Pure Laparoscopic Right Hepatectomy in a Living Donor.

Pure Laparoscopic Right Hepatectomy in a Living Donor.

Am J Transplant. 2013 Jul 18;
Soubrane O, Perdigao Cotta F, Scatton O

After reporting the first laparoscopic hepatectomy in a living donor for pediatric liver transplantation, we now report a case of pure laparoscopic right hepatectomy for adult transplantation. A 50-year-old female volunteered for living donation to her sister who suffered from primary biliary cirrhosis. The volume of the planned hepatic graft (segments 5-8) was 620?cm(3) , representing 56% of her entire liver. Five ports were used in the donor to perform the operative procedure. The right hepatic artery and portal vein were isolated. Parenchymal division was performed using an ultrasonic dissector, bipolar coagulation and clips for hemostasis. Cholangiography was performed and the right bile duct was cut at the level of a marker thread. The right liver graft was placed in a bag and removed through a 10-cm suprapubic incision. The veins of segments 5 and 8 were recanalized and the graft was transplanted in the recipient. The postoperative course was uneventful for both the donor and recipient. This case offers evidence that the right liver can be procured via a total laparoscopic approach. This technique may allow for an early rehabilitation for the living donor. HubMed – rehab

Multipotent Mesenchymal Stem Cells from Human Subacromial Bursa: Potential for Cell Based Tendon Tissue Engineering.

Tissue Eng Part A. 2013 Jul 18;
Song N, Armstong AD, Li F, Niyibizi C

Abstract Rotator cuff injuries are a common clinical problem either as a result of overuse or aging. Biological approaches to tendon repair that involve use of scaffolding materials or cell-based approaches are currently being investigated. The cell-based approaches are focused on applying multipotent mesenchymal stem cells (MSCs) mostly harvested from bone marrow. In the present study, we focused on characterizing cells harvested from tissues associated with rotator cuff tendons based on an assumption that these cells would be more appropriate for tendon repair. We isolated MSCs from bursa tissue associated with rotator cuff tendons and characterized them for multilineage differentiation in vitro and in vivo. Human bursa was obtained from patients undergoing rotator cuff surgery and cells within were isolated using collagenase and dispase digestion. The cells isolated from the tissues were characterized for osteoblastic, adipogenic, chondrogenic and tenogenic differentiation in vitro and in vivo. The results showed that the cells isolated from bursa tissue exhibited MSCs characteristics as evidenced by the expression of putative cell surface markers attributed to MSCs. The cells exhibited high proliferative capacity and differentiated toward cells of mesenchymal lineages with high efficiency. Bursa derived cells expressed markers of tenocytes when treated with BMP-12 and assumed aligned morphology in culture. Bursa cells pre-treated with BMP-12 and seeded in ceramic scaffolds formed extensive bone as well as tendon like tissue in vivo. Bone formation was demonstrated by histological analysis and immunofluorescence for DMP-1 in tissue sections made from the scaffolds seeded with the cells. Tendon-like tissue formed in vivo consisted of parallel collagen fibres typical of tendon tissues. Bursa derived cells also formed a fibrocartilagenous tissue in the ceramic scaffolds. Taken together, the results demonstrate a new source of MSCs with a high potential for application in tendon repair. HubMed – rehab

Using wireless technology in clinical practice: does feedback of daily walking activity improve walking outcomes of individuals receiving rehabilitation post-stroke? Study protocol for a randomized controlled trial.

BMC Neurol. 2013 Jul 18; 13(1): 93
Mansfield A, Wong JS, Bayley M, Biasin L, Brooks D, Brunton K, Howe JA, Inness EL, Jones S, Lymburner J, Mileris R, McIlroy WE

Regaining independent ambulation is the top priority for individuals recovering from stroke. Thus, physical rehabilitation post-stroke should focus on improving walking function and endurance. However, the amount of walking completed by individuals with stroke attending rehabilitation is far below that required for independent community ambulation. There has been increased interest in accelerometer-based monitoring of walking post-stroke. Walking monitoring could be integrated within the goal-setting process for those with ambulation goals in rehabilitation. The feedback from these devices can be downloaded to a computer to produce reports. The purpose of this study is to determine the effect of accelerometer-based feedback of daily walking activity during rehabilitation on the frequency and duration of walking post-stroke.Participants will be randomly assigned to one of two groups: feedback or no feedback. Participants will wear accelerometers daily during in- and out-patient rehabilitation and, for participants in the feedback group, the participants’ treating physiotherapist will receive regular reports of walking activity. The primary outcome measures are the amount of daily walking completed, as measured using the accelerometers, and spatio-temporal characteristics of walking (e.g. walking speed). We will also examine goal attainment, satisfaction with progress towards goals, stroke self-efficacy, and community-integration.Increased walking activity during rehabilitation is expected to improve walking function and community re-integration following discharge. In addition, a focus on altering walking behaviour within the rehabilitation setting may lead to altered behaviour and increased activity patterns after discharge.Trial registration: ClinicalTrials.gov NCT01521234. HubMed – rehab

Auricular Acupressure for Analgesia in Perioperative Period of Total Knee Arthroplasty.

Pain Med. 2013 Jul 18;
He BJ, Tong PJ, Li J, Jing HT, Yao XM

We examined whether auricular acupressure (AA) can alleviate postoperative pain and decrease narcotic consumption and its adverse effects for osteoarthritis patients after total knee arthroplasty (TKA).A prospective, randomized, sham control trial comparing AA and a sham control.Department of Orthopedics, the first Hospital affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou, China.Ninety patients with degenerative osteoarthritis undergoing TKA.The AA group received true AA by embedding vaccaria seeds at four specific AA points (knee joint, shenmen, subcortex, sympathesis) ipsilateral to the surgery site, while the control group received four nonacupuncture points on the auricular helix.Visual analog scale (VAS), the consumption of analgesic via patient-controlled analgesia, the incidence of analgesia-related adverse effects, Hospital for Special Surgery scores (HSS), and range of motion (ROM) were recorded.VAS scores were similar at 12, 24, 36, and 48?h postsurgery (P?>?0.05), but AA group scores were lower than those of the control group at 3, 4, 5, and 7 days (P??0.05), HSS scores 2 weeks postoperatively were higher in the AA group than in the control group (P??0.05).Applying auricular acupoint acupressure in the perioperative period of TKA is favorable for alleviating postoperative pain, decreasing opioid consumption and its adverse effects, and promoting early rehabilitation. Also, this intervention has the advantage of lower costs, fewer complications, simple application, and high safety. HubMed – rehab