Yazarlar, tüm prosedürler sırasındaki teknik desteği için Bay Pascal Lejeune'ye teşekkür eder.

Sunulan protokol, at hastanesinde sunulan kısraklar için kullanılır ve kurumsal hayvan bakım yönergelerine uyar.
NOT: Anestrüs öncesi endometriyal kist fotoablasyonunu gerçekleştirin: Temmuz sonu veya Ağustos ayında gözlenen ısılar bu nedenle en güvenilir görünüyor. Potansiyel bir endometriti tedavi etmek için mevcut östrus sayısını sınırlandırabileceğinden, bu prosedürü üreme mevsiminde çok geç yapmayın.
1. Önceki östrus sırasında
<ol><li>Kısrağın işlemden sonra potansiyel olarak hamile kalmasını sağlamak için endometriyal biyopsi1 (burada açıklanmamıştır) dahil olmak üzere kısrağın tam bir üreme sağlamlığı incelemesi gerçekleştirin.</li>
	<li>Kenney'in sınıflandırmasına göre kötü endometriyal biyopsi evrelemesi durumunda1, embriyo transferine veya intra sitoplazmik sperm enjeksiyonu (ICSI) programına endometriyal kist fotoabalasyon yerine tercih verin.</li>
</ol>2. Önceki diestrus sırasında
<ol><li>Rektum boşaldıktan sonra, bir çekişme stoğunda ekranda 7,5 veya 5 MHz doğrusal rektal prob ve kaliperler ile rektal palpasyon tarafındanyönlendirilen trans-rektal ultrasonografi kullanarak rahimdeki kısrağın endometriyal kistlerini sayın, ölçün ve haritalayın.</li>
	<li>Yumurtlama sonrası 6\u20127 gününden sonraki 2 veya 3 gün içinde östrus indük etmek için 250 μg kloprostenol intra-kaslı olarak uygulayın.</li>
	<li>Günlük olarak, önemli endometriyal ödem, 35 mm antral folikül ve yumuşatılmış ve açılmış serviks dahil olmak üzere östrus belirtilerini gözlemlemek için yaygın rutin ultrasonografi ve serviks palpasyonu gerçekleştirin.</li>
</ol>3. Kısrak sıcaktayken hazırlık
<ol><li>Göz koruma gözlüğü takan kişilere operasyon odasına erişimi kısıtlayın.</li>
	<li>Rektumun boşalması üzerine kuyruğu sarın ve vulvayı iyot-povidon kullanarak aseptik olarak temizleyin.</li>
	<li>Kısrağın kolay manipülasyonunu ve konforunu sağlamak için, 21 G iğne ile şahdamarına (10 μg/kg) ve butorfaninol (0,1 mg/kg) intravenöz olarak sürün.</li>
	<li>Vajina başına, embriyo toplama kateterini serviksten geçirin ve balonu 40 mL hava ile insufflate edin.</li>
	<li>Uterusun şişirmek için uterusa 1,5 L steril salin çözeltisi (%0,9 NaCl) aşılaması.</li>
	<li>Balonu söndür ve kateteri çıkarın.</li>
	<li>Endoskopu steril bir manşon içinde serviksten aseptik olarak geçirin.</li>
</ol>4. Teknik
<ol><li>600 μm kuvars fiberi 980 nm'de çalışan bir diyot lazere bağlayın. Sürekli modda gücü 20\u201225 W olarak ayarlayın.</li>
	<li>Esnek kuvars lifini 10 mm çapında bir video-endoskopun biyopsi kanalından geçirin, ta ki ekranda 3\u20124 cm serbest lif tespit edilene kadar. Lifin ucundan en az 10 mm görünür olmalıdır.</li>
	<li>Kisti ideal olarak tepe noktasında delmek için lazeri etkinleştirin: cihazda elleri serbest tutmak için özel bir pedal mevcuttur. Bazı durumlarda, kistin tamamen geçersiz kılınmasını sağlamak için çeşitli yerlerde birden fazla delinme gereklidir. Kistik sıvı pasif olarak uterusa boşaltılır.</li>
	<li>Kist astarı lifin etrafına çöktükten sonra, membran küçülene kadar lazeri dağıtın.</li>
	<li>Endometriyal kistlerin kaybolduğunu doğrulamak için işlem sırasında uterusun transrektal ultrasonografisini gerektiği kadar gerçekleştirin.</li>
</ol>5. Ameliyat sonrası tedaviler
<ol><li>Genel antibiyotik tedavisi uygulayin: 22.000 UI / kg penisilin-prokain süspansiyonu, kas içi, günde iki kez, 3 gün boyunca.</li>
	<li>Müdahaleden hemen sonra, yukarıda açıklandığı gibi rahim lavajı gerçekleştirin (bkz. adımlar 3.4-3.6).<ol>
<li>Endoskopik işlemden önce uterusa aşılanmış sıvıyı steril bir manşetli kateterden toplayın.</li>
		<li>Uterusun ardından 1 L steril izotonik çözelti (%0,9 NaCl) aşıları ile berrak bir sıvı toplanana kadar yıkayın.</li>
		<li>İşlemin sonunda, intravenöz olarak 20 IU oksitosin uygulayın.</li>
		<li>Ertesi gün kısrak uterusunun transrektal ultrasonografisini gerçekleştirin: intralüminal serbest sıvı sıklıkla gözlenir (bkz. adım 2.1).</li>
	</ol>
</li>
	<li>Transrektal ultrasonografi ile serbest ışık içi sıvı gözlendiği sürece ve ısının sonuna kadar yukarıda açıklanan işlemle günlük rahim lavajları gerçekleştirin (adım 3.4-3.6). Bazen birkaç gün boyunca serum benzeri, limpid ve sarı lekeli sıvı toplanır. NOT: Kısrak östrustayken her 4 saat veya daha az bir oksitosin (20 IU) tekrarlayan kas içi enjeksiyonları vermek sıvı birikmesini önleyebilir ve rahimde bakteriyel kontaminasyon riskini azaltabilir.</li>
	<li>Endometriyal kistlerin kayboluşunu ve intralüminal serbest sıvının yokluğunu doğrulamak için aşağıdaki diestrus sırasında trans-rektal rahim ultrasonografisi yapın. NOT: Serbest intralüminal sıvı gözlenirse, yeni bir östrus indüklenmesi, sonraki endometriti teşhis etmek ve tedavi etmek için prostaglandin enjeksiyonu önerilir.</li>
</ol>

<ol>
	<li>Kenney, R. M., Ganjam, V. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Selected+pathological+changes+of+the+mare+uterus+and+ovary.">Selected pathological changes of the mare uterus and ovary.</a> Journal of Reproduction and Fertility. (23), 335-339 (1975).</li><li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Videoendoscopic+evaluation+of+the+mare's+uterus:+II.+Findings+in+subfertile+mares.">Videoendoscopic evaluation of the mare's uterus: II. Findings in subfertile mares.</a> Equine Veterinary Journal. 24 (4), 279-284 (1992).</li><li>Kaspar, B., Kahn, W., Laging, C., Leidl, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+cysts+in+the+mare.+1.+Post-mortem+studies:+occurrence+and+morphology.">Endometrial cysts in the mare. 1. Post-mortem studies: occurrence and morphology.</a> Tier&#228;rztliche Praxis. 15 (2), 161-166 (1987).</li><li>Leidl, W., Kaspar, B., Kahn, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endometrial+cysts+in+the+mare.+2.+Clinical+studies:+occurrence+and+significance.">Endometrial cysts in the mare. 2. Clinical studies: occurrence and significance.</a> Tier&#228;rztliche Praxis. 15 (3), 281-289 (1987).</li><li>Mather, E. C., Refsal, K. R., Gustafsson, B. K., Seguin, B. E., Whitmore, H. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+fibre-optic+techniques+in+clinical+diagnosis+and+visual+assessment+of+experimental+intrauterine+therapy+in+mares.">The use of fibre-optic techniques in clinical diagnosis and visual assessment of experimental intrauterine therapy in mares.</a> Journal of Reproduction and Fertility. (27), 293-297 (1979).</li><li>Stanton, M. E., Mc Kinnon, A. O., Squires, E. L., Vaala, W. E., Varner, D. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Equine Reproduction Vol. 2. , 2665-2668 (2011).</li><li>Bracher, V., Mathias, S., Allen, W. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+chronic+degenerative+endometritis+(endometrosis)+on+placental+development+in+the+mare.">Influence of chronic degenerative endometritis (endometrosis) on placental development in the mare.</a> Equine Veterinary Journal. 28 (3), 180-188 (1996).</li><li>Tannus, R. J., Thun, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+endometrial+cysts+on+conception+rate+of+mares.">Influence of endometrial cysts on conception rate of mares.</a> Zentralbl Veterinarmed A. 42 (4), 275-283 (1995).</li><li>Pipers, F. 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R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+electrosurgical+treatment+of+endometrial+cysts+in+the+mare.">The electrosurgical treatment of endometrial cysts in the mare.</a> Tijdschr Diergeneeskd. 124 (21), 630-633 (1999).</li><li>Rambags, B. P., Stout, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcervical+endoscope-guided+emptying+of+a+transmural+uterine+cyst+in+a+mare.">Transcervical endoscope-guided emptying of a transmural uterine cyst in a mare.</a> Vet Record. 156 (21), 679-682 (2005).</li><li>Blikslager, A. T., Tate, L. 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J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Review+of+the+reproductive+endocrinology+of+the+pregnant+and+parturient+mare.">Review of the reproductive endocrinology of the pregnant and parturient mare.</a> Theriogenology. 86 (1), 355-365 (2016).</li><li>Guzeloglu, 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=Expression+of+enzymes+and+receptors+of+leukotriene+pathway+genes+in+equine+endometrium+during+the+estrous+cycle+and+early+pregnancy.">Expression of enzymes and receptors of leukotriene pathway genes in equine endometrium during the estrous cycle and early pregnancy.</a> Theriogenology. 80 (2), 145-152 (2013).</li><li>Senger, P. 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Tüm yazarlar liège Üniversitesi Equine Clinic tarafından tamamen istihdam edilmektedir ve yukarıda belirtilen ürünlerden birini ticaretini yapmak için herhangi bir şirketle çıkar çatışması yoktur.

Endometriyal kistlerin histeroskopisi ve lazer fotoablasyonu, daha önce öneren gibi kısraktaki büyük ışık içi kistleri azaltmak için kolay bir prosedürdür14. Teknik olarak, bu yöntem östrustaki bir kısrakta gerçekleştirildiğinde geliştirilmiştir. Rahmi steril salin çözeltisi ile şişirmek, işlemi gerçekleştirirken hava doldurma ve sürekli aspirasyon ile karşılaştırıldığında görünürlüğü artırdı.  Küçük parietal kistlere (<10 mm) ulaşmak ve tedavi etme...

Kısraklardaki endometriyal kistler yetmişli yıllarda Kenney1tarafından histopatolojik olarak tanımlanmıştır. Seksenli yılların sonlarında, histeroskopi ve ultrasonografi kullanımı klinik tanımlarına yol açtı ve doğurganlık üzerindeki sonuçlarını anlamaya yardımcı oldu2,3,4,5.
Erken evrelerde, endometriyal kistler şimdi endometroz 1 , 3 ,4,6,7,8 olarak adlandırılan endometriyumun dejenerasyonu ile ilişkilendirilmiştir ve şu anda daha büyük kistler lenfatik dilatasyonla ilişkili olduğunda küçük (<1 cm) kistlerin endometriyal bez fibrozis ile ilişkili olduğu kabul edilmektedir6 . Bu büyük kistler, 6,5 ve 17. gün arasında at embriyosu göçünü bozma olasılığı en yüksek olanlardır, böylece anne tanıma 1 ,3,4,6,8'ibozarak doğurganlığı azaltırlar. Endometriyal kistler, özellikle yuvarlaksa ve embriyonik vezikül 3 ,4,6,9'a benzer bir boyuta sahipse erken gebelik teşhisine de müdahale edebilir (bkz. Şekil 1). Böylece, ilk embriyo ultrasonografisini ve ikiz gebelik değerlendirmesini geciktirerek iki döllenme arasındaki aralığı potansiyel olarak artırabilirler (bkz. Şekil 2). Endometriyal kistler, endometriti tedavi etmek veya embriyoyu toplamak için gerçekleştirilen rahim lavajı sırasında sıvı toplanmasına mekanik olarak müdahale edebilir. Sonuç olarak, endometriyal kistlerin gözlenen kısrağın doğurganlığı üzerinde etkileri vardır ve üreme çiftliklerinde potansiyel ekonomik sonuçlar doğurur.
Alttaki endometrozis10'utedavi etme girişimlerinin yanı sıra kistlerin endoskopik güdümlü odak tedavileri önerilmiştir. Elektrocerrahi koterizasyon tanımlanmıştır, ancak ısıya maruz kalma kist çevresindeki endometriuma zarar verebilir11. Kistin aspirasyonu sadece salgılama yapısı delinme sırasında daha aktif değilse etkilidir12. Temas lifli 980 nm diyot lazer ile lazer ışınlama daha küçük sonraki endometriyal izleri göstermek gibi görünüyor6,13. Lazer cihazlarının ve prosedürlerinin iyileştirilmesi6 artık at klinik uygulamalarında bu güvenli ve verimli tekniği önermemizi sağlar. Ancak, kısrak sahipleri bu seçeneğin sınırları hakkında bilgilendirilmelidir. Kistlerin fotoablasyonu bazı kısraklarda embriyo tanımayı artıracak, bazı durumlarda gebelik tanısını ilerletecek ve endometriyal kistlerin endometriti tedavi etmek veya embriyo toplamak için yapılan rahim lavajı üzerindeki olumsuz mekanik etkisini sınırlayabilir. Bununla birlikte, eşlik eden alttaki endometriozis veya endometriti asla tedavi etmeyecektir.
Bu rapor, kısraklarda histeroskopi güdümlü diyot lazer kist ablasyonunu gerçekleştirmek için etkili bir prosedürü tanımlamayı amaçlamaktadır. Klinik bir uygulama için hazırlık ve prosedürler pratik olarak tanımlanacaktır.

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	<tbody>
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			<td height="21" style="height:21px;width:214px;">Butorphanol</td>
			<td style="width:121px;">Animedica</td>
			<td style="width:161px;">Morphasol 10 mg/mL</td>
			<td style="width:167px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Detomidine</td>
			<td style="width:121px;">Dechra</td>
			<td style="width:161px;">Domidine 10 mg/mL</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Endoscope</td>
			<td style="width:121px;">Olympus</td>
			<td style="width:161px;">Vet 170-10 SN2012729</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">Endoscope Vid&#233;o Tower</td>
			<td style="width:121px;">Olympus</td>
			<td style="width:161px;">CLE-E &#38; CV-E</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:214px;">Laser device</td>
			<td style="width:121px;">Wuhan Giga Optronics</td>
			<td style="width:161px;">Velas II-60B GA19-V3186</td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">NaCl 0.9%</td>
			<td style="width:121px;">Baxter</td>
			<td style="width:161px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:214px;">P&#233;nicilline-proca&#239;ne</td>
			<td style="width:121px;">Kela</td>
			<td style="width:161px;">PENI-Kel 300.00 UI/ml</td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:214px;">Ultrasonography</td>
			<td style="width:121px;">Aloka</td>
			<td style="width:161px;">Aloka 500 &#38; 5mHz transrectal probe</td>
			<td></td>
		</tr>
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endoscopy guided photoablation of endometrial cysts using a 980 nm laser with a contact fiber in mares

Kısraklarda, endometriyal kistler endometriozis ile ilişkilidir ve anne tanıma başarısızlığına veya riskten ve gebelik teşhislerini geciktirebilir. Tarihsel tedaviler invazivdi ve endometriyum üzerinde olumsuz etkileri vardı. Histoskopik güdümlü lazer tedavisi, endometrium için zararlı etkileri olmayan endometriyal kistlerin rezeksiyonu için kolay ve etkilidir.
110 cm uzunluğunda ve 1,0 cm genişliğinde bir endoskop, vulvar temizliğinden sonra östrous bir kısrağın açık serviksi yoluyla uterusa steril olarak sokulur. Rahim yavaşça 1 L'den az fizyolojik çözelti ile aşılanır ve lazer lifi endoskopun biyopsi kanalına yerleştirilir. Kistler daha sonra 980 nm diyot lazer ile 20\u20122 5W'da sürekli modda bir temas fiber seti ile dağlanır. Her kist, kistin tamamen geçersiz kılınıp lif etrafındaki kist duvarının küçülmesine kadar delinür. Steril salin çözeltisi ile rahim lavajları ameliyattan hemen sonra ve enflamatuar olmayan sıvı gözlenebildiği için bir veya iki gün boyunca gerçekleştirilir.
Bu prosedür, belirgin zararlı etkileri olmadan kolay ve hızlı bir şekilde gerçekleştirilir. Kist rezeksiyonu ultrason gebelik tanısını kolaylaştırır ve bazı durumlarda 6.5 ile 17. Ancak bu tedavi endometriozis ile ilgili altta kalan histolojik lezyonları iyileştirmez. Bu hususlar, bu işlemden önce yetiştiriciye açıkça ifade edilmelidir.

Çapları 15 mm'nin üzerinde kist olan kısraklara ameliyatlar yapıldı. Bununla birlikte, diğer küçük kistler de mevcutsa, diğer kistlerin fotoablasyonu denendi. Genellikle, bu büyük kistler çatallanmada veya boynuzların temelindeydi. Bununla birlikte, bazıları uterusun vücudunda mevcuttu ve eşit olarak tedavi edildi.
Deneyimlerimize göre, intralüminal kistlerin endoskop ile lokalize etmesi çok kolaydır. Ayrıca, bu prosedürün tuzlu su çözeltisinde yapılması uterusun ...

Watch this Scientific Journal Video about Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares at JoVE.com

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

Bu raporun amacı, endoskopik bir lazer cihazı kullanarak kısraktaki endometriyal kistlerin fotoablasyonunu tanımlamak ve düşük doğurganlık sorunlarıyla başa çıkmak için bu yeni yaklaşımın ilgisini ve sınırlamalarını tartışmaktır.

Mares'te Temas Lifli 980 nm Lazer Kullanarak Endometriyal Kistlerin Endoskopi Güdümlü Fotoablasyonu

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

endoscopy-guided-photoablation-endometrial-cysts-using-980-nm-laser

Research

JoVE Journal

Medicine

4.2K Görüntüleme.  Liège University. Bu raporun amacı, endoskopik bir lazer cihazı kullanarak kısraktaki endometriyal kistlerin fotoablasyonunu tanımlamak ve düşük doğurganlık sorunlarıyla başa çıkmak için bu yeni yaklaşımın ilgisini ve sınırlamalarını tartışmaktır.

Video: Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

MRI-guided Disruption of the Blood-brain Barrier using Transcranial Focused Ultrasound in a Rat Model

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a significant obstacle to pharmaceutical treatments of brain disorders as it limits the passage of molecules from the vasculature into the brain tissue to molecules less than approximately 500 Da in size6. FUS induced BBB disruption (BBBD) is temporary and reversible4 and has an advantage over chemical means of inducing BBBD by being highly localized. FUS induced BBBD provides a means for investigating the effects of a wide range of therapeutic agents on the brain, which would not otherwise be deliverable to the tissue in sufficient concentration. While a wide range of ultrasound parameters have proven successful at disrupting the BBB2,5,7, there are several critical steps in the experimental procedure to ensure successful disruption with accurate targeting. This protocol outlines how to achieve MRI-guided FUS induced BBBD in a rat model, with a focus on the critical animal preparation and microbubble handling steps of the experiment.

Microbubble-mediated focused ultrasound disruption of the blood-brain barrier (BBB) is a promising technique for non-invasive targeted drug delivery in the brain1-3. This protocol outlines the experimental procedure for MRI-guided transcranial BBB disruption in a rat model.

Sıçan Modelinde Transkraniyal Odaklanmış Ultrason kullanarak Kan-beyin bariyeri MRG eşliğinde bozulması

Focused ultrasound (FUS) disruption of the blood-brain barrier (BBB) is an increasingly investigated technique for circumventing the BBB1-5. The BBB is a ...

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Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and cardiac arrest. This elevation may result in further neurological injury, in the form of transtentorial herniation1,2,3,4, midbrain compression, neurological deficit or increased cerebral infarct2,4. Current therapies are often inadequate to control elevated ICP in the clinical setting5,6,7 . Thus there is a need for accurate methods of ICP measurement in animal models to further our understanding of the basic mechanisms and to develop new treatments for elevated ICP.
In both the clinical and experimental setting ICP cannot be estimated without direct measurement. Several methods of ICP catheter insertion currently exist. Of these the intraventricular catheter has become the clinical 'gold standard' of ICP measurement in humans8. This method involves the partial removal of skull and the instrumentation of the catheter through brain tissue. Consequently, intraventricular catheters have an infection rate of 6-11%9. For this reason, subdural and epidural cannulations have become the preferred methods in animal models of ischemic injury. 
Various ICP measurement techniques have been adapted for animal models, and of these, fluid-filled telemetry catheters10 and solid state catheters are the most frequently used11,12,13,14,15. The fluid-filled systems are prone to developing air bubbles in the line, resulting in false ICP readings. Solid state probes avoid this problem (Figure 1). An additional problem is fitting catheters under the skull or into the ventricles without causing any brain injury that might alter the experimental outcomes. Therefore, we have developed a method that places an ICP catheter contiguous with the epidural space, but avoids the need to insert it between skull and brain. 
An optic fibre pressure catheter (420LP, SAMBA Sensors, Sweden) was used to measure ICP at the epidural location because the location of the pressure sensor (at the very tip of the catheter) was found to produce a high fidelity ICP signal in this model. There are other manufacturers of similar optic fibre technologies13 that may be used with our methodology. Alternative solid state catheters, which have the pressure sensor located at the side of the catheter tip, would not be appropriate for this model as the signal would be dampened by the presence of the monitoring screw. 
Here, we present a relatively simple and accurate method to measure ICP. This method can be used across a wide range of ICP related animal models.

A novel technique to record the pressures within the skull is described. The minimally invasive method uses a fibre-optic pressure sensing system to accurately measure intracranial pressure (ICP) in anaesthetized rats without causing significant brain trauma. The technique may be used in a wide range of experimental models.

Bir Fiber optik Basıç kullanarak Sıçanlarda Epidural İntrakraniyal Basınç Ölçümü

Elevated intracranial pressure (ICP) is a significant problem in several forms of ischemic brain injury including stroke, traumatic brain injury and ...

Reproducable Paraplegia by Thoracic Aortic Occlusion in a Murine Model of Spinal Cord Ischemia-reperfusion

Background 
Lower extremity paralysis continues to complicate aortic interventions. The lack of understanding of the underlying pathology has hindered advancements to decrease the occurrence this injury.&#160;The current model demonstrates reproducible lower&#160;extremity paralysis following thoracic aortic occlusion.
Methods 
Adult male C57BL6 mice were anesthetized with isoflurane. Through a cervicosternal incision the aorta was exposed. The descending thoracic aorta and left subclavian arteries were identified without entrance into pleural space. Skeletonization of these arteries was followed by immediate closure (Sham) or occlusion for 4 min (moderate ischemia) or 8 min (prolonged ischemia). The sternotomy and skin were closed and the mouse was transferred to warming bed for recovery.&#160; Following recovery, functional analysis was obtained at 12 hr intervals until 48 hr.
Results 
Mice that underwent sham surgery showed no observable hind&#160;limb deficit. Mice subjected to moderate ischemia for 4 min had minimal functional deficit at 12 hr followed by progression to complete paralysis at 48 hr. Mice subjected to prolonged ischemia had an immediate paralysis with no observable hind-limb movement at any point in the postoperative period. There was no observed intraoperative or post&#160;operative mortality.
Conclusion 
Reproducible lower extremity paralysis whether immediate or delayed can be achieved in a murine model. Additionally, by using a median sternotomy and careful dissection, high survival rates, and reproducibility can be achieved.

The lack of mechanistic understanding of spinal cord ischemia-reperfusion injury has hindered further adjuncts to prevent paraplegia following high risk aortic operations. Thus, the development of animal models is imperative. This manuscript demonstrates reproducible lower extremity paralysis following thoracic aortic occlusion in a murine model.

Spinal Kord İskemi-reperfüzyon bir Mürin Modelinde Torasik Aort Tıkanıklığı tarafından tekrarlanabilir Parapleji

Background
Lower extremity paralysis continues to complicate aortic interventions. The lack of understanding of the underlying pathology has hindered ...

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The molecular mechanisms leading to cyst formation in PKD remain somewhat unclear, but many genes are thought to be involved. Wnt5a is a non-canonical glycoprotein that regulates a wide range of developmental processes. Wnt5a works through the planar cell polarity (PCP) pathway that regulates oriented cell division during renal tubular cell elongation. Defects of the PCP pathway have been found to cause kidney cyst formation. Our paper describes a method for developing a zebrafish cystic kidney disease model by knockdown of the wnt5a gene with wnt5a antisense morpholino (MO) oligonucleotides. Tg(wt1b:GFP) transgenic zebrafish were used to visualize kidney structure and kidney cysts following wnt5a knockdown. Two distinct antisense MOs (AUG - and splice-site) were used and both resulted in curly tail down phenotype and cyst formation after wnt5a knockdown. Injection of mouse Wnt5a mRNA, resistant to the MOs due to a difference in primary base pair structure, rescued the abnormal phenotype, demonstrating that the phenotype was not due to &#8220;off-target&#8221; effects of the morpholino. This work supports the validity of using a zebrafish model to study wnt5a function in the kidney.

A Possible Zebrafish Model of Polycystic Kidney Disease: Knockdown of wnt5a Causes Cysts in Zebrafish Kidneys

We describe a method of generating a possible zebrafish model of polycystic kidney disease. We used Tg(wt1b:GFP) fish to visualize kidney structure. Knockdown of wnt5a was by morpholino injection. Pronephric cyst formation after wnt5a knockdown was observed in this GFP transgenic zebrafish.

Polikistik Böbrek Hastalığı Olası Zebra balığı Modeli: demonte<em&gt; Wnt5a</em&gt; Zebra balığı Böbrekler Kistler Nedenler

Polycystic kidney disease (PKD) is one of the most common causes of end-stage kidney disease, a devastating disease for which there is no cure. The ...

Semi-automated Analysis of Mouse Skeletal Muscle Morphology and Fiber-type Composition

For years, distinctions between skeletal muscle fiber types were best visualized by myosin-ATPase staining. More recently, immunohistochemical staining of myosin heavy chain (MyHC) isoforms has emerged as a finer discriminator of fiber-type. Type I, type IIA, type IIX and type IIB fibers can now be identified with precision based on their MyHC profile; however, manual analysis of these data can be slow and down-right tedious. In this regard, rapid, accurate assessment of fiber-type composition and morphology is a very desirable tool. Here, we present a protocol for state-of-the-art immunohistochemical staining of MyHCs in frozen sections obtained from mouse hindlimb muscle in concert with a novel semi-automated algorithm that accelerates analysis of fiber-type and fiber morphology. As expected, the soleus muscle displayed staining for type I and type IIA fibers, but not for type IIX or type IIB fibers. On the other hand, the tibialis anterior muscle was composed predominantly of type IIX and type IIB fibers, a small fraction of type IIA fibers and little or no type I fibers. Several image transformations were used to generate probability maps for the purpose of measuring different aspects of fiber morphology (i.e., cross-sectional area (CSA), maximal and minimal Feret diameter). The values obtained for these parameters were then compared with manually-obtained values. No significant differences were observed between either mode of analysis with regards to CSA, maximal or minimal Feret diameter (all p &#62; 0.05), indicating the accuracy of our method. Thus, our immunostaining analysis protocol may be applied to the investigation of effects on muscle composition in many models of aging and myopathy.

Immunohistochemical staining of myosin heavy chain isoforms has emerged as the state-of-the-art discriminator of skeletal muscle fiber-type (i.e., type I, type IIA, type IIX, type IIB). Here, we present a staining protocol along with a novel semi-automated algorithm that facilitates rapid assessment of fiber-type and fiber morphology.

Fare kas iskelet morfoloji ve Fiber türü kompozisyon yarı otomatik analizi

For years, distinctions between skeletal muscle fiber types were best visualized by myosin-ATPase staining. More recently, immunohistochemical staining of ...

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc&#8212;outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 &#177; 16 years and the male/female ratio was 2:1. The mean follow-up was 19 &#177; 6 months. A total of 190 lumbar levels were operated on (L1&#8211;L2: n = 4, L2&#8211;L3: n = 17, L3&#8211;L4: n = 27, L4&#8211;5: n = 123, and L5&#8211;S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 &#177; 12 (25 - 56) min and the mean hospital stay was 1.2 &#177; 0.5 (1&#8211;3) days. The VAS score for leg pain improved from 7.5 &#177; 1 to 1.7 &#177; 0.9. The ODI improved from 70 &#177; 8.3 to 23 &#177; 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Here we present a protocol of a novel outside-in technique of transforaminal endoscopic discectomy for lumbar disc herniations. The technical aspects of the technique, the wide indications of use, and the results of the treatment in 184 patients are described in detail.

Transforaminal lomber endoskopi lomber disk Hernilerinde için mobil dış-in tekniği

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are ...

Enucleation of the Prostate for the Treatment of Benign Prostatic Hyperplasia Using a 980 nm Diode Laser

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. Here, we introduce a new technique called 980 nm diode laser enucleation (DiLEP) to treat BPH1. Diode lasers can absorb both water and hemoglobin at the same time, so they are good for cutting and hemostasis2. The diode laser was approved by the FDA in 2007, and has been used in the treatment of BPH because of its effective cutting and hemostasis effect3. DiLEP presents several advantages over other techniques, such as TURP, HoLEP, and PVP. During the procedure, we define the boundary of a high-volume prostate and separate it into three lobes with a diode laser by burning two rings and one groove (like a Cupid&#39;s arrow). Compared to other procedures, mDiLEP has fewer intraoperative complications, a shorter learning curve, and achieves more tissue resection.

Here, we present a protocol for modified 980 nm diode laser enucleation to treat large volume benign prostatic hyperplasia.

980 nm Diyot Lazer Kullanılarak İyi Huylu Prostat Hiperplazisinin Tedavisi için Prostatın Enükleasyonu

In the aging male population, the occurrence of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) is a common problem. ...

Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained using laser Doppler flowmetry (LDF). This paper demonstrates a closed skull preparation that allows cerebral blood flow to be assessed without penetrating the skull or installing a chamber or cerebral window. To evaluate autoregulatory mechanisms, a model of controlled blood pressure reduction via graded hemorrhage can be utilized while simultaneously employing LDF. This enables the real time tracking of the relative changes in the blood flow in response to reductions in arterial blood pressure produced by the withdrawal of circulating blood volume. This paradigm is a valuable approach to study cerebral blood flow autoregulation during reductions in arterial blood pressure and, with minor modifications in the protocol, is also valuable as an experimental model of hemorrhagic shock. In addition to evaluating autoregulatory responses, LDF can be used to monitor the cortical blood flow when investigating metabolic, myogenic, endothelial, humoral, or neural mechanisms that regulate cerebral blood flow and the impact of various experimental interventions and pathological conditions on cerebral blood flow.

This article demonstrates the use of laser Doppler flowmetry to evaluate the ability of the cerebral circulation to autoregulate its blood flow during reductions in arterial blood pressure.

Lazer Doppler Flowmetry Kullanarak Sıçanserebral Kan Akımı Otoregülasyon Değerlendirilmesi

When investigating the body&#39;s mechanisms for regulating cerebral blood flow, a relative measurement of microcirculatory blood flow can be obtained ...

Fertility Sparing Procedure using Carbon Dioxide Fiber Laser Vaporization of Ovarian Endometrioma

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated with a potential reduction in the ovarian reserve due to the inadvertent removal and thermal damage of healthy ovarian tissue. New ablative techniques with reduced tissue penetration depth and less thermal spread to the surrounding parenchyma may represent a viable alternative to cystectomy. For these reasons, the aim of this manuscript is to demonstrate the ablation of the endometrioma capsule using a CO2 fiber laser technique and discuss the clinical outcomes. Once the cyst has been drained and washed, a biopsy is taken. After cyst eversion, vaporization of the inner surface of the cyst is performed using a CO2 fiber laser. The technique is simple and reproducible as even young surgeons without any surgical experience were more confident in performing laser CO2 vaporization instead of cystectomy. The positive effects of CO2 technology are reported in a randomized controlled trial, where the postoperative changes in the antral follicular count (AFC) and antimullerian hormone (AMH) levels were compared between patients who had their endometrioma excised (cystectomy) and those who had undergone endometrioma vaporization with CO2 laser. The patients treated with CO2 laser showed significantly increased AFC without a reduction in serum AMH levels as compared to the cystectomy group, in which both parameters were significantly reduced. The postoperative pregnancy rate was also assessed, and comparable pregnancy rates were found after both treatments. On the contrary, patients treated with the CO2 fiber laser technique had more favorable in-vitro fertilization (IVF) outcomes compared to cystectomy.
In conclusion, the CO2 fiber laser technique may represent a viable alternative to cystectomy in the surgical treatment of endometrioma in terms of ovarian preservation, pregnancy rates, and IVF outcomes. Moreover, it has the advantage of being independent of the surgeon's skills and personal experience.

In this protocol, CO2 fiber laser technique is demonstrated for the surgical treatment of ovarian endometriosis, which represents a viable alternative in terms of fertility preservation with the major advantage of not being dependent on the surgeon's skills and personal experience.

Yumurtalık Endometriomunun Karbondioksit Fiber Lazer Buharlaştırılması Kullanılarak Doğurganlık Koruyucu Prosedür

The surgical management of endometrioma is still a matter of debate. Cystectomy, which is recognized as the standard technique, seems to be associated ...

PCL Kist Eksizyonu için Artroskopik Çift Posteromedial Yaklaşım

Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

Yazar Gündemi: Arka Çapraz Bağ Kistlerinin Tedavisinde Çift Posteromedial Yaklaşım

We present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach.

Arka Çapraz Bağ Kistlerinin Çift Posteromedial Yaklaşımla Artroskopik Eksizyonu

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament ...