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Weekes A, Wehr G, Pinto N, Jenkins J, Li Z, Meinert C, Klein TJ. Highly compliant biomimetic scaffolds for small diameter tissue-engineered vascular grafts (TEVGs) produced via melt electrowriting (MEW). Biofabrication 2023; 16:015017. [PMID: 37992322 DOI: 10.1088/1758-5090/ad0ee1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/22/2023] [Indexed: 11/24/2023]
Abstract
Biofabrication approaches toward the development of tissue-engineered vascular grafts (TEVGs) have been widely investigated. However, successful translation has been limited to large diameter applications, with small diameter grafts frequently failing due to poor mechanical performance, in particular mismatched radial compliance. Herein, melt electrowriting (MEW) of poly(ϵ-caprolactone) has enabled the manufacture of highly porous, biocompatible microfibre scaffolds with physiological anisotropic mechanical properties, as substrates for the biofabrication of small diameter TEVGs. Highly reproducible scaffolds with internal diameter of 4.0 mm were designed with 500 and 250µm pore sizes, demonstrating minimal deviation of less than 4% from the intended architecture, with consistent fibre diameter of 15 ± 2µm across groups. Scaffolds were designed with straight or sinusoidal circumferential microfibre architecture respectively, to investigate the influence of biomimetic fibre straightening on radial compliance. The results demonstrate that scaffolds with wave-like circumferential microfibre laydown patterns mimicking the architectural arrangement of collagen fibres in arteries, exhibit physiological compliance (12.9 ± 0.6% per 100 mmHg), while equivalent control geometries with straight fibres exhibit significantly reduced compliance (5.5 ± 0.1% per 100 mmHg). Further mechanical characterisation revealed the sinusoidal scaffolds designed with 250µm pores exhibited physiologically relevant burst pressures of 1078 ± 236 mmHg, compared to 631 ± 105 mmHg for corresponding 500µm controls. Similar trends were observed for strength and failure, indicating enhanced mechanical performance of scaffolds with reduced pore spacing. Preliminaryin vitroculture of human mesenchymal stem cells validated the MEW scaffolds as suitable substrates for cellular growth and proliferation, with high cell viability (>90%) and coverage (>85%), with subsequent seeding of vascular endothelial cells indicating successful attachment and preliminary endothelialisation of tissue-cultured constructs. These findings support further investigation into long-term tissue culture methodologies for enhanced production of vascular extracellular matrix components, toward the development of the next generation of small diameter TEVGs.
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Affiliation(s)
- Angus Weekes
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, Australia
| | - Gabrielle Wehr
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, Australia
| | - Nigel Pinto
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, Australia
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Jason Jenkins
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, Australia
- Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Zhiyong Li
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Christoph Meinert
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, Australia
| | - Travis J Klein
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Paul S, Schrobback K, Tran PA, Meinert C, Davern JW, Weekes A, Klein TJ. Photo-Cross-Linkable, Injectable, and Highly Adhesive GelMA-Glycol Chitosan Hydrogels for Cartilage Repair. Adv Healthc Mater 2023; 12:e2302078. [PMID: 37737465 DOI: 10.1002/adhm.202302078] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/27/2023] [Indexed: 09/23/2023]
Abstract
Hydrogels provide a promising platform for cartilage repair and regeneration. Although hydrogels have shown some efficacy, they still have shortcomings including poor mechanical properties and suboptimal integration with surrounding cartilage. Herein, hydrogels that are injectable, cytocompatible, mechanically robust, and highly adhesive to cartilage are developed. This approach uses GelMA-glycol chitosan (GelMA-GC) that is crosslinkable with visible light and photoinitiators (lithium acylphosphinate and tris (2,2'-bipyridyl) dichlororuthenium (II) hexahydrate ([RuII(bpy)3 ]2+ and sodium persulfate (Ru/SPS)). Ru/SPS-cross-linked hydrogels have higher compressive and tensile modulus, and most prominently higher adhesive strength with cartilage, which also depends on inclusion of GC. Tensile and push-out tests of the Ru/SPS-cross-linked GelMA-GC hydrogels demonstrate adhesive strength of ≈100 and 46 kPa, respectively. Hydrogel precursor solutions behave in a Newtonian manner and are injectable. After injection in focal bovine cartilage defects and in situ cross-linking, this hydrogel system remains intact and integrated with cartilage following joint manipulation ex vivo. Cells remain viable (>85%) in the hydrogel system and further show tissue regeneration potential after three weeks of in vitro culture. These preliminary results provide further motivation for future research on bioadhesive hydrogels for cartilage repair and regeneration.
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Affiliation(s)
- Sattwikesh Paul
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- Department of Surgery and Radiology, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University (BSMRAU), Gazipur, 1706, Bangladesh
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
| | - Karsten Schrobback
- School of Biomedical Sciences, Centre for Genomics and Personalised Health, Translational Research Institute, Queensland University of Technology (QUT), 37 Kent Street, Woolloongabba, QLD, 4102, Australia
| | - Phong Anh Tran
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
| | - Christoph Meinert
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
- Chief Executive Officer of Gelomics Pty Ltd, Brisbane, Queensland, 4059, Australia
| | - Jordan William Davern
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
- ARC Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Angus Weekes
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
| | - Travis Jacob Klein
- Centre for Biomedical Technologies, Queensland University of Technology, 60 Musk Ave., Kelvin Grove, QLD, 4059, Australia
- School of Mechanical, Medical and Process Engineering, Queensland University of Technology (QUT), 2 George Street, Brisbane, QLD, 4000, Australia
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Paul S, Schrobback K, Tran PA, Meinert C, Davern JW, Weekes A, Nedunchezhiyan U, Klein TJ. GelMA-glycol chitosan hydrogels for cartilage regeneration: The role of uniaxial mechanical stimulation in enhancing mechanical, adhesive, and biochemical properties. APL Bioeng 2023; 7:036114. [PMID: 37692373 PMCID: PMC10492648 DOI: 10.1063/5.0160472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Untreated osteochondral defects are a leading cause of osteoarthritis, a condition that places a heavy burden on both patients and orthopedic surgeons. Although tissue engineering has shown promise for creating mechanically similar cartilage-like constructs, their integration with cartilage remains elusive. Therefore, a formulation of biodegradable, biocompatible biomaterial with sufficient mechanical and adhesive properties for cartilage repair is required. To accomplish this, we prepared biocompatible, photo-curable, mechanically robust, and highly adhesive GelMA-glycol chitosan (GelMA-GC) hydrogels. GelMA-GC hydrogels had a modulus of 283 kPa and provided a biocompatible environment (>70% viability of embedded chondrocytes) in long-term culture within a bovine cartilage ring. The adhesive strength of bovine chondrocyte-laden GelMA-GC hydrogel to bovine cartilage increased from 38 to 52 kPa over four weeks of culture. Moreover, intermittent uniaxial mechanical stimulation enhanced the adhesive strength to ∼60 kPa, indicating that the cartilage-hydrogel integration could remain secure and functional under dynamic loading conditions. Furthermore, gene expression data and immunofluorescence staining revealed the capacity of chondrocytes in GelMA-GC hydrogel to synthesize chondrogenic markers (COL2A1 and ACAN), suggesting the potential for tissue regeneration. The promising in vitro results of this work motivate further exploration of the potential of photo-curable GelMA-GC bioadhesive hydrogels for cartilage repair and regeneration.
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Affiliation(s)
| | - Karsten Schrobback
- School of Biomedical Sciences, Centre for Genomics and Personalised Health, Translational Research Institute, Queensland University of Technology (QUT), 37 Kent Street, Woolloongabba, QLD 4102, Australia
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Weekes A, Bartnikowski N, Pinto N, Jenkins J, Meinert C, Klein TJ. Biofabrication of small diameter tissue-engineered vascular grafts. Acta Biomater 2022; 138:92-111. [PMID: 34781026 DOI: 10.1016/j.actbio.2021.11.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022]
Abstract
Current clinical treatment strategies for the bypassing of small diameter (<6 mm) blood vessels in the management of cardiovascular disease frequently fail due to a lack of suitable autologous grafts, as well as infection, thrombosis, and intimal hyperplasia associated with synthetic grafts. The rapid advancement of 3D printing and regenerative medicine technologies enabling the manufacture of biological, tissue-engineered vascular grafts (TEVGs) with the ability to integrate, remodel, and repair in vivo, promises a paradigm shift in cardiovascular disease management. This review comprehensively covers current state-of-the-art biofabrication technologies for the development of biomimetic TEVGs. Various scaffold based additive manufacturing methods used in vascular tissue engineering, including 3D printing, bioprinting, electrospinning and melt electrowriting, are discussed and assessed against the biomechanical and functional requirements of human vasculature, while the efficacy of decellularization protocols currently applied to engineered and native vessels are evaluated. Further, we provide interdisciplinary insight into the outlook of regenerative medicine for the development of vascular grafts, exploring key considerations and perspectives for the successful clinical integration of evolving technologies. It is expected that continued advancements in microscale additive manufacturing, biofabrication, tissue engineering and decellularization will culminate in the development of clinically viable, off-the-shelf TEVGs for small diameter applications in the near future. STATEMENT OF SIGNIFICANCE: Current clinical strategies for the management of cardiovascular disease using small diameter vessel bypassing procedures are inadequate, with up to 75% of synthetic grafts failing within 3 years of implantation. It is this critically important clinical problem that researchers in the field of vascular tissue engineering and regenerative medicine aim to alleviate using biofabrication methods combining additive manufacturing, biomaterials science and advanced cellular biology. While many approaches facilitate the development of bioengineered constructs which mimic the structure and function of native blood vessels, several challenges must still be overcome for clinical translation of the next generation of tissue-engineered vascular grafts.
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Affiliation(s)
- Angus Weekes
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, 4006, Australia.
| | - Nicole Bartnikowski
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, 4035, Australia.
| | - Nigel Pinto
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, 4006, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia.
| | - Jason Jenkins
- Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, 4006, Australia; Department of Vascular Surgery, The Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia.
| | - Christoph Meinert
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; Herston Biofabrication Institute, Metro North Hospital and Health Services, Herston, QLD, 4006, Australia.
| | - Travis J Klein
- Centre for Biomedical Technologies, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia; School of Mechanical, Medical and Process Engineering, Faculty of Engineering, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
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PESCOR Steering Committee, Raper J, Thomas A, Lupez K, Cox C, Esener D, Boyd J, Nomura J, Davison J, Ockerse P, Leech S, Weekes A. 269 Added Prognostic Value of Right Ventricular Dysfunction Assessments. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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PESCOR Steering Committee, Weekes A, Raper J, Lupez K, Cox C, Thomas A, Esener D, Boyd J, Nomura J, Davison J, Ockerse P, Leech S. 267 Development and Validation of a Prognostic Tool: Pulmonary Embolism Short-Term Clinical Outcomes Risk Estimation. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Weekes A, Fraga D, Belyshev V, Gardner C, Bost W, Rigdon J, O'Connell N. 270 Echocardiography Predictors of Acute Clinical Deterioration After Pulmonary Embolism. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Driscoll A, Beltrame J, Beauchamp A, Morgan C, Weekes A, Tonkin A. Reducing risk in coronary artery disease. Are Australian patients in general practice achieving targets? The Coronary Artery Disease in general practice study (CADENCE). Intern Med J 2013; 43:526-31. [DOI: 10.1111/j.1445-5994.2012.02929.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 08/01/2012] [Indexed: 11/30/2022]
Affiliation(s)
- A. Driscoll
- School of Nursing and Midwifery; Deakin University; Melbourne Victoria Australia
| | - J. Beltrame
- Cardiology Unit; The Queen Elizabeth Hospital; University of Adelaide; Adelaide South Australia Australia
| | - A. Beauchamp
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - C. Morgan
- Servier Laboratories; Melbourne Victoria Australia
| | - A. Weekes
- Servier Laboratories; Melbourne Victoria Australia
| | - A. Tonkin
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
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Tayal V, Weekes A, Tassone H, Marx J. 443: Early Impact on Workflow and Administrative Costs of a Web-Based Ultrasonography States Data Management Network on a Large Volume Emergency Ultrasonography Program. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tayal V, Weekes A, Jayarama K, Norton J. 299: Comparison of Three Different Emergency Ultrasonography Applications Using 3D and Biplanar Probe Technology. Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hohaus L, Weekes A. P01-360 - Training in cognitive reasoning for elders: is more better? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Mehra G, Weekes A, Vantrappen P, Visvanathan D, Jeyarajah A. Laparoscopic assisted radical vaginal hysterectomy for cervical carcinoma: morbidity and long-term follow-up. Eur J Surg Oncol 2009; 36:304-8. [PMID: 19800194 DOI: 10.1016/j.ejso.2009.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Revised: 08/19/2009] [Accepted: 08/23/2009] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To study the feasibility, morbidity and outcome of cervical cancer patients treated with laparoscopic assisted radical vaginal hysterectomy (LARVH). METHODS The study group included 53 women with cervical cancer (stage-Ib). They included women undergoing LARVH at the joint cancer-centres between 1994 and 2002. Data was collected on operating-time, nodal-yield, hospital-stay, complications recurrence rate and survival rate. The group was followed up until 2006. RESULTS Of 53 women who were selected for LARVH, in 2 women LARVH was abandoned when nodes were positive at frozen section. The median age was 42 years while the operating-time was 210 min with a nodal-yield of 23 and a hospital-stay of 5 days. Final histology revealed 10 women with lympho-vascular invasion, 1 nodal metastases and invasion of parametrium/vagina in 2 women. 7 received adjuvant radiotherapy. 3 had chemo-radiation. Complications included voiding difficulty (6), urinary tract infection (5), pyrexia (4), haemorrhage (2), pain (1), port-site haematoma (1) and nerve injury (1). Late complications included lymphoedema (4), urinary incontinence (4), voiding-problems (2), lymphocyst (1), venous-thrombosis (1) and rectocele (1). The median follow-up was 41 months. 4 women had recurrence, of which 3 women died. The five-year survival was 89%. CONCLUSIONS Vaginal radical hysterectomy with laparoscopic pelvic lymphadenectomy is feasible and safe with regards to mortality and has low morbidity.
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Affiliation(s)
- G Mehra
- Gynaecological Oncology Cancer Centre, St. Bartholomew's Hospital, London, UK.
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Turnbull F, Arima H, Heeley E, Peiris D, Weekes A, Morgan C, Cass A, Anderson C, Patel A, Chalmers J. Cardiovascular risk management among female and male patients in Australian General Practice: The AusHEART study. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Heeley E, Peiris D, Weekes A, Cass A, Anderson C, Patel A, Chalmers J. Prescribing of secondary prevention measures in Australian General Practice is lower in patients following an ischaemic stroke compared to those with a previous myocardial infarction. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- N Rawal
- Department of Obstetrics and Gynaecology, Harold Wood Hospital, Romford, Essex, UK.
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Grochmal SA, Weekes A, Garratt D, Slatkine M, Hanson E. Applications of the laparoscopic ultrasonic aspirator for advanced gynecologic operative endoscopic procedures. J Am Assoc Gynecol Laparosc 1993; 1:43-7. [PMID: 9050459 DOI: 10.1016/s1074-3804(05)80757-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We evaluated the efficacy of a new laparoscopic ultrasonic aspirator and applied it in gynecologic endoscopy. Two procedures were selected for preliminary evaluation of the instrument; ultrasonic aspiration for selective presacral neurectomies and total laparoscopic hysterectomy (TLH). The aspirator worked successfully in evacuating soft tissue and in adequately exposing the presacral plexus. In TLH we were able to skeletonize the broad ligament adventitia all the way to the level of the uterine arteries bilaterally, including exposure of the ureters. The time required for the procedures varied from case to case, and strongly depended on tissue type and on instruments used to dissect and improve visualization of the operative field. The aspirator may prove useful as an adjunctive in the surgical management of endometriosis, in laparoscopic lymphadenectomy, and in treating complex adhesions after further evaluation is completed.
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Affiliation(s)
- S A Grochmal
- New Jersey Laser Institute, P.O. Box 2374, Princeton, NJ 08543-2374, USA
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Abstract
Infant mortality rates vary from area to area. Part of this variation is due to the socioeconomic characteristics of the area and part to other factors including the obstetric, paediatric, and community health services. Four social indicators associated with infant deaths are used to control for some of the variations in socioeconomic characteristics and residual variation is then examined. The four social indicators are the level of unemployment, the proportion of large families, the proportion of lone-parent families, and the level of overcrowding.
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