없음 자금 소스.

1. 인도에서 태반의 준비 <ol><li> 하나 (장자) 또는 두 (두 번째로 태어난 경우) 클램프와 쌍둥이의 탯줄 코드를 라벨. </li><li> 완성도 또는 장애에 대한 태반의 모자 태아 표면을 검사합니다. </li><li> 다음과 같은 데이터를 기록 : 코드 삽입의 종류 (중앙, 편심 한계 또는 velamentous), 탯줄 (일반적으로 하나의 정맥 두 동맥, 때로는 단 하나 동맥)과 두 placental 주 사이의 색상 차이 혈관의 수입니다. 분열하는 세포막의 부분 chorionicity의 유형을 확인하는 병리로 보낼 수 있습니다. </li><li> 태반은 다음 플라스틱 그릇에 위치하고 최종 시험 (최고 주일 이내) 및 컬러 염료 주입까지 냉장 수 있습니다. </li><li> 태반은 냉동 또는 (포르말린 사용하지 마십시오) 수정해서는 안됩니다. </li></ol> 2. 제대 혈관의 Catheterization <ol><li> 따뜻한 물 또는 식염수에 태반을 씻으십시오. </li><li> 주변 세포막을 트림 amnions 해제 간 쌍둥이 분리 막 및 껍질 (혈관 anastomoses과 placental 사진의 더 나은 품질의 더 나은 시각화)을 제거합니다. </li><li> 코드 삽입에서 약 5cm 거리에서 각각의 탯줄을 가로로 쪼개다. </li><li> 부드럽게 제대 혈관과 placental 혈관에서 혈전을 짠다. </li><li> 배꼽 정맥 두 제대 동맥의 작은 직경에 비해 그 큰 직경으로 인해 식별하는 데 일반적으로 쉽습니다. </li><li> 적절한 크기의 카테터와 제대 정맥을 Cannulate. 거짓 구절을 피하십시오. </li><li> 작은 카테터 하나의 제대 동맥을 Cannulate. 제대 동맥의 루멘을 넓혀 핀셋을 사용합니다. 거짓 구절을 피하십시오. 2 제대 동맥 중 한 명만 문합이 (Hyrtl의) 코드 삽입 근처에 2 개의 동맥을 연결 이후 catheterized해야합니다. </li><li> 다른 탯줄에 대한 단계를 모두 반복합니다. </li><li> 카테 테르의 위치는 부드럽게 앞뒤로 제대 혈관의 마사지에 의해 촉진하실 수 있습니다. 카테 테르의 모든 유형은이 절차를 사용할 수 있습니다. 우리는 (및 재활용) neonates의 배꼽 catheterization위한 neonatology 병동에서 사용되는 카테터를 사용하여 선택합니다. </li><li> 염료를 주입하는 동안 색깔 염료의 흐름을 다시 피하기 위해 두 코드 주위에 테이프 조각을 묶어. </li></ol> 3. 색깔 염료로 주입 <ol><li> 각 카테 테르에 색깔 염료로 가득 20 ML의 주사기를 연결합니다. </li><li> 모든 점성 색의 염료 angio 아키텍처 placental을 시각화하는 데 사용할 수 있습니다. anastomoses (동맥에 대한 어두운 색상의 혈관에 대한 밝은 색상) 좋은 시각화를 허용하도록 대조 색상을 사용합니다. </li><li> 조교는 부드럽게 또한 placental 혈관, 작은 것들을 채울 색 염료를 허용하는 염료를 못살게 굴지 동안 부드럽게 (낮은 압력) 정맥의 색 염료를 주입. </li><li> 혈관 적도 (혈관 적도 어느 쌍둥이의 anastomoses 서로 연결하는 장소입니다) 근처에있는 작은 혈관에 특히주의를 기울이십시오. </li><li> 동맥에 색 염료를 주입하기 위해 이전 단계를 반복합니다. 주의 : 동맥 더 인내를 주입하고 요구하는 것이 더 어려울 수 있습니다. </li><li> 다른 탯줄에 대한 단계를 모두 반복합니다. </li></ol> 4. 색의 염료를 주입 후 평가 및 태반의 문서 <ol><li> 조심스럽게 혈관 적도를 검토하고 anastomoses의 수와 유형을 기록합니다. </li><li> 디지털 사진의 직경과 placental 공유를 측정하기 위해 태반에 측정 테이프를 넣으십시오. </li><li> 고해상도 디지털 카메라를 사용하여 주입 태반의 사진을 찍어. 사진이 태반 수직 이동되었는지 확인합니다. </li></ol> 5. 대표 결과 : monochorionic 쌍둥이의 angio 아키텍처 placental는 monochorionic 쌍둥이 임신의 종류에 따라 다릅니다. 사출 연구 AA, AV 및 VV anastomoses는 각각 80 % 95 % 단순한 monochorionic 트윈 임신 1 (그림 1)의 20 %에 나타날 수있는 증명하고있다. AA의 anastomoses는 TTTS와 도청 6 개발을 막기 위해 간주됩니다. 주사 연구 AA의 anastomoses는 TTTS placentas의 20 %와 도청 placentas 1,2,7 (그림 2)의 10 %에서 발생하는 것으로 나타났습니다. fetoscopic 레이저 수술로 치료 TTTS의 placentas에서 혈관 anastomoses의 레이저 응고로 인한 상처는 placental 표면 (그림 3 및 4)에 볼 수 있습니다. 도청의 placentas은 몇 소문자 유명 anastomoses 2 (그림 5)의 존재를 특징으로하고 있습니다. 기증자의 p​​lacental 공유 (그림 6) 창백 반면 도청받는 사람의 placental 점유율은 종종 과다의입니다. 출생 체중 불일치와 monochorionic 쌍둥이 임신에서 태아 성장 제한종종 velamentous 코드 삽입과 훨씬 작은 placental 주 (그림 7)이 있습니다. AA의 anastomoses는 출생 체중 불일치 8 쌍둥이에서 monochorionic placentas에서 종종 존재한다. Monochorionic - monoamniotic placentas 모두 코드 삽입합니다 (그림 8) 사이의 짧은 거리와 특성 angio 아키텍처 있습니다. monoamniotic - monochorionic placentas에서 AA anastomoses의 발병률은 거의 100 %와 monoamniotic 쌍둥이 9 TTTS의 발전을 방지한다. 이 문서에 나와있는 수치는 색상 염색으로 우리 센터에 주입 monochorionic placentas의 특성 결과를 보여줍니다. 우리는 일상적으로 동맥과 정맥에 대한 밝은 색상 (노란색, 분홍색 또는 오렌지색)에 대한 어두운 색상 (청색 또는 녹색)을 사용합니다. <img alt="그림 1" src="/files/ftp_upload/3208/3208fig1.jpg" /> 그림 1. 핑크색 정맥 (흰색 별), 푸른 동맥에서 노란색으로, 노란색에서 정맥 (녹색 별) 1 큰 AA 문합 (식별하는 방법에는 여러 VA anastomoses 녹색 동맥에서 여러 유명 anastomoses을 보여주는 일반적인 단순한 monochorionic 쌍둥이 임신에서 Monochorionic 태반 ) 블루 스타, 파란색과 녹색 염료의 혼합. <img alt="그림 2" src="/files/ftp_upload/3208/3208fig2.jpg" /> 그림 2.에만 AV (흰색 별)와 VA의 존재를 보여주는 일련 amnioreduction 취급 TTTS 임신의 태반은 Monochorionic (그린 별) AA의 문합없이 anastomoses. <img alt="그림 3" src="/files/ftp_upload/3208/3208fig3.jpg" /> 그림 3. TTTS 태반 작은 잔류 문합가 실수로 (화이트 스타) 특허를 왼쪽어진 선택적 레이저 기술을 사용하여 혈관 anastomoses의 fetoscopic 레이저 응고 후. 선택적 레이저 기술로, 혈관 anastomoses 먼저 파악하고 이후 하나씩 coagulated 있습니다. <img alt="그림 4" src="/files/ftp_upload/3208/3208fig4.jpg" /> 그림 4. TTTS 태반, 각 문합의 식별 및 응고 후, 전체 혈관 적도가 다른 한 placental 여백에서 coagulated되는 솔로몬 기법을 사용하여 fetoscopic 레이저 응고 후. <img alt="그림 5" src="/files/ftp_upload/3208/3208fig5.jpg" /> 그림 5. 몇, 소문자 VA의 anastomoses (흰색 별) 혈관 적도를 따라 볼 수있는 도청 태반. <img alt="그림 6" src="/files/ftp_upload/3208/3208fig6.jpg" /> 그림 6. 도청 태반 (그림 5 참조)의 모성 측면 모두 placental 주 사이의 특성 색상 차이를 보여줍니다. <img alt="그림 7" src="/files/ftp_upload/3208/3208fig7.jpg" /> 그림 7. 쌍둥이 중 하나의 선택적 자궁 내 성장 제한과 쌍둥이 임신의 태반 Monochorionic. 성장 제한 태아는 velamentous 코드 삽입과 훨씬 작은 placental 공유하고 있습니다. 화이트 스타는 AA 교합 (anastomosis)을 나타냅니다. <img alt="그림 8" src="/files/ftp_upload/3208/3208fig8.jpg" /> 그림 8 Monoamniotic 태반 :. 다양한 AV (그린 스타), VA (블루 스타)와 2 개의 AA anastomoses (흰색 별), 두 코드 삽입 사이의 짧은 거리를합니다.

<ol>
	<li>Lopriore, E., Middeldorp, J. M., Sueters, M., Vandenbussche, F. P., Walther, F. J. <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:+from+placental+anastomoses+to+long-term+neurodevelopmental+outcome.">Twin-to-twin transfusion syndrome: from placental anastomoses to long-term neurodevelopmental outcome.</a> Curr. Pediatr. Rev. 1, 191-203 (2005).</li><li>Slaghekke, F., Kist, W. J., Oepkes, 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+anemia-polycythemia+sequence:+diagnostic+criteria,+classification,+perinatal+management+and+outcome.">Twin anemia-polycythemia sequence: diagnostic criteria, classification, perinatal management and outcome.</a> Fetal Diagn. Ther. 27, 181-190 (2010).</li><li>Lopriore, E., Middeldorp, J. M., Oepkes, D., Klumper, F. J., Walther, F. J., Vandenbussche, F. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+anastomoses+after+fetoscopic+laser+surgery+in+twin-to-twin+transfusion+syndrome:+frequency,+associated+risks+and+outcome.">Residual anastomoses after fetoscopic laser surgery in twin-to-twin transfusion syndrome: frequency, associated risks and outcome.</a> Placenta. 28, 204-208 (2007).</li><li>Lopriore, E., Slaghekke, F., Middeldorp, J. M., Klumper, F. J., Oepkes, D., Vandenbussche, F. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Residual+anastomoses+in+twin-to-twin+transfusion+syndrome+treated+with+selective+fetoscopic+laser+surgery:+localization,+size,+and+consequences.">Residual anastomoses in twin-to-twin transfusion syndrome treated with selective fetoscopic laser surgery: localization, size, and consequences.</a> Am. J. Obstet. Gynecol. , (2009).</li><li>Lewi, L., Jani, J., Cannie, M. <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>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> Am. J. Obstet. Gynecol. 182, 417-426 (2000).</li><li>van Meir, H., Slaghekke, F., Lopriore, E., van Wijngaarden, W. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arterio-arterial+anastomoses+do+not+prevent+the+development+of+twin+anemia-polycythemia+sequence.">Arterio-arterial anastomoses do not prevent the development of twin anemia-polycythemia sequence.</a> Placenta. 31, 163-165 (2010).</li><li>De Paepe, M. E., Shapiro, S., Young, L., Luks, F. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+characteristics+of+selective+birth+weight+discordance+in+diamniotic-monochorionic+twin+gestations.">Placental characteristics of selective birth weight discordance in diamniotic-monochorionic twin gestations.</a> Placenta. 31, 380-386 (2010).</li><li>Umur, A., van Gemert, M. J., Nikkels, P. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monoamniotic-versus+diamniotic-monochorionic+twin+placentas:+anastomoses+and+twin-twin+transfusion+syndrome.">Monoamniotic-versus diamniotic-monochorionic twin placentas: anastomoses and twin-twin transfusion syndrome.</a> Am. J. Obstet. Gynecol. 189, 1325-1329 (2003).</li><li>Senat, M. V., Deprest, J., Boulvain, M., Paupe, A., Winer, N., Ville, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+laser+surgery+versus+serial+amnioreduction+for+severe+twin-to-twin+transfusion+syndrome.">Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome.</a> N. Engl. J. Med. 351, 136-144 (2004).</li><li>Lopriore, E., Sueters, M., Middeldorp, J. M., Vandenbussche, F. P., Walther, F. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Haemoglobin+differences+at+birth+in+monochorionic+twins+without+chronic+twin-to-twin+transfusion+syndrome.">Haemoglobin differences at birth in monochorionic twins without chronic twin-to-twin transfusion syndrome.</a> Prenat. Diagn. 25, 844-850 (2005).</li><li>Papathanasiou, D., Witlox, R., Oepkes, D., Walther, F. J., Bloemenkamp, K. W., Lopriore, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Monochorionic+twins+with+ruptured+vasa+previa:+double+trouble!.">Monochorionic twins with ruptured vasa previa: double trouble!.</a> Fetal Diagn. Ther. 28, 48-50 (2010).</li><li>Weingertner, A. S., Kohler, A., Kohler, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+and+placental+characteristics+in+four+new+cases+of+twin+anemia-polycythemia+sequence.">Clinical and placental characteristics in four new cases of twin anemia-polycythemia sequence.</a> Ultrasound Obstet. Gynecol. 35, 490-494 (2010).</li><li>Lewi, L., Cannie, M., Blickstein, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+sharing,+birthweight+discordance,+and+vascular+anastomoses+in+monochorionic+diamniotic+twin+placentas.">Placental sharing, birthweight discordance, and vascular anastomoses in monochorionic diamniotic twin placentas.</a> Am. J. Obstet. Gynecol. 197, 587-588 (2007).</li><li>Lewi, L., Gucciardo, L., Huber, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcome+and+placental+characteristics+of+monochorionic+diamniotic+twin+pairs+with+early-+and+late-onset+discordant+growth.">Clinical outcome and placental characteristics of monochorionic diamniotic twin pairs with early- and late-onset discordant growth.</a> Am. J. Obstet. Gynecol. , (2008).</li><li>De Paepe, M. E., Friedman, R. M., Poch, M., Hansen, K., Carr, S. R., Luks, F. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Placental+findings+after+laser+ablation+of+communicating+vessels+in+twin-to-twin+transfusion+syndrome.">Placental findings after laser ablation of communicating vessels in twin-to-twin transfusion syndrome.</a> Pediatr. Dev. Pathol. 7, 159-165 (2004).</li><li>De Paepe, M. E., DeKoninck, P., Friedman, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vascular+distribution+patterns+in+monochorionic+twin+placentas.">Vascular distribution patterns in monochorionic twin placentas.</a> Placenta. 26, 471-475 (2005).</li><li>Nikkels, P. G., Hack, K. E., vanGemert, M. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pathology+of+twin+placentas+with+special+attention+to+monochorionic+twin+placentas.">Pathology of twin placentas with special attention to monochorionic twin placentas.</a> J. Clin. Pathol. 61, 1247-1253 (2008).</li><li>Quintero, R. A., Martinez, J. M., Lopez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Individual+placental+territories+after+selective+laser+photocoagulation+of+communicating+vessels+in+twin-twin+transfusion+syndrome.">Individual placental territories after selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome.</a> Am. J. Obstet. Gynecol. 192, 1112-1118 (2005).</li><li>Quintero, R. A., Comas, C., Bornick, P. W., Allen, M. H., Kruger, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selective+versus+non-selective+laser+photocoagulation+of+placental+vessels+in+twin-to-twin+transfusion+syndrome.">Selective versus non-selective laser photocoagulation of placental vessels in twin-to-twin transfusion syndrome.</a> Ultrasound Obstet. Gynecol. 16, 230-236 (2000).</li></ol>

관심 없음 충돌 선언하지 않습니다.

TTTS와 도청 monochorionic 쌍둥이에서 발생할 수있는 두 가지 심각한 질환입니다. 두 장애는 불균형 intertwin의 혈액 흐름을 유발 AV anastomoses 예정이다. 지난 2 수십에서 fetoscopic 레이저 수술이 가능하게되었다 및 TTTS 10 치료를위한 최선의 방법으로 표시되었다. fetoscopic 레이저 치료의 목표는 placental 표면에 혈관 anastomoses의 응고를 통해 간 쌍둥이 순환을 방해하는 것입니다. 그러나, TTTS에 대한 ?...

<table border="1"><tbody><tr><th> 시약의 이름 </th><th> 회사 </th><th> 카탈로그 번호 </th><th> 댓글 </th></tr><tr><td> 제대 카테터 (각종 치수, 길이 40cm) </td><td> Vygon </td><td> 1270.08 (8 F) 1270.08 (5 F) 1270.04 (4 F) 1270.03 (3.5 F) 1270.02 (2.5 F) </td><td> 카테 테르의 모든 유형은 사용할 수 </td></tr><tr><td> 20 ML 주사기 </td><td> BD Plastipak </td><td> 300613 </td><td></td></tr><tr><td> 컬러 염색 (다양한 색상) </td><td> 로열 Talens Schoolverf </td><td> 36716010 (파란색) 36715010 (녹색) 36712350 (노란색) 36713570 (분홍색) </td><td> 모든 점성 컬러 염료를 사용할 수 있습니다 </td></tr></tbody></table>

accurate and simple evaluation of vascular anastomoses in monochorionic placenta using colored dye

placental 혈관 anastomoses의 존재는 conditio 사인 ...로서가 아닌 트윈 - 투 - 쌍둥이 수혈 증후군 (TTTS)와 쌍둥이 빈혈 polycythemia 순서 (도청) 1,2의 개발입니다. 트윈 placentas의 사출 연구는 anastomoses가 dichorionic 쌍둥이 1에 거의 죄다 monochorionic 쌍둥이에있는 매우 드문 것으로 나타났습니다. anastomoses 세 가지 종류가 문서화되었습니다 동맥에서 동맥, 정맥에서 정맥과 동맥에서 정맥 있습니다. Arterio - 정맥 (AV) anastomoses는 단방 향성하고 arterio - 동맥 (AA)와 veno - 정맥 (VV) anastomoses는 양방향이며 불리는 반면 그들이 공유 placental 떡잎을 통해 진행부터 &quot;깊이&quot;anastomoses라고합니다 그들이 chorionic 접시에 누워 이후로 &quot;천박한&quot;. 모두 TTTS와 도청은 AV anastomoses로 인해 쌍둥이 사이의 혈액 흐름 NET 불균형에 의해 발생합니다. 쌍둥이 중 하나 (기증자)의 피를 공유 placental 떡잎에 동맥을 통해 펌핑 후 다른 트윈 (받는 사람)의 순환에 정맥을 통해 새겨 졌던 것입니다. 혈액 oppositely 감독 깊은 AV anastomoses이나 표면 anastomoses을 통해받는 사람의 기증자로 펌핑되지 않는 혈액 볼륨의 불균형은 점차 TTTS 또는 도청의 발전에 선도, 발생합니다. AA 교합 (anastomosis)의 존재는 단일 방향 AV anastomoses 1,2로 인한 순환 불균형에 대한 보상으로 TTTS 및 도청 장치의 개발로부터 보호하기 위해 표시되었습니다. monochorionic placentas의 주입은 출생 직후 monochorionic 쌍둥이의 다양한 (hematological) 합병증의 병인을 이해하는 유용한 의미이며 도청 2 진단에 도달하는 데 필요한 시험입니다. 또한, fetoscopic 레이저 수술로 치료 TTTS의 placentas의 주입이 가능 잔여 anastomoses 3-5의 신분을 수 있습니다. 이 추가 정보는 TTTS이나 도청과 monochorionic 쌍둥이의 관리와 치료에 관련된 모든 perinatologists에 대한 파라마운트 중요하다. 여러 placental 사출 기술은 현재 사용되고 있습니다. 우리는 정확하게 색깔 염료의 주입을 사용하여 (잔여) 혈관의 anastomoses의 존재를 평가하는 간단한 프로토콜을 제공합니다.

Watch this Scientific Journal Video about Accurate and Simple Evaluation of Vascular Anastomoses in Monochorionic Placenta using Colored Dye at JoVE.com

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

트윈 - 투 - 쌍둥이 수혈 증후군과 트윈 빈혈 polycythemia 시퀀스는 perinatal 의학의 두 잠재적으로 치명적인 문제가 있습니다. 두 질환은 monochorionic 쌍둥이와 placental 혈관 anastomoses을 통해 불균형 혈액의 흐름에서 결과 발생합니다. 우리는 정확하게 출산 후 placental 혈관의 색깔 염료의 주입을 사용하여 혈관 anastomoses의 존재를 평가하는 간단한 프로토콜을 제공합니다.

유색 염료를 사용하여 Monochorionic 태반의 혈관 Anastomoses의 정확하고 간단한 평가

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 ...

accurate-simple-evaluation-vascular-anastomoses-monochorionic

Research

JoVE Journal

Medicine

26.6K 조회수.  Leiden University Medical Center. 트윈 - 투 - 쌍둥이 수혈 증후군과 트윈 빈혈 polycythemia 시퀀스는 perinatal 의학의 두 잠재적으로 치명적인 문제가 있습니다. 두 질환은 monochorionic 쌍둥이와 placental 혈관 anastomoses을 통해 불균형 혈액의 흐름에서 결과 발생합니다. 우리는 정확하게 출산 후 placental 혈관의 색깔 염료의 주입을 사용하여 혈관 anastomoses의 존재를 평가하는 간단한 프로토콜을 제공합니...

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

Accurate and Simple Measurement of the Pro-inflammatory Cytokine IL-1&beta; using a Whole Blood Stimulation Assay

Inflammatory processes resulting from the secretion of soluble mediators by immune cells, lead to various manifestations in skin, joints and other tissues as well as altered cytokine homeostasis. The innate immune system plays a crucial role in recognizing pathogens and other endogenous danger stimuli. One of the major cytokines released by innate immune cells is Interleukin (IL)-1. Therefore, we utilize a whole blood stimulation assay in order to measure the secretion of inflammatory cytokines and specifically of the pro-inflammatory cytokine IL-1&beta; 1, 2, 3.
Patients with genetic dysfunctions of the innate immune system causing autoinflammatory syndromes show an exaggerated release of mature IL-1&beta; upon stimulation with LPS alone. In order to evaluate the innate immune component of patients who present with inflammatory-associated pathologies, we use a specific immunoassay to detect cellular immune responses to pathogen-associated molecular patterns (PAMPs), such as the gram-negative bacterial endotoxin, lipopolysaccharide (LPS). These PAMPs are recognized by pathogen recognition receptors (PRRs), which are found on the cells of the innate immune system 4, 5, 6, 7. A primary signal, LPS, in conjunction with a secondary signal, ATP, is necessary for the activation of the inflammasome, a multiprotein complex that processes pro-IL-1&beta; to its mature, bioactive form 4, 5, 6, 8, 9, 10.
The whole blood assay requires minimal sample manipulation to assess cytokine production when compared to other methods that require labor intensive isolation and culturing of specific cell populations. This method differs from other whole blood stimulation assays; rather than diluting samples with a ratio of RPMI media, we perform a white blood cell count directly from diluted whole blood and therefore, stimulate a known number of white blood cells in culture 2. The results of this particular whole blood assay demonstrate a novel technique useful in elucidating patient cohorts presenting with autoinflammatory pathophysiologies.

Accurate and Simple Measurement of the Pro-inflammatory Cytokine IL-1&amp;#946; using a Whole Blood Stimulation Assay

We describe a simple immunoassay to measure the production of pro-inflammatory cytokines, such as IL-1 beta production, in patients presenting with autoinflammatory phenotypes. By activating cells in whole blood cultures with pathogen-associated molecular patterns, specifically with lipopolysaccharide, cytokine secretion can be conveniently evaluated in whole blood supernatants.

전체 혈액 자극 분석을 사용하여 프로 염증성 시토킨 IL - 1β의 정확하고 간단한 측정

Inflammatory processes resulting from the secretion of soluble mediators by immune cells, lead to various manifestations in skin, joints and other tissues ...

연구

의학

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

Monochorionic (MC) twin pregnancies are associated with significantly higher morbidity and mortality rates than dichorionic twins. Approximately 50% of MC twin pregnancies develop complications arising from the shared placenta and associated vascular connections1. Severe twin-to-twin syndrome (TTTS) is reported to account for approximately 20% of these complications2,3. Inter-twin vascular connections occur in almost all MC placentas and are related to the prognosis and outcome of these high-risk twin pregnancies. The number, size and type of connections have been implicated in the development of TTTS and other MC twin conditions. Three types of inter-twin vascular connections occur: 1) artery to vein connections (AVs) in which a branch artery carrying deoxygenated blood from one twin courses along the fetal surface of the placenta and dives into a placental cotyledon. Blood flows via a deep intraparenchymal capillary network into a draining vein that emerges at the fetal surface of the placenta and brings oxygenated blood toward the other twin. There is unidirectional flow from the twin supplying the afferent artery toward the twin receiving the efferent vein; 2) artery to artery connections (AAs) in which a branch artery from each twin meets directly on the superficial placental surface resulting in a vessel with pulsatile bidirectional flow, and 3) vein to vein connections (VVs) in which a branch vein from each twin meets directly on the superficial placental surface allowing low pressure bidirectional flow. In utero obstetric sonography with targeted Doppler interrogation has been used to identify the presence of AV and AA connections4. Prenatally detected AAs that have been confirmed by postnatal placental injection studies have been shown to be associated with an improved prognosis for both twins5. Furthermore, fetoscopic laser ablation of inter-twin vascular connections on the fetal surface of the shared placenta is now the preferred treatment for early, severe TTTS. 
Postnatal placental injection studies provide a valuable method to confirm the accuracy of prenatal Doppler ultrasound findings and the efficacy of fetal laser therapy6. Using colored dyes separately hand-injected into the arterial and venous circulations of each twin, the technique highlights and delineates AVs, AAs, and VVs. This definitive demonstration of MC placental vascular anatomy may then be correlated with Doppler ultrasound findings and neonatal outcome to enhance our understanding of the pathophysiology of MC twinning and its sequelae. Here we demonstrate our placental injection technique.

Vascular mapping of monochorionic (MC) twin placentas after birth provides a means for detailed demonstration of vascular connections between the twins&#x2019; circulations. 
Imbalance of these connections is thought to play a pivotal role in the development of complications of MC twinning including twin-to-twin transfusion syndrome.

Monochorionic 트윈 Placentas의 혈관 매핑을위한 가이드 와이어 원호 Catheterization과 컬러 염료 사출

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

A Simple Method of Mouse Lung Intubation

A simple procedure to intubate mice for pulmonary function measurements would have several advantages in longitudinal studies with limited numbers or expensive animal. One of the reasons that this is not done more routinely is that it is relatively difficult, despite there being several published studies that describe ways to achieve it. In this paper we demonstrate a procedure that eliminates one of the major hurdles associated with this intubation, that of visualizing the trachea during the entire time of intubation. The approach uses a 0.5 mm fiberoptic light source that serves as an introducer to direct the intubation cannula into the mouse trachea. We show that it is possible to use this procedure to measure lung mechanics in individual mice over a time course of at least several weeks. The technique can be set up with relatively little expense and expertise, and it can be routinely accomplished with relatively little training. This should make it possible for any laboratory to routinely carry out this intubation, thereby allowing longitudinal studies in individual mice, thereby minimizing the number of mice needed and increasing the statistical power by using each mouse as its own control.

This paper describes a striaghforward and efficient method of intubating mice for pulmonary function measurements or pulmonary instillation, that allows the mice to recover and be studied at later times. The procedure involves an inexpensive fiberoptic light source that directly illuminates the trachea.

마우스 폐 삽관 법의 간단한 방법

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

마우스 Aortocaval 누관의 기술적 측면

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

Fast and Accurate Exhaled Breath Ammonia Measurement

This exhaled breath ammonia method uses a fast and highly sensitive spectroscopic method known as quartz enhanced photoacoustic spectroscopy (QEPAS) that uses a quantum cascade based laser. The monitor is coupled to a sampler that measures mouth pressure and carbon dioxide. The system is temperature controlled and specifically designed to address the reactivity of this compound. The sampler provides immediate feedback to the subject and the technician on the quality of the breath effort. Together with the quick response time of the monitor, this system is capable of accurately measuring exhaled breath ammonia representative of deep lung systemic levels. 
Because the system is easy to use and produces real time results, it has enabled experiments to identify factors that influence measurements. For example, mouth rinse and oral pH reproducibly and significantly affect results and therefore must be controlled. Temperature and mode of breathing are other examples. As our understanding of these factors evolves, error is reduced, and clinical studies become more meaningful. This system is very reliable and individual measurements are inexpensive. 
The sampler is relatively inexpensive and quite portable, but the monitor is neither. This limits options for some clinical studies and provides rational for future innovations.

Ammonia is an important physiologic metabolite relevant to various disease and wellness states. It is also a difficult molecule to measure in breath, which demands particular precautions be taken to obtain accurate results. Not all factors influencing ammonia are known, but progress can be difficult without accounting for these factors.

빠르고 정확한 날숨 암모니아 측정

This exhaled breath ammonia method uses a fast and highly sensitive spectroscopic method known as quartz enhanced photoacoustic spectroscopy (QEPAS) that ...

Evaluation of Tumor-infiltrating Leukocyte Subsets in a Subcutaneous Tumor Model

Specialized immune cells that infiltrate the tumor microenvironment regulate the growth and survival of neoplasia.&#160; Malignant cells must elude or subvert anti-tumor immune responses in order to survive and flourish. Tumors take advantage of a number of different mechanisms of immune &#8220;escape,&#8221; including the recruitment of tolerogenic DC, immunosuppressive regulatory T cells (Tregs), and myeloid-derived suppressor cells (MDSC) that inhibit cytotoxic anti-tumor responses. Conversely, anti-tumor effector immune cells can slow the growth and expansion of malignancies: immunostimulatory dendritic cells, natural killer cells which harbor innate anti-tumor immunity, and cytotoxic T cells all can participate in tumor suppression. The balance between pro- and anti-tumor leukocytes ultimately determines the behavior and fate of transformed cells; a multitude of human clinical studies have borne this out. Thus, detailed analysis of leukocyte subsets within the tumor microenvironment has become increasingly important. Here, we describe a method for analyzing infiltrating leukocyte subsets present in the tumor microenvironment in a mouse tumor model. Mouse B16 melanoma tumor cells were inoculated subcutaneously in C57BL/6 mice. At a specified time, tumors and surrounding skin were resected en bloc and processed into single cell suspensions, which were then stained for multi-color flow cytometry. Using a variety of leukocyte subset markers, we were able to compare the relative percentages of infiltrating leukocyte subsets between control and chemerin-expressing tumors. Investigators may use such a tool to study the immune presence in the tumor microenvironment and when combined with traditional caliper size measurements of tumor growth, will potentially allow them to elucidate the impact of changes in immune composition on tumor growth. Such a technique can be applied to any tumor model in which the tumor and its microenvironment can be resected and processed.

This protocol describes a method for the detailed evaluation of leukocyte subsets within the tumor microenvironment in a mouse tumor model. Chemerin-expressing B16 melanoma cells were implanted subcutaneously into syngeneic mice. Cells from the tumor microenvironment were then stained and analyzed by flow cytometry, allowing for detailed leukocyte subset analyses.

피하 종양 모델에서 종양 침투 백혈구 하위 집합의 평가

Specialized immune cells that infiltrate the tumor microenvironment regulate the growth and survival of neoplasia.&#160; Malignant cells must elude or ...

Using the Sleeve Technique in a Mouse Model of Aortic Transplantation - An Instructional Video

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the aorta in mice using the sleeve method was short and easy averaging 20 min, permitting studies of iso/allo grafts. The following article describes the aortic transplantation procedure used in our laboratory. The mice were anesthetized with a mixture of 1.5% volume isoflurane and 100% oxygen through a face mask. At this point, the segment of the aorta between the renal arteries and its bifurcation was separated from the vena cava, freely prepared and clampedat the proximal and distal segments with a single silk suture. Prior to the removal of the aorta, a saline solution containing heparin was injected into the inferior vena cava. Then the aorta was cut between the clamps and a saline heparin solution was used to flush the lumen. The sleeve technique with monofilament sutures was used in order to transplant the abdominal aorta in the orthotopic position.

We present an orthotopic aortic transplantation model using the sleeve technique in mice. It is a very rapid anastomosis method, which can be employed in studies of vascular disease.

대동맥 이식-교육용 비디오의 마우스 모델에서 소매 기법을 사용 하 여

Orthotopic aortic transplantation using the sleeve technique reduces injury to the aorta with failure rate of only 10-20%. The time to anastomose the ...

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.

Monochorionic Diamniotic 트윈 태 현실 시뮬레이터를 사용 하 여의 Fetoscopic 레이저 Photocoagulation에서 모델 외과 교육: 기술 습득

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

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery

Trans-mitral blood flow produces a three-dimensional rotational body of fluid, known as a vortex ring, that enhances the efficiency of left ventricular (LV) filling compared with a continuous linear jet. Vortex ring development is most often quantified with vortex formation time (VFT), a dimensionless parameter based on fluid ejection from a rigid tube. Our group is interested in factors that affect LV filling efficiency during cardiac surgery. In this report, we describe how to use standard two-dimensional (2D) and Doppler transesophageal echocardiography (TEE) to noninvasively derive the variables needed to calculate VFT. We calculate atrial filling fraction (&#946;) from velocity-time integrals of trans-mitral early LV filling and atrial systole blood flow velocity waveforms measured in the mid-esophageal four-chamber TEE view. Stroke volume (SV) is calculated as the product of the diameter of the LV outflow track measured in the mid-esophageal long axis TEE view and the velocity-time integral of blood flow through the outflow track determined in the deep transgastric view using pulse-wave Doppler. Finally, mitral valve diameter (D) is determined as the average of major and minor axis lengths measured in orthogonal mid-esophageal bicommissural and long axis imaging planes, respectively. VFT is then calculated as 4 &#215; (1-&#946;) &#215; SV/(&#960;D3). We have used this technique to analyze VFT in several groups of patients with differing cardiac abnormalities. We discuss our application of this technique and its potential limitations and also review our results to date. Noninvasive measurement of VFT using TEE is straightforward in anesthetized patients undergoing cardiac surgery. The technique may allow cardiac anesthesiologists and surgeons to assess the impact of pathological conditions and surgical interventions on LV filling efficiency in real time.

We describe a protocol to measure vortex formation time, an index of left ventricular filling efficiency, using standard transesophageal echocardiography techniques in patients undergoing cardiac surgery. We apply this technique to analyze vortex formation time in several groups of patients with differing cardiac pathologies.

심장 수술 중 심장 Transesophageal 초음파를 사용 하 여와 동 형성 시간의 비 침범 성 결정

Trans-mitral blood flow produces a three-dimensional rotational body of fluid, known as a vortex ring, that enhances the efficiency of left ventricular ...

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale (PFO) detection, for patient selection for transcatheter ASD/PFO closure,&#160;for intraoperative guidance and for long-term follow-up. The size, shape, location and the number of the atrial communications schould be determined. The accuracy of PFO detection can be improved by using agitated saline together with maneuvers to transiently increase the right atrial (RA) pressure. The appearance of microbubbles in the left atrium (LA) within 3 cardiac cycles after opacification of the RA is considered positive for the presence of an intracardiac shunt. Three dimensional TEE identifies further septal fenestrations and describes the dynamic morphology of ASD/PFO and atrial septal aneurysm. Follow-up evaluations with TTE is recommended at 1, 6, and 12 months after the procedure, with a subsequent evaluation every year. Previous studies showed an increased incidence of atrial arrhythmias early after device closure. Speckle tracking analysis may help to understand functional left atrial remodeling following percutaneous closure and its impact on atrial arrhythmias.

Transthoracic (TTE) and transesophageal (TEE) echocardiography represent the basic imaging tools for interatrial septum examination. Three dimensional (3D) TEE provides incremental information in the assessment of the interatrial septum. Further advanced echocardiography techniques using speckle tracking echocardiography are applied for sensitive volumetric and functional assessment of the heart chambers.&#160;

트랜스카테터 폐쇄 전 심방 통신의 심초음파 평가

Transthoracic (TTE) and transesophageal echocardiography (TEE) is the standard imaging method for atrial septal defect (ASD) and patent foramen ovale ...