Name: application of hemostatic devices in laparoscopic hepatectomy
Uploaded: 2022-04-19T13:00:00
Description: Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

Эта работа была поддержана грантами Научно-технического проекта города Гуанчжоу (202102010090).

Операция является рутинной и получила одобрение этики. Одобрение для быстрого рассмотрения Комитетом по этике клинических исследований и применения Второй аффилированной больницы Медицинского университета Гуанчжоу: Проект обзора этики научных исследований «Применение простых и ле...

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Y., Han, H. S., Yoon, Y. S., Shin, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Feasibility+of+laparoscopic+liver+resection+for+tumors+located+in+the+posterosuperior+segments+of+the+liver,+with+a+special+reference+to+overcoming+current+limitations+on+tumor+location.">Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location.</a> Surgery. 144 (1), 32-38 (2008).</li><li>Ome, Y., Honda, G., Doi, M., Muto, J., Seyama, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+anatomic+liver+resection+of+segment+8+using+intrahepatic+Glissonean+approach.">Laparoscopic anatomic liver resection of segment 8 using intrahepatic Glissonean approach.</a> Journal of the American College of Surgeons. 230 (3), 13-20 (2020).</li><li>Ryu, T., 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=Perioperative+and+oncological+outcomes+of+laparoscopic+anatomical+hepatectomy+for+hepatocellular+carcinoma+introduced+gradually+in+a+single+center.">Perioperative and oncological outcomes of laparoscopic anatomical hepatectomy for hepatocellular carcinoma introduced gradually in a single center.</a> Surgical Endoscopy. 32 (2), 790-798 (2018).</li><li>Makabe, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+occlusion+of+hepatic+artery+and+risk+of+carbon+dioxide+gas+embolism+during+laparoscopic+hepatectomy+in+a+pig+model.">Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model.</a> Journal of Hepato-Biliary-Pancreatic Sciences. 21 (8), 592-598 (2014).</li><li>Miyagi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pure+laparoscopic+hepatectomy+combined+with+a+pure+laparoscopic+pringle+maneuver+in+patients+with+severe+cirrhosis.">Pure laparoscopic hepatectomy combined with a pure laparoscopic pringle maneuver in patients with severe cirrhosis.</a> Case Reports in Gastroenterology. 9 (1), 101-105 (2015).</li></ol>

Гепатэктомия является одним из наиболее важных методов лечения пациентов с первичным раком печени и вторичным раком печени. В 1991 году Райх и др. применили лапароскопию для удаления доброкачественных опухолей печени и завершили первую в мире лапароскопическую гепатэктомию4</s...

Гепатоцеллюлярная карцинома является одной из самых распространенных злокачественных опухолей пищеварительной системы. По различным первичным участкам его можно разделить на первичную гепатоцеллюлярную карциному и вторичный рак печени. Клетки могут метастазировать из первичных опухолей из органов вне печени в печень различными способами, что приводит к карциноме в печени. Сообщалось, что более 50% метастатических клеток в печени происходят от колоректального рака, в то время как другие - от опухолей молочной железы, поджелудочной железы, легких и желудка и т. Д.1. В последние годы доступно множество методов лечения вторичного рака печени, включая систематическую химиотерапию, интервенционную терапию, молекулярную таргетную терапию, хирургию и т. Д.2. Тем не менее, радикальная резекция по-прежнему является наиболее эффективным лечением, потому что она может полностью удалить рак3.
С быстрым развитием лапароскопической технологии лапароскопическая анатомическая гепатэктомия постепенно признается хирургами, но до сих пор не проводится широко, особенно в первичных медицинских учреждениях. Одной из причин является потребность в полноценных гемостатических устройствах. Они необходимы для снижения рисков кровотечения и утечки желчи в процессе эксплуатации. Здесь мы представляем набор простого и легкого гемостатического оборудования, включая однопросветный катетер, гармонический скальпель и монопольную электрокоагуляцию, для выполнения лапароскопической гепатэктомии. Для этого сначала porta hepatis периодически закупоривается с помощью катетера с одним просветом. Затем ткань паренхимы печени резецируется с помощью гармонического скальпеля. Кровоточащие пятна коагулируются монопольной электрокоагуляцией точка-точка. Это простое и легкое гемостатическое оборудование использует односветный катетер для выполнения маневра прингла и использует гемостаз гармонического скальпеля и монопольную электрокоагуляцию. Оборудование можно легко найти в больницах, тем самым обеспечивая дополнительную легкость для выполнения лапароскопии или обучения. Таким образом, эти простые и легкие гемостатические аппараты подходят для проведения процедур в первичных медицинских учреждениях.
В этом исследовании пациентом был 67-летний мужчина с диагнозом умеренно дифференцированная аденокарцинома сигмовидной кишки, метастазирующая в печень. Радикальная резекция рака сигмовидной кишки была выполнена в январе 2021 года. Патологические результаты представляли собой умеренно дифференцированную аденокарциному со стадией TNM pT4aN2aM1. Химиотерапия FOLFOX была назначена четыре раза после операции. После этого состояние организма пациента было признано пригодным для выполнения лапароскопической анатомической гепатэктомии для полного удаления поражения метастазами в печень. Степень функции печени Чайлда-Пью была степенью А. Для теста функции резерва печени R15 в тесте клиренса ICG составил 1,6% (<10%). КТ показала опухоль размером 57 мм х 68 мм х 76 мм через дорсальную часть S5 и вентральную часть S6 печени; трехмерная модель реконструкции показана на рисунке 1.

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	<tbody>
		<tr>
			<td>HARMONIC ACE Ultrasonic Surgical Devices</td>
			<td>Ethicon Endo-Surgery,LLC</td>
			<td>HAR36</td>
			<td></td>
		</tr>
		<tr>
			<td>Hem-o-lock</td>
			<td>Teleflex Medical</td>
			<td>544233</td>
			<td></td>
		</tr>
		<tr>
			<td>Monopole Electrocoagulation</td>
			<td>KANGJI MEDICAL</td>
			<td>/</td>
			<td></td>
		</tr>
		<tr>
			<td>single lumen ureter</td>
			<td>WELL LEAD MEDICAL CO.,LTD.</td>
			<td>12F</td>
			<td></td>
		</tr>
	</tbody>
</table>

application of hemostatic devices in laparoscopic hepatectomy

Лапароскопическая гепатэктомия считается обычным методом лечения доброкачественных и злокачественных заболеваний печени, поскольку является малоинвазивным методом. Несмотря на свой неинвазивный аспект, кровотечения и утечки желчи возникают при резекции ткани паренхимы печени во время операции или в послеоперационный период, что свидетельствует о необходимости использования полноценных гемостатических аппаратов, таких как ультразвуковая хирургическая аспирация, биполярная электрокоагуляция и др. Отсутствие этих полноценных гемостатических аппаратов не позволяет лапароскопической гепатэктомии стать генерализованной процедурой в базовых медицинских организациях. Ввиду ситуации, упомянутой выше, в этом протоколе разработан набор простых и легких гемостатических устройств, который включает в себя гармонический скальпель, монопольную электрокоагуляцию и катетер с одним просветом для инновационного выполнения резекции паренхимной ткани печени. Прежде всего, porta hepatis или печеночная ножка периодически закупоривается однопросветным катетером с последующим зажимом в течение 15 мин и отпусканием в течение 5 мин. Впоследствии, используя гармонический скальпель, пережатие и дробление печени делают, чтобы отрезать ткань паренхимы печени и выявить внутрипеченочные артерии, вены и желчные протоки. Наконец, кровоточащие пятна коагулируются с помощью монопольной электрокоагуляции в каждом месте. Внутрипеченочные трубопроводные структуры затем видны с помощью этих методов, которые могут легко остановить кровотечение, снизить частоту утечки желчи и повысить безопасность и осуществимость лапароскопической гепатэктомии. Поэтому простые и легкие гемостатические аппараты, показанные здесь, подходят для проведения процедур в первичных медицинских учреждениях.

Операция была завершена в течение 2,5 ч, а объем интраоперационного кровотечения составил 100 мл без переливания крови. Кратковременных осложнений не было, и пациент был выписан из больницы на8-й день после операции. Уровень канцероэмбрионального антигена (CEA) после операции снизилс?...

Watch this Scientific Journal Video about Application of Hemostatic Devices in Laparoscopic Hepatectomy at JoVE.com

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Полноценные гемостатические устройства необходимы для лапароскопической гепатэктомии. Однако эти приборы не обобщены в базовых медицинских организациях. Поэтому в этой статье показан набор простых и легких гемостатических устройств, которые могут облегчить выполнение лапароскопической гепатэктомии.

Применение гемостатических аппаратов при лапароскопической гепатэктомии

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. ...

Основным преимуществом данной методики является то, что гемостатический аппарат прост и легок в получении и может проводиться в базовых стационарах. Этот набор гемостатического оборудования может быть дополнительно применен для лапароскопической гепатэктомии и других систем. Настоятельно рекомендуется иметь определенную основу лапароскопической хирургии, особенно умелое использование гармонического скальпеля для применения этого набора гемостатических устройств при лапароскопической гепатэктомии.Начните с применения прямой пункции для установления пневмоперитонеума при лапароскопии. Поместите 10-миллиметровый троакар в каждое смотровое отверстие в субпупочной области, правую средне-ключичную линию под реберным краем и вентральной средней линией. Затем поместите пятимиллиметровый трокар в правую переднюю вспомогательную линию и вентральную среднюю линию.Соберите гемостатические устройства, начиная с гармонического скальпеля, монопольной электрокоагуляции и однопросветного катетера, для инновационного использования в резекции ткани паренхимы печени. Чтобы выполнить маневр Прингла, периодически закрывайте первый porta hepatis с помощью катетера с одним просветом. Зажмите люменовый катетер гемостатическим зажимом в течение 15 минут, а затем отпустите его в течение пяти минут, используя гармонический скальпель, чтобы отрезать зажим и вынуть зажим, чтобы восстановить кровоснабжение первого порта гепатита.Отделите печеночные ножки, снабжающие опухоль. Резекция и деление их по одному с помощью гармонического скальпеля. Наблюдают линию ишемии на поверхности печени, которая становится видимой после резекции печеночных ножек.Используйте крючок, чтобы отметить его. Резекция ткани паренхимы печени с помощью гармонического скальпеля при постепенном зажатии и дроблении печени. Наблюдайте за внутренней печеночной артерией, веной и желчным протоком.Разделите и разделите эти трубопроводные структуры. Как только кровотечение появляется, коагулируйте кровоточащие пятна на поверхности рассечения печени немедленно, используя точечную монопольную электрокоагуляцию. Используйте правую заднюю печеночную ножку в качестве указателя для внутрипеченочной резекции ткани паренхимы.Зарезервируйте основную заднюю печеночную ножку и рассекните ветвь ножек, снабжающих опухоль. Чтобы завершить операцию, промойте поверхность печени, чтобы можно было увидеть, есть ли еще кровоточащие пятна. Остановить кровотечение на поверхности рассечения печени и удалить образец опухоли из брюшной полости.Операция была завершена в течение 2,5 часов. Объем интраоперационного кровотечения составил 100 миллилитров без переливания крови и не наблюдалось кратковременных осложнений. Уровень канцероэмбрионального антигена после операции снизился до 110,64 мкг на литр с предоперационного уровня 1058,69 мкг на литр.Лечение химиотерапией было возобновлено через два месяца после операции, согласно результатам опухолевой патологии. Послеоперационное КТ-исследование сравнивали с предоперационной КТ и не наблюдалось признаков повторного роста опухоли. Важнейшим этапом хирургического процесса является использование гармонического скальпеля.Требуется большое количество навыков, чтобы избежать повреждения жизненно важных структур.

application-of-hemostatic-devices-in-laparoscopic-hepatectomy

Research

JoVE Journal

Cancer Research

Evaporation-reducing Culture Condition Increases the Reproducibility of Multicellular Spheroid Formation in Microtiter Plates

Tumor models that closely imitate in vivo conditions are becoming increasingly popular in drug discovery and development for the screening of potential anti-cancer drugs. Multicellular tumor spheroids (MCTSes) effectively mimic the physiological conditions of solid tumors, making them excellent in vitro models for lead optimization and target validation. Out of the various techniques available for MCTS culture, the liquid-overlay method on agarose is one of the most inexpensive methods for MCTS generation. However, the reliable transfer of MCTS cultures using liquid-overlay for high-throughput screening may be compromised by a number of limitations, including the coating of microtiter plates (MPs) with agarose and the irreproducibility of uniform MCTS formation across wells. MPs are significantly prone to edge effects that result from excessive evaporation of medium from the exterior of the plate, preventing the use of the entire plate for drug tests. This manuscript provides detailed technical improvements to the liquid-overlay technique to increase the scalability and reproducibility of uniform MCTS formation. Additionally, details on a simple, semi-automatic, and universally applicable software tool for the evaluation of MCTS features after drug treatment is presented.

The uneven loss of medium from microtiter plates affects the reproducibility of uniform multicellular tumor spheroid formation. Improving culture conditions to reduce significant medium loss will improve the reproducibility of spheroid formation and the results of spheroid-based assays using the liquid-overlay technique.

Испарение снижающих культуры Состояние увеличивает Воспроизводимость многоклеточных сфероида образования в микротитрационных планшетах

Tumor models that closely imitate in vivo conditions are becoming increasingly popular in drug discovery and development for the screening of potential ...

Application of Laser Micro-irradiation for Examination of Single and Double Strand Break Repair in Mammalian Cells

Highly coordinated DNA repair pathways exist to detect, excise and replace damaged DNA bases, and coordinate repair of DNA strand breaks. While molecular biology techniques have clarified structure, enzymatic functions, and kinetics of repair proteins, there is still a need to understand how repair is coordinated within the nucleus. Laser micro-irradiation offers a powerful tool for inducing DNA damage and monitoring the recruitment of repair proteins. Induction of DNA damage by laser micro-irradiation can occur with a range of wavelengths, and users can reliably induce single strand breaks, base lesions and double strand breaks with a range of doses. Here, laser micro-irradiation is used to examine repair of single and double strand breaks induced by two common confocal laser wavelengths, 355 nm and 405 nm. Further, proper characterization of the applied laser dose for inducing specific damage mixtures is described, so users can reproducibly perform laser micro-irradiation data acquisition and analysis.

Confocal fluorescence microscopy and laser micro-irradiation offer tools for inducing DNA damage and monitoring the response of DNA repair proteins in selected sub-nuclear areas. This technique has significantly advanced our knowledge of damage detection, signaling, and recruitment. This manuscript demonstrates these technologies to examine single and double strand break repair.

Применение лазерной микро облучения для рассмотрения одного и двойной стренги перерыв ремонт в клетках млекопитающих

Highly coordinated DNA repair pathways exist to detect, excise and replace damaged DNA bases, and coordinate repair of DNA strand breaks. While molecular ...

Laparoscopic Pancreatoduodenectomy With Modified Blumgart Pancreaticojejunostomy

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal pancreatectomy, laparoscopic pancreatoduodenectomy (LPD) has not yet obtained wide acceptance, probably due to technical challenges, especially regarding the pancreatic anastomosis.
The study describes and demonstrates all steps of LPD, including the modified Blumgart pancreaticojejunostomy. Indications for LPD are all pancreatic and peri-ampullary tumors without vascular involvement. Relative contra-indications are body mass index &#62;35 kg/m2, chronic pancreatitis, mid-cholangiocarcinomas and large duodenal cancers.
The patient is in French position, 6 trocars are placed, and dissection is performed using an (articulating) sealing device. A modified Blumgart end-to-side pancreaticojejunostomy is performed with 4 large needles (3/0) barbed trans-pancreatic sutures and 4 to 6 duct-to-mucosa sutures using 5/0 absorbable multifilament combined with a 12 cm, 6 or 8 Fr internal stent using 3D laparoscopy. Two surgical drains are placed alongside the pancreaticojejunostomy.
The described technique for LPD including a modified Blumgart pancreatico-jejunostomy is well standardized, and its merits are currently studied in the randomized controlled multicenter trial. This complex operation should be performed at high-volume centers where surgeons have extensive experience in both open pancreatic surgery and advanced laparoscopic gastro-intestinal surgery.

Laparoscopic pancreatoduodenctomy (LPD) may offer advantages over open pancreatoduodenectomy, including early postoperative mobilization, less delayed gastric emptying and a shorter hospital stay. However, LPD is technically challenging and not well-standardized, especially regarding the pancreatic anastomosis. We describe a standardized technique for the pancreatic anastomosis during LPD: modified Blumgart pancreaticojejunostomy.

Лапароскопическая Pancreatoduodenectomy с модифицированных Blumgart Pancreaticojejunostomy

Minimally invasive pancreatic resections are technically demanding but rapidly increasing in popularity. In contrast to laparoscopic distal ...

The Application of 1% Methylene Blue Dye As a Single Technique in Breast Cancer Sentinel Node Biopsy

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery (BCS), a separate incision in the lower axilla hairline was made to find the sentinel nodes (SNs). In mastectomy, the SNs were identified through the same mastectomy incision. The SNs were described as blue nodes or nodes with lymphatic blue channels. An anatomical landmark in the axilla was used to facilitate SNs identification. The SNs metastases were evaluated by intraoperative frozen section analysis and histopathology examination as it is a gold standard. Here, we described the MBD as the lone technique in breast cancer sentinel node biopsy (SNB) which could be useful when radioisotope tracer or patent or isosulfan blue dye (PBD) cannot be provided.

In Indonesia, sentinel node biopsy (SNB) is not routinely performed for breast cancer surgery because of the limitation to provide radioisotope tracer and isosulfan or patent blue dye (PBD). To overcome this obstacle, we applied 1% methylene blue dye (MBD) as a single agent to map the sentinel nodes (SNs).

Применение 1% Метиленовый голубой краситель как единый метод в рак молочной железы Sentinel Узел биопсии

In this study, we injected 1% methylene blue dye (MBD) into the subareolar or peritumoral space of the breast. In the case of breast conserving surgery ...

The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

Glioblastoma is the most common and lethal form of brain cancer, with a median survival of 15 months after diagnosis and a 5 year survival rate of only 5% with current standard of care. Tumors often recur within 9 months following initial surgery, radiation and chemotherapy, at which point treatment options become limited. This highlights the pressing need for the development of better therapeutics to prolong survival and increase the quality of life for these patients.
Tumor Treating Fields (TTFields) therapy was developed to take advantage of the effect of low frequency alternating electrical fields on cells for cancer therapy. TTFields have been demonstrated to disrupt cells during mitosis and slow tumor growth. There is also growing evidence that they act through stimulating immune responses within exposed tumors. The advantages of TTFields therapy include its noninvasive approach and increased quality of life compared to other treatment modalities such as cytotoxic chemotherapies. The Food and Drug Administration approved TTFields therapy for the treatment of recurrent glioblastoma in 2011 and for newly diagnosed glioblastoma in 2015. We report on the effects of TTFields during mitosis, the results of electric fields modeling, and proper transducer array placement. Our protocol outlines the clinical application of TTFields on a patient post-surgery, using the second-generation device.

Glioblastoma is the most common and aggressive primary brain malignancy in adults, with most tumors recurring after initial treatment. Tumor Treating Fields (TTFields) therapy is the newest treatment modality for glioblastoma. Here, we describe the proper application of TTFields-transducer arrays on patients and discuss theory and aspects of treatment.

Клиническое применение лечения глиобластома поля терапии опухоли

Glioblastoma is the most common and lethal form of brain cancer, with a median survival of 15 months after diagnosis and a 5 year survival rate of only 5% ...

In Vitro Evaluation of Oncogenic Transformation in Human Mammary Epithelial Cells

Tumorigenesis is a multi-step process in which cells acquire capabilities&#160;that allow their growth, survival, and dissemination under hostile conditions. Different tests seek to identify and quantify these hallmarks of cancerous cells; however, they often focus on a single aspect of cellular transformation and, in fact, multiple tests are required for their proper characterization. The purpose of this work is to provide researchers with a set of tools to assess cellular transformation in vitro from a broad perspective, thereby making it possible to draw sound conclusions.
A sustained proliferative signaling activation is the major feature of tumoral tissues and can be easily monitored under in vitro conditions by calculating the number of population doublings achieved over time. Besides, the growth of cells in 3D cultures allows their interaction with surrounding cells, resembling what occurs in vivo. This enables the evaluation of cellular aggregation and, together with immunofluorescent labeling of distinctive cellular markers, to obtain information on another relevant feature of tumoral transformation: the loss of proper organization. Another remarkable characteristic of transformed cells is their capacity to grow without attachment to other cells and to the extracellular matrix, which can be evaluated with the anchorage assay.
Detailed experimental procedures to evaluate cell growth rate, to perform immunofluorescent labeling of cell lineage markers in 3D cultures, and to test anchorage-independent cell growth in soft agar are provided. These methodologies are optimized for Breast Primary Epithelial Cells (BPEC) due to its relevance in breast cancer; however, procedures can be applied to other cell types after some adjustments.

This protocol provides experimental in vitro tools to evaluate the transformation of human mammary cells. Detailed steps to follow-up cell proliferation rate, anchorage-independent growth capacity, and distribution of cell lineages in 3D cultures with basement membrane matrix are described.

In Vitro Оценка онкогенной трансформации в эпителиальных клетках молочной железы человека

Tumorigenesis is a multi-step process in which cells acquire capabilities&#160;that allow their growth, survival, and dissemination under hostile ...

Co-culture of Glutamatergic Neurons and Pediatric High-Grade Glioma Cells Into Microfluidic Devices to Assess Electrical Interactions

Pediatric high-grade gliomas (pHGG) represent childhood and adolescent brain cancers that carry a rapid dismal prognosis. Since there is a need to overcome the resistance to current treatments and find a new way of cure, modeling the disease as close as possible in an in vitro setting to test new drugs and therapeutic procedures is highly demanding. Studying their fundamental pathobiological processes, including glutamatergic neuron hyperexcitability, will be a real advance in understanding interactions between the environmental brain and pHGG cells. Therefore, to recreate neurons/pHGG cell interactions, this work shows the development of a functional in vitro model co-culturing human-induced Pluripotent Stem (hiPS)-derived cortical glutamatergic neurons pHGG cells into compartmentalized microfluidic devices and a process to record their electrophysiological modifications. The first step was to differentiate and characterize human glutamatergic neurons. Secondly, the cells were cultured in microfluidic devices with pHGG derived cell lines. Brain microenvironment and neuronal activity were then included in this model to analyze the electrical impact of pHGG cells on these micro-environmental neurons. Electrophysiological recordings are coupled using multielectrode arrays (MEA) to these microfluidic devices to mimic physiological conditions and to record the electrical activity of the entire neural network. A significant increase in neuron excitability was underlined in the presence of tumor cells.

Recent works uncover the neuronal impact on high-grade pediatric glioma (pHGG) cells and their reciprocal interactions. The present work shows the development of an in vitro model co-culturing pHGG cells and glutamatergic neurons and recorded their electrophysiological interactions to mimic those interactivities.

Кокультура глутаматергических нейронов и педиатрических клеток глиомы высокой степени в микрофлюидные устройства для оценки электрических взаимодействий

Pediatric high-grade gliomas (pHGG) represent childhood and adolescent brain cancers that carry a rapid dismal prognosis. Since there is a need to ...

Flexible Organic Electronic Devices for Pulsed Electric Field Therapy of Glioblastoma

Glioblastoma is difficult to eradicate with standard oncology therapies due to its high degree of invasiveness. Bioelectric treatments based on pulsed electric fields (PEFs) are promising for the improvement of treatment efficiency. However, they rely on rigid electrodes that cause acute and chronic damage, especially in soft tissues such as the brain. In this work, flexible electronics were used to deliver PEFs to tumors and the biological response was evaluated with fluorescent microscopy. Interdigitated gold electrodes on a thin, transparent parylene-C substrate were coated with the conducting polymer PEDOT:PSS, resulting in a conformable and biocompatible device. The effects of PEFs on tumors and their microenvironment were examined using various biological models. First, monolayers of glioblastoma cells were cultured on top of the electrodes to investigate phenomena in vitro. As an intermediate step, an in ovo model was developed where engineered tumor spheroids were grafted in the embryonic membrane of a quail. Due to the absence of an immune system, this led to highly vascularized tumors. At this early stage of development, embryos have no immune system, and tumors are not recognized as foreign bodies. Thus, they can develop fast while developing their own vessels from the existing embryo vascular system, which represents a valuable 3D cancer model. Finally, flexible electrode delivery of PEFs was evaluated in a complete organism with a functional immune system, using a syngenic, orthograft (intracranial) mouse model. Tumor spheroids were grafted into the brain of transgenic multi-fluorescent mice prior to the implantation of flexible organic electrode devices. A sealed cranial window enabled multiphoton imaging of the tumor and its microenvironment during treatment with PEFs over a period of several weeks.

This work describes the development of flexible interdigitated electrodes for implementation in 3D brain tumor models, namely, in vitro culture, in ovo model, and in vivo murine model. The proposed method can be used to evaluate the effects of pulsed electric fields on tumors at different levels of complexity.

Гибкие органические электронные устройства для импульсной терапии глиобластомы электрическим полем

Glioblastoma is difficult to eradicate with standard oncology therapies due to its high degree of invasiveness. Bioelectric treatments based on pulsed ...

Generation and Culturing of High-Grade Serous Ovarian Cancer Patient-Derived Organoids

Organoids are 3D dynamic tumor models that can be grown successfully from patient-derived ovarian tumor tissue, ascites, or pleural fluid and aid in the discovery of novel therapeutics and predictive biomarkers for ovarian cancer. These models recapitulate clonal heterogeneity, the tumor microenvironment, and cell-cell and cell-matrix interactions. Additionally, they have been shown to match the primary tumor morphologically, cytologically, immunohistochemically, and genetically. Thus, organoids facilitate research on tumor cells and the tumor microenvironment and are superior to cell lines. The present protocol describes distinct methods to generate patient-derived ovarian cancer organoids from patient tumors, ascites, and pleural fluid samples with a higher than 97% success rate. The patient samples are separated into cellular suspensions by both mechanical and enzymatic digestion. The cells are then plated utilizing a basement membrane extract (BME) and are supported with optimized growth media containing supplements specific to the culturing of high-grade serous ovarian cancer (HGSOC). After forming initial organoids, the PDOs can sustain long-term culture, including passaging for expansion for subsequent experiments.

Patient-derived organoids (PDO) are a three-dimensional (3D) culture that can mimic the tumor environment in vitro. In high-grade serous ovarian cancer, PDOs represent a model to study novel biomarkers and therapeutics.

Генерация и культивирование высокодифференцированных серозных органоидов, полученных от пациентов с раком яичников

Organoids are 3D dynamic tumor models that can be grown successfully from patient-derived ovarian tumor tissue, ascites, or pleural fluid and aid in the ...

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when there are tumors adjacent to the cystic bed, surgeons cannot palpate the surgical margins through the laparoscopic approach, which leads to uncertainty about R0 resection. Conventionally, the gallbladder is resected first, and the hepatic lobes or segments are resected second. However, tumor tissues can be disseminated in the above cases. To address this issue, based on the recognition of the porta hepatis and intrahepatic anatomy, we propose a unique approach to hepatectomy combined with gallbladder resection by en bloc anatomic resection in situ. Firstly, after dissecting the cystic duct, without cutting the gallbladder primarily, the porta hepatis is pre-occluded by the single lumen ureter; secondly, the left hepatic pedicle is made free by the gap of the Laennec membrane and Hilar plate; thirdly, the assistant is asked to drag the fundus of the gallbladder, and the liver parenchyma tissue is resected using a harmonic scalpel along the ischemia line on the liver surface and intraoperative ultrasound. The whole middle hepatic vein (MHV) and its tributaries appear completely; lastly, the left hepatic vein (LHV) is disconnected, and the specimen is taken out from the abdominal cavity. The tumor, gallbladder, and other surrounding tissues are resected en bloc, which meets the tumor-free criterion, and a wide incisal margin and R0 resection are achieved. Therefore, the laparoscopic hepatectomy with the combination of the en bloc concept and anatomic resection is a safe, effective, and radical method with low postoperative recurrence and metastasis.

Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

Применение концепции En Bloc в сочетании с анатомической резекцией при лапароскопической гепатэктомии

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when ...