The authors acknowledge the Carefusion Foundation for support via a clinical excellence grant of this work titled &#8220;Prospective evaluation of procedural povidone iodine rectal preparation to reduce infectious complications following ultrasound guided prostate needle biopsy.&#8221;

Este estudo relacionado paciente foi aprovado pelo conselho de revisão institucional (IRB) para pesquisas com seres humanos. 1. Preparação do paciente e Posicionamento <ol><li> Trazer o paciente para a suíte procedimento e colocá-los em seu lado direito ou esquerdo com os joelhos flexionados ao peito. </li><li> Execute um tempo limite cirúrgico pelo qual o paciente, o procedimento cirúrgico, e indicação são revisados ​​e confirmados. </li><li> Quando indicado, administrar sedação endovenosa através do serviço de anestesia. </li></ol> 2. Execute um exame retal digital (DRE) <ol><li> Lugar tamanho luvas apropriadas em ambas as mãos. </li><li> Insira dedo de luva depois da lubrificação em ampola retal e próstata examinar a sentir por áreas potenciais suspeitos que necessitam de atenção concentrada durante a ultra-sonografia transretal. 10 </li></ol> 3. Criação de iodopovidona retal Preparação (PIRP) <ol><li> Deitar 15 ml de uma solução 10%disponível comercialmente solução de povidona-iodo numa bacia estéril. </li><li> Adicionar 5 ml de um 1% disponível comercialmente gel de lidocaína a esta bacia. </li><li> Misturar os conteúdos durante 15 segundos para criar uma suspensão de iodo povidona. </li></ol> 4. Administração Fundamental de PIRP <ol><li> Utilize um swab retal estéril para a cultura da ampola retal. </li><li> Abra-se a 4 cm x 4 cm de gaze estéril, mergulhar na lama iodopovidona, e depois inserir na ampola retal. Apenas uma pequena cauda de gaze é deixada emanando a partir do ânus. </li><li> Deixar a gaze no lugar durante 2 minutos após o que é removido e deitado fora. </li></ol> 5. Administração Secundária de PIRP <ol><li> Utilize um cotonete ginecológica descartável para pintar a área perianal com a solução PIRP. </li><li> Insira este swab ginecológica na ampola retal para uma distância de 3 cm do ânus. </li><li> Para maximizar ainda mais a exposição da mucosa retal para PIRP, limpe o vau rectallt de um modo semelhante, pelo menos, três vezes. </li><li> Permitir que a solução de povidona-iodo a secar durante 2 -. 3 min antes de prosseguir com ultra-sonografia padrão e biopsia posterior 11 Isto é essencial que os efeitos bactericidas da PIRP requerem que a solução seque sobre a mucosa exposta. </li><li> Utilize um swab retal estéril para a cultura da ampola retal. </li></ol> 6. transretal ultra-sonografia e biópsia <ol><li> Inserir a sonda de ultra-som através do reto. </li><li> Realizar medições da próstata e biópsia posterior da forma padrão consistente com todas as práticas urológicas 11,12. </li></ol>

<ol>
	<li>Nam, R. K., 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=Increasing+hospital+admission+rates+for+complications+after+transrectal+ultrasound+guided+prostate+biopsy.">Increasing hospital admission rates for complications after transrectal ultrasound guided prostate biopsy.</a> J Urol. 189, S12-S17 (2013).</li><li>Feliciano, J., 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=The+incidence+of+fluoroquinolone+resistant+infections+after+prostate+biopsy+are+fluoroquinolones+still+effective+prophylaxis.">The incidence of fluoroquinolone resistant infections after prostate biopsy are fluoroquinolones still effective prophylaxis.</a> J Urol. 179 (3), 952-955 (2008).</li><li>Kehinde, O., Al-Maghrebi, M., Sheikh, M., Anim, J. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+ciprofloxacin+and+amikacin+prophylaxis+in+the+prevention+of+septicemia+after+transrectal+ultrasound+guided+biopsy+of+the+prostate.">Combined ciprofloxacin and amikacin prophylaxis in the prevention of septicemia after transrectal ultrasound guided biopsy of the prostate.</a> J Urol. 189 (3), 911-915 (2013).</li><li>Taylor, A. K., 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=Targeted+antimicrobial+prophylaxis+using+rectal+swab+cultures+in+men+undergoing+transrectal+ultrasound+guided+prostate+biopsy+is+associated+with+reduced+incidence+of+postoperative+infectious+complications+and+cost+of+care.">Targeted antimicrobial prophylaxis using rectal swab cultures in men undergoing transrectal ultrasound guided prostate biopsy is associated with reduced incidence of postoperative infectious complications and cost of care.</a> J Urol. 187 (4), 1275-1279 (2012).</li><li>Gyorfi, J. R., 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=Peri+procedural+povidone+iodine+rectal+preparation+reduces+microorganism+counts+and+infectious+complications+following+ultrasound-guided+needle+biopsy+of+the+prostate.">Peri procedural povidone iodine rectal preparation reduces microorganism counts and infectious complications following ultrasound-guided needle biopsy of the prostate.</a> World J Urol. 32 (4), 905-909 (2014).</li><li>Park, D. 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=Control+of+infective+complications+of+transrectal+prostate+biopsy.">Control of infective complications of transrectal prostate biopsy.</a> Surg Infect Larchmt. 15 (4), 431-436 (2014).</li><li>Park, D. S., Oh, J. J., Lee, J. H., Jang, W. K., Hong, Y. K., Hong, S. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple+use+of+the+suppository+type+povidone+iodine+can+prevent+infectious+complications+in+transrectal+ultrasound+guided+prostate+biopsy.">Simple use of the suppository type povidone iodine can prevent infectious complications in transrectal ultrasound guided prostate biopsy.</a> Adv Urol. , (2009).</li><li>AbuGhosh, Z., 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=A+prospective+randomized+trial+of+povidone+iodine+prophylactic+cleansing+of+the+rectum+before+transrectal+ultrasound+guided+prostate+biopsy.">A prospective randomized trial of povidone iodine prophylactic cleansing of the rectum before transrectal ultrasound guided prostate biopsy.</a> J Urol. 189 (4), 1326-1331 (2013).</li><li>Gerber, G. S., Brendler, C. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluation+of+the+Urological+Patient:+History,+Physical+Exam,+and+Urinalysis.">Evaluation of the Urological Patient: History, Physical Exam, and Urinalysis.</a> Campbell Walsh Urology. , (2015).</li><li>Hodge, K. K., McNeal, J. E., Terris, M. K., Stamey, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Random+systematic+versus+directed+ultrasound+guided+transrectal+core+biopsies+of+the+prostate.">Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate.</a> J Urol. 142 (1), 71-74 (1989).</li><li>Donoghue, P. M., McSweeney, S. E., Jhaveri, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Genitourinary+imaging:+current+and+emerging+applications.">Genitourinary imaging: current and emerging applications.</a> J Postgrad Med. 56 (2), 131-139 (2010).</li></ol>

The authors have nothing to disclose.

Infecções seguintes TRUS PNB são secundárias a translocação de bactérias ampola retal na próstata altamente vascular. Com base neste princípio, temos explorado o método simples de usar um anti-séptico tópico como iodopovidona para reduzir a contagem de microrganismos colônia antes de biópsia por agulha de próstata. A nossa experiência evidencia uma redução de 4,3% a 0,6% (p = 0,02) com a utilização do presente regime PIRP no momento da biopsia. Além disso, a hipótese de que a redução de 97% em mi...

O câncer de próstata é o câncer mais comum em homens ea segunda causa de mortalidade relacionada ao câncer. Em 2014, aproximadamente 233 mil casos serão diagnosticados nos Estados Unidos, com quase 30.000 homens sucumbir a esta doença maligna. 1 Enquanto o antígeno específico da próstata (PSA) exame de sangue e exame de toque retal (DRE) desempenham um papel essencial no rastreio do cancro da próstata, transretal ultra-som de próstata guiada agulha de biópsia (USTR PNB) é o meio mais comum para obter um diagnóstico histológico de tecido. TRUS PNB envolve a inserção de uma sonda de ultra-sons no recto do paciente e, em seguida, geralmente aceite 12-14 biópsias da zona periférica da próstata localizado anteriormente. Cada biópsia de agulha requer passagem de um 18 G agulha através da parede rectal na próstata altamente vascular. Portanto, o risco teórico de sangramento e infecção devido a translocação bacteriana existe o seguinte procedimento. Nenhumobstante, o pós-procedimento taxa de complicação atuarial tem historicamente se manteve baixa. A profilaxia antibiótica antes da TRUS PNB é rotineiramente prescrita com antibióticos à base de quinolona sendo os agentes mais utilizados. Apesar profilaxia adequada, a pesquisa contemporânea implica um aumento de complicações infecciosas pós-biópsia. 2 Além disso, estudos têm atribuído esse aumento de complicações infecciosas seguinte TRUS PNB para o surgimento de microorganismos resistentes quinolonas particularmente E. coli. 3 Este aumento da taxa de resistência às quinolonas sugere a necessidade de esquemas de profilaxia alternativos para procedimentos TRUS PNB. Para este fim, vários caminhos diferentes estão sob investigação. Uma abordagem envolve a administração de um antibiótico intravenosa ou intramuscular no momento da biópsia em conjunto com uma quinolona oral. 4 Embora esta estratégia pode reduzir eventos sepse seguintes TRUS PNB,uma limitação principal desta abordagem é o potencial para o desenvolvimento de organismos resistentes ainda mais a esta família de antibióticos. Outra metodologia recentemente investigada incorpora o uso de uma zaragatoa rectal pré-biópsia para o rastreio de pacientes colonizados com resistentes à quinolona flora rectais. 5 Se forem detectados tais organismos, um regime de antibióticos &quot;alvo&quot; pode ser empregue com base no perfil de sensibilidade das bactérias resistentes identificado estirpe. Embora a metodologia é elegante, o próprio processo de obtenção de tais cotonetes, seletivamente cultura em um meio seletivo quinolonas, antibióticos e adaptando posteriormente requer uma infra-estrutura laboratorial e clínica que pode estar faltando em muitas práticas clínicas. A administração de um anti-séptico tópico para reduzir a ampola retal microorganismo colônia contagens antes da biópsia pode apresentar uma estratégia alternativa para limitar infecções TRUS PNB. Povidone iodone é um barato agente, que é prontamente disponíveldocumentados para contagens de bactérias reduzidas quando aplicada a locais cirúrgicos. Aplicações em ambas as cirurgias colorretais e ginecológicas são bem conhecidos. Portanto, o uso de iodo povidine como uma preparação rectal iria apresentar um método producible, simples e de baixo custo para reduzir infecções TRUS PNB, sem necessidade de preparação adicional antes da biópsia. No que diz respeito à literatura urológica, anteriormente trabalho observou uma redução em infecções clínicas seguintes TRUS PNB. 6-9 Este vídeo demonstra a técnica de PIRP para realçar a simplicidade e facilidade de integrar em práticas clínicas. Todos os pacientes submetidos à TRUS PNB foram inicialmente visto em uma clínica de urologia especialidade para encaminhamento ou avaliação inicial para o rastreamento do câncer de próstata. Essa avaliação envolveu uma avaliação do antígeno do paciente soro específico da próstata (PSA) e realização de um exame de toque retal (DRE). Anormalidade, quer do PSA ou DRE solicitado recomendação deum PNB TRUS. O procedimento TRUS PNB foi discutido com todos os pacientes e os riscos associados, incluindo infecção, sangramento e retenção urinária foram esclarecidas. Todos os pacientes receberam três dias de profilaxia com antibióticos orais ou com um medicamento à base de quinolona (ou seja, Ciprofloxacina) ou sulfametoxazol-trimetoprim (Bactrim) antes da biópsia.

<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>Povidone Iodine Solution, 10% Topical Microbicide Antiseptic, 8 fl oz.</td>
			<td>Equate</td>
			<td>4067979</td>
			<td></td>
		</tr>
		<tr>
			<td>4x4 sterile gauze pads, white</td>
			<td>Dukal Corporation</td>
			<td>DKL1412</td>
			<td></td>
		</tr>
		<tr>
			<td>disposable gynecologic swab&#160;</td>
			<td>numerous vendors</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>1% lidocaine gel&#160;</td>
			<td>numerous vendors</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

povidone iodine rectal preparation at time of prostate needle biopsy is a simple and reproducible means to reduce risk of procedural infection

Instituição única e estudos de base populacional destacar que as complicações infecciosas seguintes biópsia transretal ultra-som guiada agulha de próstata (USTR PNB) estão aumentando. Essas infecções são em grande parte atribuível a quinolonas microrganismos resistentes que colonizam a ampola retal e são translocados para a corrente sanguínea durante o procedimento de biópsia. A preparação iodopovidona rectal (PIRP) no momento da biópsia é um método simples e reprodutível para reduzir a contagem de colônias de microorganismos e infecções retais, portanto, resultantes seguintes TRUS PNB. Todos os pacientes são administrados três dias de terapia com antibiótico oral antes da biópsia. A técnica envolve inicialmente PIRP posicionar o paciente da maneira padrão para um TRUS PNB. Após o exame digital rectal, 15 ml de uma solução a 10% de iodo disponível comercialmente povidona é misturada com 5 ml de lidocaína a 1% geleia para criar pasta. A 4 cm x 4 cm gaze estéril é soaked nesta pasta e, em seguida, inserido no cofre rectal durante 2 min, após o que é removido. Depois disso, um descartável ginecológica cotonete de algodão é usada para pintar, tanto a região perianal e a abóbada rectal para uma distância de 3 cm do ânus. A solução de povidona-iodo é então deixado a secar durante 2 - 3 minutos antes de prosseguir com ultra-sonografia padrão e biópsia subsequente. Esta técnica PIRP tem sido na prática em nossa instituição desde março de 2012, com uma redução associada de infecções pós-biópsia de 4,3% para 0,6% (p = 0,02). A principal vantagem deste esquema profilaxia é a sua simplicidade e reprodutibilidade com o uso de uma forma facilmente disponível, barato agente para reduzir infecções. Além disso, a técnica evita expor os pacientes a antibióticos sistémicos adicionais com potencial de propagação adicional de organismos multi-resistentes a drogas. Uso de PIRP em TRUS PNB, no entanto, não é aplicável a pacientes com iodo ou um mariscollergies.

Esta técnica PIRP tem sido na prática desde janeiro de 2012 (até o presente) com 165 pacientes terem sido incluídos neste medida de melhoria da qualidade. Neste momento, apenas um paciente (0,6%) sofreu uma complicação infecciosa na forma de sepse sistêmica. Este paciente foi colonizado com E. multi-resistente estirpe de E. coli. Swab retal após a administração de PIRP neste paciente observou que a ampola retal ainda foi colonizada com bactérias 2.1 x 10 5 UFC / mL questionando, a...

Watch this Scientific Journal Video about Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection at JoVE.com

Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Iodopovidona retal Preparação no momento da próstata agulha de biópsia é um simples e reprodutível meios para reduzir o risco de infecção Processual

Single institution and population-based studies highlight that infectious complications following transrectal ultrasound guided prostate needle biopsy ...

povidone-iodine-rectal-preparation-at-time-prostate-needle-biopsy-is

Research

JoVE Journal

Medicine

31.9K visualizações.  Penn State Milton S. Hershey Medical Center. Here, we present a protocol for use at the time of transrectal ultrasound guided prostate needle biopsy (TRUS PNB) that is a simple and cost-effective means to reduce infections following the procedure.

Vídeo: Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

Evaluation of Nanoparticle Uptake in Tumors in Real Time Using Intravital Imaging

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle uptake in tumors at the microscopic level1,2,3, highlighting the utility of a suitable xenograft model in which to perform detailed uptake analyses. Here, we use high-resolution intravital imaging to evaluate nanoparticle uptake in human tumor xenografts in a modified, shell-less chicken embryo model. The chicken embryo model is particularly well-suited for these in vivo analyses because it supports the growth of human tumors, is relatively inexpensive and does not require anesthetization or surgery 4,5. Tumor cells form fully vascularized xenografts within 7 days when implanted into the chorioallantoic membrane (CAM) 6. The resulting tumors are visualized by non-invasive real-time, high-resolution imaging that can be maintained for up to 72 hours with little impact on either the host or tumor systems. Nanoparticles with a wide range of sizes and formulations administered distal to the tumor can be visualized and quantified as they flow through the bloodstream, extravasate from leaky tumor vasculature, and accumulate at the tumor site. We describe here the analysis of nanoparticles derived from Cowpea mosaic virus (CPMV) decorated with near-infrared fluorescent dyes and/or polyethylene glycol polymers (PEG) 7, 8, 9,10,11. Upon intravenous administration, these viral nanoparticles are rapidly internalized by endothelial cells, resulting in global labeling of the vasculature both outside and within the tumor7,12. PEGylation of the viral nanoparticles increases their plasma half-life, extends their time in the circulation, and ultimately enhances their accumulation in tumors via the enhanced permeability and retention (EPR) effect 7, 10,11. The rate and extent of accumulation of nanoparticles in a tumor is measured over time using image analysis software. This technique provides a method to both visualize and quantify nanoparticle dynamics in human tumors.

We present a novel approach to quantify nanoparticle localization in the vasculature of human xenografted tumors using dynamic, real-time intravital imaging in an avian embryo model.

Avaliação de Captação de nanopartículas em tumores em tempo real usando imagens intravital

Current technologies for tumor imaging, such as ultrasound, MRI, PET and CT, are unable to yield high-resolution images for the assessment of nanoparticle ...

Medicina

Combined In vivo Optical and &#181;CT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice

Multimodality imaging has emerged as a common technological approach used in both preclinical and clinical research. Advanced techniques that combine in vivo optical and &#956;CT imaging allow the visualization of biological phenomena in an anatomical context. These imaging modalities may be especially useful to study conditions that impact bone. In particular, orthopaedic implant infections are an important problem in clinical orthopaedic surgery. These infections are difficult to treat because bacterial biofilms form on the foreign surgically implanted materials, leading to persistent inflammation, osteomyelitis and eventual osteolysis of the bone surrounding the implant, which ultimately results in implant loosening and failure. Here, a mouse model of an infected orthopaedic prosthetic implant was used that involved the surgical placement of a Kirschner-wire implant into an intramedullary canal in the femur in such a way that the end of the implant extended into the knee joint. In this model, LysEGFP mice, a mouse strain that has EGFP-fluorescent neutrophils, were employed in conjunction with a bioluminescent Staphylococcus aureus strain, which naturally emits light. The bacteria were inoculated into the knee joints of the mice prior to closing the surgical site. In vivo bioluminescent and fluorescent imaging was used to quantify the bacterial burden and neutrophil inflammatory response, respectively. In addition, &#956;CT imaging was performed on the same mice so that the 3D location of the bioluminescent and fluorescent optical signals could be co-registered with the anatomical &#956;CT images. To quantify the changes in the bone over time, the outer bone volume of the distal femurs were measured at specific time points using a semi-automated contour based segmentation process. Taken together, the combination of in vivo bioluminescent/fluorescent imaging with &#956;CT imaging may be especially useful for the noninvasive monitoring of the infection, inflammatory response and anatomical changes in bone over time.

Combined In vivo Optical and  &#181;CT Imaging to Monitor Infection, Inflammation, and Bone Anatomy in an Orthopaedic Implant Infection in Mice

Combined optical and &#956;CT imaging in a mouse model of orthopaedic implant infection, utilizing a bioluminescent engineered strain of Staphylococcus aureus, provided the capability to noninvasively and longitudinally monitor the dynamics of the bacterial infection, as well as the corresponding inflammatory response and anatomical changes in the bone.

Combinado<em&gt; In vivo</em&gt; Optical e μCT imagem para monitorar infecções, inflamações, and Bone Anatomy em uma infecção Orthopaedic Implant em Ratos

Multimodality imaging has emerged as a common technological approach used in both preclinical and clinical research. Advanced techniques that combine in ...

Substernal Thyroid Biopsy Using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the lack of a standardized definition for STG. Biopsy is often required to differentiate benign from malignant lesions. Unlike cervical thyroid, the overlying sternum precludes ultrasound-guided percutaneous fine needle aspiration of STG. Consequently, surgical mediastinoscopy is performed in the majority of cases, causing significant procedure related morbidity and cost to healthcare. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) is a frequently used procedure for diagnosis and staging of non-small cell lung cancer (NSCLC). Minimally invasive needle biopsy for lesions adjacent to the airways can be performed under real-time ultrasound guidance using EBUS. Its safety and efficacy is well established with over 90% sensitivity and specificity. The ability to perform EBUS as an outpatient procedure with same-day discharges offers distinct morbidity and financial advantages over surgery. As physicians performing EBUS gained procedural expertise, they have attempted to diversify its role in the diagnosis of non-lymph node thoracic pathologies. We propose here a role for EBUS-TBNA in the diagnosis of substernal thyroid lesions, along with a step-by-step protocol for the procedure.

Substernal thyroid lesions are common, and need to be differentiated from malignancy. Obtaining percutaneous fine needle biopsy is not possible due to its retrosternal location. This article proposes a protocol for biopsy of substernal thyroid lesions using Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA).

Substernal Tireóide Biópsia Usando endobrônquica guiada por ultrassom transbrônquica Punção Aspirativa por Agulha

Substernal thyroid goiter (STG) represents about 5.8% of all mediastinal lesions1. There is a wide variation in the published incidence rates due to the ...

Preparation and Respirometric Assessment of Mitochondria Isolated from Skeletal Muscle Tissue Obtained by Percutaneous Needle Biopsy

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining samples of human Vastus lateralis, isolating mitochondria from minimal amounts of skeletal muscle tissue, and plate based respirometric profiling using an extracellular flux (XF) analyzer. Comparison of respirometric profiles obtained using 1.0, 2.5 and 5.0 &#956;g of mitochondria indicate that 1.0 &#956;g is sufficient to measure respiration and that 5.0 &#956;g provides most consistent results based on comparison of standard errors. Western blot analysis of isolated mitochondria for mitochondrial marker COX IV and non-mitochondrial tissue marker GAPDH indicate that there is limited non-mitochondrial contamination using this protocol. The ability to study mitochondrial respirometry in as little as 20 mg of muscle tissue allows users to utilize individual biopsies for multiple study endpoints in clinical research projects.

Methods for biopsy of Vastus lateralis, preparation of purified mitochondria, and respirometric profiling are described. The use of small muscle volume makes this technique suitable for clinical research applications.

Preparação e Avaliação respirométrico de mitocôndrias isoladas de tecido muscular esquelético Obtido por meio de agulha de biópsia percutânea

Respirometric profiling of isolated mitochondria is commonly used to investigate electron transport chain function. We describe a method for obtaining ...

A Simple Critical-sized Femoral Defect Model in Mice

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all limb bone fractures fail to heal completely due to the extent of the trauma, disease, or age of the patient. Our ability to improve bone regenerative strategies is critically dependent on the ability to mimic serious bone trauma in test animals, but the generation and stabilization of large bone lesions is technically challenging. In most cases, serious long bone trauma is mimicked experimentally by establishing a defect that will not naturally heal. This is achieved by complete removal of a bone segment that is larger than 1.5 times the diameter of the bone cross-section. The bone is then stabilized with a metal implant to maintain proper orientation of the fracture edges and allow for mobility. 
Due to their small size and the fragility of their long bones, establishment of such lesions in mice are beyond the capabilities of most research groups. As such, long bone defect models are confined to rats and larger animals. Nevertheless, mice afford significant research advantages in that they can be genetically modified and bred as immune-compromised strains that do not reject human cells and tissue.
Herein, we demonstrate a technique that facilitates the generation of a segmental defect in mouse femora using standard laboratory and veterinary equipment. With practice, fabrication of the fixation device and surgical implantation is feasible for the majority of trained veterinarians and animal research personnel. Using example data, we also provide methodologies for the quantitative analysis of bone healing for the model.

Animal models are frequently employed to mimic serious bone injury in biomedical research. Due to their small size, establishment of stabilized bone lesions in mice are beyond the capabilities of most research groups. Herein, we describe a simple method for establishing and analyzing experimental femoral defects in mice.

Um Defeito modelo simples Critical porte Femoral em Ratos

While bone has a remarkable capacity for regeneration, serious bone trauma often results in damage that does not properly heal. In fact, one tenth of all ...

Establishment of Human Epithelial Enteroids and Colonoids from Whole Tissue and Biopsy

The epithelium of the gastrointestinal tract is constantly renewed as it turns over. This process is triggered by the proliferation of intestinal stem cells (ISCs) and progeny that progressively migrate and differentiate toward the tip of the villi. These processes, essential for gastrointestinal homeostasis, have been extensively studied using multiple approaches. Ex vivo technologies, especially primary cell cultures have proven to be promising for understanding intestinal epithelial functions. A long-term primary culture system for mouse intestinal crypts has been established to generate 3-dimensional epithelial organoids. These epithelial structures contain crypt- and villus-like domains reminiscent of normal gut epithelium. Commonly, termed &#8220;enteroids&#8221; when derived from small intestine and &#8220;colonoids&#8221; when derived from colon, they are different from organoids that also contain mesenchyme tissue. Additionally, these enteroids/colonoids continuously produce all cell types found normally within the intestinal epithelium. This in vitro organ-like culture system is rapidly becoming the new gold standard for investigation of intestinal stem cell biology and epithelial cell physiology. This technology has been recently transferred to the study of human gut. The establishment of human derived epithelial enteroids and colonoids from small intestine and colon has been possible through the utilization of specific culture media that allow their growth and maintenance over time. Here, we describe a method to establish a small intestinal and colon crypt-derived system from human whole tissue or biopsies. We emphasize the culture modalities that are essential for the successful growth and maintenance of human enteroids and colonoids.

We describe a method to establish human enteroids from small intestinal crypts and colonoids from colon crypts collected from both surgical tissue and biopsies. In this methodological article, we present the culture modalities that are essential for the successful growth and maintenance of human enteroids and colonoids.

Estabelecimento de epiteliais humanas Enteroids e Colonoids de tecido inteiro e biópsia

The epithelium of the gastrointestinal tract is constantly renewed as it turns over. This process is triggered by the proliferation of intestinal stem ...

A Simple Device to Rapidly Prepare Whole Mounts of the Mouse Intestine

Preparing whole mounts of the mouse small intestine and colon for subsequent analysis or quantification can be time consuming and difficult. We describe the use of a simple device to cut and &#8216;roll&#8217; mouse intestines to rapidly prepare whole mount preparations of superior and uniform quality to that which can be achieved by hand. The device comprises a base that holds 4 stainless steel rods and a top, which acts a cutting guide. The rods are inserted into the lumen of the small intestine [divided into thirds] and the colon. The rods and samples are then placed over a piece of filter paper or card into the holding slots in the base of the device. The top of the device is then positioned and serves as a cutting guide. The two angled sections in the center of the top piece are used to guide a knife or scalpel and cut the intestines longitudinally on the top of the rods. Once the intestinal sections have been cut, the top is removed and the card,&#160;tissue and rods gently removed from the device and placed on the bench. The rods are then gently rolled sideways to flatten and stick the intestinal segments onto the underlying piece of filter paper or card. The final preparation can then be examined or fixed and stored for later analysis. The preparations are invaluable for the study of intestinal changes in normal or genetically modified mouse models. The preparations have been used for the study and quantification of the effects of inflammation (colitis), damage, pre-cancerous lesions (aberrant crypt foci (ACFs) and mucin depleted foci (MDFs)) and polyps or tumors.

The use of a simple device to cut and &#8216;roll&#8217; mouse intestines to rapidly prepare whole mount preparations is described.

Um dispositivo simples de preparar rapidamente inteiras Mounts do mouse Intestino

Preparing whole mounts of the mouse small intestine and colon for subsequent analysis or quantification can be time consuming and difficult. We describe ...

A Simple Mechanical Procedure to Create Limbal Stem Cell Deficiency in Mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with conjunctiva. Patients suffer from recurrent corneal defects, pain, inflammation, and loss of vision.
Previously, a murine model of LSCD was described and compared to two other models. The goal was to produce a consistent mouse model of LSCD that both mimics the phenotype in humans and lasts long enough to make it possible to study the disease pathophysiology and to evaluate new treatments. Here, the technique is described in more detail.
A motorized tool with a rotating burr has been designed to remove the rust rings from the corneal surface or to smooth the pterygium bed in patients. It is a suitable device to create the desired LSCD model. It is a readily available, easy-to-use tool with a fine tip that makes it appropriate for working on small eyes, as in mice. Its application prevents unnecessary trauma to the eye and it does not result in unwanted injuries, as often is the case with chemical injury models. As opposed to a blunt scraper, it removes the epithelium with the basement membrane. In this protocol, the limbal area was abraded two times, and then the whole corneal epithelium was shaved from limbus to limbus. To avoid stroma injury, care was taken not to brush the corneal surface once the epithelium was already removed.

The following article provides an easy, reproducible technique to effectively create a sustainable mouse model of limbal stem cell deficiency (LSCD). This animal model is useful in testing and comparing the efficacy of treatments for limbal stem cell diseases.

Um procedimento mecânico simples de criar Limbal Deficiência Stem Cell no mouse

Limbal stem cell deficiency (LSCD) is a state of malfunction or loss of limbal epithelial stem cells, after which the corneal epithelium is replaced with ...

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.

Um estudo anatômico dos nervos em risco durante a cirurgia valgo do hálux minimamente invasiva

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

Use of MRI-ultrasound Fusion to Achieve Targeted Prostate Biopsy

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has traditionally been diagnosed via transrectal ultrasound (TRUS) biopsy. Though considered the gold standard, TRUS is unable to visualize most prostate cancer lesions and therefore requires sampling of the entire prostate. This biopsy method often undergrades prostate cancer and fails to detect up to 35% of cancers on initial biopsy. Prostate MRI has been shown to have excellent sensitivity in the detection of cancerous lesions, and advancements in MRI technology during the last decade have led to the development of targeted biopsy. In targeted biopsy, a software platform overlays MRI data onto live TRUS images to create a fused MRI/US three-dimensional model of the prostate. Regions suspicious for malignancy on MRI are contoured by a radiologist, uploaded into the fusion system, and then displayed within the live MRI/US fused model. The urologist is then able to directly biopsy these targets. When compared to conventional TRUS biopsy, MRI/US fusion technology has been demonstrated to improve the detection of clinically significant cancer while reducing insignificant cancer detection. This technology, therefore, has the potential to diagnose prostate cancer primarily in men who would benefit from treatment.

Presented herein is a protocol to perform targeted biopsy of the prostate using an MRI-ultrasound fusion system.

Uso da fusão de MRI-ultra-som para atingir o alvo biópsia de próstata

Here, we present a protocol to perform targeted prostate biopsy using a magnetic resonance imaging-ultrasound (MRI/US) fusion system. Prostate cancer has ...