scholarly journals Despite the Effects of Tension and Intraluminal Pressure, Which Suture Technique Is the Most Appropriate for Prevention of Air Leakage or Anastomotic Dehiscence in Tracheal Anastomoses in the Short Term? An Experimental Research on Ex Vivo Model

2019 ◽  
Vol 25 (5) ◽  
pp. 231-236 ◽  
Author(s):  
Hasan Ersöz
2007 ◽  
Vol 293 (1) ◽  
pp. R64-R69 ◽  
Author(s):  
Kiyoshi Tsukamoto ◽  
Hajime Ariga ◽  
Chris Mantyh ◽  
Theodore N. Pappas ◽  
Hidenori Yanagi ◽  
...  

Enterochromaffin (EC) cells of the epithelial cells release 5-HT into the lumen, as well as basolateral border. However, the physiological role of released 5-HT into the lumen is poorly understood. Concentrations of 5-HT in the colonic mucosa, colonic lumen, and feces were measured by HPLC in rats. To investigate whether intraluminal 5-HT accelerates colonic transit, 5-HT and 51Cr were administered into the lumen of the proximal colon, and colonic transit was measured. To investigate whether 5-HT is released into the lumen, we used an ex vivo model of isolated vascularly and luminally perfused rat proximal colon. To investigate whether luminal 5-HT is involved in regulating stress-induced colonic motility, the distal colonic motility was recorded under the stress loading, and a 5-HT3 receptor antagonist (ondansetron, 10−6 M, 0.5 ml) was administered intraluminally of the distal colon. Tissue content of 5-HT in the proximal colon (15.2 ± 4.3 ng/mg wet tissue) was significantly higher than that in the distal colon (3.3 ± 0.7 ng/mg wet tissue), while fecal content and luminal concentration of 5-HT was almost the same between the proximal and distal colon. Luminal administration of 5-HT (10−6–10−5 M) significantly accelerated colonic transit. Elevation of intraluminal pressure by 10 cmH2O significantly increased the luminal concentration of 5-HT but not the vascular concentration of 5-HT. Stress-induced stimulation of the distal colonic motility was significantly attenuated by the luminal administration of ondansetron. These results suggest that luminally released 5-HT from EC cells plays an important role in regulating colonic motility in rats.


1998 ◽  
Vol 80 (11) ◽  
pp. 852-858 ◽  
Author(s):  
Helge Einar Roald ◽  
Torstein Lyberg ◽  
Inger Anne Hagberg

SummarySince the role of leukocytes found present in thrombi and haemo-static plugs is not clearly understood, we have investigated the interaction between leukocytes and growing thrombi in a human ex vivo model of arterial thrombogenesis. At a wall shear rate characteristic of moderately stenosed arteries (2600 s–1), granulocytes selectively accumulated at the luminal surface of platelet thrombi. The leukocyte adhesion seemed independent of fibrin formation and was clearly correlated to thrombus growth and platelet activation. In contrast, flow cytometry revealed that the expression of adhesion molecules (CD11a, CD11b, CD11c, CD3, CD14, CD62L, HLA-DR and binding of fibrinogen) on the surface of circulating leukocytes passing the thrombi was, on short term conditions (15 min), independent of thrombus growth. The adhered granulocytes probably play a pivotal role in limiting the size of the evolving thrombi, as suggested by our electron micrographs of the arterial thrombi showing lysed and phagocytosed platelets. Thus, granulocytes might play an active role in the acute/semiacute phase of local thromboregulation.


2020 ◽  
Vol 158 (6) ◽  
pp. S-1219
Author(s):  
Mathias W. Tabat ◽  
Tatiana M. Marques ◽  
John-Peter Ganda Mall ◽  
Richard A. Forsgård ◽  
Robert J. Brummer ◽  
...  
Keyword(s):  
Ex Vivo ◽  

Author(s):  
Yi-Jen Chang ◽  
Daniel J. Duffy ◽  
George E. Moore

Abstract OBJECTIVE To determine the effects of 2-, 4-, 6- and 8-strand suture repairs on the biomechanical properties of canine gastrocnemius tenorrhaphy constructs in an ex vivo model. SAMPLE 56 cadaveric gastrocnemius musculotendinous units from 28 adult large-breed dogs. PROCEDURES Tendons were randomly assigned to 4 repair groups (2-, 4-, 6- or 8-strand suture technique; n = 14/group). Following tenotomy, repairs were performed with the assigned number of strands of 2-0 polypropylene suture in a simple interrupted pattern. Biomechanical testing was performed. Yield, peak, and failure loads, the incidence of 1- and 3-mm gap formation, forces associated with gap formation, and failure modes were compared among groups. RESULTS Yield, peak, and failure forces differed significantly among groups, with significantly greater force required as the number of suture strands used for tendon repair increased. The force required to create a 1- or 3-mm gap between tendon ends also differed among groups and increased significantly with number of strands used. All constructs failed by mode of suture pull-through. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that increasing the number of suture strands crossing the repair site significantly increases the tensile strength of canine gastrocnemius tendon repair constructs and their resistance to gap formation. Future studies are needed to assess the effects of multistrand suture patterns on tendon glide function, blood supply, healing, and long-term clinical function in dogs to inform clinical decision-making.


1994 ◽  
Vol 21 (3) ◽  
pp. 239-243 ◽  
Author(s):  
Sarah H. A. Ghani ◽  
Stephen L. Creanor ◽  
John K. Luffingham ◽  
Richard H. Foye

This study was concerned with an evaluation of fluoride release from commercially available orthodontic bonding composite resins, known as Reliance® and Mirage Dual Cure®, which are claimed to release ionic floride. Forty-eight premolar teeth had brackets bonded with four different composite resins—Mirage Dual Cure®, Reliance®, Right-on® and Heliosit®. They were then immersed in a demineralizing solution. The amount of fluoride released from the composites into the solution was measured. The results indicated that Mirage Dual Curereg; released statistically significant amounts of fluoride over the first 2 days. A similar pattern was noted with Reliance® albeit releasing a lesser amount. From the third day onwards, fluoride release levelled out to concentrations similar to those of the two control materials, Right-on® and Heliosit®(i.e. 0·09 ppm). Fluoride-releasing composite resins, therefore, failed to demonstrate any potential long-term fluoride release within the ex vivo model. Even in the short term, the amount of fluoride released was very small.


Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 141-141 ◽  
Author(s):  
Konstantina Kallinikou ◽  
Fernando Anjos-Afonso ◽  
Michael P Blundell ◽  
Stuart J Ings ◽  
Deepika Kassen ◽  
...  

Abstract Abstract 141 Short term cytokine exposure reduces the engraftment potential of haematopoietic stem and progenitor cells (HSPC). We have previously shown, in MPB CD34+ cells, that this occurs in conjunction with reduced short term homing to the BM of irradiated NOD/SCID animals, and is evident by 4 hours of culture (Ahmed at al, Blood 2004; 103:2079). Homing and engraftment of HSPC is dependent on the SDF-1/CXCR4 axis, that is negatively regulated by CD26, a cell-surface peptidase that cleaves SDF-1. Thus, blockade of CD26 with diprotin A improves engraftment of cord blood HSPC. CD26 levels are low on MPB CD34+ cells, but increase on cytokine exposure, an effect that may account for reduced homing function. We tested the effect of diprotin A treatment on the homing and engraftment of MPB CD34+ progenitors in irradiated NOD/SCID mice. Cytokine exposure (SCF, FL, IL3, IL6 for 48–72 hrs) reduced BM homing of progenitors (to 32±7% of uncultured cells, p=0.031). Treatment with Diprotin A significantly improved the homing of cultured progenitors (p=0.0002 cf non-treated cells), to the levels seen in uncultured cells (NS cf homing of uncultured cells with or without Diprotin A). Despite this increase in levels of homing to the BM, long term engraftment of cultured progenitors is not rescued by CD26 blockade, suggesting a defect beyond the initial step of homing to BM. To assess the BM attachment of transplanted cells, we used the intrabone (IB) assay, injecting cells directly into the tibiae of irradiated recipients thus bypassing the need for homing from the systemic circulation. In comparison to intravenously (IV) injected cells, IB delivery improved engraftment of both cultured and uncultured MPB CD34+ cells. At a cell dose of 106, median engraftment of uncultured cells was 13.27% (range 2.43–49.1, n=5) by IB injection compared with 1.5% (0.1–4.6, n=6) by IV delivery (p<0.01). The engraftment defect of cultured cells, however, persisted in IB transplantation. At a cell dose of 106/animal, median engraftment of cultured cells was 0.73% (0.001–10.93, n=12), compared with 13.27% (2.43–49.1, n=5) for uncultured cells (p<0.05). Injecting twice the cell dose for cultured cells (expanded equivalent number) did not rescue this defect. Engraftment of cultured cells in the injected bone (0.055%, range 0.001–9.28, n=6) was significantly lower than that of uncultured cells (14.4%, 0.08–71.2, n=9, p<0.05). These findings suggest that cytokine exposure reduces the ability of MPB CD34+ cells to be retained in the BM. To study this attachment defect directly, we developed an ex-vivo model where CD34+ cells are incubated in long bones of irradiated, 3-week old Sprague Dawley rats after resident HSPC are removed by vigorous flushing. Irradiation, flushing protocols and cell doses were optimized to ensure sensitivity and reproducibility of the assay. Progenitor adherence was assessed by colony assays on infused and recovered attached cells, correcting for animal weight. In this model, cultured progenitors displayed reduced attachment: median number of attached progenitors, 182.1 (23–384, n=26), compared with 385.4 (49–1124, n=30) for uncultured cells (p<0.0001). Attachment of both uncultured and cultured progenitors was reduced by CXCR4 blockade (42%, and 53% reduction respectively, p<0.05 for both), confirming the in vivo relevance of this model. This model provides a novel system to directly study and manipulate the lodgment of HSPC in the BM. Next, we tested the effect of cytokine exposure on ligand-specific adhesion of MPB progenitors. CD34+ cells were incubated on immobilized ligands and progenitor adhesion assessed from the clonogenic output of non-adherent cells. Progenitor adhesion to several putative niche ligands was significantly reduced following cytokine exposure. Specific adhesion of uncultured progenitors to N-cadherin was 31.8±2%, compared to 19.7±3.2% for cultured progenitors (p=0.0058). Cytokine culture also reduced specific adhesion to osteopontin and VCAM-1 (p=0.0025 and p=0.0164 respectively), but not to fibronectin, suggesting that reduced adhesive function of cultured cells is not a global defect. We conclude that whilst short term homing of cultured MPB CD34+ cells to the BM can be improved by CD26 blockade, the resulting long term engraftment defect remains. This defect is at least partly related to altered adhesive interactions of cultured cells to ligands within the BM. Disclosures: No relevant conflicts of interest to declare.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Floris den Hartog ◽  
Dimitri Sneiders ◽  
John Vlot ◽  
Gert-Jan Kleinrensink ◽  
Johannes Jeekel ◽  
...  

Abstract Aim Incisional hernia remains one of the most frequent complications after abdominal surgery. Several closure techniques exist. However, fundamental biomechanical understanding of these techniques and of the differences in clinical outcomes are still lacking. It is thought that distribution of lateral forces on the midline plays a role. Testing in a clinical setting is limited by sample sizes, costs and ethical regulations. We propose a preclinical ex vivo model in which multiple closure configurations can be tested in a controlled setting, eliminating interfering variables existing in previously published, more complex abdominal wall models. Consequently, this allows a valid comparison between closure modalities based on biomechanical merits. Material and Methods The experimental set-up is represented by a vertical tensile load tester, in which a sutured tissue sample is clamped. The tissue samples are covered with a fine, random speckle pattern via miniscule ink droplets. A high-resolution camera captures the speckles as the tissue is subjected to linear pulling forces. Image analysis documenting relative movement of speckles as a means for measuring tissue deformation is performed in ex-vivo tissue samples, resulting in specific objective biomechanical characteristics for each closure configuration. Results Local tissue strain fields are visualized, and compared between closure modalities and correlated to known linear forces applied to the tissue. The latest results will be shared and discussed. Conclusions A new modality for biomechanical evaluation of closure techniques has been developed. Further validation and serial experiments with different closure modalities with and without mesh reinforcement can be performed in order to determine the biomechanically optimal suture-technique for fascial closure.


2016 ◽  
Vol 58 (1-2) ◽  
pp. 20-26 ◽  
Author(s):  
Andreas Kirschbaum ◽  
Stefanie Hemmerling ◽  
Thorsten Steinfeldt ◽  
Detlef K. Bartsch ◽  
Nikolas Mirow

Background: After resection of the carina with a length of more than 4 cm, anastomoses often need to be performed under tension despite maximum mobilization. If the patient cannot be extubated, the anastomosis remains under continued stress. Anastomoses of the carina can be constructed using various suture techniques, including single interrupted sutures, back wall running but front wall single interrupted sutures, and complete running suture. This experimental study was designed to determine the most tensile stress-resistant anastomotic suture technique. Materials and Methods: Isolated preparations of tracheobronchial trees were recovered from freshly slaughtered pigs. Resection of the carina was carried out in preparation of the experiments. After blind randomization, anastomoses (n = 15 per group) between the distal trachea and the proximal left main bronchus were performed with PDS 4-0 employing three different suture techniques: (1) single interrupted sutures, (2) back wall running but front wall single interrupted sutures (= mixed technique), and (3) complete running suture. The anastomotic specimen was fixed onto a specially constructed device. The tracheal end was intubated with a tube (CH 8.0) and connected to a respirator. Different weights were attached to the distal end of the preparation via a clamp and guide rollers. Airtightness was investigated at the following tensile loads: 0, 500, 1,000 and 1,500 g. Intrabronchial pressure was increased in 5-mbar steps. In an underwater trial, we analyzed whether anastomoses were airtight at a maximum intrabronchial ventilation pressure of 70 mbar. Results: At an intrabronchial pressure of 25 mbar without tensile stress, all anastomoses were initially airtight. In tensionless anastomoses at 70 mbar, 100% of single interrupted and continuous sutures were airtight, as compared to 80% of sutures in mixed technique. At 70 mbar and tensile loads of 1,500 g, 80% of single interrupted sutures, 60% of sutures in mixed technique and 53% of the running sutures remained competent. Conclusion: If tracheal anastomoses can be performed without tension, the suture technique is not important. With increased tension, anastomoses performed in single interrupted suture technique were clearly superior. Thus, in situations, where high tensile stress is to be expected, single interrupted sutures should be preferred.


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