Yazarlar Toskana Bölgesi&#39;nin (POR Creo FESR 2007-2013 Bando Unico R &amp; S 2012) tarafından finanse FORTE Projesi, kısmen araştırma faaliyetleri desteklenen AB 7.ÇP ECHORD ++ Deney YG-ROSES ve verilen FP7 BiophotonicPlus Projesi &quot;LITE&quot; teşekkür etmek istiyorum Toskana Bölgesi tarafından.

Çalışma hastanenin Etik Kurul onayı ile prospektif yapılmıştır; bilgilendirilmiş onam alındı. Çalışma Helsinki Bildirgesi&#39;nin ilkelerine bağlılık oldu. 1. Donör Endotel Hazırlık <ol><li> Oda sıcaklığında yerel göz banka tarafından hazırlanan bir donör korneanın kullanın. </li><li> Ameliyat odasında, kendi dağıtım konteynerinden donör kornea çekin ve kornea taşıma için kullanılan doku korunması ve beslenmesi için çözüm ayrı ayarlayabilirsiniz. </li><li> Bir sıvı akmaya ve değişken basınç oluşturabilir içine yapay ön kamara üzerinde donör corneo-skleral rim yerleştirin; Doku tutucu kafa ile kornea kapağı. </li><li> Kornea korunması ve beslenme sıvı ile dolu bir şırınga 3-yollu konnektörü aracılığıyla yapay ön kamara (AAC) bağlayın. </li><li> Yerine sıkıca tutucu tutmak için sıkıştırma halkasını kullanın. </li><li> SYR kullanınOptimum basıncı (1.7 bakınız) ulaşana kadar doku koruma solüsyonu ile ön odasını doldurun: inge intrakamaral basıncı korumak için AAC bağlı. Konektörü kapatın. </li><li> Bir parmak ile ön kamara içindeki basıncı test edin. (Aralık 60-70 mmHg olarak) sağ iç basıncı ulaşana kadar iç basıncını değiştirir. 3-yollu konnektörü kapatın. </li><li> Optik koherens Thomography (OKT) ile donör kornea kalınlığını ölçün. Enstrüman optik önünde sabit bir pozisyonda olduğunu kornea ile ön odasını koruyun ve ardından tam bir kalınlıkta-Ekim satın almak. </li></ol> Donör Endotelyumunun 2. Femtosecond Lazer Hazırlık <ol><li> Femtosaniye lazer aygıtının altında donör kornea aplanasyon gerçekleştirin. Arka tarafı kesme, tam lamellar ve ön yan kesim: Üç müteakip kesim ile donör doku kesmek için femtosec lazer kullanın. Üç kesimler için aşağıdaki parametreleri ayarlayın.<ol><li> Tam lameller kesim (raster desen, işe başlamak) için, daima 95 mikron çıkarılarak, (1.8 anlatıldığı gibi OKT ile ölçülen) donör kornea ince noktasına karşılık gelen kesik derinliğini ayarlayın. Aralık (çalışma derinliğine bağlı) 0.8-0.9 μJ darbe enerjisini ayarlayın. 8.7 mm çap ayarlayın. 2 um teğet nokta ayrımı ayarlayın. 2 um radyal nokta ayrımı ayarlayın. </li><li> Ön yan kesim, önceki tam lameller kesim 30 mikron derin arka derinliğini ayarlayın. 2.10 μJ nabız enerjisi ayarlayın; 8,6 mm çapı; tabaka ayrılması sırasında 3 um 3&#39;e um nokta ayırma. </li><li> Posterior yan kesim için, arka tarafı ön derinliği tam lameller kesim daha öne 30 mikron kesti bulun. 900 mikron posterior derinliğini ayarlayın. 2.10 μJ nabız enerjisi ayarlayın; 8.3 mm çap; 2 um nokta ayırma; 2 um tabaka ayrışması. </li></ol></li&gt; </ol> 3. Alıcı Göz Hazırlık <ol><li> Ameliyat için hastayı hazırlayın. Bıçak önceden ayarlandı 4,0 mm 12:00 azından bir 4.00 mm kornea kesi yapmak. 02:00 yerleştirilen bir 1,2 mm önceden ayarlandı bıçağı ile tek limbal parasentez, emin olun. 30 ° bıçak bıçak ile 06:00 başka biri limbal parasentez olun. </li><li> 02:00 parasentez ile, hastanın ön kamarada bir ön kamara sürdürücü yerleştirin. </li><li> Özel kancalı biri 8.2 mm çapında dairesel descemetorexis gerçekleştirin. </li><li> Posterior stromadan Descemet membranı ve endotel soyun ve bir Descemet kanca ile dokuları çıkarın. </li></ol> 4. Kromofor Hazırlık <ol><li> 1.5 ml mikrosantrifüj tüp içinde İndosiyanin Yeşil tozu 1 mg koyun. </li><li> Steril su, 9 mg ekleyin (ICG su çözeltisi ağırlık / ağırlık% 10). </li><li> Manuel metal karıştırıcı ile ICG tozu ve su karışımı. </li&gt; </ol> Donör Endotelyumunun 5. boyanması <ol><li> Enjektör yüzeyi ile temas halinde, iç tarafı bir Busin enjektör daha geniş kısmına donör endoteli koyun. </li><li> Bir spatula kullanarak, kendi periferik kısmında, kromofor çözeltisi ile donör endoteli iç tarafını Leke. Doğru lekeli doku homojen yeşilimsi bir renge sahiptir. Adım 5.3 başlamadan önce 3 dakika bekleyin. </li><li> Busin-enjektörün ön kısmına donör endotel çekin devirdi. </li></ol> 6. Donör endoteline takma <ol><li> Kavrayın ve endotel lenticule için atravmatik koaksiyel forseps kullanarak katlanmış donör endotelyumu yerleştirin. </li><li> Ön kamara sürdürücü çıkarın. </li><li> Korneal kesi ve Naylon 10.0 tek Stich ile parasentez (adım 3.1 gerçekleştirilen) dikin. </li><li> Donör doku açılmak ve alıcı kornea karşı basın bir hava kabarcığı enjekte edilir. hava kabarcığı zorunlu olmalıletely ön kamara boşluğu doldurmak. </li></ol> 7. Lazer Kaynak <ol><li> Bir kanca ile veya bir spatula ile korneanın dış hava kabarcığı hareket içinden, alıcı kornea merkezinde donör lenticule yerleştirin. </li><li> Sayısal açıklık (NA) olarak 0.22 ile 300 mikron çekirdek çapı steril fiber optik ile donatılmış 810 nm&#39;de yayan bir diyot lazer, kullanın. </li><li> Göz küresi dışında lif ucu tutun ve şeffaf kornea dokusunun aracılığıyla, lekeli endotele doğru lazer ışığı sağlar. fiber ucu temassız konfigürasyonundadır. </li><li> Tek nokta emisyon modu, 70-80 msn darbe süresi, darbe başına 35-40 mJ: lazer için aşağıdaki ayarları kullanın. He-Ne ışın hedefleyen. </li><li> Donör endotel lekeli çevresine tek lazer noktalar sunun. Sırayla noktalar sunun: nihai boy donör lenticule çevresinin noktalar bir halkasıdır. İki adja arasındaki mesafeyüzde noktalar merkezi nokta çapı iki katıdır. </li><li> % 0.3 tobramisin ve% 0.1 deksametazon oftalmik süspansiyon ile birlikte, hasta, göz ile ilgili bir kontakt lens uygulanır. </li></ol>

<ol>
	<li>Tan, D. T., Dart, J. K., Holland, E. J., Kinoshita, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Corneal+transplantation.">Corneal transplantation.</a> Lancet. 379 (9827), 1749-1761 (2012).</li><li>El Husseiny, M. A., Manero, F., Gris, O., Elies, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Historical+Review+and+Update+of+Surgical+Treatment+for+Corneal+Endothelial+Diseases.">Historical Review and Update of Surgical Treatment for Corneal Endothelial Diseases.</a> Ophthalmol Ther. , (2014).</li><li>Rossi, F., 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=Laser+tissue+welding+in+ophthalmic+surgery.">Laser tissue welding in ophthalmic surgery.</a> J Biophotonics. 1 (4), 331-342 (2008).</li><li>Pini, 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=Combining+femtosecond+laser+ablation+and+diode+laser+welding+in+lamellar+and+endothelial+corneal+transplants.">Combining femtosecond laser ablation and diode laser welding in lamellar and endothelial corneal transplants.</a> Proc. SPIE Ophthalmic Technologies XVIII. 6 (844), 684411-1-684411-7 (2008).</li><li>Rossi, F., 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=All-laser'+endothelial+corneal+transplant+in+human+patients.">All-laser' endothelial corneal transplant in human patients.</a> Proc. SPIE Ophthalmic Technologies XXII. 8209, 82091O-1-82091O-3 (2012).</li><li>Rossi, F., Pini, R., Menabuoni, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+and+model+analysis+on+the+temperature+dynamics+during+diode+laser+welding+of+the+cornea.">Experimental and model analysis on the temperature dynamics during diode laser welding of the cornea.</a> J Biomed Opt. 12 (1), 014031-1-014031-7 (2007).</li><li>Menabuoni, L., 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=Laser-assisted+corneal+welding+in+cataract+surgery:+retrospective+study.">Laser-assisted corneal welding in cataract surgery: retrospective study.</a> J Cataract Refract Surg. 33 (9), 1608-1612 (2007).</li><li>Buzzonetti, L., 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=Laser+Welding+in+Penetrating+Keratoplasty+and+Cataract+Surgery+in+Pediatric+Patients.+Early+Results.">Laser Welding in Penetrating Keratoplasty and Cataract Surgery in Pediatric Patients. Early Results.</a> J Cataract Refract Surg. 39 (12), 1829-1834 (2013).</li><li>Menabuoni, L., 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+'anvil'+profile+in+femtosecond+laser-assistedpenetrating+keratoplasty.">The 'anvil' profile in femtosecond laser-assistedpenetrating keratoplasty.</a> Acta Ophthalmol. 91 (6), e494-e495 (2013).</li><li>Canovetti, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laser-assisted+penetrating+keratoplasty:+one+year&#8217;s+results+in+patients,+using+a+laser-welded+&#8220;anvil&#8221;-profiled+graft.">Laser-assisted penetrating keratoplasty: one year&#8217;s results in patients, using a laser-welded &#8220;anvil&#8221;-profiled graft.</a> Am J Ophthalmol. 158 (4), 664-670 (2014).</li></ol>

The authors declare that they have no competing financial interests.

&quot;Tüm lazer&quot; endotel nakli orijinal bir yaklaşım minimal invaziv kornea nakli etmektir. Protokolü kapsamında açıklanan tüm prosedürler gibi steril eldiven, önlük, maske ve kapak kullanımı gibi ameliyatlar sırasında ortak uygulamaları, hijyenik ve sterilizasyon işlemi gözlemleyerek, cerrahi odasında yapıldı. ICG çözümü yakında donör endotelyumu boyama onun uygulama öncesi, ameliyat odasında hazırlanmıştır. ICG toz, su ve boyama çözeltisi hazırlamak...

Bu çalışmada, donör doku ve alıcı yatağın üzerine kaynak yapılması için bir kızıl ötesine yakın diyot lazer hazırlamak için femto saniye lazer kullanımına dayalı endotelyal keratoplastinin özgün bir yaklaşım sunmaktayız. Donör kornea intraoperatif ölçümü doğru donör doku boyutlarını tasarlamak için gereklidir. Endotel keratoplasti endotel hastalık 1,2 tedavisinde penetran keratoplasti yerine son yıllarda öne sürülmüştür. Bu tekniğin önemli avantajı, cerrahi, aşı reddi bir azalma riski ve göz bütünlüğünün korunması sırasında keratoplastinin indirgenmiş anestezi nüfuz ile ilgili olarak, daha hızlı bir görsel bir geri kazanılmasıdır. temel risk faktörü postoperatif donör lenticule çıkık olduğunu. standart teknik bir hava kabarcığı enjekte tarafından yapılmaktadır nihai pozisyonunda donör endoteli takarak gerçekleştirilir: hayır dikiş, çünkü mekanik biyofizik ve boyutsal chara ve kullanılanendotel cteristics. Ayrıca, görme keskinliği kurtarma nedeniyle nakledilen kalın dokuya temel nedeni donör ve alıcı dokular arasında bir uyumsuzluk nedeniyle sınırlı olabilir. Burada o ana sorunların üstesinden gelebilir endotel keratoplasti yerine getirirken bir prosedür mevcut. Donör endotel lazer kaynak tekniği ile, son pozisyonda sağlanabilir. Bu kontrollü ve lokal fototermal süreçtir: bu donör / alıcı ara yüzeyinde indüklenebilir. Bu son on yıl içinde okudu ve keratoplasti ve endotele 3-5 nakli öne sürülmüştür. kızıl ötesine yakın ışığı (dalga uzunluğu: 810 nm), bir düşük güç diyot lazer tarafından yayılan yara bölgesinde biyolojik doku doğru sevk edilir. Kornea bu dalga boyunda doğal saydamdır: lazer ışığı absorbe Bu doku yapmak için, bir kromofor ile lekelenmek gereklidir. Önerilen boya steril doyur olanIndosiyanin Green (ICG) d su çözeltisi. Biz kornea dokusu düzgün bu ICG hazırlığı ile boyanmış olduğunda, bu 810 nm 6&#39;da absorpsiyon pik gösterir gösterdi. Ayrıca, yaygın olarak ICG Klinik teşhis olarak kullanılır ve güvenlik hali hazırda insan deneklerde gösterilmiştir. lekeli kornea diyot lazer ışığı enerjisini emer ve ana sonuçlanan etkisi kaynak yerinde kontrollü bir sıcaklık artışı olduğunu. Resim termal etkiler boyanmamış dokularda indüklenir. Sıcaklık artışı soğutma üzerine sarılmış duvarlar acil closuring olan stromal kollajen tersine çevrilebilir bir termal denatürasyon indükler. Bu lazer kaynak etkisi öncelikle katarakt ameliyatı 7,8 ve keratoplasti 9,10 delici gösterilmiştir. Bu yazıda sunuyoruz optimize edilmiş bir yaklaşım endotelyal keratoplasti uygulama için çalışılmıştır. Önerilen cerrahisinde tek lazer noktalar (msn süren onlarca) are nokta boyutunda (çapı mikron birkaç yüz) içinde lokalize bir fototermal etkisi ile sonuçlanan doku teslim: kaynaklı etkinin donör / ana arayüzünde sınırlı kollajen fotokoagülasyon oluşan sert bir lazer kaynak olduğunu. kaynaklı yerinde kollajen denatürasyon sonucu, böylece standart tekniklere (dikiş) ile elde etmek imkansız bir sütür etki sağlayarak, donör ve host dokular arasında güçlü bir yapışma olduğunu. Doku kısa takip (1 ay) onun doğal bir görünüm kavuşur ve donör / konak dokuları arasında yapışma iyileşme evresinin çok erken dönemde sağlanan kaynakla geliştirildi. Kalın donör doku nakli, yani endotelyal keratoplasti diğer ana riskini önlemek için, intrasurgical optik koherens tomografi (OCT) kullanılır: Doğru kesim profili ile dizayn edilebilir, böylece ticari bir cihaz, donör kornea kalınlığını ölçerfemtosec lazer. Önerilen &quot;tüm lazer&quot; endotel nakli dolayısıyla bu minimal invaziv cerrahi klinik sonuçlarını geliştirmek gibi görünüyor.

<table><tbody><tr><td>Indocyanine Green</td><td>Pulsion Medical Systems, Germany</td><td>ICG-PULSION (http://www.pulsion.com/international-english/perfusion/icg-pulsion/)</td><td>Alternative product: IC-GREEN, Akorn&amp;nbsp; Inc., Lake Forest, Illinois- US (http://www.icginjection.com/)</td></tr><tr><td>Femtosecond Laser&amp;nbsp;</td><td>Abbott Medical Optics,&amp;nbsp; Abbott Laboratories Inc. Abbott Park, Illinois, USA</td><td>iFS150 (http://www.abbottmedicaloptics.com/products/refractive/ilasik/ifs-advanced-femtosecond-laser)</td><td></td></tr><tr><td>Optical Coherence Tomography (OCT)</td><td>Carl-Zeiss Meditec, Dublin, California- US (http://www.zeiss.com/meditec/en_de/home.html)</td><td>Visante</td><td></td></tr><tr><td>Diode Laser</td><td>E.l.En. Group s.pa., Calenzano-FI, Italy (http://www.elengroup.com/en/divisions/medical)</td><td>Mod. WELD 800</td><td></td></tr><tr><td>Artificial Anterior Chamber</td><td>CORONET, corneal graft products. Network Medical Products Ltd. Coronet House, Kearsley Road, Ripon, North Yorkshire, HG4 2SG, UK</td><td>Artificial Anterior Chamber (A.A.C.) with large and small tissue-retaining heads. Code 51-935 (http://www.networkmedical.co.uk/ophthalmic_artificial_&lt;br /&gt;anterior_chamber.html)</td><td></td></tr><tr><td>Solution for tissue preservation and nutrition&amp;nbsp;&amp;nbsp;</td><td>AL.CHI.MI.A. Srl, Viale Austria 14, 35020 - Ponte S. Nicol&amp;ograve; - PD&lt;br/&gt; &amp;nbsp;ITALY</td><td>Carry-C media for corneal deturgescence and transport at room temperature - 12 x 50 ml (http://www.alchimiasrl.com/en/organ-culture-at-31&amp;deg;-c-eb/carry-c-eb)</td><td></td></tr></tbody></table>

an &#8220;all-laser&#8221; endothelial transplant

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an intended depth, and a near infrared diode laser to weld the corneal tissue. The proposed technique enables to reach the three main goals in endothelial keratoplasty: a precise control in the thickness of the donor tissue; its easy insertion in the recipient bed and a reduced risk of donor lenticule dislocation. The donor cornea thickness is measured in the surgery room with optical coherence tomography (OCT), in order to correctly design the donor tissue dimensions. A femtosecond laser is used to cut the donor cornea. The recipient eye is prepared by manual stripping of the descemetic membrane. The donor endothelium is inserted into a Busin-injector, the peripheral inner side is stained with a proper chromophore (a water solution of Indocyanine Green) and then it is pulled in the anterior chamber. The transplanted tissue is placed in the final and correct location and then diode laser welding is induced from outside the eyeball. The procedure has been performed on more than 15 patients evidencing an improvement in surgery performances, with a good recovery of visual acuity and a reduced donor lenticule dislocation event.

&quot;Tüm lazer&quot; cerrahi işlem minimal invaziv kornea nakli gerçekleştirmek için önerilmiştir. saygı ile standart endotel nakli, kornea kalınlığı ölçümü donör doku boyama ve eklenen lazer ışığı teslim sadece birkaç adım için: prosedürü (Şekil 1) gerçekleştirmek kolaydır. elde edilen avantajlar büyük ölçüde birkaç dakika artan bir cerrahi zamanı telafi eder. Donör kornea kalınlığı ve donör lenticule boyutlarını özelleştirmek için kullanılan femtosani...

Watch this Scientific Journal Video about An Ã¢â‚¬Å“All-laserÃ¢â‚¬Â Endothelial Transplant at JoVE.com

An &#8220;All-laser&#8221; Endothelial Transplant

An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

Bir &quot;All-lazer&quot; Endotelyal Nakli

The &#8220;all laser&#8221; assisted endothelial keratoplasty is a procedure that is performed with a femtosecond laser used to cut the donor tissue at an ...

Research

JoVE Journal

Medicine

9.4K Görüntüleme.  Italian National Research Council. An all laser procedure is proposed in the endothelial transplant. The surgical technique is based on the use of a femtosecond laser to prepare the donor tissue. Laser welding technique is then used to secure the donor endothelium in the correct position.

Video: An “All-laser” Endothelial Transplant

Autologous Endothelial Progenitor Cell-Seeding Technology and Biocompatibility Testing For Cardiovascular Devices in Large Animal Model

Implantable cardiovascular devices are manufactured from artificial materials (e.g. titanium (Ti), expanded polytetrafluoroethylene), which pose the risk of thromboemboli formation1,2,3. We have developed a method to line the inside surface of Ti tubes with autologous blood-derived human or porcine endothelial progenitor cells (EPCs)4. By implanting Ti tubes containing a confluent layer of porcine EPCs in the inferior vena cava (IVC) of pigs, we tested the improved biocompatibility of the cell-seeded surface in the prothrombotic environment of a large animal model and compared it to unmodified bare metal surfaces5,6,7 (Figure 1). This method can be used to endothelialize devices within minutes of implantation and test their antithrombotic function in vivo. 
Peripheral blood was obtained from 50 kg Yorkshire swine and its mononuclear cell fraction cultured to isolate EPCs4,8. Ti tubes (9.4 mm ID) were pre-cut into three 4.5 cm longitudinal sections and reassembled with heat-shrink tubing. A seeding device was built, which allows for slow rotation of the Ti tubes. 
We performed a laparotomy on the pigs and externalized the intestine and urinary bladder. Sharp and blunt dissection was used to skeletonize the IVC from its bifurcation distal to the right renal artery proximal. The Ti tubes were then filled with fluorescently-labeled autologous EPC suspension and rotated at 10 RPH x 30 min to achieve uniform cell-coating9. After administration of 100 USP/ kg heparin, both ends of the IVC and a lumbar vein were clamped. A 4 cm veinotomy was performed and the device inserted and filled with phosphate-buffered saline. As the veinotomy was closed with a 4-0 Prolene running suture, one clamp was removed to de-air the IVC. At the end of the procedure, the fascia was approximated with 0-PDS (polydioxanone suture), the subcutaneous space closed with 2-0 Vicryl and the skin stapled closed. 
After 3 - 21 days, pigs were euthanized, the device explanted en-block and fixed. The Ti tubes were disassembled and the inner surfaces imaged with a fluorescent microscope.
We found that the bare metal Ti tubes fully occluded whereas the EPC-seeded tubes remained patent. Further, we were able to demonstrate a confluent layer of EPCs on the inside blood-contacting surface.
Concluding, our technology can be used to endothelialize Ti tubes within minutes of implantation with autologous EPCs to prevent thrombosis of the device. Our surgical method allows for testing the improved biocompatibility of such modified devices with minimal blood loss and EPC-seeded surface disruption.

A method for seeding titanium blood-contacting biomaterials with autologous cells and testing biocompatibility is described. This method uses endothelial progenitor cells and titanium tubes, seeded within minutes of surgical implantation into porcine venae cavae. This technique is adaptable to many other implantable biomedical devices.

Otolog Endotelyal progenitör Hücre-Yayımlama Teknoloji ve Büyük Hayvan Modeli Kardiyovasküler Cihazlar için Biyouyumluluk Testleri

Implantable cardiovascular devices are manufactured from artificial materials (e.g. titanium (Ti), expanded polytetrafluoroethylene), which pose the risk ...

Biyomühendislik

Corneal Donor Tissue Preparation for Endothelial Keratoplasty

Over the past ten years, corneal transplantation surgical techniques have undergone revolutionary changes1,2. Since its inception, traditional full thickness corneal transplantation has been the treatment to restore sight in those limited by corneal disease. Some disadvantages to this approach include a high degree of post-operative astigmatism, lack of predictable refractive outcome, and disturbance to the ocular surface. The development of Descemet's stripping endothelial keratoplasty (DSEK), transplanting only the posterior corneal stroma, Descemet's membrane, and endothelium, has dramatically changed treatment of corneal endothelial disease. DSEK is performed through a smaller incision; this technique avoids 'open sky' surgery with its risk of hemorrhage or expulsion, decreases the incidence of postoperative wound dehiscence, reduces unpredictable refractive outcomes, and may decrease the rate of transplant rejection3-6.
Initially, cornea donor posterior lamellar dissection for DSEK was performed manually1 resulting in variable graft thickness and damage to the delicate corneal endothelial tissue during tissue processing. Automated lamellar dissection (Descemet's stripping automated endothelial keratoplasty, DSAEK) was developed to address these issues. Automated dissection utilizes the same technology as LASIK corneal flap creation with a mechanical microkeratome blade that helps to create uniform and thin tissue grafts for DSAEK surgery with minimal corneal endothelial cell loss in tissue processing.
Eye banks have been providing full thickness corneas for surgical transplantation for many years. In 2006, eye banks began to develop methodologies for supplying precut corneal tissue for endothelial keratoplasty. With the input of corneal surgeons, eye banks have developed thorough protocols to safely and effectively prepare posterior lamellar tissue for DSAEK surgery. This can be performed preoperatively at the eye bank. Research shows no significant difference in terms of the quality of the tissue7 or patient outcomes8,9 using eye bank precut tissue versus surgeon-prepared tissue for DSAEK surgery. For most corneal surgeons, the availability of precut DSAEK corneal tissue saves time and money10, and reduces the stress of performing the donor corneal dissection in the operating room. In part because of the ability of the eye banks to provide high quality posterior lamellar corneal in a timely manner, DSAEK has become the standard of care for surgical management of corneal endothelial disease.
The procedure that we are describing is the preparation of the posterior lamellar cornea at the eye bank for transplantation in DSAEK surgery (Figure 1).

Endothelial corneal transplantation is a surgical technique for treatment of posterior corneal diseases. Mechanical microkeratome dissection to prepare tissue results in thinner, more symmetric grafts with less endothelial cell loss and improved outcomes. Dissections can be performed at the eye bank prior to corneal transplantation surgery.

Endotel Keratoplasti için Kornea Donör doku hazırlanması

Over the past ten years, corneal transplantation surgical techniques have undergone revolutionary changes1,2. Since its inception, traditional full ...

Tıp

Embryonic Stem Cell-Derived Endothelial Cells for Treatment of Hindlimb Ischemia

Peripheral arterial disease (PAD) results from narrowing of the peripheral arteries that supply oxygenated blood and nutrients to the legs and feet, This pathology causes symptoms such as intermittent claudication (pain with walking), painful ischemic ulcerations, or even limb-threatening gangrene. It is generally believed that the vascular endothelium, a monolayer of endothelial cells that invests the luminal surface of all blood and lymphatic vessels, plays a dominant role in vascular homeostasis and vascular regeneration. As a result, stem cell-based regeneration of the endothelium may be a promising approach for treating PAD.In this video, we demonstrate the transplantation of embryonic stem cell (ESC)-derived endothelial cells for treatment of unilateral hindimb ischemia as a model of PAD, followed by non-invasive tracking of cell homing and survival by bioluminescence imaging. The specific materials and procedures for cell delivery and imaging will be described. This protocol follows another publication in describing the induction of hindlimb ischemia by Niiyama et al.1

The surgical procedure for delivery of embryonic stem cell-derived endothelial cells to the ischemic hindlimb is demonstrated, with non-invasive tracking by bioluminescence imaging.

Embriyonik Kök Hücre Tedavi Hindlimb İskemi Türetilmiş Endotel Hücreleri

Peripheral arterial disease (PAD) results from narrowing of the peripheral arteries that supply oxygenated blood and nutrients to the legs and feet, This ...

Biyoloji

Transplantation into the Anterior Chamber of the Eye for Longitudinal, Non-invasive In vivo Imaging with Single-cell Resolution in Real-time

Intravital imaging has emerged as an indispensable tool in biological research. In the process, many imaging techniques have been developed to study different biological processes in animals non-invasively. However, a major technical limitation in existing intravital imaging modalities is the inability to combine non-invasive, longitudinal imaging with single-cell resolution capabilities. We show here how transplantation into the anterior chamber of the eye circumvents such significant limitation offering a versatile experimental platform that enables non-invasive, longitudinal imaging with cellular resolution in vivo. We demonstrate the transplantation procedure in the mouse and provide representative results using a model with clinical relevance, namely pancreatic islet transplantation. In addition to enabling direct visualization in a variety of tissues transplanted into the anterior chamber of the eye, this approach provides a platform to screen drugs by performing long-term follow up and monitoring in target tissues. Because of its versatility, tissue/cell transplantation into the anterior chamber of the eye not only benefits transplantation therapies, it extends to other in vivo applications to study physiological and pathophysiological processes such as signal transduction and cancer or autoimmune disease development.

Transplantation into the Anterior Chamber of the Eye for Longitudinal, Non-invasive In vivo Imaging with Single-cell Resolution in Real-time

A new approach combining intraocular transplantation and confocal microscopy enables longitudinal, non-invasive real-time imaging with single-cell resolution within grafted tissues in vivo. We demonstrate how to transplant pancreatic islets into the anterior chamber of the mouse eye.

Boyuna, Non-invaziv için Eye Ön Kamara içine Nakli<em&gt; In vivo</emGerçek zamanlı Tek hücreli Çözünürlük&gt; Görüntüleme

Intravital imaging has emerged as an indispensable tool in biological research.  In the process, many imaging techniques have been developed to study ...

Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty

Descemet&#8217;s Membrane Endothelial Keratoplasty (DMEK) is a form of corneal transplantation in which only a single cell layer, the corneal endothelium, along with its basement membrane (Descemet&#39;s membrane) is introduced onto the recipient&#39;s posterior stroma3. Unlike Descemet&#8217;s Stripping Automated Endothelial Keratoplasty (DSAEK), where additional donor stroma is introduced, no unnatural stroma-to-stroma interface is created. As a result, the natural anatomy of the cornea is preserved as much as possible allowing for improved recovery time and visual acuity4. Endothelial Keratoplasty (EK) is the procedure of choice for treatment of endothelial dysfunction. The advantages of EK include rapid recovery of vision, preservation of ocular integrity and minimal refractive change due to use of a small, peripheral incision1. DSAEK utilizes donor tissue prepared with partial thickness stroma and endothelium. The rapid success and utilization of this procedure can be attributed to availability of eye-bank prepared precut tissue. The benefits of eye-bank preparation of donor tissue include elimination of need for specialized equipment in the operating room and availability of back up donor tissue in case of tissue perforation during preparation. In addition, high volume preparation of donor tissue by eye-bank technicians may provide improved quality of donor tissue. DSAEK may have limited best corrected visual acuity due to creation of a stromal interface between the donor and recipient cornea. Elimination of this interface with transplantation of only donor Descemet&#39;s membrane and endothelium in DMEK may improve visual outcomes and reduce complications after EK5. Similar to DSAEK, long term success and acceptance of DMEK is dependent on ease of availability of precut, eye-bank prepared donor tissue. Here we present a stepwise approach to donor tissue preparation which may reduce some barriers eye-banks face in providing DMEK grafts.

Endothelial keratoplasty is a surgical technique continuously evolving as advancements result in transplantation of thinner grafts with each succession1. Here we present a technique for controlled manual tissue dissection to allow safe and repeatable separation of endothelium and Descemet&#39;s membranes from donor corneoscleral buttons for transplantation2.

Descemet Membran endotelyal keratoplasti için Kornea Donör doku hazırlanması

Descemet&#8217;s Membrane Endothelial Keratoplasty (DMEK) is a form of corneal transplantation in which only a single cell layer, the corneal endothelium, ...

Co-transplantation of Human Ovarian Tissue with Engineered Endothelial Cells: A Cell-based Strategy Combining Accelerated Perfusion with Direct Paracrine Delivery

Infertility is a frequent side effect of chemotherapy and/or radiotherapy and for some patients, cryopreservation of oocytes or embryos is not an option. As an alternative, an increasing number of these patients are choosing to cryopreserve ovarian tissue for autograft following recovery and remission. Despite improvements in outcomes among patients undergoing auto-transplantation of cryopreserved ovarian tissue, efficient revascularization of grafted tissue remains a major obstacle. To mitigate ischemia and thus improve outcomes in patients undergoing auto-transplantation, we developed a vascular cell-based strategy for accelerating perfusion of ovarian tissue. We describe a method for co-transplantation of exogenous endothelial cells (ExECs) with cryopreserved ovarian tissue in a mouse xenograft model. We extend this approach to employ ExECs that have been engineered to constitutively express Anti-Mullerian hormone (AMH), thus enabling sustained paracrine signaling input to ovarian grafts. Co-transplantation with ExECs increased follicular volume and improved antral follicle development, and AMH-expressing ExECs promoted retention of quiescent primordial follicles. This combined strategy may be a useful tool for mitigating ischemia and modulating follicular activation in the context of fertility preservation and/or infertility at large.

For some patients, the only option for fertility preservation is cryopreservation of ovarian tissue. Unfortunately, delayed revascularization undermines follicular viability. Here, we present a protocol to co-transplant human ovarian tissue with endothelial cells for utilization as a cell-based strategy combining accelerated perfusion with a direct paracrine delivery of bioactive molecules.

İnsan yumurtalık dokusu mühendislik endotel hücreleri ile ortak nakli: bir hücre tabanlı strateji birleştirerek perfüzyon doğrudan parakrin teslim ile hızlandırılmış

Infertility is a frequent side effect of chemotherapy and/or radiotherapy and for some patients, cryopreservation of oocytes or embryos is not an option. ...

Development of a Noninvasive, Laser-Assisted Experimental Model of Corneal Endothelial Cell Loss

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the optical breakdown at the laser focus. Acoustic shock waves and cavitation bubbles are generated, causing tissue rupture. Bubble sizes and pressure amplitudes vary with pulse energy and position of the focal point. In this study, enucleated porcine eyes were positioned in front of a commercially available Nd:YAG laser. Variable pulse energies as well as different positions of the focal spots posterior to the cornea were tested. Resulting lesions were evaluated by two-photon microscopy and histology to determine the best parameters for an exclusive detachment of corneal endothelial cells (CEC) with minimum collateral damage. The advantages of this method are the precise ablation of CEC, reduced collateral damage, and above all, the non-contact treatment.

Here, we present a protocol to detach corneal endothelial cells (CEC) from Descemet&#8217;s membrane (DM) using a neodymium:YAG (Nd:YAG) laser as an ex vivo disease model for bullous keratopathy (BK).

Kornea Endotel Hücre Kaybının Noninvaziv, Lazer Destekli Deneysel Modelinin Geliştirilmesi

Nd:YAG lasers have been used to perform noninvasive intraocular surgery, such as capsulotomy for several decades now. The incisive effect relies on the ...

A Human Corneal Organ Culture Model of Descemet's Stripping Only with Accelerated Healing Stimulated by Engineered Fibroblast Growth Factor 1

Fuchs Endothelial Corneal Dystrophy (FECD) results from dysfunctional corneal endothelial cells (CECs) and is currently treated by transplantation of the whole cornea or Descemet's membrane. Recent developments in ocular surgery have established Descemet's Stripping Only (DSO), a surgical technique in which a central circle of guttae-dense Descemet's membrane is removed to allow for the migration of CECs onto the smooth stroma, restoring function and vision to the cornea. While this potential treatment option is of high interest in the field of ophthalmic research, no successful ex vivo models of DSO have been established and clinical data is limited. This work presents a novel wound-healing model simulating DSO in human donor corneas. Using this approach to evaluate the efficacy of the human engineered FGF1 (NM141), we found that treatment accelerated healing via stimulation of migration and proliferation of CECs. This finding was confirmed in 11 pairs of human corneas with signs of dystrophy reported by the eye banks in order to verify that these results can be replicated in patients with Fuchs' Dystrophy, as the target population of the DSO procedure.

Descemet's Stripping Only is an experimental procedure wherein patients with central corneal guttae resulting from Fuchs Endothelial Corneal Dystrophy have Descemet's membrane stripped for peripheral cells to regenerate the endothelial layer. We present novel methodology simulating DSO in dystrophic human corneas ex vivo with accelerated healing stimulated by eFGF1 (NM141).

Descemet'in Sadece Mühendislik Fibroblast Büyüme Faktörü 1 Tarafından Uyarılan Hızlandırılmış İyileşme ile Sıyırılmasının İnsan Kornea Organ Kültürü Modeli

Fuchs Endothelial Corneal Dystrophy (FECD) results from dysfunctional corneal endothelial cells (CECs) and is currently treated by transplantation of the ...

Subretinal Transplantation of Human Embryonic Stem Cell Derived-retinal Pigment Epithelial Cells into a Large-eyed Model of Geographic Atrophy

Geographic atrophy (GA), the late stage of dry age-related macular degeneration is characterized by loss of the retinal pigment epithelial (RPE) layer, which leads to subsequent degeneration of vital retinal structures (e.g., photoreceptors) causing severe vision impairment. Similarly, RPE-loss and decrease in visual acuity is seen in long-term follow up of patients with advanced wet age-related macular degeneration (AMD) receiving intravitreal anti-vascular endothelial growth factor (VEGF) treatment. Therefore, on the one hand, it is fundamental to efficiently derive RPE cells from an unlimited source that could serve as replacement therapy. On the other hand, it is important to assess the behavior and integration of the derived cells in a model of the disease entailing surgical and imaging methods as close as possible to those applied in humans. Here, we provide a detailed protocol based on our previous publications that describes the generation of a preclinical model of GA using the albino rabbit eye, for evaluation of the human embryonic stem cell derived retinal pigment epithelial cells (hESC-RPE) in a clinically relevant setting. Differentiated hESC-RPE are transplanted into naive eyes or eyes with NaIO3-induced GA-like retinal degeneration using a 25 G transvitreal pars plana technique. Evaluation of degenerated and transplanted areas is performed by multimodal high-resolution non-invasive real-time imaging.

Retinal pigment epithelial cells could serve as a cell-replacement therapy for the advanced form of dry age-related macular degeneration. This protocol describes the generation of a large-eyed model of geographic atrophy and the subretinal transplantation of human embryonic stem cell-derived retinal pigment epithelial cells into this model of disease.

Büyük gözlü manken coğrafi Atrofi, içine insan embriyonik kök hücre elde edilen retina Pigment epitel hücrelerinin subretinal nakli

Geographic atrophy (GA), the late stage of dry age-related macular degeneration is characterized by loss of the retinal pigment epithelial (RPE) layer, ...

Endotelyalden mezenkimal geçişi incelemek için in vivo kalp nakli

A Neonatal Heterotopic Rat Heart Transplantation Model for the Study of Endothelial-to-Mesenchymal Transition

Endocardial fibroelastosis (EFE), defined by subendocardial tissue accumulation, has major impacts on the development of the left ventricle (LV) and precludes patients with congenital critical aortic stenosis and hypoplastic left heart syndrome (HLHS) from curative anatomical biventricular surgical repair. Surgical resection is currently the only available therapeutic option, but EFE often recurs, sometimes with an even more infiltrative growth pattern into the adjacent myocardium.
To better understand the underlying mechanisms of EFE and to explore therapeutic strategies, an animal model suitable for preclinical testing was developed. The animal model takes into consideration that EFE is a disease of the immature heart and is associated with flow disturbances, as supported by clinical observations. Thus, the heterotopic heart transplantation of neonatal rat donor hearts is the basis for this model.
A neonatal rat heart is transplanted into an adolescent rat&#39;s abdomen and connected to the recipient&#39;s infrarenal aorta and inferior vena cava. While perfusion of the coronary arteries preserves the viability of the donor heart, flow stagnation within the LV induces EFE growth in the very immature heart. The underlying mechanism of EFE formation is the transition of endocardial endothelial cells to mesenchymal cells (EndMT), which is a well-described mechanism of early embryonic development of the valves and septa but also the leading cause of fibrosis in heart failure. EFE formation can be macroscopically observed within days after transplantation. Transabdominal echocardiography is used to monitor the graft viability, contractility, and the patency of the anastomoses. Following euthanasia, the EFE tissue is harvested, and it shows the same histopathological characteristics as human EFE tissue from HLHS patients.
This in vivo model allows for studying the mechanisms of EFE development in the heart and testing treatment options to prevent this pathological tissue formation and provides the opportunity for a more generalized examination of EndMT-induced fibrosis.

Yazar Spotlight: Endotelyal-mezenkimal geçiş çalışması için yenidoğan heterotopik sıçan kalp nakli modeli  

This work presents an animal model of endothelial-to-mesenchymal transition-induced fibrosis, as seen in congenital cardiac defects such as critical aortic stenosis or hypoplastic left heart syndrome, which allows for detailed histological tissue evaluation, the identification of regulatory signaling pathways, and the testing of treatment options.

Endotelyal-mezenkimal geçiş çalışması için yenidoğan heterotopik sıçan kalp nakli modeli

Endocardial fibroelastosis (EFE), defined by subendocardial tissue accumulation, has major impacts on the development of the left ventricle (LV) and ...

Bir "All-lazer" Endotelyal Nakli

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