Effect of cilostazol on healing of achilles tendon ruptures: an experimental study on rats.

PURPOSE: This study aimed to evaluate whether cilostazol (phosphodiesterase III inhibitor) could enhance the healing of Achilles tendon ruptures in rats. MATERIALS AND METHODS: The Achilles tendons of 24 healthy male adult rats were incised and repaired. The rats were randomly allocated to cilostazol and control groups. The cilostazol group received daily intragastric administration of 50 mg/kg cilostazol for 28 days, while the control group did not receive any medication. The rats were sacrificed on the 30th day, and the Achilles tendon was evaluated for biomechanical properties, histopathological characteristics, and immunohistochemical analysis. RESULTS: All rats completed the experiment. The Movin sum score of the control group was significantly higher (p = 0.008) than that of the cilostazol group, with means of 11 ± 0.63 and 7.50 ± 1.15, respectively. Similarly, the mean Bonar score was significantly higher (p = 0.026) in the control group compared to the cilostazol group (8.33 ± 1.50 vs. 5.5 ± 0.54, respectively). Moreover, the Type I/Type III Collagen ratio was notably higher (p = 0.016) in the cilostazol group (52.2 ± 8.4) than in the control group (34.6 ± 10.2). The load to failure was substantially higher in the cilostazol group than in the control group (p = 0.034), suggesting that the tendons in the cilostazol group were stronger and exhibited greater resistance to failure. CONCLUSIONS: The results of this study suggest that cilostazol treatment significantly improves the biomechanical and histopathological parameters of the healing Achilles tendon in rats. Cilostazol might be a valuable supplementary therapy in treating Achilles tendon ruptures in humans. Additional clinical studies are, however, required to verify these outcomes.

Repairing the ruptured annular fibrosus by using type I collagen combined with citric acid, EDC and NHS: an in vivo study.

OBJECTIVES: To explore the effect of citric acid (CA)-1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC)/N-hydroxysuccinimide (NHS) collagen gel on repairing annular defects. METHODS: Type I collagen was extracted from the rat-tail tendon and crosslinked with CA at different mass ratio using EDC and NHS as crosslinking reagents to prepare four kinds of collagen gels. Forty-eight adult SD rats were divided into first sham group (n = 8), second group (n = 10) which was punctured and injected with CA-EDC/NHS collagen gel, third group (n = 10) which was punctured and injected with CA-EDC/NHS collagen gel, fourth group (n = 10) which was punctured and injected with EDC/NHS collagen gel, and fifth group (n = 10) which was punctured and untreated. X-ray images and magnetic resonance imaging images were obtained before puncture and at the 1st, 2nd, and 4th week after puncture. At each time point, disc height index (%DHI), voxel count and modified MRI Pfirrmann grading were collected and analyzed. All animals were killed at the 4th week to study the morphology. RESULTS: The discs in the second group showed only slight degeneration compared with the healthy discs, and the results of %DHI (average 79%), voxel count (average 126.9), Pfirrmann grading (average grade 1.3) and morphology in the second group indicated less degeneration tendency compared with the other three puncture groups at the 4th week (P < 0.05). The annular fibrosus was partially repaired by the collagen gels that bridged the defects. CONCLUSIONS: CA-EDC/NHS collagen gel is capable of repairing annular defects induced by needle puncture, which may be closely related to the dose of CA.

Investigation of the effects of pentoxifylline and alpha tocopherol treatment on recovery in rats with Achilles tendon rupture.

Although the Achilles tendon is the largest and strongest tendon in the body, healing of the Achilles tendon is the most common injury, and this process is difficult due to poor tendon circulation; moreover, the underlying mechanism has not been fully elucidated. In our study, we aimed to investigate the effects of pentoxifylline and alpha-tocopherol administered separately or in combination on rats with Achilles tendon injury. Forty-eight male Wistar rats weighing 230 ± 30 g were used in the study. The rats were randomly divided into eight groups of six animals each. Tendons were evaluated histopathologically and biomechanically. According to the statistical analysis, the vascularity density in the pentoxifylline group on day 14 was significantly greater than that in the other groups (p < 0.05). The collagen arrangement in the pentoxifylline and alpha-tocopherol groups on day 14 was found to be firmer and smoother than that in the control group (p < 0.05). The collagen arrangement in the pentoxifylline group on day 28 was greater than that in the other groups (p < 0.05). The biomechanical results were significantly greater in all groups (p < 0.05). Pentoxifylline contributed to tendon healing both through neovascularization in the early period and by improving collagen orientation in the late period, while alpha-tocopherol had a positive effect on collagen orientation in the early period. No beneficial effects were observed when pentoxifylline and alpha-tocopherol were used together. We believe that further research is needed to understand the effects of this combination therapy on tendon healing.

Effect of BMP-12, TGF-ß1 and autologous conditioned serum on growth factor expression in Achilles tendon healing.

PURPOSE: Achilles tendon ruptures are devastating and recover slowly and incompletely. There is a great demand for biomolecular therapies to improve recovery, yet little is understood about growth factors in a healing tendon. Here, the role of growth factors during tendon healing in a rat model and their reaction to single and multiple growth factor treatment are explored. METHODS: Rat tendons were transected surgically and resutured. The expression of bFGF, BMP-12, VEGF and TGF-ß1 was assessed by immunohistochemical analysis one to 8 weeks after surgery. Paracrine effects of TGF-ß1 or BMP-12 added by adenoviral transfer, as well as the effect of autologous conditioned serum (ACS) on growth factor expression, were evaluated. RESULTS: bFGF, BMP-12 and VEGF expression was highest 1 week after transection. bFGF and BMP-12 declined during the remaining period whereas VEGF expression persisted. TGF-ß1 expression dramatically increased after 8 weeks. ACS treatment increased bFGF (P = 0.007) and BMP-12 (P = 0.004) expression significantly after 8 weeks. Also overall expression of bFGF, BMP-12 and TGF-ß1 regardless of time point was significantly greater than controls with ACS treatment (P < 0.05). Both BMP-12 and TGF-ß1 treatments had no significant effect. No effect was observed in VEGF with any treatment. CONCLUSION: bFGF, BMP-12, VEGF and TGF-ß1 are differentially expressed during tendon healing. Additional BMP-12 or TGF-ß1 has no significant influence, whereas ACS generally increases expression of all factors except VEGF. Staged application of multiple growth factors may be the most promising biomolecular treatment.

Establishment of two canine models of benign airway stenosis and the effect of mitomycin C on airway stenosis.

OBJECTIVES: Cuffed endotracheal intubation and stent implantation were employed to simulate two types of benign airway stenosis and further to analysis the different features between them from trachecscopic characteristics, gross anatomy to histopathological changes. In addition, our study explored the therapeutic effect of mitomycin C at different concentrations on granulation tissue caused by stent implantation in order to provide a new therapeutic strategy for clinical treatment of benign airway stenosis. METHODS: Twelve beagle dogs were randomly divided into four groups, with three dogs in each group. Group A: Three beagle dogs were intubated through oral trachea after general anesthesia and cuff pressure maintained at 200 mmHg for 24 h. Group B, Group C and Group D: endotracheal coated self-expanding metal stents were placed after general anesthesia under the guidance of bronchoscope. On the Day7 after stent implantation, Group B, as control group, was injected phosphate buffer solution of 1 ml into granulation tissue at the end of stent; Group C was injected mitomycin C of 1 ml at 0.4 mg/ml and Group D was injected mitomycin C of 1 ml at 0.8 mg/ml into granulation tissue at the end of metal airway stent respectively, the same method as Group B. Bronchoscopy was used to observe tracheal lumen on the seventh day, fourteenth day and twenty-first day after modeling and pathological changes were examined on twenty-first day. RESULTS: Two models of benign airway stenosis can be established by cuffed endotracheal intubation and stent implantation. There was tracheal rupture in the trachea cartiage ring in the cuffed endotracheal intubation group, but was't in stent implantation group. Histopathological characteristics were different between cuffed endotracheal intubation and stent implantation groups. In stent placement groups, we found that the stenosis degree of mitomycin C at 0.4 mg/ml was approximately 19%-32%, mitomycin C at 0.8 mg/ml was approximately 16%-21% and the control group was approximately 36%-47%. CONCLUSION: The two models of canine benign tracheal stenosis induced by cuffed endotracheal intubation and stent implantation are relatively simple, reliable and reproducible and have different characteristics. Mitomycin C could inhibit proliferation of granulation tissue and attenuate the degree of airway stenosis caused by stent implantation.

Structural and functional modulation of early healing of full-thickness superficial digital flexor tendon rupture in rabbits by repeated subcutaneous administration of exogenous human recombinant basic fibroblast growth factor.

The present study was designed to investigate the effects of basic fibroblast growth factor on the healing of the acute phase of complete superficial digital flexor tendon rupture in rabbits. A total of 40 skeletally mature female white New Zealand rabbits were randomly divided into 2 equal groups of injured treated and injured control. After tenotomy and surgical anastomosis, using a modified Kessler and running pattern, the injured legs were placed in casts for 14 days, and basic fibroblast growth factor was injected subcutaneously over the lesion on days 3, 7, and 10 after injury. The injured control rabbits received a normal saline injection in a similar protocol. The rabbits' weight, tendon diameter, clinical signs, radiographs, and ultrasound scans were evaluated weekly. The rabbits were killed 28 days after injury, and the tendons were evaluated at the macroscopic, histopathologic, and ultrastructural levels and for biomechanical and the percentage of dry weight analysis. Treatment significantly reduced the diameter and increased the echogenicity and dry weight content and enhanced the maturation rate of the tenoblasts, fibrillogenesis, collagen fibril diameter, fibrillar density, tensile strength, and stiffness and stress of the injured tendons. Treatment with basic fibroblast growth factor was effective in restoring the morphologic and biomechanical properties of the injured superficial digital flexor tendon and could be valuable in clinical trial studies.

[Efficiency of Cikatridina spray for healing of episiotomy and perineal ruptures].

UNLABELLED: Episiotomy is the most common surgical intervention during childbirth. Cikatridina spray allows treatment of this primary contaminated surgical wound and assist its primary healing. The aim of this study is to determine the effectiveness of aid healing of episiotomy, and spontaneous perineal ruptures after normal and operative vaginal delivery. MATERIAL AND METHODS: The study included 90 women after spontaneous or operative vaginal delivery with episiotomy or a spontaneous perineal rupture treated with Cikatridina spray. Control group of 90 women was used to compare the efficency. The status of the wound was determined on the first, third, fifth and 30th day after birth, according to presence of the following symptoms: redness, swelling, pain, exudation, epithelization, open wound. RESULTS: Symptoms of redness, swelling and pain in the group treated with Cikatridina spray after normal birth resolved on the third postpartum day in 100% of cases. Same symptoms after operative vaginal birth persist in average 9% of women and resolved on the 5th day When comparing treated patients with Cikatridina spray with perineal ruptures and the control group in 100% were reported no symptoms in the study group compared with the control group where the redness, swelling persist in 20% and 85.7% epithelization is showing at 5 postpartum day. There was one open episiotomy of a patient from a control group after operative vaginal birth healed in 26 days. CONCLUSIONS: Cikatridina spray effectively eliminates symptoms of redness, swelling and pain regardless of perineal trauma and the method of delivery. There is an earlier epithelization after using the Cikatridina spray. Open and infected perineal wounds are treated with conventional medicines.

Electrospun heparin-loaded nano-fiber sutures for the amelioration of achilles tendon rupture regeneration: in vivo evaluation.

Peritendinous blood circulation improvement is a challenge to promote the healing of ruptured tendons in clinical treatment. Although electrospun membranes or scaffolds enable the reduction of complications such as adhesion, however, low efficiency, toxicity issues, the loss of biological activity, and complex electrospinning techniques are all bottlenecks of these systems. Improving the blood supply is crucial for their successful use, which involves promoting the metabolism and nutrient absorption in tendons. Here, a multifunctional, structurally simple strategy involving heparin-loaded sutures (PPH) that are clinically applicable is reported, in the form of electrospun core-shell nanofibers, with the ability to perform sustained release of anticoagulants heparin (verified in our previous publication) for the improvement of the healing of Achilles tendon. The morphology and diameter distribution of the collagen fiber in the PPH group are closely related to the health of the Achilles tendon than those of commercial sutures (CS). The in vivo results of the total collagen content and the expression of collagen type I in the PPH group are more than those of the CS group. After 6 weeks of culture, the tensile strength of the PPH group shows no significant difference compared to the healthy group. The data obtained in this study improves the current understanding on the regeneration of ruptured tendons and presents a promising strategy for clinical treatment.

Impact of PDGF-BB on cellular distribution and extracellular matrix in the healing rabbit Achilles tendon three weeks post-operation.

Current methods for tendon rupture repair suffer from two main drawbacks: insufficient strength and adhesion formation, which lead to rerupture and impaired gliding. A novel polymer tube may help to overcome these problems by allowing growth factor delivery to the wound site and adhesion reduction, and by acting as a physical barrier to the surrounding tissue. In this study, we used a bilayered DegraPol® tube to deliver PDGF-BB to the wound site in a full-transection rabbit Achilles tendon model. We then performed histological and immunohistochemical analysis at 3 weeks postoperation. Sustained delivery of PDGF-BB to the healing Achilles tendon led to a significantly more homogenous cell distribution within the healing tissue. Lower cell densities next to the implant material were determined for +PDGF-BB samples compared to -PDGF-BB. PDGF-BB application increased proteoglycan content and reduced alpha-SMA+ areas, clusters of different sizes, mainly vessels. Finally, PDGF-BB reduced collagens I and III in the extracellular matrix. The sustained delivery of PDGF-BB via an electrospun DegraPol® tube accelerated tendon wound healing by causing a more uniform cell distribution with higher proteoglycan content and less fibrotic tissue. Moreover, the application of this growth factor reduced collagen III and alpha-SMA, indicating a faster and less fibrotic tendon healing.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS IN A CASE OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO TRAUMATIC CHOROIDAL RUPTURE.

BACKGROUND/PURPOSE: To document by optical coherence tomography angiography, the onset of a choroidal neovascularization (CNV) secondary to traumatic choroidal rupture and describe its changes after an intravitreal injection of bevacizumab. METHODS: Case report. RESULTS: A 20-year-old woman presented referring vision loss after a blunt ocular trauma in her left eye. The patient underwent a complete ophthalmic examination. Best-corrected visual acuity was 20/200. Fundus examination, fluorescein angiography, indocyanine green angiography, and optical coherence tomography displayed a choroidal rupture with no evidence of CNV. Optical coherence tomography angiography showed the choroidal rupture as a line of choriocapillaris rarefaction because of the mechanical damage. Six months later, best-corrected visual acuity decreased to 20/300; optical coherence tomography angiography displayed the growth of a CNV, characterized by a tangled vascular network. After one intravitreal injection of bevacizumab, optical coherence tomography angiography documented a contraction of the CNV. CONCLUSION: Optical coherence tomography angiography is a useful imaging technique for the diagnosis and follow-up of patients with choroidal ruptures. Anti-vascular endothelial growth factor agents represent an effective therapy for the treatment of CNVs secondary to this affection.

Delayed rupture of the left ventricle inferior wall: a diagnostic and surgical challenge.

An acute rupture after an acute myocardial infarction with an unusually delayed presentation is described. The etiology, factors contributing to the delayed presentation, diagnosis, and management are discussed.

Use of Fibrin Glue in the Management of Descemet Membrane Perforation during Deep Anterior Lamellar Keratoplasty.

PURPOSE: To describe the use of fibrin glue to seal Descemet membrane (DM) microperforation and macroperforation during deep anterior lamellar keratoplasty (DALK). METHODS: A retrospective chart review was performed on patients who had DM perforation managed by fibrin glue during DALK at King Khaled Eye Specialist Hospital (KKESH) between June 2014 and February 2019. RESULTS: One thousand two hundred and eighty-eight DALK surgeries were performed at KKESH during the study period. Fibrin glue was used to seal DM perforations in four cases of DALK for keratoconus. CONCLUSION: Fibrin glue is an effective method to seal DM microperforations and macroperforations during DALK, which reduces the rate of conversion to penetrating keratoplasty (PK), preserving the advantage of DALK over PK.

Prolonged thromboprophylaxis with dalteparin after surgical treatment of achilles tendon rupture: a randomized, placebo-controlled study.

OBJECTIVES: Prophylaxis against thromboembolic complications has become routine after major orthopedic surgery. In contrast, it remains an issue for debate whether prophylaxis after minor surgery and immobilization is necessary, even though these treatments are well-known risk factors for deep-vein thrombosis (DVT). The objective of this study was to evaluate the efficacy of dalteparin during lower-limb immobilization after surgical treatment of Achilles tendon rupture. DESIGN SETTING, AND PATIENTS: Randomized, placebo-controlled, double-blind study of 105 consecutive patients surgically treated for Achilles tendon rupture in a trauma hospital. DVT screening with color duplex sonography was conducted 3 weeks and 6 weeks after surgery. All DVTs were confirmed with phlebography. Intervention was placebo or dalteparin (5000 U) given subcutaneously once daily for 6 weeks postoperatively. MAIN OUTCOME MEASURE: DVT incidence. RESULTS: Primary endpoint analysis was available for 91 patients. DVT was diagnosed in 16 of 47 patients (34%) in the dalteparin group and in 16 of 44 patients (36%) in the placebo group. These figures are not significantly different (P = 0.8). Proximal DVT was diagnosed in 1 patient (2%) in the dalteparin group and in 3 patients (6%) in the placebo group (P = 0.6). No pulmonary emboli or major bleeding occurred in either of the groups. CONCLUSIONS: DVT is common after surgical treatment of Achilles tendon rupture, and therefore effective thromboprophylaxis is desirable. In our study, thromboprophylaxis with dalteparin, however, does not affect the incidence of DVT during immobilization after Achilles tendon rupture surgery. Long-term effects of immobilization, such as the risk for postthrombotic syndrome, need to be investigated further.

Biomechanical study of the effect of platelet rich plasma on the treatment of medial collateral ligament lesion in rabbits.

PURPOSE: To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. METHODS: Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. RESULTS: Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). CONCLUSION: The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.

Multimodal Imaging in a Patient with Traumatic Choroidal Ruptures.

PURPOSE: To describe the case and the follow-up of a traumatic choroidal rupture characterized by means of multimodal imaging including color fundus photographs, infrared reflectance, blue autofluorescence, swept-source optical coherence tomography, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography angiography (OCT-A). METHODS: Case report. RESULTS: A 17-year-old boy was referred to our clinic complaining of reduction in visual acuity in the right eye (RE) after a blunt ocular trauma during a soccer match. Dilated fundus examination of RE showed 2 peripapillary choroidal ruptures located temporally and inferiorly to the optic disc. Among different imaging tools useful in the diagnosis and study of choroidal ruptures, particular attention must be paid to OCT-A, which showed the lesions as breaks in the choriocapillaris plexus with a hypointense appearance due to the lack of substance. Moreover, along the break it was possible to see the projection of the underlying choroidal vasculature, which appeared hyperintense. The retinal vascular plexa were spared. CONCLUSIONS: All patients presenting with blunt ocular trauma should undergo fundus examination to exclude damage to the optic nerve, retina, and choroid, and need close follow-up to avoid the development of secondary complications such as choroidal neovascularization. Optical coherence tomography angiography might add relevant information in the global evaluation and follow-up of choroidal ruptures in a noninvasive fashion, and could replace other invasive modalities such as FA or ICGA.

[DIPROSPAN, LONGIDAZA AND THEIR COMBINED ACTION AGAINST FIBROSIS CAUSED BY MECHANICAL INJURY OF THE INTERVERTEBRAL DISCS IN RATS].

The formation of connective tissue changes in the spinal canal of rats, caused by the method of intervertebral disc ruptures, in association with a mixture of epidural injection of longidaza and diprospan has been researched. Simultaneous injection of hialuronidase and betamethasone in composition of diprospan and longidaza, revealed a high synergistic effect and anti-fibrotic activity. Combined antifibrosis action of these two drugs is stronger than the sum of the actions of the two drugs in their separate use. Reducion of the maximum thickness of the fibrous layer was 49%, compared with the reference value and reduction of the total area of the fibrous formation was 46%. In our opinion, due to anti-inflammatory effects and the ability to reduce epidural scar adhesion, this complex is promising for its therapeutic use in treatment of spinal epidural fibrosis.

Controlled release of curcumin from curcumin-loaded nanomicelles to prevent peritendinous adhesion during Achilles tendon healing in rats.

We introduced curcumin-loaded nanomicelles into a tendon-healing model to evaluate their effects on tendon healing and adhesion. Three groups consisting of 36 rats underwent rupture and repair of the Achilles tendon. The treatment group received an injection of curcumin-loaded nanomicelles (gold nanorods [GNRs]-1/curcumin in polymeric nanomicelles [curc@PMs] at a dosage of 0.44 mg curcumin/kg in 0.1 mL saline) into the surgical site and exposed to laser postoperatively at weeks 1, 2, and 3, for three times 10 seconds each, on the surgical site in the rats that underwent tendon rupture and repair, while the other two groups received 0.44 mg curcumin/kg in 0.1 mL saline and 0.1 mL of saline, respectively. The specimens were harvested at 4 weeks and subjected to biomechanical and histological evaluation. The scoring results of tendon adhesion indicated that GNRs-1/curc@PMs group was in the lowest grade of peritendinous adhesions compared to the other groups. Histological assessment further confirmed the preventive effect of GNRs-1/curc@PMs on tendon adhesion. These findings indicated greater tendon strength with less adhesion in the group treated with GNRs-1/curc@PMs combined with laser exposure, and that nanoparticle-based therapy may be applied to prevent adhesion in clinical patients.

Superselective Intra-Arterial Ethanol Sclerotherapy of Feeding Artery and Nidal Aneurysms in Ruptured Cerebral Arteriovenous Malformations.

In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication.

Bioactive, Elastic, and Biodegradable Emulsion Electrospun DegraPol Tube Delivering PDGF-BB for Tendon Rupture Repair.

Healing of tendon ruptures represents a major challenge in musculoskeletal injuries and combinations of biomaterials with biological factors are suggested as viable option for improved healing. The standard approach of repair by conventional suture leads to incomplete healing or rerupture. Here, a new elastic type of DegraPol® (DP), a polyester urethane, is explored as a delivery device for platelet-derived growth factor-BB (PDGF-BB) to promote tendon healing. Using emulsion electrospinning as an easy method for incorporation of biomolecules within polymers, DegraPol® supports loading and release of PDGF-BB. Morphological, mechanical and delivery device properties of the bioactive DP scaffolds, as well as differences arising due to different electrospinning parameters are studied. Emulsion electrospun DP scaffolds result in thinner fibers than pure DP scaffolds and experience decreased strain at break [%], but high enough for successful surgeon handling. PDGF-BB is released in a sustained manner from emulsion electrospun DP, but not completely, with still large amount of it being inside the polymeric fibers after 30 d. In vitro studies show that the bioactive scaffolds promote tenocyte proliferation in serum free and serum(+) conditions, demonstrating the potential of this surgeon-friendly bioactive delivery device to be used for tendon repair.

Factor VIIa for Annulus Rupture After Transcatheter Aortic Valve Replacement.

Over the last decade, transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment for inoperable and selected high surgical-risk patients with aortic stenosis. However, management of procedural complications with TAVR represents a major challenge as most TAVR patients carry prohibitive or high-risk of mortality with open surgical conversion. Here we present a case of TAVR complicated by aortic annulus rupture that was successfully managed nonoperatively by pericardial drainage, blood product transfusion, and adjunctive administration of recombinant activated factor VIIa.