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Modelling insect wings using the finite element methodHerbert, Rolf China January 2001 (has links)
No description available.
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Enlarged hind wings of the Neotropical butterfly Pierella helvina (Nymphalidae) enhance gliding flight performance in ground effect.Stylman, Marc 23 May 2019 (has links)
Flight is a vital component of butterfly natural history, and flight-associated morphology is thought to be under strong selection for the performance of critical behaviors such as patrolling, courtship and oviposition. However, while different behaviors require different proportions of flapping versus gliding flight, few studies actually quantify butterfly flight behavior. Moreover, as butterfly flight is anteromotoric, no prior study has measured the role of hind wing allometry in flight. Using high-speed videography, this study compares the flight of two species of Haeterini (Nymphalidae) that regularly employ gliding flight. We also employ stereo videography and experimental hind wing area reduction to measure the effects of hind wing allometry on flight. Results suggest that although the forewings are reliable predictors of flight in these two species, relative hind wing area can significantly affect gliding flight performance, and should be considered as a factor in future investigations on flight-associated morphology in butterflies.
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Growth, Reproductive Life-History Traits and Energy Allocation in Epinephelus guttatus (red hind), E. striatus (Nassau Grouper), and Mycteroperca venenosa (yellowfin grouper) (Family Serranidae, Subfamily Epinephelinae)Cushion, Nicolle Marie 08 June 2010 (has links)
Fish populations are regulated by both external environmental factors, e.g., water quality parameters and habitat, and internal reproductive biology and physiology processes. For many species and populations there is often ample external information, while critical internal, i.e., life-history trait (LHT), information is not available. For this study, I determined LHTs and energy allocation patterns for Epinephelus guttatus (red hind), E. striatus (Nassau grouper), and Mycteroperca venenosa (yellowfin grouper) harvested from The Bahamas. I determined age ranges, and how growth patterns and rates differed among the study species. The maximum ages were: 17, E. guttatus; 22, E. striatus; and 13, M. venenosa. Epinephelus striatus was estimated to have the slowest, while M. venenosa had the fastest growth rate. A gonad histological classification system and the ageing data were used to determine the spawning seasons, sex ratios, size and age of sexual maturation and sex change and gonadosomatic indices (GSIs) for the study species. The peak spawning months were January-February for E. guttatus, December-January for E. striatus and March-April for M. venenosa. The fifty-percent sexual maturity estimates were 235 total length mm (Tlmm) (2.05 year old, yo), 435 Tlmm (4.00 yo), and 561 Tlmm (4.66 yo) for E. guttatus, E. striatus and M. venenosa, respectively. The size and age range of sex change for E. guttatus was between 257-401 Tlmm, ~4-5 years old and between 716-871 Tlmm, ~8-9 yo for M. venenosa. I determined protein and lipid concentrations in muscle and gonad tissues to ascertain energy allocation patterns. For all species and sexes except for female E. guttatus, the proportion of energy delegated to somatic growth declines as a fish grows longer, while reproduction energy allocation increases. The results of each study were compared to previous studies conducted throughout the tropical western Atlantic Ocean, and were related to species-specific ecological and spawning behaviors. The findings of each study highlight that the LHTs of the study species greatly differ and these differences will impact population dynamics and need to be considered for management initiatives. In the final chapter, the effects of fishing on LHTs are reviewed and fishery management options are discussed.
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Elninių žvėrių populiacijų valdymas ir jų įtaka miško atkūrimui Rokiškio miškų urėdijos Vyžuonos girininkijoje / Deer Populations Game Management And Their Impact On The Regeneration Of The Forest In Rokiskis Forest Stewardship, In Vyzuona ForestryZamaliauskas, Mantas 21 June 2010 (has links)
Darbo objektas. VĮ Rokiškio miškų urėdijos Vyžuonos girininkijos elninių žvėrių populiacijos, jų valdymas, įtaka miško atkūrimui, bei miško želdinių apsaugos priemonės ir jų efektyvumas. Darbo tikslas. Įvertinti VĮ Rokiškio miškų urėdijos Vyžuonos girininkijos elninių žvėrių populiacijas, jų gyvenamą aplinką bei poveikį miškui. Darbo metodai. Literatūrinės loginės analizės ir sisteminės atrankinės apskaitos. Darbo rezultatai. Vyžuonos girininkijos miškuose gyvena šie elniniai žvėrys: Taurieji elniai ( tankis 10,6 vnt.../1000ha.); Briedžiai (tankis 2,4 vnt.../1000ha.); Stirnos (tankis 80 vnt.../1000ha.) Atsižvelgiant į poveikį miško želdiniams bei žėliniams laupant žievę, elninių žvėrių gausą reikėtų išlaikyti nepakitusią. Elninių žvėrių naudojimas yra per mažas. Pagrindinė rūšis turėtų būti taurusis elnias, šalutinė – stirna, nepageidautina rūšis turėtų būti briedis. Miško želdiniai bei žėliniai nuo elninių žvėrių galimo neigiamo poveikio yra saugomi. Vyžuonos girininkijoje dažniausiai naudojama apsaugos priemonė yra repelentai. 2009 - 2010 metų žiemą saugomas plotas sudarė 44,9 ha. / Object of work. Rokiskis Forest Enterprise Forestry Vyžuonų game deer population management, the influence of forest regeneration and forest plantations, protection measures and their effectiveness. Purpose of work. To evaluate the population of the cervines , their surroundings and their influence to the forest. The methods of work. The logical analyses of the literature and systematic rating. The work results. Cervines living in the forests of the forestry Vyzuona are: Red deer (density 10,6 units/1000 ha) Moose (density 2,4 units/1000 ha) Hind (density 80 units/1000 ha) Considering the influence to sprouts and young growth the population should stay consistent. The use of the cervines is too low. Main species should be red deer, secondary hind, moose should be unacceptable. The forest sprouts and young growth have been protected from negative effects or cervines. In the forestry of Vyzuona mainly the repellents are used for the protection. In the year 2009-2010 the protected area was 44.9 ha.
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Learning from Langland : theo-poetic resources for the post-Hind landscapeBurn, Helen Mary January 2011 (has links)
In the last ten years the Church of England has tried, by means of two reports leading to what I term the ‘Hind settlement’, to re-configure its provision of theological education. The tensions generated by the attempt to hold together different discourses and to impose regional re-organisation in the context of complex developments both in higher education and in patterns of lay and ordained ministry form the basis of my critique of Hind. I argue that Hind’s recourse to the image of the ‘body of Christ’ in the service of an instrumentalist model of ministry exposes inadequacies of a theological anthropological, Christological and ecclesiological nature. I identify a medieval text, Piers Plowman, as a conversation partner which offers a different way of negotiating an analogously difficult set of issues around learning, discipleship and power. My hermeneutical approach to the poem sees its primary impetus as arising from the constant interplay between the experiences of daily life and the attempt to work out a personal and social understanding of salvation. By comparing the ways in which Hind and Langland explore learning as measurable progress, and lay and clerical models of learning, I propose that Piers Plowman offers some valuable resources to the next stage of the Hind process. Not only does the poem foreground the chaotic co-existence of multiple voices in a marketplace of competing definitions of learning, and acknowledge the recalcitrance of communities when presented with opportunities to change, but it also, in the figure of Piers, hints at the possibility of going beyond the lay/clerical impasse. The poem’s recognition of sin and the need for repentance, in contrast to Hind language of management and effectiveness, and its requirement of the reader to participate in the making of new meaning, present an ongoing challenge to a culture of ‘learning outcomes’.
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Hormonal correlates of coloration and sexual change in the hermaphroditic grouper, Epinephelus adscensionisKline, Richard Joseph, 1970- 11 February 2011 (has links)
Hermaphroditism, associated with territoriality and dominance behavior, is common in the marine environment. Male sex-specific coloration patterns and behavior are particularly evident in species where males are territorial and guard harems of females such as wrasses and groupers. Protogynous hermaphrodites that change sex from female to male are good models to study sexual behavior and related changes in the brain due to their abilities to reorganize their sexual phenotype as adults. Two hormones produced in the brain and implicated in the process of sex-specific behavior and reproductive development are arginine vasotocin (AVT) and gonadotropin releasing hormone (GnRH). While a wealth of data exists regarding these hormone systems separately, little is known about linkage between these two systems. Especially there is no data tracking these two systems together in any protogynous fish. This study was conducted to test the hypothesis that coordinated interactions between AVT and GnRH facilitate the process of behavioral and gonadal sex change in the rock hind Epinephelus adscensionis. Four topics were addressed to investigate the relationship between behavior and reproduction: i) rock hind sex change, sexual characteristics and conditions causing sex change to occur in captivity were detailed as a basis for examining the AVT system and GnRH during this process, ii) the distribution of a vasotocin V1a type receptor identified in rock hind brain was examined for the first time in a fish species using a custom designed antibody then the receptor protein was co-localized with GnRH producing cells within the brain to confirm that a pathway exists for AVT action on GnRH, iii) levels of AVT, AVT receptors, and GnRH messenger RNA (mRNA) were compared between male and female rock hind phenotypes, and iv) female rock hind at early stages of sex change were compared for brain mRNA expression of AVT, AVT receptors, and GnRH to determine the order of hormonal change during the process of sexual inversion in this species. This study provides a better understanding of the relationship between sex-specific behavior and reproductive development via AVT and GnRH systems that are conserved in all vertebrates. / text
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Tratamento com VEGFC para revascularização linfática em membros pélvicos de camundongos / VEGFC treatment for lymphatic revascularization of mice hindlimbFerrão, Juliana Shimara Pires 29 July 2013 (has links)
A revascularização linfática é um desafio e o estabelecimento de novas estratégias terapêuticas podem melhorar a qualidade de vida de pessoas que sofrem de distúrbios linfáticos. O objetivo deste estudo foi verificar a capacidade de tratamento com VEGFC exógeno na melhoria da vascularização linfática de uma maneira dependente do tempo em membros pélvicos (MP) de camundongos após a remoção do linfonodo inguinal. O linfonodo inguinal esquerdo foi removido cirurgicamente para mimetizar patologias com diminuição da vascularização linfática. Densidade vascular linfática (Vv) e de comprimento (Lv) foram avaliadas por imunohistoquímica, seguidas de estereologia, após a cirurgia com ou sem o tratamento com VEGFC exógeno. O grupo controle não foi manipulado, mas recebeu soro fisiológico em vez de tratamento com VEGFC exógeno. As expressões do VEGFC e FLT4 local foram avaliadas por qPCR. Houve efeito do tempo sobre Vv e Lv no Grupo Cirurgia e diferença significativa entre os grupos Controle e Cirurgia nas três regiões estudadas (região proximal, média e distal) do MP esquerdo (MPE). A Lv mostrou diferença significativa entre os grupos Controle e Cirurgia somente na região média do MPE. A Vv e a Lv para o Grupo Tratamento foram maiores do que os outros grupos em todas as regiões do MPE. A expressão gênica do VEGFC e do FLT4 apresentou efeito do tempo em todas as regiões do MPE para os grupos Cirurgia e Tratamento. Ambas as expressões gênicas do VEGFC e do FLT4 apresentaram diferença significativa entre os grupos Controle e Cirurgia, entre os grupos Cirurgia e Tratamento e entre os grupos Controle e Tratamento. Os resultados mostraram que os camundongos são bons modelos experimentais para o uso de VEGFC exógeno como terapia de revascularização linfática, e o tratamento com VEGFC exógeno aumenta vascularização linfática já após 3 dias de dano linfático. / Lymphatic revascularization is a challenge and the establishment of new therapeutic strategies may improve quality of life from those suffering from lymphatic disorders. The objective of this study was to verify the VEGFC treatment capacity in improving lymphatic vascularization in a time-dependent manner in mouse hind limb (HL) after removal of inguinal lymphnode. The left inguinal lymphnode was surgically removed to mimetize pathologies with decreased lymphatic vascularization. Lymphatic vascular density (Vv) and length (Lv) were evaluated by immunohistochemistry followed by stereology after surgery and/or VEGFC treatment. Control group was not manipulated but received saline instead of VEGFC treatment. VEGFC and FLT4 local expression were assessed by qPCR. There was effect of time over Vv and Lv in the SG and significant difference between CG and SG in the three studied regions (proximal, medium and distal region) of the left HL (LHL). The Lv showed significant difference between CG and SG only in the medium region. The Vv and the Lv for TG were higher than the other groups in all regions of LHL. VEGFC and FLT4 gene expression presented time effect in all regions of the LHL for SG and TG. Both VEGFC and FLT4 gene expression presented significant difference between CG and SG, between SG and TG, and between CG and TG. The results show that mice are good experimental models for VEGFC use as therapy for lymphatic revascularization, and VEGFC treatment increased the lymphatic vasculature already after 3 days of lymphatic damage.
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Tissue regeneration in composite injury models of limb traumaUhrig, Brent A. 20 September 2013 (has links)
Severe extremity trauma often involves significant damage to multiple tissue types, including bones, skeletal muscles, peripheral nerves, and blood vessels. Such injuries present unique challenges for reconstruction, and improving structural and functional outcomes of intervention remains a pressing, unmet clinical need. While tissue engineering/regenerative medicine (TE/RM) therapeutics offer promising potential to overcome the status quo limitations of surgical reconstruction, very few products have transitioned to clinical practice. Improving treatment options will likely require advancing our understanding of the biological interactions occurring in the repair of damaged tissues.
Bone tissue is known to be innervated and highly vascularized, and both tissue types are involved in normal bone physiology. However, the degree to which these tissue relationships influence the repair of large, multi-tissue defects remains unknown. Accordingly, the goal of this thesis was to investigate tissue regeneration in two novel composite injury models. First, we characterized interactions in a composite bone and nerve injury model where a segmental bone defect was combined with a peripheral nerve gap. Our results indicated that although tissue regeneration was not impaired, the composite injury group experienced a marked functional deficit in the operated limb compared to single-tissue injury. Second, we developed a model of composite bone and vascular extremity trauma by combining a critically-sized segmental bone defect with surgically-induced hind limb ischemia to evaluate the effects on BMP-2-mediated bone repair. Interestingly, our results demonstrated a stimulatory effect of the recovery response to ischemia on bone regeneration. Finally, we investigated early vascular growth and gene expression as potential mechanisms coupling the response to ischemia with bone defect repair. Although the response to ischemia promoted robust vascular growth in the thigh, it did not directly augment vascularization at the site of bone regeneration. In addition, the stimulatory effects of ischemia on bone regeneration could not be explained by gene expression alone based on the genes and time points investigated.
Taken together, this thesis presents pioneering work on a new thrust of TE/RM research – tissue regeneration in models of composite injury. This work has provided new insights on the complexity of composite tissue repair, specifically in regard to the relationship between vascular tissue growth and bone healing. Going forward, successful leverage of models of composite tissue injuries will provide valuable test beds for screening new technologies, advance the understanding of tissue repair biology, and ultimately, may produce new therapeutic interventions for limb salvage and reconstruction that improve outcomes for extremity trauma patients.
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Tratamento com VEGFC para revascularização linfática em membros pélvicos de camundongos / VEGFC treatment for lymphatic revascularization of mice hindlimbJuliana Shimara Pires Ferrão 29 July 2013 (has links)
A revascularização linfática é um desafio e o estabelecimento de novas estratégias terapêuticas podem melhorar a qualidade de vida de pessoas que sofrem de distúrbios linfáticos. O objetivo deste estudo foi verificar a capacidade de tratamento com VEGFC exógeno na melhoria da vascularização linfática de uma maneira dependente do tempo em membros pélvicos (MP) de camundongos após a remoção do linfonodo inguinal. O linfonodo inguinal esquerdo foi removido cirurgicamente para mimetizar patologias com diminuição da vascularização linfática. Densidade vascular linfática (Vv) e de comprimento (Lv) foram avaliadas por imunohistoquímica, seguidas de estereologia, após a cirurgia com ou sem o tratamento com VEGFC exógeno. O grupo controle não foi manipulado, mas recebeu soro fisiológico em vez de tratamento com VEGFC exógeno. As expressões do VEGFC e FLT4 local foram avaliadas por qPCR. Houve efeito do tempo sobre Vv e Lv no Grupo Cirurgia e diferença significativa entre os grupos Controle e Cirurgia nas três regiões estudadas (região proximal, média e distal) do MP esquerdo (MPE). A Lv mostrou diferença significativa entre os grupos Controle e Cirurgia somente na região média do MPE. A Vv e a Lv para o Grupo Tratamento foram maiores do que os outros grupos em todas as regiões do MPE. A expressão gênica do VEGFC e do FLT4 apresentou efeito do tempo em todas as regiões do MPE para os grupos Cirurgia e Tratamento. Ambas as expressões gênicas do VEGFC e do FLT4 apresentaram diferença significativa entre os grupos Controle e Cirurgia, entre os grupos Cirurgia e Tratamento e entre os grupos Controle e Tratamento. Os resultados mostraram que os camundongos são bons modelos experimentais para o uso de VEGFC exógeno como terapia de revascularização linfática, e o tratamento com VEGFC exógeno aumenta vascularização linfática já após 3 dias de dano linfático. / Lymphatic revascularization is a challenge and the establishment of new therapeutic strategies may improve quality of life from those suffering from lymphatic disorders. The objective of this study was to verify the VEGFC treatment capacity in improving lymphatic vascularization in a time-dependent manner in mouse hind limb (HL) after removal of inguinal lymphnode. The left inguinal lymphnode was surgically removed to mimetize pathologies with decreased lymphatic vascularization. Lymphatic vascular density (Vv) and length (Lv) were evaluated by immunohistochemistry followed by stereology after surgery and/or VEGFC treatment. Control group was not manipulated but received saline instead of VEGFC treatment. VEGFC and FLT4 local expression were assessed by qPCR. There was effect of time over Vv and Lv in the SG and significant difference between CG and SG in the three studied regions (proximal, medium and distal region) of the left HL (LHL). The Lv showed significant difference between CG and SG only in the medium region. The Vv and the Lv for TG were higher than the other groups in all regions of LHL. VEGFC and FLT4 gene expression presented time effect in all regions of the LHL for SG and TG. Both VEGFC and FLT4 gene expression presented significant difference between CG and SG, between SG and TG, and between CG and TG. The results show that mice are good experimental models for VEGFC use as therapy for lymphatic revascularization, and VEGFC treatment increased the lymphatic vasculature already after 3 days of lymphatic damage.
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Keratose Hydrogels Promote Vascular Smooth Muscle Differentiation from c-kit+ Human Cardiac Stem Cells: Underlying Mechanism and Therapeutic PotentialLedford, Benjamin 23 March 2018 (has links)
Cardiovascular disease is the leading cause of death in the United States, and coronary artery disease (CAD) kills over 370,000 people annually. There are available therapies that offer a temporary solution; however, only a heart transplant can fully resolve heart failure, and donor organ shortages severely limit this therapy. C-kit+ human cardiac stem cells (hCSCs) offers a viable alternative therapy to treat cardiovascular disease by replacing damaged cardiac tissue; however, low cell viability, low retention/engraftment, and uncontrollable in vivo differentiation after transplantation has limited the efficacy of stem cell therapy. Tissue engineering solutions offer potential tools to overcome current limitations of stem cell therapy. Materials derived from natural sources such as keratin from human hair offers innate cellular compatibility, bioactivity, and low immunogenicity. Keratin proteins extracted using oxidative chemistry known as keratose (KOS) have shown therapeutic potential in a wide range of applications including cardiac regeneration. My studies utilize KOS hydrogels to modulate c-kit+ hCSC differentiation, and explore the capability of differentiated cells to regenerate vascular tissue.
In the first Chapter, we reviewed literature relevant to keratin-based biomaterials and their biomedical applications, the use of stem cells in cardiovascular research, and the differentiation of vascular smooth muscle cells (VSMCs). The section on biomedical applications of keratin biomaterials focuses on the oxidized form of keratin known as keratose (KOS), because this was the material used for our research. Since we planned to use this material in conjunction with c-kit+ hCSCs, we also briefly explored the use of stem cells in cardiovascular research. Additionally, we examined some key signaling pathways, developmental origins, and the cell phenotype of VSMCs for reasons that will become clear after observing results from chapters 2 and 3. Based upon our review of the literature, KOS biomaterials and c-kit+ hCSCs were determined to be promising as a combined therapeutic for the regeneration of cardiac tissue.
Research in Chapter 2 focused on characterizing the effects of KOS hydrogel on c-kit+ hCSC cell viability, proliferation, morphology, and differentiation. Results demonstrated that KOS hydrogels could maintain hCSC viability without any observable toxic effects, but it modulated cell size, proliferation, and differentiation compared to standard tissue culture polystyrene cell culture (TCPS). KOS hydrogel produced gene and protein expression consistent with a VSMC phenotype. Further, we also observed novel "endothelial cell tube-like" microstructures formed by differentiated VSMCs only on KOS hydrogel, suggesting a potential capability of the hCSC-derived VSMCs for in vitro angiogenesis. Results from this study lead us to question what signaling pathways might be responsible for the apparent VSMC differentiation pattern we observed on KOS hydrogels.
Research in Chapter 3 explored the time course of VSMC differentiation, cell contractility, inhibition of VSMC differentiation, and measured protein expression of transforming growth factor beta 1 (TGF-β1) and its associated peptides for hCSCs cultured on KOS hydrogels, tissue culture polystyrene, and collagen hydrogels. A review of VSMC differentiation signaling pathways informed our decision to investigate the role of TGF-β1 in VSMC differentiation. Results demonstrated that KOS hydrogel differentiated hCSCs significantly increased expression for all three vascular smooth muscle (VSM) markers compared to TCPS differentiated cells. Additionally, KOS differentiated hCSCs were significantly more contractile than cells differentiated on TCPS. Recombinant human (rh) TGF-β1 was able to induce VSM differentiation on TCPS. VSM differentiation was successfully inhibited using TGF-β NABs and A83-01. Enzyme-Linked Immunosorbent Assay (ELISA) analysis revealed that both TCPS and KOS hydrogel differentiated cells produced TGF-β1, with higher levels being measured at early time points on TCPS and later time points on KOS hydrogels. Results from supplementing rhTGF-β1 to TCPS and KOS hydrogels revealed that KOS seems to interact with TGF-β to a greater extent than TCPS. Western blot results revealed that latency TGFβ binding protein (LTBP-1) and latency associated peptide (LAP) had elevated levels early during differentiation. Further, the levels of LTBP-1 and LAP were higher on KOS differentiated hCSCs than TCPS hCSCs. This study reaffirms previous results of a VSM phenotype observed on KOS hydrogels, and provides convincing evidence for TGF-β1 inducing VSM differentiation on KOS hydrogels. Additionally, results from ELISA and western blot provide evidence that KOS plays a direct role in this pathway via interactions with TGF-β]1 and its associated proteins LTBP-1 and LAP. Results from chapter 2 and 3 offered significant evidence that our cells exhibited a VSMC phenotype, and that TGF-β1 signaling was a key contributor for the observed phenotype, but we still needed an animal model to explore the therapeutic potential of our putative VSMCs.
Research in Chapter 4 investigated a disease model to test the ability of KOS hydrogel differentiated cells to regenerate vascular tissue. To measure vascular regenerative capability, we selected a murine model of critical limb ischemia (CLI). CLI was induced in 3 groups (n=15/group) of adult mixed gender NSG mice by excising the femoral artery and vein, and then treated the mice with either PBS (termed as PBS-treated), Cells differentiated on TCPS (termed as Cells from TCPS), or KOS hydrogel-derived VSMCs (termed as Cells from KOS). Blood perfusion of the hind limbs was measured immediately before and after surgery, then 14, and 28 days after surgery using Laser Doppler analysis. Tissue vascularization, cell engraftment, and skeletal muscle regeneration were measured using immunohistochemistry, 1,1'-Dioctadecyl3,3,3',3'-Tetramethylindocarbocyanine Perchlorate (DiL) vessel painting, and hematoxylin and eosin (HandE) pathohistological staining. During the 4-week period, both cell treatment groups showed significant increases in blood perfusion compared to the PBS-treated control, and at day 28 the Cells from KOS group had significantly better blood flow than the Cells from TCPS group. Additionally, the Cells from KOS group demonstrated a significant increase in the ratio of DiL positive vessels, capillary density, and a greater density of small diameter arterioles compared to the PBS-treated group. Further, both cell-treated groups had similar levels of engraftment into the host tissue. We conclude that Cells from KOS therapy increases blood perfusion in an NSG model of CLI, but does not lead to increased cell engraftment compared to other cell based therapies.
Overall, the results from this dissertation demonstrated that KOS hydrogels produce VSMC differentiation from c-kit+ hCSCs mediated by TGF-β1 signaling, and that the differentiated cells are able to increase blood perfusion in a CLI model by increasing capillary density, suggesting enhanced angiogenesis. Future studies should explore potential protein-protein interactions between KOS, TGF-β1 and its associated proteins. Additionally, we should plan animal studies that examine the efficacy of our cells to regenerate cardiac tissue following an acute myocardial infarction (AMI). / PHD
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