1。病例报告<ol><li>病人被设置为访问在妇科门诊中，常因出血性疾病的发生。进行体检。 <ol><li>如果认为适当，病人定了子宫切除术。文书工作准备，并给病人手术当天术前用药。 </li><li> 60岁及以上的患者必须先提交血液样本，并监测心电图（ECG）的程序之前。 </li></ol></li><li>在当天的手术，病人是不允许的消耗六个小时在入场前向任何经口。 <ol><li>一个例外是甜清晰不带果肉的饮料，这是允许的，直到两个小时入场前向。 </li><li>病人术前用药（t.Paracetemol 1克+ t.Etodolac 300毫克+ t.Dexamethason 8毫克）与最后的饮料。 </li></ol></li><li>在病人入院的应用程序。一小时前的计划手术时间。 <ol><li>病房护士准备手术的病人。 </li><li>麻醉医师检查病人麻醉准备的文件。 </li></ol></li><li>当手术室准备和团队准备就绪，妇科医生运送病人到手术室。 <ol><li>病人躺在手术台和覆盖手术毛毯。 </li><li>一个四线被放置在左手和1,000毫升生理盐水浏览网页。安装监控设备。 </li><li>异丙酚和芬太尼麻醉诱导直到发生意识丧失（LOC），并保持使用TOF。 </li><li>为了便于插管，小剂量罗库溴铵（15毫克）的管理方式。 </li><li>直接喉镜进行。如果很难以可视化的声带，麦格拉思videolaryngoscop的使用。随后进行气管插管。 </li></ol></li><li>喷射腹部开始在12毫米汞柱的CO 2。 <ol><li>端口放置。 </li><li>在过程开始。 </li><li>外科医生告诉当火车四（TOF）比值&gt; 90％，相应的神经肌肉阻滞作用是断奶。 </li><li>在颈部的抓手从海角到皮肤的表面在脐的距离被标记。 </li><li>抓取器被放置在手术台。抓手抓取器的颈部（在外科医生的手指）的端部之间的距离随着磁带的测量，标记，然后以厘米为单位计算出的距离的测量。 </li></ol></li><li>吹入的CO 2的压力降低到8毫米汞柱。 <ol><li>在颈部的抓手从海角到皮肤的表面在脐的距离被标记。 </li><li>抓取器被放置在表。皮尺标记的距离被解释为厘米。 </li></ol></li><l&gt; 二氧化碳充气压力被调节至12毫米汞柱。 <ol><li>深神经肌肉阻滞应用到邮政强直计数（PTC）&lt;2。 </li><li>在颈部的抓手从海角到皮肤的表面在脐的距离被标记。 </li><li>抓取器被放置在表。用卷尺测量标记的距离厘米。 </li></ol></li><li> CO 2的吹入压力降低至8毫米汞柱。 <ol><li>在颈部的抓手从海角到皮肤的表面在脐的距离被标记。 </li><li>在颈部的抓手从海角到皮肤的表面在脐的距离被标记。 </li></ol></li><li>该过程被完成。 <ol><li>输注异丙酚和芬太尼被终止。 </li><li>病人被唤醒并且移动到他或她的床上。 </li><li>病人被转移到恢复室。 </li></o升&gt; </li></ol>

<ol>
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没有利益冲突的声明。

<html>直接计算工作容积，可用腹腔镜手术是困难的，但吹入CO 2的压力和腹部体积之间的关系是比较容易衡量9。这里，我们提出的方法是使用外科抓取器内的空间，来估计在注气过程中腹部，作为一种替代的方法记录吹入CO 2的体积。 这些测量表明，它有可能保持一个稳定的量，当充气压力降低，并诱发了深刻的神经肌肉阻滞。 一个明显?...

常用的神经肌肉阻断剂促进气管插管，麻醉过程中，以方便手术。药理学试剂的使用达到深层放松整个腹腔镜手术允许外科医生或者继续在同一水平的CO 2吹入，同时受益于更好的手术条件，或降低吹入压力降低手术并发症的风险。几项研究已经表明降低工作压力5,6,7的正面效应。腹腔镜子宫切除手术后经常看到的一个症状是肩部疼痛，经常说作为一个主要问题，最重要的问题，对病人说话时跟进。 腹腔镜子宫肌瘤剔除术或子宫切除术通常是更保守的方法失败时，建议控制由子宫肌瘤引起的症状。在我们的机构中​​，这些程序进行吹入CO 2的压力为12毫米汞柱。有两个经验丰富的妇科医生进行妇科病例。我们所有的案件都与丙泊酚和芬太尼麻醉，插管往往促进了低剂量的罗库溴铵（15毫克）。 从我们日常的临床工作中，我们已经确定了一个最令人不安的副作用后腹腔镜子宫切除术，这是支持由文献8肩部疼痛。有研究表明，降低腹内压，也可以减少肩部疼痛。在努力减少CO 2的吹入压力，为事先关注的问题之一是，如果手术野，在手术过程中的可视性将受到损害。试图确定在手术过程中的概述，我们成立了一个方法来比较腹腔内的工作空间。但是，它可以是非常困难的监测在患者腹腔内体积的准确河畔期间盖瑞。在比利时的研究，卷压的关系已经说明，但该研究的作者得出的结论是有很大的个体间的变化9。为了获得更可靠的语句腹腔内的空间，我们使用海角的距离度量的皮肤。

deep neuromuscular blockade leads to a larger intraabdominal volume during laparoscopy

肩部疼痛是一种常见的症状，如子宫肌瘤剔除术或子宫切除术腹腔镜手术后，最近的研究表明，在手术过程中可能会降低充气压力减少的风险，手术后的疼痛。在这个试验性研究中，提出了一种方法，用于测量的腹腔内给外科医生在测定法laproscopy过程中的可用空间，以检查是否松弛产生的深部神经肌肉阻滞作用，可以增加工作的手术空间足以允许在CO 2的减少充气压力。使用腹腔镜抓手，皮肤海角的距离的测量是在两个不同的注气压力：8毫米汞柱和12毫米汞柱。初步测量后，神经肌肉阻断剂（罗库溴铵）向患者给药，腹腔内的体积再次测量。 15例患者收集到的导频数据表明，腹腔内的空间在8毫米汞柱与BLO与腹腔内的空间在12毫米汞柱，无封锁计量ckade。不与患者的身高，体重，BMI，年龄的影响神经肌肉阻滞。因此，使用神经肌肉阻滞作用，保持一个稳定的音量，同时降低充气压力，可能会产生改善患者预后。

这项试验研究的15例患者进行了腹腔镜手术过程中的深部神经肌肉阻滞的影响进行评估。 这里说明的方法是用于获取在腹腔镜全子宫切除术（ 图1）的患者的腹腔内空间的测量。在每一个病人，测量腹腔内空间下采取了以下条件：12毫米汞柱压力，而深部神经肌肉阻滞，12毫米汞柱，封锁不封锁，8毫米汞柱，和8毫米汞柱封锁。 在这两个12毫米?...

Watch this Scientific Journal Video about Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy at JoVE.com

Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

本文提出了一种方法测量工作期间卷腹腹腔镜子宫肌瘤剔除术的手术抓手，并应用这种技术来取得的试验数据，深神经肌肉阻滞（NMB）是否可以允许使用较低的充气压力。在腹腔镜手术中气腹压力减少已经证明，以减少手术后的疼痛，因此在手术过程中就使用NMB可能使改善患者的治疗效果。

深神经肌肉阻滞信息到更大的在腹腔镜腹腔容积

Shoulder pain is a commonly reported symptom following laparoscopic procedures such as myomectomy or hysterectomy, and recent studies have shown that ...

deep-neuromuscular-blockade-leads-to-larger-intraabdominal-volume

Research

JoVE Journal

Medicine

13.0K 次观看.  Aleris-Hamlet Hospitals, Soeborg, Denmark. 本文提出了一种方法测量工作期间卷腹腹腔镜子宫肌瘤剔除术的手术抓手，并应用这种技术来取得的试验数据，深神经肌肉阻滞（NMB）是否可以允许使用较低的充气压力。在腹腔镜手术中气腹压力减少已经证明，以减少手术后的疼痛，因此在手术过程中就使用NMB可能使改善患者的治疗效果。

视频: Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy

Intra-Operative Behavioral Tasks in Awake Humans Undergoing Deep Brain Stimulation Surgery

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through implanted electrodes. Deep brain stimulation was first implemented as a therapeutic modality by Benabid et al. in the late 1980s, when he used this technique to stimulate the ventral intermediate nucleus of the thalamus for the treatment of tremor 1. Currently, the procedure is used to treat patients who fail to respond adequately to medical management for diseases such as Parkinson's, dystonia, and essential tremor. The efficacy of this procedure for the treatment of Parkinson's disease has been demonstrated in well-powered, randomized controlled trials 2. Presently, the U.S. Food and Drug Administration has approved DBS as a treatment for patients with medically refractory essential tremor, Parkinson's disease, and dystonia. Additionally, DBS is currently being evaluated for the treatment of other psychiatric and neurological disorders, such as obsessive compulsive disorder, major depressive disorder, and epilepsy. 
DBS has not only been shown to help people by improving their quality of life, it also provides researchers with the unique opportunity to study and understand the human brain. Microelectrode recordings are routinely performed during DBS surgery in order to enhance the precision of anatomical targeting. Firing patterns of individual neurons can therefore be recorded while the subject performs a behavioral task. Early studies using these data focused on descriptive aspects, including firing and burst rates, and frequency modulation 3. More recent studies have focused on cognitive aspects of behavior in relation to neuronal activity 4,5. This article will provide a description of the intra-operative methods used to perform behavioral tasks and record neuronal data with awake patients during DBS cases. Our exposition of the process of acquiring electrophysiological data will illuminate the current scope and limitations of intra-operative human experiments.

Deep brain stimulation surgery offers a unique opportunity to examine information encoding in the awake human brain. This article will describe intra-operative methods used to perform cognitive and behavioral tasks while simultaneously acquiring physiological data such as EMG, single-unit neuronal activity and/or local field potentials.

在接受深部脑刺激手术术中唤醒人类行为任务

Deep brain stimulation (DBS) is a surgical procedure that directs chronic, high frequency electrical stimulation to specific targets in the brain through ...

科研

医学

Dorsal Column Steerability with Dual Parallel Leads using Dedicated Power Sources:  A Computational Model

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic efficacy. Since patient pain patterns can be unique, a common stimulation configuration is the placement of two leads in parallel in the dorsal epidural space. This construct provides flexibility in steering stimulation current mediolaterally over the dorsal column to achieve better pain-paresthesia overlap. Using a mathematical model with an accurate fiber diameter distribution, we studied the ability of dual parallel leads to steer stimulation between adjacent contacts on dual parallel leads using (1) a single source system, and (2) a multi-source system, with a dedicated current source for each contact. The volume conductor model of a low-thoracic spinal cord with epidurally-positioned dual parallel (2 mm separation) percutaneous leads was first created, and the electric field was calculated using ANSYS, a finite element modeling tool. The activating function for 10 um fibers was computed as the second difference of the extracellular potential along the nodes of Ranvier on the nerve fibers in the dorsal column. The volume of activation (VOA) and the central point of the VOA were computed using a predetermined threshold of the activating function. The model compared the field steering results with single source versus dedicated power source systems on dual 8-contact stimulation leads. The model predicted that the multi-source system can target more central points of stimulation on the dorsal column than a single source system (100 vs. 3) and the mean steering step for mediolateral steering is 0.02 mm for multi-source systems vs 1 mm for single source systems, a 50-fold improvement. The ability to center stimulation regions in the dorsal column with high resolution may allow for better optimization of paresthesia-pain overlap in patients.

Using a mathematical model of spinal cord stimulation, we found that a multi-source system with independent power sources for each contact can target more central points of stimulation on the dorsal column (100 vs 3) and has 50-fold more field steering resolution (0.02mm vs 1mm) than a single-source system.

背柱与双并行使用专用电源的信息Steerability，计算模型

In spinal cord stimulation (SCS), concordance of stimulation-induced paresthesia over painful body regions is a necessary condition for therapeutic ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

利用经颅磁刺激，以研究人类的神经肌肉系统

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Construction of Vapor Chambers Used to Expose Mice to Alcohol During the Equivalent of all Three Trimesters of Human Development

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal Alcohol Spectrum Disorders (FASDs). At the most severe end of the spectrum is Fetal Alcohol Syndrome (FAS), characterized by growth retardation, craniofacial dysmorphology, and neurobehavioral deficits. Studies with animal models, including rodents, have elucidated many molecular and cellular mechanisms involved in the pathophysiology of FASDs. Ethanol administration to pregnant rodents has been used to model human exposure during the first and second trimesters of pregnancy. Third trimester ethanol consumption in humans has been modeled using neonatal rodents. However, few rodent studies have characterized the effect of ethanol exposure during the equivalent to all three trimesters of human pregnancy, a pattern of exposure that is common in pregnant women. Here, we show how to build vapor chambers from readily obtainable materials that can each accommodate up to six standard mouse cages. We describe a vapor chamber paradigm that can be used to model exposure to ethanol, with minimal handling, during all three trimesters. Our studies demonstrate that pregnant dams developed significant metabolic tolerance to ethanol. However, neonatal mice did not develop metabolic tolerance and the number of fetuses, fetus weight, placenta weight, number of pups/litter, number of dead pups/litter, and pup weight were not significantly affected by ethanol exposure. An important advantage of this paradigm is its applicability to studies with genetically-modified mice. Additionally, this paradigm minimizes handling of animals, a major confound in fetal alcohol research.

We demonstrate the construction of alcohol vapor chambers using readily available materials that simultaneously house 6 mouse cages. We further describe their use in a mouse model of fetal alcohol exposure equivalent to all 3&#160;trimesters of human pregnancy. This paradigm exposes animals during gestation and postnatal days 1-12.

蒸汽腔体建设用于公开小鼠酒精在所有三个学期人类发展的等效

Exposure to alcohol during development can result in a constellation of morphological and behavioral abnormalities that are collectively known as Fetal ...

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

时空步态参数的患者和老年人的临床评估

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

Using Saccadometry with Deep Brain Stimulation to Study Normal and Pathological Brain Function

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including Parkinson's and Huntington's can disrupt it. People with Parkinson's disease, for example, tend to have increased saccadic latencies. Consequently, the quantitative measurement of saccadic eye movements has received considerable attention as a potential biomarker for neurodegenerative conditions. A lot more can be learned about the brain in both health and disease by observing what happens to eye movements when the function of specific brain areas is perturbed. Deep brain stimulation is a surgical intervention used for the management of a range of neurological conditions including Parkinson's disease, in which stimulating electrodes are placed in specific brain areas including several sites in the basal ganglia. Eye movement measurements can then be made with the stimulator systems both off and on and the results compared. With suitable experimental design, this approach can be used to study the pathophysiology of the disease being treated, the mechanism by which DBS exerts it beneficial effects, and even aspects of normal neurophysiology.

This paper describes the use of quantitative measurement of eye movements in conjunction with stimulation of focal areas of the deep brain in order to study physiology, pathophysiology, and the mechanisms of deep brain stimulation.

使用Saccadometry与深部脑刺激来研究正常和病理脑功能

The oculomotor system involves a large number of brain areas including parts of the basal ganglia, and various neurodegenerative diseases including ...

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased oxygen demand; otherwise, a diffusion limitation may occur. The increase in DLCO with exercise is due to increased capillary blood volume (Vc) and membrane diffusing capacity (Dm). Vc and Dm increase secondary to the recruitment and distension of pulmonary capillaries, increasing the surface area for gas exchange and decreasing pulmonary vascular resistance, thereby attenuating the increase in pulmonary arterial pressure. At the same time, the recruitment of intrapulmonary arteriovenous anastomoses (IPAVA) during exercise may contribute to gas exchange impairment and/or prevent large increases in pulmonary artery pressure.
We describe two techniques to evaluate pulmonary diffusion and circulation at rest and during exercise. The first technique uses multiple-fraction of inspired oxygen (FIO2) DLCO breath holds to determine Vc and Dm at rest and during exercise. Additionally, echocardiography with intravenous agitated saline contrast is used to assess IPAVAs recruitment.
Representative data showed that the DLCO, Vc, and Dm increased with exercise intensity. Echocardiographic data showed no IPAVA recruitment at rest, while contrast bubbles were seen in the left ventricle with exercise, suggesting exercise-induced IPAVA recruitment.
The evaluation of pulmonary capillary blood volume, membrane diffusing capacity, and IPAVA recruitment using echocardiographic methods is useful to characterize the ability of the lung vasculature to adapt to the stress of exercise in health as well as in diseased groups, such as those with pulmonary arterial hypertension and chronic obstructive pulmonary disease.

To assess the pulmonary diffusion and vasculature responses to exercise, we describe the multiple-inspired oxygen diffusion capacity technique to determine capillary blood volume and membrane diffusing capacity, as well as agitated saline contrast echocardiography to assess the recruitment of intrapulmonary arteriovenous anastomoses.

肺毛细血管血量，膜弥散能力，及肺内动静脉吻合的评估期间行使

Exercise is a stress to the pulmonary vasculature. With incremental exercise, the pulmonary diffusing capacity (DLCO) must increase to meet the increased ...

Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts to spare normal ovarian cortex. Optimization of tubal anatomy is another frequent consideration. Fertility-sparing laparoscopic techniques at the time of cystectomy for ovarian endometrioma seek to limit iatrogenic surgical damage to the ovarian cortex and strategically assess and respond to genital tract patency. Surgical candidates frequently desire relief from endometriosis-associated pain while also seeking to optimize spontaneous or assisted conception rates. Operative benefits include potential for surgical and histopathologic diagnosis of endometriosis, evaluation of genital tract patency, and treatment of visualized lesions. Resection of ovarian endometrioma nonetheless poses significant risks, including surgical injury, blood loss, post-surgical decline in ovarian reserve and post-operative inflammation with adhesion formation, both of which may impair folliculogenesis.
We present the case of a 32-year-old woman with known endometriosis and continued pain refractory to medical management who opted for surgical management of her disease tailored toward optimizing her chances at future conception. Using this case as an example, we describe techniques and considerations for diagnostic laparoscopy, adhesiolysis, ovarian cystectomy, chromopertubation, and salpingectomy with a focus on maintaining a fertility-preserving approach.

This protocol presents techniques to laparoscopically excise ovarian endometrioma, to perform adhesiolysis with sparing electrosurgical application, and to employ intraoperative chromopertubation to assess for genital tract patency. This systematic approach will facilitate optimal endometriosis management, guide concomitant adnexal surgeries, and enhance post-surgical fertility outcomes.

在卵巢子宫内膜异位症腹腔镜膀胱切除术期间优化卵巢储备的手术技术

Surgical management of ovarian endometrioma in patients desiring fertility is complicated by the need to balance maximal resection of disease with efforts ...

Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this approach makes an innovative improvement in the treatment of G-GISTs that are less than 5 cm in size. Laparoscopy-endoscopy cooperative surgery (LECS) is used to combine endoscopic and laparoscopic surgeries, fully realizing their respective advantages and avoiding their drawbacks. The main steps are as follows. First, gastroscopy and laparoscopy are combined to confirm the location and boundary of the tumor. Tumor resection is carried out laparoscopically, guided by a gastroscope. The specimen is removed orally and the gastric wound closed laparoscopically. Then, gastroscopy and laparoscopy are combined to determine whether there is wound bleeding, if the suture is satisfactory, and if the gastric cavity is deformed.
LECS has natural advantages in the treatment of G-GISTs that are less than 5 cm in size. The accurate estimation of tumor location and boundary greatly improves the complete resection rate of tumors. The risk of tumor rupture is substantially reduced, and the long-term prognosis of patients is significantly improved. The process allows for accurate resection of the tumor, maximum preservation of normal gastric tissue and organ function, and avoids postoperative gastric deformation. The patient's postoperative rehabilitation is greatly accelerated, and oral feeding can resume on the day of the operation. The specimen is taken out through the mouth to avoid the need for an extended abdominal incision. This greatly reduces the patient's postoperative pain and scarring. The method greatly shortens the postoperative hospital stay (i.e., discharge is possible on the day after the operation), increasing the turnover of hospital beds.

Laparoscopy-endoscopy cooperative surgery is appropriate for the treatment of gastric gastrointestinal stromal tumors less than 5 cm in size. It can achieve the respective advantages of endoscopic and laparoscopic surgeries while avoiding their drawbacks.

腹腔镜-内镜合作手术治疗胃肠道间质瘤

In view of the shortcomings of endoscopic or laparoscopic surgeries alone in the treatment of gastric gastrointestinal stromal tumors (G-GISTs), this ...

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the allocation of a growing number of donor hearts with extended criteria. These marginal grafts are associated with a high risk of primary graft failure and may benefit from ex situ perfusion before transplant. This technology allows for extended organ preservation using warm oxygenated blood perfusion with continuous metabolic monitoring. The only NESP device currently available for clinical practice perfuses the organ in an unloaded non-working state, which does not allow for functional assessment of the beating heart. We therefore developed an original platform of NESP in working mode conditions with adjustment of left ventricular preload and afterload. This protocol was applied in porcine hearts. Ex situ functional assessment of the heart was achieved with intracardiac conductance catheterization and surface echocardiography. Along with a description of the experimental protocol, we herein report the main results, as well as pearls and pitfalls associated with the acquisition of pressure-volume loops and myocardial power during NESP. Correlations between hemodynamic findings and ultrasound variables are of major interest, especially for further rehabilitation of donor hearts before transplantation. This protocol aims to improve the assessment of donor hearts to both increase the donor pool and reduce the incidence of primary graft failure.

Functional Assessment of the Donor Heart During Ex Situ Perfusion: Insights from Pressure-Volume Loops and Surface Echocardiography

A reliable noninvasive approach for functional assessment of the donor heart during normothermic ex situ heart perfusion (NESP) is lacking. We herein describe a protocol for ex situ assessment of myocardial performance using the epicardial echocardiography and conductance catheter method.

非原位灌注期间供体心脏的功能评估：来自压力-容量环和表面超声心动图的见解

Heart transplantation remains the gold standard treatment for advanced heart failure. However, the current critical organ shortage has resulted in the ...