Diss. (sammanfattning) Uppsala : Univ., 2002. / Härtill 6 uppsatser.

A função dos nervos periféricos é afetada pelo desenvolvimento e pelo envelhecimento. Entretanto, o conhecimento a respeito das diferenças entre os nervos de animais adultos e velhos tem sido embasado em comparações de apenas dois grupos experimentais e tem sido apontada a necessidade de múltiplos grupos experimentais nos estudos de desenvolvimento e envelhecimento. Apesar de algumas descrições de alterações morfológicas nos nervos periféricos de ratos velhos, a maioria dos estudos investigou nervos motores ou mistos, enquanto informações em nervos sensitivos são escassas. O nervo safeno é utilizado em estudos experimentais que investigam lesão e regeneração do sistema nervoso periférico. Apesar da utilização, informação a respeito dos aspectos morfológicos e morfométricos do nervo safeno de animais velhos não é comum na literatura. Os objetivos do presente estudo foram investigar os aspectos morfológicos e morfométricos do nervo safeno em ratos velhos. Para tanto, ratas da linhagem Wistar com 180 (N = 6), 360 (N = 6) e 720 (N = 6) dias de idade foram utilizadas. A morfometria em nível de microscopia de luz foi realizada com o auxílio de um programa de análise de imagens computacional. A análise estatística foi realizada de forma a comparar dados obtidos entre segmentos do mesmo lado, entre níveis iguais e lados diferentes e entre os nervos. Diferenças foram consideradas significativas quando p < 0,05. Alguns parâmetros, apresentaram diferenças significativas, como, densidade de fibras, área dos axônios diâmetro fascicular e razão G. Alterações morfológicas decorrentes do envelhecimento foram observadas, principalmente, relacionadas à bainha de mielina e vasos endoneurais. Concluindo, a morfologia do nervo safeno é afetada pelo envelhecimento, o que pode refletir morfometricamente nas diferenças observadas nos histogramas de distribuição de fibras e razão G. / Peripheral nerve function is significantly affected by maturation and aging. However, knowledge regarding differences between the nerves of adult and aged animals has been based on comparisons of only two experimental groups, and it has been pointed out the need for multiple time points in maturation and ageing studies. Despite some descriptions of peripheral nerve morphologic alterations in aged rats, most of the studies used motor or sensory-motor nerves, while information on sensory nerves is scanty. The saphenous nerve in rats is widely used in experimental studies investigating injury and regeneration of the peripheral nervous system. Despite this wide utilization, information on morphological and morphometric aspects of aged rats saphenous nerve is not common in the literature. The aims of the present study were to investigate morphological and morphometric aspects of the saphenous nerve in aged rats. Female Wistar rats aged 180 (N = 6), 360 (N = 6) and 720 (N = 6) days were used. Light microscopy morphometry was carried out with the aid of a computer software. Statistical analysis was performed to compare data between segments of the same hand, and between the same levels and from different sides nerves. Differences were considered significant when p <0,05. Some parameters presented significant differences, such as fiber density, axillary area, fascicular diameter and G ratio. Morphological alterations due to ageing were observed, mainly related to the myelin sheath and endoneural vessels. In conclusion, the saphenous nerve morphology is affected by ageing, which might be morphometrically reflected on the differences observed on the myelinated fiber and G ratio distributions.

A função dos nervos periféricos é afetada pelo desenvolvimento e pelo envelhecimento. Entretanto, o conhecimento a respeito das diferenças entre os nervos de animais adultos e velhos tem sido embasado em comparações de apenas dois grupos experimentais e tem sido apontada a necessidade de múltiplos grupos experimentais nos estudos de desenvolvimento e envelhecimento. Apesar de algumas descrições de alterações morfológicas nos nervos periféricos de ratos velhos, a maioria dos estudos investigou nervos motores ou mistos, enquanto informações em nervos sensitivos são escassas. O nervo safeno é utilizado em estudos experimentais que investigam lesão e regeneração do sistema nervoso periférico. Apesar da utilização, informação a respeito dos aspectos morfológicos e morfométricos do nervo safeno de animais velhos não é comum na literatura. Os objetivos do presente estudo foram investigar os aspectos morfológicos e morfométricos do nervo safeno em ratos velhos. Para tanto, ratas da linhagem Wistar com 180 (N = 6), 360 (N = 6) e 720 (N = 6) dias de idade foram utilizadas. A morfometria em nível de microscopia de luz foi realizada com o auxílio de um programa de análise de imagens computacional. A análise estatística foi realizada de forma a comparar dados obtidos entre segmentos do mesmo lado, entre níveis iguais e lados diferentes e entre os nervos. Diferenças foram consideradas significativas quando p < 0,05. Alguns parâmetros, apresentaram diferenças significativas, como, densidade de fibras, área dos axônios diâmetro fascicular e razão G. Alterações morfológicas decorrentes do envelhecimento foram observadas, principalmente, relacionadas à bainha de mielina e vasos endoneurais. Concluindo, a morfologia do nervo safeno é afetada pelo envelhecimento, o que pode refletir morfometricamente nas diferenças observadas nos histogramas de distribuição de fibras e razão G. / Peripheral nerve function is significantly affected by maturation and aging. However, knowledge regarding differences between the nerves of adult and aged animals has been based on comparisons of only two experimental groups, and it has been pointed out the need for multiple time points in maturation and ageing studies. Despite some descriptions of peripheral nerve morphologic alterations in aged rats, most of the studies used motor or sensory-motor nerves, while information on sensory nerves is scanty. The saphenous nerve in rats is widely used in experimental studies investigating injury and regeneration of the peripheral nervous system. Despite this wide utilization, information on morphological and morphometric aspects of aged rats saphenous nerve is not common in the literature. The aims of the present study were to investigate morphological and morphometric aspects of the saphenous nerve in aged rats. Female Wistar rats aged 180 (N = 6), 360 (N = 6) and 720 (N = 6) days were used. Light microscopy morphometry was carried out with the aid of a computer software. Statistical analysis was performed to compare data between segments of the same hand, and between the same levels and from different sides nerves. Differences were considered significant when p <0,05. Some parameters presented significant differences, such as fiber density, axillary area, fascicular diameter and G ratio. Morphological alterations due to ageing were observed, mainly related to the myelin sheath and endoneural vessels. In conclusion, the saphenous nerve morphology is affected by ageing, which might be morphometrically reflected on the differences observed on the myelinated fiber and G ratio distributions.

Current ACL reconstruction techniques are performed with little regard to cutaneous nerves despite the evidence that iatrogenic nerve injury often leads to painful neuromas, reflex sympathetic dystrophy, or anterior knee/kneeling pain which directly impacts patients whose profession requires kneeling (Cerulli et al. 2013; Ruffilli et al. 2016; Hurley et al. 2018). In this study, the femoral cutaneous and saphenous nerves from two embalmed lower extremities were dissected in exquisite detail to create topographic maps of the anterior thigh and knee, detailing the nerves' anatomical course and relationship to relevant landmarks. To further characterize the cutaneous innervation at the knee joint, ultrasound techniques to locate sensory nerves were also explored. In both specimens, all branches of the femoral cutaneous and saphenous nerves were located, dissected, and mapped. In addition, the ability to locate terminal branches of the anterior femoral cutaneous nerve in a cadaveric specimen on ultrasound was successfully demonstrated. However, due to the small sample size, further research implementing similar methods is necessary to ensure the results are representative of the population and can be applied to surgical innervation. These findings highlight the importance of considering cutaneous nerves in ACL reconstruction techniques to minimize the risk of iatrogenic nerve injury and associated complications.

Background: Current guidelines give a class I recommendation to use of embolic protection devices (EPD) for saphenous vein graft (SVG) intervention; however, studies have shown conflicting results. The objective of this meta-analysis is to compare all-cause mortality, major adverse cardiovascular events, myocardial infarction (MI), or target vessel revascularization in SVG intervention with and without EPD. Methods and Results: Literature was searched through October 2016. Eight studies (n=52 893) comparing SVG intervention performed with EPD (n=11 506) and without EPD (n=41 387) were included. There was no significant difference in all-cause mortality (odds ratio [OR], 0.79; confidence interval [CI], 0.55–1.12; P=0.19), major adverse cardiovascular events (OR, 0.73, CI, 0.51–1.05; P=0.09), target vessel revascularization (OR, 1.0; CI, 0.95–1.05; P=0.94), periprocedural MI (OR, 1.12; CI, 0.65–1.90, P=0.69), and late MI (OR, 0.80; CI, 0.52–1.23; P=0.30) between the 2 groups. Sensitivity analysis excluding CathPCI Registry study showed no difference in periprocedural MI, late MI, and target vessel revascularization; however, it favored EPD use in all-cause mortality and major adverse cardiovascular events. Further sensitivity analysis including only observational studies revealed no difference in all-cause mortality, major adverse cardiovascular events, target vessel revascularization, and late MI. Additional analysis after excluding CathPCI Registry study revealed no difference in outcomes. Conclusions: This study including 52 893 patients suggests no apparent benefit in routine use of EPD during SVG intervention in the contemporary real-world practice. Further randomized clinical trials are needed in current era to evaluate long-term outcomes in routine use of EPD, and meanwhile, current guideline recommendations on EPD use should be revisited.

<p>The primary aim of this thesis was to modify saphenous vein (SV) harvesting technique and evaluate its clinical importance. A new "no touch" (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasm therefore obviating the need for distension.</p><p>Firstly, a prospective randomised study in 156 patients who underwent coronary artery bypass grafting was done to compare this new "no touch" technique to two others, the conventional (C) and the intermediate (I) techniques. A morphological study of the endothelium showed an endothelial integrity of 97% in NT vessels while about half of endothelial surface of veins harvested by the other two techniques was devoid of endothelium. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. A statistically significant difference in patency rate was found between the NT group and group C (p=0.025) and the poorest result was observed in group I.</p><p>Secondly, the immunohistochemistry assessment using CD31-antibody confirmed a better-preserved endothelium for NT vessels. Putative NOS was identified by NADPH-diaphorase histochemistry and autoradiographic localization of [3H] L-nitroarginine (NOARG) binding. NADPH staining was almost continuous on the luminal aspect and was also present in the intact adventitia of NT vessels, which was markedly reduced in conventionally harvested veins. Autoradiographic analysis of specific NOARG binding showed greater binding in the no-touch vessels, confirming the histochemistry results. All three NOS isoforms were identified in the media of SV grafts. In NT, NOS I was abundant in adventitial nerves; NOS II was found in adventitial vasa vasorum and NOS III was associated with endothelial cells lining both the vessel lumen and microvessels within the adventitia.</p><p>In conclusion, this study demonstrated that the endothelial integrity and NOS activity are better maintained when using the no-touch technique for vein graft harvesting. The vasorelaxant and thromboresistent activities of NO may be responsible for the reduced venospasm and improved early patency rates observed. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in grafts harvested by NT technique may contribute to the observed high patency rate.</p>

The primary aim of this thesis was to modify saphenous vein (SV) harvesting technique and evaluate its clinical importance. A new "no touch" (NT) technique of SV preparation was developed where the vein is harvested with a pedicle of surrounding tissue, which protects the vein from spasm therefore obviating the need for distension. Firstly, a prospective randomised study in 156 patients who underwent coronary artery bypass grafting was done to compare this new "no touch" technique to two others, the conventional (C) and the intermediate (I) techniques. A morphological study of the endothelium showed an endothelial integrity of 97% in NT vessels while about half of endothelial surface of veins harvested by the other two techniques was devoid of endothelium. At angiographic follow up, the patency for NT was 95.4%, 88.9% for grafts in group C and 86.2% for grafts in group I. A statistically significant difference in patency rate was found between the NT group and group C (p=0.025) and the poorest result was observed in group I. Secondly, the immunohistochemistry assessment using CD31-antibody confirmed a better-preserved endothelium for NT vessels. Putative NOS was identified by NADPH-diaphorase histochemistry and autoradiographic localization of [3H] L-nitroarginine (NOARG) binding. NADPH staining was almost continuous on the luminal aspect and was also present in the intact adventitia of NT vessels, which was markedly reduced in conventionally harvested veins. Autoradiographic analysis of specific NOARG binding showed greater binding in the no-touch vessels, confirming the histochemistry results. All three NOS isoforms were identified in the media of SV grafts. In NT, NOS I was abundant in adventitial nerves; NOS II was found in adventitial vasa vasorum and NOS III was associated with endothelial cells lining both the vessel lumen and microvessels within the adventitia. In conclusion, this study demonstrated that the endothelial integrity and NOS activity are better maintained when using the no-touch technique for vein graft harvesting. The vasorelaxant and thromboresistent activities of NO may be responsible for the reduced venospasm and improved early patency rates observed. Furthermore, the mechanical properties provided by the cushion of surrounding tissue in grafts harvested by NT technique may contribute to the observed high patency rate.

Bakgrund: Venduplex har på senare år vuxit fram som den mest använda metoden vid diagnostik av venös insufficiens eftersom det är en ofarlig, kostnadseffektiv, non-invasiv metod med hög sensitivitet och specificitet där både den anatomiska placeringen av insufficiensen samt den funktionella förändringen av venen kan påvisas direkt vid undersökningen. Olika manövrar kan genomföras för att påfresta venklaffarna och därmed framkalla en eventuell reflux, men det är oklart om de olika manövrerna kan påverka den reflux som provoceras fram och därmed också påverkar bedömningen av insufficiensgraden. Syfte: Syftet med studien var att undersöka om det förelåg skillnad i graderingen av insufficiensen samt om den maximala refluxhastigheten påverkades beroende på vilken manöver som användes för att framkalla en reflux. Metod: 20 v. saphena magna mitt på låret med påvisad reflux deltog i studien. Två upprepade mätningar genomfördes där venklaffarna provocerades med hjälp av en blodtrycksmanschett över vaden, med en manuell kompression över låret samt med en manuell kompression över vaden. Resultat: Den maximala refluxhastigheten blev 0,33±0,20m/s när en blodtrycksmanschett över vaden användes, 0,31±0,22m/s när en manuell handkompression över vaden användes samt 0,17±0,16m/s när en manuell lårkompression genomfördes. Slutsats: Ingen signifikant skillnad på maximal refluxhastighet kunde konstateras när en automatisk uppblåsbar blodtrycksmanschett över vaden jämfördes med en manuell handkompression över vaden. En signifikant högre maximal refluxhastighet konstaterades när en manuell vadkompression jämfördes med en manuell lårkompression.

No description available.

The final publication is available at http://dx.doi.org/10.1016/j.jtcvs.2013.11.054. Motoaki Ohnaka, Akira Marui, Kenichi Yamahara, Kenji Minakata, Kazuhiro Yamazaki, Motoyuki Kumagai, Hidetoshi Masumoto, Shiro Tanaka, Tadashi Ikeda, Ryuzo Sakata, Effect of microRNA-145 to prevent vein graft disease in rabbits by regulation of smooth muscle cell phenotype, The Journal of Thoracic and Cardiovascular Surgery, Volume 148, Issue 2, August 2014, Pages 676-682.e2, ISSN 0022-5223. / 京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18544号 / 医博第3937号 / 新制||医||1006(附属図書館) / 31444 / 京都大学大学院医学研究科医学専攻 / (主査)教授 木村 剛, 教授 野田 亮, 教授 瀬原 淳子 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM