Yordamlar Lipogems sistemini kullanarak gerçekleştirilir.

Çalışmalarda etik standartlarına kurumsal ve/veya Ulusal Araştırma Komitesi ve 1964 Helsinki Bildirisi'ne ve daha sonraki değişiklikler veya karşılaştırılabilir etik ile ilgili insan katılımcılar vardı tüm yordamları gerçekleştirilen standartları.
1. tıbbi geçmişi
<ol><li>Klinik muayene ile ayrıntılı bir hasta Tarih başlatın. Not: Bir OLT her zaman ayak bileği istikrarsızlık durumunda tekrarlanan burkulma şişme, sertlik, ağrı ve eklem tıkanıklık ile ilişkili ile şüpheli gerekir. Ayrıca, birçok durumda OLT enflamatuar veya vasküler hastalıklar, nöropati veya nörolojik hastalık ve diyabet gibi sistemik hastalığı öyküsü ile iliskili olabilir. Uyuşturucu veya şifa etkileyebilecek tıbbi sorunları değerlendirilecek ve dikkate alınır.</li>
</ol>2. klinik muayene
<ol><li>Ortostatik bir pozisyon hastanın ayak bileği veya hind-ayak deformitesi vurgulamak için değerlendirin. Kas ve tendon işlev ve ayak bileği aralığı hareketi (ROM) değerlendirmek. Diffüz hassasiyet kez en fazla fleksiyon ve uzantısı özellikle sırasında mevcut, ve dokunmatik alanı parçalanmõ * eklem düzeyinde karşılaşmaya nadir değildir.</li>
	<li>Eşlik eden yanal ayak bileği istikrarsızlık tanımlamak için bir anterior ve posteiror çekmece testi gerçekleştirin.</li>
	<li>Ameliyat öncesi Danışma sırasında aşağıdaki klinik ve fonksiyonel skorları kaydetmek: Amerikan ortopedik ayak ve ayak bileği Derneği (AOFAS) ayak bileği ve hind-ayak puanları15, görsel analog ölçek (VAS) ağrı Puan16ve 12 maddelik kısa formu Sağlık Anketi (SF-12)17.</li>
</ol>3. radyolojik değerlendirme
<ol><li>İkili bir ağırlık ayak ve ayak bileği grafisi taşıyan gerçekleştirin. Bu geleneksel ağırlık taşıyan hastanın (AP) gömme ve ayak bileği lateral ağırlık taşıyan sayısı oluşur. AP gömme nötr konumda ve iç rotasyon talus bir daha iyi görselleştirme için 15 derece ile gerçekleştirin. Not: OLT sadece % 50 grafisi ile teşhis edilebilir; Büyük lezyonlar halinde müstakil kemik radiolucency tarafından çevrili bir alan ünlü18olabilir.</li>
	<li>Geleneksel hesaplanan tomografi-tomografi (tomografi) ayak bileği gerçekleştirin. Tomografi tam yerini ve boyutunu lezyon, Ayrıca kemik parçaları dekolmanı durumunda tanımlama sağlar. Zayıf nokta CT kıkırdak durumunu göstermek için yeteneğidir. Bir önceki çalışmada bir duyarlılık ve özgüllük 0,81 ve 0,99, sırasıyla, CT19,20OLTs algılamak için gösterdi.</li>
	<li>Manyetik rezonans görüntüleme (MRG) ayak bileği gerçekleştirin. MRI kıkırdak ve subchondral kemik değerlendirme esastır. Ayrıca, Mr'ı iyonizan radyasyon içermeyen ve yumuşak doku daha iyi görselleştirme sağlar. Belgeleri bir duyarlılık ve özgüllük % 96 içinde OLTs21,22hafiye raporları.</li>
</ol>4. Cerrahi teknik
<ol><li>Hasatı ve işlenmesi yağ dokusu
	<ol>
<li>Klein çözüm hazırlamak: 1 L 9 g/L serum, %1 lidokain 50 mL, 1 mL 1: 1000 epinefrin, 10 mL % 8.4 sodyum bikarbonat ve triamsinolon acetonide 10 mg/mL 0.1 mL.</li>
		<li>İki para-göbek insizyon yaklaşık 0.5 cm bir neşter bıçakla oluşturun. Cilt altı yağ dokusu 18 G iğne (şekil 1) 60 mL şırınga kullanarak insizyon ile karın içine yaklaşık 300 mL Klein çözeltisi enjekte.</li>
		<li>40-45 mL 20 mL şırınga bağlı ve işleme Kiti (Şekil 2) tanıttı 13 G künt kanül kullanılarak ADSCs hasat. Genellikle, peri-göbek alanında hasat gerçekleştirin.</li>
		<li>Lipoaspirate 100-130 mL kapalı sistemde yerleştirin. Lipoaspirate ilk küme azaltma elde etmek için büyük bir filtre cihazın içine itin; aynı zamanda, karşılık gelen bir miktar tuzlu çözüm doğru israf çanta çıkar. Yağ, kan ve serum arasında geçici bir emülsiyon elde etmek için paslanmaz çelik mermer tarafından önemli bir rol oynadı. Yağ artıkları ve kirli kan yerçekimi bir karşı akış tuzlu çözüm tarafından kaldırın.</li>
		<li>(Akan çözüm görünür açık ve lipoaspirate sarı) bu çamaşır adım sonra tuzlu su akışı durdurmak ve ikinci adipose küme azaltılması için önde gelen aygıt (gri kap kadar), ters. Azaltılması yoluyla sıvı aşağıdan bir 10 mL şırınga ile iterek ikinci kesim altıgen filtre, yüzen yağ kümeleri iterek edinin. Cihazın üst açılışına bağlı bir 10 mL şırınga içine nihai ürün toplamak. Not: Yağ dokusu için işleme Seti standart lipofilling tekniği geliştirir: Aslında, perisitlerden çok sayıda içeren akıcı ve düzgün bir ürün elde etmek için bir kapalı, tam-daldırma, alçak basınç silindirik bir sistem, sistem oluşur. Bu yordam sadece hafif mekanik kuvvetleri ile yağ hücreleri işleme ve stromal vasküler niş bütünlüğünü koruyarak sağlar. İşlemin mümkün olan en az travmatik ve nihai ürün enzimatik tedaviler veya genişleme olmadan kısa sürede (15-20 dk), kullanılabilir hale getirir. Hasarsız vasculostromal niş iyileşme sürecine yardımcı.</li>
		<li>Bir kez ADSCs hasat, karın bölgesinde bir sıkıştırma bandaj uygulanır.</li>
	</ol></li>
	<li>Cerrahi müdahale ve yağ dokusu enjeksiyonu
	<ol>
<li>Hasta sırtüstü pozisyonda kanamayı azaltmak ve daha iyi artroskopik görselleştirme1izin vermek için uyluk düzeyde 250 mmHg basınçta bir sargı bezi ile spinal anestezi altında yerleştirin.</li>
		<li>Ciltte anatomik yerlerinden dermographic kalemle işaretlemek. Simge yapılar iyatrojenik yaralanmaları önlemek için gereklidir. Şu işareti (şekil 3): Her iki malleoli ((LM) lateral ve medial (MM)) dorsi - ve plantar-fleksiyon ile ayak bileği eklemin tanımlanan ön ortak satıra (JL), tibialis anterior tendon (TAT) ve Aşil tendonu büyük Safen ven, sadece bileşenleri öncesinde çalıştığı Yüzeysel peroneal sinir (SPN)</li>
		<li>İlk olarak, sadece yumuşak bir nokta ile rastlayan tibialis anterior tendon medial anteromedial portal gerçekleştirin. Bu portal yaklaşım portal temsil eder. Çoğu durumda, bir depresyon dorsiflexion bileğinden ile görünür ve elle tutulur.<ol>
<li>Sadece deriyi bir bıçak ile kesme ve künt diseksiyon tarafından kapsül sorgulamaktı. Safen sinir ve büyük Safen ven kaçının için dikkat ediniz. Sinir 7.4 mm portala yanal olmakla Safen ven yanal portala bulunduğu 9 mm olduğunu. Bu iki birincil izleme portalları birini oluşturmaktadır.</li>
		</ol>
</li>
		<li>Ortak satırı denetleyin, anterolateral portal için yanal fibula, medial yerleştirin ve ekstansiyon digitorum tendonu lateral. Not: anterolateral portal gerçekleştirirken, engel herhangi bir yaralanma ara dorsal Kutanöz sinir (yüzeysel peroneal sinir lateral dalı); Bu nedenle, kesme sonra cilt künt diseksiyon tarafından izlenmesi gerekir.</li>
		<li>Boyutunu ve konumunu değerlendirmek için eklem kıkırdak bakarak kontrol edin. Koşul ve kıkırdak palpator ile kalitesini değerlendirmek. Talus osteokondral lezyon genellikle ya posteromedially ya da anterolaterally.<ol>
<li>Artroskopik tedavi bazı cerrahlar bir daha büyük 4 mm arthroscope kullanabilir ve araç eklem ön duruşmaya ara tutabilirsiniz 30 ° görüş açısı ile geniş açılı 2.7 mm arthroscopes kullanarak gerçekleştirin. Non-invaziv ortak oyalama teknikleri ve hiper plantar fleksiyon talar kubbe çoğuna erişim için kullanılabilir.</li>
			<li>Posterior bir lezyon halinde iğneyle ortak dikkatini dağıtmak ve lezyon maruz izin vermek için bir Hintermann dağıtıcı yerleştirin. Hintermann dağıtıcı bir açılış kolu vardır daha önce hemen veya yanal, lezyon tarafında göre tibia ve talar kemik konumlandırılmış iki K-telleri üzerinde uygulanan kol. Yanal bir lezyon söz konusu olduğunda, tibial kemik eklem daha iyi dikkat dağıtıcı ulaşmak için fibula, kaçınarak, proksimal K-tel eklemek için dikkat ediniz.</li>
		</ol>
</li>
		<li>Lezyon ile bir küret hazırlamak, hasarlı ve kararsız kıkırdak kaldırma, kalsifiye katman ve düzenli şeklindeki oluşturmak için nekrotik ve sklerotik kemik bulunan omuzlu kenarlıklı bir lezyon. Bu adımda, bir standart artroskopik küret (şekil 4) kullanın.</li>
		<li>Kemik iliği kök hücrelerden subchondral kemik microperforations yuvarlak sıra dışarıdan lezyon içine gerçekleştirme. teşvik.<ol>
<li>Aralarında yaklaşık 3 mm aralıklarla delikler yerine getirir. Kusur (şekil 5) altında sağlıklı subchondral kemik kıkırdak Pick kullanarak mikro çatlaklar neden. Not: Bir kanama fibrin pıhtısı oluşumunda sonuçları. Ürünler, inflamatuar cascade etkinleştirme, pıhtılaşma kan vazoaktif arabulucu, büyüme faktörleri ve sitokinler bırakın. Bu faktörlerin damar işgali ve lezyon kıkırdak kısmı içine Mezenkimal kök hücrelerin göç teşvik gücüne sahip. Bu pluripotent hücreler fibroblastlar, kondrosit ve dokusunu ayırmak ve lezyon tamiri uyarılması içinde önemli bir rol oynamak için uyarılır. Parakrin büyüme faktörleri artiküler ortamında hücre dışı matriks oluşumu ve fibrocartilage üretimi teşvik. Aynı zamanda, lezyon kemik parçası hücreleri aşamalı olarak olgun kemik tarafından değiştirilir bir olgunlaşmamış kemik dokusu üretmek.</li>
		</ol>
</li>
		<li>İntra artiküler su aspirasyon ve eklem tamamen kuru olana bir pamuk sünger kullanarak kalan sıvı tıraş makinesi kullanarak kaldırın.</li>
	</ol></li>
	<li>Yağ kaynaklı kök hücre enjeksiyon
	<ol>
<li>5-7 mL yağ kaynaklı kök hücre, önceden hazırlanmış adım 4.1.3, iki portalları (anteromedial veya anterolateral) birini kullanarak ayak bileği eklem enjekte.</li>
		<li>Turnikeyi serbest bırakın.</li>
	</ol></li>
</ol>5. ameliyat sonrası bakım
<ol><li>Tam deşarj işletilen uzuv ile 15 gündür ayak bileği hareketleri önlemek.</li>
	<li>Tam kurtarma ve hareket aralığı ulaşılana kadar 15 gün sonra ameliyat, ayak bileği, aktif ve pasif hareketler sağlar.</li>
	<li>Şarj ameliyattan sonra 30 gün izin verir.</li>
</ol>6. klinik ve radyografik takip
<ol><li>Hastaların klinik ve radiologically altı ve on iki ay ve, bundan sonra her yıl değerlendirin. İzleme protokolü her son nokta15,16,17, AOFAS ayak bileği ve hind-ayak puanları, VAS ağrı puan ve SF-12 oluşur. Radyografik muayene bir Mr ve tomografi işletilen ayak bileği içerir.</li>
</ol>

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G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+of+mesenchymal+stem+cell+injection+with+arthroscopic+treatment+in+older+patients+with+osteochondral+lesions+of+the+talus.">Clinical outcomes of mesenchymal stem cell injection with arthroscopic treatment in older patients with osteochondral lesions of the talus.</a> Am. J. Sports Med. 41 (5), 1090-1099 (2013).</li><li>Kim, Y. S., Lee, H. J., Choi, Y. J., Kim, Y. I., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Does+an+injection+of+a+stromal+vascular+fraction+containing+adipose-derived+mesenchymal+stem+cells+influence+the+outcomes+of+marrow+stimulation+in+osteochondral+lesions+of+the+talus?+A+clinical+and+magnetic+resonance+imaging+study.">Does an injection of a stromal vascular fraction containing adipose-derived mesenchymal stem cells influence the outcomes of marrow stimulation in osteochondral lesions of the talus? A clinical and magnetic resonance imaging study.</a> Am. J. Sports Med. 42 (10), 2424-2434 (2014).</li><li>Kim, Y. S., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Injection+of+Mesenchymal+Stem+Cells+as+a+Supplementary+Strategy+of+Marrow+Stimulation+Improves+Cartilage+Regeneration+After+Lateral+Sliding+Calcaneal+Osteotomy+for+Varus+Ankle+Osteoarthritis:+Clinical+and+Second-Look+Arthroscopic+Results.">Injection of Mesenchymal Stem Cells as a Supplementary Strategy of Marrow Stimulation Improves Cartilage Regeneration After Lateral Sliding Calcaneal Osteotomy for Varus Ankle Osteoarthritis: Clinical and Second-Look Arthroscopic Results.</a> Arthroscopy. 32 (5), 878-889 (2016).</li><li>Kim, Y. S., Lee, M., Koh, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Additional+mesenchymal+stem+cell+injection+improves+the+outcomes+of+marrow+stimulation+combined+with+supramalleolar+osteotomy+in+varus+ankle+osteoarthritis:+short-term+clinical+results+with+second-look+arthroscopic+evaluation.">Additional mesenchymal stem cell injection improves the outcomes of marrow stimulation combined with supramalleolar osteotomy in varus ankle osteoarthritis: short-term clinical results with second-look arthroscopic evaluation.</a> J. Exp. Orthop. 3 (1), 12 (2016).</li><li>Hanke, C. W., Bernstein, G., Bullock, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+tumescent+liposuction+in+15,336+patients.+National+survey+results.">Safety of tumescent liposuction in 15,336 patients. National survey results.</a> Dermatol Surg. 21 (5), 459-462 (1995).</li><li>Illouz, Y. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+liposuction.">Complications of liposuction.</a> Clin Plast Surg. 33 (1), 129-163 (2006).</li><li>Dixit, V. V., Wagh, M. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Unfavourable+outcomes+of+liposuction+and+their+management.">Unfavourable outcomes of liposuction and their management.</a> Indian J Plast Surg. 46 (2), 377-392 (2013).</li><li>Lehnhardt, M., Homann, H. H., Daigeler, A., Hauser, J., Palka, P., Steinau, H. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Major+and+lethal+complications+of+liposuction:+review+of+72+cases+in+Germany+between+1998+and+2002.">Major and lethal complications of liposuction: review of 72 cases in Germany between 1998 and 2002.</a> Plast Reconstr Surg. 121 (6), 396e-403e (2008).</li><li>Usuelli, F. G., de Girolamo, L., Grassi, M., D'Ambrosi, R., Montrasio, U. A., Boga, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=All-Arthroscopic+Autologous+Matrix-Induced+Chondrogenesis+for+the+Treatment+of+Osteochondral+Lesions+of+the+Talus.">All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Treatment of Osteochondral Lesions of the Talus.</a> Arthrosc Tech. 4 (3), e255-e259 (2015).</li><li>Simonson, D. C., Roukis, T. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+of+ankle+arthroscopy+for+the+treatment+of+anterolateral+soft-tissue+impingement.">Safety of ankle arthroscopy for the treatment of anterolateral soft-tissue impingement.</a> Arthroscopy. 30 (2), 256-259 (2014).</li><li>Suzangar, M., Rosenfeld, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ankle+arthroscopy:+is+preoperative+marking+of+the+superficial+peroneal+nerve+important?.">Ankle arthroscopy: is preoperative marking of the superficial peroneal nerve important?.</a> J. Foot. Ankle Surg. 51 (2), 179-181 (2012).</li><li>Kraeutler, M. 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=Current+Concepts+Review+Update:+Osteochondral+Lesions+of+the+Talus.">Current Concepts Review Update: Osteochondral Lesions of the Talus.</a> Foot Ankle Int. 38 (3), 331-342 (2017).</li><li>Looze, C. 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=Evaluation+and+Management+of+Osteochondral+Lesions+of+the+Talus.">Evaluation and Management of Osteochondral Lesions of the Talus.</a> Cartilage. 8 (1), 19-30 (2017).</li><li>Dragoo, J. 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=Healing+full-thickness+cartilage+defects+using+adipose-derived+stem+cells.">Healing full-thickness cartilage defects using adipose-derived stem cells.</a> Tissue Eng. 13 (7), 1615-1621 (2007).</li><li>Lee, S. Y., Kim, W., Lim, C., Chung, S. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+of+Lateral+Epicondylosis+by+Using+Allogeneic+Adipose-Derived+Mesenchymal+Stem+Cells:+A+Pilot+Study.">Treatment of Lateral Epicondylosis by Using Allogeneic Adipose-Derived Mesenchymal Stem Cells: A Pilot Study.</a> Stem Cells. 33 (10), 2995-3005 (2015).</li><li>Feisst, V., Meidinger, S., Locke, M. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=From+bench+to+bedside:+use+of+human+adipose-derived+stem+cells.">From bench to bedside: use of human adipose-derived stem cells.</a> Stem Cells Cloning. 8, 149-162 (2015).</li></ol>

Federico Giuseppe Usuelli, MD, kişisel ücretleri Integra ve Geistlich, ve hibe ve kişisel Zimmer, gönderilen iş dışında ücretleri bildirir.

Son yıllarda preklinik ve klinik denemeler farklı kas-iskelet patolojiler tedavisinde ADSCs etkisi onların dikkatini odaklanmıştır. Bu makalenin amacı Protokolü osteokondral lezyon artroskopik microperforations birlikte microfractured ve saf yağ dokusu kullanarak talus, tedavisi için tarif etmektir. Protokol komplikasyonların yüksek risk ile birkaç kritik adımları içerir. Şişman hasat sırasında komplikasyon lokal veya sistemik sorunlar ayrılabilir.
En yaygın ameliyat sonr...

Artroskopi altın osteokondral lezyonlari talus (OLTs) tedavisinde ağrı kesici, işlevselliği geri yükleme ve genç ve aktif hastalarda özellikle yaşam kalitesini artırma amacı ile standarttır.
Şu anda, artroskopik teknikleri üç şekilde sınıflandırılabilir. Onarıcı tekniği kemik iliği debridman ve microperforations lezyon düzeyde yoluyla elde hücreleri uyarır. Estetik tekniği bir Otolog veya kapaklı ostechondral greft kullanarak lezyon yerini alır. Rejeneratif tekniği ayırt etmek ve çoğaltmak için multipotent hücreler hasarlı doku1,2,3,4,5,6 yeniden yeteneği olağanüstü başarı .
Son yıllarda yeniden üretim teknikleri çok sayıda vitro ve in vivo çalışmalar OLTs ve yağ dokusu (ADSCs)7,8 ' den türetilmiş özellikle Mezenkimal Kök hücre tedavisi için konu oldu , 9. bu Mezenkimal Kök hücre morfolojik ve fonksiyonel özellikleri diğer dokulardan; izole multipotent diğer hücrelere benzer sergi Onlar da birkaç ayırt etmek için yeteneği var ve farklı cep satırları içinde in vitro ve in vivo10,11,12,13. Bu hücreler araştırmalarına odaklanmak çoğunlukla onların yerelleştirme nedeniyle, aslında temsil ettikleri % 10 dan 5000 hücre, doku13,14gram başına bir konsantrasyon ile normal vücut ağırlığının % 30. Öte yandan, bu hücreler kısıtlar bir faktör kullandıklarında daha laboratuvar işlemleri sırasında ilişkili. Toplamları adipositler, kollajen lifleri ve normal vasküler bileşenleri içeren lipoaspirate enzimatik A tip ı ve hemoliz kültür önce tabi kollajen ile işlenir. Burada amaç Protokolü osteokondral lezyon microfractured ve saf yağ dokusu kullanarak talus, tedavisi için tarif etmektir.

<table>
	<tbody>
		<tr>
			<td>PROCESS KIT - PROCESSING KIT FOR FAT TISSUE</td>
			<td>LIPOGEMS</td>
			<td>LG PK 60</td>
			<td>Lipogems Kit to obtain microfractured and purified ADSCs</td>
		</tr>
		<tr>
			<td>HINTERMANN SPREADER</td>
			<td>INTEGRA</td>
			<td>119654</td>
			<td>The spreader allow to access most of the talar dome, in particular in case of posterior lesion</td>
		</tr>
		<tr>
			<td>CUP CURETTE</td>
			<td>ARTHREX</td>
			<td>AR-8655-02</td>
			<td>To remove the damaged cartilage and necrotic and sclerotic bone</td>
		</tr>
		<tr>
			<td>CHONDRAL PICK 30&#176; TIP / 60&#176; TIP</td>
			<td>ARTHREX</td>
			<td>AR-8655-05 
			AR-8655-06</td>
			<td>To perfrom microperforation at the level of the lesion, stimulating bleeding from the subchondral bone</td>
		</tr>
		<tr>
			<td>SHAVER</td>
			<td>ARTHREX</td>
			<td>AR-7300SR</td>
			<td>To clean the joint and aspirate water</td>
		</tr>
	</tbody>
</table>

autologous microfractured and purified adipose tissue for arthroscopic management of osteochondral lesions of the talus

Son yıllarda yeniden üretim teknikleri edilmiş giderek okudu ve osteokondral lezyon talus, tedavi etmek için kullanılır. Özellikle, çeşitli çalışmalarda dikkatlerini Yağ dokusundan elde edilen Mezenkimal Kök hücre üzerinde odaklanmıştır. Yağ kaynaklı kök hücreler (ADSCs) Morfolojik özellikleri ve özellikleri diğer Mezenkimal hücrelerin benzer sergi ve birkaç hücresel hattı ayırt edebiliyoruz. Ayrıca, bu hücreler de yaygın olarak normal vücut ağırlığının 10-%30 5000 hücre, doku gram başına bir konsantrasyon ile temsil eden subkutan doku mevcuttur.
Sunulan teknikte ilk adım ADSCs karın ve mikro çatlak ve arıtma süreci hasat içerir; ardından, cerrahi prosedür tamamen arthroscopically, daha az yumuşak doku diseksiyon, daha iyi ortak görselleştirme ve standart açık prosedürler ile karşılaştırıldığında daha hızlı bir iyileşme ile gerçekleştirilir. Artroskopi içinde lezyon tespit, izole ve microperforations ile hazırlanan ilk aşaması ile karakterizedir; İkinci adım, gerçekleştirilen kuru, enjeksiyon lezyon düzeyde yağ dokusunun içerir.
Ocak 2016 ve Eylül 2016 arasında dört hasta osteokondral lezyon microfractured ve saf yağ dokusu ile talus, artroskopik tedavi uygulandı. Tüm hastalar klinik iyileşme bildirilen komplikasyon ile altı ay ameliyat sonrası bildirdi. En son takip fonksiyonel sonuçlarına ümit verici ve tekniği güvenilir ağrı ve talus osteokondral lezyon olan hastalarda iyileştirmeler sağlar onaylayın.

Ocak 2016 ve Eylül 2016 arasında dört hasta osteokondral lezyon microfractured ve saf yağ dokusu ile talus, artroskopik tedavi uygulandı. Tüm hastalar klinik iyileşme altı ay ameliyat sonrası bildirdi. İlk klinik sonuçlar Tablo 1' de rapor edilir. Herhangi bir komplikasyon bildirildi.
Son yıllarda, ayak ve ayak bileği patolojiler tedavisi için ADSCs kullanımı artmıştır. 2013 yılında, Kim <em...

Watch this Scientific Journal Video about Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus at JoVE.com

Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

Bu çalışmada microfractured ve saf yağ kaynaklı kök hücre kullanarak talus osteokondral lezyon artroskopik tedavi için bir protokol rapor etmektir.

Otolog Microfractured ve saf yağ dokusu osteokondral lezyon Talus, artroskopik yönetimi için

In recent years, regenerative techniques have been increasingly studied and used to treat osteochondral lesions of the talus. In particular, several ...

autologous-microfractured-purified-adipose-tissue-for-arthroscopic

Research

JoVE Journal

Medicine

10.2K Görüntüleme.  IRCCS Istituto Ortopedico Galeazzi - C.A.S.C.O. Piede e Caviglia. Bu çalışmada microfractured ve saf yağ kaynaklı kök hücre kullanarak talus osteokondral lezyon artroskopik tedavi için bir protokol rapor etmektir.

Video: Autologous Microfractured and Purified Adipose Tissue for Arthroscopic Management of Osteochondral Lesions of the Talus

Breathing-controlled Electrical Stimulation (BreEStim) for Management of Neuropathic Pain and Spasticity

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. It has been extensively used in various clinical settings. Based upon recent discoveries related to the systemic effects of voluntary breathing and intrinsic physiological interactions among systems during voluntary breathing, a new EStim protocol, Breathing-controlled Electrical Stimulation (BreEStim), has been developed to augment the effects of electrical stimulation. In BreEStim, a single-pulse electrical stimulus is triggered and delivered to the target area when the airflow rate of an isolated voluntary inspiration reaches the threshold. BreEStim integrates intrinsic physiological interactions that are activated during voluntary breathing and has demonstrated excellent clinical efficacy. Two representative applications of BreEStim are reported with detailed protocols: management of post-stroke finger flexor spasticity and neuropathic pain in spinal cord injury.

Breathing-controlled Electrical Stimulation BreEStim for Management of Neuropathic Pain and Spasticity

The purpose is to present a new method, breathing-control electrical stimulation (BreEStim) for management of neuropathic pain and spasticity.

Nöropatik Ağrı ve Spastisite Yönetiminde Solunum kontrollü Elektriksel Stimülasyon (BreEStim)

Electrical stimulation (EStim) refers to the application of electrical current to muscles or nerves in order to achieve functional and therapeutic goals. ...

Tıp

Steps for the Autologous Ex vivo Perfused Porcine Liver-kidney Experiment

The use of ex vivo perfused models can mimic the physiological conditions of the liver for short periods, but to maintain normal homeostasis for an extended perfusion period is challenging. We have added the kidney to our previous ex vivo perfused liver experiment model to reproduce a more accurate physiological state for prolonged experiments without using live animals. Five intact livers and kidneys were retrieved post-mortem from sacrificed pigs on different days and perfused for a minimum of 6 hr. Hourly arterial blood gases were obtained to analyze pH, lactate, glucose and renal parameters. The primary endpoint was to investigate the effect of adding one kidney to the model on the acid base balance, glucose, and electrolyte levels. The result of this liver-kidney experiment was compared to the results of five previous liver only perfusion models. In summary, with the addition of one kidney to the ex vivo liver circuit, hyperglycemia and metabolic acidosis were improved. In addition this model reproduces the physiological and metabolic responses of the liver sufficiently accurately to obviate the need for the use of live animals. The ex vivo liver-kidney perfusion model can be used as an alternative method in organ specific studies. It provides a disconnection from numerous systemic influences and allows specific and accurate adjustments of arterial and venous pressures and flow.

Steps for the Autologous Ex vivo Perfused Porcine Liver-kidney Experiment

Study of the animal organ physiology can be achieved by performing an experimental ex vivo perfusion system. The addition of a porcine kidney, as a homeostatic organ to our previously developed ex vivo liver perfusion model can be a principal step to achieve a better physiological environment.

The use of ex vivo perfused models can mimic the physiological conditions of the liver for short periods, but to maintain normal homeostasis for an ...

Generation and 3-Dimensional Quantitation of Arterial Lesions in Mice Using Optical Projection Tomography

The generation and analysis of vascular lesions in appropriate animal models is a cornerstone of research into cardiovascular disease, generating important information on the pathogenesis of lesion formation and the action of novel therapies. Use of atherosclerosis-prone mice, surgical methods of lesion induction, and dietary modification has dramatically improved understanding of the mechanisms that contribute to disease development and the potential of new treatments.
Classically, analysis of lesions is performed ex vivo using 2-dimensional histological techniques. This article describes application of optical projection tomography (OPT) to 3-dimensional quantitation of arterial lesions. As this technique is non-destructive, it can be used as an adjunct to standard histological and immunohistochemical analyses.
Neointimal lesions were induced by wire-insertion or ligation of the mouse femoral artery whilst atherosclerotic lesions were generated by administration of an atherogenic diet to apoE-deficient mice.
Lesions were examined using OPT imaging of autofluorescent emission followed by complementary histological and immunohistochemical analysis. OPT clearly distinguished lesions from the underlying vascular wall. Lesion size was calculated in 2-dimensional sections using planimetry, enabling calculation of lesion volume and maximal cross-sectional area. Data generated using OPT were consistent with measurements obtained using histology, confirming the accuracy of the technique and its potential as a complement (rather than alternative) to traditional methods of analysis.
This work demonstrates the potential of OPT for imaging atherosclerotic and neointimal lesions. It provides a rapid, much needed ex vivo technique for the routine 3-dimensional quantification of vascular remodelling.

Ex vivo analysis of arterial lesions from animal models of cardiovascular disease classically relies on histological and immunohistochemical techniques. These provide 2-dimensional measurements in 3-dimensional lesions. This manuscript describes the generation of arterial lesions for quantitative analysis in 3-dimensions using optical projection tomography.

Üretim ve Farelerde arteriyel Lezyonlarının 3-Boyutlu kantitasyonu Optik Projeksiyon Tomografi ile

The generation and analysis of vascular lesions in appropriate animal models is a cornerstone of research into cardiovascular disease, generating ...

Cerenkov Luminescence Imaging of Interscapular Brown Adipose Tissue

Brown adipose tissue (BAT), widely known as a &#8220;good fat&#8221; plays pivotal roles for thermogenesis in mammals. This special tissue is closely related to metabolism and energy expenditure, and its dysfunction is one important contributor for obesity and diabetes. Contrary to previous belief, recent PET/CT imaging studies indicated the BAT depots are still present in human adults. PET imaging clearly shows that BAT has considerably high uptake of 18F-FDG under certain conditions. In this video report, we demonstrate that Cerenkov luminescence imaging (CLI) with 18F-FDG can be used to optically image BAT in small animals. BAT activation is observed after intraperitoneal injection of norepinephrine (NE) and cold treatment, and depression of BAT is induced by long anesthesia. Using multiple-filter Cerenkov luminescence imaging, spectral unmixing and 3D imaging reconstruction are demonstrated. Our results suggest that CLI with 18F-FDG is a practical technique for imaging BAT in small animals, and this technique can be used as a cheap, fast, and alternative imaging tool for BAT research.

In this video report, we show the application of Cerenkov Luminescence Imaging (CLI) for interscapular brown adipose tissue in mice under activated and depressed conditions.

Interskapular kahverengi adipoz dokuda arasında Çerenkov Lüminesans Görüntüleme

Brown adipose tissue (BAT), widely known as a &#8220;good fat&#8221; plays pivotal roles for thermogenesis in mammals. This special tissue is closely ...

Encapsulation Thermogenic Preadipocytes for Transplantation into Adipose Tissue Depots

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

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

Yağ Dokusu Depolarında içine Nakli Enkapsülasyon termojenik Preadipositler

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

A Technique for Subcutaneous Abdominal Adipose Tissue Biopsy via a Non-diathermy Method

Adipose tissue biopsies offer tissue samples that, upon analysis, may provide insightful overviews of mechanisms relating to metabolism and disease. To obtain subcutaneous adipose tissue biopsies in the abdominal area, researchers and physicians use either a surgical or a needle-based technique. However, surgical subcutaneous fat biopsies can offer tissue samples that may provide a more comprehensive overview of the complexities of biological indices in white adipose tissue. Usually, a surgical adipose tissue biopsy includes a diathermy treatment for cauterizing blood vessels to prevent excessive bleeding. Nevertheless, side effects, such as flash fires and skin lesions in the tissue, have been reported after diathermy. Therefore, we aimed to standardize a surgical abdominal adipose tissue biopsy performed under local anesthesia using a non-diathermy method. We conducted 115 subcutaneous adipose tissue biopsies in healthy men using a non-diathermy abdominal surgical biopsy method. Our results showed three cases of excessive post-operation bleeding out of 115 operations (2.61%).In conclusion, our standardized subcutaneous abdominal adipose tissue surgical biopsy using a non-diathermy method can be safely applied to healthy men at the bedside, with minimal side effects.

We standardized an abdominal adipose tissue biopsy using a non-diathermy method performed under local anesthesia. Three cases of excessive post-operation bleeding out of 115 operations (2.61%) occurred.We conclude that an abdominal adipose tissue surgical biopsy using a non-diathermy method can be safely applied to healthy men.

Bir teknik subkutan karın yağ doku biyopsisi diyatermi sigara yöntemi ile için

Adipose tissue biopsies offer tissue samples that, upon analysis, may provide insightful overviews of mechanisms relating to metabolism and disease. To ...

Assessment of Human Adipose Tissue Microvascular Function Using Videomicroscopy

While obesity is closely linked to the development of metabolic and cardiovascular disease, little is known about mechanisms that govern these processes. It is hypothesized that pro-atherogenic mediators released from fat tissues particularly in association with central/visceral adiposity may promote pathogenic vascular changes locally and systemically, and the notion that cardiovascular disease may be the consequence of adipose tissue dysfunction continues to evolve. Here, we describe a unique method of videomicroscopy that involves analysis of vasodilator and vasoconstrictor responses of intact small human arterioles removed from the adipose depot of living human subjects. Videomicroscopy is used to examine functional properties of isolated microvessels in response to pharmacological or physiological stimuli using a pressured system that mimics in vivo conditions. The technique is a useful approach to gain understanding of the pathophysiology and molecular mechanisms that contribute to vascular dysfunction locally within the adipose tissue milieu. Moreover, abnormalities in the adipose tissue microvasculature have also been linked with systemic diseases. We applied this technique to examine depot-specific vascular responses in obese subjects. We assessed endothelium-dependent vasodilation to both increased flow and acetylcholine in adipose arterioles (50 - 350 &#181;m internal diameter, 2 - 3 mm in length) isolated from two different adipose depots during bariatric surgery from the same individual. We demonstrated that arterioles from visceral fat exhibit impaired endothelium-dependent vasodilation compared to vessels isolated from the subcutaneous depot. The findings suggest that the visceral microenvironment is associated with vascular endothelial dysfunction which may be relevant to clinical observation linking increased visceral adiposity to systemic disease mechanisms. The videomicroscopy technique can be used to examine vascular phenotypes from different fat depots as well as compare findings across individuals with different degrees of obesity and metabolic dysfunction. The method can also be used to examine vascular responses longitudinally in response to clinical interventions.

Videomicroscopy systems are used to examine functional properties of isolated adipose tissue arterioles in response to physiological and pharmacological stimuli. This technique can be used to examine microvascular phenotypes in different adipose tissue domains in obese humans.

İnsan yağ dokusu mikrovasküler işlevini kullanarak Videomicroscopy değerlendirilmesi

While obesity is closely linked to the development of metabolic and cardiovascular disease, little is known about mechanisms that govern these processes. ...

Clinical Protocol of Producing Adipose Tissue-Derived Stromal Vascular Fraction for Potential Cartilage Regeneration

Osteoarthritis (OA) is one of the most common debilitating disorders.&#160;Recently, numerous attempts have been made to improve the functions of the knees by using different forms of mesenchymal stem cells (MSCs). In Korea, bone marrow concentrates and cord blood-derived stem cells have been approved by the Korean Food and Drug Administration (KFDA) for cartilage regeneration. In addition, an adipose tissue-derived stromal vascular fraction (SVF) has been allowed by the KFDA for joint injections in human patients. Autologous adipose tissue-derived SVF contains extracellular matrix (ECM) in addition to mesenchymal stem cells. ECM excretes various cytokines that, along with hyaluronic acid (HA) and platelet-rich plasma (PRP) activated by calcium chloride, may help MSCs to regenerate cartilage and improve knee functions. In this article, we presented a protocol to improve knee functions by regenerating cartilage-like tissue in human patients with OA. The result of the protocol was first reported in 2011 followed by a few additional publications. The protocol involves liposuction to obtain autologous lipoaspirates that are mixed with collagenase. This lipoaspirates-collagenase mixture is then cut and homogenized to remove large fibrous tissue that may clog up the needle during the injection. Afterwards, the mixture is incubated to obtain adipose tissue-derived SVF. The resulting adipose tissue-derived SVF, containing both adipose tissue-derived MSCs and remnants of ECM, is injected into knees of patients, combined with HA and calcium chloride activated PRP. Included are three cases of patients who were treated with our protocol resulting in improvement of knee pain, swelling, and range of motion along with MRI evidence of hyaline cartilage-like tissue.

Here, we present a protocol to produce an adipose tissue-derived stromal vascular fraction and its application to improve knee functions by regenerating cartilage-like tissue in human patients with osteoarthritis.

Yağ dokusundan elde edilen Stromal vasküler kesir için potansiyel kıkırdak rejenerasyon üreten klinik protokol

Osteoarthritis (OA) is one of the most common debilitating disorders.&#160;Recently, numerous attempts have been made to improve the functions of the ...

Inguinal Subcutaneous White Adipose Tissue (ISWAT) Transplantation Model of Murine Islets

Pancreatic islet transplantation is a well-established therapeutic treatment for type 1 diabetes. The kidney capsule is the most commonly used site for islet transplantation in rodent models. However, the tight kidney capsule limits the transplantation of sufficient islets in large animals and humans. The inguinal subcutaneous white adipose tissue (ISWAT), a new subcutaneous space, was found to be a potentially valuable site for islet transplantation. This site has better blood supply than other subcutaneous spaces. Moreover, the ISWAT accommodates a larger islet mass than the kidney capsule, and transplantation into it is simple. This manuscript describes the procedure of mouse islet isolation and transplantation in the ISWAT site of syngeneic diabetic mouse recipients. Using this protocol, murine pancreatic islets were isolated by standard collagenase digestion and a basement membrane matrix hydrogel was used for fixing the purified islets in the ISWAT site. The blood glucose levels of the recipient mice were monitored for more than 100 days. Islet grafts were retrieved at day 100 after transplantation for histological analysis. The protocol for islet transplantation in the ISWAT site described in this manuscript is simple and effective.

Inguinal Subcutaneous White Adipose Tissue ISWAT Transplantation Model of Murine Islets

In this protocol, a method of murine islet isolation and transplantation into the inguinal subcutaneous white adipose tissue is described. Isolated syngeneic murine islets are transplanted into a murine recipient using a basement membrane hydrogel. The blood glucose level of the recipients is monitored, and histology analysis of the islet grafts is performed.

Inguinal Subkutan Beyaz Yağ Dokusu (ISWAT) Transplantasyon Modeli Murine Adacıkları

Pancreatic islet transplantation is a well-established therapeutic treatment for type 1 diabetes. The kidney capsule is the most commonly used site for ...

Fat-Covered Islet Transplantation Using Epididymal White Adipose Tissue

Islet transplantation is a cellular replacement therapy for severe diabetes mellitus. The intraperitoneal cavity is typically the transplant site for this procedure. However, intraperitoneal islet transplantation has some limitations, including poor transplant efficacy, difficult graft detection ability, and a lack of graftectomy capability for post-transplant analysis. In this paper, "fat-covered islet transplantation", an intraperitoneal islet transplantation method that utilizes epididymal white adipose tissue, is used to assess the therapeutic effects of bioengineered islets. The simplicity of the method lies in the seeding of islets onto epididymal white adipose tissue and using the tissue to cover the islets. While this method can be categorized as an intraperitoneal islet transplantation technique, it shares characteristics with intra-adipose tissue islet transplantation. The fat-covered islet transplantation method demonstrates more robust therapeutic effects than intra-adipose tissue islet transplantation, however, including the improvement of blood glucose and plasma insulin levels and the potential for graft removal. We recommend the adoption of this method for assessing the mechanisms of islet engraftment into white adipose tissue and the therapeutic effects of bioengineered islets.

This fat-covered islet transplantation method is suitable for the detection of engrafted islets in the intraperitoneal cavity. Notably, it does not require the use of biobinding agents or suturing.

Epididim Beyaz Yağ Dokusu Kullanılarak Yağ Kaplı Adacık Nakli

Islet transplantation is a cellular replacement therapy for severe diabetes mellitus. The intraperitoneal cavity is typically the transplant site for this ...