Minimize Tissue Injury Research Articles

Managing Basilar Artery Occlusions with Endovascular Thrombectomy: A Single-Center Case Series

Acute ischemic infarctions are caused by occlusions to blood vessels supplying the brain. Rapid recognition and intervention affect the course of management to provide prompt recanalization to minimize tissue injury, for which endovascular thrombectomy (EVT) has become an emerging standard of care. Recent clinical trials for basilar artery occlusions done in 2022 concluded that mechanical thrombectomy performed on patients with a National Institutes of Health Stroke Scale of ≥6 within 24 hours offers a significantly lower risk of 90-day mortality, and a 90-day modified Rankin scale of 0-3 despite the higher incidence of intracranial hemorrhage. Three of four cases of basilar artery occlusion completed their mechanical thrombectomies in our institution; two of which were performed under the recommended time window. Among those, two cases had prolonged hospital stay due to complications, but had a 90-day mRS of 3. Although larger studies should be performed for better representation of clinical outcomes, there is difficulty in gathering cases in the Philippines as it belongs to a low-middle income country with a low annual thrombectomy rate. This study reports three cases of basilar artery occlusions managed through mechanical thrombectomy in a single institution with outcomes consistent with the conclusions of the recent clinical trials.

Minimizing Tissue Injury and Incisions in Multilevel Biportal Endoscopic Spine Surgery: Technical Note and Preliminary Results.

Background and Objectives: Biportal endoscopic spine surgery (BESS) is a promising technique that can be applied for the treatment of various spinal diseases. However, traditional BESS procedures require multiple, separate incisions. We present, herein, various techniques to reduce the number of incisions in multi-level surgery and their clinical outcomes. Materials and Methods: Three different techniques were used to reduce the number of incisions for the preservation of normal tissue associated with BESS: the step-ladder technique, employing a common portal for the scope and instruments; the portal change technique employing a two-level procedure with two incisions; and the tilting technique, employing more than three levels. Pain (Visual Analog Scale), disability (Oswestry Disability Index), and patient satisfaction were evaluated before and 12 months after the procedure. Results: Among the 122 cases of multilevel spine surgery, 1.43 incisions per level were employed for multilevel BESS. Pain and disability showed significant improvement. Patient satisfaction showed favorable results. Conclusions: Combining multiple techniques during biportal surgery could decrease the number of incisions needed and preserve musculature with favorable clinical outcomes.

Laparoscopic medulla-sparing ovarian tissue biopsy for cryopreservation: step-by-step surgical technique

To describe a laparoscopic technique for ovarian tissue biopsy (OTB) for fertility preservation. In the last years, the demand for fertility preservation has grown because of the increasing survival rates among patients with cancer and the rising awareness of the importance of quality of life after gonadotoxic therapy. Among fertility-sparing approaches, ovarian tissue cryopreservation is a valid strategy to preserve ovarian endocrine and reproductive function in prepubertal and postpubertal women who will undergo gonadotoxic cancer treatments. Currently, there is no universal consensus regarding ovarian tissue retrieval technique for fertility preservation. Step-by-step description of the surgical technique with narrated video footage. Academic tertiary hospital. Patients with a high risk of premature ovarian insufficiency, usually due to gonadotoxic treatments, who undergo OTB for fertility preservation were included in the study. In this video, we present the clinical case of a 28-year-old patient affected by Hodgkin lymphoma who underwent laparoscopy for OTB before chemotherapy. After exposing the chosen ovary, an incision at the tubal pole of the ovary is made with scissors. Through section and dissection, a large cortical biopsy of the ovary is performed without removing and avoiding any damage to the medulla. At the end of the procedure, hemostasis was achieved with selective coagulation using bipolar coagulation. Step by step educational video. The post-operative course was uneventful and the patient was discharge 24 hours after surgery. Standardization of a step-by-step laparoscopic technique can provide an effective method to optimize ovarian tissue removal while minimizing tissue injury. Medulla-sparing ovarian biopsy allows retrieval of only the cortical part of the ovary, maximizing the number of primordial follicles obtained without damaging the vascular supply of the ovary contained within the medulla. Primordial follicles are resistant to cryoinjury owing to their relatively inactive metabolism, and they are usually found at approximately 0.8 mm below the surface of the cortex. This technique could also reduce the back-table processing time of the ovarian tissue before cryopreservation. One disadvantage could be the difficulty of the technique compared to an oophorectomy because it requires a skilled surgeon that can easily find the cleavage plane between the medulla and the cortex, even in patients submitted to previous chemoradiotherapy or during gonadotropin-releasing hormone analogue therapy.

O-028 Genital tract infection and pelvic surgery contribute to the development of endometriosis

Abstract Study question Was the incidence of endometriosis in women with a recent history of genital infection, pelvic surgery, or both increased? Summary answer The pelvic inflammation resulting from genital infection and pelvic surgical injury may play a role in developing endometriosis. What is known already Endometriosis is a multifactorial disease, and inflammation is considered a core pathology. Inflammation occurs due to pathogenic infection and tissue injury, and genital tract infection and surgical injury can be inducers for pelvic inflammation in endometriosis. Study design, size, duration A retrospective cohort study using the Korean National Health Insurance Service -National Sample Cohort I (KNHIS-SC I) from 2002-2013 (N = 1,025,340) was performed. Participants/materials, setting, methods 20- to 49-year-old women diagnosed with genital tract infections (GTI) or who underwent pelvic surgeries between 2002 and 2008 were collected and followed up for five years. A total of 30,336 women were diagnosed with GTI, 2,894 women underwent pelvic surgery, and 788 women with GTI and pelvic surgery were enrolled in each study. The comparison groups matched sociodemographic factors for each group were collected. The incidence of endometriosis in each group was analyzed. Main results and the role of chance The incidence of endometriosis per 1,000 person-year was 5.37, 5.17, and 20.81 in each case group and was significantly higher than in each comparison group. A recent history of GTI increased an adjusted hazard ratio (aHR) of 2.29 (1.99-2.63, 95% confidence interval) for the development of endometriosis. The aHRs of pelvic surgery history and the history of both GTI and pelvic surgery were 2.10 and 7.82, respectively. Limitations, reasons for caution The diagnosis and treatment codes registered on the NHIS data are used to claim HIRA NHI benefits, which may differ from the diagnosis or treatment performed in practice and it does not contain the used diagnostic method, disease severity, and the disease led to pelvic surgery were not specified. Wider implications of the findings Active treatment of genital infections and careful surgical procedures to minimize tissue injury may reduce the incidence of pelvic endometriosis. Trial registration number Not Applicable

Real-time passive cavitation mapping with high spatial-temporal resolution

Shock wave lithotripsy (SWL) and laser lithotripsy (LL) have been widely used for clinical treatment of kidney stones. Cavitation plays an important role in stone fragmentation in both SWL and LL, yet it may also contribute to renal tissue injury. It is therefore crucial to determine the spatiotemporal distributions of cavitation activities to maximize stone fragmentation while minimizing tissue injury. Passive cavitation mapping (PCM) has most practical applications in deep biological tissues and is most promising for clinical translation. We have developed a set of technologies for 2D/3D PCM that can be seamlessly integrated with ultrasound imaging and photoacoustic imaging. Our 2D/3D PCM has achieved a spatial resolution of hundreds of micrometers and a temporal resolution of several microseconds. We also developed a transient angular spectrum approach for PCM reconstruction, which is ten times faster than the traditional delay-and-sum method. Using the 2D/3D PCM system, we imaged shockwave- and laser-induced single cavitation bubbles in both free field and constricted space, as well as on large animal models. Collectively, our results have demonstrated the high reliability and spatial-temporal accuracy of the 2D/3D PCM approach, which paves the way for future in vivo applications and human studies during SWL and LL.

Genital tract infection and pelvic surgery contribute to the development of endometriosis

Endometriosis is a multifactorial disease, and inflammation is considered a core pathology. Inflammation related to genital tract infection (GTI) and surgical injury may cause endometriosis. Therefore, we investigated the incidence of endometriosis in women with a recent history of GTI, pelvic surgery, or both. Using the Korean National Health Insurance Service-National Sample Cohort, 20- to 49-year-old women diagnosed with GTI or who underwent pelvic surgeries between 2002 and 2008 were collected and followed up for five years. After excluding women who had already been diagnosed with endometriosis or diseases that may affect endometriosis, a total of 30,336 women were diagnosed with GTI (Study 1), 2894 women who underwent pelvic surgery (Study 2), and 788 women who underwent GTI and pelvic surgery, both (Study 3) were enrolled for each study. The comparison groups in which sociodemographic factors matched for each group were collected. The incidence of endometriosis per 1000 person-year was 5.37, 5.17, and 20.81 in each case group and was significantly higher than each comparison group. A recent history of GTI increased an adjusted hazard ratio (aHR) of 2.29 (1.99–2.63, 95% confidence interval) for the development of endometriosis. The aHRs of pelvic surgery history and the history of both GTI and pelvic surgery were 2.10 and 7.82, respectively. In conclusion, the pelvic inflammation resulting from genital infection and pelvic surgical injury may play a role in developing endometriosis. Active treatment of genital infections and careful surgical procedures to minimize tissue injury may reduce the incidence of pelvic endometriosis.

Real-time passive cavitation mapping with high spatial-temporal resolution

Shock wave lithotripsy (SWL) and laser lithotripsy (LL) have been widely used for clinical treatment of kidney stones. Cavitation plays an important role in stone fragmentation in both SWL and LL, yet it may also contribute to renal tissue injury. It is therefore crucial to determine the spatiotemporal distributions of cavitation activities to maximize stone fragmentation while minimizing tissue injury. Passive cavitation mapping (PCM) has most practical applications in deep biological tissues and is most promising for clinical translation. We have developed a set of technologies for 2D/3D PCM that can be seamlessly integrated with ultrasound imaging and photoacoustic imaging. Our 2D/3D PCM has achieved a spatial resolution of hundreds of micrometers and a temporal resolution of several microseconds. We also developed a transient angular spectrum approach for PCM reconstruction, which is ten times faster than the traditional delay-and-sum method. Using the 2D/3D PCM system, we imaged shockwave- and laser-induced single cavitation bubbles in both free field and constricted space, as well as on large animal models. Collectively, our results have demonstrated the high reliability and spatial-temporal accuracy of the 2D/3D PCM approach, which paves the way for future in vivo applications and human studies during SWL and LL.

Full-endoscopic versus microscopic unilateral laminotomy for bilateral decompression of lumbar spinal stenosis at L4-L5: comparative study.

Full-endoscopic spine surgery for degenerative lumbar diseases is growing in popularity and has shown favourable outcomes. Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been used to treat lumbar spinal stenosis (LSS). However, studies comparing LE-ULBD to microscopic ULBD are lacking. This study compared the clinical efficacy and radiological outcomes between the LE-ULBD and microscopic ULBD. The study retrospectively enrolled patients undergoing either LE-ULBD or microscopic ULBD for spinal stenosis at the L4-L5 level. The demographic data, operative details, radiological images, clinical outcomes, and complications of patients from the two groups were compared through matched-pairs analysis. The minimum follow-up duration was 24months. There were 93 patients undergoing either LE-ULBD (n = 42) or microscopic ULBD (n = 51). The patient demographics were similar between the two groups. The LE-ULBD group had significantly less estimated blood loss, less analgesic use, and shorter hospitalization duration (P < .05). The endoscopic group had a significantly lower visual analog scale for back pain at all follow-up intervals compared with the microscopic group (P < .05). There were no significant differences in leg pain or Oswestry Disability Index. The cross-section area of the spinal canal was significantly wider after microscopic ULBD. There were no significant differences in post-operative degenerative changes in disc height, translational motion, or facet preservation rate. LE-ULBD is comparable in clinical and radiological outcomes with enhanced recovery for single-level LSS. The endoscopic approach might further minimize tissue injury and enhance post-operative recovery.

Three-dimensional cavitation mapping in shock wave and laser lithotripsy

Shock wave lithotripsy (SWL) and laser lithotripsy (LL) have been widely used for non-invasive treatment of kidney stones. Cavitation plays an important role in stone fragmentation, yet it may also contribute to renal injury during SWL and LL. It is therefore crucial to determine the spatiotemporal distributions of cavitation activities to maximize stone fragmentation while minimizing tissue injury. Traditional cavitation detection methods include high-speed optical imaging, active cavitation mapping (ACM), and passive cavitation mapping (PCM), among which PCM has most practical applications in biological tissues. To image the dynamics of cavitation bubble collapse, we have developed tri-modality cavitation imaging that includes 3D high-speed optical imaging, ACM, and PCM seamlessly integrated in a single imaging system. We also developed a transient angular spectrum approach for PCM reconstruction, which is ten times faster than the traditional delay-and-sum method. Using the tri-modality system, we imaged and analyzed laser-induced single cavitation bubbles in both free field and constricted space and shock wave-induced cavitation clusters. Collectively, our results have demonstrated the high reliability and spatial-temporal accuracy of the 3D PCM approach, which paves the way for future in vivo applications in large animals and human studies during SWL and LL.

Mesenchymal stromal cell treatment of donor kidneys during ex vivo normothermic machine perfusion: A porcine renal autotransplantation study.

Normothermic machine perfusion (NMP) of injured kidneys offers the opportunity for interventions to metabolically active organs prior to transplantation. Mesenchymal stromal cells (MSCs) can exert regenerative and anti-inflammatory effects in ischemia-reperfusion injury. The aims of this study were to evaluate the safety and feasibility of MSC treatment of kidneys during NMP using a porcine autotransplantation model, and examine potential MSC treatment-associated kidney improvements up to 14days posttransplant. After 75min of kidney warm ischemia, four experimental groups of n=7 underwent 14h of oxygenated hypothermic machine perfusion. In three groups this was followed by 240min of NMP with infusion of vehicle, 10million porcine, or 10million human adipose-derived MSCs. All kidneys were autotransplanted after contralateral nephrectomy. MSC treatment did not affect perfusion hemodynamics during NMP or cause adverse effects at reperfusion, with 100% animal survival. MSCs did not affect plasma creatinine, glomerular filtration rate, neutrophil gelatinase-associated lipocalin concentrations or kidney damage assessed by histology during the 14days, and MSCs retention was demonstrated in renal cortex. Infusing MSCs during ex vivo NMP of porcine kidneys was safe and feasible. Within the short posttransplant follow-up period, no beneficial effects of ex vivo MSC therapy could be demonstrated.

Tri-modality cavitation mapping in shock wave lithotripsy

Shock wave lithotripsy (SWL) has been widely used for non-invasive treatment of kidney stones. Cavitation plays an important role in stone fragmentation, yet it may also contribute to renal injury during SWL. It is therefore crucial to determine the spatiotemporal distributions of cavitation activities to maximize stone fragmentation while minimizing tissue injury. Traditional cavitation detection methods include high-speed optical imaging, active cavitation mapping (ACM), and passive cavitation mapping (PCM). While each of the three methods provides unique information about the dynamics of the bubbles, PCM has most practical applications in biological tissues. To image the dynamics of cavitation bubble collapse, we previously developed a sliding-window PCM (SW-PCM) method to identify each bubble collapse with high temporal and spatial resolution. In this work, to further validate and optimize the SW-PCM method, we have developed tri-modality cavitation imaging that includes three-dimensional high-speed optical imaging, ACM, and PCM seamlessly integrated in a single system. Using the tri-modality system, we imaged and analyzed laser-induced single cavitation bubbles in both free field and constricted space and shock wave-induced cavitation clusters. Collectively, our results have demonstrated the high reliability and spatial-temporal accuracy of the SW-PCM approach, which paves the way for the future in vivo applications on large animals and humans in SWL.

Optimal design and evaluation of a multi-shank structure based neural probe

In order to develop long-lifetime neural electrodes, the insertion tissue injury caused by two optimized neural electrode (convex streamline electrode and vibration attenuation electrode) models were evaluated compared with a reference electrode. Based on the experimental evaluation system for testing tissue injury, the effects of insertion speeds on tissue injury of the two optimized electrodes with different insertion depths were studied. The maximum tissue strain caused by the two optimized neural electrodes firstly increased and then decreased with the increase of insertion speed at the depths of 3 mm and 4.5 mm. The insertion forces caused by vibration attenuation electrode are steady with the change of insertion speed. The convex streamline neural electrode caused less tissue injury compared with the other two electrodes. The higher or lower insertion speed causes smaller tissue strain for the two optimized electrodes, which is conductive to set implantation parameters to minimize tissue injury.

Immune Response to Borrelia: Lessons from Lyme Disease Spirochetes.

The mammalian host responds to infection with Borrelia spirochetes through a highly orchestrated immune defense involving innate and adaptive effector functions aimed toward limiting pathogen burdens, minimizing tissue injury, and preventing subsequent reinfection. The evolutionary adaptation of Borrelia spirochetes to their reservoir mammalian hosts may allow for its persistence despite this immune defense. This review summarizes our current understanding of the host immune response to B. burgdorferi sensu lato, the most widely studied Borrelia spp. and etiologic agent of Lyme borreliosis. Pertinent literature will be reviewed with emphasis on in vitro, ex vivo and animal studies that influenced our understanding of both the earliest responses to B. burgdorferi as it enters the mammalian host and those that evolve as spirochetes disseminate and establish infection in multiple tissues. Our focus is on the immune response of inbred mice, the most commonly studied animal model of B. burgdorferi infection and surrogate for one of this pathogen's principle natural reservoir hosts, the white-footed deer mouse. Comparison will be made to the immune responses of humans with Lyme borreliosis. Our goal is to provide an understanding of the dynamics of the mammalian immune response during infection with B. burgdorferi and its relation to the outcomes in reservoir (mouse) and non-reservoir (human) hosts.

Laparoscopic assisted extracorporeal ovarian harvest: A novel technique to optimize ovarian tissue for cryopreservation in young females with cancer

BackgroundAdvances in pediatric cancer therapy have improved the long-term survival for many children with cancer. The awareness of quality of life aspects, specifically fertility preservation, has become a reality for many of these families and children. Ovarian tissue cryopreservation has emerged as an available fertility option for young females with cancer. Safe and effective removal of ovarian tissue in these girls is paramount. We report a laparoscopic assisted extracorporeal ovarian harvest technique that achieves this goal. Operative techniqueWe place a 5 mm port at the umbilicus and in the right lower quadrant. Under laparoscopic guidance we place a 12 mm port in the left suprapubic area. Utilizing the 12 mm port site a monofilament traction suture is placed through the left ovary. The traction suture is used to translocate the ovary to an extracorporeal position via the 12 mm port site. Ovarian tissue is then excised utilizing standard surgical technique with the scalpel. Hemostasis is obtained and the capsule is closed with a running absorbable suture. The ovary is placed back in its native position laparoscopically. ConclusionsThe use of this extracorporeal ovarian harvesting technique is a safe and effective method to optimize removal and minimize tissue injury. Utilization of this technique, may have potential benefit to the young female with cancer.

Variations in plantar pressure variables across elliptical trainers in older adults

BackgroundEllipticals are used to address walking and cardiorespiratory training goals of older adults, some of whom are at risk for foot injuries. Variations in joint kinematics and muscle demands when using different ellipticals could lead to plantar pressure differences. This study explored plantar pressure variables during gait and use of four ellipticals. MethodsPlantar pressures were recorded while 10 adults [68.1 (4.5) years] walked and used the True, Octane, Life Fitness, and SportsArt ellipticals. Repeated-measures ANOVAs (5 × 1) identified forefoot and heel differences across conditions. FindingsMaximum forefoot forces and peak pressures were significantly lower than walking for each elliptical condition with one exception (Life Fitness peak pressure). However, sustained elliptical pedal contact time contributed to forefoot pressure-time integrals and dosages (i.e., cumulative pressure during one minute of activity) not varying significantly amongst elliptical and walking conditions. Heel maximum forces and peak pressures were significantly lower than walking during all elliptical conditions except SportsArt. Heel contact time on SportsArt and Octane exceeded walking, and SportsArt heel contact time exceeded Life Fitness. Heel pressure-time integral was greater on SportsArt compared to walking, Life Fitness, and True. Sports Art heel dosage exceeded Life Fitness and True. InterpretationWhile elliptical training's sustained double limb support diminished maximal forces and peak pressures under the forefoot and heel compared to walking, each ellipticals' pressure-time integral and dosage were not significantly lower than walking. These findings point to the importance of carefully initiating elliptical training programs to minimize tissue injury, particularly if sensory neuropathy is present.

Experimental evaluation of optimal-designed neural electrodes based on simulated implantation system

In order to develop long-lifetime neural electrodes, the insertion tissue injury caused by two optimized neural electrode (convex streamline electrode and vibration attenuation electrode) models were evaluated compared with a reference electrode. Based on the experimental evaluation system for testing tissue injury, the effects of insertion speeds on tissue injury of the two optimized electrodes with different insertion depths were studied. The maximum tissue strain caused by the two optimized neural electrodes firstly increased and then decreased with the increase of insertion speed at the depths of 3 mm and 4.5 mm. The insertion forces caused by vibration attenuation electrode are steady with the change of insertion speed. The convex streamline neural electrode caused less tissue injury compared with the other two electrodes. The higher or lower insertion speed causes smaller tissue strain for the two optimized electrodes, which is conductive to set implantation parameters to minimize tissue injury.

Evaluation Of Antioxidant And Cytotoxicity Properties Of Amygdalin Extracted From Prunus Dulcis

Free-radical reactions have been implicated in the pathology of many human diseases like atherosclerosis, ischemic heart disease, aging process, inflammation, diabetes, immuno-suppression,neurodegenerative disease etc. Radicals and other reactive oxygen species are formed constantly in the human body and are removed by the enzymatic and non-enzymatic antioxidant defence. The disturbance in ‘redox homeostasis’ that occurs when antioxidant defences are inadequate can damage lipids, proteins,carbohydrates and DNA. Drugs with multiple protective mechanisms, including antioxidant activity, may be one way of minimizing tissue injury. Phytochemicals with antioxidant property are naturally present in food are of great interest due to their beneficial effects on human health as they offer protection against oxidative deterioration. Amygdalin, also known as vitamin B17 is a cyanogenic glycoside found in several sources mainly in apples, pears, apricots, plums, peaches. Several reports claim amygdalin to be good chemopreventive agent, however these claims are not often backed by proper scientific evidence. Thus the present study is aimed to evaluate the therapeutic potential of amygdalin isolated from Prunus dulcis by studying its in vitro antioxidant and cytotoxic properties.Free-radical reactions have been implicated in the pathology of many human diseases like atherosclerosis, ischemic heart disease, aging process, inflammation, diabetes, immuno-suppression,neurodegenerative disease etc. Radicals and other reactive oxygen species are formed constantly in the human body and are removed by the enzymatic and non-enzymatic antioxidant defence. The disturbance in ‘redox homeostasis’ that occurs when antioxidant defences are inadequate can damage lipids, proteins,carbohydrates and DNA. Drugs with multiple protective mechanisms, including antioxidant activity, may be one way of minimizing tissue injury. Phytochemicals with antioxidant property are naturally present in food are of great interest due to their beneficial effects on human health as they offer protection against oxidative deterioration. Amygdalin, also known as vitamin B17 is a cyanogenic glycoside found in several sources mainly in apples, pears, apricots, plums, peaches. Several reports claim amygdalin to be good chemopreventive agent, however these claims are not often backed by proper scientific evidence. Thus the present study is aimed to evaluate the therapeutic potential of amygdalin isolated from Prunus dulcis by studying its in vitro antioxidant and cytotoxic properties.

Successful outcomes in laparoscopic pyeloplasty using knotless self-anchoring barbed suture in children

Laparoscopic pyeloplasty for ureteropelvic junction obstruction in children has gained increasing importance over the last decade. Intracorporeal knot tying still remains a technical challenge for the surgeon. Self-anchoring suture incorporates a new concept for tissue approximation and reduces intracorporeal knot tying problems. There are very few reports on self-anchoring knotless suture and its application for laparoscopic pyeloplasty in children. We present our results of a series of consecutive children undergoing laparoscopic pyeloplasty with knotless barbed sutures. We prospectively evaluate 15 consecutive patients who underwent laparoscopic pyeloplasty with knotless barbed sutures (V-LocTM, Covidien) for ureteropelvic anastomosis. The decision of the operation was given by pediatric nephrology-urology-radiologic imaging diagnostic team, and all patients were operated by a single surgeon. Pyeloplasty was performed without pelvic reduction, and the anastomosis was made by barbed sutures using running fashion. The mean age of the patients were 5.39 (3 months-17 years). Two cases had undergone a right-sided pyeloplasty, and thirteen had undergone a left-sided pyeloplasty. The duration of the operative procedure was 60-110min. Neither intraoperative nor postoperative complication was encountered in any of the cases. Patients were followed by ultrasonographic evaluation. The anteroposterior diameter (AP) diameter of renal pelvis and hydronephrosis grade Society for Fetal Urology (SFU) are significantly different when compared with pre-operative and postoperative period (p=0.001 and p=0.001, respectively). Owing to the renal parenchymal thickness change by age pre-operative and postoperative thickness comparison is adjusted by age, because age is considered as a covariate (confounder variable). We observed statistically significant (p=0.003) difference in parenchymal thickness in all cases. Follow-up periods of the 15 consecutive pediatric pyeloplasty cases were 6-54 months. In the present study, successful outcome of the laparoscopic pyeloplasty using barbed suture was shown for the first time in children in literature. We believe that successful outcome of laparoscopic pyeloplasty could be achieved by eliminating knots and less manipulation on the wound edge also minimizes tissue injury during the procedure.

Novel Chitohexaose Analog Protects Young and Aged mice from CLP Induced Polymicrobial Sepsis

In Gram-negative bacterial sepsis, production of excess pro-inflammatory cytokines results in hyperinflammation and tissue injury. Anti-inflammatory cytokines such as IL-10 inhibit inflammation and enhance tissue healing. Here, we report a novel approach to treat septicemia associated with intra-abdominal infection in a murine model by delicately balancing pro- and anti-inflammatory cytokines. A novel oligosaccharide compound AVR-25 selectively binds to the TLR4 protein (IC50 = 0.15 µM) in human peripheral blood monocytes and stimulates IL-10 production. Following the cecal ligation and puncture (CLP) procedure, intravenous dosing of AVR-25 (10 mg/kg, 6–12 h post-CLP) alone and in combination with antibiotic imipenem protected both young adult (10–12 week old) and aged (16–18 month old) mice against polymicrobial infection, organ dysfunction, and death. Proinflammatory cytokines (TNF-α, MIP-1, i-NOS) were decreased significantly and restoration of tissue damage was observed in all organs. A decrease in serum C-reactive protein (CRP) and bacterial colony forming unit (CFU) confirmed improved bacterial clearance. Together, these findings demonstrate the therapeutic ability of AVR-25 to mitigate the storm of inflammation and minimize tissue injury with high potential for adjunctive therapy in intra-abdominal sepsis.

A 90-day mortality risk model as a support in managing patients undergoing video-assisted thoracic surgery for lung cancer

The introduction of the video-assisted thoracoscopic (VATS) approach for lung lobectomy in the treatment of lung cancer has led to a reduction of postoperative morbidity, length of stay and, in some studies, of mortality when compared to thoracotomy (1-3). The improvement of postoperative outcomes as a consequence of this mini-invasive approach, which minimize tissue injury and immune-stress response, has allowed a rapid diffusion of this technique that is currently preferred to thoracotomy approach in several experienced centers.