Cellulose microfluidic pH boosting on copper oxide non-enzymatic glucose sensor strip for neutral pH samples.

A cellulose microfluidic pH boosting layer adapts a non-enzymatic copper oxide glucose sensor strip for neutral pH samples. This adaptation allows the non-enzymatic technology to realize in-situ glucose measurements. A three-electrode system is constructed to test samples in a classical electrochemical cell, and in a sensing strip to test the microfluidic system. The system consists of copper oxide as working electrode, and silver and carbon paints as reference, and counter electrodes, respectively. The fabrication of the pH-boosting layer is made with natural cellulose. Within this layer are NaOH crystals, grown by a drying processes after immersion of cellulose in a concentrated solution of NaOH. The microfluidic layer is placed on top of the sensing electrodes, and while it transports the fluid sample to the sensing electrodes, the fluid dissolves the NaOH crystals, increasing the pH of the sample. This change allows the non-enzymatic mechanism to sense the glucose concentration in the fluid. Our system shows the capability to measure glucose in samples with neutral pH and human blood with a sensitivity of 70 µA/mM cm2, enough to distinguish between hypoglycemia and hyperglycemia.

Two-Year Survival of Ceramic Endocrowns and Partial Coverage Ceramic Restorations with Fiber Post: A 2-Year Double-Blind Randomized Clinical Trial.

PURPOSE: This double-blind randomized clinical trial (RCT) aimed to evaluate the 2-year survival rates of endocrowns and partial coverage ceramic restorations (PCCR) with fiber posts. MATERIAL AND METHODS: Forty (40) participants fulfilled the elegibility criteria, and they were randomly allocated in 2 groups: Endocrown or PCCR+post. The survival rates were assessed based on USPHS modified and radiographic examinations. A Chi-square test was used to assess the distribution of characteristics between groups. Kaplan-Meier and Log-rank tests were used to estimate the survival rate. To evaluate the association between survival of the restorations and the explanatory variables, the Multivariate Cox regression model was used. Only variables presenting p⟨0.20 were maintained in final model (α= 0.05). RESULTS: The highest 2-year survival rates were recorded for the Endocrown group (100%), whereas the PCCR+post group exhibited the lowest performance (66.7%). Most of the restoration failures was due to lack of marginal adaption, fracture, and recurrent caries. Cox Regression unadjusted analysis showed that only type of restoration presented a significant effect (p⟨0.20). Thus, adjusted analysis was not performed. CONCLUSIONS: Endocrowns appear to be a promising conservative restorative option and to be feasible and reliable approach restoring endodontically.

Efficient Laser-Driven Proton Acceleration from a Cryogenic Solid Hydrogen Target.

We report on the successful implementation and characterization of a cryogenic solid hydrogen target in experiments on high-power laser-driven proton acceleration. When irradiating a solid hydrogen filament of 10 µm diameter with 10-Terawatt laser pulses of 2.5 J energy, protons with kinetic energies in excess of 20 MeV exhibiting non-thermal features in their spectrum were observed. The protons were emitted into a large solid angle reaching a total conversion efficiency of several percent. Two-dimensional particle-in-cell simulations confirm our results indicating that the spectral modulations are caused by collisionless shocks launched from the surface of the the high-density filament into a low-density corona surrounding the target. The use of solid hydrogen targets may significantly improve the prospects of laser-accelerated proton pulses for future applications.

Nitric oxide and immune response in infection control of Caseous Lymphadenitis / Óxido nítrico e resposta imune no controle de infecção da Linfadenite Caseosa

This study aimed to evaluate aspects of host immune response using an experimental infection model of Corynebacterium pseudotuberculosis (CP) in C57/Black6 wild-type and knockout for nitric oxide (KO-NO) mice. 28 mice were evaluated: 4 wild-type controls; 10 wild-type infected with CP; 4 KO-NO controls; 10 KO-NO infected with CP. Infection procedures were carried out by intraperitoneal inoculation using 107. Infected C57/Black6 KO-NO mice began to die after the 5° day post-inoculation, up until the 14º day. Neutrophils were found in increased numbers in the infiltrate of KO-NO murine peritoneal cavities. Examination of splenic tissue revealed an accumulation of lymphocytes, predominantly CD8 T-cells, in experimental animal groups. KO-NO animals were found to have a predominance of granulomas 7 days post-inoculation, primarily in the lymph nodes. In addition, greater amounts of bacteria were recovered from the mesenteric lymph nodes of KO-NO mice. There was no statistically significant difference in the levels of total IgG and its subclasses 14 days post-inoculation between KO-NO and wild groups. The results suggest the importance of nitric oxide in the process of controlling CP infection, as KO-NO animals were observed to be markedly more affected by infection with this bacterium.(AU)

O objetivo deste estudo foi avaliar os aspectos da resposta imune do hospedeiro, mediante o uso de um modelo experimental de infecção de Corynebacterium pseudotuberculosis (CP) em camundongos C57/Black6 do tipo selvagem e em C57/Black6 knockout para o óxido nítrico (KO-NO). Foram avaliados 28 camundongos: quatro controles de tipo selvagem; 10 do tipo selvagem infectados com CP; quatro controles KO-NO; e 10 KO-NO infectados com CP. A infecção foi realizada via intraperitoneal, usando-se 107. Os animais C57/Black6 KO-NO infectados começaram a vir a óbito no quinto dia pós-inoculação, o que aconteceu até o 14º dia. Um número maior de neutrófilos foi encontrado na sua cavidade peritoneal. O exame do baço revelou um acúmulo de linfócitos, predominantemente células T CD8, nos grupos de animais experimentais. Nos animais KO-NO, foi observada a presença de granulomas, sete dias pós-inoculação, principalmente nos gânglios linfáticos. Além disso, uma maior quantidade de bactérias foi detectada dos linfonodos mesentéricos desses animais. Não houve diferença estatisticamente significante nos níveis séricos IgG total e em suas subclasses aos 14 dias pós-inoculação nos grupos KO-NO e selvagem. Os resultados obtidos sugerem a importância do óxido nítrico no processo de controle da infecção por CP.(AU)

An efficient synthesis of 1α,25-dihydroxy-20-epi-vitamin D3.

The synthesis of 1α,25-dihydroxy-20-epi-vitamin D3 (1) by Pd(0)-catalyzed coupling between the boronate ester (2) and the enol triflate (3) is described. This article is part of a Special Issue entitled 'Vitamin D Workshop'.

Efectos del parto y ooforectomía sobre el colágeno uretral: estudio experimental / Effects of Delivery and Oophorectomy on Urethral Collagen: An Experimental Study

Objetivo: Realizar una evaluación estereológica de la concentración de fibras colágenas tipo I y III en el tejido uretral de ratas sometidas a simulación de trabajo de parto y ooforectomía. Comparar las concentraciones de colágeno entre ratas ooforectomizadas y no ooforectomizadas. Material y método: Sesenta ratas Wistar adultas se dividieron en 6 grupos. Como control se utilizó un grupo compuesto por ratas vírgenes y otro por ratas ooforectomizadas. Dos grupos se sometieron a distensión vaginal durante 30 y 120 minutos, respectivamente. Los otros dos grupos se sometieron a iguales períodos de distensión, seguidos de ooforectomía. Sesenta días después se les realizó eutanasia y extracción de tejido uretral para el análisis estereológico de las fibras colágenas tipo I y III tras tinción con hematoxilina-eosina y rojo picrosirius. Resultados: Las ratas ooforectomizadas mostraron una disminución en los niveles estrogénicos. Hubo reducción de colágeno tipo III en el grupo control ooforectomizado respecto al control al analizarse de manera independiente, sin evidenciarse diferencias significativas entre los demás grupos. El colágeno tipo I disminuyó en todos los grupos con respecto al control, pero en el grupo de distensión vaginal prolongada y ooforectomía estas fibras aumentaron. Conclusión: En ratas normoestrogénicas la simulación del trabajo de parto no altera los niveles de colágeno III. En ratas hipoestrogénicas disminuyó la concentración de colágeno tipo I y III, pero al ser sometidas a trabajo de parto prolongado el colágeno I aumentó (AU)

Objective: Stereological evaluation of the concentration of type I and III collagen fibers in the urethral tissue of rats subjected to simulated labor and oophorectomy. To compare the concentrations of collagen between oophorectomized and non-oophorectomized rats. Material and method: Sixty adult Wistar rats were divided into six groups. A group made up of virgin rats was used as control group and another group was made up of oophorectomized rats. Two groups underwent vaginal distention for 30 and 120minutes, respectively. The two other groups were subjected to the same distension periods, followed by oophorectomy. Sixty days later, euthanasia and removal of urethral tissue was carried out for stereological analysis of type I and III collagen after staining with hematoxylin and eosin and picrosirius red. Results: A decrease in estrogen levels was observed in the oophorectomized rats. There was a reduction of type III collagen in the oophorectomized control group compared to the control group when analyzed independently. No significant differences were observed among the other groups. Type I collagen decreased in all groups compared to the control group. However, in the prolonged vaginal distension and oophorectomy group, these fibers increased. Conclusion: In normal rats, simulation of labor does not alter the collagen III levels. In hypoestrogenic rats, the concentration of collagen type I and III decreased, except in those undergoing prolonged labor simulation in which collagen I increased (AU)

Compact cryogenic source of periodic hydrogen and argon droplet beams for relativistic laser-plasma generation.

We present a cryogenic source of periodic streams of micrometer-sized hydrogen and argon droplets as ideal mass-limited target systems for fundamental intense laser-driven plasma applications. The highly compact design combined with a high temporal and spatial droplet stability makes our injector ideally suited for experiments using state-of-the-art high-power lasers in which a precise synchronization between the laser pulses and the droplets is mandatory. We show this by irradiating argon droplets with multi-terawatt pulses.

[Effects of delivery and oophorectomy on urethral collagen: an experimental study]. / Efectos del parto y ooforectomía sobre el colágeno uretral: estudio experimental.

OBJECTIVE: Stereological evaluation of the concentration of type I and III collagen fibers in the urethral tissue of rats subjected to simulated labor and oophorectomy. To compare the concentrations of collagen between oophorectomized and non-oophorectomized rats. MATERIAL AND METHOD: Sixty adult Wistar rats were divided into six groups. A group made up of virgin rats was used as control group and another group was made up of oophorectomized rats. Two groups underwent vaginal distention for 30 and 120 minutes, respectively. The two other groups were subjected to the same distension periods, followed by oophorectomy. Sixty days later, euthanasia and removal of urethral tissue was carried out for stereological analysis of type I and III collagen after staining with hematoxylin and eosin and picrosirius red. RESULTS: A decrease in estrogen levels was observed in the oophorectomized rats. There was a reduction of type III collagen in the oophorectomized control group compared to the control group when analyzed independently. No significant differences were observed among the other groups. Type I collagen decreased in all groups compared to the control group. However, in the prolonged vaginal distension and oophorectomy group, these fibers increased. CONCLUSION: In normal rats, simulation of labor does not alter the collagen III levels. In hypoestrogenic rats, the concentration of collagen type I and III decreased, except in those undergoing prolonged labor simulation in which collagen I increased.

Relationship between ischemia/reperfusion injury and the stimulus of fibrogenesis in an experimental model: comparison among different preservation solutions.

BACKGROUND AND AIMS: Orthotopic liver transplantation (OLT) has been the standard treatment for end-stage acute and chronic liver disease. Ischemia-reperfusion (I/R) injury is one of the major causes of poor graft function early after OLT, and adversely influencing graft and patient survivals. It is unknown whether I/R injury influences liver fibrogenesis. MATERIALS AND METHODS: Livers from 25 adult male Wistar rats were randomly assigned into 5 experimental groups according to the preservation solution: saline solution (SS); University of Wisconsin (UW) solution; Fructose 1, 6-biphosphate (FBP); S-Nitroso-N-Acetylcysteine (SNAC): or UW+SNAC (SNAC+UW). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactic dehydrogenase (LDH) were determined in preservation solution samples at 2, 4, and 6 hours. After 6 hours of cold ischemia, ex situ reperfusion was applied to the liver for 15 minutes. Serum AST, ALT, LDH, and renin levels were determined. Fresh liver slices were processed for histological studies, determination of thiobarbituric acid reactive substances, catalase, and glutathione, and expression of TGF-ß1 and angiotensin II AT1 receptor. RESULTS: AST was significantly lower during cold storage with UW than with the older media (P=.001); ALT was lower in the FBP group (P=.023) and LDH was lower in the FBP and SNAC groups (P=.007). After reperfusion, serum AST, ALT, LDH, and TBARS showed no significant differences among the groups. Catalase was significantly lower in the SS and FBP groups (P=.008 and P=.006, respectively). Compared with UW, glutathione concentrations were significantly higher in SS, FBP, and SNAC 200 (P=.004). Renin levels were significantly lower in the FBP group (P=.022). No histological signs of preservation injury were observed in the hepatic sample. No expressions were detected of TGF-ß1 or AT1 receptor. CONCLUSION: In this experimental model of early reperfusion injury, preservation changes related to higher levels of renin, which suggest its role in fibrogenesis. FBP was associated with lower renin levels than other solutions including UW.

Echinococcus granulosus glycoconjugates induce peritoneal B cell differentiation into antibody-secreting cells and cytokine production.

Helminth parasite infections are associated with predominant Th2-type cytokine responses, and parasite glycoconjugates have been recognized as partially responsible for such immune bias. It has been proved that Echinococcus granulosus evokes a Th2-type cytokine pattern characterized by a high production of IL-4, IL-5, IL-6 and IL-10, and no or mild IFN-γ levels in animal models and in patients with cystic echinococcosis, respectively. Here, we show that E4(+) (a glycoconjugate-enriched fraction from E. granulosus protoscolex) stimulated the secretion of a high concentration of IL-6, followed by IL-10 and TNF-α by normal peritoneal B cells. We determined that E4(+) bound to the surface of peritoneal B cells and induced their activation and, also, triggered the differentiation of peritoneal B cells into IgM-, IgG2b- and IgG3-secreting cells in a T-independent way. Interestingly, the IgM released by E4(+) -stimulated peritoneal B cells from normal mice recognized protoscolex antigens. Results showed that, after the encounter with antigens from E. granulosus protoscolex, peritoneal B cells are a source of Th2-type cytokines and polyclonal antibodies, some of which recognize parasite antigens, suggesting that peritoneal B cells can condition the outcome of the infection.

Fructose 1-6 bisphosphate versus University of Wisconsin solution for rat liver preservation: does FBP prevent early mitochondrial injury?

BACKGROUND: Fructose 1,6-biphosphate (FBP) has been shown to exert therapeutic effects in models of ischemia-reperfusion in organs other than the liver. This study compared FBP and University of Wisconsin (UW) solution during cold storage and reperfusion, among mitochondria of adult male Wistar rat livers. METHODS: Adult male Wistar rats were assigned to two groups according to the preservation solution used; UW or FBP Aspartate transaminase (AST), alanine transferase (ALT); and lactic dehydrogenase (LDH) were measured in samples of the storage solution obtained at 2, 4 and 6 hours of preservation. After 6 hours of cold storage, we reperfused the liver, taking blood samples to measure AST, ALT, LDH, and throbarbituric acid reactive substances (TBARS). Hepatic fragments were processed for histologic analysis; for determinations of TBARS, catalase, and nitric oxide as well as for mitochondrial evaluation by infrared spectroscopy. RESULTS: During cold preservation, levels of AST and LDH in the storage solution were lower among the FBP group, but after reperfusion, serum levels of AST, ALT, and LDH were higher in this group, as was catalase activity. TBARS and nitric oxide were comparable between the groups. In the UW group there was a higher amide I/amide II ratio than in the FBP group, suggesting an abnormal protein structure of the mitochondrial membrane. No signs of preservation injury were observed in any liver biopsy, but sinusoidal congestion was present in livers preserved with FBP. CONCLUSION: FBP showed a protective effect for preservation during cold storage seeming to protect the mitochondrial membrane although it did not prevent reperfusion injury.

S-nitroso-N-acetylcysteine: a promising drug for early ischemia/reperfusion injury in rat liver.

BACKGROUND/AIMS: Ischemia-reperfusion (I/R) injury is among the major causes of poor graft function early after liver transplantation that adversely influences patient survival. A variety of mediators have been implicated in the pathogenesis of I/R vascular injury, including nitric oxide (NO). Because of the beneficial effects of NO during preconditioning and reperfusion, strategies to prevent or ameliorate I/R injury through the stimulation of hepatic NO production are an area of significant clinical interest. We evaluated the role of S-nitroso-N-acetylcysteine (SNAC) as an NO donor in the prevention of liver I/R injury in an animal model. METHODS: Adult male Wistar rats were randomly assigned to 3 experimental groups containing 5 animals each: the University of Wisconsin (UW) solution group; SNAC solution group; and SNAC-containing UW solution (SNAC+UW) group. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) were determined in samples of the cold storage solution at 2, 4, and 6 hours of preservation. After 6 hours of cold storage, We applied a 15-minute reperfusion period. Thereafter, the reperfusion was interrupted with blood samples obtained to measure AST, ALT, LDH, and thiobarbituric acid reactive substances (TBARS). Hepatic fragments were processed for histologic analysis, and to determine of TBARS, catalase, and glutathione levels. RESULTS: During cold preservation, AST and LDH were significantly lower among the SNAC than the UW group or the SNAC+UW group (P = .004 and P = .03, respectively). ALT was comparable among the groups (P = .3). After reperfusion, serum levels of AST, ALT, and LDH, as well as of hepatic TBARS and catalase showed no differences among the groups. Glutathione concentration was lower in the SNAC and SNAC+UW group (P < .001) compared with the UW group. We did not observe histologic signs of preservation injury. CONCLUSION: The SNAC solution showed a greater protective effect to preserve rat livers during cold storage, but it was comparable with UW.

Interference in the collective electron momentum in double photoionization of H2.

We investigate single-photon double ionization of H(2) by 130 to 240 eV circularly polarized photons. We find a double slitlike interference pattern in the sum momentum of both electrons in the molecular frame which survives integration over all other degrees of freedom. The difference momentum and the individual electron momentum distributions do not show such a robust interference pattern. We show that this interference results from a non-Heitler-London fraction of the H(2) ground state where both electrons are at the same atomic center.

Monitoring rheumatoid arthritis synovitis with 99mTc-anti-CD3.

The aim of this study was to investigate the feasibility of using a monoclonal antibody (OKT3) labelled with technetium-99m (99mTc) to monitor disease activity in patients with rheumatoid arthritis. We evaluated 38 patients who were diagnosed with rheumatoid arthritis and classified as Classes II and III after functional assessment (according to the revised criteria specified by the American College of Rheumatology). Two sets of planar anterior images of the patients' wrists, metacarpophalangeal and interphalangeal joints, elbows, shoulders and knees joints were obtained 1 h and 3 h after the injection of 99mTc-OKT3. The scintigraphic findings showed significant correlation (p<0.05) between the radiopharmaceutical accumulation of 99mTc-OKT3 and swollen joints, tender joints and the visual analogue scale. They were able to differentiate patients in remission from patients with active synovitis, according to DAS 28. In contrast, there was no correlation between the radiopharmaceutical accumulation and the patients' age, gender, duration of disease or erythrocyte sedimentation rate. A relatively high disease activity score of 28 joints (4.08+/-1.74) was found in the majority of patients. In conclusion, 99mTc-OKT3 scintigraphy is a reliable and objective method for detecting synovial activity, and can be used to observe disease prognosis.

Hepatic reperfusion in rats: a new model with portal arterialization in studying early ischemia-reperfusion injury.

Isolated liver perfusion has been used to evaluate the beneficial effects of several agents. In the present study, we developed a model using a recipient rat to reperfuse harvested livers in an ex situ, in vivo recirculating system. A total of 25 reperfusion procedures using adult male Wistar rats as donors and recipients were done. The preservation of the livers was performed with University of Wisconsin solution for 6 hours. Thereafter, the liver was reperfused with blood from another rat. We believe that the model presented herein offers an alternative method to evaluate early hepatocellular damage or hepatic microcirculation.

The simplest double slit: interference and entanglement in double photoionization of H2.

The wave nature of particles is rarely observed, in part because of their very short de Broglie wavelengths in most situations. However, even with wavelengths close to the size of their surroundings, the particles couple to their environment (for example, by gravity, Coulomb interaction, or thermal radiation). These couplings shift the wave phases, often in an uncontrolled way, and the resulting decoherence, or loss of phase integrity, is thought to be a main cause of the transition from quantum to classical behavior. How much interaction is needed to induce this transition? Here we show that a photoelectron and two protons form a minimum particle/slit system and that a single additional electron constitutes a minimum environment. Interference fringes observed in the angular distribution of a single electron are lost through its Coulomb interaction with a second electron, though the correlated momenta of the entangled electron pair continue to exhibit quantum interference.

[Long term follow-up of the tendinous urethral support: an anatomical approach for stress urinary incontinence]. / Seguimiento a largo plazo del soporte uretral tendinoso: un enfoque anatómico para incontinencia urinaria de esfuerzo.

Sling procedures have been around for decades in the management female stress urinary incontinence (SUI), but only in the past decade they have become the preferred technique. Minimally invasive procedures are the procedure of choice in many centers for your efficacy and low morbidity. The tendinous urethral support (TUS) represents an anatomical approach that consists in placing a midurethral low tension tape anchored to the tendinous arc bilaterally. From February 1999 to October 2000, 25 female patients (mean age: 53 years old), with SUI underwent TUS procedure, and 23 were available for follow-up. Those patients were followed until 72 months. After six months, 20 (87%) patients were dry, 2 (8.7%) improved and 1 (4.3%) incontinent. However, at the last evaluation, 15 (65.2%) investigation.

Seguimiento a largo plazo del soporte uretral tendinoso: un enfoque anatómico para incontinencia urinaria de esfuerzo / Long term follow-up of the tendinous urethral support: an anatomical approach for stress urinary incontinence

Los procedimientos tipo sling han sido utilizados por décadas para el manejo de la incontinencia urinaria de esfuerzo (IUE) femenina, pero sólo en la década pasada han llegado a ser la técnica de elección. Los procedimientos mínimamente invasivos son el procedimiento de elección en algunos centros por su eficacia y baja morbilidad. El soporte uretral tendinoso (TUS) representa un enfoque anatómico que consiste en colocar una cincha de baja tensión a nivel de la uretra media, anclada al arco tendíneo de manera bilateral. De febrero 1999 a octubre 2000, 25 pacientes femeninas con IUE y con una edad media de 53 años fueron intervenidas mediante TUS. De ellas, 23 pudieron evaluarse a largo plazo con un seguimiento un máximo 72 meses. Después de 6 meses, 20 pacientes (87%) se encontraban secas, 2 (8,7%) mejoraron y 1 (4,3%) era incontinente. Sin embargo, al final del seguimiento, 15 pacientes estaban continentes (65,2%), 3 (13%) mejoraron y 5 (21%) seguían incontinentes. Por lo que, el TUS es un concepto que merece investigaciones adicionales

Sling procedures have been around for decades in the management female stress urinary incontinence (SUI), but only in the past decade they have become the preferred technique. Minimally invasive procedures are the procedure of choice in many centers for your efficacy and low morbidity. The tendinous urethral support (TUS) represents an anatomical approach that consists in placing a midurethral low tension tape anchored to the tendinous arc bilaterally. From February 1999 to October 2000, 25 female patients (mean age: 53 years old), with SUI underwent TUS procedure, and 23 were available for follow-up. Those patients were followed until 72 months. After six months, 20 (87%) patients were dry, 2 (8.7%) improved and 1 (4.3%) incontinent. However, at the last evaluation, 15 (65.2%) vestigation

[Three dimensional anatomy and virtual surgery for transobturator approach]. / Anatomía tridimensional y cirugía virtual para procedimientos transobturatrizes.

INTRODUCTION: Stress Urinary Incontinence (SUI) may be managed by transobturator approach. We developed a three-dimensional model, for understanding the surgical anatomy and manual training as well, in order to reduce the learning curve for pelvic surgeries. OBJECTIVE: To demonstrate in synthetic models, the anatomical basis for the management of SUI and cystocele. METHOD: The anatomical model includes: pelvic bones, the main layers of the pelvic muscles, ligaments and fascias. The surgical devices were transobturator needles, synthetic slings and meshes for anterior vaginal wall repair. The workshop was carried out with an anatomical overview and hands-on training in this tridimentional models and finally surgery in animals. At the end, a questionnaire was applied to verify the impact of this tool in the learning process and trainee satisfaction. RESULTS: As far as the anatomical concept, 90% (n=72) of the participants classified this model as very good and 10% (n=8) as good. As a tool for understanding the tridimentional pelvic floor anatomy applied to transobturator procedures there were 100% of approval. CONCLUSIONS: This synthetic model allows for understanding the pelvic floor tridimentional anatomy and surgical procedures as well. Further skill is got in the animal model reducing the learning curve for transobturator procedures.

Anatomía tridimensional y cirugía virtual para procedimientos transobturatrizes / Three dimensional anatomy and virtual surgery for transobturator approach

Introducción: La Incontinencia Urinaria de Esfuerzo (IUE) se maneja quirúrgicamente diferente siguiendo la Teoría Integral de la Continencia razón por la cual es importante el conocimiento de las estructuras anatómicas. Desarrollamos un modelo tridimensional basado en la anatomía de la pelvis para el entrenamiento manual de la cirugía y así disminuir la curva de aprendizaje de urólogos y ginecólogos. Objetivo: Demostrar en modelos sintéticos, las bases anatómicas del manejo transobturatriz en la IUE, cistoceles y en IUE recidivante post tratamiento quirúrgico. Metodología: El modelo anatómico incluye: huesos pélvicos, las principales capas de los músculos pélvicos, ligamentos y fascias. Los dispositivos quirúrgicos son agujas transobturatrizes en forma de “C” y helicoidales; un sling reajustable de acceso universal y una malla especial autofijable y el sling crossover. Fue realizado un entrenamiento con clases teóricas y prácticas. Las clases prácticas fueron realizadas con las pelvis y los dispositivos de la cirugía transobturatriz. A continuación fueran realizadas cirugías transobturatrizes en ovejas. Al final, se aplicó un cuestionario para verificar el impacto de esta herramienta en la curva de aprendizaje del acceso transobturatriz. Resultados: Con respecto al concepto anatómico, el 90% (n=72) de los participantes, clasificó el modelo como muy bueno y 10% (n=8) como bueno. Como herramienta para el aprendizaje de los procedimientos transobturatrizes, el 100% aprobó tanto el material escrito como el modelo anatómico tridimensional. Conclusiones: Este modelo sintético permite entender y poner en práctica las diversas técnicas quirúrgicas, substituyendo los modelos animales, las reconstrucciones tridimensionales computarizadas y las imágenes bidimensionales, contribuyendo así de forma significativa en la curva de aprendizaje

Introduction: Stress Urinary Incontinence (SUI) may be managed by transobturator approach. We developed a threedimensional model, for understanding the surgical anatomy and manual training as well, in order to reduce the learning curve for pelvic surgeries. Objective: To demonstrate in synthetic models, the anatomical basis for the management of SUI and cystocele. Method: The anatomical model includes: pelvic bones, the main layers of the pelvic muscles, ligaments and fascias. The surgical devices were transobturator needles, synthetic slings and meshes for anterior vaginal wall repair. The workshop was carried out with an anatomical overview and hands-on training in this tridimentional models and finally surgery in animals. At the end, a questionnaire was applied to verify the impact of this tool in the learning process and trainee satisfaction. Results: As far as the anatomical concept, 90% (n=72) of the participants classified this model as very good and 10% (n=8) as good. As a tool for understanding the tridimentional pelvic floor anatomy applied to transobturator procedures there were 100% of approval. Conclusions: This synthetic model allows for understanding the pelvic floor tridimentional anatomy and surgical procedures as well. Further skill is got in the animal model reducing the learning curve for transobturator procedures