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Zvidzidzo zvakasiyana-siyana zvepreclinical zveyakagadzirwa Eustachian chubhu (ET) stent zviri kuitika pari zvino, asi hazvisati zvashandiswa mukudzidzira kwekiriniki.Muzvidzidzo zvepreclinical, ET scaffolds yakaganhurirwa kune scaffold-induced tissue proliferation.Kubudirira kwecobalt-chromium sirolimus-eluting stent (SES) mukudzivisa stent-induced tissue kuwanda mushure mekuiswa kwe stent kwakadzidzwa mune porcine ET model.Nguruve nhanhatu dzakakamurwa kuita mapoka maviri (kureva boka rekutonga neboka reSES) nenguruve nhatu muboka rimwe nerimwe.Boka rekutonga rakagamuchira isina kuvharwa cobalt-chromium stent (n = 6), uye boka reSES rakagamuchira cobalt-chromium stent ine sirolimus-eluting coating (n = 6).Mapoka ese akabayirwa mavhiki e4 mushure mekuiswa stent.Kuiswa kweStent kwakabudirira mune ese maET pasina matambudziko ane chekuita nekuvhiyiwa.Hapana kana imwe yemastents yaigona kuchengetedza chimiro chayo chepakutanga chakatenderera, uye kuunganidzwa kwemakasi kwakaonekwa mukati nekutenderedza stents mumapoka ese ari maviri.Histological ongororo yakaratidza kuti nzvimbo yekuwedzera kwetishu uye ukobvu hwe submucosal fibrosis muboka reSES yaive yakaderera zvakanyanya pane iri muboka rekutonga.SES inoratidzika kunge inoshanda mukudzivisa scaffold-induced tissue kuwanda muET nguruve.Nekudaro, zvimwe zvidzidzo zvinodikanwa kusimbisa izvo zvakaringana zvigadzirwa zvema stents uye antiproliferative zvinodhaka.
Eustachian chubhu (ET) ine mabasa akakosha mukati menzeve (semuenzaniso, kufefetedza, kudzivirira kutamiswa kwehutachiona uye secretions kune nasopharynx)1.Inosanganisirawo dziviriro kubva kune nasopharyngeal ruzha uye regurgitation2.Iyo ET inowanzovharwa, asi inovhura nekumedza, kukwenya, kana kutsenga.Zvisinei, ET dysfunction inogona kuitika kana chubhu isingavhuri kana kuvhara zvakanaka3,4.Dilated (obstructive) dysfunction yeET depresses ET basa uye, kana mabasa aya asina kuchengetedzwa, anogona kukura kuva acute kana asingagumi otitis media, chimwe chezvirwere zvinowanzoitika mu ENT maitiro.Mishonga yemazuva ano yekusashanda zvakanaka kweET (semuenzaniso, kuvhiyiwa kwemhino, kuiswa kwechubhu yemhepo, uye mishonga) inoshandiswa muvarwere.Zvisinei, marapirwo aya ane simba shoma uye anogona kutungamirira kune ET kuvharwa, utachiona, uye isingachinjiki tympanic membrane perforation3,6,7.Eustachian chubhu balloon angioplasty yakaunzwa seimwe nzira yekurapa yeDilated ET 8 dysfunction.Kunyange zvazvo zvidzidzo zvakati kuti kubvira 2010 zvakaratidza kuti Eustachian tube balloon kugadziriswa kwakakwirira kudarika kurapwa kwakajairika kweET dysfunction, vamwe varwere havapinduri kune dilatation8,9,10,11.Nokudaro, stenting inogona kuva nzira yekurapa inoshanda12,13.Pasinei nezvidzidzo zvakawanda zvinoramba zvichienderera mberi zvichiongorora kugona kwehunyanzvi uye mhinduro yematishu mushure mekuiswa mu ET, stent-induced tissue hyperplasia nekuda kwekukuvadzwa kwemagetsi inoramba iri yakakosha postoperative complication 14,15,16,17,18,19.mishonga-yakavharwa, yakatakurwa ne-anti-proliferative agents inovandudza mamiriro aya.
Zvinodhaka-eluting stents zvakashandiswa kuvharidzira mu-stent restenosis inokonzerwa nematishu uye neointimal hyperplasia mushure mekuiswa kwe stent.Kazhinji, stent scaffolds kana linings dzakaputirwa nemishonga (semuenzaniso, everolimus, paclitaxel, uye sirolimus) 20,23,24.Sirolimus inowanzoitika inorwisa proliferative mushonga unodzivirira matanho akati wandei erestenosis cascade (semuenzaniso, kuzvimba, neointimal hyperplasia, uye collagen synthesis) 25.Nokudaro, chidzidzo ichi chakafungidzira kuti sirolimus-yakavharwa stents inogona kudzivirira stent-induced tissue hyperplasia muET nguruve (Mufananidzo 1).Chinangwa chechidzidzo ichi chaive chekuongorora kushanda kwe sirolimus-eluting stents (SES) mukuvharidzira kuwanda kwetishu stent-induced tissue mushure mekuiswa stent mune porcine ET modhi.
Schematic illustration yecobalt-chromium sirolimus-eluting stent (SES) yekurapa Eustachian tube dysfunction, ichiratidza kuti sirolimus-eluting stent inhibits stent-induced tissue kuwanda.
Cobalt-chromium (Co-Cr) alloy stents akagadzirwa nelaser yekucheka Co-Cr alloy chubhu (Genoss Co., Ltd., Suwon, Korea).Iyo stent chikuva inoshandisa yakavhurika kaviri chisungo chine yakabatana dhizaini yekuchinjika yakakwirira ine yakakwana radial simba, kupfupisa uye kutevedzera.Iyo stent yaive nedhayamita ye3 mm, kureba kwe18 mm, uye strut ukobvu hwe78 µm (Fig. 2a).Zviyero zveCo-Cr alloy frame zvakatemwa zvichibva pakudzidza kwedu kwekare.
Cobalt-chromium (Co-Cr) alloy stent uye simbi inotungamira sheath yeEustachian chubhu stent kuiswa.Mapikicha anoratidza (a) Co-Cr alloy stent uye (b) stent-yakasungirirwa chibharuru catheter.(c) Balloon catheter uye stent zvakaiswa zvizere.(d) Isimbi inotungamira sheath yakagadzirwa kune porcine Eustachian chubhu modhi.
Sirolimus yakaiswa pamusoro pe stent uchishandisa ultrasonic spray tekinoroji.SES yakagadzirirwa kuburitsa ingangoita makumi manomwe muzana ekutanga zvinodhaka (1.15 µg/mm2) mukati memazuva makumi matatu ekutanga mushure mekuiswa.Iyo yekupedzisira-yakatetepa 3 µm coating inoiswa chete kudivi repedyo re stent kuti uwane inodiwa yekuburitsa mushonga uye kuderedza huwandu hwepolymer;iyi biodegradable coating ine copolymer yelactic uye glycolic acids uye proprietary blend ye poly(1) -lactic acid)26,27.Co-Cr alloy stents akarovererwa pabharumu catheter 3 mm muhupamhi uye 28 mm kureba (Genoss Co., Ltd.; Fig. 2b).Aya ma stents anowanikwa muSouth Korea kurapwa kwechirwere chemoyo.
Iyo ichangobva kugadzirwa simbi inotungamira goko yenguruve ET modhi yakagadzirwa nesimbi isina tsvina (Fig. 2c).Madhayamita emukati nekunze ehoko ndeye 2 mm uye 2.5 mm, maererano, kureba kwe250 mm.Iyo distal 30 mm sheath yakanga yakakotama kuita J-chimiro pa 15 ° angle kune axis kubvumira kupinda nyore kubva kumhino kusvika kune nasopharyngeal orifice yeET mumuenzaniso wenguruve.
Ichi chidzidzo chakatenderwa neInstitutional Animal Care and Use Committee yeAsan Institute of Life Sciences (Seoul, South Korea) uye inoenderana neNational Institutes of Health Guidelines yeHumane Treatment of Laboratory Animals (IACUC-2020-12-189)..Chidzidzo ichi chakaitwa zvichitevedza gwara reARRIVE.Ichi chidzidzo chakashandisa 12 ETs mu 6 yenguruve inorema 33.8-36.4 kg pa 3 mwedzi yezera.Nguruve nhanhatu dzakakamurwa kuita mapoka maviri (kureva boka rekutonga neboka reSES) nenguruve nhatu muboka rimwe nerimwe.Boka rekutonga rakagamuchira isina kuvharwa Co-Cr alloy stent, nepo boka reSES rakagamuchira Co-Cr alloy stent eluting sirolimus.Nguruve dzose dzakanga dzakasununguka kuwana mvura uye kudya uye dzakachengetwa pa 24 ° C ± 2 ° C kwemaawa gumi nemaviri masikati-usiku.Zvadaro, nguruve dzose dzakabayirwa mavhiki e4 mushure mekuiswa kwe stent.
Nguruve dzose dzakagamuchira musanganiswa we50mg/kg zolazepam, 50mg/kg teletamide (Zoletil 50; Virbac, Carros, France) uye 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Germany).ipapo tracheal tube yakaiswa ne inhalation ye 0.5-2% isoflurane (Ifran®; Hana Pharm. Co., Seoul, Korea) uye oksijeni 1: 1 (510 ml / kg / min) yeanesthesia.Nguruve dzakaiswa panzvimbo yepamusoro uye yekutanga endoscopy (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Japan) yakaitwa kuti iongorore nasopharyngeal orifice yeET.A metal guide sheath yakasimudzwa kuburikidza nemhino kusvika kune nasopharyngeal orifice yeET pasi pe endoscopic control (Fig. 3a, b).A balloon catheter, corrugated stent, inopinzwa kuburikidza ne introducer mu ET kusvikira muromo wayo wasangana nekupikisa mu osteochondral isthmus ye ET (Fig. 3c).Ibharuni catheter yakanyatsozadzwa nesaline kune 9 atmospheres, sezvakatsanangurwa nemanometer monitor (Fig. 3d).Bharumu catheter yakabviswa mushure mekuisa stent (Fig. 3f), uye kuvhura kwenasopharyngeal kwakanyatsoongororwa endoscopy yezvinetso zvekuvhiya (Fig. 3f).Yese nguruve yakaitwa endoscopy isati yasvika uye pakarepo mushure mekuita stenting, pamwe nemavhiki mana mushure mekuita, kuongorora patency ye stent site uye yakapoteredza secretions.
Matanho ehunyanzvi ekuisa stent mueustachian chubhu (ET) yenguruve pasi pe endoscopic control.(a) Endoscopic mufananidzo unoratidza nasopharyngeal kuvhura (museve) uye yakaiswa simbi dhizaini sheath (museve).(b) Kupinzwa kwesimbi (museve) paburi renasopharyngeal.(c) A stent-clamped balloon catheter (museve) inounzwa muET kuburikidza nesheath (museve).(d) Bharumu catheter (museve) wakazara mweya.(e) Mhedziso yepamusoro ye stent inobuda kubva kuET orifice ye nasopharynx.(f) Endoscopic mufananidzo unoratidza stent lumen patency.
Nguruve dzose dzakasunungurwa nekupa 75 mg / kg potassium chloride nejekiseni renzeve.Zvikamu zveMedian sagittal zvemusoro weporcine zvakaitwa uchishandisa chainsaw yakateverwa nekunyatsotorwa kweET scaffold tissue samples ye histological examination (Supplementary Fig. 1a, b).ET tissue samples dzakagadziriswa mu10% neutral buffered formalin kwemaawa makumi maviri nemana.
ET tissue samples dzaive sequentially dehydrated nedoro rezvakasiyana siyana.Samples akaiswa mu resin blocks nekupinzwa ne ethylene glycol methacrylate (Technovit 7200® VLC; Heraus Kulzer GMBH, Wertheim, Germany).Zvikamu zveAxial zvakaitwa pane zvakavharidzirwa ET tissue specimens muzvikamu zveproximal uye distal (Supplementary Fig. 1c).Mabhuroko epolymer akabva aiswa pamasiraidhi egirazi re acrylic.Resin block masiraidhi aive microground uye akakwenenzverwa nesilicon carbide bepa rehukobvu hwakasiyana kusvika pakukora 20 µm uchishandisa grid system (Apparatebau GMBH, Hamburg, Germany).Ese masiraidhi akaiswa pasi pekuongororwa kwe histological ne hematoxylin uye eosin staining.
Histological evaluation yakaitwa kuti iongorore huwandu hwekuwanda kwematishu, ukobvu hwe submucosal fibrosis, uye dhigirii rekuputika kwesero.Iyo muzana yetishu hyperplasia ine yakamanikana ET muchinjiko-chikamu nzvimbo yakaverengerwa nekugadzirisa iyo equation:
Ukobvu hwe submucosal fibrosis hwakayerwa wakamira kubva kune stent struts kuenda kune submucosa.Chiyero chekuvhiringidza kwesero infiltration chakanga chiri subjectively kutongwa nekugoverwa uye kuwanda kwemasero ekuputika, kureva: 1st degree (munyoro) - imwe chete yeukocyte infiltration;2nd degree (zvinyoro kusvika pakati) - focal leukocyte infiltration;3rd degree (yepakati) - yakasanganiswa.nemaleukocyte asingakwanisi kusiyanisa pakati peloci yega;giredhi 4 (yakaenzana kusvika kune yakaoma) leukocytes inopararira inopinda mukati mese submucosa, uye giredhi 5 (yakaoma) inopararira kupindira nefoci yakawanda ye necrosis.Ukobvu hwe submucosal fibrosis uye dhigirii rekuputika kwesero kupinza zvakawanikwa neavhareji mapoinzi masere akapoteredza denderedzwa.Histological analysis yeET yakaitwa uchishandisa microscope (BX51; Olympus, Tokyo, Japan).Zviyero zvakawanikwa pachishandiswa CaseViewer software (CaseViewer; 3D HISTECH Ltd., Budapest, Hungary).Kuongororwa kwezvinyorwa zvehistological zvakabva pakubvumirana kwevatatu vanocherechedza vasina kutora chikamu muchidzidzo.
Iyo Mann-Whitney U-bvunzo yakashandiswa kuongorora mutsauko pakati pemapoka sezvinodiwa. A p <0.05 yaionekwa seyakakosha. A p <0.05 yaionekwa seyakakosha. Значение p < 0,05 считалось статистически значимым. A p kukosha <0.05 yaionekwa seyakakosha. 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 yaionekwa seyakakosha. Bonferroni-yakagadziriswa Mann-Whitney U-test yakaitirwa p values ​​<0.05 kuona misiyano yeboka (p <0.008 seyakanyanya kukosha). Iyo Bonferroni-yakagadziridzwa Mann-Whitney U-bvunzo yakaitirwa p kukosha <0.05 kuona mutsauko weboka (p <0.008 seyakakosha manhamba). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 для выявления групповых различи00 (p.0,05) Bonferroni-yakagadziridzwa Mann-Whitney U bvunzo yakaitirwa p values ​​​​ <0.05 kuona mutsauko weboka (p <0.008 seyakakosha manhamba).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 具有统计学意义）.对p 值< 0.05 进行Bonferroni 校正的Mann-Whitney U U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p < 0,05 ) Bonferroni-yakagadziriswa Mann-Whitney U-test yakaitirwa p <0.05 kuti ione kusiyana kweboka (p <0.008 yakanga yakakosha).Kuongorora kwenhamba kwakaitwa pachishandiswa SPSS software (version 27.0; SPSS, IBM, Chicago, IL, USA).
Yese porcine stent kuiswa kwakabudirira zvehunyanzvi.A metal guide sheath yakabudirira kuiswa mu nasopharyngeal orifice ye ET pasi pe endoscopic control, kunyange zvazvo mucosal kukuvara nekubuda ropa kwakaonekwa mu 4 ye 12 mienzaniso (33.3%) panguva yekuiswa kwesimbi sheath.Mushure memasvondo mana, kubuda ropa kwaiyerera kwakangoerekana kwamira.Nguruve dzese dzakapona kusvika pakupera kwechidzidzo pasina matambudziko ane chekuita ne stent.
Endoscopy mhedzisiro inoratidzwa muMufananidzo 4. Munguva ye4-vhiki yekutevera, stents yakaramba iri munzvimbo yenguruve dzose.Mucus kuunganidza mukati uye kumativi ose eET stent akaonekwa mune zvose (100%) ETs muboka rekutonga uye zvitatu (50%) zveETE matanhatu muboka reSES, uye pakanga pasina kusiyana kwezviitiko pakati pemapoka maviri (p = 0.182).Hapana imwe yemastents akaiswa aigona kuchengetedza chimiro chakatenderera.
Endoscopic mifananidzo yeEustachian tube (ET) yenguruve muboka rekutonga uye boka rine cobalt-chromium stent (CXS) eluting sirolimus.(a) Baseline endoscopic mufananidzo wakatorwa usati waiswa stent unoratidza nasopharyngeal kuvhura (museve) weET.(b) Mufananidzo weEndoscopic wakatorwa pakarepo mushure mekuisa stent inoratidza ET yekuiswa kwe stent.Kubuda ropa kwakaonekwa nekuda kwesimbi inotungamira sheath (museve).(c) Mufananidzo weEndoscopic wakatorwa mavhiki e4 mushure mekuiswa kwe stent inoratidza kuungana kwemucus kutenderedza stent (museve).(d) Endoscopic mufananidzo unoratidza kuti stent haigone kuramba yakatenderera (museve).
Histological zviwanikwa zvinoratidzwa muFigure 5 uye Supplementary Figure 2. Tissue proliferation uye submucosal fibrous proliferation pakati pe stent posts mu ET lumen yemapoka maviri. Izvo zvinorehwa muzana zvetishu hyperplasia nzvimbo yakanga yakakura zvikuru muboka rekutonga kupfuura muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Izvo zvinorehwa muzana zvetishu hyperplasia nzvimbo yakanga yakakura zvikuru muboka rekutonga kupfuura muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Средний процент площади гиперплазии тканей был значительно больше в контрольной группе, чем в группе СЭС (74,6,48% ± 2,6,8% 0,06%, p <0,001). Iyo inoreva nzvimbo yezana yetishu hyperplasia yakanga yakakura zvikuru muboka rekutonga kupfuura muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001).SES 组 (79.48% ± 6.82% vs.48.36% ± 10.06%,p <0.001). 48.36% ± 10.06%,p <0.001). Средний процент площади гиперплазии тканей в контрольной группе был значительно выше, чем в группе СЭС (79,8,48,6% 06%, p <0,001). Iyo inoreva nzvimbo yezana yetishu hyperplasia muboka rekutonga yakanga yakakwirira kudarika muboka reSES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p <0.001). Uyezve, kuremerwa kwe submucosal fibrosis kwaive kwakakwira zvakanyanya muboka rekutonga kupfuura muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Uyezve, kuremerwa kwe submucosal fibrosis kwaive kwakakwira zvakanyanya muboka rekutonga kupfuura muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001). Более того, средняя толщина подслизистого фиброза также была значительно выше в контрольной группе, чем в группе СЭС,250,± 6,50,± 1,50, 61, 5, 5, 5, 5, 5, 5, 5. 20 мм, p <0,001). Uyezve, kuremerwa kwe submucosal fibrosis kwaive kwakakwira zvakanyanya muboka rekutonga kupfuura muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001).SES 组（1.41 ± 0.25 vs.0.56 ± 0.20 mm,p <0.001). 0.56±0.20mm,p<0.001). Кроме того, средняя толщина подслизистого фиброза в контрольной группе также была значительно выше, чем в группе СЭ0 ± 5,20,20,25,25,± 1,5,25,25 (1,50,60,60), 0 мм, p < 0,001). Mukuwedzera, iyo inorema ye submucosal fibrosis muboka rekutonga yakanga yakanyanya kukwirira kudarika muboka reSES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p <0.001).Zvisinei, pakanga pasina misiyano yakakura muhuwandu hwekuputika kwemasero ekupinda mukati memapoka maviri (boka rekutonga [3.50 ± 0.55] vs. SES boka [3.00 ± 0.89], p = 0.270).
Ongororo yekuongorora kwehistological yemapoka maviri emastenti akaiswa muEustachian lumen.(a, b) Nzvimbo ye tishu hyperplasia (1 yea uye b) uye ukobvu hwe submucosal fibrosis (2 yea uye b; kaviri miseve) yaive yakakura zvakanyanya muboka rekutonga kupfuura muboka reSES rine strut stenting (madotsi matema), nzvimbo yakatetepa lumen (yero) uye yepakutanga stent nzvimbo (tsvuku).Chiyero chekuputira cell infiltration (3 yea uye b; miseve) haina kusiyana zvakanyanya pakati pemapoka maviri.(c) Histological results of percent area of ​​tissue hyperplasia, (d) makubvu e submucosal fibrosis, uye (e) dhigirii rekuputika kwesero kupinda mukati masvondo e4 mushure mekuiswa stent mumapoka maviri.SES, cobalt-chromium sirolimus iriting stent.
Zvinodhaka-eluting stents zvinobatsira kuvandudza stent patency uye kudzivirira stent restenosis20,21,22,23,24.Stent-induced strictures inokonzerwa nekuumbwa kwetishu yegranulation uye shanduko yefibrous tishu munhengo dzakasiyana dzisiri dzevascular, kusanganisira esophagus, trachea, gastroduodenum, uye bile ducts.Mishonga yakadai sedexamethasone, paclitaxel, gemcitabine, EW-7197, uye sirolimus inoiswa pamusoro petambo mesh kana stent coating kudzivirira kana kurapa tishu hyperplasia mushure mekuisa stent29,30,34,35,36.Zvichangoburwa zvitsva mumunda we multifunctional stents uchishandisa fusion tekinoroji iri kunyatsoongororwa kurapwa kweasina-vascular occlusive zvirwere37,38,39.Muchidzidzo chekare mune porcine ET modhi, scaffold-induced tissue proliferation yakaonekwa.Kunyange zvazvo stent kukura muET kusinganzwisisike zvakanaka, mhinduro yetishu mushure mekuiswa kwe stent yakawanikwa yakafanana neyeimwe nhengo dzisina vascular luminal19.Muchidzidzo chemazuva ano, SES yakashandiswa kuvharidzira scaffold-induced tissue kuwanda mune porcine ET modhi.Sirolimus ine chepfu kune pancreatic islets uye beta cell mitsara, inoderedza kushanda kwesero uye inowedzera apoptosis40,41.Mhedzisiro iyi inogona kubatsira kudzivirira kuumbwa kwetishu kuwedzera nekukurudzira kufa kwesero.Kudzidza kwedu kwakaratidza kuti kushandiswa kwekutanga kwezvinodhaka-eluting stents muET zvakanyatsodzivisa stent-induced tissue proliferation muET.
Bharumu-inowedzerwa Co-Cr alloy stent inoshandiswa muchidzidzo ichi inowanikwa nyore nyore sezvo inowanzoshandiswa kurapa coronary artery disease 42.Mukuwedzera, Co-Cr alloys ane mechanical properties (somuenzaniso, high radial simba uye inelastic masimba) 43.Zvinoenderana neendoscopy yechidzidzo chazvino, iyo Co-Cr alloy stent inoshandiswa ET yenguruve haigone kuchengetedza chimiro chakatenderera munguruve dzese nekuda kwekusakwana elasticity uye haina kugona kuzviwedzera.Chimiro che stent chakaiswa chinogonawo kuchinjwa nekufamba kwakapoteredza ET yemhuka mhenyu (semuenzaniso, kutsenga nekumedza).Iyo mechanic properties yeCo-Cr alloy stents yave kukanganisa mukuiswa kweporcine ET stents.Mukuwedzera, kuiswa kwe stent muisthmus kunogona kukonzera kuvhurika zvachose ET.Inoramba yakavhurika kana yakawedzera ET inobvumira kutaura uye nasopharyngeal ruzha, gastrointestinal reflux, uye hutachiona 1 kuti hufambe kusvika mukati menzeve, zvichikonzera kutsamwa kwemucosal uye hutachiona.Nokudaro, kuvhurwa kwekusingaperi nasopharyngeal kunofanira kudziviswa.Naizvozvo, kupihwa chimiro cheET cartilage, scaffolds zviri nani kugadzirwa kubva muchimiro memory alloys ane superelastic properties, senge nitinol.Kazhinji, kubuda kunorema kwakawanikwa mukati uye kwakatenderedza nasopharyngeal orifice ye stent.Sezvo yakajairwa mucociliary kufamba kwemucus yakavharwa, chakavanzika chinotarisirwa kuungana mumakashafadhi anobuda kubva pakuvhurwa kwenasopharyngeal.Kudzivirirwa kwekukwira kwehutachiwana hwepakati nzeve ndechimwe chezvinangwa zvikuru zveET, uye kuiswa kwema stents anobuda kunze kweET kunofanira kudziviswa, sezvo kushamwaridzana kwakananga kwe stents ne nasopharyngeal bacterial flora kunogona kukonzera kuwedzera kukwira kwezvirwere.
Eustachian tube balloon plasty kuburikidza nekuvhurwa kwenasopharyngeal mushonga mutsva ushoma wekusashanda zvakanaka kweET wakanangana nekuvhura nekukudza chikamu checartilaginous cheET8,9,10,46.Zvisinei, nzira yekurapa yepasi haina kuonekwa47 uye migumisiro yayo yenguva refu inogona kuva suboptimal8,9,11,46.Pasi pemamiriro ezvinhu aya, simbi yenguva pfupi inogona kunge iri nzira yekurapa inoshanda kune varwere vasingapindure Eustachian tube balloon kugadziriswa, uye kukwanisa kweET stenting kwakaratidzwa mune dzakawanda zvidzidzo zvepreclinical.Poly-l-lactide scaffolds yakasimwa kuburikidza ne tympanic membrane mu chinchillas uye tsuro kuti iongorore kushivirira uye kuora mwoyo mu vivo17,18.Pamusoro pezvo, muenzaniso wehwai wakagadzirwa kuti uongorore chimiro chesimbi bharumu inowedzerwa stents mu vivo.Muchidzidzo chedu chekare, porcine ET modhi yakagadziridzwa kuti iongorore kugona kwehunyanzvi uye kuongororwa kwematambudziko anokonzerwa ne stent, 19 ichipa hwaro hwakasimba hwechidzidzo ichi kuongorora kushanda kweSES uchishandisa nzira dzakambomiswa.Muchidzidzo ichi, SES yakabudirira kuiswa kune cartilage uye inobudirira inhibited kupararira kwenyama.Pakanga pasina matambudziko ane chekuita ne stent, asi pakanga paine kukuvara kwemucosal kwakakonzerwa nesimbi dhizaini sheath ine kusangana nekubuda ropa kwakagadziriswa zvega mukati memavhiki e4.Tichifunga nezve zvinogona kunetsa zvesimbi sheaths, kuvandudza iyo SES yekuendesa sisitimu inokurumidza uye yakakosha.
Ichi chidzidzo chine zvimwe zvinogumira.Kunyange zvazvo zvakawanikwa zvehistological zvakasiyana zvakanyanya pakati pemapoka, nhamba yemhuka muchidzidzo ichi yakanga iri diki kuti iongororwe nhamba yakavimbika.Kunyange zvazvo vataridzi vatatu vakapofumadzwa kuti vaongorore kusiyana kwe-inter-observer, dhigirii ye submucosal inflammatory cell infiltration yakatemerwa subjectively zvichienderana nekuparadzirwa uye kuwanda kwemasero ekuputika nekuda kwekuoma kwekuverenga masero ekuputika.Sezvo chidzidzo chedu chakaitwa tichishandisa nhamba shoma yemhuka huru, imwe yero yemishonga yakashandiswa, in vivo pharmacokinetic zvidzidzo hazvina kuitwa.Zvimwe zvidzidzo zvinodikanwa kusimbisa iyo yakakwana dosage yemushonga uye kuchengetedzeka kwe sirolimus muET.Chekupedzisira, iyo 4-vhiki yekutevera nguva zvakare iganhuriro yechidzidzo, saka zvidzidzo pamusoro pekushanda kwenguva refu kweSES zvinodiwa.
Mhedzisiro yechidzidzo ichi inoratidza kuti SES inogona kunyatso kuvharidzira kukuvara kwemagetsi-induced tissue kuwanda mushure mekuiswa kwebharumu-inowedzerwa Co-Cr alloy scaffolds mune porcine ET modhi.Vhiki ina mushure mekuiswa kwe stent, zvinosiyana zvine chekuita ne stent-induced tissue kuwanda (kusanganisira nzvimbo yekuwanda kwetishu uye ukobvu hwe submucosal fibrosis) yaive yakadzikira zvakanyanya muboka reSES kupfuura muboka rekutonga.SES inoratidzika kunge inoshanda mukudzivisa scaffold-induced tissue kuwanda muET nguruve.Kunyangwe kumwe kutsvagisa kuchidikanwa kuyedza iyo yakakwana stent zvinhu uye dosages yevanoda zvinodhaka, SES ine yemuno yekurapa mukana mukudzivirira ET tishu hyperplasia mushure mekuiswa stent.
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