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Ana gudanar da bincike daban-daban na gwajin bututun Eustachian (ET) da aka haɓaka a yanzu, amma ba a yi amfani da shi ba tukuna a aikin asibiti. A cikin nazarin da aka yi kafin a fara aikin asibiti, an takaita tsarin ET ga yaduwar nama da scaffold ya haifar. An yi nazarin ingancin stent na cobalt-chromium sirolimus-eluting (SES) wajen hana yaduwar nama da stent ya haifar bayan sanya stent a cikin samfurin ET na alade. 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 na cobalt-chromium wanda ba a rufe shi ba (n = 6), kuma ƙungiyar SES ta sami stent na cobalt-chromium tare da rufin sirolimus-eluting (n = 6). An yanka dukkan ƙungiyoyi makonni 4 bayan sanya stent. Sanya stent ya yi nasara a duk ET ba tare da rikitarwa da ke da alaƙa da tiyata ba. Babu ɗayan stent ɗin da ya iya riƙe siffar zagaye ta asali, kuma an lura da tarin majina a ciki da kewayen stent ɗin a cikin ƙungiyoyin biyu. Binciken histological ya nuna cewa yankin yaduwar nama da kauri na submucosal fibrosis a cikin rukunin SES ya yi ƙasa sosai fiye da na ƙungiyar kulawa. Da alama SES tana da tasiri wajen hana yaduwar nama da scaffold ke haifarwa a cikin aladu ET. Duk da haka, ana buƙatar ƙarin bincike don tabbatar da mafi kyawun kayan aiki don stents da magungunan hana yaduwa.
Bututun Eustachian (ET) yana da muhimman ayyuka a kunnen tsakiya (misali, iska, hana canja wurin ƙwayoyin cuta da fitar da abubuwa zuwa nasopharynx)1. Haka kuma ya haɗa da kariya daga sautin nasopharyngeal da kuma sake dawowa2. ET yawanci ana rufe shi, amma yana buɗewa da haɗiyewa, hamma, ko taunawa. Duk da haka, rashin aikin ET na iya faruwa idan bututun bai buɗe ko rufewa yadda ya kamata ba3,4. Rashin aikin ET mai faɗaɗa (mai toshewa) yana rage aikin ET kuma, idan ba a kiyaye waɗannan ayyukan ba, na iya zama media mai tsanani ko na yau da kullun na otitis, ɗaya daga cikin cututtukan da aka fi sani a aikin ENT. Ana amfani da magungunan da ake amfani da su a yanzu don rashin aikin ET (misali, tiyatar hanci, sanya bututun iska, da magani) ga marasa lafiya. Duk da haka, waɗannan jiyya suna da iyakataccen tasiri kuma suna iya haifar da toshewar ET, kamuwa da cuta, da kuma toshewar membrane na tympanic mara canzawa3,6,7. An gabatar da angioplasty na balan-balan na bututun Eustachian a matsayin madadin magani don rashin aikin ET 8 mai faɗaɗa. Duk da cewa bincike da dama tun daga shekarar 2010 sun nuna cewa gyaran balan-balan na bututun Eustachian ya fi magani na gargajiya ga matsalar rashin aikin ET, wasu marasa lafiya ba sa mayar da martani ga faɗaɗawa8,9,10,11. Don haka, stenting na iya zama zaɓi mai inganci na magani12,13. Duk da ci gaba da bincike da yawa na asibiti da ke kimanta yuwuwar fasaha da kuma martanin nama bayan sanya stent a cikin ET, hyperplasia nama da stent ya haifar saboda lalacewar injiniya ya kasance babban matsala bayan tiyata 14,15,16,17,18,19. wanda aka shafa wa magani, wanda aka cika da magungunan hana yaɗuwa yana inganta wannan yanayin.
An yi amfani da stents masu ɗauke da magunguna don hana restenosis na in-stent wanda nama da neointimal hyperplasia ke haifarwa bayan an sanya stent. Yawanci, ana shafa stent scaffolds ko linings na stent da magunguna (misali, everolimus, paclitaxel, da sirolimus)20,23,24. Sirolimus magani ne na yau da kullun na hana yaduwa wanda ke hana matakai da yawa na restenosis cascade (misali, kumburi, neointimal hyperplasia, da haɗin collagen)25. Saboda haka, wannan binciken ya yi hasashen cewa stents masu ɗauke da sirolimus na iya hana hyperplasia nama da stent ke haifarwa a cikin aladu ET (Hoto na 1). Manufar wannan binciken ita ce bincika ingancin stents na sirolimus-eluting (SES) wajen hana yaduwar nama da stent ke haifarwa bayan an sanya stent a cikin samfurin ET na alade.
Misalin zane na stent na cobalt-chromium sirolimus-eluting (SES) don magance matsalar aikin bututun Eustachian, wanda ke nuna cewa stent na sirolimus-eluting yana hana yaduwar kyallen da stent ke haifarwa.
An ƙera stents ɗin ƙarfe na Cobalt-chromium (Co-Cr) ta hanyar amfani da bututun ƙarfe na Co-Cr masu yanke laser (Genoss Co., Ltd., Suwon, Koriya). Dandalin ƙarfen yana amfani da haɗin buɗaɗɗen manne mai tsari ɗaya don sassauci mai yawa tare da ƙarfin radial mafi kyau, gajarta da bin ƙa'ida. Stent ɗin yana da diamita na 3 mm, tsawon 18 mm, da kauri na strut na 78 µm (Hoto na 2a). An ƙayyade girman firam ɗin ƙarfe na Co-Cr bisa ga bincikenmu na baya.
Stent ɗin ƙarfe na Cobalt-chromium (Co-Cr) da kuma murfin jagora na ƙarfe don sanya stent ɗin bututun Eustachian. Hotunan sun nuna (a) stent ɗin ƙarfe na Co-Cr da (b) catheter ɗin balan-balan da aka manne da stent. (c) Catheter ɗin balan-balan da stent an haɗa su gaba ɗaya. (d) An ƙera murfin jagora na ƙarfe don samfurin bututun alade na Eustachian.
An shafa Sirolimus a saman stent ɗin ta amfani da fasahar fesawa ta ultrasonic. An tsara SES don sakin kusan kashi 70% na nauyin maganin asali (1.15 µg/mm2) a cikin kwanaki 30 na farko bayan sanyawa. Ana shafa wani shafi mai siriri mai girman µm 3 kawai a gefen kusa na stent ɗin don cimma yanayin sakin maganin da ake so da kuma rage adadin polymer; wannan shafi mai lalacewa yana ɗauke da copolymer na lactic da glycolic acid da haɗin poly(1)-lactic acid)26,27 na musamman. An saka stent ɗin ƙarfe na Co-Cr a kan catheters na balan-balan mai diamita 3 mm da tsawon mm 28 (Genoss Co., Ltd.; Hoto na 2b). Waɗannan stent ɗin suna samuwa a Koriya ta Kudu don maganin cututtukan zuciya.
An yi sabon harsashin jagorar ƙarfe na samfurin alade ET da bakin ƙarfe (Hoto na 2c). Diamita na ciki da na waje na harsashin shine 2 mm da 2.5 mm, bi da bi, tsawon jimlar shine 250 mm. An lanƙwasa murfin mai nisan mm 30 zuwa siffar J a kusurwar 15° zuwa ga axis don ba da damar shiga cikin sauƙi daga hanci zuwa ga hancin nasopharyngeal na ET a cikin samfurin alade.
Kwamitin Kula da Dabbobi da Amfani da su na Cibiyar Kimiyyar Rayuwa ta Asan (Seoul, Koriya ta Kudu) ya amince da wannan binciken kuma ya bi ka'idojin Hukumar Kula da Lafiya ta Ƙasa don Kula da Dabbobin Dabbobi Masu Jin Daɗi (IACUC-2020-12-189). . An gudanar da binciken ne bisa ga jagororin ARRIVE. Wannan binciken ya yi amfani da ET guda 12 a cikin aladu 6 masu nauyin kilogiram 33.8-36.4 a cikin watanni 3. 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 na Co-Cr wanda ba a rufe shi ba, yayin da ƙungiyar SES ta sami stent na Co-Cr wanda ke fitar da sirolimus. Duk aladu suna da damar samun ruwa da abinci kyauta kuma an ajiye su a zafin jiki na 24°C ± 2°C na tsawon awanni 12 na dare da rana. Daga baya, an yanka dukkan aladu makonni 4 bayan sanya stent.
An ba dukkan aladu cakuda zolazepam 50mg/kg, teletamide 50mg/kg (Zoletil 50; Virbac, Carros, Faransa) da 10mg/kg xylazine (Rompun; Bayer HealthCare, Les Varkouzins, Jamus). Sannan aka sanya bututun tracheal ta hanyar shaƙar isoflurane 0.5-2% (Ifran®; Hana Pharm. Co., Seoul, Korea) da iskar oxygen 1:1 (510 ml/kg/min) don maganin sa barci. An sanya aladu a wurin kwance kuma an yi gwajin endoscopy na farko (VISERA 4K UHD rhinolaryngoscope; Olympus, Tokyo, Japan) don duba hancin nasopharyngeal na ET. An ci gaba da ɓoyewar jagora ta ƙarfe ta hanyar hancin zuwa hancin nasopharyngeal na ET a ƙarƙashin ikon endoscopic (Hoto na 3a, b). Ana saka wani bututun balan-balan, wani bututun da aka yi da corrugated, ta hanyar mai gabatarwa zuwa cikin ET har sai ƙarshensa ya gamu da juriya a cikin isthmus na osteochondral na ET (Hoto na 3c). An hura catheter ɗin balan-balan gaba ɗaya da ruwan gishiri zuwa yanayi 9, kamar yadda aka ƙaddara ta hanyar na'urar auna manometer (Hoto na 3d). An cire catheter ɗin balan-balan bayan an sanya stent (Hoto na 3f), kuma an yi nazari sosai kan buɗewar nasopharyngeal don matsalolin tiyata (Hoto na 3f). An yi wa duk aladu gwajin endoscopy kafin da kuma bayan stent, da kuma makonni 4 bayan stent, don tantance ƙarfin wurin stent da abubuwan da ke kewaye da shi.
Matakan fasaha don sanya stent a cikin bututun eustachian (ET) na alade a ƙarƙashin ikon endoscopic. (a) Hoton endoscopic wanda ke nuna buɗewar nasopharyngeal (kibiya) da murfin jagora na ƙarfe (kibiya). (b) Shigar da murfin ƙarfe (kibiya) a cikin buɗewar nasopharyngeal. (c) Ana shigar da catheter balan-balan mai manne da stent a cikin ET ta cikin murfin (kibiya). (d) Catheter balan-balan (kibiya) ya hura gaba ɗaya. (e) Ƙarshen kusa na stent yana fitowa daga saman ET na nasopharynx. (f) Hoton endoscopic wanda ke nuna ƙarfin stent lumen.
An kashe duk aladu ta hanyar ba su sinadarin potassium chloride 75 mg/kg ta hanyar allurar jijiyar kunne. An yi amfani da chainsaw sannan aka cire samfuran ET scaffold na kyallen don yin gwajin histological (Ƙarin Hoto na 1a,b). An gyara samfuran ET na kyallen a cikin formalin mai kauri 10% na tsawon awanni 24.
An cire samfuran nama na ET daga jiki ta hanyar shan barasa mai yawa daban-daban. An sanya samfuran a cikin tubalan resin 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 saka a cikin sassan kusanci da na nesa (Hoto na Ƙari na 1c). Sannan an ɗora tubalan polymer akan zane-zanen gilashin acrylic. An yi zane-zanen tubalan resin a microground kuma an goge su da takarda mai kauri daban-daban har zuwa kauri na 20 µm ta amfani da tsarin grid (Apparatebau GMBH, Hamburg, Jamus). An yi wa duk zane-zanen kimantawa ta hanyar amfani da hematoxylin da eosin staining.
An yi gwajin histological don tantance kashi na yaduwar nama, kauri na submucosal fibrosis, da kuma matakin shigar ƙwayoyin kumburi. An ƙididdige kashi na hyperplasia na nama tare da yanki mai kunkuntar ET ta hanyar warware lissafin:
An auna kauri na ƙwayar cuta ta submucosal fibrosis a tsaye daga stent struts zuwa submucosa. An yi la'akari da matakin shigar ƙwayoyin cuta ta hanyar rarrabawa da yawan ƙwayoyin cuta masu kumburi, wato: digiri na 1 (mai laushi) - shigar leukocyte guda ɗaya; digiri na 2 (mai laushi zuwa matsakaici) - shigar leukocyte mai zurfi; digiri na 3 (matsakaici) - haɗuwa. tare da ƙwayoyin cuta waɗanda ba za su iya bambance tsakanin loci ɗaya ba; ƙwayoyin cuta na leukocytes na aji na 4 (matsakaici zuwa mai tsanani) suna yaɗuwa suna shiga cikin dukkan submucosa, da kuma shigar leukocytes na aji na 5 (mai tsanani) tare da foci na necrosis da yawa. An sami kauri na ƙwayar cuta ta submucosal fibrosis da matakin shigar leukocytes ta hanyar matsakaicin maki takwas a kusa da kewaye. An yi nazarin histological na ET ta amfani da na'urar hangen nesa (BX51; Olympus, Tokyo, Japan). An sami ma'aunin ta amfani da software na CaseViewer (CaseViewer; 3D HISTEC Ltd., Budapest, Hungary). Binciken bayanan tarihi ya dogara ne akan ra'ayin masu lura uku waɗanda ba su shiga cikin binciken ba.
An yi amfani da gwajin Mann-Whitney U-test don yin nazarin bambance-bambance tsakanin ƙungiyoyi kamar yadda ake buƙata. An yi la'akari da cewa p <0.05 yana da mahimmanci a kididdiga. An yi la'akari da cewa p <0.05 yana da mahimmanci a kididdiga. Значение p <0,05 считалось статистически значимым. An yi la'akari da ƙimar p < 0.05 a matsayin muhimmiyar kididdiga. p <0.05 被认为具有统计学意义。 p < 0.05 p <0,05 считали статистически значимым. An yi la'akari da p <0.05 a matsayin mai mahimmanci a kididdiga. An yi gwajin Mann-Whitney U da Bonferroni ya gyara don ƙimar p < 0.05 don gano bambance-bambancen rukuni (p < 0.008 a matsayin mai mahimmanci a kididdiga). An yi gwajin Mann-Whitney U da Bonferroni ya gyara don ƙimar p < 0.05 don gano bambance-bambancen rukuni (p < 0.008 a matsayin mai mahimmanci a kididdiga). U-критерий Манна-Уитни с поправкой на Бонферрони был выполнен для значений p <0,05 для выявления гирупой как статистически значимое). An yi gwajin Mann-Whitney U da aka gyara da Bonferroni don ƙimar p <0.05 don gano bambance-bambancen rukuni (p <0.008 a matsayin mai mahimmanci a kididdiga).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 с поправкой на Бонферрони был выполнен для значений p <0,05 0,008 был статистически значимым). An yi gwajin Mann-Whitney U da aka gyara na Bonferroni don p < 0.05 don gano bambance-bambancen rukuni (p < 0.008 yana da mahimmanci a kididdiga).An yi nazarin ƙididdiga ta amfani da manhajar SPSS (sigar 27.0; SPSS, IBM, Chicago, IL, Amurka).
Duk wuraren da aka sanya stent na alade sun yi nasara a fasaha. An sanya murfin jagora na ƙarfe cikin nasarar a cikin ramin hanci na ET a ƙarƙashin kulawar endoscopic, kodayake an ga raunin mucosa tare da zubar jini ta hanyar hulɗa a cikin samfura 4 daga cikin 12 (33.3%) yayin saka murfin ƙarfe. Bayan makonni 4, zubar jini mai bayyana ya tsaya kwatsam. Duk aladu sun rayu har zuwa ƙarshen binciken ba tare da rikitarwa da suka shafi stent ba.
An nuna sakamakon binciken endoscopic a Hoto na 4. A lokacin bin diddigin makonni 4, an ci gaba da samun stains a cikin dukkan aladu. An lura da tarin majina a cikin da kewaye da ET stent a cikin dukkan ETs (100%) a cikin rukunin kulawa da kuma uku (50%) na ETs shida a cikin rukunin SES, kuma babu wani bambanci a cikin faruwar lamarin tsakanin ƙungiyoyin biyu (p = 0.182). Babu ɗaya daga cikin stants da aka sanya da zai iya riƙe siffar zagaye.
Hotunan endoscopic na bututun Eustachian (ET) na alade a cikin rukunin sarrafawa da kuma rukunin da ke ɗauke da cobalt-chromium stent (CXS) yana fitar da sirolimus. (a) Hoton endoscopic na asali da aka ɗauka kafin sanya stent wanda ke nuna buɗewar nasopharyngeal (kibiya) na ET. (b) Hoton endoscopic da aka ɗauka nan da nan bayan sanya stent wanda ke nuna ET na sanya stent. An lura da zubar jini ta hanyar hulɗa saboda murfin jagora na ƙarfe (kibiya). (c) Hoton endoscopic da aka ɗauka makonni 4 bayan sanya stent yana nuna tarin majina a kusa da stent (kibiya). (d) Hoton endoscopic da ke nuna cewa stent ba zai iya zama zagaye ba (kibiya).
An nuna binciken tarihi a Hoto na 5 da Hoto na Ƙari na 2. Yaɗuwar nama da yaduwar ƙwayoyin cuta a cikin mucosa tsakanin sandunan stent a cikin lumen ET na ƙungiyoyin biyu. Matsakaicin kaso na yankin hyperplasia na nama ya fi girma sosai a cikin rukunin kulawa fiye da na ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Matsakaicin kaso na yankin hyperplasia na nama ya fi girma sosai a cikin rukunin kulawa fiye da na ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Средний процент площади гиперплазии тканей был значительно быльше в контрольной группе, 8% 6,82% daidai 48,36% ± 10,06%, p <0,001). Matsakaicin kaso na yankin hyperplasia na nama ya fi girma sosai a cikin rukunin kulawa fiye da na 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 (7%) 6,82% daidai 48,36% ± 10,06%, p <0,001). Matsakaicin kaso na yankin hyperplasia na nama a cikin rukunin kulawa ya fi girma sosai fiye da na ƙungiyar SES (79.48% ± 6.82% vs. 48.36% ± 10.06%, p < 0.001). Bugu da ƙari, matsakaicin kauri na submucosal fibrosis shi ma ya fi girma sosai a cikin ƙungiyar kulawa fiye da na ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Bugu da ƙari, matsakaicin kauri na submucosal fibrosis shi ma ya fi girma sosai a cikin ƙungiyar kulawa fiye da na ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001). Более того, средняя толщина подслизистого фиброза также СЭС (1,41 ± 0,25 sitiv 0,56 ± 0,20 mm, p <0,001). Bugu da ƙari, matsakaicin kauri na submucosal fibrosis shi ma ya fi girma sosai a cikin ƙungiyar kulawa fiye da na 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, средняя толщина подслизистого фиброза. СЭС (1,41 ± 0,25 sitiv 0,56 ± 0,20 mm, p <0,001). Bugu da ƙari, matsakaicin kauri na submucosal fibrosis a cikin rukunin kulawa shi ma ya fi girma sosai fiye da na ƙungiyar SES (1.41 ± 0.25 vs. 0.56 ± 0.20 mm, p < 0.001).Duk da haka, babu wani bambanci mai mahimmanci a matakin shigar ƙwayoyin kumburi tsakanin ƙungiyoyin biyu (ƙungiyar kulawa [3.50 ± 0.55] idan aka kwatanta da ƙungiyar SES [3.00 ± 0.89], p = 0.270).
Binciken binciken histological na ƙungiyoyi biyu na stents da aka sanya a cikin Eustachian lumen. (a, b) Yankin hyperplasia na nama (1 na a da b) da kauri na submucosal fibrosis (2 na a da b; kibiyoyi biyu) sun fi girma a cikin rukunin kulawa fiye da na ƙungiyar SES tare da strut stenting (dige baƙi), yankin lumen mai ƙunci (rawaya) da yankin stent na asali (ja). Matsayin shigar ƙwayoyin kumburi (3 na a da b; kibiyoyi) bai bambanta sosai tsakanin ƙungiyoyin biyu ba. (c) Sakamakon histological na kashi na yankin hyperplasia na nama, (d) kauri na submucosal fibrosis, da (e) matakin shigar ƙwayoyin kumburi makonni 4 bayan sanya stent a cikin ƙungiyoyin biyu. SES, cobalt-chromium sirolimus eluting stent.
Stents masu fitar da ƙwayoyi suna taimakawa wajen inganta ƙarfin stent da kuma hana stent restenosis20,21,22,23,24. Ƙunƙarar da stent ke haifarwa tana faruwa ne sakamakon samuwar ƙwayoyin granulation da canje-canje a cikin ƙwayoyin cuta daban-daban waɗanda ba na jijiyoyin jini ba, gami da esophagus, trachea, gastroduodenum, da hanyoyin bile. Ana amfani da magunguna kamar dexamethasone, paclitaxel, gemcitabine, EW-7197, da sirolimus a saman ragar waya ko murfin stent don hana ko magance hyperplasia na nama bayan sanya stent29,30,34,35,36. Ana binciken sabbin abubuwa a fannin stents masu aiki da yawa ta amfani da fasahar haɗaka don magance cututtukan da ba na jijiyoyin jini ba37,38,39. A wani bincike da aka yi a baya a cikin samfurin ET na alade, an lura da yaduwar nama da scaffold ke haifarwa. Duk da cewa ba a fahimci ci gaban stent a cikin ET sosai ba, an gano cewa amsawar nama bayan sanya stent yayi kama da na sauran gabobin haske marasa jijiyoyin jini19. A cikin wannan binciken, an yi amfani da SES don hana yaduwar nama da scaffold ke haifarwa a cikin samfurin ET na alade. Sirolimus yana da guba ga tsibiran pancreatic da layin ƙwayoyin beta, yana rage yuwuwar ƙwayoyin halitta kuma yana haɓaka apoptosis40,41. Wannan tasirin na iya taimakawa wajen hana samuwar yaduwar nama ta hanyar ƙarfafa mutuwar ƙwayoyin halitta. Bincikenmu ya nuna cewa amfani da stents masu fitar da magunguna na farko a cikin ET ya hana yaduwar nama da stent ke haifarwa a cikin ET yadda ya kamata.
Ana iya samun stent ɗin Co-Cr mai faɗaɗa balan-balan da aka yi amfani da shi a wannan binciken cikin sauƙi domin ana amfani da shi akai-akai don magance cututtukan jijiyoyin zuciya 42. Bugu da ƙari, stent ɗin Co-Cr yana da kaddarorin injiniya (misali, ƙarfin radial mai yawa da ƙarfin inelastic) 43. Dangane da endoscopy na binciken na yanzu, stent ɗin Co-Cr da aka yi amfani da shi don ET na aladu ba zai iya riƙe siffar zagaye a cikin dukkan aladu ba saboda rashin isasshen sassauci kuma ba shi da ikon faɗaɗa kansa. Hakanan ana iya canza siffar stent ɗin da aka saka ta hanyar motsi a kusa da ET na dabba mai rai (misali, taunawa da haɗiye). Halayen injiniya na stent ɗin Co-Cr sun zama rashin amfani wajen sanya stent ɗin alade ET. Bugu da ƙari, sanya stent a cikin isthmus na iya haifar da buɗewar ET har abada. ET mai ɗorewa ko tsawaita yana ba da damar magana da sautunan nasopharyngeal, reflux na ciki, da ƙwayoyin cuta1 su yi tafiya zuwa tsakiyar kunne, suna haifar da haushi da kamuwa da cuta a mucosa. Saboda haka, ya kamata a guji buɗewar nasopharyngeal na dindindin. Saboda haka, idan aka yi la'akari da tsarin guringuntsi na ET, ana fi son a yi scaffolds daga siffa memory alloys masu siffa mai ƙarfi, kamar nitinol. Gabaɗaya, an sami fitar ruwa mai yawa a ciki da kewayen nasopharyngeal ofice na stent. Tunda motsin mucociliary na yau da kullun yana toshewa, ana sa ran sirrin zai taru a cikin scaffolds da ke fitowa daga buɗewar nasopharyngeal. Rigakafin kamuwa da cutar kunne mai hawa sama yana ɗaya daga cikin manyan manufofin ET, kuma ya kamata a guji sanya stents waɗanda suka fito bayan ET, tunda hulɗa kai tsaye da stents tare da ƙwayoyin cuta na nasopharyngeal na iya haifar da ƙaruwar kamuwa da cuta.
Filastar balan-balan na bututun Eustachian ta hanyar buɗewar nasopharyngeal sabuwar hanya ce ta rage girman matsalar rashin aikin ET da nufin buɗewa da faɗaɗa ɓangaren cartilaginous na ET8,9,10,46. Duk da haka, ba a gano hanyar maganin da ke ƙarƙashinta ba47 kuma sakamakonta na dogon lokaci na iya zama ƙasa da kyau8,9,11,46. A ƙarƙashin waɗannan yanayi, yin amfani da ƙarfe na wucin gadi na iya zama zaɓi mai inganci na magani ga marasa lafiya waɗanda ba su mayar da martani ga gyaran balan-balan na bututun Eustachian ba, kuma an nuna yuwuwar yin amfani da ET a cikin bincike da yawa kafin asibiti. An dasa poly-l-lactide scaffolds ta cikin membrane na tympanic a cikin chinchillas da zomaye don tantance juriya da lalacewa a cikin vivo17,18. Bugu da ƙari, an ƙirƙiri samfurin tumaki don kimanta bayanin stents na balan-balan na ƙarfe da za a iya faɗaɗa su a cikin vivo. A cikin bincikenmu na baya, an ƙirƙiri wani samfurin alade na ET don bincika yuwuwar fasaha da kimanta rikice-rikicen da stent ya haifar,19 wanda ya samar da tushe mai ƙarfi don wannan binciken don bincika ingancin SES ta amfani da hanyoyin da aka riga aka kafa. A cikin wannan binciken, an sami nasarar gano SES a cikin guringuntsi kuma ya hana yaduwar nama yadda ya kamata. Babu wata matsala da ta shafi stent, amma akwai raunin mucosa da murfin jagora na ƙarfe tare da zubar jini ta hanyar tuntuɓar wanda ya warke kwatsam cikin makonni 4. Ganin yuwuwar rikice-rikicen murfin ƙarfe, inganta tsarin isar da SES yana da gaggawa kuma yana da mahimmanci.
Wannan binciken yana da wasu iyakoki. Duk da cewa binciken histological ya bambanta sosai tsakanin ƙungiyoyi, adadin dabbobin da ke cikin wannan binciken ya yi ƙanƙanta don ingantaccen nazarin ƙididdiga. Duk da cewa masu lura uku sun makance don tantance bambancin da ke tsakanin masu lura, an ƙayyade matakin shigar ƙwayoyin kumburi na submucosal bisa ga rabe-raben ƙwayoyin kumburi da yawa saboda wahalar ƙidaya ƙwayoyin kumburi. Tunda bincikenmu an gudanar da shi ta amfani da ƙayyadadden adadin manyan dabbobi, an yi amfani da allurar magani guda ɗaya, ba a gudanar da nazarin pharmacokinetic a cikin jiki ba. Ana buƙatar ƙarin bincike don tabbatar da mafi kyawun adadin maganin da amincin sirolimus a cikin ET. A ƙarshe, lokacin bin diddigin makonni 4 shi ma iyakance ne na binciken, don haka ana buƙatar nazarin kan ingancin SES na dogon lokaci.
Sakamakon wannan binciken ya nuna cewa SES na iya hana yaduwar kyallen da rauni ya haifar bayan sanya sassan Co-Cr da za a iya faɗaɗawa a cikin samfurin ET na alade. Makonni huɗu bayan sanya stent, canje-canjen da ke da alaƙa da yaduwar kyallen da stent ya haifar (gami da yankin yaduwar kyallen da kauri na submucosal fibrosis) sun yi ƙasa sosai a cikin ƙungiyar SES fiye da ƙungiyar kulawa. SES da alama tana da tasiri wajen hana yaduwar kyallen da scaffold ke haifarwa a cikin aladu ET. Kodayake ana buƙatar ƙarin bincike don gwada mafi kyawun kayan stent da adadin magungunan da ake buƙata, SES tana da yuwuwar warkewa ta gida don hana hyperplasia na kyallen ET bayan sanya stent.
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