Bayan Angela Freund'a gömme ve slayt üretimindeki paha biçilmez teknik yardımı için teşekkür ederiz. Ayrıca Laboratuvar Hayvan Bilimi ve Deneysel Cerrahi Enstitüsü'ndeki Bay Tadeusz Stopinski'ye veterinerlik çalışmalarına yaptığı anlayışlı yardımlar için teşekkür ederiz.

Deneyler, bilimsel amaçlarla kullanılan hayvanların korunmasıyla ilgili Alman hayvan refahı yasası (TSchG) ve Direktifi 2010/63/AB uyarınca gerçek gerçekleştirildi. Bu çalışma için resmi onay Hükümet Hayvan Bakım ve Kullanım Komitesi tarafından verilmiştir (Protokol No.: AZ 87-51.04.2010.A065; Landesamt für Natur, Umwelt und Verbraucherschutz Nordrhein-Westfalen, Recklinghausen, Almanya). Çalışma protokolü Laboratuvar Hayvanlarının Bakımı ve Kullanımı Kılavuzu'na uygun olarak gerçekleştirildi. Ameliyat sonrası ağrı tedavisi, Alman Laboratuvar Hayvanları Bilimi Derneği'nin (GV-SOLAS) önerilerine ve Girişim Veteriner Ağrı Terapisi'ne dayanmaktadır.
1. Temel teknikler ve ortak prosedürler
<ol><li>Homozigöz apoE-/- Sprague-Dawley sıçanları kullanın. Standart yöntemler kullanarak her hayvanın genotipini tanımlayın17.</li>
	<li>Hayvanları aynı koşullarda (21 °C ± 2 °C, %60 ± %5 nem ve 12 saat açık/karanlık döngü) tutun ve suya ve yiyeceğe ücretsiz erişim sağlayın.</li>
	<li>Tüm prosedürleri temiz ama nonsteril koşullar altında gerçekleştirin.</li>
	<li>Sıçan uyuşturuldıktan sonra, tüm prosedürleri 16x büyütmede cerrahi bir mikroskop altında gerçekleştirin.</li>
	<li>Sıkıştırma hemostazı için pamuklu çubuk kullanın. Laktlı Ringer çözeltisi ile ıslatılmış gazlı bez sürüntüleri (5 cm x 5 cm) kasık nemli tutmak için faydalıdır.</li>
	<li>Kullanılmış malzemeleri bertaraf etmek için atık bertaraf yönetmeliklerine uyun.</li>
</ol>2. Ameliyat öncesi hazırlıklar
<ol><li>Operasyona başlamadan önce veteriner ilaçlarını hazırlayın. Aksi belirtilmedikçe tüm çözümleri oda sıcaklığında tutun.</li>
	<li>
İşlemden otuz dakika önce, 0.03-0.05 mg/kg buprenorfin deri altından uygulayın.
</li>
	<li>Sıçanı 100 mg/kg vücut ağırlığı (BW) (S)-ketamin ve 8 mg/kg BW ksilazin intraperitoneal enjeksiyon ile uyuşturun.</li>
	<li>Bir tartım terazisi kullanarak sıçanın ağırlığını değerlendirin.</li>
	<li>Sıçanı bir ısıtma yastığına yerleştirin ve tıbbi bant kullanarak üst ve alt uzuvları sabitleyin. Sıçanı sol arka uzvu tamamen uzatılmış ve omurgasıyla mümkün olduğunca uyumlu olarak konumlandırın, böylece femoral arter ve aort arasında düz bir çizgi oluşturun. Bu, balona monte stentlerin aort çatallanması yoluyla ilerletilmesini kolaylaştıracaktır.</li>
	<li>2 L/dk akış hızında %97,5 oksijende %1,5 vol izofluran soluma ile anesteziyi koruyun. NOT: Sıçanın entübasyon yapmadan kendiliğinden nefes almasına izin verin.</li>
	<li>Bilinçsizlik sırasında göz hasarlarını önlemek için göz merhemi uygulayın.</li>
	<li>Kürkü sıçanın kasık ve alt karın bölgesinden tıraş edin ve ilgili cildi bir povidone-iyot çözeltisi ile sterilize edin.</li>
	<li>Ameliyata başlamadan önce kuyruk ucunu ve interdigital dokuyu sıkıştırarak yeterli anestezi derinliğini doğrulayın.</li>
</ol>3. Cerrahi
<ol><li>Cildi ve alttaki fasyayı açmak için sol kasıkta ~0,5\u20121 cm medial kesi yapın.</li>
	<li>Titreşen sol uyluk atardamarı tespit edilene kadar derinlikleri künt bir şekilde parçalara ayrılın ve araştırın.</li>
	<li>Çok ince tokmalar kullanarak, çevredeki bağ dokusunu nazikçe çıkararak femoral arteri hazırlayın. Ne femoral sinire ne de artere medial olan femoral damara zarar vermeye dikkat edin.</li>
	<li>Femoral arterin yaklaşık 1 cm'sini hazırlayın. Yavaşça kaldırmak için kabın altına asma ucunu dikkatlice koyun.</li>
	<li>Atardamarın distal ve proksimal kısımlarının altında 4-0 ipek dikiş iplik parçaları ve sapanlar oluşturur. İki iplik sapanının her birinin uçlarını cerrahi kelepçenin dalları arasında sıkıştırın. Atardamarı kontrol etmek için cerrahi kelepçeleri kullanın. Kan akışını geçici olarak kesmek için sapanları hafifçe uzatın ve kaldırın. NOT: Doku hasarına yol açabilecek uzun süreli bir turnikeden kaçınmak için hızlı çalışın.</li>
	<li>Keskin mikro makas kullanarak, femoral arterin ortasında bir arteriotomi gerçekleştirin.</li>
	<li>Arteriotomi yoluyla bir kılavuz tel tanıtın. Proksimal iplik sapanlarına ulaşırken, cerrahi kelepçeyi hareket ettirerek ipliğin gerginliğini serbest bırakın ve kılavuz teli karın aortine doğru daha da ilerletin. NOT: Elleçlemeyi kolaylaştırmak için kılavuz teli bir tel kesici kullanarak kesin.</li>
	<li>Kılavuz telin proksimal ucunu diyafram ve renal arterler arasına yerleştirin. NOT: Kılavuz telin çok ileriye doğru ilerleten aort veya kardiyak yaralanma riski taşır. Kılavuz telin ve stenin en azından ilk birkaç hayvan için yeterli konumlandırılmasını sağlamak için karnın açılmasını öneririz.</li>
	<li>Kılavuz tel üzerinden uyluk atardamarına 2,25 mm x 8 mm (maks. 2,5 mm x 8 mm) ölçülerinde kıvrkıt ve balona monte koroner stent takın ve karın aortuna ilerletin.</li>
	<li>Stetiği aort çatallanmasının hemen üstüne ancak renal arterlerin altına yerleştirin. Balon kateterini şişirerek steni 15 sn için 12 atm'ye şişirerek bir şişirme şırınna sistemi kullanarak dağıtın.</li>
	<li>Balon kateterini söndür ve üreticinin kullanımdaki stent için önerilerine göre negatif basıncı koruyun.</li>
	<li>Sönmüş kateteri yavaşça çekin ve steni yerinde bırakın.</li>
	<li>Kateteri çıkarmadan hemen önce, kan akışını tekrar kesmek için cerrahi kelepçe ile kesiğin üzerindeki iplik halkasında gerginlik yaratın. Daha sonra balon kateterini çıkarın ve damarı proksimally olarak doğrudan lige edin.</li>
	<li>Femoral arteri lige etmek ve arteriotomi yeterli hemostazı doğrulamak için proksimal ve distal iplik döngülerini bağlayın. Kollateral arterler uzuvlara daha fazla perfüzyon sağlayacaktır.</li>
	<li>10-0 resorbable olmayan dikiş kullanarak arterin üzerindeki kası ve cilt kesisini kapatın.</li>
</ol>4. Stent implantasyonundan sonra hayvan bakımı
<ol><li>Ameliyattan hemen sonra, farenin ısınan hava (30\u201235 °C) ve oksijen kaynağı olan özel bir yoğun bakım ünitesi kafesinde 60 dakika boyunca iyileşmesine izin verin.</li>
	<li>Tamamen iyileşene kadar hayvanları dikkatlice izleyin. Daha sonra, sıçanları normal bir kafese taşıyın. Suya ve yiyeneğe reklam libitum erişimi sağlayın.</li>
	<li>Klinik değerlendirme altında toplam 72 saat boyunca 0.03-0.05 mg/kg buprenorfin (s.c., in 500μl NaCl) ile her 6-12 saatte bir postoperatif analjezi uygulamak.</li>
	<li>İmplant edilen stensin trombozdan kaçınmak için yiyecekleri klopidogrel (15 mg/kg) ile karıştırın.</li>
	<li>Hiperkolestemik koşulları ve plak oluşumunu geliştirmek için doğumdan 6\u20128 hafta sonra batı diyet beslenmesine başlayın ve ötanaziye kadar devam edin. İstenirse, normal sıçan yemeğiyle beslenen bir hayvan grubu kontrol görevi görebilirsiniz.</li>
</ol>5. Doku toplama ve işleme
<ol><li>Doku eksplantasyonuna belirlenen zaman noktasında başlamadan önce, hayvanı IACUC yönergelerine göre ötenazi edin. Gözlem süresinin sonunda histolojik analiz için stented aort hasat edin.</li>
	<li>Karnı orta çizgi kesiğiyle açın ve aortun eğimli segmentini ve aortun bitişik olmayan kısımlarını her biri 0,5 cm ölçülerinde çıkarın.</li>
	<li>Dokuyu sabitleme için 24 saat boyunca% 4 tamponlanmış formalin çözeltisine yerleştirin.</li>
	<li>Stented arteriyel dokuyu plastiğe gömün ve standart protokollere göre histolojik ve immünohistokimyasal lekeleme gerçekleştirin18,19.</li>
</ol>6. Histomorfometrik analiz
<ol><li>Uygun bir görüntü analiz yazılımına sahip bir bilgisayara bağlı mikroskop vasıtasıyla, stental aortun proksimal, orta ve distal kısmının sıralı bölümlerinin histoporfometrik analizini yapın.</li>
	<li>Dış elastik lamina (EEL, adventitia ve medya arasında), iç elastik lamina (IEL, medya ve neointima arasında) ve lümen konturlarını bir grafik çizim tableti ile takip edin. Bu değerlerden, yazılımla birlikte EEL alanını, IEL alanını ve lümen alanını hesaplayın.</li>
	<li>Stent restenozunda (ISR) kesitsel alan yüzdesini hesaplayın: <img alt="Equation 1" src="/files/ftp_upload/61442/61442equ01.jpg">
</li>
	<li>Toplam neointimal alanı hesaplayın (Ai): <img alt="Equation 2" src="/files/ftp_upload/61442/61442equ02.jpg">
</li>
	<li>Her stent payandası üzerindeki neointimal kalınlığı (NIT) payanda ve lümen arasındaki mesafe olarak ölçün. Nit'i stent payandaları arasında IEL ve lümen arasındaki mesafe olarak ölçün. NOT: Alternatif olarak, NIT'yi <img alt="Equation 3" src="/files/ftp_upload/61442/61442equ03.jpg"> burada PL ve PIEL sırasıyla lümen ve iç elastik lamina çevresidir20.</li>
	<li>Çalışmanın gerekliliklerine göre ek analizler yapmak.</li>
</ol>

<ol>
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M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Early+adaptations+in+collateral+and+microvascular+resistances+after+ligation+of+the+rat+femoral+artery.">Early adaptations in collateral and microvascular resistances after ligation of the rat femoral artery.</a> Journal of Applied Physiology. 79 (1), 73-82 (1985).</li><li>Nevzati, E., 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=Biodegradable+Magnesium+Stent+Treatment+of+Saccular+Aneurysms+in+a+Rat+Model+-+Introduction+of+the+Surgical+Technique.">Biodegradable Magnesium Stent Treatment of Saccular Aneurysms in a Rat Model - Introduction of the Surgical Technique.</a> Journal of Visualized Experiments. (128), e56359 (2017).</li><li>Aquarius, R., Smits, D., Gounis, M. J., Leenders, W. P. J., de Vries, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Flow+diverter+implantation+in+a+rat+model+of+sidewall+aneurysm:+a+feasibility+study.">Flow diverter implantation in a rat model of sidewall aneurysm: a feasibility study.</a> Journal of NeuroInterventional Surgery. 10 (1), 88-92 (2018).</li></ol>

Yazarların açıklayacak bir şeyi yok.

Bu protokol, insan büyüklüğündeki koroner stentlerin apoE-/- sıçanların karın aortuna implantesini açıklar. Birkaç teknik nokta vurgu etmeye değer. İlk olarak, stent boyutu ile aortun büyüklüğü arasında bir uyumsuzluk önlenmelidir. Çok küçük bir stent yerleştirmek stent malappozasyonuna yol açabilirken, aort için çok büyük bir stent takılması damarın aşırı uzamasına, yırtılmasına ve yaralanmasına neden olabilir. Bu nedenle, çapı 2,0 ila 2,5 mm arasında stent kullanm...

Perkütan koroner girişim (PCI), koroner stent dağıtımı ile birlikte koroner arter hastalığının girişimsel tedavisinde altın standardı temsil eder1. Bununla birlikte, stentlerin uzun vadeli başarısı, stent içinde neointimal dokunun aşırı çoğalması ile belirlenen stent istirenozunun (ISR) ortaya çıkması ile sınırlanabilir2,3. ISR koroner arter bypass veya yeniden PCI ile yeniden müdahale gerektirebilir. ISR'nin çalışması için her biri avantaj ve eksiklik içeren çeşitli hayvan modelleri önerilmiştir. En sık kullanılan porcine koroner ve tavşan iliak arter modellerinin en büyük dezavantajları, stent implantasyonu4,5'ten sonra insanlara belirgin bir şekilde benzeyen lezyonlar geliştirmek deolsa,özellikle uzun vadeli çalışmalarda lojistik zorlukların yanı sıra elleçleme ve ekipman sınırlamalarını gündeme getiren büyük hayvan ve barınma maliyetleridir. Ayrıca, domuz ve tavşanların hücresel proteinlerine karşı antikorların mevcudiyeti sınırlıdır. Öte yandan, murine modelleri yüksek verim ve tekrarlanabilirliğin yanı sıra kullanım kolaylığı, konut ve dolayısıyla maliyet etkinliğinin önemli avantajlarını sağlar. Ayrıca, daha fazla sayıda antikor mevcuttur. Bununla birlikte, apolipoprotein E-eksik (apoE-/-) fareler ateroskleroz6,7,8çalışması için yaygın olarak kullanılmış olsa da, stentlerin farelere implante edilmesi için minyatürleştirilmesi ve stentlerin mekanik özelliklerinin potansiyel olarak değiştirilmesi gerektiği için ISR çalışması için uygun değildir. Ayrıca, farelerin aort duvarı genç farelerde 50 μm ile yaşlı farelerde 85 μm arasında ölçülmektedir9ve stentler 2 atm kadar düşük basınç seviyeleri kullanılarak dağıtılmalıdır, bu da stenin malapposition10'ayol açabilir. Bununla birlikte, sıçanlar, ticari olarak mevcut insan koroner stentlerin implantasyonuna izin verir ve ilk olarak Langeveld ve ark.11tarafından bildirilen aort stent implantasyonundan sonra daha büyük hayvanlara benzer bir damar iyileşme kursu gösterir. Bu teknik başlangıçta, kan akışının geçici olarak kesintiye uğraması için aortu fiziksel olarak daraltmayı gerektiren bir trans-abdominal erişim gerektiriyordu. Potansiyel olarak ilişkili damar yaralanmasını ve enflamatuar reaksiyonları önlemek için, teknik daha sonra hayvanların daha yüksek bir hayatta kalma oranına neden olan bir trans-iliak erişimin tanıtılmasıyla rafine edildi12.
Wildtype sıçanlar aterosklerotik lezyonlar geliştirmediği için13, apoE-/- sıçanlar Transkripsiyon Aktivatör Benzeri Efektör Nükleaz (TALEN)14, Kümelenmiş Düzenli Aralıklı Kısa Palindropik Tekrarlar (CRISPR/ Cas9)15ve Çinko Parmak (ZF)16gibi nükleaz teknikleri kullanılarak üretilmiştir. ApoE-/- sıçanlar 2011 yılından beri ticari olarak mevcuttur. Aterojenik bir arka plan sağlayan apoE-/- sıçanlar, özellikle ISR ile ilgili olarak insan büyüklüğündeki koroner stentlerin daha gerçekçi bir şekilde değerlendirilmesini sağlar.
Burada, yöntemi transfemoral erişim yolu üzerinden ve piyasada bulunan ince payanda kobalt-krom ilaç eluting stent (DES) kullanarak açıklıyoruz, ancak çıplak metal stentler (BMS) veya biyolojik olarak parçalanabilir stentler gibi diğer stent türlerinin çalışması için de uygulanabilir.

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			<td></td>
			<td></td>
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			<td></td>
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			<td></td>
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			<td>Essex Pharma</td>
			<td>997.00.00</td>
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			<td>DeltaSelect GmbH</td>
			<td>PZN 00765145</td>
			<td></td>
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			<td>Ringer&#39;s lactate solution</td>
			<td>Baxter Deutschland GmbH</td>
			<td>3775380</td>
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			<td>(S)-ketamine</td>
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			<td></td>
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			<td>72PAH200</td>
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			<td>Sterican needle 18 G</td>
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			<td>304622</td>
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			<td>Sterican needle 27 3/4 G</td>
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			<td>Tissue Paper</td>
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			<td>Graefe forceps curved x1</td>
			<td>Fine Science Tools Inc.</td>
			<td>11151-10</td>
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			<td>Graefe forceps straight</td>
			<td>Fine Science Tools Inc.</td>
			<td>11050-10</td>
			<td></td>
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		<tr>
			<td>Needle holder Mathieu</td>
			<td>Fine Science Tools Inc.</td>
			<td>12010-14</td>
			<td></td>
		</tr>
		<tr>
			<td>Scissors</td>
			<td>Fine Science Tools Inc.</td>
			<td>14074-11</td>
			<td></td>
		</tr>
		<tr>
			<td>Semken forceps</td>
			<td>Fine Science Tools Inc.</td>
			<td>11008-13</td>
			<td></td>
		</tr>
		<tr>
			<td>Small surgical scissors curved</td>
			<td>Fine Science Tools Inc.</td>
			<td>14029-10</td>
			<td></td>
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		<tr>
			<td>Small surgical scissors straight</td>
			<td>Fine Science Tools Inc.</td>
			<td>14028-10</td>
			<td></td>
		</tr>
		<tr>
			<td>Standard pattern forceps</td>
			<td>Fine Science Tools Inc.</td>
			<td>11000-12</td>
			<td></td>
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			<td>Vannas spring scissors</td>
			<td>Fine Science Tools Inc.</td>
			<td>15000-08</td>
			<td></td>
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			<td></td>
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			<td></td>
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			<td>Dissecting microscope</td>
			<td>Leica MZ9</td>
			<td></td>
			<td></td>
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			<td>Temperature controlled heating pad</td>
			<td>Sygonix</td>
			<td>26857617</td>
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		<tr>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
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			<td>Equipment for stent implantation</td>
			<td></td>
			<td></td>
			<td></td>
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			<td>Drug-eluting stent Xience 2,25mm x 8mm</td>
			<td>Abbott Vascular USA</td>
			<td>1009544-18</td>
			<td></td>
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			<td>Guide wire Fielder XT PTCA guide wire: 0.014&#34; x 300cm</td>
			<td>ASAHI INTECC CO., LTD Japan</td>
			<td>AGP140302</td>
			<td></td>
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			<td>1000186</td>
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			<td></td>
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			<td></td>
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			<td>30% H2O2</td>
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			<td>Graphic Drawing Tablet</td>
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			<td>Roti Histofix, Formaldehyd 4% buffered</td>
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			<td>Technovit 9100</td>
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			<td>12225.K1000</td>
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implantation of human-sized coronary stents into rat abdominal aorta using a trans-femoral access

Perkütan koroner girişim (PCI), koroner stent dağıtımı ile birlikte koroner arter hastalığının girişimsel tedavisinde altın standardı temsil eder. Stent içi restenoz (ISR), stent içindeki neointimal dokunun aşırı çoğalması ile belirlenir ve stentlerin uzun süreli başarısını sınırlar. Steno-in-stent restenozunun (ISR) altında yatan patofizyolojik süreçlerin aydınlatılması için çeşitli hayvan modelleri kullanılmıştır, porsin koroner ve tavşan iliak arter modelleri en sık kullanılanlardır. Murine modelleri, yüksek verim, kullanım ve gövde kolaylığı, tekrarlanabilirlik ve moleküler belirteçlerin geniş bir kullanılabilirliği avantajları sağlar. Apolipoprotein E eksikliği (apoE-/- ) fare modeli kardiyovasküler hastalıkları incelemek için yaygın olarak kullanılmıştır. Bununla birlikte, stentlerin farelere yerleştirilmek için minyatürleştirilmesi gerekir, mekanik ve (potansiyel olarak) biyolojik özelliklerinin önemli değişikliklerini içeren. ApoE-/- sıçanların kullanımı, apoE-/- sıçanlar insan büyüklüğünde koroner stentlerin değerlendirilmesine izin verirken aynı zamanda aterojenik bir fenotip sağlarken bu eksikliklerin üstesinden gelebilir. Bu, stent implantasyonundan sonra ISR'yi araştırmak için mükemmel ve güvenilir bir model haline getirir. Burada, ticari olarak mevcut insan koroner stentlerinin trans-femoral erişim kullanarak apoE-/- arka plan ile sıçanların karın aortuna implante edilmesi ayrıntılı olarak açıklanmaktadır.

Bu protokol, trans-femoral erişim yolu kullanan sıçanların karın aortunda stent implantasyonunu açıklar (Şekil 1). Bu hayvan modelinin ilk merkezi noktası, insan büyüklüğünde koroner stentlerin yerleştirilmesine izin veriyor olmasıdır. Piyasada bulunan kıvraklı ve balona monte koroner stent, sıçanların karın aortuna yerlenebilir. Böylece, ek olarak, insanlarda olduğu gibi aynı stent dağıtım prensibi uygulanabilir. Sıçan kullanımının bir başka avantajı, tic...

Watch this Scientific Journal Video about Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access at JoVE.com

Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access

Bu protokol, insan koroner stentlerin trans-femoral erişim kullanılarak apoE-/- arka plan ile sıçanların karın aortuna implantesini açıklar. Diğer hayvan modelleriyle karşılaştırıldığında, murine modelleri yüksek verim, tekrarlanabilirlik, kullanım ve muhafaza kolaylığı ve moleküler belirteçlerin geniş bir kullanılabilirliği avantajlarını taşır.

Trans-Femoral Erişim Kullanılarak İnsan Büyüklüğünde Koroner Stentlerin Rat Abdominal Aort'a yerleştirilmesi

Percutaneous coronary intervention (PCI), combined with the deployment of a coronary stent, represents the gold standard in interventional treatment of ...

implantation-human-sized-coronary-stents-into-rat-abdominal-aorta

Research

JoVE Journal

Medicine

4.1K Görüntüleme.  University Hospital RWTH Aachen. Bu protokol, insan koroner stentlerin trans-femoral erişim kullanılarak apoE-/- arka plan ile sıçanların karın aortuna implantesini açıklar. Diğer hayvan modelleriyle karşılaştırıldığında, murine modelleri yüksek verim, tekrarlanabilirlik, kullanım ve muhafaza kolaylığı ve moleküler belirteçlerin geniş bir kullanılabilirliği avantajlarını taşır.

Video: Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access

The C-seal: A Biofragmentable Drain Protecting the Stapled Colorectal Anastomosis from Leakage

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL varies between 2.5 and 20% 2-5. Over the years, many strategies aimed at lowering the incidence of anastomotic leakage have been examined6, 7. 
The cause of AL is probably multifactorial. Etiological factors include insufficient arterial blood supply, tension on the anastomosis, hematoma and/or infection at the anastomotic site, and co-morbid factors of the patient as diabetes and atherosclerosis8. Furthermore, some anastomoses may be insufficient from the start due to technical failure.
Currently a new device is developed in our institute aimed at protecting the colorectal anastomosis and lowering the incidence of AL. This so called C-seal is a biofragmentable drain, which is stapled to the anastomosis with the circular stapler. It covers the luminal side of the colorectal anastomosis thereby preventing leakage.
The C-seal is a thin-walled tube-like drain, with an approximate diameter of 4 cm and an approximate length of 25 cm (figure 1). It is a tubular device composed of biodegradable polyurethane. Two flaps with adhesive tape are found at one end of the tube. These flaps are used to attach the C-seal to the anvil of the circular stapler, so that after the anastomosis is made the C-seal can be pulled through the anus. The C-seal remains in situ for at least 10 days. Thereafter it will lose strength and will degrade to be secreted from the body together with the gastrointestinal natural contents.
The C-seal does not prevent the formation of dehiscences. However, it prevents extravasation of faeces into the peritoneal cavity. This means that a gap at the anastomotic site does not lead to leakage.
Currently, a phase II study testing the C-seal in 35 patients undergoing (colo-)rectal resection with stapled anastomosis is recruiting. The C-seal can be used in both open procedures as well as laparoscopic procedures. The C-seal is only applied in stapled anastomoses within 15cm from the anal verge. In the video, application of the C-seal is shown in an open extended sigmoid resection in a patient suffering from diverticular disease with a stenotic colon.

The C-seal is a biofragmentable drain protecting the stapled colorectal anastomosis. In this video, details of the manufacturing, deployment and use are shown.

C-mühür: Kaçak Zımbalanmış Kolorektal Anastomoz korunması Biofragmentable Tahliye

Colorectal anastomotic leakage (AL) is a serious complication in colorectal surgery leading to high morbidity and mortality rates1. The incidence of AL ...

Tıp

Rat Heterotopic Abdominal Heart/Single-lung Transplantation in a Volume-loaded Configuration

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft involves anastomosis of donor inferior vena cava (IVC) to recipient IVC, and donor ascending aorta (Ao) to recipient abdominal Ao. The right upper and middle lung lobes are preserved and function as conduits for blood flow from right heart to left heart.
There are several advantages to using this technique, and it lends itself to a broad range of applications. Because the graft is transplanted in a configuration that allows for dyamic volume-loading, cardiac function may be directly assessed in vivo. The use of pressure-volume conductance catheters permits characterization of load-dependent and load-independent hemodynamic parameters. The graft may be converted to a loaded configuration by applying a clamp to the recipient&#8217;s infra-hepatic IVC. We describe modified surgical techniques for both donor and recipient operations, and an ideal myocardial protection strategy. Depending on the experimental aim, this model may be adapted for use in both acute and chronic studies of graft function, immunologic status, and variable ventricular loading conditions. The conducting airways to the transplanted lung are preserved, and allow for acute lung re-ventilation. This facilitates analysis of the effects of the mixed venous and arterial blood providing coronary perfusion to the graft.
A limitation of this model is its technical complexity. There is a significant learning curve for new operators, who should ideally be mentored in the technique. A surgical training background is advantageous for those wishing to apply this model. Despite its complexity, we aim to present the model in a clear and easily applicable format. Because of the physiologic similarity of this model to orthotopic transplantation, and its broad range of study applications, the effort invested in learning the technique is likely to be worthwhile.

We describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The transplant configuration results in a partially loaded graft circulation, allowing direct functional assessment. This model may be employed for acute or chronic studies of function and immunologic status of the transplanted graft.

Sıçan Heterotopik Abdominal Kalp / Bir Ses yüklenen Yapılandırması Tek akciğer transplantasyonu

Herein, we describe a novel technique for heterotopic abdominal heart-lung transplantation (HAHLT) in rats. The configuration of the transplant graft ...

Creation of Abdominal Adhesions in Mice

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or intraabdominal infection. The precise mechanisms underlying adhesion formation are poorly understood. Many compounds and physical barriers have been tested for their ability to prevent adhesions after surgery with varying levels of success. The mouse and rat are important models for the study of abdominal adhesions. Several different techniques for the creation of adhesions in the mouse and rat exist in the literature. Here we describe a protocol utilizing abrasion of the cecum with sandpaper and sutures placed in the right abdominal sidewall. The mouse is anesthetized and the abdomen is prepped. A midline laparotomy is created and the cecum is identified. Sandpaper is used to gently abrade the surface of the cecum. Next, several figure-of-eight sutures are placed into the peritoneum of the right abdominal sidewall. The abdominal cavity is irrigated, a small amount of starch is applied, and the incision is closed. We have found that this technique produces the most consistent adhesions with the lowest mortality rate.

Abdominal adhesions that form after surgery are a major cause of pain, infertility, and hospitalization and reoperation for small bowel obstruction. Our surgical procedure for creating abdominal adhesions in mice is a reliable tool to study the mechanisms underlying the formation of adhesions.

Farelerde Karın Adezyonların Oluşturulması

Abdominal adhesions consist of fibrotic tissue that forms in the peritoneal space in response to an inflammatory insult, typically surgery or ...

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and fluid retention. Changes in myocardial structure, electrical conduction, and energy metabolism develop with heart failure, leading to contractile dysfunction, increased risk of arrhythmias, and sudden death. Hypertensive heart disease is one of the key contributing factors of cardiac remodeling associated with heart failure. The most commonly-used animal model mimicking hypertensive heart disease is created via surgical interventions, such as by narrowing the aorta. Abdominal aortic constriction is a useful experimental technique to induce a pressure overload, which leads to heart failure. The surgery can be easily performed, without the need for chest opening or mechanical ventilation. Abdominal aortic constriction-induced cardiac pathology progresses gradually, making this model relevant to clinical hypertensive heart failure. Cardiac injury and remodeling can be observed 10 weeks after the surgery. The method described here provides a simple and effective approach to produce a hypertensive heart disease animal model that is suitable for studying disease mechanisms and for testing novel therapeutics.

A rat model of abdominal aortic constriction that induces cardiac hypertrophy and remodeling is described. An efficient, highly-reproducible, and minimally-invasive method is used to provide a simple yet useful platform for research in myocardial hypertrophy and dysfunction.

Sıçanlarda Karın Aort Konstrüksiyon sayesinde Kardiyak Yaptırma Bir Model

Heart failure is one of the leading causes of death worldwide. It is a complex clinical syndromethat includes fatigue, dyspnea, exercise intolerance, and ...

Patch Angioplasty in the Rat Aorta or Inferior Vena Cava

Pericardial patches are commonly used in vascular surgery to close vessels. To facilitate studies of the neointimal hyperplasia that forms on the patch, we developed a rat model of patch angioplasty that can be used in either a vein or an artery, creating a patch venoplasty or a patch arterioplasty, respectively. Technical aspects of this model are discussed. The infra-renal IVC or aorta are dissected and then clamped proximally and distally. A 3 mm venotomy or arteriotomy is performed in the infrarenal inferior vena cava or aorta of 6 to 8 week-old Wistar rats. A bovine pericardial patch (3 mm x 1.5 mm x 0.6 mm) is then used to close the site using a 10-0 nylon suture. Compared to arterial patches, venous patches show increased neointimal thickness on postoperative day 7. This novel model of pericardial patch angioplasty can be used to examine neointimal hyperplasia on vascular biomaterials, as well as to compare the differences between the arterial and venous environments.

We have established a model of pericardial patch angioplasty that can be used in either small-diameter veins or arteries. This model can be used to compare venous and arterial neointimal hyperplasia formation.

Sıçan Aort veya İnferior Vena Cava de Anjiyoplasti Patch

Pericardial patches are commonly used in vascular surgery to close vessels. To facilitate studies of the neointimal hyperplasia that forms on the patch, ...

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ischemia and infarction in children. If left untreated, it results in a 90% mortality rate in the first year of life. In patients who survive to the adulthood, the coronary steal phenomenon and retrograde left-sided coronary flow provide a substrate for chronic subendocardial ischemia, which may lead to left ventricular dysfunction, ischemic mitral regurgitation, malignant ventricular arrhythmias, and sudden cardiac death. The average age of life-threatening presentation is 33 years and of sudden cardiac death 31 years. Therefore, surgical correction is highly recommended as soon as the diagnosis is made, regardless of age. In adult-type ALCAPA originating from the right-facing sinus of the pulmonary artery, direct re-implantation of the ALCAPA into the aorta is the more physiologically sound repair technique to re-establish the dual-coronary perfusion system and is recommended. This protocol describes the technique of direct re-implantation of adult-type ALCAPA into the aorta.

Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA

Surgical correction of ALCAPA is highly recommended, regardless of age or the degree of intercoronary collateralization. This protocol presents a technique for the direct re-implantation of adult-type ALCAPA into the aorta to re-establish the dual-coronary perfusion. Whenever feasible, direct re-implantation is preferred to other surgical correction techniques.

Pulmoner Arter Left Koroner arter çıkış anomalileri Erişkin Aort içine Sol Koroner Arter Doğrudan Yeniden implantasyon (ALCAPA)

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly which is one of leading causes of myocardial ...

Balloon-based Injury to Induce Myointimal Hyperplasia in the Mouse Abdominal Aorta

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine balloon denudation model, which is comparable with established vessel injury models in large animals. The aorta denudation model with balloon catheters mimics the clinical setting and leads to comparable pathobiological and physiological changes. Briefly, after performing a horizontal incision in the aorta abdominalis, a balloon catheter will be inserted into the vessel, inflated, and introduced retrogradely. Inflation of the balloon will lead to intima injury and overdistension of the vessel. After removing the catheter, the aortic incision will be closed with single stiches. The model shown in this article is reproducible, easy to perform, and can be established quickly and reliably. It is especially suitable for evaluating expensive experimental therapeutic agents, which can be applied in an economical fashion. By using different knockout-mouse strains, the impact of different genes on MH development can be assessed.

This article demonstrates a murine model to study the development of myointimal hyperplasia (MH) after aortic balloon injury.

Fare Abdominal aort Myointimal Hiperplazi ikna etmek için balon tabanlı yaralanma

The use of animal models is essential for a better understanding of MH, one major cause for arterial stenosis.In this article, we demonstrate a murine ...

Ultrasound Imaging of the Thoracic and Abdominal Aorta in Mice to Determine Aneurysm Dimensions

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been widely used to measure aortic dimensions in mouse models of aortic aneurysms. Aortic aneurysms are defined as permanent dilations of the aorta, which occur most frequently in the ascending and abdominal regions. Sequential measurements of aortic dimensions by ultrasound are the principal approach for assessing the development and progression of aortic aneurysms in vivo. Although many reported studies used ultrasound imaging to measure aortic diameters as a primary endpoint, there are confounding factors, such as probe position and cardiac cycle, that may impact the accuracy of data acquisition, analysis, and interpretation. The purpose of this protocol is to provide a practical guide on the use of ultrasound to measure the aortic diameter in a reliable and reproducible manner. This protocol introduces the preparation of mice and instruments, the acquisition of appropriate ultrasound images, and data analysis.

Ultrasound imaging has become a common modality to determine the luminal dimensions of thoracic and abdominal aortic aneurysms in mice. This protocol describes the procedure to acquire reliable and reproducible two-dimensional ultrasound images of the ascending and abdominal aorta in mice.

Torasik ve Abdominal aort anevrizması boyutlarını belirlemek farelerde ultrason görüntüleme

Contemporary high-resolution ultrasound instruments have sufficient resolution to facilitate the measurement of mouse aortas. These instruments have been ...

A Murine Model of Hemodialysis Access-Related Hand Dysfunction

Chronic kidney disease is a major public health problem, and the prevalence of end-stage renal disease (ESRD) requiring chronic renal replacement therapies such as hemodialysis continues to increase. Autogenous arteriovenous fistula (AVF) placement remains a primary vascular access option for ESRD patients. Unfortunately, approximately half of the hemodialysis patients experience dialysis access-related hand dysfunction (ARHD), ranging from subtle paresthesia to digital gangrene. Notably, the underlying biologic drivers responsible for ARHD are poorly understood, and no adequate animal model exists to elucidate the mechanisms and/or develop novel therapeutics for the prevention/treatment of ARHD. Herein, we describe a new mouse model in which an AVF is created between the left common iliac artery and vein, thereby facilitating the assessment of limb pathophysiology. The microsurgery includes vessel isolation, longitudinal venotomy, creation of arteriovenous anastomosis, and venous reconstruction. Sham surgeries include all the critical steps except for AVF creation. Iliac AVF placement results in clinically relevant alterations in central hemodynamics, peripheral ischemia, and impairments in hindlimb neuromotor performance. This novel preclinical AVF model provides a useful platform that recapitulates common neuromotor perturbations reported by hemodialysis patients, allowing researchers to investigate the mechanisms of ARHD pathophysiology and test potential therapeutics.

This protocol details the surgical steps of murine common iliac arteriovenous fistula creation. We developed this model to study hemodialysis access-related limb pathophysiology.

Hemodiyaliz Erişimi ile İlişkili El Disfonksiyonunun Bir Murine Modeli

Chronic kidney disease is a major public health problem, and the prevalence of end-stage renal disease (ESRD) requiring chronic renal replacement ...

Robotic Cochlear Implantation for Direct Cochlear Access

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of the clinical workflow for robotic cochlear implantation using a robotic system specifically developed for a minimally invasive, direct cochlear access. The clinical workflow involves experts from various disciplines and requires training to ensure a smooth and safe procedure. The protocol briefly summarizes the history of robotic cochlear implantation. The clinical sequence is explained in detail, beginning with the assessment of patient eligibility and covering surgical preparation, preoperative planning with the special planning software, drilling of the middle ear access, intraoperative imaging to confirm the trajectory, milling of the inner ear access, insertion of the electrode array, and implant management. The steps that require special attention are discussed. As an example, the postoperative outcome of robotic cochlear implantation in a patient with advanced otosclerosis is presented. Finally, the procedure is discussed in the context of the authors' experience.

Robotic cochlear implantation is a procedure for minimally invasive inner ear access. Compared to conventional surgery, robotic cochlear implantation involves additional steps that need to be carried out in the operating room. In this article we give a description of the procedure and highlight the important aspects of robotic cochlear implantation.

Doğrudan Koklear Erişim için Robotik Koklear İmplantasyon

Robot-assisted systems offer great potential for gentler and more precise cochlear implantation. In this article, we provide a comprehensive overview of ...