Microvascular anastomosis using modified micro-stents: a pilot in vivo study.

INTRODUCTION: Microvascular sutured anastomosis remains the gold standard in microvascular flap surgery but is technically challenging, time-consuming, and sometimes unreliable. The goal of our study has been to develop a microvascular stenting system that can be used for microvascular anastomosis, even without the use of a microscope. MATERIALS AND METHODS: Custom-made stainless-steel stents were used to re-establish vessel continuity after the severance of the abdominal aortic vessel in nine rats. At 30 min after re-opening the blood flow, Doppler flowmetry and indocyanine green (ICG) angiography were used to assess vessel patency, and vessels were inspected microscopically for signs of thrombosis. RESULTS: Eight of the nine animals survived the procedure. In one case, the abdominal aorta was torn during balloon dilation of the stent. Four out of the nine stent anastomoses showed an excellent fit. In the remaining four cases, a collagen membrane and fibrin glue were successfully used to stop vascular leakage. However, these additional steps might have had a negative impact on vessel patency, and thrombus formation impaired blood flow completely in one case. CONCLUSION: Microvascular stent anastomosis is feasible and might in some cases be superior to standard sutured anastomosis. However, a number of technical difficulties remain to be addressed, and long-term results are not yet available.

Hiatal hernia, Barrett's esophagus, and long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux.

BACKGROUND: The aim of this study was to determine the long-term symptom control after laparoscopic fundoplication for gastroesophageal reflux disease (GERD), and possible prognostic factors. METHODS: A cohort of 271 patients, operated on at a university hospital from 1996 through 2002, was eligible for evaluation after a median interval of 102 months (range = 12-158). The time between surgery and recurrence of reflux symptoms (i.e., time to treatment failure) served as the end point for statistical analysis. Putative risk factors for symptom recurrence were analyzed by univariate analysis and by using Cox's multiple-hazards regression. RESULTS: According to Kaplan-Meier estimates, the rate of reflux symptom recurrence was 15 % after 108 months, 11 % in cases without intestinal metaplasia, but 43 % in patients with long-segment (≥ 3 cm) Barrett's esophagus (BE; p < 0.0001). Reflux symptoms recurred in 22 % of cases with a hiatal hernia (HH) ≥ 3 cm before operation, but only in 7 % with smaller or absent HH (p = 0.005). Multivariate analysis revealed a relative risk of 6.6 (CI = 3.0-13.0) for long-segment BE and 3.0 (CI = 1.7-10.1) for HH ≥ 3 cm. A strong statistical interaction was found between HH ≥ 3 cm and long-segment BE: the small group (n = 18) of cases exhibiting both risk factors had an exaggerated recurrence rate of 72 % at 108 months. CONCLUSIONS: Laparoscopic fundoplication for symptomatic GERD provided a long-lasting abolition of reflux symptoms in 231 of 271 (85 %) patients. HH ≥ 3 cm and long-segment BE were shown as independent prognostic factors favoring recurrence.

Quantitative comparison of the expression of antimicrobial peptides in the oral mucosa and extraoral skin.

Antimicrobial peptides (AMP) defend epithelial surfaces against pathological micro-organisms. We know of no comparison of their expression between the oral mucosa and extraoral epithelium, but knowledge of differences in their quantities is of interest, possibly as a starting point for new treatments. Expression of AMP human beta-defensin (hBD)-1/-2/-3 and psoriasin in the oral mucosa and extraoral epithelium of the head and neck were measured by real-time polymerase chain reaction (RT-PCR) (n=14), immunohistochemistry (n=6), and western blot (n=8). RT-PCR showed that all the genes investigated were expressed significantly more in the oral mucosa than in the skin (hBD-1: p=0.002; hBD-2: p=0.006; hBD-3: p=0.035; psoriasin: p=0.02). Immunohistochemistry and western blot showed differential concentrations of proteins: hBD-2 (p=0.021) and hBD-3 (p=0.043) were pronounced in the oral mucosa, whereas psoriasin was raised in the extraoral skin (p=0.021). There was no difference in protein concentrations for hBD-1 (p=0.08). The observed differences in the expression of AMP may be important for new treatments such as topical application of AMP derivatives.

Experimental analysis of tensile force of individualized stents for microvascular anastomoses.

The aim of this project was to investigate the fundamental idea of the possibility of anastomosing small blood vessels in microvascular transplant procedures by an individualized stent known from coronary angioplasty. We investigated the influence of length, dilation and differences in fabrication of the newly developed balloon-expandable stent on the tensile force of stented anastomoses. Various gripping devices were tested and validated to investigate how the length, dilatation and differences in fabrication of the newly developed stent influence the tensile force of the stented anastomosis. Overall, 66 arteries of thiel-fixed human cadavers were investigated, divided into 11 groups. The median tensile force in sutured anastomoses was 2.96 N. The stented anastomoses with 24 mm stents and Ø 3.5 mm dilation attained approximately two-thirds of F(max)-values compared with conventional sutured anastomoses. If the stent was less dilated or had a shorter length, the maximum tensile force of the anastomosis was lower. Recent developments with an inversely oriented stent structure are expected to achieve even higher tensile force values. Further research in stent design to reduce leakage is necessary. A reduction of stent and catheter dimension is also needed to enhance the implantation method.

Immune-modulating efficacy of a polyphenol-rich beverage on symptoms associated with the common cold: a double-blind, randomised, placebo-controlled, multi-centric clinical study.

In the present study, the immune-modulating efficacy of a polyphenol-rich beverage on symptoms associated with the common cold was evaluated. For this purpose, ninety-eight patients reporting common cold symptoms that began no longer than 24 h before the study intervention were randomly assigned to consume either the test beverage or placebo twice per d for 10 d. The severity of the disease was expressed as the total score of the five cold symptoms 'general feeling of sickness', 'headache and/or joint aches', 'sore throat and/or difficulty swallowing', 'hoarseness and/or cough' and 'stuffy nose/sniffle'. Consequently, the decrease from 10.2 (sd 3.1) points at the beginning to 2.1 (sd 2.7) points by the end of the study in the verum group demonstrated a clear improvement, whereas in the placebo group only a reduction from 10.5 (sd 3.0) to 6.3 (sd 3.8) points could be observed. The mean difference between the groups (primary efficacy criterion) of 3.9 points was highly significant (P < 0.01). At the end of the study there were highly significantly (P < 0.01) more patients in the verum group complaint free than in the placebo group (secondary efficacy criterion). In addition to these self-reported values, several local findings of the physical examination were also significantly improved in the verum group.

Quantitative determination of phenolic compounds in artichoke-based dietary supplements and pharmaceuticals by high-performance liquid chromatography.

Dietary supplements are among the most rapidly growing products in the food and personal care market with an estimated worldwide volume exceeding $60 billion. The main problem associated with dietary supplements is their legal classification. Being neither food nor medicine, they often inhabit a gray area between the two, which makes legal regulatory extremely difficult. Thus, a coexistence of products processed from the same botanical source on the same market as dietary supplement or pharmaceutical is possible. In the present study, various artichoke-based dietary supplements were investigated for their phenolic profile and compared to artichoke phytopharmaceuticals. Quantification of individual hydroxycinnamic acids and flavonoids was carried out by external calibration. For the first time, determination of several apigenin derivatives was included. Chlorogenic acid represented the major constituent in all samples investigated with the exception of juice derived from fresh flower heads, which exhibited a higher cynarin content. Furthermore, a distinction between products made from artichoke leaves or flower heads was possible. The results obtained revealed great diversity of pharmaceuticals and dietary supplements, highlighting the need of standardized quality requirements.

Taraxacum--a review on its phytochemical and pharmacological profile.

The genus Taraxacum is a member of the family Asteraceae, subfamily Cichorioideae, tribe Lactuceae and widely distributed in the warmer temperate zones of the Northern Hemisphere. The perennial weed has been known since ancient times for its curative properties and has been utilized for the treatment of various ailments such as dyspepsia, heartburn, spleen and liver complaints, hepatitis and anorexia. However, its use has mainly been based on empirical findings. This contribution provides a comprehensive review of the pharmacologically relevant compounds of Taraxacum characterized so far and of the studies supporting its use as a medicinal plant. Particular attention has been given to diuretic, choleretic, anti-inflammatory, anti-oxidative, anti-carcinogenic, analgesic, anti-hyperglycemic, anti-coagulatory and prebiotic effects. Finally, research needs such as quantification of individual Taraxacum constituents and assessment of their pharmacological activities in humans have briefly been outlined.

Separation and quantification of inulin in selected artichoke (Cynara scolymus L.) cultivars and dandelion (Taraxacum officinale WEB. ex WIGG.) roots by high-performance anion exchange chromatography with pulsed amperometric detection.

The profile of fructooligosaccharides and fructopolysaccharides in artichoke heads and dandelion roots was investigated. For this purpose, a suitable method for high-performance anion exchange chromatography with pulsed amperometic detection was developed. The separation of monomers, oligomers and polymers up to a chain length of 79 sugar residues was achieved in one single run. Glucose, fructose, sucrose and individual fructooligosaccharides (kestose, nystose, fructofuranosylnystose) were quantified in six different artichoke cultivars and in dandelion roots. The contents ranged from 12.9 g/kg DM to 71.7 g/kg DM for glucose, from 15.8 g/kg DM to 67.2 g/kg DM for fructose, and from 16.8 g/kg DM to 55.2 g/kg DM for sucrose in the artichoke heads. Kestose was the predominant fructooligosaccharide, followed by nystose and fructofuranosylnystose. In four cultivars fructofuranosylnystose was only detectable in traces and reached its maximum value of 3.6 g/kg DM in the cultivar Le Castel. Furthermore, an average degree of polymerization of 5.3 to 16.7 was calculated for the individual artichoke cultivars, which is noticeably lower than hitherto reported. In contrast, the contents of kestose, nystose and fructofuranosylnystose in dandelion root exceeded that of artichoke, reflecting the short chain characteristic of the inulin, which was confirmed by chromatographic analysis.

Characterization and quantification of anthocyanins in selected artichoke (Cynara scolymus L.) cultivars by HPLC-DAD-ESI-MSn.

The anthocyanin pattern of artichoke heads (Cynara scolymus L.) has been investigated by high-performance liquid chromatography-electrospray ionization mass spectrometry. For this purpose a suitable extraction and liquid chromatographic method was developed. Besides the main anthocyanins-cyanidin 3,5-diglucoside, cyanidin 3-glucoside, cyanidin 3,5-malonyldiglucoside, cyanidin 3-(3''-malonyl)glucoside, and cyanidin 3-(6''-malonyl)glucoside-several minor compounds were identified. Among these, two peonidin derivatives and one delphinidin derivative were characterized on the basis of their fragmentation patterns. To the best of our knowledge this is the first report on anthocyanins in artichoke heads consisting of aglycones other than those of cyanidin. Quantification of individual compounds was performed by external calibration. Cyanidin 3-(6''-malonyl)glucoside was found to be the major anthocyanin in all the samples analyzed. Total anthocyanin content ranged from 8.4 to 1,705.4 mg kg(-1) dry mass.

Characterization of phenolic acids and flavonoids in dandelion (Taraxacum officinale WEB. ex WIGG.) root and herb by high-performance liquid chromatography/electrospray ionization mass spectrometry.

Phenolic acids and flavonoids were extracted from a dandelion (Taraxacum officinale WEB. ex WIGG.) root and herb juice and characterized by high-performance liquid chromatography/electrospray ionization mass spectrometry. Among the 43 compounds detected, 5 mono- and dicaffeoylquinic acids, 5 tartaric acid derivatives, 8 flavone and 8 flavonol glycosides were characterized based on their UV spectra and their fragmentation patterns in collision-induced dissociation experiments. The predominant compound was chicoric acid (dicaffeoyltartaric acid). Furthermore, several caffeoylquinic acid isomers were distinguished in dandelion extracts for the first time by their specific mass spectral data. The present study reveals that even more quercetin glycosides were found in dandelion than hitherto assumed. The occurrence of di- and triglycosylated flavonoids in particular has not yet been described. This paper marks the first report on HPLC-DAD/ESI-MSn investigations of phenolic compounds in dandelion.

Identification and quantification of caffeoylquinic acids and flavonoids from artichoke (Cynara scolymus L.) heads, juice, and pomace by HPLC-DAD-ESI/MS(n).

A method for the identification and quantification of phenolic compounds from artichoke (Cynara scolymus L.) heads, juice, and pomace by HPLC with diode array and mass spectrometric detection was developed. Among the 22 major compounds, 11 caffeoylquinic acids and 8 flavonoids were detected. Quantification of individual compounds was carried out by external calibration. Apigenin 7-O-glucuronide was found to be the major flavonoid in all samples investigated. 1,5-Di-O-caffeoylquinic acid represented the major hydroxycinnamic acid, with 3890 mg/kg in artichoke heads and 3269 mg/kg in the pomace, whereas in the juice 1,3-di-O-caffeoylquinic acid (cynarin) was predominant, due to the isomerization during processing. Total phenolic contents of approximately 12 g/kg on a dry matter basis revealed that artichoke pomace is a promising source of phenolic compounds that might be recovered and used as natural antioxidants or functional food ingredients.