膜フラップを近似します。<ol>
<li>後方切開縫合糸を開始、反対側に隔壁を介してそれらを渡す、それらを皮膚切開部位の前方から戻ってプルします。</li>
		<li>それぞれ自分自身に縫合糸を結び目。2 つの縫合はパラレル、他の上の 1 つを配置します。</li>
	</ol>
</li>
</ol>3. の手順と手術後の評価
<ol><li>Nasopore と鼻腔をパックします。</li>
	<li>患者が血腫や中隔の感染症をチェックする手術後 1 週間を確認します。</li>
	<li>前方 rhinoscopy と 0 度内視鏡と鼻腔内を調べ、手術後 6 ヶ月 VAS で鼻の開存性を評価するために患者をお願いします。</li>
	<li>レコードの術後の鼻中隔血腫、一時的な歯の痛み、塞栓、癒着、鼻出血、鼻中隔膿瘍、中隔スイング、中隔穿孔、背は、手術の合併症として崩壊します。</li>
</ol>

<ol>
	<li>Chung, B. J., Batra, P. S., Citardi, M. J., Lanza, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+revisitation+of+the+technique,+indications,+and+outcomes.">Endoscopic septoplasty: revisitation of the technique, indications, and outcomes.</a> The American Journal of Rhinology. 21 (3), 307-311 (2007).</li><li>Hwang, P. H., McLaughlin, R. B., Lanza, D. C., Kennedy, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+septoplasty:+indications,+technique,+and+results.">Endoscopic septoplasty: indications, technique, and results.</a> Otolaryngology-Head and Neck Surgery. 120 (5), 678-682 (1999).</li><li>Fettman, N., Sanford, T., Sindwani, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+management+of+the+deviated+septum:+techniques+in+septoplasty.">Surgical management of the deviated septum: techniques in septoplasty.</a> Otolaryngologic Clinics of North America. 42 (2), 241-252 (2009).</li><li>Killian, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+submucous+window+resection+of+the+nasal+septum.">The submucous window resection of the nasal septum.</a> Annals of Otology, Rhinology &amp; Laryngology. 14, 363-393 (1905).</li><li>Freer, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+correction+of+deflections+of+the+nasal+septum+with+a+minimum+of+traumatism.">The correction of deflections of the nasal septum with a minimum of traumatism.</a> The Journal of The American Medical Association. 38, 636-642 (1902).</li><li>Aaronson, N. L., Vining, E. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Correction+of+the+deviated+septum:+from+ancient+Egypt+to+the+endoscopic+era.">Correction of the deviated septum: from ancient Egypt to the endoscopic era.</a> International Forum of Allergy &amp; Rhinology. 4 (11), 931-936 (2014).</li><li>Bloom, J. D., Kaplan, S. E., Bleier, B. S., Goldstein, S. 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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Newer+concepts+of+septum+surgery;+present+status.">Newer concepts of septum surgery; present status.</a> Eye, Ear, Nose &amp; Throat Monthly. 27 (9), 403-406 (1948).</li><li>Gibson, T., Davis, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+distortion+of+autogenous+cartilage+grafts:+Its+causes+and+prevention.">The distortion of autogenous cartilage grafts: Its causes and prevention.</a> British Journal of Plastic Surgery. 10, 257-274 (1958).</li><li>Kenedi, R. M., Gibson, T., Abrahams, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanical+characteristics+of+skin+and+cartilage.">Mechanical characteristics of skin and cartilage.</a> Human Factors. 5, 525-529 (1963).</li><li>Stenstroem, S. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+&amp;#34;natural&amp;#34;+technique+for+correction+of+congenitally+prominent+ears.">A &amp;#34;natural&amp;#34; technique for correction of congenitally prominent ears.</a> Plastic and Reconstructive Surgery. 32, 509-518 (1963).</li><li>Fry, H. 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著者が明らかに何もありません。

2LoRs プロシージャは、逸脱した鼻の隔壁の胎生学的、解剖学的知識に基づいています。鼻中隔は、3 つの異なるコンポーネントで構成されています: 前方の膜、真ん中の軟骨と後部と下の骨。鼻中隔の開発、中にさまざまなコンポーネントは異なる時系列で骨化します。通説では、軟骨がまだ成長しながら骨がその拡張を完了すること。したがって、軟骨を鼻中隔が変形して初期勢力で、その...

内視鏡 septoplasty が鼻中隔偏差1によって引き起こされる鼻の気道閉塞を治療するために耳鼻科で一般的に行わ手術です。鼻の気道閉塞の徴候と、septoplasty の目的は鼻気道の開存性の機能の改善を提供するために、原則は最小限の外科的侵襲2隔偏差を修正します。
Septoplasty、まだ今日使用されているプロシージャの先頭トレース バック フリーア、キリアン公開粘膜切除 (SMR)3と呼ばれていた初期の 20 世紀の技術。SMR は、鼻4、5の外観を構造的にサポートするための L 字の支柱を残して subperichondrial 平面の鼻軟骨偏差の直接の除去によって特徴付けられます。SMR は、徐々 に受け入れ、その時に、前の技術上の利点を示した。1990 年代、内視鏡検査は septoplasty1に適用されました。照明や手術場の可視化が非常に改善されて、直接かつ正確に切除を実行可能性があります6。その後、SMR の徴候が拡張されたと様々 な septoplasty 技術を開発しました。これらのテクニックは、切開、フラップの上昇、切除、縫合、またはパッキングの多様化が、一方、この直接除去の本質は変わっていません。したがって、軟骨を切除した大きく、一度、大中隔穿孔や鞍鼻変形などの合併症は7、8を発生します。
コトルと 1948 年に提案した Loring、逸脱した軟骨の切除は保守的な9をする必要があります。軟骨の偏差の直接の除去とは異なり、septoplasty に適用される軟骨のバイオメカニクスを必要と限られた手術で軟骨の偏差をまっすぐに軟骨の弾性特性の利用部分切開 (例えば傷や薄いスライス) と (例えば、完全カットまたはくさび) 完全切開などの介入。1958 年にギブソンとデイビス最初、軟骨が報告その成長パターン10の結果として内部自己ロック ストレス システム。凹面の側面の部分切開は凸側切開が強化、お辞儀、軟骨の湾曲を減らす、ストレスをリリースでしょう。1963 年、ケネディ、ギブソン、Abrahams はさらに肋骨軟骨11断面力分布をマッピングに関する研究のシリーズを通して自己ロック ストレス システムを実証。同じ年では、・ ステンスト ロームは antihelix12部分切開の効果を確認しました。数年後、フライは、一貫性のある13であった人間の鼻の中隔軟骨で結果を公開しました。つまり、軟骨の力学は、軟骨内で力を解放することによって軟骨の形態を変更する使用できます。この基礎理論に基づき、軟骨の力学的機能の活用術は、先進14でした。
後部と下の接合部に 2 回線切除 (2LoRs) の技術と鼻中隔、ここで、変更された内視鏡 septoplasty プロシージャの発生学と解剖学的知識を持つ以前手術を組み合わせることにより、軟骨性と骨質の隔壁 (図 1) が詳細に表示されます。この手順は外部鼻の奇形はない、鼻の開存性を改善するためにまたは真ん中の道または術前操作として介内の腋窩部へのアクセスを改善するときに逸脱した鼻の隔壁を修正する勧めします。この手順は、その低侵襲アプローチのため隔偏差を修正するため、子供で使用される可能性があります。

<table border="0" cellpadding="0" cellspacing="0" style="width:755px;" width="755">
	<tbody>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasal Endoscopy (0o)</td>
			<td style="width:221px;">Karl Storz-Endoskope</td>
			<td style="width:127px;">7230 AA</td>
			<td style="width:180px;"></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Tetracaine</td>
			<td style="width:221px;">Eye &#38; ENT Hospital of Fudan University</td>
			<td style="width:127px;">180130</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Epinephrine Hydrochloride Injection</td>
			<td style="width:221px;">Shanghai Harvest Pharmaceutical Co., Ltd</td>
			<td style="width:127px;">10170405</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Number 15 blade</td>
			<td style="width:221px;">Shanghai Pudong Jinhuan Medical Products Co., Ltd</td>
			<td style="width:127px;">35T1205</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Suction Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2117.1</td>
			<td>Width: 4 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Electrocoagulation</td>
			<td style="width:221px;">Shanghai Hutong Electronics. Co.,Ltd</td>
			<td style="width:127px;">GD350-B5</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">4-0 Brided Absorbable Suture</td>
			<td style="width:221px;">Covidien Healthcare</td>
			<td style="width:127px;">SL-691</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Rongeur forcep</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2300.3</td>
			<td></td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Nasopore</td>
			<td style="width:221px;">Nasopore, Stryker, USA</td>
			<td style="width:127px;"></td>
			<td>Lengh: 8 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">Gauze</td>
			<td style="width:221px;">Ningbo Shenyuan Medical Material Co., Ltd</td>
			<td style="width:127px;"></td>
			<td>6 cm x 60 cm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">5mm Elevator</td>
			<td style="width:221px;">Zhejiang Tian Song Medical Products Co., Ltd</td>
			<td style="width:127px;">B2067</td>
			<td>Width: 5 mm</td>
		</tr>
		<tr height="40">
			<td height="40" style="height:40px;width:227px;">2mm Elevator</td>
			<td style="width:221px;">Shanghai Medical Instruments (Group) Ltd., Corp. Surgical Instruments Factory</td>
			<td style="width:127px;">HBL020</td>
			<td>Width: 2 mm</td>
		</tr>
	</tbody>
</table>

endoscopic septoplasty with limited two-line resection: minimally invasive surgery for septal deviation

内視鏡 septoplasty は鼻中隔偏差によって引き起こされる鼻の気道閉塞を治療するために実行される一般耳鼻咽喉科手術です。それは、複数のバリエーションで長い歴史を持ちます。鼻腔の発生学と解剖学的知識に基づいて軟骨性と骨質の中隔の後部と下交差点 2 回線切除 (2LoRs) 手法を使用して変更された内視鏡 septoplasty 手順を提示この記事で中隔と軟骨の動作のバイオメカニクス。この手順では、四角形の軟骨を保持できます、できるだけ支援する枠組みと鼻中隔の維持に有用であります。2LoRs は、効果的かつ稀な合併症で鼻中隔偏差の補正のためサウンドに実証されています。鼻の開存性を改善するためにまたは真ん中の道または中鼻甲介の腋窩領域へのアクセスを改善するために任意の外部鼻の変形のない状態で鼻腔鼻中隔の偏位を修正するこの修正の手順を適用できます。子どもや若者にその低侵襲アプローチのため septoplasty の適応症の拡大にも使えます。

成人患者 (> 18 歳の) 鼻中隔偏差でこの研究に含まれていた。除かれた septoplasty の以前の手術歴のある方や慢性副鼻腔炎、副鼻腔腫瘍、外鼻変形、伴う鼻中隔偏位を伴う患者。まっすぐ背、尾側軟骨の脱臼をした患者から大きい鼻翼も除外された鼻の玄関の 1 つに、突出していた。
30 人の患者は、この研究に含まれていた?...

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Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内視鏡 septoplasty は、複数のバリエーションで由緒ある手術です。本稿は 2 回線切除として知られている変更された septoplasty の手順を実行するステップバイ ステップの手術アプローチに焦点を当ててください。この手技は、外部鼻変形のない状態で逸脱した鼻中隔の修正を適用できます。

2 回線切除と内視鏡 Septoplasty: 隔偏差の低侵襲手術

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

endoscopic-septoplasty-with-limited-two-line-resection-minimally

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Anatomy and Physiology

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Unit 1

The Axial Skeleton

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16.5K ビュー.  Fudan University. 内視鏡 septoplasty は、複数のバリエーションで由緒ある手術です。本稿は 2 回線切除として知られている変更された septoplasty の手順を実行するステップバイ ステップの手術アプローチに焦点を当ててください。この手技は、外部鼻変形のない状態で逸脱した鼻中隔の修正を適用できます。

ビデオ: Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

Murine Ileocolic Bowel Resection with Primary Anastomosis

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer being two common examples. Despite the frequency of these procedures, a significant knowledge gap remains in describing the inherent effects of intestinal resection on host physiology and disease pathophysiology. This article provides detailed instructions for an ileocolic resection with primary end-to-end anastomosis in mice, as well as essential aspects of peri-operative care to maximize post-operative success. When followed closely, this procedure yields a 95% long-term survival rate, no failure to thrive, and minimizes post-operative complications of bowel obstruction and anastomotic leak. The technical challenges of performing the procedure in mice are a barrier to its wide spread use in research. The skills described in this article can be acquired without previous surgical experience. Once mastered, the murine ileocolic resection procedure will provide a reproducible tool for studying the effects of intestinal resection in models of human disease.

Ileocolic resection is commonly performed in several human diseases; however, little is known regarding the impact of intestinal resection on surgical illnesses. This article provides instruction on executing the procedure in mice with high success, providing a means to study the effects of ileocolic resection in models of disease.

プライマリ吻合とネズミ回結腸腸切除

Intestinal resections are frequently required for treatment of diseases involving the gastrointestinal tract, with Crohn&#8217;s disease and colon cancer ...

医学

Encapsulation Thermogenic Preadipocytes for Transplantation into Adipose Tissue Depots

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular weight metabolites in tissues of the treated host to achieve long-term survival. The semipermeable membrane allows engrafted encapsulated cells to avoid rejection by the immune system. The encapsulation procedure was designed to enable a controlled release of bioactive compounds, such as insulin, other hormones, and cytokines. Here we describe a method for encapsulation of catabolic cells, which consume lipids for heat production and energy dissipation (thermogenesis) in the intra-abdominal adipose tissue of obese mice. Encapsulation of thermogenic catabolic cells may be potentially applicable to the prevention and treatment of obesity and type 2 diabetes. Another potential application of catabolic cells may include detoxification from alcohols or other toxic metabolites and environmental pollutants.

Here, we present a protocol for encapsulation of catabolic cells, which consume lipids for heat production in intra-abdominal adipose tissue and increase energy dissipation in obese mice.

移植のためのカプセル化サーモ前脂肪細胞の脂肪組織デポへ

Cell encapsulation was developed to entrap viable cells within semi-permeable membranes. The engrafted encapsulated cells can exchange low molecular ...

An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.

Minimally invasive surgical (MIS) procedures rely on anatomical references to localize structures not directly visible to the surgeon. This manuscript describes a combined method of plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to locate the structures at risk during MIS procedures.

低侵襲外反母趾外反母趾手術中リスクで神経の解剖学的研究

The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional ...

A Minimally Invasive Model to Analyze Endochondral Fracture Healing in Mice Under Standardized Biomechanical Conditions

Bone healing models are necessary to analyze the complex mechanisms of fracture healing to improve clinical fracture treatment. During the last decade, an increased use of mouse models in orthopedic research was noted, most probably because mouse models offer a large number of genetically-modified strains and special antibodies for the analysis of molecular mechanisms of fracture healing. To control the biomechanical conditions, well-characterized osteosynthesis techniques are mandatory, also in mice. Here, we report on the design and use of a closed bone healing model to stabilize femur fractures in mice. The intramedullary screw, made of medical-grade stainless steel, provides through fracture compression an axial and rotational stability compared to the mostly used simple intramedullary pins, which show a complete lack of axial and rotational stability. The stability achieved by the intramedullary screw allows the analysis of endochondral healing. A large amount of callus tissue, received after stabilization with the screw, offers ideal conditions to harvest tissue for biochemical and molecular analyses. A further advantage of the use of the screw is the fact that the screw can be inserted into the femur with a minimally invasive technique without inducing damage to the soft tissue. In conclusion, the screw is a unique implant that can ideally be used in closed fracture healing models offering standardized biomechanical conditions.

This protocol describes a minimally invasive osteosynthesis technique using an intramedullary screw for standardized stabilization of femur fractures, which can be used to analyze endochondral bone healing in mice.

癒しの標準化された生体力学的条件下でマウスの軟骨破壊を分析する低侵襲モデル

Bone healing models are necessary to analyze the complex mechanisms of fracture healing to improve clinical fracture treatment. During the last decade, an ...

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

最小侵襲性トランスフォラミン間融合のためのコーンビーム術内コンピュータ断層撮影ベースの画像ガイダンス

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or excision. Many of these nodules are identified and excised via minimally invasive thoracic surgery; however, subcentimeter and subsolid nodules are frequently difficult to identify intra-operatively. This can be mitigated by the use of electromagnetic transthoracic needle localization. This protocol delineates the step-by-step process of electromagnetic localization from the pre-operative period to the postoperative period and is an adaptation of the electromagnetically guided percutaneous biopsy previously described by Arias et al. Pre-operative steps include obtaining a same day CT followed by the generation of a three-dimensional virtual map of the lung. From this map, the target lesion(s) and an entry site are chosen. In the operating room, the virtual reconstruction of the lung is then calibrated with the patient and the electromagnetic navigation platform. The patient is then sedated, intubated, and placed in the lateral decubitus position. Using a sterile technique and visualization from multiple views, the needle is inserted into the chest wall at the prechosen skin entry site and driven down to the target lesion. Dye is then injected into the lesion and, then, continuously during needle withdrawal, creating a tract for visualization intra-operatively. This method has many potential benefits when compared to the CT-guided localization, including a decreased radiation exposure and decreased time between the dye injection and the surgery. Dye diffusion from the pathway occurs over time, thereby limiting intra-operative nodule identification. By decreasing the time to surgery, there is a decrease in wait time for the patient, and less time for dye diffusion to occur, resulting in an improvement in nodule localization. When compared to electromagnetic bronchoscopy, airway architecture is no longer a limitation as the target nodule is accessed via a transparenchymal approach. Details of this procedure are described in a step-by-step fashion.

Presented here is a protocol for lung nodule localization using dye marking via electromagnetically navigated transthoracic needle access. The technique described here can be accomplished in the peri-operative period to optimize nodule localization and to successful resection when performing minimally invasive thoracic surgery.

低侵襲胸部手術のための電磁航法経胸結節局在

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

A Pre-clinical Rat Model for the Study of Ischemia-reperfusion Injury in Reconstructive Microsurgery

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many areas of biomedical research due to its cost-effectiveness and its translation to humans. This protocol describes a method to create a preclinical free skin flap model in rats with ischemia-reperfusion injury. The described 3 cm x 6 cm rat free skin flap model is easily obtained after the placement of several vascular ligatures and the section of the vascular pedicle. Then, 8 h after the ischemic insult and completion of the microsurgical anastomosis, the free skin flap develops the tissue damage. These ischemia-reperfusion injury-related damages can be studied in this model, making it a suitable model for evaluating therapeutic agents to address this pathophysiological process. Furthermore, two main monitoring techniques are described in the protocol for the assessment of this animal model: transit-time ultrasound technology and laser speckle contrast analysis.

Here, we describe a pre-clinical animal model for studying the pathophysiology of ischemia-reperfusion injury in reconstructive microsurgery. This free skin flap model based on the superficial caudal epigastric vessels in the rat may also allow for the evaluation of different therapies and compounds to counteract ischemia-reperfusion injury-related damage.

再建微小外科における虚血再灌流損傷の研究のための前臨床ラットモデル

Ischemia-reperfusion injury is the main cause of flap failure in reconstructive microsurgery. The rat is the preferred preclinical animal model in many ...

Evaluation of Capnography Sampling Line Compatibility and Accuracy when Used with a Portable Capnography Monitor

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment of end-tidal CO2 (ETCO2), its accuracy is commonly validated using commercial kits composed of a capnography monitor and its matching disposable nasal cannula sampling lines. The purpose of this study was to assess the compatibility and accuracy of cross-paired capnography sampling lines with a single portable bedside capnography monitor. A series of 4 bench tests were performed to evaluate the tensile strength, rise time, ETCO2 accuracy as a function of respiratory rate, and ETCO2 accuracy in the presence of supplemental O2. Each bench test was performed using specialized, validated equipment to allow for a full evaluation of sampling line performance. The 4 bench tests successfully differentiated between sampling lines from different commercial sources and suggested that due to increased rise time and decreased ETCO2 accuracy, not all nasal cannula sampling lines provide reliable clinical data when cross-paired with a commercial capnography monitor. Care should be taken to ensure that any cross-pairing of capnography monitors and disposable sampling lines is fully validated for use across respiratory rates and supplemental O2 flow rates commonly encountered in clinical settings.

The goal of this study was to evaluate the accuracy of capnography sampling lines used in conjunction with a portable bedside capnography monitor. Sampling lines from 7 manufacturers were evaluated for tensile strength, rise time, and ETCO2 accuracy as a function of respiratory rate or supplemental oxygen flow rate.

ポータブル・キャプノグラフィー・モニターで使用した場合の、キャポグラフィー・サンプリング・ラインの適合性と精度の評価

Capnography is commonly used to monitor patient&#8217;s ventilatory status. While sidestream capnography has been shown to provide a reliable assessment ...

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. ...

Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for minimally invasive anterior lumbar interbody fusion (Mini-ALIF). This article is a technical description of anterior lumbar spine surgery under a microscope. We retrospectively collected information on patients who underwent microscope-assisted Mini-ALIF surgery at our hospital between July 2020 and August 2022. A repeated-measures ANOVA was used to compare imaging indicators between periods. Forty-two patients were included in the study. The mean volume of intraoperative bleeding was 180 mL, and the mean operative time was 143 min. The mean follow-up time was 18 months. Apart from one case of peritoneal rupture, no other serious complications occurred. The postoperative foramen and disc height were both higher on average than before surgery. The spreader-assisted micro-Mini-ALIF is simple and easy to use. It can provide good intraoperative disc exposure, good discrimination of important structures, adequate spreading of the intervertebral space, and the restoration of the necessary intervertebral height, which is very helpful for less experienced surgeons.

The technique described in this article is well-suited to the Mini-ALIF procedure, allows for excellent exposure and decompression, and facilitates microscope-assisted manipulation.

顕微鏡支援低侵襲前腰椎椎体間固定術の臨床応用

This study aims to investigate the technical aspects of microscope-assisted anterior decompression fusion and to introduce a spreader system suitable for ...