George Cheng

Transparent antifouling material for improved operative field visibility in endoscopy

Significance Inspection devices are frequently occluded by highly contaminating fluids that disrupt the visual field and their effective operation. These issues are particularly striking in endoscopes, where the diagnosis and treatment of diseases are compromised by the obscuring of the operative field by body fluids. Here we demonstrate that the application of a liquid-infused surface coating strongly repels sticky biological secretions and enables an uninterrupted field of view. Extensive bronchoscopy procedures performed in vivo on a porcine model shows significantly reduced fouling, resulting in either unnecessary or ∼10–15 times shorter and less intensive lens clearing procedures compared with an untreated endoscope. Camera-guided instruments, such as endoscopes, have become an essential component of contemporary medicine. The 15–20 million endoscopies performed every year in the United States alone demonstrate the tremendous impact of this technology. However, doctors heavily rely on the visual feedback provided by the endoscope camera, which is routinely compromised when body fluids and fogging occlude the lens, requiring lengthy cleaning procedures that include irrigation, tissue rubbing, suction, and even temporary removal of the endoscope for external cleaning. Bronchoscopies are especially affected because they are performed on delicate tissue, in high-humidity environments with exposure to extremely adhesive biological fluids such as mucus and blood. Here, we present a repellent, liquid-infused coating on an endoscope lens capable of preventing vision loss after repeated submersions in blood and mucus. The material properties of the coating, including conformability, mechanical adhesion, transparency, oil type, and biocompatibility, were optimized in comprehensive in vitro and ex vivo studies. Extensive bronchoscopy procedures performed in vivo on porcine lungs showed significantly reduced fouling, resulting in either unnecessary or ∼10–15 times shorter and less intensive lens clearing procedures compared with an untreated endoscope. We believe that the material developed in this study opens up opportunities in the design of next-generation endoscopes that will improve visual field, display unprecedented antibacterial and antifouling properties, reduce the duration of the procedure, and enable visualization of currently unreachable parts of the body, thus offering enormous potential for disease diagnosis and treatment.

Engineering a highly elastic human protein–based sealant for surgical applications

A highly elastic and adhesive photocrosslinkable surgical sealant using a modified human protein controls liquid leakages without the need for suturing. A stretchy, sticky alternative to sutures Repairing tissue ruptures during surgery can be complicated: Suturing requires piercing an already damaged tissue, and sealants such as glues may not match the material properties of the tissue, leading to subsequent leakage or rupture. Annabi et al. capitalized on the elastic properties of the human protein tropoelastin to engineer a photocrosslinkable hydrogel sealant material. The injectable material, MeTro, successfully sealed surgical incisions in blood vessels in rats and in lungs in pigs without evidence of leakage or rupture. Tunable elastic hydrogel sealants offer a promising adhesive, biocompatible, biodegradable material for tissue repair. Surgical sealants have been used for sealing or reconnecting ruptured tissues but often have low adhesion, inappropriate mechanical strength, cytotoxicity concerns, and poor performance in biological environments. To address these challenges, we engineered a biocompatible and highly elastic hydrogel sealant with tunable adhesion properties by photocrosslinking the recombinant human protein tropoelastin. The subcutaneous implantation of the methacryloyl-substituted tropoelastin (MeTro) sealant in rodents demonstrated low toxicity and controlled degradation. All animals survived surgical procedures with adequate blood circulation by using MeTro in an incisional model of artery sealing in rats, and animals showed normal breathing and lung function in a model of surgically induced rat lung leakage. In vivo experiments in a porcine model demonstrated complete sealing of severely leaking lung tissue in the absence of sutures or staples, with no clinical or sonographic signs of pneumothorax during 14 days of follow-up. The engineered MeTro sealant has high potential for clinical applications because of superior adhesion and mechanical properties compared to commercially available sealants, as well as opportunity for further optimization of the degradation rate to fit desired surgical applications on different tissues.

External Fixation of Proximal Tracheal Airway Stents: A Modified Technique

Treatment of subglottic and proximal tracheal stenosis for nonsurgical candidates includes tracheostomy, Montgomery T tubes, and silicone stents. When used in lesions with concomitant malacia, silicone stents have a high incidence of migration. We describe a simple and effective technique of securing endoluminal stents using an Endo Close suturing device (Coviden, Boston, MA) and an external silicone button in 9 consecutive patients.

Evidence-Based Assessment of Bronchial Thermoplasty in Asthma: Mechanisms and Outcomes

Purpose of ReviewAsthma is a heterogenous, chronic respiratory disease characterized by airway inflammation, obstruction, and hyperresponsiveness that results in debilitating respiratory symptoms. Despite advances in management strategies, severe asthmatics are often not responsive to the standard management and are disproportionately impacted. Bronchial thermoplasty offers a treatment option for this subgroup of severe asthmatics.Recent FindingsMultiple clinical studies have examined bronchial thermoplasty effectiveness and safety in severe asthma. Recent post-market and translational studies have brought new insights into the mechanism of action behind bronchial thermoplasty.SummaryBronchial thermoplasty is a treatment option for severe asthmatics who are not adequately controlled on their current treatment regimen.