The protocol was carried out in accordance with the principles of the Helsinki Declaration and all the methods described here have been approved by the ethics committee of Daping Hospital and written consent was obtained from the patients.
1. Instruments for operation
<ol>
	<li>Conduct all the procedures under an operating microscope with 5-10x magnification to achieve precise anastomoses and anatomic reconstruction.</li>
</ol>
2. Inclusion and exclusion criteria
<ol>
	<li>Use the following inclusion criteria: patients who experience penile glans amputation during circumcision; the injury of penile glans mainly contains glans and/or distal urethra.</li>
	<li>Use the following exclusion criteria: penile amputation; injured not during circumcision or by disposable stapler; secondary stage repair.</li>
</ol>
3. Preparation for operation
<ol>
	<li>Tie a rubber band at the root of the penis to stop bleeding in advance.</li>
	<li>Keep the amputated glans in the sterile ice-cold saline during the transfer and before replantation.
	<ol>
		<li>Once the glans is amputated, do not discard it.</li>
		<li>Immerse the amputated glans in about 10-20 mL of sterile normal saline (preferably sterile ice-cold saline), and wrap it with two layers of sterile gloves.</li>
		<li>Place it in an ice bucket or vacuum cup with ice and transfer it to a hospital where microsurgery can be performed as soon as possible.</li>
	</ol>
	</li>
	<li>Rinse and disinfect the amputated glans with iodophor three times before replantation.</li>
	<li>Give antibiotics intravenously 30 mins before surgery. Use cefuroxime sodium 0.50-0.75 g with 100 mL of 0.9% sodium chloride solution according to patient&#39;s weight.</li>
</ol>
4. Procedure
<ol>
	<li>Repairment of the amputated penile glans and frenulum if applicable.
	<ol>
		<li>Remove the amputated glans from the preserved ice bag and disinfect. Observe the morphology and integrity of the glans under the microscope. If there is fragmentation, repair it first (Figure 1A).</li>
		<li>Apply 8-0 non-absorbable thread to suture the inner cavernous incision of the glans (Figure 1B). Meanwhile, use 6-0 absorbable thread to suture the tears on the surface of the glans (Figure 1C).</li>
		<li>Trim the alongside frenulum if applicable.</li>
	</ol>
	</li>
	<li>End-to-end urethral anastomosis
	<ol>
		<li>Put the patient in a supine position.</li>
		<li>Observe and evaluate the damage of the stump of glans under the microscope (Figure 1D), and align the amputated glans and frenulum with the stump of glans. Insert an 8 Fr. Foley catheter via the urethral orifice for the drainage of urine (Figure 1E).</li>
		<li>Perform end-to-end urethral anastomosis using 6-0 absorbable thread through the intermittent suture&#160;method with precise positioning. Usually, suture one stitch at 12:00 and 6:00 o&#39;clock of the urethra, respectively at first, and then on the base of two positioning points; suture about four stitches tightly on the left and right sides, respectively in a counterclockwise or clockwise direction (Figure 1F).</li>
	</ol>
	</li>
	<li>Anastomosis of amputated glans surface and reconstruction of the frenulum
	<ol>
		<li>Suture the edge of amputated glans to the edge of the penile stump using 6-0 absorbable thread. Suture a few fixed points at 6, 12, 9, and 3 o&#39;clock at first, and then suture the space between the fixed points with a space of 1 mm for each to achieve a precise anastomosis (Figure 1G).</li>
		<li>Trim the excess inner plate of prepuce on the ventral side of the penile glans if applicable.</li>
		<li>Reconstruct the frenulum by intermittent suture to achieve a satisfactory shape if applicable (Figure 1H,I).</li>
	</ol>
	</li>
</ol>
5. Postoperative care
<ol>
	<li>Evaluate the recovery of local blood circulation by closely observing the color of the replanted penile glans. 
	NOTE: A dark red glans is expected (cherry pulp-like) and it should be observed dynamically. There are some blackish crusts on the surface after days and&#160;make sure not to remove them. Blackish crust does not mean necrosis of the amputated glans.</li>
	<li>Maintain postoperative intravenous antibiotic treatment for 2-3 days and change to oral treatment for 5-7 days.</li>
	<li>Keep the drainage of indwelling catheter unobstructed and remove it 1-2 weeks after the operation.</li>
</ol>

<ol>
	<li>Pippi Salle, J. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glans+amputation+during+routine+neonatal+circumcision:+mechanism+of+injury+and+strategy+for+prevention.">Glans amputation during routine neonatal circumcision: mechanism of injury and strategy for prevention.</a> Journal of Pediatric Urology. 9, 763-768 (2013).</li><li>Rizvi, S. A., Naqvi, S. A., Hussain, M., Hasan, A. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Religious+circumcision:+a+Muslim+view.">Religious circumcision: a Muslim view.</a> BJU International. 83, 13-16 (1999).</li><li>Weiss, H. A., Larke, N., Halperin, D., Schenker, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+circumcision+in+male+neonates,+infants+and+children:+a+systematic+review.">Complications of circumcision in male neonates, infants and children: a systematic review.</a> BMC Urology. 10, 2 (2010).</li><li>Harrison, N. W., Eshleman, J. L., Ngugi, P. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ethical+issues+in+the+developing+world.">Ethical issues in the developing world.</a> BJU International. 76, 93-96 (1995).</li><li>Ceylan, 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=Severe+complications+of+circumcision:+an+analysis+of+48+cases.">Severe complications of circumcision: an analysis of 48 cases.</a> Journal of Pediatric Urology. 3 (1), 32-35 (2007).</li><li>Okeke, L. I., Asinobi, A. A., Ikuerowo, O. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epidemiology+of+complications+of+male+circumcision+in+Ibadan,+Nigeria.">Epidemiology of complications of male circumcision in Ibadan, Nigeria.</a> BMC Urology. 6, 21 (2006).</li><li>Shabanzadeh, D. M., Clausen, S., Maigaard, K., Fode, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Male+circumcision+complications+-+A+systematic+review,+meta-analysis+and+meta-regression.">Male circumcision complications - A systematic review, meta-analysis and meta-regression.</a> Urology. 152, 25-34 (2021).</li><li>Aboutaleb, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reconstruction+of+an+amputated+glans+penis+with+a+buccal+mucosal+graft:+case+report+of+a+novel+technique.">Reconstruction of an amputated glans penis with a buccal mucosal graft: case report of a novel technique.</a> Korean Journal of Urology. 55 (12), 841-843 (2014).</li><li>Co&#349;kunfirat, O. K., Sayilkan, S., Velidedeoglu, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Glans+and+penile+skin+amputation+as+a+complication+of+circumcision.">Glans and penile skin amputation as a complication of circumcision.</a> Annals of Plastic Surgery. 43 (4), 457 (1999).</li><li>El-Bahnasawy, M. S., El-Sherbiny, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Paediatric+penile+trauma.">Paediatric penile trauma.</a> BJU International. 90 (1), 92-96 (2002).</li><li>Petrella, F., Amar, S., El-Sherbiny, M., Capolicchio, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Total+glans+amputation+after+neonatal+circumcision.">Total glans amputation after neonatal circumcision.</a> Urology Case Reports. 37, 101624 (2021).</li><li>Raisin, G., 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=Glans+injury+during+ritual+circumcision.">Glans injury during ritual circumcision.</a> Journal of Pediatric Urology. 16 (4), 471 (2020).</li><li>Nasr, R., Traboulsi, S. L., Abou Ghaida, R. R., Bakhach, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Iatrogenic+penile+glans+amputation:+major+novel+reconstructive+procedure.">Iatrogenic penile glans amputation: major novel reconstructive procedure.</a> Case Reports in Urology. 2013, 741980 (2013).</li><li>Yosra, K., Wiem, H., Mourad, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Saving+an+amputated+glans:+Role+of+winter+shunt.">Saving an amputated glans: Role of winter shunt.</a> Journal of Pediatric Urology. 16 (2), 238-240 (2020).</li><li>Manentsa, M., 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=Complications+of+high+volume+circumcision:+glans+amputation+in+adolescents;+a+case+report.">Complications of high volume circumcision: glans amputation in adolescents; a case report.</a> BMC Urology. 19 (1), 65 (2019).</li><li>Wang, P., 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=Microscopic+Replantation+of+Complete+Penile+Amputation+With+Video+Demonstration.">Microscopic Replantation of Complete Penile Amputation With Video Demonstration.</a> Urology. , (2022).</li></ol>

The authors have nothing to disclose.

For religious or therapeutic purposes, about one-quarter of men around the world have had circumcision1. The incidence of complications is far from negligible, approximately 1% to 20%3,4,5,6,7. Circumcision-related glans amputation is extremely rare and there are no exact statistics depicting its incidence. Owing to its rarity, previous...

Around 25% of men worldwide are circumcised1,2. Circumcision in China is mostly performed in childhood. Over the past decades, the improvements in surgical techniques and equipment have made circumcision less complicated, faster, and with fewer post-circumcision complications. However, the popularity of these devices has also brought new challenges.
The incidence of post-circumcision complications is around 1%-20%, mostly mild3,4,5,6,7. In a recent meta-analysis, which included 351 studies with 4,042,988 participants, the overall complication risk was 3.84% (95% confidence interval 3.35-4.37)7. Circumcision-related glans amputation is a quite rare yet devastating injury during the surgery. Such complication is conventionally treated by simple hemostasis to achieve self-healing, early gross replantation, or delayed plastic surgery8,9. However, these can result in permanent damage to penile appearance and function, along with psychologic problems, if not handled properly8,9. The prevention and treatment of glans amputation have recently developed into a challenging problem for circumcision due to the increasing public health awareness and use of various suture devices in China. There are currently no existing protocols or guidelines for the treatment of such injury, which may be due to its rarity. As a result, there is no unified understanding of the injury mechanism of glans amputations, and there is a lack of early treatment management or prevention strategies.
In this study, we reported a case series of amputated penile glans caused by dispoable stapler during&#160;circumcision, which were successfully treated by microsurgery. The&#160;technical details of microsurgery were presented by video, and their possible injury mechanisms and prevention strategies were also discussed. This protocol is applicable for early microscopic replantation of all patients with penile glans amputation caused by accidental injury.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Catheter&#160;</td>
			<td>Guangzhou Weili Co., Ltd</td>
			<td>12 Fr</td>
			<td></td>
		</tr>
		<tr>
			<td>Cefuroxime sodium</td>
			<td>Yiyi Saite, Co., Ltd</td>
			<td>0.75 g</td>
			<td></td>
		</tr>
		<tr>
			<td>Cis-atrecu besylate</td>
			<td>Jiangsu Dongying CO.,&#160; Ltd</td>
			<td>10 mg</td>
			<td></td>
		</tr>
		<tr>
			<td>Operating microscope system</td>
			<td>Carl Zeiss Co., Ltd</td>
			<td>OPMI VARIO 700&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Pentylpheptyl ether hydrochloride</td>
			<td>Chengdu Lisi Co., Ltd</td>
			<td>1.0 mg</td>
			<td></td>
		</tr>
		<tr>
			<td>Prolene</td>
			<td>Ethicon, LLC</td>
			<td>W2777/2780</td>
			<td></td>
		</tr>
		<tr>
			<td>Sufentanni citrate</td>
			<td>Renfu Phermaceutical</td>
			<td>50 &#181;g</td>
			<td></td>
		</tr>
		<tr>
			<td>Vicryl</td>
			<td>Ethicon, LLC</td>
			<td>W9981</td>
			<td></td>
		</tr>
	</tbody>
</table>

microscopic replantation of penile glans amputation due to circumcision

Circumcision using a disposable stapler is becoming quite popular in China. However, improper surgical procedures also bring the risk of penile glans amputation, which is a very rare iatrogenic genital injury. Such complication is conventionally treated by simple hemostasis to achieve self-healing, early gross replantation, or delayed plastic surgery. However, these may lead to obvious unfavorable outcomes such as amputated glans loss, necrosis, malformation healing, or urethral orifice stenosis. In the present study, we adopted microscopic replantation as an emergency approach to achieve the precise anastomoses and anatomic reconstruction of penile glans. The goal of this protocol is to present a detailed emergency management strategy with meticulous surgical skills for the penile glans amputation. The postoperative results showed that the original shape of the glans was perfectly restored with satisfactory cosmetic appearance. The micturition function was completely restored to normal without any obvious complications. There was also no significant reduction in the sensation of amputated glans area. Hence, early meticulous microscopic replantation as soon as possible is an ideal emergency management strategy for the penile glans amputation due to circumcision.

Three 7-8 years old children, whose distal penile glans were completely (2 cases) or incompletely (1 case) amputated during circumcision using a disposable stapler, were admitted to the hospital within 2-3 h after injury from June 2019 to July 2021. Physical examination confirmed that about 1/3 of the distal end of the penile glans with 3-4 mm of distal urethra was completely or incompletely amputated. In one severe case, the inner plate of prepuce and frenulum on the ventral side of the glans were also seriously damaged...

Watch this Scientific Journal Video about Microscopic Replantation of Penile Glans Amputation Due to Circumcision at JoVE.com

Microscopic Replantation of Penile Glans Amputation Due to Circumcision

The present protocol describes the emergency management of microscopic replantation of penile glans amputation due to circumcision.

Circumcision using a disposable stapler is becoming quite popular in China. However, improper surgical procedures also bring the risk of penile glans ...

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17.9K Views.  Army Medical University. The present protocol describes the emergency management of microscopic replantation of penile glans amputation due to circumcision.

Video: Microscopic Replantation of Penile Glans Amputation Due to Circumcision

The Measurement and Treatment of Suppression in Amblyopia

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current estimates put the prevalence of amblyopia at approximately 1-3%1-3, the majority of cases being monocular2. Amblyopia is most frequently caused by ocular misalignment (strabismus), blur induced by unequal refractive error (anisometropia), and in some cases by form deprivation.
Although amblyopia is initially caused by abnormal visual input in infancy, once established, the visual deficit often remains when normal visual input has been restored using surgery and/or refractive correction. This is because amblyopia is the result of abnormal visual cortex development rather than a problem with the amblyopic eye itself4,5 . Amblyopia is characterized by both monocular and binocular deficits6,7 which include impaired visual acuity and poor or absent stereopsis respectively. The visual dysfunction in amblyopia is often associated with a strong suppression of the inputs from the amblyopic eye under binocular viewing conditions8. Recent work has indicated that suppression may play a central role in both the monocular and binocular deficits associated with amblyopia9,10 .
Current clinical tests for suppression tend to verify the presence or absence of suppression rather than giving a quantitative measurement of the degree of suppression. Here we describe a technique for measuring amblyopic suppression with a compact, portable device11,12 . The device consists of a laptop computer connected to a pair of virtual reality goggles. The novelty of the technique lies in the way we present visual stimuli to measure suppression. Stimuli are shown to the amblyopic eye at high contrast while the contrast of the stimuli shown to the non-amblyopic eye are varied. Patients perform a simple signal/noise task that allows for a precise measurement of the strength of excitatory binocular interactions. The contrast offset at which neither eye has a performance advantage is a measure of the "balance point" and is a direct measure of suppression. This technique has been validated psychophysically both in control13,14 and patient6,9,11 populations.
In addition to measuring suppression this technique also forms the basis of a novel form of treatment to decrease suppression over time and improve binocular and often monocular function in adult patients with amblyopia12,15,16 . This new treatment approach can be deployed either on the goggle system described above or on a specially modified iPod touch device15.

Amblyopia is a developmental disorder of the visual cortex that is often accompanied by strong suppression of one eye. We present a new technique for measuring and treating interocular suppression in patients with amblyopia that can be deployed using virtual reality goggles or a portable iPod Touch device.

Amblyopia, a developmental disorder of the visual cortex, is one of the leading causes of visual dysfunction in the working age population. Current ...

A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based three-chamber bags (3CBs) and soybean-oil-based compounded bags (CoBs) in hospitalized adult patients. We designed a multicenter, randomized, prospective, open-label, noninferiority protocol to compare the efficacy, safety, and distribution of olive-oil-based 3CBs and soybean-oil-based CoB formulations in adult Chinese patients requiring PN during surgical intervention. Subjects were randomized to receive either one of the study treatments using an interactive voice or web-based recognition system in accordance with the randomization code. Randomization was further stratified based on the study site and surgical category. Both treatment groups received similar amounts of calories and protein. In addition, the two study treatments contained a similar composition of the amino-acid component. The only difference between the two PN formulations was the lipid constitution. The duration of administration of study treatments was a minimum of 5 days up to a maximum of 14 days after the surgical procedure. The primary efficacy endpoint was serum prealbumin levels on day 5 of the study. Noninferiority was proved if the anti-log of the lower bound of the 95% confidence interval (CI) of the treatment difference was at least 0.80. Other efficacy measures included treatment preparation time; duration to achieve tolerability of oral nutrition; associated infectious complications; length of hospitalization; and laboratory assessment of markers of nutrition, inflammation, metabolism, and oxidative stress. A total of 458 patients were enrolled in the study. The results showed that olive-oil-based 3CBs were non-inferior to soybean-based CoBs, besides being well tolerated. The infection rate was found to be significantly lower in the olive-oil-based 3CB group. Thus, this study may be used as a reference for future research on lipid emulsion and 3CBs.

Here, we present a protocol for a study comparing the efficacy, safety, and delivery of olive-oil-based 3CB and soybean-oil-based CoB formulations in adults requiring parenteral nutrition. The results revealed that olive-oil-based 3CBs is non-inferior and well tolerated compared to soybean formulations.

Limited evidence exists to precisely estimate efficacy and safety differences between parenteral nutrition (PN) prepared using olive-oil-based ...

Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia

Critical limb ischemia (CLI) represents an advanced stage of the peripheral arterial disease. Angioplasty improves the blood flow to the lower limb; however, some patients irreversibly progress to limb amputation. The extent of vascular damage and the mechanisms of vascular repair are factors affecting post-angioplasty outcome. Mononuclear Progenitor Cells (MPCs) are reactive to vascular damage and repair, with the ability to reflect vascular diseases. The present protocol describes quantification of MPCs obtained from blood circulation from vessel close to the angioplasty site, as well as its relationship with endothelial dysfunction and its predictive ability for limb amputation in the next 30 days after angioplasty in patients with CLI.

Lower limb amputation may occur even after angioplasty of obstructed vessels in Critical Limb Ischemia (CLI). Mononuclear Progenitor Cells (MPCs) reflect vascular repair. The present protocol describes the quantification of MPCs from circulation close to angioplasty, and its relationship with endothelial dysfunction and prediction of lower limb amputation.

Critical limb ischemia (CLI) represents an advanced stage of the peripheral arterial disease. Angioplasty improves the blood flow to the lower limb; ...

Microscopic Observation of Lymphocyte Dynamics in Rat Peyer's Patches

Na&#239;ve lymphocytes recirculate from the blood to the lymphoid tissues under physiological condition and it is commonly recognized as an important phenomenon in the gut immunity. The stroma of secondary lymphoid organs, such as Peyer&#8217;s patches (PPs) or mesenteric lymph nodes, are where na&#239;ve lymphocytes sense antigens. Na&#239;ve lymphocytes circulate through the bloodstream to reach high endothelial venules, the portal of entry into PPs. Some immunomodulators are estimated to influence lymphocyte migration, but the precise evaluation of microcirculation dynamics is very difficult, and establishing a method to observe lymphocyte migration in vivo can contribute to the clarification of the precise mechanisms. We refined the method of collecting lymphocytes from the lymph duct and observing the detailed dynamics of gut-tropic lymphocytes in rat PPs. We chose confocal laser scanning microscopy to observe rat PPs in vivo and recorded it using time-lapse photography. We can now obtain clear images that can contribute to the analysis of lymphocyte dynamics.

Here, we describe a precise method for collecting thoracic duct lymphocytes and observing the migration of gut-tropic lymphocytes in rat Peyer&#8217;s patches for 3 hours using time-lapse photography. This technique can clarify how the dynamics of lymphocytes are affected under inflammatory conditions.

Na&#239;ve lymphocytes recirculate from the blood to the lymphoid tissues under physiological condition and it is commonly recognized as an important ...

The Microscopic Transcanal Approach in Stapes Surgery Revisited

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the external auditory canal, the middle ear, and epitympanon. Such an approach avoids a retroauricular or endaural skin incision; however, working through a narrow space needs angled microsurgical instruments and specific training in otologic surgery. The transcanal approach restricts the working space; however, it offers a binocular microscopic vision into the middle ear without extended skin incisions and thus, reducing post-operative pain and bleeding. In addition, this minimally invasive approach avoids scar tissue complications, hypoesthesia of the auricle, and potential protrusion of the pinna. Despite its numerous advantages, this method is still not routinely performed by otologic surgeons. Since this minimally invasive technique is more challenging, there is a need for extensive training in order for it to be widely adopted by otologic surgeons. This article provides step-by-step surgical instructions for stapes surgery and reports possible indications, pitfalls, and limitations using this microscopic transcanal technique.

This article describes the microscopic transcanal technique for stapes surgery, providing step-by-step surgical instructions for familiarizing surgeons with this approach.

The microscopic transcanal (aka transmeatal) surgical approach was first described in the 60s, offering a minimally invasive means of reaching the ...

A Model of Reverse Vascular Remodeling in Pulmonary Hypertension Due to Left Heart Disease by Aortic Debanding in Rats

Pulmonary hypertension due to left heart disease (PH-LHD) is the most common form of PH, yet its pathophysiology is poorly characterized than pulmonary arterial hypertension (PAH). As a result, approved therapeutic interventions for the treatment or prevention of PH-LHD are missing. Medications used to treat PH in PAH patients are not recommended for treatment of PH-LHD, as reduced pulmonary vascular resistance (PVR) and increased pulmonary blood flow in the presence of increased left-sided filling pressures may cause left heart decompensation and pulmonary edema. New strategies need to be developed to reverse PH in LHD patients. In contrast to PAH, PH-LHD develops due to increased mechanical load caused by congestion of blood into the lung circulation during left heart failure. Clinically, mechanical unloading of the left ventricle (LV) by aortic valve replacement in aortic stenosis patients or by implantation of LV assist devices in end-stage heart failure patients normalizes not only pulmonary arterial and right ventricular (RV) pressures but also PVR, thus providing indirect evidence for reverse remodeling in the pulmonary vasculature. Using an established rat model of PH-LHD due to left heart failure triggered by pressure overload with subsequent development of PH, a model is developed to study the molecular and cellular mechanisms of this physiological reverse remodeling process. Specifically, an aortic debanding surgery was performed, which resulted in reverse remodeling of the LV myocardium and its unloading. In parallel, complete normalization of RV systolic pressure and significant but incomplete reversal of RV hypertrophy was detectable. This model may present a valuable tool to study the mechanisms of physiological reverse remodeling in the pulmonary circulation and the RV, aiming to develop therapeutic strategies for treating PH-LHD and other forms of PH.

The present protocol describes a surgical procedure to remove ascending-aortic banding in a rat model of pulmonary hypertension due to left heart disease. This technique studies endogenous mechanisms of reverse remodeling in the pulmonary circulation and the right heart, thus informing strategies to reverse pulmonary hypertension and/or right ventricular dysfunction.

Pulmonary hypertension due to left heart disease (PH-LHD) is the most common form of PH, yet its pathophysiology is poorly characterized than pulmonary ...

Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion

The benefits of renal sympathetic denervation (RDN) on blood pressure have been proved in a large number of clinical trials in recent years. However, the regulatory mechanism of RDN on hypertension remains elusive. Thus, it&#39;s essential to establish a simpler RDN model in mice. In this study, osmotic mini pumps filled with Angiotensin II were implanted in 14-week-old C57BL/6 mice. One week after the implantation of the mini-osmotic pump, a modified RDN procedure was performed on bilateral renal arteries of the mice using phenol. Age-sex-matched mice were given saline and served as sham group. Blood pressure was measured at baseline and every week subsequently for 21 days. Then, renal artery, abdominal aorta and heart were collected for histological examination using H&#38;E and Masson staining. In this study, we present a simple, practical, repeatable, and standardized RDN model, which can control hypertension and alleviate cardiac hypertrophy. The technique can denervate peripheral renal sympathetic nerves without renal artery damage. Compared to previous models, the modified RDN facilitates the study of the pathobiology and pathophysiology of hypertension.

Here, we present a protocol for renal sympathetic denervation (RDN) in mice with hypertension induced by Angiotensin II infusion. The procedure is repeatable, convenient and allows to study the regulatory mechanisms of RDN on hypertension and cardiac hypertrophy.

The benefits of renal sympathetic denervation (RDN) on blood pressure have been proved in a large number of clinical trials in recent years. However, the ...

Network Pharmacology Prediction and Experimental Validation of Trichosanthes-Fritillaria thunbergii Action Mechanism Against Lung Adenocarcinoma

We aimed to study the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma (LUAD) based on network pharmacology and experimental verification. The effective components and potential targets of Trichosanthis and Fritillaria thunbergii were collected by high-throughput experiment and reference-guided (HERB) database of traditional Chinese medicine and a similarity ensemble approach (SEA) database, and the LUAD-related targets were queried by the GeneCards and Online Mendelian Inheritance in Man (OMIM) databases. A drug-component-disease-target network was constructed by Cytoscape software. Protein-protein interaction (PPI) network, gene ontology (GO) function, and Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analyses were conducted to obtain core targets and key pathways. An aqueous extract of Trichosanthes-Fritillaria thunbergii and A549 cells were used for the subsequent experimental validation. Through the HERB database and literature search, 31 effective compounds and 157 potential target genes of Trichosanthes-Fritillaria thunbergii were screened, of which 144 were regulatory targets of Trichosanthes-Fritillaria thunbergii in the treatment of lung adenocarcinoma. The GO functional enrichment analysis showed that the mechanism of action of Trichosanthes-Fritillaria thunbergii against lung adenocarcinoma is mainly protein phosphorylation. The KEGG pathway enrichment analysis suggested that the treatment of lung adenocarcinoma by Trichosanthes-Fritillaria thunbergii mainly involves the PI3K/AKT signaling pathway. The experimental validation showed that an aqueous extract of Trichosanthes-Fritillaria thunbergii could inhibit the proliferation of A549 cells and the phosphorylation of AKT. Through network pharmacology and experimental validation, it was verified that the PI3K/AKT signaling pathway plays a vital role in the action of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma.

Network Pharmacology Prediction and Experimental Validation of Trichosanthes-Fritillaria thunbergii Action Mechanism Against Lung Adenocarcinoma

This study reveals the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma based on network pharmacology and experimental verification. The study also demonstrates that the PI3K/AKT signaling pathway plays a vital role in the action of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma.

We aimed to study the mechanism of Trichosanthes-Fritillaria thunbergii in treating lung adenocarcinoma (LUAD) based on network pharmacology and ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled &#34;microscopic epididymal exploration and cystectomy&#34;. The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (&#62;0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.

Here, we present a protocol to treat patients diagnosed with an epididymal cyst using microscopic cyst resection. Based on microscopic manipulation, a largely improved visualization of the subtle tissue structures of the epididymis was obtained, so the cyst could be clearly dissected apart and completely removed intact.

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

Comparative Study of Blood Collection Techniques in Rats

Modified Tail Vein and Penile Vein Puncture for Blood Sampling in the Rat Model

Blood samples are required in most experimental animal designs to assess various hematological parameters. This paper presents two procedures for blood collection in rats: the lateral tail vein puncture and the dorsal penile vein puncture, which offer significant advantages over other previously described techniques. This study shows that these two procedures allow for fast sampling (under 10 min) and yield sufficient blood volumes for most assays (202 &#956;L &#177; 67.7 &#956;L). The dorsal penile vein puncture must be done under anesthesia, whereas the lateral tail vein puncture can be done on a conscious, restrained animal.
Alternating these two techniques, therefore, enables blood draw in any situation. While it is always recommended for an operator to be assisted during a procedure to ensure animal welfare, these techniques require only a single operator, unlike most blood sampling methods that require two. Moreover, whereas these previously described methods (e.g., jugular stick, subclavian vein blood draw) require extensive prior training to avoid harm to or death of the animal, tail vein and dorsal penile vein puncture are rarely fatal. For all these reasons, and according to the context (e.g., for studies including male rats, during the perioperative or immediate postoperative period, for animals with thin tail veins), both techniques can be used alternately to enable repeated blood draws.

Author Spotlight: Context Dependent Blood Collection Methods in Rats 

Here, we present a protocol to offer rapid, easy, and reliable blood collection alternatives for the rat model. We describe three different blood sampling methods according to the context: tail vein puncture under anesthesia or on a conscious animal, and dorsal penile vein puncture under anesthesia.

Blood samples are required in most experimental animal designs to assess various hematological parameters. This paper presents two procedures for blood ...