Publications by authors named "Jun Araki"

91 Publications

Liquid Crystal-Mediated 3D Printing Process to Fabricate Nano-Ordered Layered Structures.

ACS Appl Mater Interfaces 2021 Jun 10;13(24):28627-28638. Epub 2021 Jun 10.

School of Chemical Engineering, University of New South Wales (UNSW), Sydney 2052, New South Wales, Australia.

The emergence of three-dimensional (3D) printing promises a disruption in the design and on-demand fabrication of smart structures in applications ranging from functional devices to human organs. However, the scale at which 3D printing excels is within macro- and microlevels and principally lacks the spatial ordering of building blocks at nanolevels, which is vital for most multifunctional devices. Herein, we employ liquid crystal (LC) inks to bridge the gap between the nano- and microscales in a single-step 3D printing. The LC ink is prepared from mixtures of LCs of nanocellulose whiskers and large sheets of graphene oxide, which offers a highly ordered laminar organization not inherently present in the source materials. LC-mediated 3D printing imparts the fine-tuning required for the design freedom of architecturally layered systems at the nanoscale with intricate patterns within the 3D-printed constructs. This approach empowered the development of a high-performance humidity sensor composed of self-assembled lamellar organization of NC whiskers. We observed that the NC whiskers that are flat and parallel to each other in the laminar organization allow facile mass transport through the structure, demonstrating a significant improvement in the sensor performance. This work exemplifies how LC ink, implemented in a 3D printing process, can unlock the potential of individual constituents to allow macroscopic printing architectures with nanoscopic arrangements.
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http://dx.doi.org/10.1021/acsami.1c05025DOI Listing
June 2021

Anorectal Transplantation: The First Long-Term Success in a Canine Model.

Ann Surg 2021 Jan 22. Epub 2021 Jan 22.

Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan Laboratory of Veterinary Surgery, Graduate School of Agricultural and Life Science, The University of Tokyo, Tokyo, Japan Saitama Shinkaibashi Clinic, Saitama, Japan Department of Anatomy, Aichi Medical University, Aichi, Japan Department of Plastic and Reconstructive Surgery, Juntendo University, Tokyo, Japan Laboratory of Liver Transplantation and Experimental Surgery (LIM-37), Division of Liver Transplantation, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan.

Objective: Anorectal transplantation is a challenging procedure but a promising option for patients with weakened or completely absent anorectal function.

Summary Background Data: We constructed a canine model of anorectal transplantation, evaluated the long-term outcomes, and controlled rejection and infection in allotransplantation.

Methods: In the pudendal nerve function study, 6 dogs were randomly divided into 2 groups, transection and anastomosis, and were compared with a control using anorectal manometry, electromyography, and histological examination. In the anorectal transplantation model, 4 dogs were assigned to 4 groups: autotransplant, allotransplant with immunosuppression, allotransplant without immunosuppression, and normal control. Long-term function was evaluated by defecography, videography, and histological examination.

Results: In the pudendal nerve function study, anorectal manometry indicated that the anastomosis group recovered partial function 6 months postoperatively. Microscopically, the pudendal nerve and the sphincter muscle regenerated in the anastomosis group. Anorectal transplantation was technically successful with a 3-stage operation: colostomy preparation, anorectal transplantation, and stoma closure. The dog who underwent allotransplantation and immunosuppression had 2 episodes of mild rejection, which were reversed with methylprednisolone and tacrolimus. The dog who underwent allotransplantation without immunosuppression had a severe acute rejection that resulted in graft necrosis. Successful dogs had full defecation control at the end of the study.

Conclusions: We describe the critical role of the pudendal nerve in anorectal function and the first long-term success with anorectal transplantation in a canine model. This report is a proof-of-concept study for anorectal transplantation as a treatment for patients with an ostomy because of anorectal dysfunction.
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http://dx.doi.org/10.1097/SLA.0000000000004141DOI Listing
January 2021

Utility of the evaluation of blood flow of remnant esophagus with indocyanine green in esophagectomy with jejunum reconstruction: Case series.

Ann Med Surg (Lond) 2021 Feb 5;62:21-25. Epub 2020 Dec 5.

Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka, 411-8777, Japan.

Background: Pedicled jejunal flap can be utilized with various tips for esophageal reconstruction in patients with a history of gastrectomy or those who have undergone synchronous esophagogastrectomy. However, the rate of anastomosis leakage is high; therefore, we considered the evaluation of blood flow of the remnant esophagus with indocyanine green in setting the anastomosis site.

Methods: Fifty patients who underwent radical esophagectomy with pedicled jejunal flap between January 2011 and June 2020 were identified. From June 2019, blood flow in the pedicled jejunum and remnant esophagus were evaluated to set the anastomosis site of the latter. Usually, the second and third jejunal vessels are transected, and if the jejunal flap cannot reach to the anastomosis point, we actively transect the marginal vessels to stretch the jejunal flap. Microvascular anastomosis between the jejunal branches and the internal thoracic vessels is usually made, and the anastomosis site is set at the well-stained part of the esophagus.

Results: Overall, 39 patients underwent the procedure before June 2019 (Group A), and 11 patients underwent the procedure since June 2019 (Group B). No significant difference was found in the patients' background, type of preoperative therapy, presence or absence of ligation of marginal vessels and two-stage operation between the groups. Group A had 16 cases of anastomosis leakage; B had only 1 case ( < 0.05). There were no cases of pedicled jejunum graft necrosis.

Conclusion: Assessing remnant esophageal perfusion by indocyanine green imaging in pedicled jejunum reconstruction resulted in a lower anastomotic leak rate.
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http://dx.doi.org/10.1016/j.amsu.2020.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808916PMC
February 2021

Verification system for intensity-modulated radiation therapy with scintillator.

Phys Eng Sci Med 2021 Mar 18;44(1):9-21. Epub 2020 Nov 18.

Hiroshima University Hospital, Hiroshima, Japan.

In the preparation of intensity-modulated radiation therapy (IMRT), patient-specific verification is widely employed to optimize the treatment. To accurately estimate the accumulated dose and obtain the field-by-field or segment-by-segment verification, an original IMRT verification tool using scintillator light and an analysis workflow was developed in this study. The raw light distribution was calibrated with respect to the irradiated field size dependency and light diffusion in the water. The calibrated distribution was converted to dose quantity and subsequently compared with the results of the clinically employed plan. A criterion of 2-mm dose-to-agreement and 3% dose difference was specified in the gamma analysis with a 10% dose threshold. By applying the light diffusion calibration, the maximum dose difference was corrected from 7.7 cGy to 3.9 cGy around the field edge for a 60 cGy dose, 7 × 7 cm irradiation field, and 10 MV beam energy. Equivalent performance was confirmed in the chromodynamic film. The average dose difference and gamma pass rate of the accumulated dose distributions in six patients were 0.8 ± 4.5 cGy and 97.4%, respectively. In the field-by-field analysis, the average dose difference and gamma pass rate in seven fields of Patient 1 were 0.2 ± 1.2 cGy and 93.9%, respectively. In the segment-by-segment analysis, the average dose difference and gamma pass rate in nine segments of Patient 1 and a 305° gantry angle were - 0.03 ± 0.2 cGy and 93.9%, respectively. This system allowed the simultaneous and independent analysis of each field or segment in the accumulated dose analysis.
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http://dx.doi.org/10.1007/s13246-020-00946-4DOI Listing
March 2021

Thorax anthropometric position index: a simple evaluation of the inframammary fold position in the thorax.

J Plast Surg Hand Surg 2021 Feb 5;55(1):21-24. Epub 2020 Oct 5.

Department of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan.

Appropriate positioning of the inframammary fold (IMF) is essential for breast reconstruction. The purpose of this study was to quantitatively measure and evaluate the anthropometric position of the IMF in the thorax. A total of 145 Japanese women with unilateral breast cancer were analyzed. To indicate the superior-inferior position of the IMF on the non-diseased side, the distances from the sternal notch (SN) to the IMF along the midline (SN-IMFM) and from the SN to the umbilicus (UB) (SN-UB) were measured. A new index, the thorax anthropometric position (TAP) index for the IMF, was then defined as the ratio of SN-IMFM to SN-UB. The TAP index was calculated for each patient, and its correlations with demographic parameters, including age, body height, and body mass index, were statistically assessed. The TAP index was normally distributed and ranged from 0.500 to 0.704, with a mean of 0.590. Multivariate analysis revealed that age was an independent factor associated with a higher TAP index ( < .01). In addition, the paired -test showed that the TAP index was significantly greater in the standing position than in the supine position ( < .001). The position of the IMF in the thorax could be objectively described by the TAP index, and it was suggested to become inferior with age and the standing position. The index, along with these findings, will provide useful information for the evaluation of the breast contour in an objective and simple manner.
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http://dx.doi.org/10.1080/2000656X.2020.1828896DOI Listing
February 2021

[Current Incidence and Contamination Sources of Ascariasis in Japan].

Shokuhin Eiseigaku Zasshi 2020 ;61(4):103-108

Laboratory of Helminthology, Department of Parasitology, National Institute of Infectious Diseases.

Ascaris lumbricoides or roundworm is one of the key soil-transmitted helminths affecting humans. A small number of infections continue to occur in Japan, suggesting plant foodstuff contamination as the source of infection. To understand the current status of ascariasis incidence and to identify potential sources of infection, we extensively surveyed the available literature and collected data from testing facilities that examined clinical samples or foodstuffs. We observed that from 2002 onwards, there was a decrease in the number of ascariasis cases reported in scientific journals. Data from a clinical testing facility indicated that the number of detected cases declined remarkably from 2009. Foodstuff testing facilities reported that 11 of 10,223 plant foodstuff specimens were contaminated with anisakid nematodes but not with Ascaris. Imported kimchi was suspected as the most probable source of ascarid nematode infection, as one Ascaris egg-positive sample was detected among 60 kimchi samples in a testing facility. Therefore, the sources of Ascaris infection are still not fully known and need to be clarified to establish preventive countermeasures to safeguard Ascaris infections that continue to occur in Japan.
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http://dx.doi.org/10.3358/shokueishi.61.103DOI Listing
November 2020

Cellulose Nanowhisker/Silver Nanoparticle Hybrids Sterically Stabilized by Surface Poly(ethylene glycol) Grafting.

Langmuir 2020 09 3;36(36):10868-10875. Epub 2020 Sep 3.

Graduate School of Science and Technology, Shinshu University, Tokida 3-15-1, Ueda, Nagano prefecture 386-8567, Japan.

Sterically stabilized hybrids of cellulose nanowhiskers (CNWs) and silver nanoparticles (AgNPs) were prepared poly(ethylene glycol) (PEG) grafting and subsequent reduction of Ag counterions by sodium borohydride (NaBH) for improved dispersion stability after hybridization. The preparation scheme includes surface carboxylation of CNWs using a 2,2,6,6-tetramethyl-1-pyperidinyloxy radical (TEMPO), grafting of monomethoxy PEG (mPEG) amidation mediated by 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride or 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride, exchange of countercation of residual carboxyls to Ag, and deposition of AgNPs reduction with NaBH. UV-vis spectroscopy and electron microscopy analyses confirmed the successful deposition of AgNPs. Most of the mPEG-grafted hybrids were stable under the presence of an electrolyte, although some of them were precipitated by the addition of 0.1 M CaCl. The addition of CaCl was also found to trigger discoloration of the hybrids, suggesting the partial dissolution of AgNPs and the formation of water-insoluble AgCl.
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http://dx.doi.org/10.1021/acs.langmuir.0c02129DOI Listing
September 2020

Phase II study of vinorelbine plus carboplatin with concurrent radiotherapy in elderly patients with non-small cell lung cancer.

Jpn J Clin Oncol 2020 Mar;50(3):318-324

Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.

Objective: Concurrent chemoradiotherapy is the standard treatment for locally advanced non-small cell lung cancer. In the current aging society, the establishment of an ideal treatment strategy for locally advanced non-small cell lung cancer in the elderly is warranted. To assess the efficacy of concurrent chemoradiotherapy with carboplatin and vinorelbine in elderly patients with locally advanced non-small cell lung cancer.

Purpose: To assess the efficacy of concurrent chemoradiotherapy with carboplatin and vinorelbine in elderly patients with locally advanced non-small cell lung cancer.

Methods: This multicenter, phase II study included patients with physiologically or medically unresectable stage I-III NSCLC, who were ≥70 years old. The patients received carboplatin (AUC 2) and vinorelbine (15 mg/m2) both on day 1, 8, 22 and 29 concurrently with radiotherapy (2.0 Gy/day, 30 fractions, total 60 Gy). The primary endpoint was the objective response rate. The secondary endpoints were the progression-free survival, overall survival and the incidence of adverse events.

Results: 50 patients were accrued (42 men and 8 women). The median age was 77 years (range, 70-89 years) and the clinical stage was I/II/III in 3/7/40, respectively. Forty-seven patients completed the planned treatment. The response was complete remission in 4, partial response in 31, stable disease in 12 and progressive disease in 3, giving an objective response rate of 70% (95% confidence interval: 55.4-82.1). Frequent high Grade 3 or higher adverse events were hematologic, but no treatment deaths were noted. The median and 2-year progression-free survival were 8.4 months and 21.1% (95% confidence interval: 9.5-32.7%), respectively, and the median and 2-year overall survival were 15.4 months and 41.1% (95% confidence interval: 27.0-55.2), respectively.

Conclusion: Concurrent chemoradiotherapy with carboplatin and vinorelbine showed an acceptable objective response rate and safety in elderly patients.
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http://dx.doi.org/10.1093/jjco/hyz179DOI Listing
March 2020

Combination of Dual Wavelength Picosecond and Nanosecond Pulse Width Neodymium-Doped Yttrium-Aluminum-Garnet Lasers for Tattoo Removal.

Lasers Surg Med 2020 07 14;52(6):515-522. Epub 2019 Nov 14.

Luce Tokyo Aesthetic Clinic, Tokyo, Japan.

Background And Objectives: Tattoo removal by laser has been mostly performed using Q-switched laser, which has nanosecond pulse width. In recent years, the efficacy of treatment with picosecond pulse width laser has also been reported.

Study Design/materials And Methods: Using a picosecond-domain, neodymium-doped yttrium-aluminum-garnet laser with a potassium-titanyl-phosphate frequency-doubling crystal, we performed a retrospective clinical study with combination treatment using pulse widths of 750 ps and 2 ns. The number of treatments was compared with the Kirby-Desai score. Tissue changes immediately after laser irradiation at 2 ns and 750 ps were compared using an electron microscope.

Results: The combination treatment using pulse widths of 2 ns and 750 ps was safe and more effective than the Q-switched neodymium-doped yttrium-aluminum-garnet laser treatment. Tattoo removal was possible with significantly fewer treatment numbers than the Kirby-Desai score, without adverse events. The results from the scanning electron microscope revealed that ink particles irradiated by 750 ps were more dispersed than those by 2 ns.

Conclusions: The combination treatment with pulse widths of 2 ns and 750 ps and 1064 nm and 532 nm wavelengths using the neodymium-doped yttrium-aluminum-garnet laser was safe and effective and can be a useful option for tattoo removal. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/lsm.23181DOI Listing
July 2020

Changing clinical and molecular characteristics of hepatitis E virus infection in Mie Prefecture, Japan: Disappearance of indigenous subtype 3e strains.

Hepatol Res 2019 Sep 7;49(9):1003-1014. Epub 2019 Jun 7.

Department of Gastroenterology and Hepatology, Mie University School of Medicine, Mie, Japan.

Aim: To evaluate the clinical and molecular characteristics of hepatitis E virus (HEV) infection in Mie Prefecture, Japan, from 2004 through 2018.

Methods: The clinical information of hepatitis E cases was collected from 21 medical institutions in Mie Prefecture. The nucleotide sequences of infecting HEV strains were determined for cases with available serum samples. The origins or transmission routes were inferred from phylogenetic analyses of the nucleotide sequences.

Results: Fifty-three patients were diagnosed with HEV infection. The number of cases increased each year through 2012 and then decreased. Analyses of the clinical characteristics of the cases indicated that even mild cases were detected in the latter 10 years of the study. Nucleotide sequence analyses were undertaken on 38 of the 53 cases. The HEV subtype 3e (HEV-3e) strains identified for 13 cases were closely related to a swine HEV-3e strain that was isolated from the liver of a pig bred in Mie Prefecture. The number of cases infected with the indigenous Mie HEV-3e strains increased until 2012 but have not been reported since 2014. In the latter half of the study, cases involving various HEV strains of different genotypes and subtypes emerged.

Conclusions: The disappearance of indigenous Mie HEV-3e strains appeared to be the primary cause for the decrease in hepatitis E cases in Mie Prefecture. The disappearance might have been associated with improved hygienic conditions on pig farms or the closure of contaminated farms. The results suggest that indigenous HEV strains can be eradicated by appropriate management.
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http://dx.doi.org/10.1111/hepr.13357DOI Listing
September 2019

Exposed Artificial Plate Covered With Perifascial Areolar Tissue as a Nonvascularized Graft.

Plast Reconstr Surg Glob Open 2019 Feb 5;7(2):e2109. Epub 2019 Feb 5.

Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.

Perifascial areolar tissue (PAT) is a loose connective tissue on deep fascia, such as on the groin, thigh, or temporal region, which has abundant vascular plexus and mesenchymal stem cells. Nonvascularized PAT grafts can survive even on hypovascular wound beds. Therefore, PAT grafting is a possible alternative to conventional flap surgery to cover exposed bone or artifacts. In this article, we describe 2 cases of PAT grafting for the treatment of skin ulcers with exposed bone and artificial plate after mandible reconstruction. After negative-pressure wound therapy, PAT was used to covering exposed artificial plate for both cases, and a skin graft onto the PAT graft was performed in 1 case. The ulcers improved in both cases without recurrence. The gold-standard treatment of intractable ulcers and fistulas with an exposed tendon, bone, or artifact is coverage by a well-vascularized skin flap. However, PAT grafting has advantages in similar situations, occasionally together with skin grafting and/or negative-pressure wound therapy, because it is technically simple and less invasive.
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http://dx.doi.org/10.1097/GOX.0000000000002109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6416139PMC
February 2019

Validity of Japanese version of SARC-F questionnaire in patients with chronic liver disease.

J Gastroenterol Hepatol 2019 May 16;34(5):947-953. Epub 2018 Sep 16.

Department of Diabetes and Metabolism, Ise Red Cross Hospital, Ise-shi, Mie, Japan.

Background And Aim: We aimed to examine the validity of the Japanese version of SARC-F questionnaire (SARC-F-J) that employs the diagnostic criteria for sarcopenia established by the Japan Society of Hepatology in patients with chronic liver disease.

Methods: Subjects were outpatients at the Department of Hepatology at the Japanese Red Cross Ise Hospital, Japan. Evaluations were performed using the following self-administered questionnaires: SARC-F-J, Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC), the Japanese version of the Falls Efficacy Scale (FES), and Kaigo-Yobo Checklist (CL). Based on the diagnostic criteria of the Japan Society of Hepatology, we diagnosed sarcopenia from the skeletal muscle index calculated using the iliopsoas muscle area at the third lumbar vertebra on computed tomography and from grip strength. To evaluate construct validity, we calculated the sensitivity, specificity, and positive and negative predictive values of SARC-F-J that used the diagnostic criteria of the Japan Society of Hepatology as reference. Furthermore, to evaluate convergent validity, we calculated Pearson's correlation coefficients between SARC-F-J and TMIG-IC, FES, and CL.

Results: A total of 140 subjects were included in the analysis set. Sensitivity and specificity were 16.3% and 45.0% and 95.3% and 90.8% for men and women, respectively. The positive predictive value was 81.8% for both, whereas the negative predictive value was 47.1% and 64.5% for men and women, respectively. A significant correlation was seen between SARC-F-J and TMIG-IC, FES, and CL.

Conclusions: We believe that the SARC-F-J is a valid tool for patients with chronic liver disease.
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http://dx.doi.org/10.1111/jgh.14449DOI Listing
May 2019

A 10-year Follow-up Study of a Japanese Family with Ferroportin Disease A: Mild Iron Overload with Mild Hyperferritinemia Co-occurring with Hyperhepcidinemia May Be Benign.

Intern Med 2018 Oct 18;57(19):2865-2871. Epub 2018 May 18.

Department of Medicine, Aichi-Gakuin University School of Pharmacy, Japan.

This is a 10-year follow-up study of a family with ferroportin disease A. The proband, a 59-year-old man showed no noteworthy findings with the exception of an abnormal iron level. The proband's 90-year-old father showed reduced abilities in gait and cognition; however, with the exception of his iron level, his biochemistry results were almost normal. Brain imaging showed age-matched atrophy and iron deposition. In both patients, the serum levels of ferritin and hepcidin25, and liver computed tomography scores declined over a 10-year period. These changes were mainly due to a habitual change to a low-iron diet. The iron disorder in this family was not associated with major organ damage.
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http://dx.doi.org/10.2169/internalmedicine.0481-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207810PMC
October 2018

Preservation of rat limbs by hyperbaric carbon monoxide and oxygen.

Sci Rep 2018 04 26;8(1):6627. Epub 2018 Apr 26.

Department of Anatomy, Tokyo Medical University, Tokyo, Japan.

Cold ischemia times ranging from <6 h to as long as 24 h are generally quoted as the limits for attempting the replantation of amputated extremities. In this study, we aimed to assess the effect of hyperbaric carbon monoxide (CO) and oxygen (O) on rat limb preservation. Donor rat limbs were preserved in a chamber filled with hyperbaric CO and O for 3 days (CO + O 3 days) or 7 days (CO + O 7 days). Positive and negative control groups were created by using non-preserved limbs (NP) and limbs wrapped in saline-moistened gauze for 3 days (SMG 3 days), respectively. The survival rate of transplanted limbs at postoperative day 90 was 88% in the NP and 86% in the CO + O 3 days. The corresponding survival rate was 50% in the CO + O 7 days at postoperative day 90 but was 0% in the SMG 3 days at postoperative day 3. Muscle mass decreased in the CO + O 3 days and CO + O 7 days compared with the NP, but sciatic-tibial nerve conduction velocities did not differ. These results indicate that amputated extremities preservation with hyperbaric CO and O could extend the time limits of preservation, maintaining their viability for replantation.
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http://dx.doi.org/10.1038/s41598-018-25070-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919920PMC
April 2018

Platelet-derived Factor Concentrates with Hyaluronic Acid Scaffolds for Treatment of Deep Burn Wounds.

Plast Reconstr Surg Glob Open 2016 Oct 26;4(10):e1089. Epub 2016 Oct 26.

Department of Plastic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan; Department of Plastic Surgery, School of Medicine, University of Tokyo, Tokyo, Japan; Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; and Department of Plastic Surgery, Jichi Medical University, Tochigi, Japan.

A deep burn wound is a critical condition that generally necessitates vascularized tissue coverage. We performed the injection of platelet-derived factor concentrates combined with non-cross-linked hyaluronic acid scaffolds for 2 patients with critical burn wounds with bone and tendon exposure and achieved successful healing. Hyaluronic acid was considered to have served as a controlled-release carrier of platelet-derived factors, being clinically effective for the treatment of deep burn wounds.
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http://dx.doi.org/10.1097/GOX.0000000000001089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096537PMC
October 2016

Allogeneic anorectal transplantation in rats: technical considerations and preliminary results.

Sci Rep 2016 08 4;6:30894. Epub 2016 Aug 4.

Laboratory of Experimental Transplant Surgery, LIM-37, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.

Fecal incontinence is a challenging condition with numerous available treatment modalities. Success rates vary across these modalities, and permanent colostomy is often indicated when they fail. For these cases, a novel potential therapeutic strategy is anorectal transplantation (ATx). We performed four isogeneic (Lewis-to-Lewis) and seven allogeneic (Wistar-to-Lewis) ATx procedures. The anorectum was retrieved with a vascular pedicle containing the aorta in continuity with the inferior mesenteric artery and portal vein in continuity with the inferior mesenteric vein. In the recipient, the native anorectal segment was removed and the graft was transplanted by end-to-side aorta-aorta and porto-cava anastomoses and end-to-end colorectal anastomosis. Recipients were sacrificed at the experimental endpoint on postoperative day 30. Surviving animals resumed normal body weight gain and clinical performance within 5 days of surgery. Isografts and 42.9% of allografts achieved normal clinical evolution up to the experimental endpoint. In 57.1% of allografts, signs of immunological rejection (abdominal distention, diarrhea, and anal mucosa inflammation) were observed three weeks after transplantation. Histology revealed moderate to severe rejection in allografts and no signs of rejection in isografts. We describe a feasible model of ATx in rats, which may allow further physiological and immunologic studies.
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http://dx.doi.org/10.1038/srep30894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4973224PMC
August 2016

Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction.

J Plast Reconstr Aesthet Surg 2016 Jun 26;69(6):827-834. Epub 2016 Mar 26.

Tokyo University School of Medicine, Department of Plastic and Reconstructive Surgery, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.

For hand and finger reconstruction, thin and flexible skin coverage is ideally required. A free flap is one of the surgical options used for large defects. However, a flap containing the fat layer is bulky. Several debulking surgeries are often needed for aesthetic and functional purposes. To overcome this disadvantage, we herein report our experience of six cases of hand and finger reconstruction using a pure skin perforator (PSP) flap concept. A PSP flap is a thin skin flap that is vascularized by a perforator branch penetrating the dermis. The thickness of the PSP flap could be approximately ≤2 mm as needed. The superficial circumflex iliac artery and superficial inferior epigastric artery were used as a flap pedicle. Secondary defatting operations were not required. For the success of PSP flap elevation, we applied three techniques: the microdissection technique for vessel separation, thin flap elevation at the superficial fascial layer, and the temporary clamping method. Temporary clamping was applied for the main trunk of pedicle vessels during debulking to prevent unwanted bleeding, which allowed us to freely perform three-dimensional defatting. Using these three techniques, the PSP flap can be elevated and adjusted for complex contouring of the hand and finger. Although the use of the PSP flap requires further study, the PSP flap is an effective, superthin flap with the advantages of both skin graft and perforator flaps.
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http://dx.doi.org/10.1016/j.bjps.2016.03.005DOI Listing
June 2016

Robotic Harvest of a Right Gastroepiploic Lymph Node Flap.

Arch Plast Surg 2016 Mar 18;43(2):210-2. Epub 2016 Mar 18.

Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.

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http://dx.doi.org/10.5999/aps.2016.43.2.210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807177PMC
March 2016

The venous lymph node flap for the treatment of peripheral lymphedema: Preliminary evidence.

Microsurgery 2017 Jan 13;37(1):86-87. Epub 2016 Feb 13.

Superintendent and Professor, Department of Plastic and Reconstructive Surgery, China Medical University Hospital, 2 Yude Road, Taichung, 40477, ROC Taiwan.

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http://dx.doi.org/10.1002/micr.30036DOI Listing
January 2017

Preoperative color Doppler ultrasonographic examination in the planning of thoracodorsal artery perforator flap with capillary perforators.

J Plast Reconstr Aesthet Surg 2016 Mar 14;69(3):346-50. Epub 2015 Nov 14.

Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.

Introduction: The thoracodorsal artery perforator flap with capillary perforators (TAPcp) is based on capillary perforators arising from the descending branch of the thoracodorsal artery and can overcome the drawbacks of the conventional TAP flap, which results in anatomical variations due to the presence of a dominant muscle or septocutaneous perforators. We applied color Doppler ultrasonography (US) to preoperatively visualize capillary perforators of the descending branch of thoracodorsal artery to facilitate successful flap elevation.

Patients And Methods: Using preoperative color Doppler US, we examined seven flaps in seven patients who had undergone reconstruction with TAPcp flaps between January 2014 and April 2015. Capillary perforators with diameters <0.5 mm were identified in the anterior border of the latissimus dorsi (LD) muscle. Perforator courses and their penetration points were marked to guide dissection.

Results: All seven TAPcp flaps were successfully harvested without pedicle damage or perfusion disorders. No serious postoperative complications occurred such as total necrosis or absorption of the transferred adipose flap. In all seven cases, capillary perforators and the descending branch of the thoracodorsal artery were found almost exactly where the preoperative color Doppler US was targeted.

Conclusion: Using the technique described herein, capillary perforators of the descending branch of the thoracodorsal artery are easily visualized, and TAPcp flaps can be easily used for various kinds of reconstruction. Moreover, this technique is quick and safe to administer.
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http://dx.doi.org/10.1016/j.bjps.2015.10.026DOI Listing
March 2016

[Protein-losing enteropathy with systemic lupus erythematosus effectively treated with octreotide and medium chain triglyceride diet: A case report].

Nihon Rinsho Meneki Gakkai Kaishi 2015 ;38(5):421-5

Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine.

In January 2009, a 62-year-old man presented with diarrhea, leg edema, and thrombopenia and was admitted to our hospital. The past medical history revealed Sjögren's syndrome and autoimmune hepatitis for which he had been administered prednisolone. On admission, a laboratory examination revealed massive hypoalbuminemia and high levels of C-reactive protein and platelet-associated IgG. Anti-double stranded DNA and anti-Sm antibodies were negative. Analysis of the bone marrow aspirate and Tc-99m albumin scintigraphy findings suggested autoimmune thrombocytopenic purpura (AITP) and protein-losing enteropathy (PLE), respectively. We diagnosed him as SLE, because past immunoserological testing had showed positivity for anti-double stranded DNA antibody and LE cells. Methylprednisolone pulse therapy and intravenous immunoglobulin therapy were ineffective. Rituximab was ineffective against PLE but was effective against AITP. Cyclosporine and Cyclophosphamide were ineffective against PLE. Subcutaneous injection of 200-μg octreotide daily and a medium chain triglyceride (MCT) diet was effective against PLE, and the patient's condition dramatically improved. The effectiveness of octreotide treatment and an MCT diet in the treatment of PLE with SLE is discussed.
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http://dx.doi.org/10.2177/jsci.38.421DOI Listing
September 2016

Normothermic preservation of the rat hind limb with artificial oxygen-carrying hemoglobin vesicles.

Transplantation 2015 Apr;99(4):687-92

1 Department of Plastic Surgery, University of Tokyo, Tokyo, Japan. 2 Artificial Red Cells Group, Waseda Bioscience Research Institute in Singapore (WABIOS), Biopolis, Singapore. 3 Department of Chemistry, School of Medicine, Nara Medical University, Nara, Japan. 4 Department of Plastic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan. 5 Department of Plastic Surgery, University of Yamanashi Hospital, Yamanashi, Japan. 6 Department of Anatomy, Aichi Medical University, Aichi, Japan.

Background: For managing major limb amputation, it is important to consider ischemic time and reperfusion injury by free radicals after the blood supply is reestablished. State of preservation during transplant surgery is crucial for the survival and function of the tissue, graft, or organ. In this study, we confirmed the effect of intermittent blood flow in rat ischemic hind limb and developed a new oxygenic preservation method using artificial oxygen carrying hemoglobin vesicles (HbVs).

Methods: We first compared a continuous ischemic model and an intermittent reflow model on rat hind limb. At postoperative day 7, hind limbs were evaluated. Next, we performed total amputation, normothermic preservation by perfusion with extracellular-trehalose-Kyoto (ETK) solution or HbV, and microsurgical replantation of the left hind limb. Venous efflux was analyzed, the amputated limb evaluated after 6 hr perfusion, and the replantation outcome of each model was compared.

Results: In our early study, 24 hr continuous ischemic model necrotized, but intermittent reflow model almost survived except for partial necrosis at postoperative day 7. Scar tissue on the right limb showed myonecrosis and infiltration of inflammatory cells. Skeletal muscle on the right limb was structurally well maintained. Hemoglobin vesicle-treated limbs appeared to have much better oxygenation than ETK-treated limbs. Aerobic respiration remained in the amputated limb, gastrocnemius muscle was well maintained, and the overall replantation was successful in the limb preserved using HbV.

Conclusion: These studies demonstrated that oxygenic preservation is effective for rat ischemic limb, suggesting that this method may be useful for other replantation and transplantation surgeries.
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http://dx.doi.org/10.1097/TP.0000000000000528DOI Listing
April 2015

Steric stabilization of "charge-free" cellulose nanowhiskers by grafting of poly(ethylene glycol).

Molecules 2014 Dec 24;20(1):169-84. Epub 2014 Dec 24.

Graduate School of Science and Technology, Shinshu University, Tokida 3-15-1, Ueda, Nagano Prefecture, 386-8567, Japan.

A sterically stabilized aqueous suspension of "charge-free" cellulose nanowhiskers was prepared by hydrochloric acid hydrolysis of cotton powders and subsequent surface grafting of monomethoxy poly(ethylene glycol) (mPEG). The preparation scheme included carboxylation of the terminal hydroxyl groups in mPEG via oxidation with silica gel particles carrying 2,2,6,6-tetramethyl-1-pyperidinyloxyl (TEMPO) moieties and subsequent esterification between terminal carboxyls in mPEG and surface hydroxyl groups of cellulose nanowhiskers, mediated by 1,1'-carbonyldiimidazole (CDI) in dimethyl sulfoxide or dimethylacetamide. Some of the prepared PEG-grafted samples showed remarkable flow birefringence and enhanced stability after 24 h, even in 0.1 M NaCl, suggesting successful steric stabilization by efficient mPEG grafting. Actual PEG grafting via ester linkages was confirmed by attenuated total reflectance-Fourier transform infrared spectrometry. In a typical example, the amount of grafted mPEG was estimated as ca. 0.3 g/g cellulose by two measurements, i.e., weight increase after grafting and weight loss after alkali cleavage of ester linkages. Transmission electron microscopy indicated unchanged nanowhisker morphology after mPEG grafting.
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http://dx.doi.org/10.3390/molecules20010169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6272749PMC
December 2014

Saturated salt solution method: a useful cadaver embalming for surgical skills training.

Medicine (Baltimore) 2014 Dec;93(27):e196

From the Department of Anatomy (SH, SK, TS, NQ, NH, SH, MI); Department of Emergency and Critical Care Medicine (HH, JO, KK, TS, TY); Department of Anesthesiology (TN, HF, KO), Tokyo Medical University, Tokyo, Japan; Department of Anatomy (MN), Aichi Medical University School of Medicine, Aichi, Japan; Department of Diagnostic Radiology/Division of Ultrasound (AK), Tokyo Medical University Hospital, Tokyo, Japan; Department of Primary Care and Emergency Medicine (NS), Graduate School of Medicine and University School of Medicine, Kyoto University, Kyoto, Japan; Advanced Disaster Medical and Emergency Critical Care Center (TF), Niigata University Medical and Dental Hospital, Niigata, Japan; Department of Emergency and Critical Care Medicine (HT), Kinki University School of Medicine, Osaka, Japan; Shock and Trauma Center (KM), Chiba Hokusoh Hospital, Nippon Medical School, Chiba, Japan; Department of Emergency and Critical Care Medicine (TA), Nihon University School of Medicine Itabashi Hospital, Tokyo, Japan; Department of Orthopaedic Surgery (MI), Niigata City General Hospital, Niigata, Japan; Department of Colorectal Surgery (YN), National Cancer Center Hospital East, Chiba, Japan; Department of Plastic Surgery (JA), University of Tokyo Graduate School of Medicine, Tokyo, Japan; and Division of Gastroenterological and General Surgery (NM), Asahikawa Medical University School of Medicine, Hokkaido, Japan.

This article evaluates the suitability of cadavers embalmed by the saturated salt solution (SSS) method for surgical skills training (SST). SST courses using cadavers have been performed to advance a surgeon's techniques without any risk to patients. One important factor for improving SST is the suitability of specimens, which depends on the embalming method. In addition, the infectious risk and cost involved in using cadavers are problems that need to be solved. Six cadavers were embalmed by 3 methods: formalin solution, Thiel solution (TS), and SSS methods. Bacterial and fungal culture tests and measurement of ranges of motion were conducted for each cadaver. Fourteen surgeons evaluated the 3 embalming methods and 9 SST instructors (7 trauma surgeons and 2 orthopedists) operated the cadavers by 21 procedures. In addition, ultrasonography, central venous catheterization, and incision with cauterization followed by autosuture stapling were performed in some cadavers. The SSS method had a sufficient antibiotic effect and produced cadavers with flexible joints and a high tissue quality suitable for SST. The surgeons evaluated the cadavers embalmed by the SSS method to be highly equal to those embalmed by the TS method. Ultrasound images were clear in the cadavers embalmed by both the methods. Central venous catheterization could be performed in a cadaver embalmed by the SSS method and then be affirmed by x-ray. Lungs and intestines could be incised with cauterization and autosuture stapling in the cadavers embalmed by TS and SSS methods. Cadavers embalmed by the SSS method are sufficiently useful for SST. This method is simple, carries a low infectious risk, and is relatively of low cost, enabling a wider use of cadavers for SST.
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http://dx.doi.org/10.1097/MD.0000000000000196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602773PMC
December 2014

Preparation of sterically stabilized chitin nanowhisker dispersions by grafting of poly(ethylene glycol) and evaluation of their dispersion stability.

Biomacromolecules 2015 Jan 12;16(1):379-88. Epub 2014 Dec 12.

Faculty of Textile Science and Technology, and Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University , Tokida 3-15-1, Ueda, Nagano Prefecture 386-8567, Japan.

Sterically stabilized chitin nanowhiskers (ChNWs) were prepared by surface grafting monomethoxy poly(ethylene glycol) (mPEG) via reductive amination of primary amino groups on ChNWs and terminal aldehydes on mPEG. The amount of grafted mPEG was determined to be 0.2-0.3 g/g ChNWs, by conductometric titration, from the decrease in amino groups after grafting. ChNWs with controlled amounts of surface amino groups were obtained by deacetylation; however, this did not cause a drastic change in the amount of grafted mPEG. Grafting was confirmed by Fourier-transform infrared spectroscopy; however, X-ray diffractometry indicated no sign of mPEG. Thermogravimetry indicated a higher amount of mPEG than that from titration, suggesting an overestimation due to the facilitated combustion of grafted samples. In contrast to ungrafted samples, all grafted samples were stable in the presence of electrolytes. However, liquid-crystalline phase separation of grafted ChNWs was not observed, possibly owing to the high viscosity of the concentrated sample.
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http://dx.doi.org/10.1021/bm5016078DOI Listing
January 2015

Application of normobaric hyperoxygenation to an ischemic flap and a composite skin graft.

Plast Reconstr Surg Glob Open 2014 May 6;2(5):e152. Epub 2014 Jun 6.

Department of Plastic Surgery, University of Tokyo, Tokyo, Japan.

Background: Hyperbaric oxygenation has been used for various purposes, but its clinical application is limited due to its pulmonary toxicity. We evaluated the therapeutic value of normobaric hyperoxygenation (NBO) for vascularized and nonvascularized tissue transplantation.

Methods: Tissue oxygen partial pressure (PtO2) was measured for various organs in mice under inspiratory oxygen of 20%, 60%, or 100%. A rectangular skin flap (1 × 4 cm) or a composite skin graft (2 × 2 cm) was made on the back of mice, which were housed under 20% or 60% oxygen for the first 3 days after surgery. Cell survival was also examined in organ culture skin samples.

Results: PtO2 varied among tissues/organs, but increased depending on inspiratory oxygen concentration in all tissues/organs. Although NBO with 100% O2 was toxic, NBO with 60% O2 was safe even when used continuously for a long period. NBO did not significantly improve survival of the rectangular skin flap. On the other hand, in the composite skin graft model, the engraftment area increased significantly (52 ± 10 at 20% vs 68 ± 5.1 at 60%) and contraction decreased significantly (42 ± 8.0 at 20% vs 27 ± 5.7 at 60%). Organ culture of a composite skin sample showed significant cell death under lower oxygen concentrations, supporting the data in vivo.

Conclusions: The composite graft was maintained until revascularization by plasmatic diffusion from surrounding tissues, in which PtO2 was improved by NBO. NBO may be an effective adjunct therapy that can be performed readily after nonvascularized tissue grafting.
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http://dx.doi.org/10.1097/GOX.0000000000000029DOI Listing
May 2014

Anorectal autotransplantation in a canine model: the first successful report in the short term with the non-laparotomy approach.

Sci Rep 2014 Sep 10;4:6312. Epub 2014 Sep 10.

Department of Plastic Surgery, University of Tokyo, Tokyo, Japan.

Colostomy is conventional treatment for anal dysfunction. Recently, a few trials of anorectal transplantation in animals have been published as a potential alternative to colostomies; however, further development of this technique is required. In this study, we utilized a canine model of anorectal transplantation, evaluated the patency of our microsurgical anastomoses, and assessed the perfusion of the transplanted anus. We designed a canine anorectal transplantation model, wherein anorectal autotransplantation was performed in four healthy beagle dogs by anastomoses of the lower rectum, the bilateral pudendal arteries (PAs) and veins (PVs), and pudendal nerves (PNs). Postoperative graft perfusion was measured by indocyanine green (ICG) angiography and histological examination. The length of the anorectal graft including perianal skin, anal sphincter muscle, bilateral PAs, PVs, and PNs was 4.9 ± 0.3 cm. All diameters of the PAs, PVs, and PNs were large enough to be microscopically anastomosed. Both ICG angiography and histological examination demonstrated good graft perfusion, except for one case that lead to venous congestion. These results show that anastomosis of the bilateral PAs, PVs, and PNs is required for anorectal transplantation. This is the first successful report of canine anorectal autotransplantation.
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http://dx.doi.org/10.1038/srep06312DOI Listing
September 2014

Normobaric hyperoxygenation enhances initial survival, regeneration, and final retention in fat grafting.

Plast Reconstr Surg 2014 Nov;134(5):951-959

Tokyo, Japan From the Department of Plastic Surgery, University of Tokyo School of Medicine.

Background: Fat grafting is a promising modality for soft-tissue augmentation/reconstruction. However, grafted fat tissue is not initially perfused and relies on plasmatic diffusion from the recipient bed until revascularization occurs. The authors evaluated the therapeutic effects of normobaric hyperoxygenation for enhancing fat graft retention.

Methods: Aspirated human fat tissue was cultured under tissue hypoxia (1% oxygen), normoxia (6%), and hyperoxia (20%) levels, and evaluated for adipocyte viability. Inguinal fat pads were autografted under mouse scalps (n=36), and mice were housed in either 20% (control) or 60% (normobaric hyperoxygenation) atmospheric oxygen for the first 3 days, and then returned to normoxia. Samples harvested at 0, 1, 2, 4, 8, and 12 weeks were analyzed immunohistochemically for adipocyte viability and regeneration.

Results: Organ culture adipocytes died more quickly under lower oxygen tensions; thus, hyperoxygenation of recipient tissues may delay adipocyte death after fat grafting. Autografted mouse adipose tissue underwent dynamic remodeling, from ischemic degeneration to partial regeneration, over 12 weeks. Normobaric hyperoxygenation grafted samples showed significantly larger survival zones and engraftment scores (calculated using sample weight and adipocyte viability) at 1 and 12 weeks, respectively, than control samples. In addition, adipocyte regeneration (number of perilipin-positive preadipocytes), which peaked at 4 weeks, was significantly increased in normobaric hyperoxygenation samples.

Conclusion: The normobaric hyperoxygenation protocol using 60% oxygen can be safely applied to enhance adipocyte survival, regeneration, and final engraftment after fat grafting.
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http://dx.doi.org/10.1097/PRS.0000000000000600DOI Listing
November 2014

Uterus allotransplantation in cynomolgus macaque: a preliminary experience with non-human primate models.

J Obstet Gynaecol Res 2014 Apr 26;40(4):907-18. Epub 2014 Feb 26.

Department of Obstetrics and Gynecology, Keio University, Tokyo, Japan.

Aim: Uterine transplantation (UTx) is a potential option for child-bearing in women with uterine infertility. Recovery of uterine function after allogeneic UTx in non-human primates has not been reported. The objective of this study is to establish the functional uterine transplant model in non-human primates.

Methods: Uteri of two cynomolgus monkeys were simultaneously removed, cooled at 4°C and perfused with heparin saline. The uteri were interchanged with each other and then orthotopically transplanted. Immunosuppressive protocols included use of three agents (tacrolimus, mycophenolate mofetil and methylprednisolone) in case 1 and two agents (tacrolimus and methylprednisolone) in case 2. Transabdominal ultrasonography, vaginoscopy and biopsy of the transplanted uterine cervix were routinely conducted to monitor rejection after surgery.

Results: The blood concentration of tacrolimus decreased 11 days after surgery and evidence of rejection was found in biopsy of the uterine cervix in both cases. The suspected rejection disappeared 23 days after surgery in case 1 and temporary menstruation resumed at 3 months after surgery. In case 2, blood flow to the uterine artery gradually decreased and the uterus resulted in atrophy due to ischemia, which has been triggered by rejection.

Conclusion: Allogeneic UTx in the cynomolgus monkeys resulted in temporary recovery of menstruation with three immunosuppressants and uterine atrophy with two immunosuppressants. This preliminary experience suggests that recovery of uterine function after allogeneic UTx in non-human primates is possible but more experiments are required.
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http://dx.doi.org/10.1111/jog.12302DOI Listing
April 2014
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