Biliverdin Protects against Liver Ischemia Reperfusion Injury in Swine

Ischemia reperfusion injury (IRI) in organ transplantation remains a serious and unsolved problem. Organs that undergo significant damage during IRI, function less well immediately after reperfusion and tend to have more problems at later times when rejection can occur. Biliverdin has emerged as an agent that potently suppress IRI in rodent models. Since the use of biliverdin is being developed as a potential therapeutic modality for humans, we tested the efficacy for its effects on IRI of the liver in swine, an accepted and relevant pre-clinical animal model. Administration of biliverdin resulted in rapid appearance of bilirubin in the serum and significantly suppressed IRI-induced liver dysfunction as measured by multiple parameters including urea and ammonia clearance, neutrophil infiltration and tissue histopathology including hepatocyte cell death. Taken together, our findings, in a large animal model, provide strong support for the continued evaluation of biliverdin as a potential therapeutic in the clinical setting of transplantation of the liver and perhaps other organs

Detailed knowledge of regional anatomy and anatomical variations is fundamental to achieve successful surgical procedure. Although primary objective of neurosurgery is to restore physiological vital functions, remove intracranial mass and prevent further

Detailed knowledge of regional anatomy and anatomical variations is fundamental to achieve successful surgical procedure. Although primary objective of neurosurgery is to restore physiological vital functions, remove intracranial mass and prevent further brain damage, while preserving tissue and organ integrity, the neurosurgeon takes the risk of impairing non-vital functions. Occasionally, as with the hypoglossal nerve, the impairment of anatomical structures found on surgical route is due to their still barely known anatomical relations and variations. In order to provide an anatomically and surgically oriented classification to guide neurosurgical procedures and to ensure the preservation of nerve integrity, the aim of the present study is to detail the course of the 12th cranial nerve (CN) and to establish anatomical landmarks for surgeons. A combination of anatomical dissection of the neck and oral floor and skull base far lateral approach of 6 cadaveric human heads (3 male, 3 female, age 62+4) was performed, on both sides, to explore and follow the entire course of the 12th CN, from its emergence in the preolivary sulcus to the tongue. Skeletal, muscular and vascular relationships were meticulously analyzed and documented during anatomic and surgical dissections. According to our observations, hypoglossal nerve can be divided into five segments. The first two are intracranial, cisternal and intracanalar, and the other three, namely the descending, horizontal and ascending, are extracranial. Intriguingly, we found unreported relations of the nerve that, apart from their anatomical interest, have tremendous significance for surgeons operating on head and neck. Specifically, the intracanalar segment passes through a venous lacuna that, to the best of our knowledge, was never described before as such. This venous structure drains into the jugular bulb and acts as a sheath between the nerve and the osseous wall of the canal. The nerve in the venous sheath bends and it is elastically fixed to the osseous wall of the canal by fibrous bands. Therefore, the venous lacuna guarantees mobility to the nerve, and cushion the nerve from the bone. As for the descending segment, during its course it has very close relationship with the internal jugular vein, the internal carotid artery, the posterior belly of digastric muscle, and the styloid process and muscles inserting on it. The descending segment provides the ansa hypoglossi, branches to muscles inserting on the styloid process and to the sternocleidomastoid muscle. The horizontal segment has relationship with the intermediate digastric tendon, the stylohyoid, hyoglossus and mylohyoid muscles and the submandibular gland. The ascending segment might be very short and sometimes it is absent. The fifth and last segment becomes deeper at the anterior edge of hyoglossus muscle, and terminates into several branches supplying intrinsic and extrinsic musculature of tongue

A longitudinal study on BIO14.6 hamsters with dilated cardiomyopathy: micro-echocardiographic evaluation

<p>Abstract</p> <p>Background</p> <p>In recent years, several new technologies for small-animal imaging have been developed. In particular, the use of ultrasound in animal imaging has focused on the investigation of accessible biological structures such as the heart, of which it provides a morphological and functional assessment. The purpose of this study was to investigate the role of micro-ultrasonography (μ-US) in a longitudinal study on BIO14.6 cardiomyopathic hamsters treated with gene therapy.</p> <p>Methods</p> <p>Thirty hamsters were divided into three groups (n = 10): Group I, untreated BIO 14.6 hamsters; Group II, BIO 14.6 hamsters treated with gene therapy; Group III, untreated wild type (WT) hamsters. All hamsters underwent serial μ-US sessions and were sacrificed at predetermined time points.</p> <p>Results</p> <p>μ-US revealed: in Group I, progressive dilation of the left ventricle with a change in heart morphology from an elliptical to a more spherical shape, altered configuration of the mitral valve and subvalvular apparatus, and severe reduction in ejection fraction; in Group II, mild decrease in contractile function and ejection fraction; in Group III, normal cardiac chamber morphology and function. There was a negative correlation between the percentage of fibrosis observed at histology and the ejection fraction obtained on μ-echocardiography (Spearman r: -0.839; p < 0.001).</p> <p>Conclusions</p> <p>Although histological examination remains indispensable for a conclusive diagnosis, high-frequency μ-echocardiography, thanks to the high spatial and contrast resolution, can be considered sufficient for monitoring therapeutic efficacy and/or the progression of dilated cardiomyopathy, providing an alternative tool for repeatable and noninvasive evaluation.</p

A Hybrid Analytic Hierarchy Process and Likert Scale Approach for the Quality Assessment of Medical Education Programs

The quality assessment of training courses is of utmost importance in the medical education field to improve the quality of the training. This work proposes a hybrid multicriteria decision-making approach based on two methodologies, a Likert scale (LS) and the analytic hierarchy process (AHP), for the quality assessment of medical education programs. On one hand, the qualitative LS method was adopted to estimate the degree of consensus on specific topics; on the other hand, the quantitative AHP technique was employed to prioritize parameters involved in complex decision-making problems. The approach was validated in a real scenario for evaluating healthcare training activities carried out at the Centre of Biotechnology of the National Hospital A.O.R.N. “A. Cardarelli” of Naples (Italy). The rational combination of the two methodologies proved to be a promising decision-making tool for decision makers to identify those aspects of a medical education program characterized by a lower user satisfaction degree (revealed by the LS) and a higher priority degree (revealed by the AHP), potentially suggesting strategies to increase the quality of the service provided and to reduce the waste of resources. The results show how this hybrid approach can provide decision makers with helpful information to select the most important characteristics of the delivered education program and to possibly improve the weakest ones, thus enhancing the whole quality of the training courses

Training models in pediatric minimally invasive surgery: Rabbit model versus porcine model: a comparative study

The porcine model is the most widely used animal model for laparoscopic training. However, in pediatric surgery, an experimental setting with smaller animals could improve the training conditions. We compared the efficiency of a rabbit model versus the porcine model for training in pediatric minimally invasive surgery (MIS). MATERIALS AND METHODS: At the training center of Cardarelli Hospital in Naples, Italy, 10 young pediatric surgeons underwent training sessions on rabbit and porcine models under the supervision of five experienced tutors. The results of four laparoscopic techniques (inguinal hernia repair, varicocelectomy [basic procedures], nephrectomy, and fundoplication [advanced procedures]) were evaluated in regard to mean operative time, intraoperative complications, and surgical performances. Results were analyzed using Fisher's exact test and Student's t test. RESULTS: Practitioners were significantly more confident in the rabbit model compared with the pig model, especially for advanced procedures (P = .03). The overall surgical performance score (ranging from 0 [unacceptable] to 10 [excellent]) was significantly higher in the rabbit model compared with the pig model (8.1 versus 6.0; P = .01). The most significant scoring differences between the surgical performances of the trainees in the two models were reported in regard to dissection, suturing and knot-tying, tissue handling, and handling of instruments. In addition, the length of surgery for advanced procedures was statistically shorter in the rabbit model compared with the pig model (P = .01). We found that only the performances of those who started on the pig had a significantly higher improvement when transitioning to the rabbit compared with those who started on the rabbit (P = .01). Of the trainees, 90% preferred the rabbit model to the pig model. CONCLUSIONS: On the basis of our preliminary results, rabbits are preferred over pigs as the training model in pediatric MIS. In the rabbit model it is possible to perform more procedures and perform them more easily compared with the porcine model. The rabbit model provides a comfortable approach to technical training in basic and advanced laparoscopic procedures

Magnetic resonance imaging: A new tool for diagnosis of acute ischemic colitis?

AIM: To define the evolution of ischemic lesions with 7T magnetic resonance imaging (7T-MRI) in an animal model of acute colonic ischemia

Laparoscopic Injection of Tissue Adhesives for Inguinal Hernia Repair in a Rabbit Model: Results of an Experimental Comparative Study with the Standard Laparoscopic Inguinal Hernia Repair

Background: The injection of tissue adhesives has been proposed as an alternative to standard laparoscopic inguinal hernia repair but no evidence is available in the pediatric population. This study aimed to evaluate safety, efficacy, and feasibility of injection of tissue adhesives for inguinal hernia repair in a rabbit model. Materials and Methods: Thirty-six New Zealand White male rabbits underwent laparoscopic inguinal hernia repair. In each animal, the hernia defect was repaired using glue on the right side and purse-string suture on the left side. The animals were divided in 3 groups, each 1 of 12 animals, according to the glue used: Glubran 2® (cyanoacrylate), Histoacryl® (cyanoacrylate), and BioGlue® (bovine serum albumin-based). For each group, 6 animals were sacrificed at 7 days postoperatively, and 6 animals at 90 days postoperatively. Histopathological exam of testis and spermatic bundle was performed. Results: The hernia defect was successfully closed on both sides in all cases. The injection of glue was faster than suture repair (P = .001). Postoperative complications (epiploon-parietal adhesions, spermatic vessel ectasia, and hydrocele) rate was significantly higher on the right side compared to the left side at both short- and long-term follow-up (P = .001). Furthermore, a lower maturity of testicles treated by adhesive compared with suture was histologically demonstrated at both short- and long-term follow-up (P = .001). Conclusions: The present experimental study confirmed the feasibility and efficacy of inguinal hernia repair by injection of tissue adhesive. However, several critical issues emerged about the safety of this technique. The use of glue was associated with higher incidence of postoperative complications and significant decrease of testicular maturity compared with standard suture repair. Based upon these preliminary results, repair using suture remains the standard of care for inguinal hernia in children. Further experimental studies are needed to assess the safety of injection of tissue adhesives for pediatric inguinal hernia repair

Acute arterial mesenteric ischemia and reperfusion: macroscopic and MRI findings, preliminary report

AIM: To explore the physiopathology and magnetic resonance imaging (MRI) findings in an animal model of acute arterial mesenteric ischemia (AAMI) with and without reperfusion.METHODS: In this study, 8 adult Sprague-Dawley rats underwent superior mesenteric artery (SMA) ligation and were then randomly divided in two groups of 4. In group., the ischemia was maintained for 8 h. In group., 1-h after SMA occlusion, the ligation was removed by cutting the thread fixed on the back of the animal, and reperfusion was monitored for 8 h. MRI was performed using a 7-T system.RESULTS: We found that, in the case of AAMI without reperfusion, spastic reflex ileus, hypotonic reflex ileus, free abdominal fluid and bowel wall thinning are present from the second hour, and bowel wall hyperintensity in T2-W sequences are present from the fourth hour. The reperfusion model shows the presence of early bowel wall hyperintensity in T2-W sequences after 1 h and bowel wall thickening from the second hour.CONCLUSION: Our study has shown that MRI can assess pathological changes that occur in the small bowel and distinguish between the presence and absence of reperfusion after induced acute arterial ischemia. (C) 2013 Baishideng. All rights reserved