Este trabalho foi financiado pelo R21CA134819 (CH), T32CA009035 (SD) e P30CA006927 (Cancer Center Núcleo Grant). Os autores gostariam de agradecer a Elizabeth Culnan por sua assistência com o recrutamento participante, Lia Boyle, Eva Panigrahi e Kate Menezes para a sua assistência no desenvolvimento de procedimentos e Jeanne Pomenti com sua ajuda com a preparação do manuscrito. Agradecemos também aos revisores do jornal para as suas sugestões.

1. Preparando-se para exposição UV <ol><li> Explique ao participante como funciona o MED testes (&quot;Eu vou expor um pouco de pele em seu braço à luz UV ao longo de cerca de 20 min, e amanhã, vamos verificar que a seção de sua pele, a fim de determinar como você é sensível à luz. Você pode experimentar uma queimadura nas pequenas áreas que expor aos raios UV. Se a queimadura é doloroso ou incomoda, você pode tratá-lo como faria com qualquer outra queimadura. &quot;) </li><li> Staff e participante deve usar óculos de proteção UV. </li><li> O participante deve estar vestindo uma camisa de manga curta ou enrolar a manga para cima. </li><li> Tenha o participante colocar uma luva para proteger a pele em sua mão. </li><li> Retire o Daavlin remendo 1 backing nos lados esquerdo e direito do patch e coloque-o no braço inferior interior apenas ao lado da luva, evitando manchas de pele existentes. </li><li> Cobrir toda a pele adicional sobre o wi braçoª camisa do participante ou de outro material. </li><li> Coloque o braço de modo a que os orifícios do patch irá ser exposto à fonte de luz UV. Nenhuma outra pele deve ser exposta à luz UV. </li><li> Diga ao participante que ela vai se sentir calor, mas o braço não vai estar queimando durante o teste. </li></ol> 2. Realização de exposição UV <ol><li> Buracos patch (por exemplo, 6) devem ser expostas à radiação UV, a intervalos ao longo do período de exposição. </li><li> Comece com um buraco aberto. </li><li> Selecione a duração total da exposição com base nas especificações do fabricante para a fonte de luz e Fitzpatrick tipo de pele do participante I-VI (muito justo muito escuro; Fitzpatrick, 1988). 2 pele mais clara é mais provável para queimar. </li><li> Definir um temporizador para a duração total de exposição (por exemplo, 20 min). Um segundo temporizador de reserva também pode ser utilizado. Iniciar o temporizador (es). </li><li> Por exemplo, abra o buraco 2, após 2 min, buraco aberto após 3 4min, buraco aberto 4 após 8 min, buraco aberto 5 após 12 min e 6 buraco aberto após 16 min. Assim, os tempos de exposição à radiação UV da pele será de 20 min para o furo 1, 18 para o orifício 2 min, 16 min para o furo 3, 12 min para o orifício 4, 8 min para o orifício 5, e 4 minutos para o orifício 6. </li><li> De modo a identificar mais facilmente as áreas expostas, após 24-48 horas, marcar a pele exposta na extremidade distante do primeiro e do último furo do remendo e pedir ao participante para não lavar as marcas após a pele é examinada. </li><li> Já o participante retirar a luva e patch. </li><li> Reiterar ao participante que a pele deve ser reexaminada em 24-48 horas. </li></ol> 3. Avaliando o MED <ol><li> Após 24-48 horas, examine as áreas expostas da pele. Pele vermelha ou rosa indica eritema ou queimadura. Erythemetous pele expostos a uma menor duração do UV é definida como a dose eritematosa mínima ou MED. </li><li> Exposições futuras a UV deve ser por períodos mais curtos do que tele MED para evitar a queima. </li><li> Se as áreas de exposição são difíceis de identificar, você pode querer colocar o patch novamente usando as marcas para se alinhar com a pele exposta. Isso também é útil se estiver usando um dispositivo de medição de cor da pele, tais como espectrofotômetro. </li><li> Espectrofotômetros fornecer medidas de L * (escuridão) e b * (matiz). um * refere-se a vermelhidão da pele. A um valor mais alto * indica pele avermelhada. </li><li> Se usar um dispositivo de medição da cor da pele, tais como um espectrofotómetro, coloque a abertura espectrofotómetro no centro do furo a ser medido. </li><li> Medir cada uma das 6 áreas de exposição na ordem numérica e uma área não exposta perto dos outros, para comparação. Tente medir o centro de cada buraco, mas não uma sarda ou moles ou outras descolorações não-UV. Rotular cada uma das medições. A medição da área não exposta deve ser rotulado 0 min e ser listados junto à zona 6 (a área de exposição mais curto - 4 min.) </li><li> Aumentos nos valores de a * deve corresponder ao aumento de duração de exposição à radiação UV. Tente novamente valores de medição que não estão em ordem correspondente. </li><li> Uma diferença de 2,5 pontos no * um de pele não exposta em comparação com a pele exposta indica uma diferença significativa em vermelhidão, sugerindo possível de combustão. </li><li> Adicionar 2,5 para o menor valor a *. Tudo igual ou superior a este valor seria considerado potencialmente ardente. O menor tempo de exposição acima deste valor é considerado o MED. </li></ol>

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

Não temos nada a divulgar.

A radiação ultravioleta (UV), a terapia é por vezes usado como um tratamento para várias condições de pele comuns, incluindo a psoríase, acne e eczema. A dosagem de luz ultravioleta é prescrito de acordo com a sensibilidade da pele de um indivíduo, o qual é determinado como uma função de Fitzpatrick tipo de pele do indivíduo de I a VI (muito justo ao muito escuro). Dois pele humana varia na sua sensibilidade à radiação UV devido à variação graus de pigmentação da pele, espessura e outros ...

minimal erythema dose (med) testing

A radiação ultravioleta (UV), a terapia é por vezes usado como um tratamento para várias condições de pele comuns, incluindo a psoríase, acne e eczema. A dosagem de luz ultravioleta é prescrito de acordo com a sensibilidade da pele de um indivíduo. Assim, para determinar a dosagem apropriada de luz UV para administrar a um paciente, o paciente é conferido, por vezes, para determinar a dose eritematosa mínima (DEM), o que representa a quantidade de radiação UV que vai produzir eritema mínima (vermelhidão ou queimaduras causadas por ingurgitamento de capilares) da pele de um indivíduo dentro de algumas horas após a exposição. Este artigo descreve como realizar testes de dosagem eritematosa mínima (DEM). Não há atualmente nenhuma maneira fácil de determinar uma dose UV apropriado para fins clínicos ou de investigação, sem a realização de testes formais MED, exigindo horas de observação após o teste, ou julgamento informal e testes de erro com os riscos de sub-ou sobre-dosagem. No entanto, alguns métodos alternativos são discutidos.

<img alt="Figura 1" fo:content-width="4in" fo:src="/files/ftp_upload/50175/50175fig1highres.jpg" src="/files/ftp_upload/50175/50175fig1.jpg" /> Figura 1 As quatro etapas de realização de testes MED:. Preparando para exposição aos raios UV, a realização de exposição aos raios UV, a avaliação do MED, e determinar o MED. <img alt="Figura 2" src="/files/ftp_upload/50175/501...

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

Minimal Erythema Dose MED Testing

Este artigo descreve como realizar o teste da dose eritematosa mínima (DEM), a fim de determinar a dose mínima de radiação ultravioleta, que vai provocar eritema (queimadura), quando administrados a um indivíduo.

Eritema Dose (MED), testes mínimos

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

Research

JoVE Journal

Medicine

Minimal Erythema Dose (MED) Testing

41.2K visualizações.  Fox Chase Cancer Center. Este artigo descreve como realizar o teste da dose eritematosa mínima (DEM), a fim de determinar a dose mínima de radiação ultravioleta, que vai provocar eritema (queimadura), quando administrados a um indivíduo.

Vídeo: Minimal Erythema Dose MED Testing

Quantitative Autonomic Testing

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

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

Teste Autônomo quantitativa

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

Medicina

X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging

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

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

X-ray através da redução da dose de exposição Adaptive em Imaging fluoroscópicas

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

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

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

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

Preparação e inativação de patógenos de dose dupla de Buffy produtos de plaquetas revestimento utilizando o Sistema de Sangue INTERCEPT

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

A Novel Application of Musculoskeletal Ultrasound Imaging

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

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

A Aplicação da novela da Musculoskeletal Ecografia

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

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

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

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

Voluntário Técnica de apneia para a Redução Coração Dose em Radioterapia mama esquerda

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

Minimal Invasive Surgical Procedure of Inducing Myocardial Infarction in Mice

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

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

Minimal procedimento cirúrgico invasivo de induzir Infarto do Miocárdio em Ratos

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

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

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

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

Técnica e critérios de seleção dos pacientes do Anterior direita mini toracotomia para substituição da valva aórtica de acesso mínimo

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

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

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

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

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

Implementação de precisão do teste de dose mínima de eritema (MED) para avaliar a variação individual na resposta inflamatória humana

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

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

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

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

Método invasivo semi-mínimo para induzir infarto do miocárdio em ratos e a avaliação da função cardíaca por um sistema cardíaco de trabalho isolado

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

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

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

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

Excisão total mesorectal assistida por robô e dissecção de linfonodo pélvico lateral para câncer retal médio-baixo localmente avançado

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