The authors have no acknowledgements.

1. Preparación: <ol><li> Obtener un microscopio estéreo de sobremesa, con una variable de 3,5 x de 45x de zoom, 200 mm de distancia de trabajo, variable de 55 a 75 mm de distancia entre la pupila y un accesorio llevó la luz del anillo. Cualquier microscopio similar es el adecuado, se puede configurar en una mesa pequeña y no es muy caro. </li><li> Reunir y preparar un conjunto de instrumentos de microcirugía con dos pastillas de microcirugía, una tijera de disección y una aguja-conductor; este es el mínimo requerido, se debe tener en cuenta que estos son instrumentos de la práctica, y no son necesarios instrumentos de calidad de gama alta. </li><li> Utilice 9/0 monofilamento micro-sutura para todas las prácticas. Comprar disponible comercialmente muslos de pollo o las alas y colorante de alimentos en el supermercado local. </li><li> A 20 G angio-catéter se utiliza para las pruebas de permeabilidad en las arterias femorales de pollo. Por las arterias braquial se necesita un anticoagulante 27 G catéter. Estos se pueden adquirir en internet en una farmacia local ocon los instrumentos establecidos. Comprar una jeringa disponible comercialmente para inyectar el colorante de alimentos. </li></ol> 2. técnicas de disección macroscópicas: <ol><li> El enfoque de los vasos femorales es sencillo. Para muslos de pollo, lleve a cabo una técnica de disección roma justo medial al eje femoral, separar el músculo femoral del hueso y exponer la arteria femoral, la vena y el nervio. El nervio puede ser diseccionado su vez en dos fascículos separados para diferentes tipos de prácticas de reparación del nervio. </li><li> Con el fin de acceder a la arteria braquial pollo en las alas de pollo, una incisión de la piel longitudinalmente con una tijera, desde el hombro hasta la punta del ala. Observar la arteria que corre entre el bíceps y el tríceps braquial. </li></ol> 3. Recomendado régimen de entrenamiento: <ol><li> El entrenamiento con la arteria femoral. NOTA: El primer paso en el régimen de entrenamiento es practicar con la arteria femoral de pollo. </li></ol><ol><li> Colocar la pieza bajo el microscopio y comenzar la disección microquirúrgica. Liberar la arteria femoral de los tejidos subyacentes; y se divide horizontalmente. Realizar una adventicectomy. Utilice los micro-camionetas y micro-tijeras para recortar cualquier adventicia que recubre la luz arterial. Enjuague el lumen interior con agua del grifo. Anote la hora de inicio </li><li> Realizar un extremo a otro de anastomosis. <ol><li> Inicio en la pared posterior de la arteria en el lado opuesto al operador. Coloque el primer punto; comenzar en el lado izquierdo si se trabaja en posición horizontal, en la parte inferior si se trabaja verticalmente. Pasar la aguja desde el exterior de la arteria hacia el lumen y después desde el lumen hacia el exterior de la arteria. </li><li> Ate la puntada, realice un doble nudo primero, y luego dos tiros sola direcciones alternas. Completar toda la pared del fondo con la técnica descrita anteriormente. </li><li> Empezando por el lado derecho si se está trabajando en horizontal o la parte superior si es wojo verticalmente, coloque una sola puntada desde el exterior hacia el lumen y después desde el lumen hacia el exterior. Atar el nudo como se describe anteriormente. Complete la pared frontal repitiendo el procedimiento descrito en 3.1.2.2. </li><li> Anote la última vez que esto permitirá que usted mantenga un registro de tiempo, así que usted puede controlar su progresión. NOTA: Los autores prefieren una técnica de una sola manera para arriba; pero cualquier tipo de sutura microquirúrgica puede ser ensayada. Es recomendable que el alumno finaliza alrededor de 25 anastomosis microquirúrgicas de esta manera antes de que pueda probar otros escenarios clínicos. Estos incluyen el injerto de vena, para brechas arteriales, de extremo a extremo reparaciones nerviosas, y el uso de conductos de la vena para el tratamiento de deficiencias nerviosas. Una técnica importante en la cirugía microvascular, que se puede aprender con este método de entrenamiento es la sutura continua o correr, para llevar a cabo esta técnica el producto en prácticas como 3.1.2.1 pero el stich no se corta, continuar realizando puntadas como en 3.1.2.1 sin cortándolos uasta de completar toda la sutura y lo atan a la malla original al final. </li></ol></li></ol><ol start="2"><li> Entrenamiento con la arteria braquial <ol><li> Coloque la pieza bajo el microscopio. Complete el procedimiento como se describe anteriormente para la arteria femoral. NOTA: La única diferencia es el tamaño. La arteria braquial es mucho menor que la arteria femoral y la anastomosis es considerablemente más difícil. </li></ol></li><li> Pruebas de permeabilidad <ol><li> Cruzar un 20 o 27 G angio-catéter suave a través de la anastomosis, para comprobar si hay obstrucciones causadas por puntos de sutura ambas paredes de los vasos juntos. </li><li> Aplicar una jeringa con colorante alimentario comercial al final de la angio-catéter, y perfundir teñir en la arteria para la prueba de fugas jet </li><li> Abra la arteria longitudinalmente para visualizar los puntos de sutura, el paralelismo y la cantidad de la pared tomado. </li></ol></li></ol>

<ol><li>Lee, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Historical+events+on+development+of+experimental+microsurgical+organ+transplantation%5BTitle%5D)+AND+%22Yonsei+Med+J%22%5BJournal%5D)">Historical events on development of experimental microsurgical organ transplantation.</a> Yonsei Med J. 45 (6), 1115-1120 (2004).</li>
<li>Shurey, S., Akelina, Y., Legagneux, J., Malzone, G., Jiga, L., Ghanem, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+rat+model+in+microsurgery+education%3A+classical+exercises+and+new+horizons%5BTitle%5D)+AND+%22Arch+Plast+Surg%22%5BJournal%5D)">The rat model in microsurgery education: classical exercises and new horizons.</a> Arch Plast Surg. 41 (3), 201-208 (2014).</li>
<li>Olabe, J., Olabe, J., Sancho, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Human+cadaveric+infusi%C3%B3n+model+for+neurosurgical+training%5BTitle%5D)+AND+%22Surg+Neurol%22%5BJournal%5D)">Human cadaveric infusión model for neurosurgical training.</a> Surg Neurol. 72, 700-702 (2009).</li>
<li>Peled, I. J., Kaplan, H. Y., Wexler, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsilicone+anastomoses%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">Microsilicone anastomoses.</a> Ann Plast Surg. 10 (4), 331-332 (1983).</li>
<li>Gluer, N. M., Rao, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Canniesburn+%E2%80%9Cever-ready%E2%80%9D+model+to+practise+microsurgery%5BTitle%5D)+AND+%22Br+J+Plast+Surg%22%5BJournal%5D)">Canniesburn “ever-ready” model to practise microsurgery.</a> Br J Plast Surg. 43 (3), 381-382 (1990).</li>
<li>Hino, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Training+in+microvascular+surgery+using+a+Chicken+wing+artery%5BTitle%5D)+AND+%22Neurosurgery%22%5BJournal%5D)">Training in microvascular surgery using a Chicken wing artery.</a> Neurosurgery. 52 (6), 1495-1498 (2003).</li>
<li>Marsh, D. J., Norton, S. E., Mok, J., Patel, H. D., Chen, H. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+training+the+Chicken+thigh+model%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">Microsurgical training the Chicken thigh model.</a> Ann Plast Surg. 59 (3), 355-356 (2007).</li>
<li>Jeong, H. S., Moon, M. S., Kim, H. S., Lee, H. K., Yi, S. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+training+with+fresh+chicken+legs+and+their+histological+characteristics%5BTitle%5D)+AND+%22Ann+Plast+Surg%22%5BJournal%5D)">Microsurgical training with fresh chicken legs and their histological characteristics.</a> Ann Plast Surg. 70 (1), 57-61 (2013).</li>
<li>Couceiro, J., Ozyurekoglu, T., Sanders, S., Tien, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+training+regimen+with+nonliving+chicken+models%5BTitle%5D)+AND+%22Microsurgery%22%5BJournal%5D)">Microsurgical training regimen with nonliving chicken models.</a> Microsurgery. 33 (3), 251-252 (2013).</li>
<li>Phoon, A. F., Gumley, G. J., Rtshiladze, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Microsurgical+training+using+a+pulsatile+membrane+pump+and+chicken+thigh%3A+A+new%2C+realistic%2C+practical%2C+nonliving+educational+model%5BTitle%5D)+AND+%22Plast+Reconstr+Surg%22%5BJournal%5D)">Microsurgical training using a pulsatile membrane pump and chicken thigh: A new, realistic, practical, nonliving educational model.</a> Plast Reconstr Surg. 126 (5), 278e-279e (2010).</li>
<li>Zhou, Y., Gu, X., Xiang, J., Qian, S., Chen, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+comparative+study+on+suture+versus+cuff+anastomosis+in+mouse+cervical+cardiac+transplant%5BTitle%5D)+AND+%22Exp+Clin+Transplant%22%5BJournal%5D)">A comparative study on suture versus cuff anastomosis in mouse cervical cardiac transplant.</a> Exp Clin Transplant. 8 (3), 245-249 (2010).</li>
</ol>

The authors have nothing to disclose.

The clinical practice of microsurgery requires a continuous practice and a high level of expertise; it&#8217;s applications include free flaps, replantation and revascularization procedures, intracranial &#8211; extracranial anastomoses for neurosurgical procedures, peripheral nerve surgery and others. In spite of the wide variety of procedures that require microsurgical techniques, some of them are seldom performed in many centers. The surgeons therefore need sometimes to maintain their skill level rehearsing the surgeries on different practice models. 
The most widely spread training model is currently the rat 1,2; it is considered by many to be the &#8220;gold standard&#8221; in microsurgical instruction. Rats are indeed a very valuable tool in the teaching and learning of microsurgery. They provide a very similar environment to that of the clinical situation. This approach however exhibits some intrinsic limitations. The use of living animals presents an ethical dilemma; and is generally subjected to institutional review board approval. Furthermore they require anesthesia, and dedicated technicians and facilities. All These factors imply important economic costs; this restricts training on living animals to specific teaching units, experimental surgery departments and hospitals with similar resources. 
The use of nonliving animal models described in this protocol, has the advantage of not raising any ethical concerns; it does not require institutional review board approval. Economically it compares favorably to living animal training. The required equipment is limited and can be acquired over the internet for a reasonable price; the author&#8217;s tabletop stereomicroscope was bought for around 450 United States Dollars (USD) and the set of practice microsurgical instruments was purchased for around 150 USD. The author uses microsurgical sutures provided by his sponsoring institution; the price of sutures varies greatly and high quality sutures are not needed, a box of twelve sutures can be bought for around 70 USD on the internet. A microsurgical training station can be set up on a very limited area at home or at work; Jeong et al.8 Placed their microscope at the residents&#8217; office; whilst we9 used an available microscope close to the hand surgery fellows&#8217; quarters. 
The most critical point in the application of this protocol is the need for the trainee to be constant and to stay motivated with his training, it is therefore very important that he starts training with the bigger vessels first and then proceed to the smaller chicken wing vessels to avoid frustration. The limitations of training with nonliving models involve primarily the lack of bleeding and the inexistence of hemodynamic phenomena like vasospasm and clotting. The advantages and disadvantages of this type of training are summarized on Table 1. The three tests detailed in section three are aimed to help the trainee check the vessel&#8217;s patency in the absence of the earlier mentioned phenomena; they provide information on the quality of the trainee&#8217;s suture, leaking, suture misalignment, and lumen obstruction caused by stitches suturing the front and back wall together. 
The protocol can potentially be improved by the addition of a peristaltic pump10 to simulate vessel flow or by flooding the field with liquid to simulate superficial tension. It is the authors opinion that this would result in the production of an even more realistic training environment and this should be the direction of future research. 
Another possible field for development is the application of this training method to help the trainee learn more complex procedures, such as the cuff anastomosis technique11 before it&#8217;s actual application on animal research. The authors have however no experience with such techniques at present time. 
In conclusion the protocol described in the present manuscript allows a determined trainee to setup a small practice station and use it to learn, perfect and maintain microsurgical skills progressively and sustainably; without the need for special facilities and minimizing animal deaths.

An ample array of training models have been described for the learning and maintenance of both basic and advanced microsurgical skills. These include living animals1,2, human cadaveric specimens3, inert models4,5 and non-living animal models6-9.The Living animal models, specifically those using rats have been extensively used in the teaching of microsurgery 1,2; and they are considered the current gold standard of training. In spite of their remarkable instructive value, when an intensive or prolonged training is required; economical and ethical concerns can hinder their practical usage. 
Cadaveric models3 offer the opportunity to practice in an environment similar to that of the actual clinical situation; they are unfortunately restricted to anatomy labs and similar facilities, a microscope must be available at the lab as well; these models are therefore not widely available. Inert models such as rubber tubes, or gloves4,5 are cheap, and easily accessible, the required equipment for their application is minimal. The resemblance to a clinical situation is tenuous however; and their application is generally limited to the introductory stages of training, before the trainee starts practicing on rats. To the best of our knowledge Hino6 was the first to propose the use of non-living chicken for the development and maintenance of clinical microsurgical skills. His model is based on the extraction and subsequent usage of the chicken brachial artery from commercial chicken wings. This approach does not need institution review board approval, rodent anaesthesia, laboratory technicians or postoperative care. 
Following Hino&#180;s description of the chicken wing artery model numerous other nonliving animal models were published. The use of commercial chicken thighs was first suggested by Marsh et al.7 who reported the use of the femoral artery, vein and nerve for didactic purposes. This particular model expands the possibilities of training including structures different from the arteries; it permits the trainee to perform a variety of complex procedures such as vein grafts, nerve grafts or fascicular repairs. Jeong et al.8 Further studied Marsh&#8217; chicken thigh model and its applications to the teaching of resident doctors. The authors analysed chicken tissue samples histologically and found that it presented similarities to human tissues. The time to perform an anastomosis by the trainee was significantly reduced by practice in their study. They concluded that &#8220;the femoral neurovascular bundles of chicken are an appropriate and effective model for teaching and practicing microsurgery&#8221;. In 2013 my colleagues and I9 published a microsurgical training regimen that combined both the chicken thigh and the chicken wing models; this approach benefits from the versatility of the chicken thighs and from the limited size of the chicken wing artery which can represent more of a challenge than the femoral vessels for the more advanced trainees. 
On the current manuscript we describe step by step the process of setting up a microsurgical practice station; the materials required, how to dissect the neurovascular structures of each model and how to effectively apply the training regimen.

<table><tbody><tr><td>Stereomicroscope</td><td>Amscope</td><td>SM-1BX</td><td>Microscope</td></tr><tr><td>Led light</td><td>Amscope</td><td>LED-80S-YA</td><td>illumination system</td></tr><tr><td>Microsurgical instruments set</td><td>Chen hen microsurgical instruments</td><td>HC- X803-1</td><td>Microsurgical instruments</td></tr><tr><td>Microsurgical sutures</td><td>S/T microsurgical</td><td>9/0 Suture</td><td>Sutures</td></tr></tbody></table>

step by step: microsurgical training method combining two nonliving animal models

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly laboratory rats. This method although extremely valuable can be economically demanding both for the surgeon and the sponsoring institution; it also requires special training facilities that may not always be available or accessible. Furthermore ethical concerns can limit the use of living animals for training purposes. Alternative training methods, such as inert tubes and gloves have not gained popularity among surgeons since they do not offer an experience similar to that of a clinical situation. Non-living animal models include the use of chicken thighs and wings; they offer a practice experience that resembles a clinical situation to a considerable extent. This type of training is relatively cheap and easily available. The microscope and instruments required can be acquired over the internet, and the chicken pieces can be bought at the local supermarket.
This approach allows a motivated trainee to rehearse different types of surgical techniques several times at a reasonable expense, helping to develop or maintain his surgical expertise if more complex facilities are not available. On the current manuscript we describe how to setup a small practice station, how to dissect the specimens, and how to practice both with the chicken thighs and with the chicken wings in a progressive fashion. This approach takes advantage on the versatility of the chicken thigh model and the small size of the chicken wing Brachial artery.

Los autores han chronometered sus tiempos con el método de entrenamiento presentes y han visto que para reducir significativamente los tiempos de anastomosis para que una arteria femoral en el final de la tercera semana. El alumno puede controlar las mejoras en su técnica mediante la comprobación de sus tiempos, sus porcentajes de permeabilidad y la alineación de sus puntos de sutura. El sistema descrito en este manuscrito se representa en la Figura 1 que incluye un microscopio de mesa y un conjunto de instrumentos de microcirugía. Las disecciones macroscópicas se muestran en las Figuras 2 y 3. Un ejemplo de una anastomosis microquirúrgica arteria femoral se muestra en la Figura 4. La Figura 5 muestra una anastomosis microquirúrgica arteria braquial. La Figura 6 muestra una reparación de la arteria femoral con un injerto de vena. Las pruebas de permeabilidad se muestran en la Figura 7. <img alt="Figura 1" src="/files/ftp_upload/52625/52625fig1.jpg" /> Figura 1: El corrESPONDER propia estación de la práctica microquirúrgica de autor. Incluye un microscopio de mesa y un juego de entrenamiento de instrumentos de microcirugía. Se puede configurar en un espacio muy limitado en la oficina o en casa. <img alt="Figura 2" src="/files/ftp_upload/52625/52625fig2.jpg" /> Figura 2 A: A la disección macroscópica de un muslo de pollo, los vasos femorales y el nervio ciático puede ser fácilmente expuesto pasando un dedo justo medial al eje femoral. La flecha horizontal marca la cabeza femoral. El plano de disección está marcada por la flecha vertical justo en paralelo al eje femoral B: La arteria femoral (a) vena (v) y el nervio ciático (n) se muestran aquí en detalle. <img alt="Figura 3" src="/files/ftp_upload/52625/52625fig3.jpg" /> Figura 3 A y B: A la disección macroscópica de un ala de pollo. El braquial un<html> rtery corre entre el bíceps y el tríceps braquial. La arteria está marcado con una flecha en ambas fotografías es muy superficial y el enfoque es simple; se puede lograr con las tijeras de cocina comerciales. <img alt="Figura 4" src="/files/ftp_upload/52625/52625fig4.jpg" /> Figura 4: Imagen microscópica de un extremo de la arteria femoral para poner fin a la sutura, se realizó aquí una manera para arriba técnica con puntos individuales. Cualquier otro tipo de sutura se puede practicar a discreción del alumno. <img alt="Figura 5" src="/files/ftp_upload/52625/52625fig5.jpg" /> Figura 5: extremo a extremo de la sutura de una arteria braquial pollo. Este arterias son mucho más pequeños que los femorales y el procedimiento es mucho más técnicamente exigentes. carga / 52625 / 52625fig6.jpg &quot;/&gt; Figura 6: Una reparación de la arteria femoral con un injerto de vena recogida de la vena femoral. El modelo de muslo de pollo es muy versátil permitiendo para diferentes tipos de ejercicios de práctica. <img alt="Figura 7" src="/files/ftp_upload/52625/52625fig7.jpg" /> Figura 7:. Las pruebas de permeabilidad A: Un angio-catéter del diámetro apropiado es atravesado a través de la anastomosis para comprobar si hay obstrucciones causadas por puntos de sutura sutura tanto de las paredes del buque B:.. Tinte se perfunde a través de la anastomosis a prueba de fugas C : La anastomosis se abre longitudinalmente para visualizar la alineación de sutura.

Watch this Scientific Journal Video about Step By Step: Microsurgical training method combining two nonliving animal models at JoVE.com

Step By Step: Microsurgical training method combining two nonliving animal models

Paso a paso: método de entrenamiento microquirúrgica combinar dos modelos animales no vivos

Here we describe how to set up a small microsurgical practice station and a simple and inexpensive method for the training of microsurgery with non-living animal models.

The learning of microsurgical techniques and the maintenance of microsurgical skills have been traditionally based on the use of living animals, mainly ...

step-step-microsurgical-training-method-combining-two-nonliving

Universidad San Sebastian

Research

JoVE Journal

Medicine

15.2K vistas.  POVISA Hospital. Here we describe how to set up a small microsurgical practice station and a simple and inexpensive method for the training of microsurgery with non-living animal models. 

Video: Step By Step: Microsurgical training method combining two nonliving animal models

Murine Cervical Heart Transplantation Model Using a Modified Cuff Technique

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are available to perform mechanistic in vivo studies. While heart transplantation models using a suture technique were first successfully developed in rats, the translation into an equally widespread used murine equivalent was never achieved due the technical complexity of the microsurgical procedure. In contrast, non-suture cuff techniques, also developed initially in rats, were successfully adapted for use in mice1-3. This technique for revascularization involves two major steps I) everting the recipient vessel over a polyethylene cuff; II) pulling the donor vessel over the formerly everted recipient vessel and holding it in place with a circumferential tie. This ensures a continuity of the endothelial layer, short operating time and very high patency rates4.
Using this technique for vascular anastomosis we performed more than 1,000 cervical heart transplants with an overall success rate of 95%. For arterial inflow the common carotid artery and the proximal aortic arch were anastomosed resulting in a retrograde perfusion of the transplanted heart. For venous drainage the pulmonary artery of the graft was anastomosed with the external jugular vein of the recipient5.
Herein, we provide additional details of this technique to supplement the video.

The murine cervical heart transplantation model is well suited for immunological as well as ischemia reperfusion injury studies. We modified the procedure using a non-suture cuff technique and performed more than 1,000 successful transplants with this approach.
Herein, we provide additional details of this technique to supplement the video.

Murino Cervical Trasplante Cardiaco Modelo Usando una técnica de Cuff Modificado

Mouse models are of special interest in research since a wide variety of monoclonal antibodies and commercially defined inbred and knockout strains are ...

Investigación

Medicina

Seguimiento en tiempo real de nanopartículas en tumores cerebrales mediante 2P-IVM en ratones

Two-Photon Intravital Microscopy of Glioblastoma in a Murine Model

The delivery of intravenously administered cancer therapeutics to brain tumors is limited by the blood-brain barrier. A method to directly image the accumulation and distribution of macromolecules in brain tumors in vivo would greatly enhance our ability to understand and optimize drug delivery in preclinical models. This protocol describes a method for real-time in vivo tracking of intravenously administered fluorescent-labeled nanoparticles with two-photon intravital microscopy (2P-IVM) in a mouse model of glioblastoma (GBM).
The protocol contains a multi-step description of the procedure, including anesthesia and analgesia of experimental animals, creating a cranial window, GBM cell implantation, placing a head bar, conducting 2P-IVM studies, and post-surgical care for long-term follow-up studies. We show representative 2P-IVM imaging sessions and image analysis, examine the advantages and disadvantages of this technology, and discuss potential applications.
This method can be easily modified and adapted for different research questions in the field of in vivo preclinical brain imaging.

Autor destacado: Estrategias de imágenes multimodales para optimizar la administración de fármacos y la detección temprana en el tratamiento del glioblastoma

We present a novel approach for two-photon microscopy of the tumor delivery of fluorescent-labeled iron oxide nanoparticles to glioblastoma in a mouse model.

Microscopía intravital de dos fotones de glioblastoma en un modelo murino

The delivery of intravenously administered cancer therapeutics to brain tumors is limited by the blood-brain barrier. A method to directly image the ...

Investigación sobre el cáncer

<meta charset="utf8"></head><body>Reparación común de la arteria carótida después de la inyección en un modelo de ratón

Facilitating Repeat Intracarotid Injections in Mouse Models by a Novel Injection Site Repair Technique

Given recent advances in the delivery of novel antitumor therapeutics using endovascular selective intraarterial delivery methods in neuro-oncology, there is an urgent need to develop methods for intracarotid injections in mouse models, including methods to repair the carotid artery in mice after injection to allow for subsequent injections. We developed a method of intracarotid injection in a mouse model to deliver therapeutics into the internal carotid artery (ICA) with two alternative procedures. 
During injection, the needle is inserted into the common carotid artery (CCA) after tying a suture around the external carotid artery (ECA) and injected therapeutics are delivered into the ICA. Following injection, the common carotid artery (CCA) can be ligated, which limits the number of intracarotid injections to one. The alternative procedure described in this article includes a modification where intracarotid artery injection is followed by injection site repair of the CCA, which restores blood flow within the CCA and avoids the complication of cerebral ischemia seen in some mouse models. 
We also compared the delivery of bone marrow-derived human mesenchymal stem cells (BM-hMSCs) to intracranial tumors when delivered through intracarotid injection with and without injection site repair following the injection. Delivery of BM-hMSCs does not differ significantly between the methods. Our results demonstrate that injection site repair of the CCA allows for repeat injections through the same artery and does not impair the delivery and distribution of injected material, thus providing a model with greater flexibility that more closely emulates intracarotid injection in humans.

<meta charset="utf8"></head><body>Autor destacado: Avance en el tratamiento del glioblastoma a través de estrategias de administración intraarterial para virus oncolíticos y microARN

Repair of the intracarotid artery in a mouse model after injection returns blood flow to the artery without negatively impacting the distribution of the injected material. Injection site repair facilitates subsequent injections through the same artery and prevents cerebral ischemia in mouse strains that lack a complete Circle of Willis.

Facilitación de la repetición de inyecciones intracarotídeas en modelos de ratón mediante una novedosa técnica de reparación en el lugar de la inyección

Given recent advances in the delivery of novel antitumor therapeutics using endovascular selective intraarterial delivery methods in neuro-oncology, there ...

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression must be pursued. Employing vascularized bone marrow transplantation and co-transplantation of the thymus have shown promise in this regard in various animal models.1-11 Vascularized bone marrow transplantation allows for the uninterrupted transfer of donor bone marrow cells within the preserved donor microenvironment, and the incorporation of thymus tissue with vascularized bone marrow transplantation has shown to increase T-cell chimerism ultimately playing a supportive role in the induction of immune regulation. The combination of solid organ and vascularized composite allotransplantation can uniquely combine these strategies in the form of a novel transplant model. Murine models serve as an excellent paradigm to explore the mechanisms of acute and chronic rejection, chimerism, and tolerance induction, thus providing the foundation to propagate superior allograft survival strategies for larger animal models and future clinical application. Herein, we developed a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique. The experience in syngeneic and allogeneic transplant settings is described for future broader immunological investigations via an instructional manuscript and video supplement.

To study combined solid organ and vascularized composite allotransplantation, we describe a novel heterotopic en bloc chest wall, thymus, and heart transplant model in mice using a cervical non-suture cuff technique.

Un microquirúrgica Modelo Novela de heterotópico, en bloque, pared torácica, el timo y el trasplante cardiaco en ratones

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression ...

Surgical Training for the Implantation of Neocortical Microelectrode Arrays Using a Formaldehyde-fixed Human Cadaver Model

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. Recent technological progress has enabled the fabrication of microelectrode arrays that allow recording the activity of multiple individual neurons in the neocortex of the human brain. These arrays have the potential to bring unique insight onto the neuronal correlates of cerebral function in health and disease. Furthermore, the identification and decoding of volitional neuronal activity opens the possibility to establish brain-computer interfaces, and thus might help restore lost neurological functions. The implantation of neocortical microelectrode arrays is an invasive procedure requiring a supra-centimetric craniotomy and the exposure of the cortical surface; thus, the procedure must be performed by an adequately trained neurosurgeon. In order to provide an opportunity for surgical training, we designed a procedure based on a human cadaver model. The use of a formaldehyde-fixed human cadaver bypasses the practical, ethical and financial difficulties of surgical practice on animals (especially non-human primates) while preserving the macroscopic structure of the head, skull, meninges and cerebral surface and allowing realistic, operating room-like positioning and instrumentation. Furthermore, the use of a human cadaver is closer to clinical daily practice than any non-human model. The major drawbacks of the cadaveric simulation are the absence of cerebral pulsation and of blood and cerebrospinal fluid circulation. We suggest that a formaldehyde-fixed human cadaver model is an adequate, practical and cost-effective approach to ensure proper surgical training before implanting microelectrode arrays in the living human neocortex.

We designed a procedure in which a formaldehyde-fixed human cadaver is used to assist neurosurgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain.

Formación quirúrgica para la implantación de microelectrodos Neocortical matrices usando un modelo de cadáver humano formaldehído-fija

This protocol describes a procedure to assist surgeons in training for the implantation of microelectrode arrays into the neocortex of the human brain. ...

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome (TTTS), but is technically challenging and can lead to significant complications. Acquiring and maintaining the necessary surgical skills require consistent practice, a critical caseload, and time. Training on realistic surgical simulators can potentially shorten this steep learning curve and enables several proceduralists to acquire procedure-specific skills simultaneously. Here we describe realistic simulators designed to allow the user familiarity with the equipment and specific steps required in the surgical treatment of TTTS, including fetoscopic handling, approaches to anterior and posterior placenta, recognition of anastomoses, and efficient coagulation of vessels. We describe the skills that are especially important in conducting placental laser coagulation that the surgeon can practice on the model and apply in a clinical case. These models can be adapted easily depending on the availability of materials and require standard fetoscopy equipment. Such training systems are complementary to traditional surgical apprenticeships and can be useful aids for fetal medicine units that provide this clinical service.

Practicing the specific skills required for fetoscopic laser coagulation of monochorionic placental anastomoses on realistic models can aid less experienced surgeons in overcoming the steep learning curve associated with this procedure that is now regarded as the standard of care for twin-twin transfusion syndrome.

Entrenamiento quirúrgico modelo: Adquisición de habilidades en el photocoagulation del Laser Fetoscopic de Monochorionic Diamniotic Twin Placenta utilizando simuladores realistas

Fetoscopic laser coagulation of arterio-venous anastomoses (AVA) in a monochorionic placenta is the standard of care for twin-twin transfusion syndrome ...

Paso a paso: método de entrenamiento microquirúrgica combinar dos modelos animales no vivos

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