Tissue Coagulation Research Articles

A study on correction method of total acoustic power in presence of shielding in focused ultrasound treatment using acoustic radiation force imaging

High-intensity focused ultrasound (HIFU) therapy is a noninvasive treatment for cancer. Prediction of the HIFU treatment region in advance by ultrasound imaging is important for the efficacy and safety of the treatment. Acoustic radiation force (ARF) imaging has been shown to be useful in estimating the heat distribution caused by HIFU. In this study, we investigated the effect of shielding on the estimated heat distribution when the propagation of HIFU is partially shielded by an object simulating ribs, imitating an actual clinical situation, and examined the correction method of HIFU output power using ARF imaging to obtain tissue coagulation equivalent to that without shielding. As a result, it was suggested that even with partial acoustic shielding, when the HIFU output power is adjusted so that the displacement induced by ARF is equal to that without shielding, almost the same coagulated region can be obtained as in the unshielded case.

MP51-17 INITIAL EXPERIENCE OF TRANSURETHRAL BLUE LASER VAPORIZATION OF PROSTATE USING A NOVEL DUAL WAVELENGTH LASER SYSTEM

You have accessJournal of UrologyCME1 Apr 2023MP51-17 INITIAL EXPERIENCE OF TRANSURETHRAL BLUE LASER VAPORIZATION OF PROSTATE USING A NOVEL DUAL WAVELENGTH LASER SYSTEM Lin Yang, Zhihui Zou, Xiaofeng Xu, Weimin Gan, Liyue Mu, and Dalin He Lin YangLin Yang More articles by this author , Zhihui ZouZhihui Zou More articles by this author , Xiaofeng XuXiaofeng Xu More articles by this author , Weimin GanWeimin Gan More articles by this author , Liyue MuLiyue Mu More articles by this author , and Dalin HeDalin He More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003299.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Our preclinical study confirmed that compared with the commonly used 532 nm, 980 nm and 1470 nm lasers, under the same power, the 450 nm laser has the advantages of higher vaporization efficiency, thinner coagulation layer and lower noise, theoretically it’s more suitable for BPH surgery. In this study, we reported the initial experience of transurethral blue laser vaporization of prostate (BLVP). METHODS: The novel blue laser surgical system is a dual wavelength laser system, which output 450 nm laser (Max: 200 W) and 976 nm laser (Max: 50 W), which are respectively used for tissue vaporization and coagulation by foot switch. Between May and September 2022, four centers were selected to perform BLVP using this novel blue laser surgical system and photo-selective prostate vaporization (PVP) was served as control with the patients ratio of 1:1. The international prostate symptom score (IPSS), Quality of life (QoL), maximum urinary flow rate (Qmax) before and 1 month after operation were collected, and also the operation time and bleeding. The evaluation of blue and green laser surgery from 8 operators was also collected. RESULTS: Total 101 BPH patients were enrolled and 51 received BLVP, 50 received PVP, 8 cases of PVP and 3 cases of BLVP convert to transurethral resection of prostate (TURP) mainly due to uncontrollability bleeding, the other 90 patients completed the follow-up. The novel 200 W 450 nm laser vaporized visible more rapidly than PVP. In surgeons with PVP experience, they found it’s easier to perform BLVP than PVP duo to the reliable hemostatic function by 976 nm laser. In surgeons with no PVP experience, it took 3-5 operations to overcome the desire of "TURP conversion" for BLVP and 5-10 operations for PVP. There was no significant difference between the two groups in baseline data, IPSS, QoL, Qmax and bleeding before and after operation, however, there were no difference of the operation time between two groups. The mainly reason was the power of the blue laser is very strong, which can lead to "bursting" of optical fiber once touch the tissue. It took about 10-20 operations to adapt to this "non-contact" vaporization mode. CONCLUSIONS: The novel blue laser surgical system has high vaporization efficiency, rapid and reliable hemostasis, therefore safe and effectiveness, and easy to learn. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e700 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lin Yang More articles by this author Zhihui Zou More articles by this author Xiaofeng Xu More articles by this author Weimin Gan More articles by this author Liyue Mu More articles by this author Dalin He More articles by this author Expand All Advertisement PDF downloadLoading ...

MP01-12 HISTOLOGY APPEARS TO REVEAL GOOD SEALING OF THE HUMAN, PORCINE AND DOG VASECTOMY SPECIMENS USING THE VASECTOMY SEALING PROCEDURE

You have accessJournal of UrologyCME1 Apr 2023MP01-12 HISTOLOGY APPEARS TO REVEAL GOOD SEALING OF THE HUMAN, PORCINE AND DOG VASECTOMY SPECIMENS USING THE VASECTOMY SEALING PROCEDURE Gerard Henry, Tariq Hakky, Ryan Griggs, Warren Nighan, Alex Fuselier, and Leroy Jones Gerard HenryGerard Henry More articles by this author , Tariq HakkyTariq Hakky More articles by this author , Ryan GriggsRyan Griggs More articles by this author , Warren NighanWarren Nighan More articles by this author , Alex FuselierAlex Fuselier More articles by this author , and Leroy JonesLeroy Jones More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Sealed Vasectomy Procedure (SVP) is a new bipolar radiofrequency sealing tool for transdermal vasectomy in hopes of making the procedure a faster, simpler, and safer office procedure. Testing has been successful in rabbits with excellent wound healing, complete vas occlusion on histology, and no sperm in post procedural semen analysis. The study data was presented last year as a video submission and subsequently won the AUA 2022’s “Best Video” of the andrology/infertility/sexual dysfunction session. Further studies in larger animals were indicated and FDA-approval are needed before its application in humans. The issue of “does the SVP effectively seal the vas deferens in animals larger than a rabbit and in humans?” is a critical one for treating physicians. Evaluate the effectiveness of the SVP in sealing the vas deferens in animals larger than a rabbit and in humans. METHODS: Animal (rabbit) studies have been previously described. We preformed microscopic evaluation of the vas deferens tissues from canines treated with the SVP at either 40 or 60 watts, euthanized at 14 days post-treatment under the conditions of this study. Human vas deferens specimens after removal from the patient were then immediately treated with SVP tool on benchtop. Porcine vas deferens samples were procured and underwent benchtop testing. Specimens were sent for pathologic evaluation by a third-party professional vendor [Crisp County Regional Medical Center in Cordele, Georgia]. RESULTS: 4 canine, 6 human, and 26 porcine vas deferens were included in SVP testing. Human, porcine, and canine specimens demonstrated tissue coagulation and fibrosis in the treated vasa deferentia. (See Figure 1 Human and Figure 2 Canine) CONCLUSIONS: SVP is a potentially exciting novel vasectomy procedure that appears to provide good sealing of the vas deferens in the canine animal model and on benchtop for the human and porcine vas deferens. FDA-approval is still needed before use in humans. Source of Funding: Signati © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e6 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gerard Henry More articles by this author Tariq Hakky More articles by this author Ryan Griggs More articles by this author Warren Nighan More articles by this author Alex Fuselier More articles by this author Leroy Jones More articles by this author Expand All Advertisement PDF downloadLoading ...

Pulsed thulium laser blood vessel haemostasis as an alternative to bipolar forceps during neurosurgical tumour resection

Due to wavelength-specific water absorption, infrared lasers like the thulium laser emitting at 1940 nm wavelength proved to be suitable for coagulation in neurosurgery. Commonly bipolar forceps used for intraoperative haemostasis can cause mechanical and thermal tissue damage, whilst thulium laser can provide a tissue-gentle haemostasis through non-contact coagulation. The aim of this work is a less-damaging blood vessel coagulation by pulsed thulium laser radiation in comparison to standard bipolar forceps haemostasis. Ex vivo porcine blood vessels in brain tissue (0.34 ± 0.20 mm diameter) were irradiated in non-contact with a thulium laser in pulsed mode (1940 nm wavelength, 15 W power, 100–500 ms pulse duration), with a CO2 gas flow provided simultaneously at the distal fibre tip (5 L/min). In comparison, a bipolar forceps was used at various power levels (20–60 W). Tissue coagulation and ablation were evaluated by white light images and vessel occlusion was visualised by optical coherence tomography (OCT) B-scans at a wavelength of 1060 nm. Coagulation efficiency was calculated by means of the quotient of the difference between the coagulation and ablation radius to the coagulation radius. Pulsed laser application achieved blood vessel occlusion rate of 92% at low pulse duration of 200 ms with no occurrence of ablation (coagulation efficiency 100%). Bipolar forceps showed an occlusion rate of 100%, however resulted in tissue ablation. Tissue ablation depth with laser application is limited to 40 μm and by a factor of 10 less traumatising than with bipolar forceps. Pulsed thulium laser radiation achieved blood vessel haemostasis up to 0.3 mm in diameter without tissue ablation and has proven to be a tissue-gentle method compared to bipolar forceps.

Thermoacoustic signals generated from pulsed microwave ablation in liver tissue

Microwave-induced thermoacoustic signals are generated when pulsed microwave energy is absorbed by tissue. Thermoacoustic signals contain information about the electromagnetic, thermal, and acoustic material properties of the tissue. Thus, we propose using microwave-induced thermoacoustic signals to monitor microwave ablation, a thermal therapy used to heat and kill malignant tissue, in real-time. Conventional microwave-induced thermoacoustic signals are excited using an external waveguide. Our approach excites thermoacoustic signals via pulsed microwave energy delivered by the already present interstitial microwave ablation antenna. In this talk, we will present the experimental investigation of the evolution of microwave-induced thermoacoustic signals generated during microwave ablation in bovine liver tissue. Pulsed microwave energy was delivered via a narrow-diameter coaxial ablation antenna to simultaneously ablate tissue and excite thermoacoustic signals. Trials were conducted in room-temperature fresh liver tissue as well as room-temperature boiled liver tissue to investigate the influence of ablative temperature rise and tissue coagulation on thermoacoustic signals. Our experimental results show thermoacoustic signal characteristics change throughout the course of microwave ablation that could potentially be used for monitoring the microwave ablation process.

Endoscopic image-guided laser treatment system based on fiber bundle laser steering

A miniaturized endoscopic laser system with laser steering has great potential to expand the application of minimally invasive laser treatment for micro-lesions inside narrow organs. The conventional systems require separate optical paths for endoscopic imaging and laser steering, which limits their application inside narrower organs. Herein, we present a novel endoscopic image-guided laser treatment system with a thin tip that can access inside narrow organs. The system uses a single fiber bundle to simultaneously acquire endoscopic images and modulate the laser-irradiated area. The insertion and operation of the system in a narrow space were demonstrated using an artificial vascular model. Repeated laser steering along set targets demonstrated accurate laser irradiation within a root-mean-square error of 28 mum, and static repeatability such that the laser irradiation position was controlled within a 12 mum radius of dispersion about the mean trajectory. Unexpected irradiation on the distal irradiated plane due to fiber bundle crosstalk was reduced by selecting the appropriate laser input diameter. The laser steering trajectory spatially controlled the photothermal effects, vaporization, and coagulation of chicken liver tissue. This novel system achieves minimally invasive endoscopic laser treatment with high lesion-selectivity in narrow organs, such as the peripheral lung and coronary arteries.

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Spray coagulation as an alternative to argon plasma coagulation for bleeding portal hypertensive gastropathy

Hemocompatibility tuning of an innovative glutaraldehyde-free preparation strategy using riboflavin/UV crosslinking and electron irradiation of bovine pericardium for cardiac substitutes

Hemocompatibility tuning was adopted to explore and refine an innovative, GA-free preparation strategy combining decellularization, riboflavin/UV crosslinking, and low-energy electron irradiation (SULEEI) procedure. A SULEEI-protocol was established to avoid GA-dependent deterioration that results in insufficient long-term aortic valve bioprosthesis durability. Final SULEEI-pericardium, intermediate steps and GA-fixed reference pericardium were exposed in vitro to fresh human whole blood to elucidate effects of preparation parameters on coagulation and inflammation activation and tissue histology. The riboflavin/UV crosslinking step showed to be less efficient in inactivating extracellular matrix (ECM) protein activity than the GA fixation, leading to tissue-factor mediated blood clotting. Intensifying the riboflavin/UV crosslinking with elevated riboflavin concentration and dextran caused an enhanced activation of the complement system. Yet activation processes induced by the previous protocol steps were quenched with the final electron beam treatment step. An optimized SULEEI protocol was developed using an intense and extended, trypsin-containing decellularization step to inactivate tissue factor and a dextran-free, low riboflavin, high UV crosslinking step. The innovative and improved GA-free SULEEI-preparation protocol results in low coagulant and low inflammatory bovine pericardium for surgical application.

Simultaneous proton resonance frequency T1 - MR shear wave elastography for MR-guided focused ultrasound multiparametric treatment monitoring.

To develop an efficient MRI pulse sequence to simultaneously measure multiple parameters that have been shown to correlate with tissue nonviability following thermal therapies. A 3D segmented EPI pulse sequence was used to simultaneously measure proton resonance frequency shift (PRFS) MR thermometry (MRT), T1 relaxation time, and shear wave velocity induced by focused ultrasound (FUS) push pulses. Experiments were performed in tissue mimicking gelatin phantoms and ex vivo bovine liver. Using a carefully designed FUS triggering scheme, a heating duty cycle of approximately 65% was achieved by interleaving FUS ablation pulses with FUS push pulses to induce shear waves in the tissue. In phantom studies, temperature increases measured with PRFS MRT and increases in T1 correlated with decreased shear wave velocity, consistent with material softening with increasing temperature. During ablation in ex vivo liver, temperature increase measured with PRFS MRT initially correlated with increasing T1 and decreasing shear wave velocity, and after tissue coagulation with decreasing T1 and increasing shear wave velocity. This is consistent with a previously described hysteresis in T1 versus PRFS curves and increased tissue stiffness with tissue coagulation. An efficient approach for simultaneous and dynamic measurements of PRSF, T1 , and shear wave velocity during treatment is presented. This approach holds promise for providing co-registered dynamic measures of multiple parameters, which correlates to tissue nonviability during and following thermal therapies, such as FUS.

Ex vivo vaporization performance study of human prostate tissue using in-house designed thulium fiber laser

Introduction: Laser technologies including thulium, Holmium: Yttrium aluminum garnet (Ho: YAG), Potassium-titanyl-phosphate and diode laser have been explored in recent years for the treatment of benign prostatic hyperplasia. These thermal modalities impart their effect through ablative and coagulative mechanisms of action. Although Ho: YAG laser is a gold standard clinical tool in urology, its properties are not sufficient for cutting or coagulation of prostatic tissue. Thulium: YAG laser is a promising alternative laser but with limitations. The recent technological advancements in thulium fiber laser (TFL) provide various advantages along with a compact system for urosurgical applications. This paper depicts the work done in initial validation of an in-house designed TFL in ex vivo vaporization and vaporesection of human prostatic tissue. Comparison of its ablation rate and coagulation zone was done with the existing laser systems. Methods: An in-house designed TFL having maximum continuous wave (CW) power level of 70 W at 1.94 mm optical wavelength had been used for the ex vivo experiment on human prostatic tissue. The rate of tissue vaporization and zone of thermal coagulation were assessed. Results: The in-house made (CSIR-CGCRI, Kolkata, India) CW TFL used at power of 60 W at 1.94 mm was capable of providing tissue vaporization rate of 0.13–0.45 g/min with a thermal coagulation zone of 100 mm. Conclusions: In our study, the TFL was efficient in vaporization, vaporesection, and coagulation of the prostatic tissue under controlled circumstances. Compared to the existing laser systems, the TFL could be a new alternative in Endourology.

Protease‐ and cell type–specific activation of protease‐activated receptor 2 in cutaneous inflammation

BackgroundProtease‐activated receptor 2 (PAR2) signaling controls skin barrier function and inflammation, but the roles of immune cells and PAR2‐activating proteases in cutaneous diseases are poorly understood. ObjectiveTo dissect PAR2 signaling contributions to skin inflammation with new genetic and pharmacological tools. Methods/ResultsWe found markedly increased numbers of PAR2+ infiltrating myeloid cells in skin lesions of allergic contact dermatitis (ACD) patients and in the skin of contact hypersensitivity (CHS) in mice, a murine ACD model for T cell–mediated allergic skin inflammation. Cell type–specific deletion of PAR2 in myeloid immune cells as well as mutation‐induced complete PAR2 cleavage insensitivity significantly reduced skin inflammation and hapten‐specific Tc1/Th1 cell response. Pharmacological approaches identified individual proteases involved in PAR2 cleavage and demonstrated a pivotal role of tissue factor (TF) and coagulation factor Xa (FXa) as upstream activators of PAR2 in both the induction and effector phase of CHS. PAR2 mutant mouse strains with differential cleavage sensitivity for FXa versus skin epithelial cell–expressed proteases furthermore uncovered a time‐dependent regulation of CHS development with an important function of FXa‐induced PAR2 activation during the late phase of skin inflammation. ConclusionsMyeloid cells and the TF–FXa–PAR2 axis are key mediators and potential therapeutic targets in inflammatory skin diseases.

An attenuated vaccinia vaccine encoding the severe acute respiratory syndrome coronavirus-2 spike protein elicits broad and durable immune responses, and protects cynomolgus macaques and human angiotensin-converting enzyme 2 transgenic mice from severe acute respiratory syndrome coronavirus-2 and its variants.

As long as the coronavirus disease-2019 (COVID-19) pandemic continues, new variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) with altered antigenicity will emerge. The development of vaccines that elicit robust, broad, and durable protection against SARS-CoV-2 variants is urgently required. We have developed a vaccine consisting of the attenuated vaccinia virus Dairen-I (DIs) strain platform carrying the SARS-CoV-2 S gene (rDIs-S). rDIs-S induced neutralizing antibody and T-lymphocyte responses in cynomolgus macaques and human angiotensin-converting enzyme 2 (hACE2) transgenic mice, and the mouse model showed broad protection against SARS-CoV-2 isolates ranging from the early-pandemic strain (WK-521) to the recent Omicron BA.1 variant (TY38-873). Using a tandem mass tag (TMT)-based quantitative proteomic analysis of lung homogenates from hACE2 transgenic mice, we found that, among mice subjected to challenge infection with WK-521, vaccination with rDIs-S prevented protein expression related to the severe pathogenic effects of SARS-CoV-2 infection (tissue destruction, inflammation, coagulation, fibrosis, and angiogenesis) and restored protein expression related to immune responses (antigen presentation and cellular response to stress). Furthermore, long-term studies in mice showed that vaccination with rDIs-S maintains S protein-specific antibody titers for at least 6 months after a first vaccination. Thus, rDIs-S appears to provide broad and durable protective immunity against SARS-CoV-2, including current variants such as Omicron BA.1 and possibly future variants.

Selection and improvement of the method and tool for restoring the anatomical integrity of the retina after its detachment

Introduction. Retinal detachment (RD) is a common pathological condition that without timely surgical treatment leads to vision loss. The patients with significant RD undergo one of three retreatment procedures: Pneumatic Retinopexy, Scleral Buckling, and/or Pars Plana Vitrectomy. Techniques and tools for these procedures have been developed, but the methods themselves still have a significant number of complications. A possible alternative to their further improvement may be a fundamentally new method of treatment, coagulation of the retina with high-frequency electric current (HFEC), for which significant improvement of the tool is still possible. The purpose of the study was to determine a safer method of RD treating and to improve medical tools for restoring anatomical integrity and repositioning a detached retina under two conditions: firstly, obtaining a reliable chorioretinal adhesion, and secondly, minimizing the number of incidental effects of surgical intervention. Materials and methods. The bibliosemantic method, the system analysis method, an experiment on laboratory animals (rabbits) with RD simulation and its coagulation by HFEC, tissue biopsy of operated animals after their euthanasia on the 7th day after surgery, and the production of histological micro-preparations were used. Results. To fulfill the conditions for improving the method, a chorioretinal high-frequency electrocoagulation operation with suprachoroidal access, a modified EK-300M1 generator (Kyiv, Ukraine) with an electrode with a gold hemispherical tip of 25 gauge and electrical generation parameters of 66 kHz, 10‒16 V, 0.1 A was proposed, which causes chorioretinal adhesion in the place where the electrode is used. The method of calculating the parameters of heat transfer from the electrocoagulation tool to the tissues and fluids of the eye was selected: it was proposed to use the Fourier-Kirchhoff and Newton-Richmann equations. Destructive phenomena in the retina from the thermal effect of tissue coagulation in the form of the destruction of rods, cones, the development of cysts, the loss of bipolar, amacrine, horizontal and ganglion cells were noted. Atrophic changes in the retina were minimal at a voltage of 10‒12 V. Conclusions. The problem of improving the methods of restoring the anatomical position of the retinal layers has been relevant for many decades, but it does not lead to a significant reduction in the number of complications. The proposed method and tool for its application causes the creation of a reliable chorioretinal adhesion in a short period of time after surgical intervention with minimal thermal tissue damage. The use of the method of chorioretinal high-frequency electrocoagulation with suprachoroidal access is recommended in conditions of urgent restoration of vision, but not recommended for the prevention of retinal detachment in retinopathies. Keywords: retinal detachment, chorioretinal adhesion, high-frequency electrocoagulation, suprachoroidal access.

Combined staged surgical hemostasis in a case of Placenta previa and Placenta accreta spectrum disorders

The objective: to develop the optimal delivery algorithm in persons with Placenta previa alone and with partial Placenta accreta, using innovative technologies with the priority of organ-saving operations.Materials and methods. 106 pregnant women with prenatal diagnosis of Placenta previa and the possibility of the safe pregnancy prolongation till 34-36 weeks of gestation were included in the study. To achieve the aim of the study, two groups were formed: the first (control) group – 75 patients were delivered via standard elective cesarean section in terms of 34-36 weeks; the second (main) group – 51 patients delivered in the same terms via our organ-saving method (elective cesarean section using argon-plasma tissue coagulation, agonists of oxytocin and vasopressors; and ligation of main uterine vessels and internal iliac arteries).The following characteristics of cesarean section were taken into account: time of the fetal extraction, duration of the operation, intraoperative blood loss volume and Placenta accreta spectrum disorders (PAS) complications were compared in groups with further statistical data analysis.Results. The mean indices of the cesarean section duration and time from the start of an operation till the fetal extraction were significantly lower (p<0.05) in the second group and amounted 55.7±5.1 min and 195.0±21.0 sec, respectively, versus 74.5±4.3 min and 274.0±17.0 sec in the first group. Intraoperative blood loss volume was also significantly lower in the second group than in the first one – 775.0±60.0 ml versus 970.0±55.0 ml, p<0.05).The part of Placenta previa and PAS combination in one patient amounted to 20.0% in the first group and 17.6% in the second one. Pl. accreta was diagnosed in 17.33% cases in the first group, Pl. increta – in 1.33%, Pl. percreta – in 1.33%. Hysterectomy has been performed in 8.0% cases, all Pl. increta and percreta cases required the hysterectomy and were followed by massive obstetric hemorrhages (MOH). DIC-syndrome developed in 2.67%. In the second group Pl. accreta was diagnosed in 19.61% and Pl. increta – in 3.92%, patients with Pl. increta had hysterectomy. MOH were observed in 38.7% cases in the first group versus 9.7% cases in the second group (p<0.05). Furthermore, in the first group hysterectomy was performed almost four times more frequently than in the second group (24.0% versus 6.5% respectively, p<0.05).Conclusions. The developed delivery algorithm in pregnant women with Placenta previa alone or in a combination with PAS allowed to reduce intraoperative blood loss significantly, prevent the MOH development, therefore to reach secure hemostasis and save the uterus.

163 Caustic Ingestions: Acids or Bases. Does It Matter?

Caustic ingestions can be classified as either acids or bases. Acidic ingestions can lead to coagulative tissue necrosis; basic ingestions can result in liquefactive tissue necrosis. While the coagulative necrosis is presumed to form an eschar that limits the depth of penetration, significant tissue damage can occur with both types of ingestion. While previous studies involving exploratory ingestions of bases demonstrated asymptomatic patients can be safely observed and discharged without an esophagogastroduodenoscopy (EGD), the safety of this practice in acidic ingestions has been questioned.

CHARACTERISTICS OF THE VAGINAL BIOCENOSE OF WOMEN OF EARLY REPRODUCTIVE AGE WITH ENDOCERVICOSIS

Purpose. To study the state of the vaginal ecosystem in nulliparous women with endocervicosis by improving diagnostic methods.
 Materials and methods. The contingent of the study was 142 women of early reproductive age (20-24 years old), who did not give birth, 112 with a histologically established diagnosis of endocervicosis. In all 142 examined women, the determination of vaginal biocenosis was carried out by means of bacterioscopy of smears with determination of the degree of purity and bacteriological examination of discharge, determination of HPV of high carcinogenic risk.
 The proposed comprehensive approach to the treatment of young women with endocervicosis who did not give birth consisted of the following. Destruction of the pathological focus was carried out by the method of argon plasma coagulation (APC) of tissues using the Fotek-EA 142 apparatus. In the postoperative period, vaginal suppositories were prescribed for this group of patients on the 10th day after the procedure, once a day for 10 days. One suppository contains two active substances: dexpanthenol 100 mg, chlorhexidine bigluconate - 16 mg and a polyethylene oxide base. Dexpanthenol normalizes cell metabolism, stimulates the regeneration of mucous membranes, increases the strength of collagen fibers and accelerates mitosis. In addition, an antiseptic was prescribed, which shows activity against gram-positive and gramnegative bacteria.In order to treat the human papillomavirus in this group, together with the interferon drug, the drug tyloron was prescribed in the generally accepted dosage.
 Research results. Sexually transmitted infections play an important role in the occurrence and progression of background cervical pathology. When conducting an in-depth analysis of vaginal microbiocenosis with the help of bacteriological research in patients with endocervicosis, in significant concentrations, an increase in the quantitative indicators of contamination of the vagina with conditionally pathogenic microorganisms was established relative to the diagnostic level. A high degree of infection with chlamydia, genital mycoplasmas, pathogenic strains of ureaplasma, trichomonads, herpes virus infections creates a risk group upon occurrence and the development of infertility, miscarriage and other perinatal pathology in patients with endocervicosis who did not give birth. Clinically significant and, especially, high viral load in HPV-infected young women with endocervicosis occurs in a significant percentage of cases. The results of the cytological characteristics of smears of the exo- and endocervix indicate that 12 women (21.82%) of the I group and 10 women (17 .54%) of the II group during the cytological diagnosis changes characteristic of the IIa class were established. In 32.73% of cases of group I and 33.33% of group II, cytograms show varieties of pathological keratinization, namely hyperkeratosis, parakeratosis, dyskeratosis. In 38.18% of patients of the I group and in 40.35% of the II group, cells with characteristic manifestations of damage by the human papilloma virus are found in cytological preparations.
 Conclusion. Thus, women with endocervicosis who have not given birth need more careful observation and effective treatment.

Plasma SARS-CoV-2 nucleocapsid antigen levels are associated with progression to severe disease in hospitalized COVID-19

BackgroundStudies quantifying SARS-CoV-2 have focused on upper respiratory tract or plasma viral RNA with inconsistent association with clinical outcomes. The association between plasma viral antigen levels and clinical outcomes has not been previously studied. Our aim was to investigate the relationship between plasma SARS-CoV-2 nucleocapsid antigen (N-antigen) concentration and both markers of host response and clinical outcomes.MethodsSARS-CoV-2 N-antigen concentrations were measured in the first study plasma sample (D0), collected within 72 h of hospital admission, from 256 subjects admitted between March 2020 and August 2021 in a prospective observational cohort of hospitalized patients with COVID-19. The rank correlations between plasma N-antigen and plasma biomarkers of tissue damage, coagulation, and inflammation were assessed. Multiple ordinal regression was used to test the association between enrollment N-antigen plasma concentration and the primary outcome of clinical deterioration at one week as measured by a modified World Health Organization (WHO) ordinal scale. Multiple logistic regression was used to test the association between enrollment plasma N-antigen concentration and the secondary outcomes of ICU admission, mechanical ventilation at 28 days, and death at 28 days. The prognostic discrimination of an externally derived “high antigen” cutoff of N-antigen ≥ 1000 pg/mL was also tested.ResultsN-antigen on D0 was detectable in 84% of study participants. Plasma N-antigen levels significantly correlated with RAGE (r = 0.61), IL-10 (r = 0.59), and IP-10 (r = 0.59, adjusted p = 0.01 for all correlations). For the primary outcome of clinical status at one week, each 500 pg/mL increase in plasma N-antigen level was associated with an adjusted OR of 1.05 (95% CI 1.03–1.08) for worse WHO ordinal status. D0 plasma N-antigen ≥ 1000 pg/mL was 77% sensitive and 59% specific (AUROC 0.68) with a positive predictive value of 23% and a negative predictive value of 93% for a worse WHO ordinal scale at day 7 compared to baseline. D0 N-antigen concentration was independently associated with ICU admission and 28-day mechanical ventilation, but not with death at 28 days.ConclusionsPlasma N-antigen levels are readily measured and provide important insight into the pathogenesis and prognosis of COVID-19. The measurement of N-antigen levels early in-hospital course may improve risk stratification, especially for identifying patients who are unlikely to progress to severe disease.

Моделирование совмещенного нагрева для абляции опухолей

In the field of oncology therapy in the last few decades, methods of local thermal destruction have been intensively developed, which is heating a malignant neoplasm to a coagulation temperature and above. Among them, radiofrequency ablation (RFA) and microwave ablation (MWA) are the most common. The main problem of the existing MWA and RFA units is the insufficient degree of tissue coagulation. Depending on the type of tissue, various methods of exposure to an electromagnetic field can be used. In the radio frequency (RF) range, ohmic heating can be used, suitable for highly conductive tissues, and dielectric heating for low conductivity tissues. To increase the heating volume, it is proposed to combine ohmic and dielectric heating. The purpose of this work was to study the possibility of combining the processes of ohmic and dielectric heating based on methods of microwave and radiofrequency thermal destruction. A computer simulation of the combined heating electrode was carried out. The COMSOL Multiphysics software package was used to create the model. The algorithm for constructing the model consisted in creating the geometry, choosing the sizes of the working zones of the electrodes, setting the power parameters and imposing a finite element mesh. The model was two-dimensional. Various configurations of the combined heating electrode were considered. As a result, it was found that it is possible to create a heating area of a larger volume than with separate exposure. The overall shape of the resulting heating in all cases had an elliptical shape. At the same time, the heating pattern for RF working zones with a size of 5 mm had a shape more suitable for the treatment of spherical tumors than for working zones with a size of 10–20 mm. The results obtained demonstrate the possibility of increasing the heating volume by more than 40% compared to single operating modes. The most suitable sizes of RF heating zones are calculated, at which the heating volume will be maximum. The use of combined heating in clinical practice will partially solve the problems of insufficient heating volume inherent in the single-electrode heating mode in both RFA and MWA.

Acute vaping in a golden Syrian hamster causes inflammatory response transcriptomic changes.

E-cigarette vaping is a major aspect of nicotine consumption, especially for children and young adults. Although it is branded as a safer alternative to cigarette smoking, murine and rat models of subacute and chronic e-cigarette vaping exposure have shown many proinflammatory changes in the respiratory tract. An acute vaping exposure paradigm has not been demonstrated in the golden Syrian hamster, and the hamster is a readily available small animal model that has the unique benefit of becoming infected with and transmitting respiratory viruses, including SARS-CoV-2, without genetic alteration of the animal or virus. Using a 2-day, whole body vaping exposure protocol in male golden Syrian hamsters, we evaluated serum cotinine, bronchoalveolar lavage cells, lung, and nasal histopathology, and gene expression in the nasopharynx and lung through reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Depending on the presence of nonnormality or outliers, statistical analysis was performed by ANOVA or Kruskal-Wallis tests. For tests that were statistically significant (P < 0.05), post hoc Tukey-Kramer and Dunn's tests, respectively, were performed to make pairwise comparisons between groups. In nasal tissue, RT-qPCR analysis revealed nicotine-dependent increases in gene expression associated with type 1 inflammation (CCL-5 and CXCL-10), fibrosis [transforming growth factor-β (TGF-β)], nicotine-independent increase oxidative stress response (SOD-2), and a nicotine-independent decrease in vasculogenesis/angiogenesis (VEGF-A). In the lung, nicotine-dependent increases in the expression of genes involved in the renin-angiotensin pathway [angiotensin-converting enzyme (ACE), ACE2], coagulation (tissue factor, Serpine-1), extracellular matrix remodeling (MMP-2, MMP-9), type 1 inflammation (IL-1β, TNF-α, and CXCL-10), fibrosis (TGF-β and Serpine-1), oxidative stress response (SOD-2), neutrophil extracellular traps release (ELANE), and vasculogenesis and angiogenesis (VEGF-A) were identified. To our knowledge, this is the first demonstration that the Syrian hamster is a viable model of e-cigarette vaping. In addition, this is the first report that e-cigarette vaping with nicotine can increase tissue factor gene expression in the lung. Our results show that even an acute exposure to e-cigarette vaping causes significant upregulation of mRNAs in the respiratory tract from pathways involving the renin-angiotensin system, coagulation, extracellular matrix remodeling, type 1 inflammation, fibrosis, oxidative stress response, neutrophil extracellular trap release (NETosis), vasculogenesis, and angiogenesis.

The Effect of Trimetazidine on Diathermy-related Thermic Injury of the Rat Liver.

Owing to new oncotherapy modalities, the importance of an R0 resection decreased in the last decade; however, liver metastasis of colorectal cancer significantly decreases survival. Furthermore, to prevent cardiovascular disease, more and more patients are treated with anti-ischemic drugs, which may influence oncologic treatments in such patients. This study aimed to examine the effect of Trimetazidine on liver surface injury after spray diathermy. We performed standard liver resections with resection-margin spray coagulation in 36 rats on both liver lobes. In all procedures, a Pringle maneuver was performed on the right lobe, while on the left lobe, no vessel occlusion was applied. Half of the animals were on Trimetazidine therapy. In 12 animals, histologic samples were taken immediately after operation, while 12 animals were terminated 1 week later, and the remaining 12 animals 3 weeks later. After standard HE staining, histologic analysis was performed. When diathermy was used, a coagulation zone appeared. Destruction was slightly wider in case of Trimetazidine therapy (745.75 vs. 680.04 μm). In cases of 1-week-surviving animals, a necrotic zone was observed under the coagulated tissue, and a fibrotic zone appeared after 3 weeks. In TMZ medicated animals, the destruction zone was significantly thinner (645.08 vs. 893.76 μm; p<0.001) and the necrosis zone showed the same difference (2,430.05 vs. 3,238.45 μm; p<0.001). Administration of Trimetazidine can reduce the extent of thermic necrosis. Furthermore, a great effort should be applied to achieve R0 resection in patients on anti-ischemic therapy.