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Ali, Ahsan T., Christopher Bell, J. Gregory Modrall, R. James Valentine, and G. Patrick Clagett. "Graft-associated hemorrhage from femoropopliteal vein grafts." Journal of Vascular Surgery 42, no. 4 (2005): 667–72. http://dx.doi.org/10.1016/j.jvs.2005.06.002.
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Di Zazzo, Antonio, Sang-Mok Lee, Jaemyoung Sung, et al. "Variable Responses to Corneal Grafts: Insights from Immunology and Systems Biology." Journal of Clinical Medicine 9, no. 2 (2020): 586. http://dx.doi.org/10.3390/jcm9020586.
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Corneal grafts interact with their hosts via complex immunobiological processes that sometimes lead to graft failure. Prediction of graft failure is often a tedious task due to the genetic and nongenetic heterogeneity of patients. As in other areas of medicine, a reliable prediction method would impact therapeutic decision-making in corneal transplantation. Valuable insights into the clinically observed heterogeneity of host responses to corneal grafts have emerged from multidisciplinary approaches, including genomics analyses, mechanical studies, immunobiology, and theoretical modeling. Here, we review the emerging concepts, tools, and new biomarkers that may allow for the prediction of graft survival.
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Sonnery-Cottet, Bertrand, Adnan Saithna, Maxime Cavalier, et al. "Anterolateral Ligament Reconstruction Is Associated With Significantly Reduced ACL Graft Rupture Rates at a Minimum Follow-up of 2 Years: A Prospective Comparative Study of 502 Patients From the SANTI Study Group." American Journal of Sports Medicine 45, no. 7 (2017): 1547–57. http://dx.doi.org/10.1177/0363546516686057.
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Background: Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. Purpose: To evaluate the association between reconstruction techniques and subsequent graft rupture and return-to-sport rates in patients aged 16 to 30 years participating in pivoting sports. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of patients undergoing primary ACL reconstruction with a bone–patellar tendon–bone (B-PT-B) graft, quadrupled hamstring tendon (4HT) graft, or hamstring tendon graft combined with anterolateral ligament reconstruction (HT+ALL) was conducted by the Scientific ACL NeTwork International (SANTI) Study Group. Survivorship data from Kaplan-Meier analysis were analyzed in multivariate Cox regression models to identify the prognosticators of graft ruptures and return to sport. Results: Five hundred two patients (mean age, 22.4 ± 4.0 years) with a mean follow-up of 38.4 ± 8.5 months (range, 24-54 months) were included. There were 105 B-PT-B, 176 4HT, and 221 HT+ALL grafts. The mean postoperative scores at latest follow-up were the following: Lysholm: 92.4 ± 8.6, Tegner: 7.4 ± 2.1, and subjective International Knee Documentation Committee (IKDC): 86.8 ± 10.5 for B-PT-B grafts; Lysholm: 91.3 ± 9.9, Tegner: 6.6 ± 1.8, and subjective IKDC: 85.4 ± 10.4 for 4HT grafts; and Lysholm: 91.9 ± 10.2, Tegner: 7.0 ± 2.0, and subjective IKDC: 81.8 ± 13.1 for HT+ALL grafts. The mean side-to-side laxity was 0.6 ± 0.9 mm for B-PT-B grafts, 0.6 ± 1.0 mm for 4HT grafts, and 0.5 ± 0.8 mm for HT+ALL grafts. At a mean follow-up of 38.4 months, the graft rupture rates were 10.77% (range, 6.60%-17.32%) for 4HT grafts, 16.77% (range, 9.99%-27.40%) for B-PT-B grafts, and 4.13% (range, 2.17%-7.80%) for HT+ALL grafts. The rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts (hazard ratio [HR], 0.393; 95% CI, 0.153-0.953) and 3.1 times less than with 4HT grafts (HR, 0.327; 95% CI, 0.130-0.758). There was no significant difference in the graft failure rate between 4HT and B-PT-B grafts (HR, 1.204; 95% CI, 0.555-2.663). Other prognosticators of graft failure included age ≤25 years ( P = .012) and a preoperative side-to-side laxity >7 mm ( P = .018). The HT+ALL graft was associated with higher odds of returning to preinjury levels of sport than the 4HT graft (odds ratio [OR], 1.938; 95% CI, 1.174-3.224) but not compared with the B-PT-B graft (OR, 1.460; 95% CI, 0.813-2.613). Conclusion: In a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.
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Santos Silva, João, Anne Olland, Gilbert Massard, and Pierre-Emmanuel Falcoz. "In lung transplantation, are pulmonary grafts from donors deceased from hanging as suitable as grafts from donors deceased from other causes?" Interactive CardioVascular and Thoracic Surgery 30, no. 1 (2019): 30–32. http://dx.doi.org/10.1093/icvts/ivz218.
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Abstract A best evidence topic was constructed according to a structured protocol. The question addressed was whether pulmonary grafts from donors deceased from hanging offer the same benefit as grafts from donors deceased from other causes in lung transplantation. Of the 17 papers found, 4 provided the best evidence to answer the question. The authors, date, journal, country of publication, study type, group studied, relevant outcomes and results of these papers are tabulated. One study reported a large cohort of donors and analysed the outcomes by cause of death, reporting no differences in survival. The remaining 3 papers analysed observational studies on the outcomes of lung transplantation using pulmonary grafts from donors deceased from hanging, compared with donors deceased from other causes. No differences in the rates of post-transplantation pulmonary graft dysfunction and long-term overall survival were reported. Although the cohort of donors deceased from hanging is small, we conclude that these donors are an important contribution to the donor pool. Ex vivo lung perfusion may have a role in assessing graft viability in this scenario.
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Yang, Hsiao Yun, Shae-Lee Cox, Graham Jenkin, Jock Findlay, Alan Trounson, and Jillian Shaw. "Graft site and gonadotrophin stimulation influences the number and quality of oocytes from murine ovarian tissue grafts." Reproduction 131, no. 5 (2006): 851–59. http://dx.doi.org/10.1530/rep.1.00916.
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Ovarian tissue cryopreservation and subsequent transplantation can restore fertility in cancer patients. This study used a mouse ovarian grafting model to investigate whether the graft site (bursal cavity, the kidney capsule or subcutaneous) influences the number, fertilization rate and developmental potential of oocytes recovered from grafts and whether using a standard gonadotrophin stimulation protocol would increase oocyte yield from the grafts. Mouse ovarian tissue was grafted into four week old mice and collected three weeks later. Graft recipients were treated either with or without exogenous gonadotrophin stimulation prior to graft collection. Grafted ovaries yielded oocytes that were either at the germinal vesicle (GV) stage or mature metaphase II (MII) stage at collection. These GV oocytes were matured beforein vitrofertilization (IVF), while the MII oocytes underwent IVF immediately. Oocytes collected from the oviducts of non-grafted superovulated mice of the same age served as controls. Two-cell embryos were transferred to pseudopregnant recipients and recovered at day 15 of gestation or left to go to term. Graft retrieval and the number of oocytes from each graft were lowest from the subcutaneous graft site. The number of two-cell embryos produced was significantly higher for oocytes from the grafts to the bursa as compared with the other sites. All graft sites gave rise to embryos with comparable implantation rates and developmental potential to fetuses and offspring following transfer. However, the oocytes from grafted ovaries had a significantly lower developmental potential when compared with the control group. Stimulation with exogenous gonadotrophins did not significantly increase oocyte yield from grafted ovaries but did enhance oocyte maturation and development. In conclusion, graft site affects the number and quality of oocytes produced from ovarian grafts.
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Lyman, Donald J., Jacqueline Murray-Wijelath, Esteban Ambrad-Chalela, and Errol S. Wijelath. "Vascular graft healing. II. FTIR analysis of polyester graft samples from implanted bi-grafts." Journal of Biomedical Materials Research 58, no. 3 (2001): 221–37. http://dx.doi.org/10.1002/1097-4636(2001)58:3<221::aid-jbm1011>3.0.co;2-v.
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Gage, Shawn M., Michael Lawson, Craig Nichols, Dalton Sycks, Roberto J. Manson, and Joseph A. Knight. "An immediate access dialysis graft designed to prevent needle-related complications: Results from the initial pre-clinical studies." Journal of Vascular Access 21, no. 3 (2019): 328–35. http://dx.doi.org/10.1177/1129729819874987.
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Introduction: No technology has been specifically developed with the intent to reduce needle-related vascular access injuries; a significant source of complications and abandonment. We present the initial pre-clinical study results of a novel, self-sealing, immediate cannulation dialysis graft that aims to prevent needle-related complications; to promote safe, reliable needle access; to reduce catheter use; and could facilitate home hemodialyisis. Methods: The innovative graft design consists of two cannulation chambers with self-sealing properties and materials that prevent side and back wall needle puncture. Study and control grafts (expanded polytetrafluoroethylene) were implanted in one pig and 10 sheep in two studies over the course of 1 year. First cannulation occurred immediately post implant for all study grafts. Post-cannulation time to hemostasis, hematoma and seroma formation, infection, and patency were recorded. Results: The two studies account for nearly 60 weeks (average 6.4 weeks/graft) of study graft follow-up. In the ovine study, average study graft time to hemostasis was 27.3 s (standard deviation = 26.3, range = 0–120), and the control averaged 177.2 s (standard deviation = 113.4, range = 60–600), p < 0.0001. Secondary patency was 75% and 67% for the study and control grafts, respectively. Neither study nor control groups experienced seroma, graft infections, or deaths. Discussion: All novel grafts in the studies were implanted successfully and functioned as intended. There were no complications related to tunneling of the study graft and the chamber prevented back/side wall needle injury. This novel technology may help to mitigate these needle-related complications, while allowing for early/immediate cannulation which could also reduce catheter contact time.
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Sherris, David A., and Eugene B. Kern. "The Versatile Autogenous Rib Graft in Septorhinoplasty." American Journal of Rhinology 12, no. 3 (1998): 221–28. http://dx.doi.org/10.2500/105065898781390136.
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In the graft depleted revision rhinoplasty patient and the patient with major tissue needs, alternatives to septal and conchal cartilage grafts are needed. The costal cartilage graft and rib bone/costal cartilage combination graft are excellent alternatives. In this study 14 patients received 40 grafts from 20 autogenous ribs harvested during septorhinoplasty. Materials were harvested for use as septal replacement grafts, cantilevered grafts, dorsal onlay grafts, columellar struts, and tip grafts. Patient followup was 6 to 31 months, and no evidence of graft resorption or warpage was evident during that period. Complications of harvest were minimal, and harvest techniques are detailed.
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Hashimoto, Koji. "Liver graft from donation after circulatory death donor: Real practice to improve graft viability." Clinical and Molecular Hepatology 26, no. 4 (2020): 401–10. http://dx.doi.org/10.3350/cmh.2020.0072.
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Donation after circulatory death (DCD) is an increasing source of liver grafts for transplantation, yet outcomes have been inferior compared to donation after brain death liver transplantation. These worse outcomes are mainly due to the severe graft injury resulting from mandatory warm ischemia during DCD organ recovery. New evidence, however, indicates that improved donor selection and surgical techniques can decrease the risk of graft failure and ischemic cholangiopathy (IC). Under current best practices, DCD organs are retrieved with the super-rapid technique, optimizing timing and protecting the liver graft from detrimental warm ischemia. Graft viability is influenced by both the quantity and quality of warm ischemia, which is unique to each donor and causes various degrees of pathophysiologic consequences. Evidence also shows that the choice of preservation solution and premortem heparin administration influences graft viability. Additionally, although the precise mechanism of IC remains unknown, stasis of blood during donor warm ischemia may cause the formation of microthrombi in the peribiliary vascular plexus and ischemia of the bile duct. Importantly, thrombolytic protocols show a possible preventive modality for IC. Finally, while <i>ex vivo</i> machine perfusion technology has gained an interest in DCD liver transplantation, further studies are necessary to evaluate the effectiveness of this evolving field to improve graft quality and transplant outcomes.
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Lin, Chia-Hsun, Yen-Yang Chen, Chai-Hock Chua, and Ming-Jen Lu. "Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts." Vasa 44, no. 6 (2015): 466–72. http://dx.doi.org/10.1024/0301-1526/a000470.
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Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.
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Ekeland, Arne, Lars Engebretsen, Anne Marie Fenstad, and Stig Heir. "Similar risk of ACL graft revision for alpine skiers, football and handball players: the graft revision rate is influenced by age and graft choice." British Journal of Sports Medicine 54, no. 1 (2019): 33–37. http://dx.doi.org/10.1136/bjsports-2018-100020.
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ObjectivesThe risk of graft revision following ACL reconstruction may depend on the sport type the individuals are engaged in. The purpose of this study was to report the ACL graft revision rate in alpine skiers, football and handball players.Materials and methodsPrimary ACL reconstructions and graft revision data from 2004 to December 2016 were obtained from the Norwegian Cruciate Ligament Registry. The graft survival rates were calculated for individuals in each of the three sport types, for bone patellar tendon bone (BPTB) and hamstring tendons (HT) grafts separately, and related to age at primary operation and sex.ResultsA total of 711 grafts in 14 201 primary ACL reconstructions were revised (5.0%) after median 6 years, 3.8% in alpine skiers, 5.0% in soccer and 6.1% in handball players (p<0.001). Adjusted Cox regression showed similar ACL graft survival rates in the three groups. The HR for graft revision was 5 times higher for individuals aged ≤18 years than for those aged ≥35 years (p<0.001). The corresponding HR for graft type was 1.8 times higher for HT than for BPTB grafts (p<0.001), but 2.8 times higher for individuals aged ≤18 years (p<0.001). The 12 years survival of BPTB grafts was 96% compared with 93% for HT grafts (p <0.001).ConclusionThe revision rate for ACL grafts was similar among alpine skiers, football and handball players, and the results support the use of BPTB grafts in young athletes with closed growth zones in the knee.Study designCohort study; level of evidence, 2.
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Cardona-Ramirez, Sebastian, Aaron M. Stoker, James L. Cook, and Richard Ma. "Fibroblasts From Common Anterior Cruciate Ligament Tendon Grafts Exhibit Different Biologic Responses to Mechanical Strain." American Journal of Sports Medicine 49, no. 1 (2020): 215–25. http://dx.doi.org/10.1177/0363546520971852.
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Background: Different tendons are chosen for anterior cruciate ligament (ACL) reconstruction based on perceived advantages and disadvantages, yet there is a relative paucity of information regarding biologic responsiveness of commonly used tendon grafts to mechanical strain. Purpose: To evaluate the in vitro responses of graft fibroblasts derived from tendons used for ACL reconstruction to clinically relevant strain levels. Study Design: Controlled laboratory study. Methods: Twelve quadriceps tendons (QTs), 12 patellar tendons (PTs), and 9 hamstring tendons (HTs) were harvested from skeletally mature dogs (n = 16). Tendon fibroblasts were isolated and seeded onto BioFlex plates (1 × 105 cells/well). Cells were subjected to 3 strain conditions (stress deprivation, 0%; physiologic, 4%; high, 10%) for 5 days. Media were collected for proinflammatory and metabolic assays. RNA was extracted for gene expression analysis using real-time reverse transcription polymerase chain reaction. Results: Stress deprivation elicited significantly higher metabolic activity from HT and PT cells than from QT cells ( P < .001 and P = .001, respectively). There were no differences in metabolic activity among all 3 graft fibroblasts at physiologic and high strain. COL-1 expression was significantly higher in PT versus HT during physiologic strain ( P = .007). No significant differences with COL-3 expression were seen. TIMP-1 ( P = .01) expression was higher in PT versus HT under physiologic strain. Scleraxis expression was higher in PT versus HT ( P = .007) under physiologic strain. A strain-dependent increase in PGE2 levels occurred for all grafts. At physiologic strain conditions, HT produced significantly higher levels of PGE2 versus QT ( P < .001) and PT ( P = .005). Conclusion: Fibroblasts from common ACL graft tissues exhibited different metabolic responses to mechanical strain. On the basis of these data, we conclude that early production of extracellular matrix and proinflammatory responses from ACL grafts are dependent on mechanical loading and graft source. Clinical Relevance: Graft-specific differences in ACL reconstruction outcomes are known to exist. Our results suggest that there are differences in the biologic responsiveness of cells from the tendon grafts used in ACL reconstruction, which are dependent on strain levels and graft source. The biologic properties of the tissue used for ACL reconstruction should be considered when selecting graft source.
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Ghoneim, Mohamed A., Mohamed A. Bakr, Ayman F. Refaie, et al. "Factors Affecting Graft Survival among Patients Receiving Kidneys from Live Donors: A Single-Center Experience." BioMed Research International 2013 (2013): 1–9. http://dx.doi.org/10.1155/2013/912413.
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Introduction. The aim of this report is to study the graft and patient survival in a large cohort of recipients with an analysis of factors that may affect the final outcomes.Methods. Between March 1976 and March 2008, 1967 consecutive live-donor renal transplants were carried out. Various variables that may have an impact on patients and/or graft survival were studied in two steps. Initially, a univariate analysis was carried out. Thereafter, significant variables were embedded in a stepwise regression analysis.Results. The overall graft survival was 86.7% and 65.5%, at 5 and 10 years, respectively. The projected half-life for grafts was 17.5 years and for patients was 22 years. Five factors had an independent negative impact on graft survival: donor's age, genetic considerations, the type of primary immunosuppression, number of acute rejection episodes, and total steroid dose during the first 3 months after transplantation.Conclusions. Despite refinements in tissue matching techniques and improvements in immunosuppression protocols, an important proportion of grafts is still lost following living donor kidney transplantation, presumably due to chronic allograft nephropathy.
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Widner, Håkan, and Patrik Brundin. "Sequential Intracerebral Transplantation of Allogeneic and Syngeneic Fetal Dopamine-Rich Neuronal Tissue in Adult Rats: Will the First Graft be Rejected?" Cell Transplantation 2, no. 4 (1993): 307–17. http://dx.doi.org/10.1177/096368979300200413.
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The immune response against intracerebral grafts of allogeneic fetal dopamine-rich tissue was assessed in adult rats. Sprague-Dawley rats, now outbred, but originating from an inbred stock, were given unilateral 6-hydroxy-dopamine lesions of the mesostriatal pathway, and grafted intrastriatally with mechanically dissociated ventral mesencephalic tissue (embryonic day 13-15) obtained from an inbred Lewis strain. Graft survival was assessed by functional recovery of amphetamine-induced rotational behavior on four different occasions postsurgery, and histologically using catecholamine histofluorescence and tyrosine hydroxylase immunohistochemistry. The following groups were analysed: long-term survival of a single allogeneic graft; survival of a first allogeneic graft with a syngeneic second graft; survival of a first allograft combined with a second allogeneic graft; the survival of bilateral allogeneic grafts following a subsequent orthotopic allogeneic skin graft. Evidence for recipient immunization was obtained using an indirect fluorescent antibody detection technique, Simonsen's Spleen Index (S I) test. Viable grafts, giving rise to behavioral compensation, were present after 40 wk in rats from all groups. The “first” allograft always displayed good survival and function, even following a second intracerebral allograft. However, five of nine “second” allogeneic intracerebral grafts survived poorly. In contrast, all secondary syngeneic grafts survived well. Following the application of a subsequent orthotopic allogeneic skin graft in a subgroup of rats, there was a significantly lower survival of grafted dopamine neurons in the “first” graft.
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Rashid, Harun Or, AKM Anwarul Islam, AKM Khursidul Alam, Md Sajid Hasan, and Md Habibur Rahman Dulal. "Comparative Study of Short-Term Outcome of Live Related Renal Transplantation From Grafts Having Single vs Multiple Arteries." Bangladesh Journal of Urology 17, no. 1 (2020): 9–16. http://dx.doi.org/10.3329/bju.v17i1.49108.
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Objective: To compare the outcome of live related renal transplantation between the Grafts having single vs multiple arteries.
 Materials and Methods: The data of 94 renal transplants with single and multiple arteries performed between January 2011 and December 2012 were collected from Bangabandhu Sheikh Mujib Medical University and National Kidney Foundation. Sixty three renal transplants with single renal artery were compared to 31 transplants with multiple arteries. The aspects analyzed were number of arteries of the graft, donor type, ischemia time, time spent for arterial anastomosis, time spent for total vascular anastomosis and time for whole operation, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 6 month after transplantation, graft loss and mortality.
 Results: The incidence of surgical complications in grafts with single artery and multiple renal artery was respectively: vascular 6.4% and 3.2%; urological 13.2% and 9.6%, other surgical complications was 3,2% and 3.2%, and the difference were not significant among the two groups. Symptomatic lymphocele was 3.2% observed in single artery group but the incidence of lymphoceles was 6.4% in grafts with multiple arteries (p < 0.005). The incidence of delayed graft function in grafts with a single artery and multiple arteries was respectively 6.4% and 6.4% (p =<0.005). Mean serum creatinine at the end of 6th months of postoperative period was 1.33mg/dl and 1.67 mg/dl in grafts with single and multiple arteries respectively (p<0.005). Cold ischemia time, preparation time duration of in vivo arterial anastomosis and the total length of operation time was significantly longer in the multiple artery group(p<0.005). Six months grafts survival in single and multiple artery was 88.9% and 87.1% respectively.
 Conclusions: Kidney transplantation using grafts having single and multiple arteries present similar indeces of surgical complications and short-term outcome. Though, lymphoceles was more frequent among grafts with multiple arteries but the difference were not significant among the two groups. In other words. Live related renal transplantation from grafts having multiple arteries is safe and has a good outcome.
 Bangladesh Journal of Urology, Vol. 16, No. 1, Jan 2014 p.9-16
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Latt, L. Daniel, Richard R. Glisson, Harvey E. Montijo, Federico G. Usuelli, and Mark E. Easley. "Effect of Graft Height Mismatch on Contact Pressures With Osteochondral Grafting of the Talus." American Journal of Sports Medicine 39, no. 12 (2011): 2662–69. http://dx.doi.org/10.1177/0363546511422987.
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Background: Osteochondral allograft transplantation is technically demanding. It is not always possible to place the surface of the graft perfectly flush with the surrounding cartilage. One must often choose between placing at least some portion of the surface of the graft slightly elevated or recessed. The effect of this choice on joint contact pressure is unknown. Purpose: This study was undertaken to determine the effect of graft height mismatch on joint contact pressure in the ankle. Study Design: Controlled laboratory study. Methods: Ten human cadaveric ankles underwent osteochondral grafting by removal then replacement of an osteochondral plug. Six conditions were tested: intact, graft flush, graft elevated 1.0 mm, graft elevated 0.5 mm, graft recessed 0.5 mm, and graft recessed 1.0 mm. Joint contact pressures were measured with a Tekscan sensor while loads of 200 N, 400 N, 600 N, and 800 N were sequentially applied. Results: The peak contact pressure at the graft site for the flush condition was not significantly different from the intact condition for either medial or lateral lesions. In contrast, peak pressure on the opposite facet of the talar dome was significantly increased during the flush condition for the medial but not the lateral grafts. Elevated grafts experienced significantly increased contact pressures, whereas recessed grafts experienced significantly decreased pressures. These changes were greater for lateral than for medial lesions. Reciprocal changes in joint contact pressures were found on the opposite facet of the talus with elevated grafts on the lateral side and recessed grafts on the medial side. Conclusion: Flush graft placement can restore near-normal joint contact pressure. Elevated graft placement leads to significant increases in joint contact pressure at the graft site. Recessed graft placement leads to a transfer of pressure from the graft site to the opposite facet of the talus. Clinical Relevance: Osteochondral grafts in the talus should be placed flush if possible or else slightly recessed.
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Megaloikonomos, Panayiotis D., Thekla Antoniadou, Leonidas Dimopoulos, et al. "Spondylitis transmitted from infected aortic grafts: a review." Journal of Bone and Joint Infection 2, no. 2 (2017): 96–103. http://dx.doi.org/10.7150/jbji.17703.
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Abstract. Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases.Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.
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Tatic, Vujadin, Vladimir Kanjuh, Sasa Rafajlovski, Dusan Suscevic, and Radoje Ilic. "Morphological changes in aorto-coronary vein graft: The analysis of autopsy and biopsy material." Vojnosanitetski pregled 61, no. 5 (2004): 499–506. http://dx.doi.org/10.2298/vsp0405499t.
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Background. Patients with implanted aortic coronary grafts have different survival time, which raises the question why the efficacy of graft implants is so poor. The aim of this study was to present the results of the analysis of morphological changes in the vein grafts taken after the death of patients who died after surgery in different time intervals, as well to present the analysis of the grafts obtained after surgical reintervention. Methods. The total number of 656 grafts of 308 dead patients was analyzed, as well as 76 grafts from 40 patients who underwent surgical reintervention. According to the duration of the graft since surgical intervention until death, all the analyzed changes were divided into two groups: a) early changes and complications, and b) late changes and complications in aorto-coronary vein grafts. Results. After the autopsy, 518 vein grafts from the first group were evaluated histopathologically. Changes were found in the form of small or large areas with peeled endothelium in 266 grafts, with the insudation of fibrin and thrombocytes in such places, subendothelial edema, and occlusive thrombosis of the graft lumen. Significant stenosis, which occurred distally from the anastomoses, was present in 118 grafts without changes in the walls of the graft, and there was significant narrowing of the graft lumen in 134 vein grafts due to intimal hyperplasia. In the second group, 138 grafts were histopathologically analyzed after autopsy. Significant hyperplasia was present in 117 grafts with the migration of smooth muscle cells from media into intima, and in 21 grafts there were atheromatous plaques. In 120 veins analyzed before the graft implantation, the lesion or the lack of endothelium was found, as well as the penetration of fibrin and blood elements and intimal hyperplasia. In 46 veins analyzed before the graft implantation, significant intimal hyperplasia with the elevated number of smooth muscle cells was found. Conclusion. The most frequent lesions in the grafts were the lesions of the endothelium, which caused thrombosis formation and lumen occlusion. Intimal hyperplasia in patients with longer survival time occurred due to the migration of smooth muscle cells from the media, or due to the formation of atherosclerotic plaques, which caused graft lumen stenosis or thrombosis.
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Fassas, A. B. T., C. Morris, A. Badros, F. Van Rhee, and G. Tricot. "Separating Graft-versus-tumor from Graft-versus-host Reactions." Leukemia & Lymphoma 43, no. 4 (2002): 725–33. http://dx.doi.org/10.1080/10428190290016818.
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Hong, Yuhwan, Brent G. Parks, and Stuart D. Miller. "Biomechanical Analysis of Tibial Strength After Harvest of Unicortical Tibial Grafts from Two Different Sites." Foot & Ankle International 27, no. 3 (2006): 190–95. http://dx.doi.org/10.1177/107110070602700307.
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Background: Use of tibial strut grafts has several potential advantages over other donor sites and would be ideal as a harvest site for bone grafts if there are minimal or no resulting risks to tibial stability. Methods: Ten matched-pair cadaver tibiae were randomized to have a 1.5 × 4.0 cm cortical graft harvested from the tibial crest or 1 cm posterior to the tibial crest. Both locations were 6 cm distal to the tibial plateau. The grafts were removed using a high-speed oscillating saw, and each end of the tibia was mounted for testing and loaded onto a servohydraulic test frame. The samples were axially loaded with 720 N (162 lbs) of force, and an external rotational torque was applied at 5 degrees per second to failure. Failure torque for each tibia was recorded. A paired Student's t-test was used to determine whether any observed differences in failure torques were significant. Results: The torque to failure range for on-crest grafts was 11.65 to 81.76 Nm (average, 44.53 Nm; SD, 22.82 Nm). The torque to failure range for the tibiae with the graft 1 cm off-crest was 13.30 to 70.45 Nm (average, 41.64 Nm; SD, 17.83 Nm). All fractures were spiral, included the distalmost anterior corner of the donor site, and extended distally. There was no significant difference in torque to failure between the two donor sites ( p = 0.22). The grafts varied consistently in quality. Conclusion: Considering that there was no statistically significant difference in torque to failure between the two groups of tibiae, the site for tibial bone graft can be selected based on the shape of the cortical graft necessary for each specific surgery.
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Eghtedari, Masoomeh, Mahmood Kamalzadeh, Masoud Yasemi, Hossein Movahedan, and Mohammad Javad Ashraf. "Five Years Pathological Evaluation of Corneal Regrafts: A Study from Southern Iran." Journal of Ophthalmology 2020 (November 4, 2020): 1–6. http://dx.doi.org/10.1155/2020/2546923.
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Purpose. Corneal regrafts sometimes needed to restore the transparency after graft failure. The aim of the study is five years epidemiologic and histopathological evaluation of corneal regrafts. Methods. In this cross-sectional study, all corneal regrafts during 5 years (2012–2016) were assessed in the Khalili Ophthalmology Center at Shiraz city. Demographic data including age, area of residence, primary disease, type of graft, cause of regraft, interval between primary and subsequent grafts (IPSG), associated eye diseases or surgeries, and systemic diseases were recorded. Also, microscopic findings of corneas were reviewed. Results. Among a total of 1190 corneal grafts, 76 of them (6.38%) were regrafts. The most common type of grafting was penetrating keratoplasty (PK). The shortest IPSG was observed in fungal keratitis. Main causes of graft failure were endothelial dysfunction, infection, immunologic rejection, technical problems, and recurrence of primary disease, respectively. The most common histopathological finding in failed grafts was severe endothelial cell loss (89.8%). Also, more than half and one-third of cases had Descemet membrane changes and stromal ingrowth, respectively. Conclusion. Endothelial cell loss was the major cause of failure in our study. Also, recurrence rate in infective cases, especially fungal keratitis, was very high. Considerable presence of histopathological changes such as doubling of Descemet membrane and retrocorneal fibrous ingrowth need further investigations. Perhaps, modification in techniques of corneal grafting and assessment of donor tissue and recipient bed along with any need for longer medical treatment are the basis for future studies in order to increase graft survival.
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Wijermars, Leonie G. M., Alexander F. Schaapherder, Thomas George, Pritam Sinharoy, and Eric R. Gross. "Association of Impaired Reactive Aldehyde Metabolism with Delayed Graft Function in Human Kidney Transplantation." Oxidative Medicine and Cellular Longevity 2018 (December 23, 2018): 1–10. http://dx.doi.org/10.1155/2018/3704129.
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Delayed graft function is an early complication following kidney transplantation with an unclear molecular mechanism. Here we determined whether impaired reactive aldehyde metabolism is associated with delayed graft function. Human kidney biopsies from grafts with delayed graft function were compared with grafts that did not develop delayed graft function by Ingenuity gene pathway analysis. A second series of grafts with delayed graft function (n=10) were compared to grafts that did not develop delayed graft function (n=10) by measuring reactive aldehyde metabolism, reactive aldehyde-induced protein adduct formation, and aldehyde dehydrogenase (ALDH) gene and protein expression. In the first series of kidney biopsies, several gene families known for metabolizing reactive aldehydes, such as aldehyde dehydrogenase (ALDH), aldo-keto reductase (AKR), and glutathione-S transferase (GSTA), were upregulated in kidneys that did not develop delayed graft function versus those that did. In the second series of kidney grafts, we focused on measuring aldehyde-induced protein adducts and ALDH enzymatic activity. The reactive aldehyde metabolism by ALDH enzymes was reduced in kidneys with delayed graft function compared to those that did not (37 ± 12∗ vs. 79 ± 5 μg/min/mg tissue, ∗P<0.005, respectively). ALDH enzymatic activity was also negatively correlated with length of hospital stay after a kidney transplant. Together, our study identifies a reduced ALDH enzymatic activity with kidneys developing delayed graft function compared to those that did not. Measuring ALDH enzymatic activity and reactive aldehyde-induced protein adducts can potentially be further developed as a biomarker to assess for delayed graft function and recovery from a kidney transplant.
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Boerboom, L. E., G. N. Olinger, B. J. Karas, et al. "Heparinization of Biological Vascular Graft Reduces Fibrin Deposition." International Journal of Artificial Organs 16, no. 5 (1993): 263–67. http://dx.doi.org/10.1177/039139889301600506.
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An alternative graft is needed for coronary bypass operations in patients lacking suitable autologous vessels. We therefore studied Denaflex™, a biologic graft, in a dog ex-vivo shunt model to determine whether heparin treatment makes this graft less thrombogenic. Comparison was also made to Bioflow™, a nonheparinized biologic graft. Fibrinogen deposition during high flow (593 ± 202 ml/min) decreased from 672 ± 467 ngl mm2 in nonheparinized Denaflex grafts to 448 ± 298 ng/mm2 (p<0.05) in heparinized Denaflex grafts. At low flow (117 ± 13 ml/min), heparinization of Denaflex grafts similarly decreased fibrinogen deposition from 1102 ± 601 ng/mm2 to 703 ± 405 ng/mm2 (p<0.05). At both flow rates fibrinogen deposition in Bioflow grafts was less than in nonheparinized Denaflex, but was similar to heparinized Denaflex grafts. Platelet deposition was not influenced by heparinization of Denaflex grafts and was similar among Denaflex and Bioflow preparations. Whether Denaflex performs acceptably in vivo as a xenograft requires extensive study.
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Matsuzaki, Yuichi, Kelly John, Toshihiro Shoji, and Toshiharu Shinoka. "The Evolution of Tissue Engineered Vascular Graft Technologies: From Preclinical Trials to Advancing Patient Care." Applied Sciences 9, no. 7 (2019): 1274. http://dx.doi.org/10.3390/app9071274.
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Currently available synthetic grafts have contributed to improved outcomes in cardiovascular surgery. However, the implementation of these graft materials at small diameters have demonstrated poor patency, inhibiting their use for coronary artery bypass surgery in adults. Additionally, when applied to a pediatric patient population, they are handicapped by their lack of growth ability. Tissue engineered alternatives could possibly address these limitations by producing biocompatible implants with the ability to repair, remodel, grow, and regenerate. A tissue engineered vascular graft (TEVG) generally consists of a scaffold, seeded cells, and the appropriate environmental cues (i.e., growth factors, physical stimulation) to induce tissue formation. This review critically appraises current state-of-the-art techniques for vascular graft production. We additionally examine current graft shortcomings and future prospects, as they relate to cardiovascular surgery, from two major clinical trials.
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Love, T. C., and D. C. Tucker. "Possible paracrine facilitation of ventricular growth in oculo by atrial tissue." American Journal of Physiology-Heart and Circulatory Physiology 265, no. 4 (1993): H1082—H1088. http://dx.doi.org/10.1152/ajpheart.1993.265.4.h1082.
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Load-independent growth controls were investigated in embryonic atria and ventricles cultured in the anterior eye chamber of adult rats. At embryonic day 12, the mass of atria was half that of ventricles (0.11 vs. 0.24 mg), whereas after 8 wk in oculo, atrial grafts were threefold larger than ventricular grafts (2.26 +/- 0.36 vs. 0.69 +/- 0.16 mg). To examine possible paracrine communication between atria and ventricles, two grafts were cocultured in the same eye chamber. Atrial grafts cocultured with either another atrial graft or a ventricular graft did not differ in projected area or mass from atrial grafts cultured alone. Ventricular grafts cocultured with another ventricular graft did not differ in projected area or mass from ventricular grafts cultured alone. However, ventricular grafts cocultured with an atrial graft grew larger than single ventricular grafts. At 1 wk in oculo, DNA synthesis (bromodeoxyuridine incorporation) was higher in ventricular grafts cocultured with atrial grafts than in single ventricular grafts (6.84 +/- 0.88 vs. 4.40 +/- 0.10%). Thus atria may stimulate growth, including DNA synthesis, in developing ventricles via a paracrine mechanism.
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Dorros, Gerald, Surendra Avula, Paul Fox, Bernard Rhomberg, and Paul Werner. "Endovascular Covered Stent Repair of an Intercostal Artery Patch Dehiscence from a Descending Thoracic Aortic Aneurysm Graft." Journal of Endovascular Therapy 3, no. 3 (1996): 299–305. http://dx.doi.org/10.1177/152660289600300310.
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Purpose: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. Methods and Results: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. Conclusions: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.
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Absood, Afaf, Akira Furutani, Tsutomu Kawamura, and Linda M. Graham. "Differential PDGF secretion by graft and aortic SMC in response to oxidized LDL." American Journal of Physiology-Heart and Circulatory Physiology 283, no. 2 (2002): H725—H732. http://dx.doi.org/10.1152/ajpheart.00060.2002.
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Smooth muscle cells (SMC) from prosthetic vascular grafts constitutively secrete higher levels of platelet-derived growth factor-AA (PDGF-AA) than aortic SMC. Lipid oxidation products accumulate in grafts and may stimulate PDGF production. The effect of oxidized low-density lipoprotein (oxLDL) on PDGF-AA secretion by aortic and graft SMC was compared. SMC isolated from canine thoracic aorta or Dacron thoracoabdominal grafts ( n = 10) were incubated with native LDL or oxLDL (0–400 μg/ml) for 72 h. PDGF-AA in the conditioned medium was measured with enzyme-linked immunosorbent assay. OxLDL increased PDGF-AA production by graft SMC from 78 ± 2 to 256 ± 16 pg PDGF/μg DNA and aortic SMC from 21 ± 1 to 40 ± 2 pg PDGF/μg DNA. Native LDL had no effect. N-acetylcysteine inhibited oxLDL-induced PDGF increase. Both superoxide and H2O2 stimulated PDGF secretion by graft SMC had little effect on aortic SMC. Our results suggest that PDGF production by graft (synthetic) SMC is more sensitive to stimulation by oxidative stress than aortic (contractile) SMC. Lipid oxidation products that accumulate in prosthetic vascular grafts can cause an oxidative stress, which stimulates PDGF production by graft SMC. PDGF can induce migration of aortic SMC onto the graft, contributing to the development of intimal hyperplasia.
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Thuijs, Daniel J. F. M., Margreet W. A. Bekker, David P. Taggart, et al. "Improving coronary artery bypass grafting: a systematic review and meta-analysis on the impact of adopting transit-time flow measurement." European Journal of Cardio-Thoracic Surgery 56, no. 4 (2019): 654–63. http://dx.doi.org/10.1093/ejcts/ezz075.
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Summary Despite there being numerous studies of intraoperative graft flow assessment by transit-time flow measurement (TTFM) on outcomes after coronary artery bypass grafting (CABG), the adoption of contemporary TTFM is low. Therefore, on 31 January 2018, a systematic literature search was performed to identify articles that reported (i) the amount of grafts classified as abnormal or which were revised or (ii) an association between TTFM and outcomes during follow-up. Random-effects models were used to create pooled estimates with 95% confidence intervals (CI) of (i) the rate of graft revision per patient, (ii) the rate of graft revision per graft and (iii) the rate of graft revision among grafts deemed abnormal based on TTFM parameters. The search yielded 242 articles, and 66 original articles were included in the systematic review. Of those articles, 35 studies reported on abnormal grafts or graft revisions (8943 patients, 15 673 grafts) and were included in the meta-analysis. In 4.3% of patients (95% CI 3.3–5.7%, I2 = 73.9) a revision was required and 2.0% of grafts (95% CI 1.5–2.5%; I2 = 66.0) were revised. The pooled rate of graft revisions among abnormal grafts was 25.1% (95% CI 15.5–37.9%; I2 = 80.2). Studies reported sensitivity ranging from 0.250 to 0.457 and the specificity from 0.939 to 0.984. Reported negative predictive values ranged from 0.719 to 0.980 and reported positive predictive values ranged from 0.100 to 0.840. This systematic review and meta-analysis showed that TTFM could improve CABG procedures. However, due to heterogeneous data, drawing uniform conclusions appeared challenging. Future studies should focus on determining the optimal use of TTFM and assessing its diagnostic accuracy.
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See, Woan Shiang, Syed Rasul Bin Ghouse Syed Hamid, Cheang Leng Benjamin Leo, and Kian Boon Law. "Graft Patency Rate and Risk Factors for Graft Failure among Symptomatic Post Coronary Artery Bypass Graft Surgery Patients." ASEAN Heart Journal 28, no. 1 (2020): 32–37. http://dx.doi.org/10.31762/ahj2028.0105.
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BACKGROUND Malaysia, a multiracial country, has been burdened by ischemic heart disease, the leading cause of death for the past 10 years. The success of coronary artery bypass grafting surgery (CABG) particularly depends on the continued patency of aortocoronary grafts. The study aims to identify the graft patency rate and risk factors of graft failure among symptomatic post CABG patients. METHODS Data were collected from 80 patients with a history of CABG, who underwent conventional coronary angiography for refractory angina in Hospital Sultanah Aminah Johor, Malaysia from January 2014 till December 2018. The graft patency was evaluated with conventional coronary angiography. Graft patency was assessed with the Kaplan-Meier method. Differences between graft patency were tested with log-rank test at a 5% significance level and result with p-value <0.05 was considered statistically significant. RESULTS Among the 80 post CABG patients with cardiac symptoms, there were 2 patients with acute myocardial infarction (2.5%) and 24 patients with NSTEMI (30%). 22 patients (27.5%) were found to have all grafts patent despite being persistently symptomatic. Left internal mammary arterial (LIMA) graft remained as the best conduit with a significantly better short, medium, and long term patency (up to 20 years) compared to SVG graft (Log-rank test, p-value < 0.05). Indian race and age less than 70 years had higher risk of SVG graft stenosis. CONCLUSION Type of conduits remains the most important factor in determining the coronary artery bypass graft patency, with LIMA produces the best patency rate in both short and long term.
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Kocherova, Ievgeniia, Artur Bryja, Paul Mozdziak, et al. "Human Umbilical Vein Endothelial Cells (HUVECs) Co-Culture with Osteogenic Cells: From Molecular Communication to Engineering Prevascularised Bone Grafts." Journal of Clinical Medicine 8, no. 10 (2019): 1602. http://dx.doi.org/10.3390/jcm8101602.
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The repair of bone defects caused by trauma, infection or tumor resection is a major clinical orthopedic challenge. The application of bone grafts in orthopedic procedures is associated with a problem of inadequate vascularization in the initial phase after implantation. Meanwhile, the survival of cells within the implanted graft and its integration with the host tissue is strongly dependent on nutrient and gaseous exchange, as well as waste product removal, which are effectuated by blood microcirculation. In the bone tissue, the vasculature also delivers the calcium and phosphate indispensable for the mineralization process. The critical role of vascularization for bone healing and function, led the researchers to the idea of generating a capillary-like network within the bone graft in vitro, which could allow increasing the cell survival and graft integration with a host tissue. New strategies for engineering pre-vascularized bone grafts, that apply the co-culture of endothelial and bone-forming cells, have recently gained interest. However, engineering of metabolically active graft, containing two types of cells requires deep understanding of the underlying mechanisms of interaction between these cells. The present review focuses on the best-characterized endothelial cells—human umbilical vein endothelial cells (HUVECs)—attempting to estimate whether the co-culture approach, using these cells, could bring us closer to development and possible clinical application of prevascularized bone grafts.
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Chandra, Ankur, and Niren Angle. "Occluded Infrainguinal Bypass Graft: Potential Source of Limb-Threatening Emboli." Vascular 14, no. 3 (2006): 156–60. http://dx.doi.org/10.2310/6670.2006.00029.
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Surgical bypass represents one of the chief treatment modalities for peripheral arterial occlusive disease. Despite improving techniques, graft occlusion accounts for the majority of these bypass failures. Once occluded, however, these grafts are thought to rarely pose a threat for future ischemic events. This report describes two patients with previously thrombosed grafts who subsequently presented with limb-threatening ischemia owing to peripheral embolization from the graft. Two patients with occluded grafts presented with ipsilateral limb-threatening acute ischemia. Both of these patients developed severe acute limb-threatening ischemia weeks to months after known graft thrombosis. Arteriography revealed peripheral embolization in each case. Both patients were operated on for disconnection of the thrombosed graft from the native circulation and have been free of recurrent symptoms. The occluded graft, although generally innocuous, can be a source of peripheral emboli, resulting in peripheral embolization and acute limb ischemia. Both patients in this report developed limb-threatening ischemia owing to embolization from the cul-de-sac of occluded prosthetic grafts. Due to the rarity of the condition and its associated morbidity and mortality, awareness and recognition of this phenomenon are critical. Operative disconnection is recommended if the embolism occurs downstream of the graft and no other embolic source can be identified.
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Parekh, Mohit, Gianni Salvalaio, Alessandro Ruzza, et al. "Posterior Lamellar Graft Preparation: A Prospective Review from an Eye Bank on Current and Future Aspects." Journal of Ophthalmology 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/769860.
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Descemet membrane endothelial keratoplasty (DMEK) is a corneal surgical technique which selectively replaces the damaged posterior part of the cornea with a healthy donor graft retaining the rest of the tissue intact. There is a need to validate and standardize the donor tissue before grafting due to certain issues that can lead to consequences such as graft failure due to poor endothelial cell count, higher mortality, detachment of the graft, or increased surgical expenses, time, and effort. Thus, prospective potential surgeons and eye banks should now aim at developing new improved surgical techniques in order to prepare the best suited, validated, precut, preloaded, and easy to transplant tissue to reduce pre- and postsurgical complications. This could be achieved by defining parameters like graft thickness, accepted mortality threshold of the endothelial cells, and behavior of grafts during preservation and transportation along with using more sophisticated instruments like microkeratome and femtosecond lasers for graft preparation. Thus, a rapport between the eye banks and the surgeons along with the advanced instruments can overcome this challenge to find the best possible solution for endothelial keratoplasty (EK).
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Ma, Richard, Mark Stasiak, Xiang-Hua Deng, and Scott Rodeo. "A Preclinical Model to Study the Influence of Graft Force on the Healing of the Anterior Cruciate Ligament Graft." Journal of Knee Surgery 32, no. 05 (2018): 441–47. http://dx.doi.org/10.1055/s-0038-1646931.
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AbstractThe purpose of this study is to establish a small animal anterior cruciate ligament (ACL) reconstruction research model where ACL graft force can be varied to create different graft force patterns with controlled knee motion. Cadaveric (n = 10) and in vivo (n = 10) rat knees underwent ACL resection followed by reconstruction using a soft tissue autograft. Five cadaveric and five in vivo knees received a nonisometric, high-force femoral graft tunnel position. Five cadaveric and five in vivo knees received a more isometric, low-force graft tunnel position. ACL graft force (N) was then recorded as the knee was ranged from extension to 90 degrees using a custom knee flexion device. Our results demonstrate that distinct ACL graft force patterns were generated for the high-force and low-force femoral graft tunnels. For high-force ACL grafts, ACL graft forces increased as the knee was flexed both in cadaveric and in vivo knees. At 90 degrees of knee flexion, high-force ACL grafts had significantly greater mean graft force when compared with baseline (cadaver: 7.76 ± 0.54 N at 90 degrees vs. 4.94 ± 0.14 N at 0 degree, p = 0.004; in vivo: 7.29 ± 0.42 N at 90 degrees vs. 4.74 ± 0.13 N at 0 degree, p = 0.007). In contrast, the graft forces for low-force ACL grafts did not change with knee flexion (cadaver: 4.94 ± 0.11 N at 90 degrees vs. 4.72 ± 0.14 N at 0 degree, p = 0.41; in vivo: 4.78 ± 0.26 N at 90 degrees vs. 4.77 ± 0.06 N at 0 degree, p = 1). Compared with nonisometric ACL grafts, the graft force for grafts placed in an isometric position had significantly lower ACL graft forces at 15, 30, 45, 60, 70, and 90 degrees in both cadaveric and in vivo knees. In conclusion, we have developed a novel ACL reconstruction model that can reproducibly produce two ACL graft force patterns. This model would permit further research on how ACL graft forces may affect subsequent graft healing, maturation, and function.
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Waller, Edmund K., Brent R. Logan, Wayne A. C. Harris, et al. "Improved Survival After Transplantation of More Donor Plasmacytoid Dendritic or Naïve T Cells From Unrelated-Donor Marrow Grafts: Results From BMTCTN 0201." Journal of Clinical Oncology 32, no. 22 (2014): 2365–72. http://dx.doi.org/10.1200/jco.2013.54.4577.
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Purpose To characterize relationships between specific immune cell subsets in bone marrow (BM) or granulocyte colony-stimulating factor–mobilized peripheral blood (PB) stem cells collected from unrelated donors and clinical outcomes of patients undergoing transplantation in BMTCTN 0201. Patients and Methods Fresh aliquots of 161 BM and 147 PB stem-cell allografts from North American donors randomly assigned to donate BM or PB stem cells and numbers of transplanted cells were correlated with overall survival (OS), relapse, and graft-versus-host disease (GvHD). Results Patients with evaluable grafts were similar to all BMTCTN 0201 patients. The numbers of plasmacytoid dendritic cells (pDCs) and naïve T cells (Tns) in BM allografts were independently associated with OS in multivariable analyses including recipient and donor characteristics, such as human leukocyte antigen mismatch, age, and use of antithymocyte globulin. BM recipients of > median number of pDCs, naïve CD8+ T cells (CD8Tns), or naïve CD4+ T cells (CD4Tns) had better 3-year OS (pDCs, 56% v 35%; P = .025; CD8Tns, 56% v 37%; P = .012; CD4Tns, 55% v 37%; P = .009). Transplantation of more BM Tns was associated with less grade 3 to 4 acute GvHD but similar rates of relapse. Transplantation of more BM pDCs was associated with fewer deaths resulting from GvHD or from graft rejection. Analysis of PB grafts did not identify a donor cell subset significantly associated with OS, relapse, or GvHD. Conclusion Donor immune cells in BM but not PB stem-cell grafts were associated with survival after unrelated-donor allogeneic hematopoietic stem-cell transplantation. The biologic activity of donor immune cells in allogeneic transplantation varied between graft sources. Donor grafts with more BM-derived Tns and pDCs favorably regulated post-transplantation immunity in allogeneic hematopoietic stem-cell transplantation.
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Absood, Afaf, Akira Furutani, Tsutomu Kawamura, and Linda M. Graham. "A comparison of oxidized LDL-induced collagen secretion by graft and aortic SMCs: role of PDGF." American Journal of Physiology-Heart and Circulatory Physiology 287, no. 3 (2004): H1200—H1206. http://dx.doi.org/10.1152/ajpheart.00228.2004.
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Smooth muscle cells (SMCs) from prosthetic vascular grafts constitutively secrete higher levels of collagen than aortic SMCs. Lipid oxidation products accumulate in grafts, and we postulated that they stimulate SMC production of collagen. The effect of oxidized low-density lipoprotein (oxLDL) on type I collagen secretion by aortic and graft SMCs was compared. SMCs isolated from the canine thoracic aorta or Dacron thoracoabdominal grafts ( n = 10) were incubated with native LDL or oxLDL (0–400 μg cholesterol/ml) for 72 h. Type I collagen in the conditioned medium was measured by ELISA. OxLDL increased collagen production by graft SMCs from 4.1 ± 0.3 to 11.0 ± 0.4 ng/μg DNA and by aortic SMCs from 2.3 ± 0.1 to 3.5 ± 0.2 ng/μg DNA. Native LDL had little effect. LY-83583, a superoxide generator, stimulated a dramatic increase in collagen secretion by graft SMCs and a smaller but significant elevation by aortic SMCs. OxLDL has been shown to increase PDGF production by graft SMCs, and PDGF can stimulate collagen production. Anti-PDGF antibody inhibited the increase in collagen production by graft SMCs that was stimulated by oxLDL, implicating PDGF as one mechanism of oxLDL-induced collagen production. Lipid oxidation products that accumulate in prosthetic vascular grafts can cause an oxidative stress that stimulates PDGF production by graft SMCs that in turn stimulates collagen production, contributing to the progression of intimal hyperplasia.
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Kusaka, Mamoru, Yoko Kuroyanagi, Terumi Mori, et al. "Global Expression Profiles in 1-Hour Biopsy Specimens of Human Kidney Transplantation from Donors after Cardiac Death." Cell Transplantation 18, no. 5-6 (2009): 647–56. http://dx.doi.org/10.1177/096368970901805-621.
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Because of the worldwide shortage of renal grafts, kidney transplantation (KTx) from donors after cardiac death (DCD) is an alternative way to obtain KTx from brain-dead donors. Although the prognosis of DCD KTx is gradually improving, the graft often undergoes delayed graft function (DGF), rendering the control of DGF essential for post-KTx patient care. In an attempt to characterize etiology of DGF, genome-wide gene expression profiling was performed using renal biopsy samples performed at 1 h after KTx from DCD and the data were compared with those of KTx from living donors (LD). A total of 526 genes were differentially expressed between them. Genes involved in acute inflammation were activated, while metabolic pathways were consistently downregulated in DCD. These findings imply the inferior performance of the DCD grafts relative to LD grafts. Several genes were identified where the expression levels were correlated well with parameters indicating short- and long-term prognosis of the DCD patients. In addition, several genes encoding secretory proteins were identified that might reflect the performance of the graft and be potential noninvasive biomarkers. These data provide a good source for candidates of biomarkers that are potentially useful for the control of DGF.
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White, William E., Emma L. Olone, Michael T. Sheaff, and Muhammad M. Yaqoob. "Graft pyelonephritis causing graft failure from de novo AA amyloid." Kidney International 85, no. 2 (2014): 481. http://dx.doi.org/10.1038/ki.2013.233.
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Fischer, Peter E., Timothy C. Fabian, Waldemar G. Derijk, et al. "Prosthetic Vascular Conduit in Contaminated Fields: A New Technology to Decrease ePTFE Infections." American Surgeon 74, no. 6 (2008): 524–29. http://dx.doi.org/10.1177/000313480807400611.
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Vascular reconstruction using prosthetic materials in contaminated fields can lead to infection, graft loss, and subsequent amputation. We hypothesized that minocycline and rifampin bound to an ePTFE graft using a unique methacrylate technology would provide for resistance from infection and controlled antibiotic elution. Kirby Bauer susceptibility testing was performed on plates overlaid with Staph aureus (SA) and Staph epidermidis (SE) using 6 mm diameter discs of uncoated graft or antibiotic coated graft (ABX). Zones of inhibition (ZIH) were determined after 24 hours. ABX grafts were then placed in a continuous water bath and a recirculating, pulsatile flow device. Susceptibility testing and high performance liquid chromatography with mass spectroscopy was performed to determine graft performance and antibiotic elution rate. ABX grafts had an average ZIH of 35 mm for SA and 44 mm for SE (each P < 0.0001). After the 1 week water bath, the ZIH of the ABX grafts was 23 mm on both the SA and SE plates. The high performance liquid chromatography with mass spectroscopy revealed that after 24 hours, 50 per cent of the antibiotics remained on the graft, and there was a sustained elution for 7 days. Minocycline and rifampin can be bound to ePTFE vascular grafts using a unique methacrylate method. In vitro, the grafts provide a slow elution of antibiotics that provide resistance from infection by SA and SE for up to 2 weeks after graft insertion.
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Miyake, Keisuke, Katsukiyo Kitabayashi, and Nobuo Sakagoshi. "Results of Graft Removal and Negative Pressure Wound Therapy in Management of Graft Infection." International Journal of Angiology 28, no. 01 (2019): 039–43. http://dx.doi.org/10.1055/s-0038-1676798.
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AbstractGraft infections are a challenging complication in lower extremity bypass surgery with poor outcome, even when treated with graft removal (Gr-R) as a gold standard therapy. The efficacy of negative pressure wound therapy (NPWT) for graft infections has been reported recently, but it is still controversial. The purpose of this study was to assess the efficacy of NPWT and Gr-R for treating graft infections. Twelve consecutive patients with graft infections from 2008 to 2014, treated with Gr-R or NPWT, were enrolled. Those procedures were assessed in complete wound healing, reinfection, amputation, and mortality rate. Five grafts were treated with Gr-R, and seven grafts with NPWT. The initial indications for bypass surgery were claudication, in five grafts treated with Gr-R and three grafts treated with NPWT, and critical limb ischemia in four grafts treated with NPWT. The median time until healing in Gr-R and NPWT was 12 and 59 days, with complete healing seen in 100 and 85.7%, respectively. The major amputation rate was 20 and 14.3%, and reinfection rate was 20 and 14.3%, respectively. There was no perioperative mortality. Gr-R did not show devastating outcome when applied for grafts without limb-threatening ischemia. NPWT showed a low level of invasiveness with excellent results, except for anastomosis site infections. To achieve optimal results, a tailored treatment strategy should be considered.
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Shumborski, Sarah, Lucy J. Salmon, Claire Monk, Emma Heath, Justin P. Roe, and Leo A. Pinczewski. "Allograft Donor Characteristics Significantly Influence Graft Rupture After Anterior Cruciate Ligament Reconstruction in a Young Active Population." American Journal of Sports Medicine 48, no. 10 (2020): 2401–7. http://dx.doi.org/10.1177/0363546520938777.
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Background: Graft selection in anterior cruciate ligament (ACL) surgery can be difficult in a young active population given their high rates of reinjury. Allografts allow for control over graft size and reduce morbidity of autograft harvest. There are mixed results about the use of allograft in the literature; however, the influence of the properties of the allograft on outcomes has not been considered. Hypothesis: ACL reconstruction with allografts from older donors will have a higher rate of graft rupture when compared with allograft from young donors. Study Design: Cohort study; Level of evidence, 3. Methods: Patients (N = 211) aged 13 to 25 years underwent primary ACL reconstruction with fresh-frozen nonirradiated allograft. Four graft types were used: patellar tendon, Achilles tendon, tibialis anterior, and tibialis posterior. Details were collected on allograft donor age and sex. At a minimum of 24 months, patients were evaluated for any further injuries and subjective analysis by International Knee Documentation Committee (IKDC) questionnaire. Results: ACL graft rupture occurred in 23.5%. When grafts were separated into single strand (patellar and Achilles tendon) and multistrand (tibialis anterior and posterior), there was a significantly higher rate of reinjury in the single-strand grafts (29.9% vs 11%; P = .014). Grafts from female donors aged ≥50 years had significantly higher rates of ACL graft rupture (52.6%; P = .003) with increased odds by 6.7 times when compared with grafts from male donors aged <50 years. There was no significant difference in mean IKDC scores among the groups based on the age and sex of the allograft donor. Conclusion: The age and sex of the allograft donor and the morphology of the graft significantly influenced the rate of ACL graft rupture in young active patients. Tendons from female donors aged ≥50 years should be avoided given the higher rerupture rates as compared with male donors of any age and younger females.
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Stephenson, Katherine Kelly, John R. Stommel, and Timothy J. Ng. "Feasibility Studies for in Vitro Grafting and Chimera Formation among Lycopersicon spp." HortScience 32, no. 3 (1997): 449B—449. http://dx.doi.org/10.21273/hortsci.32.3.449b.
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A protocol was developed to make in vitro graft unions among Lycopercicon spp., and regenerates from cultured graft unions were evaluated for chimera formation. Young seedlings were preconditioned for 4 to 6 days in liquid 1/2-strength Murashige & Skoog (MS) basal medium supplemented with 8.9 μM benzyladenine and 1.0 μM indole-3-butyric acid. Preconditioned seedlings exhibited increased biomass and enhanced graft union survival. In particular, survival of cleft grafts increased from 37% to 95% with the seedling preconditioning. When graft unions among different genotypes were excised from apex-to-apex in vitro cleft grafts and plated on MS basal medium supplemented with 9.1 μM zeatin and 3.9 μM ancymidol, as many as 100 plantlets were regenerated from a single graft union. However, no chimeric regenerates were recovered, indicating that asymmetric responses to grafting may be a limiting factor to in vitro chimera formation.
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Gocer, Hakan, Ahmet Baris Durukan, Osman Tunc, Erdinc Naseri, and Ertugrul Ercan. "A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models." Heart Surgery Forum 23, no. 2 (2020): E135—E139. http://dx.doi.org/10.1532/hsf.2765.
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Background: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length.
 Methods: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared.
 Results: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05).
 Conclusion: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites.
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Issa, Naim, Camden L. Lopez, Aleksandar Denic, et al. "Kidney Structural Features from Living Donors Predict Graft Failure in the Recipient." Journal of the American Society of Nephrology 31, no. 2 (2020): 415–23. http://dx.doi.org/10.1681/asn.2019090964.
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BackgroundNephrosclerosis, nephron size, and nephron number vary among kidneys transplanted from living donors. However, whether these structural features predict kidney transplant recipient outcomes is unclear.MethodsOur study used computed tomography (CT) and implantation biopsy to investigate donated kidney features as predictors of death-censored graft failure at three transplant centers participating in the Aging Kidney Anatomy study. We used global glomerulosclerosis, interstitial fibrosis/tubular atrophy, artery luminal stenosis, and arteriolar hyalinosis to measure nephrosclerosis; mean glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area to measure nephron size; and calculations from CT cortical volume and glomerular density on biopsy to assess nephron number. We also determined the death-censored risk of graft failure with each structural feature after adjusting for the predictive clinical characteristics of donor and recipient.ResultsThe analysis involved 2293 donor-recipient pairs. Mean recipient follow-up was 6.3 years, during which 287 death-censored graft failures and 424 deaths occurred. Factors that predicted death-censored graft failure independent of both donor and recipient clinical characteristics included interstitial fibrosis/tubular atrophy, larger cortical nephron size (but not nephron number), and smaller medullary volume. In a subset with 12 biopsy section slides, arteriolar hyalinosis also predicted death-censored graft failure.ConclusionsSubclinical nephrosclerosis, larger cortical nephron size, and smaller medullary volume in healthy donors modestly predict death-censored graft failure in the recipient, independent of donor or recipient clinical characteristics. These findings provide insights into a graft’s “intrinsic quality” at the time of donation, and further support the use of intraoperative biopsies to identify kidney grafts that are at higher risk for failure.
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Kholinne, Erica, Jae-Man Kwak, Hyojune Kim, Yucheng Sun, Kyoung-Hwan Koh, and In-Ho Jeon. "Osteochondral reconstruction for post-traumatic coronoid deficiency." Journal of Orthopaedic Surgery 28, no. 3 (2020): 230949902096860. http://dx.doi.org/10.1177/2309499020968606.
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Purpose: This study aimed to evaluate the clinical outcome and graft survival following coronoid reconstruction with osteochondral bone grafts for post-traumatic coronoid deficiency treatment. We hypothesized that coronoid reconstruction using an osteochondral bone graft will provide favorable results in treating post-traumatic coronoid deficiency. Methods: A retrospective review was performed on eight patients (mean age = 45.8 years) who underwent osteochondral bone graft reconstruction indicated for post-traumatic coronoid deficiency. The osteochondral bone grafts were obtained from the radial head remnant (four patients), olecranon tip (two patients), and iliac crest (two patients). All the injuries were terrible triad. The mean duration from injury to surgery was 79.3 weeks. The visual analog scale (VAS) for pain, motion arc, and Mayo elbow performance score (MEPS) were used to evaluate the clinical outcome. Radiologic evaluation of graft healing and integrity was performed using computed tomography at 19 months and plain elbow radiography at 24.1 months after reconstruction. The immediate graft height was measured. Results: VAS and MEPS values improved from 4.1 ± 1.2 to 1.1 ± 0.3 and 34.2 ± 16.9 to 85.0 ± 7.1, respectively ( p = 0.018, p = 0.018) after reconstruction. The motion arc significantly improved from 84.2° ± 16.1° to 102.1° ± 18.2° at the final follow-up of 39.1 ± 18.8 months ( p = 0.048). All the osteochondral grafts survived, with nonunion in two patients (25%). The mean immediate graft height was 15.4 ± 2.6 mm. Among the eight patients, three (37.5%) developed secondary osteoarthritis of the ulnohumeral joint. Conclusions: Coronoid reconstruction with osteochondral bone graft may serve as an option to salvage post-traumatic coronoid deficiency. Sufficient graft height was required for graft survival. Secondary osteoarthritis of the ulnohumeral joint should not be underestimated during follow-up.
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Reshef, Ran, Austin P. Huffman, Amy Gao, et al. "High Graft CD8 Cell Dose Predicts Improved Survival and Enables Better Donor Selection in Allogeneic Stem-Cell Transplantation With Reduced-Intensity Conditioning." Journal of Clinical Oncology 33, no. 21 (2015): 2392–98. http://dx.doi.org/10.1200/jco.2014.60.1203.
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Purpose To characterize the impact of graft T-cell composition on outcomes of reduced-intensity conditioned (RIC) allogeneic hematopoietic stem-cell transplantation (alloHSCT) in adults with hematologic malignancies. Patients and Methods We evaluated associations between graft T-cell doses and outcomes in 200 patients who underwent RIC alloHSCT with a peripheral blood stem-cell graft. We then studied 21 alloHSCT donors to identify predictors of optimal graft T-cell content. Results Higher CD8 cell doses were associated with a lower risk for relapse (adjusted hazard ratio [aHR], 0.43; P = .009) and improved relapse-free survival (aHR, 0.50; P = .006) and overall survival (aHR, 0.57; P = .04) without a significant increase in graft-versus-host disease or nonrelapse mortality. A cutoff level of 0.72 × 108 CD8 cells per kilogram optimally segregated patients receiving CD8hi and CD8lo grafts with differing overall survival (P = .007). Donor age inversely correlated with graft CD8 dose. Consequently, older donors were unlikely to provide a CD8hi graft, whereas approximately half of younger donors provided CD8hi grafts. Compared with recipients of older sibling donor grafts (consistently containing CD8lo doses), survival was significantly better for recipients of younger unrelated donor grafts with CD8hi doses (P = .03), but not for recipients of younger unrelated donor CD8lo grafts (P = .28). In addition, graft CD8 content could be predicted by measuring the proportion of CD8 cells in a screening blood sample from stem-cell donors. Conclusion Higher graft CD8 dose, which was restricted to young donors, predicted better survival in patients undergoing RIC alloHSCT.
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Rocha, Flaviana Soares, Jonas Dantas Batista, Darceny Zanetta-Barbosa, and Paula Dechichi. "Effect of Different Storage Media on the Regenerative Potential of Autogenous Bone Grafts: A Histomorphometrical Analysis in Rabbits." Journal of Oral Implantology 39, no. 6 (2013): 635–42. http://dx.doi.org/10.1563/aaid-joi-d-11-00020.
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The success of autogenous bone graft is related to the graft cell viability. In bone-grafting procedures, harvested grafts are often maintained in extraoral media while the recipient site is prepared. The aim of this study was to evaluate in vivo the effect of storage media over autogenous bone grafts during the transsurgical time. Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was immediately fixed in the mandibular angle (control group), and the other was maintained in air exposure (dry group), 0.9% NaCl solution (saline group), or platelet-poor plasma (PPP group) during 30 minutes and stabilized in the symmetrical location of control grafts. After 28 days, the animals were euthanized and the bone fragments were removed, demineralized, and embedded in paraffin. Histological evaluation was performed under light microscope. Empty lacunae and bone graft area quantification were carried out for the sections. The histomorphometrical analysis revealed reduction of the graft area and increase of empty lacunae in the dry group when compared with control. No significant differences were found in the number of empty lacunae or bone graft area between the saline group and its control and also between the PPP group and its control. The dry group showed more empty lacunae and less graft area than the saline and PPP groups. In accordance with the results, PPP and physiologic solution demonstrated osteocyte preservation and bone graft area maintenance, being satisfactory storage media for autogenous bone grafts during the transsurgical period.
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Mancusi, Antonella, Loredana Ruggeri, and Andrea Velardi. "Haploidentical hematopoietic transplantation for the cure of leukemia: from its biology to clinical translation." Blood 128, no. 23 (2016): 2616–23. http://dx.doi.org/10.1182/blood-2016-07-730564.
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Abstract The present review describes the biology of human leukocyte antigen haplotype mismatched (“haploidentical”) transplantation, its translation to clinical practice to cure leukemia, and the results of current transplantation protocols. The 1990s saw what had been major drawbacks of haploidentical transplantation, ie, very strong host-versus-graft and graft-versus-host alloresponses, which led respectively to rejection and graft-versus-host disease (GVHD), being overcome through transplantation of a “mega-dose” of T cell–depleted peripheral blood hematopoietic progenitor cells and no posttransplant pharmacologic immunosuppression. The absence of posttransplant immunosuppression was an opportunity to discover natural killer cell alloreactions that eradicated acute myeloid leukemia and improved survival. Furthermore, it also unveiled the benefits of transplantation from mother donors, a likely consequence of the mother-to-child interaction during pregnancy. More recent transplantation protocols use unmanipulated (without ex vivo T-cell depletion) haploidentical grafts combined with enhanced posttransplant immunosuppression to help prevent GVHD. Unmanipulated grafts substantially extended the use of haploidentical transplantation with results than even rival those of matched hematopoietic transplantation. In T cell–depleted haploidentical transplantation, recent advances were made by the adoptive transfer of regulatory and conventional T cells.
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Xiao, Yang, Ming Ling, Zhenming Liang, et al. "Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels." International Journal of Computer Assisted Radiology and Surgery 16, no. 3 (2021): 495–504. http://dx.doi.org/10.1007/s11548-021-02307-2.
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Abstract Purpose Little is known about the in vivo forces and stresses on grafts used in anterior cruciate ligament (ACL) reconstruction. The aims of this study were to evaluate and compare the forces and stresses on grafts used in anatomical single-bundle ACL reconstruction at different locations of the femoral footprint (anterior vs middle vs posterior; high vs middle vs low) during a lunge motion. Methods Establish subject-specific finite element models with different graft’s tunnel loci to represent the primary ACL reconstructions. A displacement controlled finite element method was used to simulate lunge motions (full extension to ~ 100° of flexion) with six-degree-of-freedom knee kinematics data obtained from the validated dual fluoroscopic imaging techniques. The reaction force of the femur and maximal principal stresses of the grafts were subsequently calculated during knee flexion. Results Increased and decreased graft forces were observed when the grafts were located higher and lower on the femoral footprint, respectively; anterior and posterior graft placement did not significantly affect the graft force. Lower and posterior graft placement resulted in less stress on the graft at higher degrees of flexion; there were no significant differences in stress when the grafts were placed from 0° to 30° of flexion on the femoral footprint. Conclusion The proposed method is able to simulate knee joint motion based on in vivo kinematics. The results demonstrate that posterior to the centre of the femoral footprint is the strategic location for graft placement, and this placement results in anatomical graft behaviour with a low stress state.
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RAO, G. S., P. KEOGH, H. WEBSTER, P. G. LUNN, and F. D. BURKE. "Aneurysmal Bone Cysts in the Hand Treated by Free Non-Vascular Transfer of Metatarsal or Proximal Phalanx from the Foot." Journal of Hand Surgery 18, no. 6 (1993): 736–41. http://dx.doi.org/10.1016/0266-7681(93)90233-6.
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Two cases of aneurysmal bone cyst in the hand are reported. In one case the entire first metacarpal was resected and grafted using the fourth metatarsal. In the second case diaphysectomy of the middle phalanx of the index digit was performed, and the proximal phalanx of the second toe was used as graft. Satisfactory length and function were maintained, the grafts remained viable and there was no donor site morbidity. Transplant of a metatarsal or toe phalanx to the hand, as a free non-vascularized graft, is a relatively straight forward operation, requires minimal refashioning of the graft, provides articular surfaces for joint reconstruction and leaves little donor site morbidity.
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Hofstra, L., D. C. Bergmans, A. P. Hoeks, P. J. Kitslaar, K. M. Leunissen, and J. H. Tordoir. "Mismatch in elastic properties around anastomoses of interposition grafts for hemodialysis access." Journal of the American Society of Nephrology 5, no. 5 (1994): 1243–50. http://dx.doi.org/10.1681/asn.v551243.
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Arteriovenous (AV) fistulas for hemodialysis access, constructed with the use of interposition grafts, are often complicated by intimal hyperplastic stenosis, mainly occurring at the venous anastomosis. In this study, mismatch in elastic properties around the arterial and venous anastomoses of graft AV fistulas in humans was quantified in order to find clues for the predisposition of intimal hyperplasia to develop at the venous anastomosis. The elastic properties of graft AV fistulas in 31 hemodialysis patients were investigated by the use of vessel wall Doppler tracking, 2 wk after construction. Nine saphenous vein grafts, 8 expanded polytetrafluoroethylene (ePTFE) grafts, and 14 stretch-PTFE (sPTFE) grafts were measured at the arterial inflow segment, the proximal graft segment, the distal graft segment, and the venous outflow segment. Area increase (AI), representing the capacity of the vessel wall to store blood volume, and relative distension, representing the intrinsic elastic properties, were calculated from diameter and distension. A decrease in AI was observed in the arterial anastomoses of all graft types. An increase in AI was found in the venous anastomosis of ePTFE and sPTFE grafts. Higher values for AI and relative distension were found at the proximal and distal graft segments of the saphenous vein grafts when compared with the prosthetic grafts. In the sPTFE grafts, the level of AI was maintained along the graft, whereas in the ePTFE grafts, a decrease in AI was found. In the arterial anastomoses of AV fistulas, a decline in the capacity to store blood volume was observed. By contrast, an increase in the capacity to store blood volume was found in the venous anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)