ENDOSURGICAL TECHNOLOGIES FOR TREATMENT OF BRONCHOPULMONARY SEQUESTRATION IN CHILDREN

The study systematized the long-term experience of thoracoscopic and laparoscopic treatment of intra- and extrapleural forms of bronchopulmonary sequestration (BPS). Materials and methods of research: a retrospective study analysed clinical data of 20 patients with BPS who have underwent thoracoscopic and laparoscopic surgeries for 15 years, starting from 2005. The main surgical methods included thoracoscopic lobectomy, thoracoscopic sequestrectomy, laparoscopic sequestrectomy and combined thoracoscopic transdiaphragmatic access in a patient with multiple forms of BPS. Results: a total of 20 patients with BPS had an intralobar form, 5 had an extralobar form, 4 had an extrapleural type, and 1 had a combined (extralobar + extrapleural) form. Intralobar form of BPS was found in the left lower lobe in 6 patients, in the right lower lobe – in 4. Extralobar BPS was found near the left lower lobe in 3 patients, near the lower right lobe – in 2. Extrapleural BPS was observed in the abdominal cavity under the diaphragm in 3 patients, in one patient – in the thickness of the diaphragmatic muscle. One patient had a combined form of BPS in the form of an association of extralobaric and intra-abdominal types. Thoracoscopy was performed in 16 patients, laparoscopy in 4 patients. The mean operative time was 60 min (range: 40–100 min). Intraoperative blood loss was not observed. A drainage tube was installed in 10 patients with intralobaric BPS. In all other cases, the pleural and abdominal cavity was not drained. A histological examination of all resected pulmonary sequesters showed that in half of the cases (10/20) the anomaly was associated with other malformations of the lungs (cystoadenomatous malformation of the lungs, bronchogenic cyst or intestinal duplication). During the 5 year average observation period after surgery (range: 1–15 years), musculoskeletal deformities of the chest and adhesive intestinal obstruction were not recorded. Conclusion: the series of minimally invasive treatment of patients with BPS presented in this study demonstrates the effectiveness and safety of this approach, especially for the surgical correction of those forms of pulmonary sequestration when they are located in hard-to-reach anatomical spaces of the body.

EVALUATION OF POSTOPERATIVE SHOULDER TIP PAIN IN LOW PRESSURE VERSUS STANDARD PRESSURE PNEUMOPERITONEUM DURING LAPAROSCOPIC CHOLECYSTECTOMY

Introduction:- Insufation of carbon dioxide during laparoscopic cholecystectomy carries on to postoperative shoulder tip pain. The beginning of shoulder pain is commonly presumed to be due to overstretching of the diaphragmatic muscle bres due to high carbon dioxide pressure. Methods: - Patients came and admitted to the surgery department for elective cholecystectomy were enrolled in the study. The patients were randomly divided in two groups (group A and group B). In group A - low-pressure pneumoperitoneum (8 mm Hg) and in group B- standard pressure pneumoperitoneum (14 mm Hg) was created during laparoscopic cholecystectomy. Postoperative shoulder tip pain was evaluated at 4 hours and 24 hours after the operation. Results:- Fourteen patients or 28 % of patients in group B complained of postoperative shoulder tip pain as collated to only ve patients (10%) in group A. The mean intensity of postoperative shoulder tip pain assessed by the visual analogue scoring scale at 4 hours and 24 hours was less in group A as collated to group B. However, statistical signicance was seen only at four hours. Analgesic requirements and the mean length of postoperative stay in the hospital were minor in group-A as collated to group B. Conclusion: - Low-pressure laparoscopic cholecystectomy signicantly reduces the frequency and intensity of postoperative shoulder tip pain. Low-pressure laparoscopic cholecystectomy decreases the demand for postoperative analgesics, decreases postoperative hospital stay, and improves the quality of life in the initial stage of postoperative rehabilitation.

Skeletal Deformities in Osterix-Cre;Tgfbr2f/f Mice May Cause Postnatal Death

Transforming growth factor β (TGFβ) signaling plays an important role in skeletal development. We previously demonstrated that the loss of TGFβ receptor II (Tgfbr2) in Osterix-Cre-expressing mesenchyme results in defects in bones and teeth due to reduced proliferation and differentiation in pre-osteoblasts and pre-odontoblasts. These Osterix-Cre;Tgfbr2f/f mice typically die within approximately four weeks for unknown reasons. To investigate the cause of death, we performed extensive pathological analysis on Osterix-Cre- (Cre-), Osterix-Cre+;Tgfbr2f/wt (HET), and Osterix-Cre+;Tgfbr2f/f (CKO) mice. We also crossed Osterix-Cre mice with the ROSA26mTmG reporter line to identify potential off-target Cre expression. The findings recapitulated published skeletal and tooth abnormalities and revealed previously unreported osteochondral dysplasia throughout both the appendicular and axial skeletons in the CKO mice, including the calvaria. Alterations to the nasal area and teeth suggest a potentially reduced capacity to sense and process food, while off-target Cre expression in the gastrointestinal tract may indicate an inability to absorb nutrients. Additionally, altered nasal passages and unexplained changes in diaphragmatic muscle support the possibility of hypoxia. We conclude that these mice likely died due to a combination of breathing difficulties, malnutrition, and starvation resulting primarily from skeletal deformities that decreased their ability to sense, gather, and process food.

Porcine Decellularized Diaphragm Hydrogel: A New Option for Skeletal Muscle Malformations

Hydrogels are biomaterials that, thanks to their unique hydrophilic and biomimetic characteristics, are used to support cell growth and attachment and promote tissue regeneration. The use of decellularized extracellular matrix (dECM) from different tissues or organs significantly demonstrated to be far superior to other types of hydrogel since it recapitulates the native tissue’s ECM composition and bioactivity. Different muscle injuries and malformations require the application of patches or fillers to replenish the defect and boost tissue regeneration. Herein, we develop, produce, and characterize a porcine diaphragmatic dECM-derived hydrogel for diaphragmatic applications. We obtain a tissue-specific biomaterial able to mimic the complex structure of skeletal muscle ECM; we characterize hydrogel properties in terms of biomechanical properties, biocompatibility, and adaptability for in vivo applications. Lastly, we demonstrate that dECM-derived hydrogel obtained from porcine diaphragms can represent a useful biological product for diaphragmatic muscle defect repair when used as relevant acellular stand-alone patch.

Effects of Pilates Breathing on Chest Expansion, Dyspnoea and Functional Capacity in COPD Patients - An Experimental Study

COPD is highly prevalent and not fully reversible. Hence there arises need for finding new significant treatment strategies for treating and preventing COPD. Pilates breathing is growing in both the area of fitness and rehabilitation, but there is scarcely any scientific research on Pilates breathing, particularly in the area related to respiration, with no research done in India. Pilates breathing if proved effective can be of great benefit in curing and rehabilitating respiratory conditions like COPD who present diaphragmatic muscle dysfunction, where it can be of maximum utility. Taking into consideration the progressive acceptance of the Pilates breathing and lack of its studies in COPD, the study was undertaken to study its effectiveness and inculcate it in routine rehabilitation of COPD patients if proven effective. Keywords: Pilates breathing, COPD, Chronic obstructive pulmonary disease, chest expansion, dyspnoea, functional capacity, experimental study.