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1.
PLoS One ; 15(12): e0242494, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33259489

RESUMO

Although non-fatal and mostly self-healing in the case of Leishmania (L.) major, cutaneous leishmaniasis (CL) is mainly treated to reduce lesion healing time. Less attention is paid to the improvement of scars, especially in aesthetically relevant areas of the body, which can dramatically affect patients' wellbeing. We explored patients' perspectives about treatment options and the social and psychological burden of disease (lesion and scar). Individual in-depth interviews were conducted with ten confirmed CL patients at two L. major endemic sites in Southern Tunisia (Sidi Bouzid and Gafsa). Participants were selected using a sampling approach along a spectrum covering e.g. age, sex, and clinical presentation. Patients' experiences, opinions and preferences were explored, and their detailed accounts gave an insight on the impact of CL on their everyday lives. The impact of CL was found to be considerable. Most patients were not satisfied with treatment performance and case management. They expected a shorter healing time and better accessibility of the health system. Tolerance of the burden of disease was variable and ranged from acceptance of hidden scars to suicidal thoughts resulting from the fear to become handicapped, and the stress caused by close relatives. Some believed CL to be a form of skin cancer. Unexpectedly, this finding shows the big gap between the perspectives of patients and assumptions of health professionals regarding this disease. This study provided valuable information for better case management emphasizing the importance of improving communication with patients, and accessibility to treatment. It generated context-specific knowledge to policy makers in Tunisia to implement effective case management in a country where access to treatment remains a challenge due to socio-economic and geographic barriers despite a long tradition in CL control.


Assuntos
Cicatriz/epidemiologia , Leishmania major/patogenicidade , Leishmaniose Cutânea/epidemiologia , Adulto , Idoso , Cicatriz/parasitologia , Cicatriz/patologia , Cicatriz/terapia , Feminino , Humanos , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Leishmaniose Cutânea/terapia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Tunísia/epidemiologia
2.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(6): 642-646, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33377340

RESUMO

OBJECTIVE: To study the comprehensive impact of scar and maxillary expansion combined with protraction on the development of maxilla with cleft lip and palate after repair operation. METHODS: In the original finite element model of the maxilla with cleft palate, a finite element model of the maxilla with cleft lip and palate was established by using Boolean operation in ANSYS. Scar force after cleft lip and palate repair and maxillary expansion force combined with protraction were added simultaneously to process the stress analysis. RESULTS: Maxillary deformation occurred in the three-dimensional direction. The comparison of displacements was as follows: X-axis>Z-axis>Y-axis. CONCLUSIONS: Maxillary growth is significantly inhibited in the three-dimensional direction under the comprehensive impact of scar and maxillary expansion combined with protraction after repair operation, especially transverse and sagittal growth.


Assuntos
Fenda Labial , Fissura Palatina , Cicatriz/patologia , Fenda Labial/cirurgia , Fissura Palatina/patologia , Fissura Palatina/cirurgia , Análise de Elementos Finitos , Humanos , Maxila/patologia , Maxila/cirurgia , Técnica de Expansão Palatina
3.
Hua Xi Kou Qiang Yi Xue Za Zhi ; 38(6): 657-661, 2020 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-33377343

RESUMO

OBJECTIVE: To observe and compare the clinical efficacy of CO2 fractional laser in the early control of scar post-secondary repair in patients with a cleft lip. METHODS: In the treatment group, 43 patients with secondary repair of cleft lip were treated via CO2 fractional laser. The control group covered 70 patients post-cheiloplasty. The effect in the two groups after six months was compared. The duration from the beginning of the laser treatment to surgery and patient gender were analyzed to determine if they affected the efficacy of the laser treatment for scars. RESULTS: 1) The curative effect in the treatment group was better than that in the control group (P<0.000 1), the total effectiveness rate was 90.7% in the treatment group. 2) No significant statistical difference in efficacy was observed between men and women (P=0.487). Moreover, no significant statistical difference in efficacy (P=0.055) was observed among patients one year after surgery, within the duration of <3 months, and within the duration of ≥3 months. CONCLUSIONS: CO2 fractional laser had a definite effect on the treatment of scar post-secondary repair in patients with a cleft lip. No significant correlation was observed between treatment effect and patient gender, and no difference was noted among patients one year after surgery. In the beginning of the laser treatment, no difference was observed between the durations of <3 months and ≥3 months after the reconstruction, Therefore, early intervention of scars a year after secondary repair of a cleft lip can achieve good results.


Assuntos
Cicatriz , Fenda Labial , Dióxido de Carbono , Cicatriz/etiologia , Cicatriz/patologia , Fenda Labial/cirurgia , Feminino , Humanos , Lasers , Masculino , Resultado do Tratamento
4.
Clin Ter ; 171(6): e539-e548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33151254

RESUMO

OBJECTIVE: The aim of study is to evaluate the aesthetic outcome of specific formulated cosmeceutical product to mask and reduce the appearance surgical scars or unappealing skin tags in chronic diseases, such as cancer METHODS: In a spontaneous, anecdotal, retrospective study, 26 patients with skin disorders appealed to Second Opinion Medical Network (Modena, Italy), required masking and improving the skin appearance. To evaluate the aesthetic improvement of skin imperfections, a gelcream containing 10% of acetyl hexapeptide-8 (registered trademark Argireline®) was selected, that can be applied directly upon the lesion, followed by a light massage in the treated area for a few minutes RESULTS: The skin quality parameters (hydration, elasticity, sebum), photographs and investigators clinical assessment have been performed before and after the treatment and demonstrated that this cream significantly improved the skin values and the self-image expectation of each patient. No allergic reactions were documented during the period treatment CONCLUSIONS: The topical administration of this cosmeceutical cream is a safe and effective alternative to the invasive procedures, to improve the quality of life in patients with some skin disorders such as cancer, surgical scars, hidradenitis, aging wrinkles


Assuntos
Cicatriz/tratamento farmacológico , Oligopeptídeos/farmacologia , Envelhecimento da Pele/efeitos dos fármacos , Pele/efeitos dos fármacos , Administração Cutânea , Adulto , Cicatriz/patologia , Dermatologia , Feminino , Humanos , Itália , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Pele/patologia , Resultado do Tratamento , Adulto Jovem
5.
PLoS One ; 15(11): e0241569, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141875

RESUMO

Glaucoma filtration surgery is one of the most effective methods for lowering intraocular pressure in glaucoma. The surgery efficiently reduces intra-ocular pressure but the most common cause of failure is scarring at the incision site. This occurs in the conjunctiva/Tenon's capsule layer overlying the scleral coat of the eye. Currently used antimetabolite treatments to prevent post-surgical scarring are non-selective and are associated with potentially blinding side effects. Developing new treatments to target scarring requires both a better understanding of wound healing and scarring in the conjunctiva, and new means of delivering anti-scarring drugs locally and sustainably. By combining plastic compression of collagen gels with a soft collagen-based layer, we have developed a physiologically relevant model of the sub-epithelial bulbar conjunctiva/Tenon's capsule interface, which allows a more holistic approach to the understanding of subconjunctival tissue behaviour and local drug delivery. The biomimetic tissue hosts both primary human conjunctival fibroblasts and an immune component in the form of macrophages, morphologically and structurally mimicking the mechanical proprieties and contraction kinetics of ex vivo porcine conjunctiva. We show that our model is suitable for the screening of drugs targeting scarring and/or inflammation, and amenable to the study of local drug delivery devices that can be inserted in between the two layers of the biomimetic. We propose that this multicellular-bilayer engineered tissue will be useful to study complex biological aspects of scarring and fibrosis, including the role of inflammation, with potentially significant implications for the management of scarring following glaucoma filtration surgery and other anterior ocular segment scarring conditions. Crucially, it uniquely allows the evaluation of new means of local drug delivery within a physiologically relevant tissue mimetic, mimicking intraoperative drug delivery in vivo.


Assuntos
Materiais Biomiméticos , Cicatriz/prevenção & controle , Túnica Conjuntiva/patologia , Complicações Pós-Operatórias/prevenção & controle , Cápsula de Tenon/patologia , Animais , Biomimética , Linhagem Celular , Cicatriz/etiologia , Cicatriz/patologia , Túnica Conjuntiva/citologia , Túnica Conjuntiva/efeitos dos fármacos , Túnica Conjuntiva/cirurgia , Sistemas de Liberação de Medicamentos/métodos , Avaliação Pré-Clínica de Medicamentos/métodos , Estudos de Viabilidade , Fibroblastos , Fibrose , Cirurgia Filtrante/efeitos adversos , Glaucoma/cirurgia , Humanos , Cuidados Intraoperatórios/métodos , Monócitos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Cultura Primária de Células , Suínos , Cápsula de Tenon/efeitos dos fármacos , Cápsula de Tenon/cirurgia , Cicatrização/efeitos dos fármacos
6.
Khirurgiia (Mosk) ; (10): 5-10, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047580

RESUMO

Currently, a single classification of cicatricial tracheal stenosis is absent in national and world surgical practice. This issue is actual considering anatomical variability of tracheal structure in people with different constitutional features and previous complications. The proposed classification ensures individualized approach in surgical treatment of patients with cicatricial tracheal stenosis considering anatomical features in a particular patient.


Assuntos
Traqueia/anatomia & histologia , Traqueia/patologia , Estenose Traqueal/classificação , Cicatriz/patologia , Cicatriz/cirurgia , Constrição Patológica/patologia , Constrição Patológica/cirurgia , Humanos , Estenose Traqueal/cirurgia
7.
Cell Prolif ; 53(11): e12916, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33058377

RESUMO

Healing after mammalian skin injury involves the interaction between numerous cellular constituents and regulatory factors, which together form three overlapping phases: an inflammatory response, a proliferation phase and a remodelling phase. Any slight variation in these three stages can substantially alter the healing process and resultant production of scars. Of particular significance are the mechanisms responsible for the scar-free phenomenon observed in the foetus. Uncovering such mechanisms would offer great expectations in the treatment of scars and therefore represents an important area of investigation. In this review, we provide a comprehensive summary of studies on injury-induced skin regeneration within the foetus. The information contained in these studies provides an opportunity for new insights into the treatment of clinical scars based on the cellular and molecular processes involved.


Assuntos
Cicatriz/fisiopatologia , Pele/fisiopatologia , Cicatrização , Adulto , Animais , Cicatriz/patologia , Feto/patologia , Feto/fisiopatologia , Fibroblastos/patologia , Humanos , Queratinócitos/patologia , Lesões Pré-Natais/patologia , Lesões Pré-Natais/fisiopatologia , Pele/embriologia , Pele/lesões , Pele/patologia
9.
Sci Rep ; 10(1): 15808, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32978500

RESUMO

Retinal diseases are frequently characterized by the accumulation of excessive scar tissue found throughout the neural retina. However, the pathophysiology of retinal fibrosis remains poorly understood, and the cell types that contribute to the fibrotic response are incompletely defined. Here, we show that myofibroblast differentiation of mural cells contributes directly to retinal fibrosis. Using lineage tracing technology, we demonstrate that after chemical ocular injury, Myh11+ mural cells detach from the retinal microvasculature and differentiate into myofibroblasts to form an epiretinal membrane. Inhibition of TGFßR attenuates Myh11+ retinal mural cell myofibroblast differentiation, and diminishes the subsequent formation of scar tissue on the surface of the retina. We demonstrate retinal fibrosis within a murine model of oxygen-induced retinopathy resulting from the intravitreal injection of adipose Myh11-derived mesenchymal stem cells, with ensuing myofibroblast differentiation. In this model, inhibiting TGFßR signaling does not significantly alter myofibroblast differentiation and collagen secretion within the retina. This work shows the complexity of retinal fibrosis, where scar formation is regulated both by TGFßR and non-TGFßR dependent processes involving mural cells and derived mesenchymal stem cells. It also offers a cautionary note on the potential deleterious, pro-fibrotic effects of exogenous MSCs once intravitreally injected into clinical patients.


Assuntos
Diferenciação Celular , Cicatriz/patologia , Fibrose/patologia , Células-Tronco Mesenquimais/patologia , Miofibroblastos/patologia , Cadeias Pesadas de Miosina/metabolismo , Doenças Retinianas/patologia , Animais , Células Cultivadas , Cicatriz/metabolismo , Feminino , Fibrose/metabolismo , Masculino , Células-Tronco Mesenquimais/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Miofibroblastos/metabolismo , Doenças Retinianas/metabolismo , Transdução de Sinais
10.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 203-207, 2020 08 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32991102

RESUMO

Introduction: Lung cancer is the leading cause of cancer-related mortality worldwide. Although lung cancer is predominantly observed in smokers, non-smoking patients account for 20% of cases worldwide. In this article, we present a case of lung adenocarcinoma that originated from a postoperative scar. We present a 62-year-old male patient who, while being studied for Paget's disease of bone, presented a 1.5 cm pulmonary nodule (SUV 1.6) as an imaging finding in the posterior segment of the left lung. He underwent a upper left lung segmentectomy. Results: During the routine follow-up of his underlying disease, 12 years after the original surgery, a pulmonary nodule was found. The particularity of the sample is based on the macroscopic observation of the tumor piece where the development of the neoplastic mass on the mechanical suture of the previous surgery performed 12 years ago is shown. Conclusion: We describe a rare cancer development mechanism in clinical practice, from chronic postoperative inflammation due to mechanical suturing.


Assuntos
Adenocarcinoma de Pulmão , Cicatriz/patologia , Pneumopatias/cirurgia , Neoplasias Pulmonares , Adenocarcinoma de Pulmão/diagnóstico por imagem , Adenocarcinoma de Pulmão/cirurgia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Pneumonectomia
11.
Acta Chir Plast ; 62(1-2): 18-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911938

RESUMO

The progress in critical and intensive care burn management in the 21st century has significantly reduced mortality in patients with critical burn injuries. This progress has moved the focus of burns care from simple survival to the quality of life after the burn trauma, in particular to healing of defects caused by full-thickness burns, subsequent maturation, characteristics and appearance of the scars. The benefits of the application of skin substitutes include elimination of excessive scarring, hypertrophic and keloid scar formation and subsequent contracture development. The authors of this article present the strategy of use, application and development of dermal scaffolds as well as the current trends in the use of dermal scaffolds in the treatment of full-thickness burns.


Assuntos
Pele Artificial , Queimaduras/cirurgia , Cicatriz/patologia , Humanos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Cicatrização
12.
Medicine (Baltimore) ; 99(31): e21432, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756152

RESUMO

INTRODUCTION: A cesarean scar pregnancy (CSP), when combined with an arteriovenous malformation (AVM), is a rare, but potentially life-threatening condition that may be associated with uncontrolled hemorrhage. Hysterectomy is indicated when conservative treatment fails. Preservation of fertility is challenging. PATIENT CONCERNS: We reported a 33-year-old woman with a CSP combined with an AVM who failed methotrexate administration as conservative treatment. DIAGNOSES: A CSP combined with an AVM was diagnosed via three-dimensional color Doppler angiogram and magnetic resonance imaging. INTERVENTIONS: Transvaginal removal of the ectopic gestation and repair of the uterine defect was performed without incident. OUTCOMES: The fertility of the patient was preserved and hysterectomy was avoided. CONCLUSION: Transvaginal fertility-sparing surgery may be successfully performed to prevent hysterectomy when conservative treatment fails in patients with a CSP combined with an AVM.


Assuntos
Malformações Arteriovenosas/complicações , Malformações Arteriovenosas/cirurgia , Cicatriz/patologia , Preservação da Fertilidade/métodos , Adulto , Angiografia/métodos , Antimetabólitos Antineoplásicos/administração & dosagem , Antimetabólitos Antineoplásicos/uso terapêutico , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/tratamento farmacológico , Cesárea/efeitos adversos , Cicatriz/cirurgia , Feminino , Humanos , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Gravidez , Gravidez Ectópica/cirurgia , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos
13.
Ann R Coll Surg Engl ; 102(8): 621-624, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735124

RESUMO

INTRODUCTION: Depressed tethered scar is a common problem that can cause emotional, social and behavioural problems, especially when it involves the exposed body parts. Several techniques have been described for treating these depressed scars, but none of these can fulfil the optimal results. AIM: Evaluating the aesthetic outcome of using a double vest lipodermal flaps for treating depressed facial scars. MATERIALS AND METHODS: The study included 25 patients with depressed facial scars who underwent scar revision. Their mean age was 31 years. Under local anaesthesia, the scarred area was de-epithelialised and double dart lipodermal flaps were used for revision. Visual analogue and Vancouver scar scales were used as subjective and objective parameters of evaluation, respectively. RESULTS: All the patients followed up for five to eight months. No complications were observed during the scar healing period. Patients satisfaction according to the visual analogue scale showed an average value of 8. The mean total scale according to the Vancouver scar scale was 2.6. CONCLUSION: The new technique of using double vest lipodermal flaps is simple and offers a promising alternative for revising depressed scars.


Assuntos
Cicatriz/cirurgia , Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/transplante , Adolescente , Adulto , Cicatriz/patologia , Face/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
14.
Arch Gynecol Obstet ; 302(5): 1215-1220, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32803393

RESUMO

OBJECTIVE: To investigate the effect of hysteroscopic surgery on the outcomes of obstetrics and gynecology among patients with cesarean section diverticulum. METHODS: Ninety-nine infertile patients with cesarean section diverticulum received hysteroscopic treatment and were retrospectively analyzed. Patients were followed for 1 year. RESULTS: The study included ninety-nine symptomatic patients with cesarean section diverticulum. After surgery, the menstrual periods of patients were improved from 11.15 ± 4.44 to 7.69 ± 2.85 days. Forty-seven (47/99) women became pregnant after surgery. The number of patients who became pregnant with an anteflexion uterus after hysteroscopic surgery is 32 (32/57), and the number of women who became pregnant with a retroflexion uterus is 15 (15/42). CONCLUSION: Hysteroscopic surgery could improve the PCSD-associated prolonged menstrual bleeding, and satisfactory obstetrical outcomes could be achieved by the surgery treatment in women with cesarean defect.


Assuntos
Cesárea/efeitos adversos , Cicatriz/etiologia , Cicatriz/cirurgia , Divertículo/cirurgia , Histeroscopia/métodos , Hemorragia Uterina/cirurgia , Adulto , Cicatriz/patologia , Feminino , Humanos , Histeroscopia/efeitos adversos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Hemorragia Uterina/etiologia
15.
Fa Yi Xue Za Zhi ; 36(3): 311-315, 2020 Jun.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32705842

RESUMO

Abstract: Objective To validate the accuracy and reliability of structured-light three-dimensional (SL-3D) scanning in measuring the length and area of the regular and irregular scars on body surface and discuss its value in forensic practice. Methods The lengths of 30 cases of simulated linear scars and 50 cases of linear scars after injury were measured using soft ruler, vernier caliper + thin line method, and SL-3D scanning. The areas of 35 cases of simulated patchy scars and 15 cases of patchy scars after injury were measured using length × width, film tracing with coordinate paper method, pixel method, and SL-3D scanning, and then statistically analyzed. Results The differences between the length of the simulated linear scars measured by SL-3D scanning and standard length had no statistical significance. When simulated patchy scars and patchy scars after injury were measured with high surface curvature and large irregular areas, the differences between the results of SL-3D scanning measurement and the standard area had no statistical significance. When the length of 50 cases of linear scars after injury were measured using SL-3D scanning, the correlation coefficient between the measurement results of two different investigators was 0.998, and the correlation coefficient between the two measurement results by the same investigator was 1.000. The correlation coefficient between the results of SL-3D scanning and that of vernier caliper + thin line method was 0.996. Conclusion The three-dimensional information of the scars on the body surface can be acquired using SL-3D scanning. The measurement of the length and area of the scars is not influenced by the location of scars, curvature of surface, and human factors. The measurement results are accurate, reliable and has unique advantages.


Assuntos
Cicatriz , Imageamento Tridimensional , Cicatriz/diagnóstico por imagem , Cicatriz/patologia , Coleta de Dados , Medicina Legal , Humanos , Reprodutibilidade dos Testes , Projetos de Pesquisa
17.
Ceska Gynekol ; 85(2): 104-110, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32527103

RESUMO

OBJECTIVE: To describe a case history of a patient after two caesarean sections, planning another pregnancy. Due to the dehiscent lower uterine segment, surgical correction of the defect was performed. Performance followed by an unplanned pregnancy five weeks after the operation. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Hospital in Frýdek-Místek. CASE REPORT: We present a case of a 31-year-old third-graders, anamnestically after two caesarean sections, which were performed laparoscopical correction of isthmocoele in our department. Our patient was diagnosed with six weeks old intrauterine pregnancy only eleven weeks after surgery. The gravidity was successfully completed in the 38th week of pregnancy by the planned caesarean section with finding of a solid lower uterine segment. Whole duration of the pregnancy was uncomplicated. CONCLUSION: Women, after previous surgery of the uterus, are exposed to complications such as nidation disorders, placental disorders, risk of uterine rupture etc. during future pregnancy and childbirth. We want to show possible advantage of laparoscopic isthmocoele resection in combination with ventrosuspension of uterus.


Assuntos
Cesárea/efeitos adversos , Cicatriz/cirurgia , Laparoscopia/métodos , Aderências Teciduais/cirurgia , Doenças Uterinas/cirurgia , Útero/cirurgia , Adulto , Cicatriz/complicações , Cicatriz/patologia , Feminino , Humanos , Gravidez , Resultado da Gravidez , Aderências Teciduais/etiologia , Resultado do Tratamento , Doenças Uterinas/etiologia , Ruptura Uterina , Útero/patologia
18.
J Vis Exp ; (160)2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32597875

RESUMO

Myocardial infarction (MI) remains the main contributor to morbidity and mortality worldwide. Therefore, research on this topic is mandatory. An easily and highly reproducible MI induction procedure is required to obtain further insight and better understanding of the underlying pathological changes. This procedure can also be used to evaluate the effects or potency of new and promising treatments (as drugs or interventions) in acute MI, subsequent remodeling and heart failure (HF). After intubation and pre-operative preparation of the animal, an anesthetic protocol with isoflurane was performed, and the surgical procedure was conducted quickly. Using a minimally invasive approach, the left anterior descending artery (LAD) was located and occluded by a ligature. The occlusion can be performed acutely for subsequent reperfusion (ischemia/reperfusion injury). Alternatively, the vessel can be ligated permanently to investigate the development of chronic MI, remodeling or HF. Despite common pitfalls, the drop-out rates are minimal. Various treatments such as remote ischemic conditioning can be examined for their cardioprotective potential pre-, peri- and post-operatively. The post-operative recovery was quick as the anesthesia was precisely controlled and the duration of the operation was short. Post-operative analgesia was administered for three days. The minimally invasive procedure reduces the risk of infection and inflammation. Furthermore, it facilitates rapid recovery. The "working heart" measurements were performed ex vivo and enabled precise control of preload, afterload and flow. This procedure requires specific equipment and training for adequate performance. This manuscript provides a detailed step-by-step introduction for conducting these measurements.


Assuntos
Coração/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Anestesia , Animais , Cicatriz/patologia , Eletrocardiografia , Insuficiência Cardíaca , Hemodinâmica , Precondicionamento Isquêmico , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/cirurgia , Cuidados Pré-Operatórios , Ratos Sprague-Dawley , Remodelação Vascular , Função Ventricular
20.
Sci Rep ; 10(1): 9459, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32528051

RESUMO

Coronary heart disease is a leading cause of death. Tissue remodeling and fibrosis results in cardiac pump dysfunction and ischemic heart failure. Cardiac fibroblasts may rebuild damaged tissues when prompted by suitable environmental cues. Here, we use acellular biologic extracellular matrix scaffolds (bioscaffolds) to stimulate pathways of muscle repair and restore tissue function. We show that acellular bioscaffolds with bioinductive properties can redirect cardiac fibroblasts to rebuild microvascular networks and avoid tissue fibrosis. Specifically, when human cardiac fibroblasts are combined with bioactive scaffolds, gene expression is upregulated and paracrine mediators are released that promote vasculogenesis and prevent scarring. We assess these properties in rodents with myocardial infarction and observe bioscaffolds to redirect fibroblasts, reduce tissue fibrosis and prevent maladaptive structural remodeling. Our preclinical data confirms that acellular bioscaffold therapy provides an appropriate microenvironment to stimulate pathways of functional repair. We translate our observations to patients with coronary heart disease by conducting a first-in-human observational cohort study. We show that bioscaffold therapy is associated with improved perfusion of infarcted myocardium, reduced myocardial scar burden, and reverse structural remodeling. We establish that clinical use of acellular bioscaffolds is feasible and offers a new frontier to enhance surgical revascularization of ischemic heart muscle.


Assuntos
Fibroblastos/patologia , Traumatismos Cardíacos/patologia , Infarto do Miocárdio/patologia , Miocárdio/patologia , Animais , Linhagem Celular , Cicatriz/patologia , Estudos de Coortes , Matriz Extracelular/patologia , Fibrose/patologia , Coração/fisiopatologia , Humanos , Masculino , Ratos , Roedores , Tecidos Suporte , Remodelação Ventricular/fisiologia
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