The aim of this study was to test whether an omental pouch can be used as an alternative site for islet implantation in diabetic monkeys. Here we report the successful engraftment of islets in ...diabetic cynomolgus monkeys when loaded on a synthetic biodegradable scaffold and placed in an omental pouch. One autologous and five allogeneic diabetic monkey transplants under the cover of steroid‐free immune suppression (SFIS) were undertaken. Fasting blood glucose (FBG) and C‐peptide (CP), exogenous insulin requirements (EIR), intravenous glucose tolerance test (IVGTT), A1C and histopathology were used to assess islet engraftment and survival. All animals achieved CP levels > 1.0 ng/mL following transplant, a 66–92% posttransplant decrease in EIR and reduced A1C. Following graft removal, CP became negative and histopathological analysis of the explanted grafts demonstrated well‐granulated and well‐vascularized, insulin‐positive islets, surrounded by T‐cell subsets and macrophages. Compared to intrahepatic allogeneic islet transplants (n = 20), there was a delayed engraftment for omental pouch recipients but similar levels of CP production were ultimately achieved, with a broad range of IEQ/kg transplanted in both sites. Our results suggest this extrahepatic transplantation site has potential as an alternative site for clinical islet cell transplantation.
Auto and allogeneic islets seeded on a synthetic biodegradable scaffold and transplanted in an omental pouch in nonhuman primates engrafted and survived for long periods of time, with sustained improvement in metabolic control.
To provide an overview of cadaver models for cardiac arrest and to identify the most appropriate cadaver model to improve cardiopulmonary resuscitation through a systematic review.
The search ...strategy included PubMed, Embase, Current contents, Pascal, OpenSIGLE and reference tracking. The search concepts included “heart arrest”, “cardiopulmonary resuscitation” and “cadavers”. All studies, published until February 2019, in English or French, on research or simulation in the field of cardiac arrest and using cadaver models were eligible for inclusion.
Overall, 29 articles out of the 244 articles located were selected. The characteristics of the studies and the cadaver models were heterogenous. Indeed, 31% of the studies lacked a proper description of the model used and its specificities. Fresh cadavers were used in 55% of the studies and chest compressions were performed in 90%. This model was appreciated for its realism in terms of mechanical properties and tissue conservation. Thiel-embalmed cadavers also showed promising results concerning lung and chest compliance. The lack of circulation stood out as the strongest limitation of all types of human cadaver models.
Four types of cadaver models are used in cardiac arrest research. The great heterogeneity of these models coupled with unequal quality in reporting makes comparisons between studies difficult. There is a need for uniform reporting and standardisation of human cadaver models in cardiac arrest research.
Purpose
The objective of this study was to identify the most appropriate cadaver perfusion techniques for surgical training through a systematic review with a description of the protocols used.
...Methods
The search strategy included PubMed and reference tracking. Studies were identified by searching the electronic Medline databases. The search concepts included perfusion, cadavers and simulation training, and the protocol used is reported. This resulted in a qualitative review of 12 articles out of 250 articles consulted. We collected all the important data from these 12 articles.
Results
Regarding the characteristics of the studies and the declotting or perfusion techniques, the results were heterogeneous. Indeed, in several studies, a good deal of information was unclear or insufficiently precise, making it unfeasible to summarize the data. The methods used were not sufficiently explicit and detailed. However, a majority of the fresh cadavers used tap water for declotting. Perfusion, type of fluid, number of pumps, pressure, pulsatility, and arterial or venous approaches differed greatly. Only two studies fulfilled five of our six realism criteria for surgical simulation.
Conclusions
This systematic review provided an overview of all the different cadaver perfusion techniques. It could be used to establish a reference method of a simulation model.
Purpose
Dissection provides direct experience in anatomy, which constitutes an essential discipline for medical students. For this purpose, we created a dissection guide for students in the 2nd-year ...of medical studies at the Grenoble University School of Medicine. The objective was to evaluate this tool of reverse pedagogy in terms of student satisfaction and educational interest.
Methods
Every 2nd-year student takes four sessions of limb dissection. To assist this dissection course, we developed a photographic guide launched in 2013. It includes an introduction presenting a methodology for dissection, followed by detailed protocols for each dissection area. Each step is illustrated with captioned photographs associated with a concise explanatory text. A questionnaire was then sent to 242 students to assess the impact of this tool and their overall satisfaction.
Results
Overall student satisfaction with this guidebook was rated 8.1 out of 10 with a 93.2% with significant improvement (
p
= 0.0137) and 78.7% of them declaring they had a better understanding of anatomy and mastery of the dissection techniques, respectively. In addition, students assessed the usefulness of the dissection guide at 3.6 out of 4 with the relevance of the content and presentation judged at 3.4 out of 4. Finally, the exam scores increased significantly with use of the guidebook (
p
< 0.0001).
Conclusions
Students deemed the organization of this anatomy tutorial as highly satisfactory, and using the guidebook as a reference in dissection sessions allowed students to prepare for the dissection and improve their knowledge of anatomy, as demonstrated by improved exam scores.
Purpose
The pain involved in the herniated discs could be generated by some mobility of the nerve roots during straight leg raising (SLR). SLR produces some movement of nerves, but the magnitude of ...this displacement needs to be thorough, that is why we have investigated lumbo-sacral nerve root displacement in the spinal canal during the passive straight leg raise (SLR).
Methods
Fourteen cadavers underwent laminectomy to mark the nerve roots of L2–S1 with lead balls. X-rays were taken during different movements imposed on the body: bilateral hip extension, left SLR then right and bilateral SLR. By superimposing these images two by two, the displacement of the nerve roots is quantified numerically during the various SLR maneuvers with respect to the reference position corresponding to the bilateral hip extension.
Results
The median range of the different nerve root movements ranged from 0.10 to 0.51 cm (
p
< 0.05 except for the L2 root) when the left SLR is applied, from 0.26 to 0.48 cm (
p
< 0.05) with the right SLR and from 0.30 to 0.65 cm (
p
< 0.05) with a bilateral SLR. No statistically significant relationship was found between age and movement value.
Conclusions
The lumbo-sacral nerve roots in the spinal canal region move statistically significantly in response to the clinically applied SLR test, except for L2 root during the left SLR. This movement is symmetric and greater when a bilateral SLR is applied. These anatomical results are correlated with those observed empirically in clinical practice.
Purpose
Perfusion techniques on cadavers are heterogeneous and imperfect. The objective of this study was to improve the existing circulation model for surgical simulation on cadavers.
Methods
We ...used a three-step experimental approach. The first part of the experiment tested two variables: the type of circuit and the use of a heater for perfusion. The second approach evaluated two parameters: the injection fluid and the type of body conditioning (embalmed or freshly dead prepared using different washing techniques). The third one was an improvement on the best circulation obtained, which focused on the injection fluid. To compare the realism of these different techniques, we constructed a score with realism parameters: the volume of return flow, the presence of peripheral venous return and the perfusion of abdominal arteries.
Results
We found that the use of a heater seemed to improve the perfusion, while performing an arteriovenous bypass did not seem very effective. A correlation rate of 0.84 was found between the realism score and the injected fluid chosen. The best score (4/6) was found for a non-embalmed body with a low-pressure washing technique using a gelatin-based liquid at a concentration of 4 g/L for circulation. Scores obtained using embalmed bodies for both injection fluids for high-pressure washing or for 8-g/L gelatin injection fluid did not exceed 3/6.
Conclusions
We showed that using a non-embalmed body with low-pressure washing and a 4-g/L gelatin-based fluid was the most effective technique for cadaver perfusion.
Background
There is no demonstrated benefit of high-tie versus low-tie vascular transections in low rectal cancer surgery. The aim of this study was to compare the effects of high tie and low tie of ...the inferior mesenteric artery on colonic length.
Methods
This study was conducted in a surgical anatomy research laboratory. Anatomical dissections were performed on 11 human cadavers. We performed full left colonic mobilization, section of the descending-sigmoid junction, and high and low ligation of the inferior mesenteric artery. Distance from the proximal colon limb to the lower edge of the pubis symphysis was recorded after each step of vascular division. Three measurements were successively performed: before vascular section, after inferior mesenteric artery ligation, and after inferior mesenteric artery and vein section.
Results
Before vascular section, the mean distance between colonic end and lower edge of the symphysis pubis was − 1.9 ± 3.5 cm. After combined artery and vein section, the mean distance was + 10.7 ± 4.6 cm for high tie and + 1.5 ± 3 cm for low tie. A limitation of this study is the use of embalmed anatomical specimens, rather than live patients, and the small number of specimens. This study also does not evaluate colon limb vascularization or the impact of proximal lymph node dissection on survival rates.
Conclusions
High tie of the inferior mesenteric artery at its aortic origin allows a gain of extra length of about 9 cm over low tie.
Introduction
Given the high variability and fragility of the thoracic duct, good knowledge of its anatomy is essential for its repair or to prevent iatrogenic postoperative chylothorax. The objective ...of this study was to define a site where the thoracic duct is consistently found for its ligation. The second objective was to define an anatomically safe surgical pathway to prevent iatrogenic chylothorax in surgery for aortic arch anomalies with vascular ring, through better knowledge of the anatomical relationships of the thoracic duct.
Methods
Seventy adult formalin-fixed cadavers were dissected. The anatomical relationships of the thoracic duct were reported at the postero-inferior mediastinum, at levels T3 and T4.
Results
The thoracic duct was consistently situated between the left anterolateral border of the azygos vein and the right border of the aorta between levels T9 and T10, whether it was simple, double, or plexiform. It was located medially, anteromedially, or posteriorly to the left subclavian artery in 51%, 21%, and 28% of the cases, respectively, at the level of T3. At T4, it was posteromedial in 27% of the cases or had no direct relationship with the aortic arch.
Conclusion
These results favor mass ligation of the thoracic duct at levels T9–T10 between the right border of the aorta and the azygos vein, eventually including the latter. To prevent iatrogenic postoperative chylothorax in aortic arch anomalies with vascular ring surgery, we recommend remaining strictly lateral to the left subclavian artery at the level of T3 to reach the aortic arch anomalies with vascular ring at T4.
Purpose
The feasibility of coronary artery bypass grafting using an internal thoracic artery (ITA) depends on the length of the graft with respect to the optimal route to reach the coronary target. ...The goal of this study was to assess the gain in length afforded by skeletonization and to evaluate the lengths of different pathways of the ITAs to the left coronary arteries.
Methods
The left and right ITAs were dissected out from 20 specimens and measured before and after skeletonization. Distance between the origin of the right ITA and the base of the left atrial appendage, corresponding to the proximal circumflex artery, was measured for both the transverse pericardial sinus and preaortic routes.
Results
Skeletonization gave a significant gain of length for both ITAs. Analysis showed no significant correlation between the ITA length and the height, weight, and BMI of specimens. We found no association between the length of the sternum and the length of skeletonized RITA or LITA. The anterior route of the skeletonized right ITA was shorter than the transverse pericardial sinus route in 18 cases. The average length to the circumflex artery territory was 132.8 ± 23.5 mm in front of the aorta and 150.5 ± 18.8 through the transverse pericardial sinus with a gain of length of 17.7 mm (
p
< 0.0001).
Conclusion
Skeletonization gave significant gains in length of both ITAs. The preaortic route for the skeletonized right ITA toward the circumflex territory was shorter than the transverse pericardial sinus route in 90 % of cases.
Purpose
The anatomy of gubernaculum testis (GT) is often discussed; however, the postnatal anatomy of the GT or scrotal ligament (SL) is rarely described. Hence, we performed an anatomical and ...histological study to analyze histologically the structures between testis and scrotum.
Methods
We performed anatomical dissections on 25 human fresh cadavers’ testes. Each testis was removed with its envelopes and macroscopically analyzed. Then samples were included for histological study. Finally, they were analyzed under microscope, looking for attachments between testis, epididymis and scrotal envelopes.
Results
The absence of proximal and distal attachment was found in 56.0% of cases. Looking at the proximal attachment of the SL, the main one found is the epididymal attachment (28.0%), whereas no cases of testis attachment was found. Distally, there are more variations with scrotal attachment (12%) and cremaster attachment (12.0%). We found a significant prevalence of multiple adherences in 16.0% of cases too. Finally, in 15 cases (57.7%) an attachment is present between testis and epididymis, as it is commonly described.
Conclusions
In the majority of cases there is no attachment of the lower pole of the testis and epididymis and these structures remain free. So it seems that the SL disappears with aging. Moreover, there is not only one kind of ligamentous attachment, but a high variability of attachments at the lower pole of the testiculo-epididymal structure. When it exists, this structure is never a real ligament and it seems more appropriate to use the term “attachments”.
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