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A halin yanzu ana kan gudanar da bincike daban-daban na ƙayyadaddun ƙayyadaddun bututun Eustachian (ET), amma har yanzu ba a yi amfani da shi ba a aikin asibiti.A cikin bincike na yau da kullun, ET scaffolds an iyakance ga haɓakar nama da ke haifar da ɓarna.Ingancin cobalt-chromium sirolimus-eluting stent (SES) a cikin hana haɓakar nama da ke haifar da stent bayan an yi nazarin saka stent a cikin samfurin porcine ET.An raba aladu shida zuwa ƙungiyoyi biyu (watau ƙungiyar kulawa da ƙungiyar SES) tare da aladu uku a kowace ƙungiya.Ƙungiyar kulawa ta sami stent cobalt-chromium wanda ba a rufe shi ba (n = 6), kuma ƙungiyar SES ta sami cobalt-chromium stent tare da suturar sirolimus-eluting (n = 6).An sadaukar da duk ƙungiyoyin makonni 4 bayan sanya stent.Sanya Stent ya yi nasara a duk ETs ba tare da rikitarwa masu alaƙa da tiyata ba.Babu ɗaya daga cikin stent ɗin da zai iya riƙe ainihin siffar zagayensa, kuma an ga tarin gaɓoɓin a ciki da kewayen stent a ƙungiyoyin biyu.Binciken tarihi ya nuna cewa yanki na haɓakar nama da kauri na fibrosis na submucosal a cikin ƙungiyar SES sun kasance ƙasa da ƙasa fiye da ƙungiyar kulawa.SES ya bayyana yana da tasiri wajen hana yaduwar nama mai lalacewa a cikin ET aladu.Koyaya, ana buƙatar ƙarin karatu don tabbatar da mafi kyawun kayan don stent da magungunan antiproliferative.
Bututun Eustachian (ET) yana da ayyuka masu mahimmanci a cikin kunnen tsakiya (misali, samun iska, hana canja wurin ƙwayoyin cuta da ɓoyewa zuwa nasopharynx)1.Hakanan ya haɗa da kariya daga sautin nasopharyngeal da regurgitation2.Yawancin lokaci ana rufe ET, amma yana buɗewa da haɗiye, hamma, ko tauna.Duk da haka, rashin aiki na ET na iya faruwa idan bututun bai buɗe ko rufe daidai ba3,4.Rashin aiki mai lalacewa (mai hanawa) na ET yana lalata aikin ET kuma, idan waɗannan ayyukan ba a kiyaye su ba, na iya haɓaka zuwa kafofin watsa labarai na otitis mai tsanani ko na yau da kullun, ɗayan cututtukan da aka fi sani da aikin ENT.Jiyya na yanzu don rashin aiki na ET (misali, tiyatar hanci, sanya bututun iska, da magani) ana amfani da su a cikin marasa lafiya.Koyaya, waɗannan jiyya suna da ƙayyadaddun inganci kuma suna iya haifar da toshewar ET, kamuwa da cuta, da ɓarna tympanic membrane mara jurewa3,6,7.An gabatar da Eustachian tube balloon angioplasty azaman madadin magani don lalatawar ET 8.Ko da yake da yawa karatu tun 2010 ya nuna cewa Eustachian tube balloon gyara ya fi na al'ada magani ga ET dysfunction, wasu marasa lafiya ba su amsa dilatation8,9,10,11.Don haka, stenting na iya zama zaɓin magani mai inganci12,13.Duk da ɗimbin karatun ƙididdiga masu yawa waɗanda ke kimanta yuwuwar fasaha da amsawar nama bayan sanya stent a cikin ET, stent-induced nama hyperplasia saboda lalacewar inji ya kasance babban mawuyacin rikitarwa bayan tiyata 14,15,16,17,18,19.mai rufaffiyar ƙwayoyi, wanda aka ɗora tare da magungunan rigakafin haɓaka wannan yanayin.
An yi amfani da stent mai cire ƙwayoyi don hana in-stent restenosis lalacewa ta hanyar nama da neointimal hyperplasia bayan sanya stent.Yawanci, ana lulluɓe stent ko linings da kwayoyi (misali, Everolimus, paclitaxel, da sirolimus)20,23,24.Sirolimus wani nau'in magani ne na antiproliferative wanda ke hana matakai da yawa na cascade na restenosis (misali, kumburi, hyperplasia neointimal, da haɗin collagen)25.Sabili da haka, wannan binciken yayi tsammanin cewa sirolimus-mai rufi stent zai iya hana stent-induced nama hyperplasia a cikin ET aladu (Figure 1).Manufar wannan binciken shine don bincika ingancin sirolimus-eluting stent (SES) a cikin hana yaduwar nama mai lalacewa bayan sanyawa a cikin samfurin ET porcine.
Hoton zane-zane na cobalt-chromium sirolimus-eluting stent (SES) don maganin rashin aikin bututun Eustachian, yana nuna cewa sirolimus-eluting stent yana hana yaduwar nama mai haifar da stent.
Cobalt-chromium (Co-Cr) alloy stents an ƙirƙira su ta hanyar Laser yankan Co-Cr gami tubes (Genoss Co., Ltd., Suwon, Korea).Dandalin stent yana amfani da buɗaɗɗen haɗin gwiwa biyu tare da haɗin ginin gine-gine don babban sassauci tare da mafi kyawun ƙarfin radial, gajarta da yarda.Tsawon yana da diamita na 3 mm, tsayin 18 mm, da kauri na 78 µm (Fig. 2a).An ƙididdige ma'auni na firam ɗin Co-Cr dangane da bincikenmu na baya.
Cobalt-chromium (Co-Cr) alloy stent da karfe jagorar sheath don Eustachian tube stent jeri.Hotunan sun nuna (a) Co-Cr alloy stent da (b) catheter balloon mai kauri.(c) Katheter na balloon da stent an tura su gabaɗaya.(d) An ƙera wani kumfa mai jagora na ƙarfe don ƙirar bututun porcine Eustachian.
An yi amfani da Sirolimus a saman stent ta amfani da fasahar fesa ultrasonic.An tsara SES don sakin kusan kashi 70% na ainihin nauyin ƙwayoyi (1.15 μg/mm2) a cikin kwanaki 30 na farko bayan sanyawa.An yi amfani da murfin 3 µm mai ƙwanƙwasa kawai zuwa gefen kusa da stent don cimma bayanin sakin miyagun ƙwayoyi da ake so kuma rage girman adadin polymer;wannan rufin da za a iya cirewa ya ƙunshi copolymer na lactic da glycolic acid da haɗin mallakar mallaka na poly (1) -lactic acid)26,27.Co-Cr alloy stent an crimped a kan balloon catheters 3 mm a diamita da 28 mm tsawo (Genoss Co., Ltd.; Hoto 2b).Ana samun waɗannan stent a Koriya ta Kudu don maganin cututtukan zuciya.
Sabuwar harsashi mai jagora na ƙarfe don ƙirar ET alade an yi shi da bakin karfe (Fig. 2c).A ciki da waje diamita na harsashi ne 2 mm da 2.5 mm, bi da bi, jimlar tsawon shi ne 250 mm.Kwancen 30 mm mai nisa an lankwasa shi a cikin siffar J a kusurwar 15 ° zuwa axis don ba da damar sauƙi daga hanci zuwa nasopharyngeal orifice na ET a cikin samfurin alade.
Kwamitin Kula da Dabbobi na Cibiyar Kula da Dabbobi da Amfani na Cibiyar Nazarin Rayuwa ta Asan (Seoul, Koriya ta Kudu) ta amince da wannan binciken kuma ya bi ka'idodin Cibiyoyin Kiwon Lafiya na Kasa don Kula da Dabbobin Dabbobi (IACUC-2020-12-189)..An gudanar da binciken ne bisa ka'idojin ARRIVE.Wannan binciken ya yi amfani da 12 ET a cikin 6 aladu masu nauyin 33.8-36.4 kg a 3 watanni.An raba aladu shida zuwa ƙungiyoyi biyu (watau ƙungiyar kulawa da ƙungiyar SES) tare da aladu uku a kowace ƙungiya.Ƙungiya mai kulawa ta sami stent Co-Cr alloy stent wanda ba a rufe shi ba, yayin da ƙungiyar SES ta sami Co-Cr alloy stent eluting sirolimus.Duk aladu suna da damar samun ruwa da abinci kyauta kuma an kiyaye su a 24°C ± 2°C don zagayowar rana-12-hour.Daga baya, duk aladu an yi hadaya 4 makonni bayan sanya stent.
Duk aladu sun sami cakuda 50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, Faransa) da 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Jamus).sannan an sanya bututun tracheal ta hanyar inhalation na 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Korea) da oxygen 1: 1 (510 ml / kg / min) don maganin sa barci.An sanya aladu a cikin matsayi na baya kuma an yi amfani da endoscopy na asali (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Japan) don bincikar nasopharyngeal orifice na ET.An ci gaba da kumfa mai jagora na ƙarfe ta hanci zuwa madaidaicin nasopharyngeal na ET a ƙarƙashin ikon endoscopic (Fig. 3a, b).Ana saka catheter na balloon, stent corrugated, ta hanyar mai gabatarwa a cikin ET har sai titinsa ya gamu da juriya a cikin osteochondral isthmus na ET (Fig. 3c).An lulluɓe catheter ɗin balloon tare da saline zuwa yanayi 9, kamar yadda mai duba manometer ya ƙaddara (Fig. 3d).An cire catheter na balloon bayan da aka sanya stent (Fig. 3f), kuma an yi la'akari da budewar nasopharyngeal a hankali don matsalolin tiyata (Fig. 3f).Dukkan aladu an yi amfani da endoscopy kafin da nan da nan bayan stenting, da kuma makonni 4 bayan stenting, don tantance patency na stent site da kewaye secretions.
Matakan fasaha don sanya stent a cikin bututun eustachian (ET) na alade a ƙarƙashin ikon endoscopic.(a) Hoton Endoscopic yana nuna buɗaɗɗen nasopharyngeal (kibiya) da shigar da sheath jagorar ƙarfe (kibiya).(b) Shigar da kwandon karfe (kibiya) cikin buɗaɗɗen hanci.(c) Ana shigar da catheter na balloon mai stent (kibiya) a cikin ET ta kube (kibiya).(d) Katheter na balloon (kibiya) ya cika sosai.(e) Ƙarshen ƙarshen stent yana fitowa daga ET orifice na nasopharynx.(f) Hoton Endoscopic yana nuna patency na stent lumen.
Dukkan aladu an cire su ta hanyar ba da 75 mg/kg potassium chloride ta allurar jijiya ta kunne.An yi sassan sagittal na tsaka-tsaki na kan porcine ta amfani da chainsaw sannan a hankali cire samfuran nama na ET don gwajin tarihi (Ƙarin Hoton 1a,b).Samfuran nama na ET an gyara su a cikin 10% na tsaka-tsaki da aka buffered formalin na awanni 24.
Samfuran nama na ET an bi da su tare da barasa mai yawa daban-daban.An sanya samfurori a cikin tubalan guduro ta hanyar shigar da ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Jamus).An yi sassan axial akan samfuran nama na ET da aka haɗa a cikin sassan kusa da nesa (Ƙarin Hoton 1c).Sannan an ɗora tubalan polymer akan faifan gilashin acrylic.Gudun toshe nunin faifai sun kasance ƙananan ƙasa kuma an goge su tare da takardar siliki mai kauri daban-daban har zuwa kauri na 20 µm ta amfani da tsarin grid (Apparatebau GMBH, Hamburg, Jamus).Dukkan nunin nunin faifai an sanya su don kimanta ilimin tarihi tare da hematoxylin da tabon eosin.
An gudanar da kima na tarihi don tantance yawan yawan ƙwayar nama, kauri na fibrosis na submucosal, da kuma matakin ƙwayar ƙwayar ƙwayar cuta.An ƙididdige yawan adadin hyperplasia na nama tare da kunkuntar yanki na giciye ET ta hanyar warware lissafin:
An auna kaurin fibrosis na submucosal a tsaye daga stent struts zuwa submucosa.Digiri na ƙwayar ƙwayar cuta mai zurfi da aka yi hukunci da tsari ta hanyar rarraba da yawa na kumburi da sel, wato: 1st) - insigra guda ɗaya;Mataki na 2 (mai sauƙi zuwa matsakaici) - ƙaddamar da leukocyte mai mahimmanci;Digiri na 3 (matsakaici) - hade.tare da leukocytes sun kasa bambanta tsakanin loci na mutum;aji na 4 (matsakaicin zuwa mai tsanani) leukocytes suna yaduwa suna kutsawa cikin dukkan submucosa, da kuma aji 5 (mai tsanani) suna yada kutse tare da yawan abubuwan da ke tattare da necrosis.An sami kauri na fibrosis na submucosal da matakin ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta samu ta hanyar matsakaicin maki takwas a kusa da kewaye.An yi nazarin tarihin tarihi na ET ta amfani da na'ura mai ma'ana (BX51; Olympus, Tokyo, Japan).An samo ma'aunin ta amfani da software na CaseViewer (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary).Binciken bayanan tarihi ya dogara ne akan ijma'in masu lura guda uku waɗanda ba su shiga cikin binciken ba.
An yi amfani da gwajin Mann-Whitney U-test don tantance bambance-bambance tsakanin ƙungiyoyi kamar yadda ake buƙata. A p <0.05 an yi la'akari da mahimmancin ƙididdiga. A p <0.05 an yi la'akari da mahimmancin ƙididdiga. Значение p <0,05 считалось статистически значимым. An yi la'akari da ƙimar p <0.05 a cikin ƙididdiga. p <0.05 被认为具有统计学意义。 p <0.05 p <0,05 считали статистически значимым. p <0.05 an yi la'akari da mahimmancin ƙididdiga. An yi gwajin gwajin Mann-Whitney U-Bonferroni don ƙimar p <0.05 don gano bambance-bambancen rukuni (p <0.008 a matsayin mahimmancin ƙididdiga). An yi gwajin Mann-Whitney U-Bonferroni da aka gyara don ƙimar p <0.05 don gano bambance-bambancen rukuni (p <0.008 a matsayin mahimmancin ƙididdiga). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 атистически значимое). An yi gwajin Bonferroni-daidaitacce Mann-Whitney U don ƙimar p <0.05 don gano bambance-bambancen rukuni (p <0.008 a matsayin mahimmancin ƙididdiga).对p 值< 0.05 进行Bonferroni 校正的 Mann-Whitney U 检验以检测组差异（p <0.008对p 值< 0.05 进行Bonferroni 校正的 Mann-Whitney U U-критерий Манна-Уитни споправкой на Бонферрони был выполнен для значений p <0,05 для выявления гиб статистически значимым). An yi gwajin Bonferroni Mann-Whitney U-gwajin don p <0.05 don gano bambance-bambancen rukuni (p <0.008 yana da mahimmanci a ƙididdiga).An yi nazarin ƙididdiga ta amfani da software na SPSS (sigar 27.0; SPSS, IBM, Chicago, IL, Amurka).
Duk wuraren da aka sanya stent na porcine sun yi nasara a fasaha.An sami nasarar sanya suturar jagorar ƙarfe a cikin nasopharyngeal orifice na ET a ƙarƙashin kulawar endoscopic, kodayake raunin mucosal tare da zubar da jini an lura da shi a cikin 4 na samfuran 12 (33.3%) yayin shigar da suturar ƙarfe.Bayan makonni 4, zubar da jini mai kama da juna ya tsaya.Duk aladu sun tsira har zuwa ƙarshen binciken ba tare da rikitarwa masu alaƙa da stent ba.
Ana nuna sakamakon Endoscopy a cikin Hoto 4. A lokacin bin 4-mako, stents sun kasance a wurin a duk aladu.An lura da tarin ƙwayar cuta a ciki da kuma kewaye da ET stent a cikin duk (100%) ET a cikin ƙungiyar kulawa da uku (50%) na ETs shida a cikin ƙungiyar SES, kuma babu wani bambanci a tsakanin ƙungiyoyi biyu (p = 0.182).Babu ɗaya daga cikin stent ɗin da aka shigar da zai iya kiyaye siffar zagaye.
Hotunan Endoscopic na Eustachian tube (ET) na alade a cikin ƙungiyar kulawa da rukuni tare da cobalt-chromium stent (CXS) eluting sirolimus.(a) Hoton endoscopic na asali da aka ɗauka kafin sanya stent yana nuna buɗewar nasopharyngeal (kibiya) na ET.(b) Hoton Endoscopic da aka ɗauka nan da nan bayan sanya stent yana nuna ET na sanya stent.An ga zubar jini na tuntuɓar juna saboda kullin jagorar ƙarfe (kibiya).(c) Hoton Endoscopic da aka ɗauka makonni 4 bayan sanya stent yana nuna tarin gamsai a kusa da stent (kibiya).(d) Hoton Endoscopic yana nuna cewa stent ba zai iya zama zagaye ba (kibiya).
An nuna sakamakon binciken tarihi a cikin Hoto na 5 da Ƙarin Hoto 2. Yaduwan nama da haɓakar fibrous na submucosal tsakanin stent posts a cikin ET lumen na ƙungiyoyin biyu. Matsakaicin matsakaicin yanki na hyperplasia nama ya fi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Matsakaicin matsakaicin yanki na hyperplasia nama ya fi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Средний процент площади гиперплазии ткане был значительно в контрольной группе, 8% 8% ротив 48,36% ± 10,06%, p <0,001). Matsakaicin matsakaicin yanki na hyperplasia nama ya fi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001).SES (79.48% ± 6.82% vs.48.36% ± 10.06% p <0.001) 48.36% ± 10.06% p <0.001) Средний процент площади гиперплазии ткане в контрольной групе был значительно выше, чем в ± 8% (9%) 48,36% ± 10,06%, p <0,001). Matsakaicin matsakaicin yanki na hyperplasia nama a cikin ƙungiyar kulawa ya fi girma fiye da ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Bugu da ƙari, ma'anar kauri na fibrosis na submucosal ya kasance mafi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Bugu da ƙari, ma'anar kauri na fibrosis na submucosal ya kasance mafi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Боле того, средня толщина подслизистого фиброза также была значительно выше в контрольной, 1, 1. 1 ± 0,25 против 0,56 ± 0,20 mm, p <0,001). Bugu da ƙari, ma'anar kauri na fibrosis na submucosal ya kasance mafi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001).SES (1.41 ± 0.25 vs.0.56 ± 0.20 mm p <0.001) 0.56 ± 0.20mm, p <0.001) Кроме того, средня толщина подслизистого фиброза 1 ± 0,25 против 0,56 ± 0,20 mm, p <0,001). Bugu da ƙari, ma'anar kauri na fibrosis na submucosal a cikin ƙungiyar kulawa ya kasance mafi girma fiye da a cikin ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001).Koyaya, babu wani banbanci mai mahimmanci a cikin matakin ƙwayar cuta na ciki tsakanin ƙungiyoyi biyu (ƙungiyar sarrafawa [3.50) SES rukuni [3.00 ± 0.87].
Analysis na histological jarrabawa na ƙungiyoyi biyu na stent sanya a cikin Eustachian lumen.(a, b) Yankin hyperplasia nama (1 na a da b) da kauri na fibrosis na submucosal (2 na a da b; kibiyoyi biyu) sun fi girma a cikin ƙungiyar kulawa fiye da ƙungiyar SES tare da ƙwanƙwasawa (dige baƙar fata), yanki na kunkuntar lumen (rawaya) da yanki na asali (ja).Matsayin kutsawar kwayar halitta mai kumburi (3 na a da b; kibiyoyi) bai bambanta sosai tsakanin ƙungiyoyin biyu ba.(c) Sakamakon Histological na kashi na yanki na hyperplasia nama, (d) kauri na fibrosis submucosal, da (e) digiri na kutsawa tantanin halitta 4 makonni bayan sanya stent a cikin ƙungiyoyin biyu.SES, cobalt-chromium sirolimus eluting stent.
Maganin da ke kawar da ƙwayoyi yana taimakawa inganta haɓakar stent da kuma hana stent restenosis20,21,22,23,24.Ƙunƙarar da aka haifar da stent yana haifar da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta, ciki har da esophagus, trachea, gastroduodenum, da bile ducts.Ana amfani da kwayoyi irin su dexamethasone, paclitaxel, gemcitabine, EW-7197, da sirolimus a saman ragar waya ko suturar stent don hana ko magance hyperplasia nama bayan sanyawa stent29,30,34,35,36.Sabbin sababbin abubuwa na baya-bayan nan a fagen stent masu aiki da yawa ta amfani da fasahar fusion ana bincike sosai don maganin cututtukan cututtukan da ba na jijiyoyin jini ba37,38,39.A cikin binciken da aka yi a baya a cikin samfurin porcine ET, an lura da yaduwar nama wanda ya haifar da ɓarna.Kodayake ci gaban stent a cikin ET ba a fahimta sosai ba, amsawar nama bayan sanya stent an gano yayi kama da na sauran gabobin haske marasa jijiyoyin jini19.A cikin binciken da aka yi a yanzu, an yi amfani da SES don hana yaduwar nama mai lalacewa a cikin samfurin ET porcine.Sirolimus yana da guba ga tsibiran pancreatic da layin ƙwayoyin beta, yana rage ƙarfin tantanin halitta kuma yana haɓaka apoptosis40,41.Wannan tasiri na iya taimakawa wajen hana samuwar yaduwar nama ta hanyar haifar da mutuwar kwayar halitta.Bincikenmu ya nuna cewa farkon amfani da stents na miyagun ƙwayoyi a cikin ET ya hana yaduwar nama mai haifar da ƙwayar cuta a cikin ET.
Balloon-expandable Co-Cr alloy stent da aka yi amfani da shi a cikin wannan binciken yana samuwa a shirye kamar yadda ake amfani da shi don magance cututtukan zuciya 42 .Bugu da ƙari, haɗin gwiwar Co-Cr suna da kaddarorin inji (misali, ƙarfin radial mai ƙarfi da ƙarfin inelastic) 43.Bisa ga endoscopy na binciken na yanzu, Co-Cr alloy stent da aka yi amfani da shi don ET na aladu ba zai iya kula da siffar zagaye a cikin dukan aladu ba saboda rashin isasshen elasticity kuma ba shi da ikon fadada kansa.Hakanan za'a iya canza siffar tamburan da aka saka ta motsi a kusa da ET na dabba mai rai (misali, tauna da hadiyewa).Kaddarorin injiniyoyi na Co-Cr alloy stent sun zama hasara a cikin jeri na porcine ET stent.Bugu da kari, sanya stent a cikin isthmus na iya haifar da buɗe ET na dindindin.Buɗewa ko tsawaita ET yana ba da damar magana da sautin nasopharyngeal, reflux gastrointestinal, da pathogens1 don tafiya zuwa cikin kunnen tsakiya, haifar da haushin mucosal da kamuwa da cuta.Saboda haka, ya kamata a kauce wa budewar nasopharyngeal na dindindin.Sabili da haka, idan aka ba da tsarin guringuntsi na ET, an fi dacewa da ɓangarorin da aka yi daga sifofin ƙwaƙwalwar ajiya tare da kaddarorin superelastic, kamar nitinol.Gabaɗaya, an sami fitar ruwa mai nauyi a ciki da kuma kewayen kogin nasopharyngeal na stent.Tun lokacin da aka toshe motsi na mucociliary na al'ada, ana sa ran asirin ya taru a cikin ɓangarorin da ke fitowa daga buɗewar nasopharyngeal.Rigakafin hawan tsakiyar kunne yana daya daga cikin manyan manufofin ET, kuma ya kamata a guji sanya stent da ke fitowa bayan ET, tun da tuntuɓar stent kai tsaye tare da ƙwayoyin ƙwayoyin cuta na nasopharyngeal na iya haifar da karuwar cututtuka masu tasowa.
Eustachian tube balloon plasty ta cikin nasopharyngeal buɗaɗɗen sabon magani ne mai ƙanƙanta don tabarbarewar ET da nufin buɗewa da faɗaɗa ɓangaren cartilaginous na ET8,9,10,46.Duk da haka, ba a gano ainihin hanyar warkewa ba47 kuma sakamakonsa na dogon lokaci yana iya zama mafifici8,9,11,46.A ƙarƙashin waɗannan sharuɗɗan, ƙaddamar da ƙarfe na wucin gadi na iya zama zaɓin magani mai inganci ga marasa lafiya waɗanda ba su amsa gyaran balloon bututun Eustachian, kuma an nuna yuwuwar stenting na ET a cikin ɗimbin bincike na asali.Poly-l-lactide scaffolds an dasa su ta hanyar tympanic membrane a cikin chinchillas da zomaye don tantance haƙuri da lalacewa a cikin vivo17,18.Bugu da kari, an ƙirƙiri samfurin tumaki don kimanta bayanin martabar balloon ƙarfe wanda za a iya faɗaɗawa a cikin vivo.A cikin bincikenmu na baya, an ƙirƙiri samfurin ET na porcine don bincika yiwuwar fasaha da kimanta rikice-rikicen da ke haifar da stent,19 yana ba da ingantaccen tushe don wannan binciken don bincika ingancin SES ta amfani da hanyoyin da aka kafa a baya.A cikin wannan binciken, SES an sami nasarar gano shi zuwa guringuntsi kuma ya hana yaduwar nama.Babu wani rikitarwa da ke da alaƙa da stent, amma an sami raunin mucosal sakamakon kullin jagorar ƙarfe tare da zubar da jini wanda ya warware ba tare da bata lokaci ba cikin makonni 4.Ganin yiwuwar rikice-rikice na sheath na ƙarfe, inganta tsarin isar da SES yana da gaggawa da mahimmanci.
Wannan binciken yana da wasu iyakoki.Kodayake binciken tarihi ya bambanta sosai tsakanin ƙungiyoyi, adadin dabbobin da ke cikin wannan binciken ya yi ƙanƙanta don ingantaccen bincike na ƙididdiga.Kodayake masu kallo guda uku sun makanta don tantance bambancin masu lura da juna, matakin ƙaddamar da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta submucosal an ƙaddara shi bisa ga rarrabawa da kuma yawan ƙwayoyin ƙwayoyin cuta saboda wahalar ƙididdige ƙwayoyin ƙwayoyin cuta.Tun lokacin da aka gudanar da bincikenmu ta amfani da ƙayyadaddun adadin manyan dabbobi, an yi amfani da kashi ɗaya na miyagun ƙwayoyi, a cikin vivo pharmacokinetic nazarin ba a gudanar da su ba.Ana buƙatar ƙarin karatu don tabbatar da mafi kyawun sashi na miyagun ƙwayoyi da amincin sirolimus a cikin ET.A ƙarshe, lokacin bibiyar makonni 4 kuma shine iyakancewar binciken, don haka ana buƙatar nazarin kan tasirin dogon lokaci na SES.
Sakamakon wannan binciken ya nuna cewa SES na iya hana yaduwar nama mai rauni na inji bayan sanya balloon-expandable Co-Cr alloy scaffolds a cikin samfurin ET porcine.Makonni hudu bayan da wuri mai hade, masu canji da ke hade da yaduwar nama da ke haifar da yaduwa (gami da yanki na submucosal fibrosis) suna da ƙasa sosai fiye da rukunin sarrafawa.SES ya bayyana yana da tasiri wajen hana yaduwar nama mai lalacewa a cikin ET aladu.Kodayake ana buƙatar ƙarin bincike don gwada mafi kyawun kayan stent da nau'ikan ƙwararrun ƙwararrun ƙwayoyi, SES yana da yuwuwar warkewar gida don hana hyperplasia nama na ET bayan sanya stent.
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