作者要感谢珍妮特·海斯-克鲁格和凯利·安德森管理蒙特雅克殖民地，艾伦·杨博士向我们介绍了蒙特雅克和Cervid解决方案公司的克莱夫·特德福德先生为这个项目提供种子蒙贾克。这项工作得到了NIH赠款R01AI093634的支持。

1. 程序准备
所述所有动物程序都已由科罗拉多州立大学动物护理和使用机构委员会（实验室动物护理评估和认证协会）审查和批准，该协会是国际认可机构。
<ol><li>在检查之前，使用适当的静剂或麻醉方案固定动物，以提供放松，并允许适当的定位。一个处理者限制鹿，而另一个人给动物施用安定。 注： 作者已经找到以下组合，以提供有效的静剂在这个物种：丁醇（0.45毫克/千克），阿扎佩龙（0.035毫克/千克）和甲基胺（0.04毫克/千克），肌肉内在臀部肌肉管理。</li>
	<li>一旦脚趾达到允许合规处理的沉着状态，将她定位在复明或横向重新任职的检查台上或 V 槽内。稍微提升头部、颈部和胸腔（约 20-30°），以降低反流和渴望的神经内含物的风险，并便于在手术过程中进行适当的通风。 注： 在大多数腹腔或其他反胃动物中，腹部超声波在站立动物中进行：然而，这个物种的体积小和行为考虑需要大量的沉淀检查和胸骨定位因此更加困难，并可能排除有效的成像技术。将动物置于胸骨和横向重新任职之间的中途，可能是降低再叛乱和低气流风险的理想之选，如果可能，应予以考虑。在任何卧存位置，必须仔细监测动物的呼吸，并立即停止检查，如果发现动物出现回流或通风过低，则将其置于严重重新监禁状态。</li>
	<li>如有必要，从腹部区域剪发，以便实现传感器的脚印和皮肤之间的适当接触。 注： 在妊娠早期，可以在乳腺附近的腹腔腹部检测到怀孕的证据。蒙特雅克的这个区域通常是无毛的，因此此时可能不会指示剃须。随着胎儿的生长和子宫的衰减，在腹部占据更颅骨的位置，在成像之前需要剪头发。应小心避免对皮肤造成任何机械创伤，包括剃须刀刀片的撕裂或电剪的热损伤。</li>
	<li>将超声波装置放置在一个位置，使技术人员能够在用占主导地位的手进行检查时轻松可视化监视器。将动物识别信息（名称、识别号 等）输入系统，以自动标记保存的图像和视频循环。</li>
</ol>2. 跨性别生殖超声检查
<ol><li>将大量的声学耦合凝胶涂抹在腹腔上。</li>
	<li>将 5 - 10 MHz 弯曲的线性传感器放在腹腔皮肤上，立即颅到，然后缓慢地朝颅面方向移动，以评估骨盆腔内的结构。扫描胆汁腹部的左右象限，以评估蒙贾克双角子宫的两个角。 注： 全面的腹部超声波检查包括所有腹部内脏，包括肝脏、肾脏、脾脏、胃肠道、尿囊和生殖道。为了本议定书的目的，将只详细讨论对怀孕的检查：然而，其他腹腔器官的正常外观应被识别为这些结构可能会在研究过程中遇到。在这个位置最常见的器官包括胃肠道、尿囊和生殖道的片段。大肠和小肠通过肠道壁的特征分层外观来识别。流明可能发音，也可能不发音，具体取决于内容的类型和数量，其中可能包括液体、气体、粘液或食物颗粒。除非尿液分离，否则膀胱可能难以识别，膀胱壁的层明显不如肠道的层明显不同。除了子宫外，卵巢也可能在雌性蒙贾克的生殖道的超声波上找到。卵巢将以卵巢结构出现，靠近肾脏的卵巢极，其外观可能会在骨循环过程中发生变化。皮层内存在多个成熟、充满液体的卵泡，这暗示着雌激素。 注： 通过旋转和/或"扇动"传感器的扫描头，结构可以用横向或下垂平面进行评估。<ol>
<li>如果需要区分子宫与尿囊，通过对腹腔腹部施加温和压力或放置尿导管并重复扫描，手动排空膀胱。 注： 只有在动物处于胸骨或直立位置时，才应尝试手动表达膀胱，这有利于腹部内脏更自然地方向，并降低对其他结构造成创伤的风险。子宫也可以通过评估器官壁的厚度来区分尿囊。中度放开的膀胱的典型厚度约为1.4毫米24，而作者发现，在蒙贾克，大子宫的肌肉壁通常尺寸在7-8毫米之间。 注：由于缺乏可识别的胎儿结构，早孕很难确定，事实上，怀孕的第一个迹象可能只是腹腔内的一个小液体口袋。如果此时看到，发育中的胚胎将呈超选择性，卵形到子宫内的无定形结构（图1）。</li>
	</ol></li>
	<li>根据需要对深度、频率和增益进行调整，以改善对比度和图像细节。 注意：更高的频率与较短的波长相关联，这是提高图像分辨率所必需的。大多数转导器能够在频率范围内工作（例如，6-10 MHz）24。频率可以通过超声波单元上的扫描仪控制进行调整，增加频率将导致图像更清晰。增加频率同时降低声波渗透深度：因此，减少频率可能是必要的可视化更深的结构，但分辨率可能会成为妥协24。因此，选择尽可能高的频率以达到所需的组织深度非常重要。增益控制的调整将改变声波从组织返回到传感器的放大，并影响图像24的对比度。增益应设置为实现高选择组织和低氧组织之间的最佳对比的点，这些设置可能需要根据正在成像的结构进行调整。</li>
</ol>3. 获得胎儿测量
注意：许多家畜物种的妊娠年龄可以使用从超声检查获得的胎儿测量的既定参考范围来估算。最常用的测量包括直冠凸长（SCRL）、胸部深度（CD）和头部长度（HL）17。虽然尚未收集到足够的数据，以制定可靠的妊娠年龄指南在里维斯的蒙贾克鹿，测量可以收集，以开始建立这些参考。胎儿心率 （FHR） 已在其他类型的子宫颈和反胃动物中显示，随着妊娠进展到某一点（通常在妊娠的第 60 天左右），线性增加，此时心率开始下降17。FHR可用于与其他超声波观察一起估计妊娠年龄，但更常用于测量胎儿存活率17，24。FHR早在观察后35天就计算在里维斯的蒙贾克。
<ol><li>要测量 SCRL，将子宫定位在监视器上，并对传感器的位置进行微调，直到获得整个胎儿的下垂视图（图 2和图 3）。冻结图像并测量头骨最后部和囊基之间的距离（图 2和3）。</li>
	<li>要测量 CD，获取胎儿的下垂视图（可用于测量 SCRL 的相同图像），并测量胸腔的支部和腹腔方面之间的距离（图 2和图 3）。</li>
	<li>要测量 HL，使用与 SCRL 和 CD 测量中描述的胎儿相同的下垂视图，测量从腹股顶到鼻底的距离（图 2和图 3）。</li>
	<li>要计算胎儿心率，通过可视化胎儿的有节奏收缩来识别胎儿胸腔内的心脏。通过计算在 1 分钟内发生的收缩（心跳）数来计算心率。 注： 如果使用的超声波装置具有多普勒功能，则此功能可能用于进一步帮助区分心脏和其他非特定胎儿运动。</li>
	<li>验证所有保存的图像和视频循环包括所有必要的识别信息，包括动物名称或数量、日期、测量和适当的结构标签。</li>
</ol>4. 程序结论和恢复
<ol><li>使用软布或纸巾从动物腹部取出所有残留的超声波接触凝胶。在存储前从传感器中清洁凝胶。</li>
	<li>如果使用步骤 1.1 中描述的沉静协议，以 0.25 毫克/kg 的剂量在皮下施用阿提帕梅索莱，以扭转甲基霉素的影响。如果使用其他可用拮抗剂的缓解协议，则在程序结束时根据已公布的剂量将这种剂给动物管理，以加快恢复速度。</li>
	<li>将 muntjac 放在软床表面的胸骨重新任职，头部稍微抬起，以减少反胃和渴望的鲁梅纳尔内容的风险。密切监视动物，直到完全恢复，并能够在没有帮助的情况下在围栏周围流动。</li>
</ol>

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S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Chapter 2. Small Animal Diagnostic Ultrasound. , 19-29 (2002).</li><li>Huang, F., Cockrell, D. C., Stephenson, T. R., Noyes, J. H., Sasser, R. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+serum+pregnancy+test+with+a+specific+radioimmunoassay+for+moose+and+elk+pregnancy-specific+protein+B.">A serum pregnancy test with a specific radioimmunoassay for moose and elk pregnancy-specific protein B.</a> J. Wildl. Manag. 64, 492-499 (2000).</li></ol>

作者没有什么可透露的。

该协议描述了在里维斯的蒙特雅克鹿怀孕诊断中应用跨性别超声波。与其他超声波研究一致，适当的设备和技术熟练程度对于成功进行蒙贾克多伊的生殖检查至关重要。仔细审查哺乳动物的基本解剖学、诊断超声波的物理原理以及腹部内脏典型的超声学外观将有助于减少误诊。此外，选择适当的转导器和熟悉仪器和扫描仪控制对于获得高质量的图像和准确的解释至关重要。
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超声检查是牛1、绵羊2、3、山羊4、马5、伴侣动物6、7等家畜种孕期诊断方法。这种成像方式也被确定为一个有价值的工具，以怀孕检测和胎儿年龄估计在几个品种的圈养颈椎，包括休养鹿8-11，红鹿12-16，北海道西卡鹿17，驯鹿18，19。在许多情况下，超声学产生的准确率高于其他妊娠检测机制，如血清孕酮或妊娠相关糖蛋白分析9，18。此外，生殖道的超声学可视化可以提供有关胎儿生存能力、妊娠年龄和发育异常的识别的其他信息，否则将难以评估。超声学用于评估生殖状态表明，这种方法应适应其他使用活性繁殖程序的物种。
里维斯的蒙特雅克鹿（蒙蒂亚库斯里韦西）是原产于东南亚20岁的小种。虽然这些动物的繁殖周期在它们的本领地并不明显，但对英格兰南部部分地区的野性种群的研究已经加深了对它们繁殖模式的了解。与大多数认证不同，里维斯的蒙特雅克似乎全年繁殖，没有明显的季节性讨好高峰20-22。雌性小鹿通常在怀孕210天后生下一只小鹿，并在24小时20-22小时内可靠地进入产后雌性。这是否不设想在这个产后期间将返回到埃斯特鲁斯约24-25天后20。在俘虏的情况下，繁殖通常是通过住房与一个或多个完整的男性实现的。该系统产生令人满意的受孕率，对人员要求很少的技术技能，但确切的育种日期很难确定，如果不是不可能的话。
蒙特雅克是细胞遗传学研究中常用的，因为不同物种23的双体染色体数量广泛，卡约蒂奇多样化率高。这些动物目前正在作为普里昂病发病机理和传播的模型进行调查，特别感兴趣的是研究慢性浪费病（CWD）在子宫颈的垂直传播。蒙古人在若干不同研究应用中的重要性表明，应建立改进的生殖技术，以补充目前的调查程序。具体来说，评估妊娠期的非侵入性机制有可能阐明不同实验条件下生殖性能和胎儿生长发育的关键变化。此外，在无法确定繁殖日期的情况下，开发实时胎儿测量参考值对于估计妊娠年龄具有潜在的价值。先前的研究已经描述了使用胎儿测量的机制，如冠冠长度（CRL）、胸部深度（CD）和头部长度（HL），以估计11-14、16，17等物种妊娠的大致阶段。此外，其中一些研究还建立了指导方针，描述何时可以识别特定的发展里程碑，如骨骼矿化或胎儿心跳。虽然这些数据可能有助于指导muntjac的生殖超声波分析，但大多数其他被研究的认证物种的体型要大得多，妊娠期更长，降低了这些研究对muntjac应用的转化价值。
此处概述的协议描述了女性蒙贾克的跨性别超声波扫描，用于诊断和监测怀孕。此协议的成功执行可促进胎儿早期妊娠检测和胎儿生长发育评估。该技术在研究繁殖、 子宫发育 或以小型子宫颈模型垂直传播传染病的研究方面具有宝贵的应用，也可用于圈养繁殖手术的临床目的。

<table border="0" cellpadding="0" cellspacing="0" width="547">
	<colgroup>
		<col />
		<col />
		<col />
		<col />
	</colgroup>
	<tbody>
		<tr height="61">
			<td height="61" style="height:61px;width:187px;">Butorphanol tartrate (Torbugesic) (0.45 mg/kg)</td>
			<td style="width:127px;">Fort Dodge Animal Health, Fort Dodge, Iowa</td>
			<td style="width:64px;">NADA 135-780</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:187px;">Azaperone tartrate (0.035 mg/kg)</td>
			<td style="width:127px;">ZooPharm</td>
			<td style="width:64px;"></td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:187px;">Medetomidine HCl (0.04 mg/kg)</td>
			<td style="width:127px;">ZooPharm</td>
			<td style="width:64px;"></td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:187px;">Ultrasound contact gel</td>
			<td style="width:127px;">Medline, Mundelein, Illinois</td>
			<td style="width:64px;">MDS092005</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:187px;">Atipamezole hydrochloride (Antisedan) (0.25 mg/kg)</td>
			<td style="width:127px;">Orion Corporation, Espoo, Finland</td>
			<td style="width:64px;">NADA 141-033</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="20">
			<td height="20" style="height:20px;"></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;">Table 2 Equipment</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr height="41">
			<td height="41" style="height:41px;width:187px;">Name of Equipment</td>
			<td style="width:127px;">Company</td>
			<td style="width:64px;">Catalog Number</td>
			<td style="width:171px;">Comments</td>
		</tr>
		<tr height="201">
			<td height="201" style="height:201px;width:187px;">V-trough (optional)</td>
			<td style="width:127px;">N/A</td>
			<td style="width:64px;">N/A</td>
			<td style="width:171px;">Animal may be supported in dorsal recumbency on a standard examination table or other surface without the use of a V-trough</td>
		</tr>
		<tr height="61">
			<td height="61" style="height:61px;width:187px;">Electrical clippers or razor blades for hair removal</td>
			<td style="width:127px;">Oster, McMinnville, Tennessee</td>
			<td style="width:64px;">78005-140</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="61">
			<td height="61" style="height:61px;width:187px;">Ultrasound system: Ibex Pro portable ultrasound</td>
			<td style="width:127px;">E.I. Medical Imaging, Loveland, CO</td>
			<td style="width:64px;">Ibex Pro</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="61">
			<td height="61" style="height:61px;width:187px;">5-10 MHz transducer: CL3.8 5-2.5 MHz 60 mm curved linear array</td>
			<td style="width:127px;">E.I. Medical Imaging, Loveland, CO</td>
			<td align="right" style="width:64px;">290420</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:187px;">3 ml syringes</td>
			<td style="width:127px;">Covidien</td>
			<td align="right" style="width:64px;">1.18E+09</td>
			<td style="width:171px;"></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:187px;">22 G needles</td>
			<td style="width:127px;">Covidien</td>
			<td align="right" style="width:64px;">8.88E+09</td>
			<td style="width:171px;"></td>
		</tr>
	</tbody>
</table>

transabdominal ultrasound for pregnancy diagnosis in reeves' muntjac deer

里维斯的蒙特雅克鹿（蒙蒂亚库斯·里韦西）是原产于东南亚的小型认证物种，目前正在被调查为普里昂病传播和发病机理的潜在模型。垂直传播是研究传染病（包括普里昂病）的研究人员感兴趣的一个领域，这些调查需要有效的方法来评估母体感染对生殖性能的影响。超声检查是诊断妊娠和评估胎儿健康的一个成熟的工具，在许多动物物种1-7，包括几个品种的养殖证明8-19，但这种技术还没有在里维斯的蒙贾克鹿描述。在这里，我们描述了跨位超声波的应用，以检测怀孕在蒙贾克做，并评估胎儿生长和发展在整个妊娠期。使用此程序，怀孕的动物早在多巴克配对后 35 天就被识别出来，这是定期安全监测怀孕的有效方法。这项工作的未来目标将包括建立正常的胎儿测量参考，以估计妊娠年龄，确定诊断妊娠不同阶段怀孕的技术的敏感性和特殊性，以及确定不同实验条件下胎儿生长发育的变化。

使用此处描述的协议，可以使用微创技术在里夫的蒙特雅克鹿中诊断和监测怀孕。作者可以检测到怀孕的最早时间点是在观察到的交配行为之后大约35天。
在妊娠的早期阶段，通过可视化一个被确定为胆汁腹部缺氧空间的充满液体的子宫来诊断怀孕。在子宫内，发育中的胚胎以超选择卵巢结构出现，几乎没有可识别的特征（图1）。随着妊娠的进展，胎儿结构变得...

Watch this Scientific Journal Video about Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves' Muntjac Deer at JoVE.com

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves&#039; Muntjac Deer

跨地超声波被描述为评估里维斯蒙贾克鹿生殖状态的有效、非侵入性手段。这些方法可用于实现妊娠早期诊断和评估胎儿存活率。这项技术的未来应用包括估计妊娠年龄和母体疾病对胎儿发育的影响。

里维斯的蒙特雅克鹿怀孕诊断的跨性别超声波

Reeves' muntjac deer (Muntiacus reevesi) are a small cervid species native to southeast Asia, and are currently being investigated as a potential model of ...

transabdominal-ultrasound-for-pregnancy-diagnosis-reeves-muntjac

Research

JoVE Journal

Medicine

Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves' Muntjac Deer

10.2K 次观看.  Colorado State University. 跨地超声波被描述为评估里维斯蒙贾克鹿生殖状态的有效、非侵入性手段。这些方法可用于实现妊娠早期诊断和评估胎儿存活率。这项技术的未来应用包括估计妊娠年龄和母体疾病对胎儿发育的影响。

视频: Transabdominal Ultrasound for Pregnancy Diagnosis in Reeves' Muntjac Deer

FISH for Pre-implantation Genetic Diagnosis

Pre-implantation genetic diagnosis (PGD) is an established alternative to pre-natal diagnosis, and involves selecting pre-implantation embryos from a cohort generated by assisted reproduction technology (ART). This selection may be required because of familial monogenic disease (e.g. cystic fibrosis), or because one partner carries a chromosome rearrangement (e.g. a two-way reciprocal translocation). PGD is available for couples who have had previous affected children, and/or in the case of chromosome rearrangements, recurrent miscarriages, or infertility. Oocytes aspirated following ovarian stimulation are fertilized by in vitro immersion in semen (IVF) or by intracytoplasmic injection of an individual spermatozoon (ICSI). Pre-implantation cleavage-stage embryos are biopsied, usually by the removal of a single cell on day 3 post-fertilization, and the biopsied cell is tested to establish the genetic status of the embryo. Fluorescence in situ hybridization (FISH) on the fixed nuclei of biopsied cells with target-specific DNA probes is the technique of choice to detect chromosome imbalance associated with chromosome rearrangements, and to select female embryos in families with X-linked disease for which there is no mutation-specific test. FISH has also been used to screen embryos for spontaneous chromosome aneuploidy (also known as PGS or PGD-AS) in order to try and improve the efficiency of assisted reproduction; however, the predictive value of this test using the spreading and FISH technique described here is likely to be unacceptably low in most people's hands and it is not recommended for routine clinical use. We describe the selection of suitable probes for single-cell FISH, spreading techniques for blastomere nuclei, and in situ hybridization and signal scoring, applied to PGD in a clinical setting.

This article describes the selection of suitable probes for single-cell FISH, spreading techniques for blastomere nuclei, and in situ hybridization and signal scoring, applied to pre-implantation genetic diagnosis (PGD) in a clinical setting.

鱼的胚胎植入前基因诊断

Pre-implantation genetic diagnosis (PGD) is an established alternative to pre-natal diagnosis, and involves selecting pre-implantation embryos from a ...

科研

医学

Hydra, a Computer-Based Platform for Aiding Clinicians in Cardiovascular Analysis and Diagnosis

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect of different cardiovascular risk factors (e.g., diabetes, raised blood pressure, unhealthy diet, tobacco use, stress, etc.) that commonly coexist and act multiplicatively. Most CVDs can be prevented by an early identification of the highest risk factors and an appropriate treatment. The stratification of cardiovascular risk factors involves a wide range of parameters and tests that specialists use in their clinical practice. In addition to cardiovascular (CV) risk stratification, ambulatory blood pressure monitoring (ABPM) also provides relevant information for diagnostic and treatment purposes. This work presents a list of protocols based on the Hydra platform, a web-based system for clinical decision support which incorporates a set of functionalities and services that are required for complete cardiovascular analysis, risk assessment, early diagnosis, treatment and monitoring of patients over time. The program includes tools for inputting and managing comprehensive patient data, organized into different checkups to track the evolution over time. It also has a risk stratification tool to compute a CV risk factor based upon several risk stratification tables of reference. Additionally, the program includes a tool that incorporates ABPM analysis and allows the extraction of valuable information by monitoring blood pressure over a specific period of time. Finally, the reporting service summarizes the most relevant information in a set of reports that aid clinicians in their clinical decision-making process.

This article presents a protocol based on Hydra &#8212; a web-based system for clinical decision support that integrates a full and detailed set of functionalities and services required by physicians for complete cardiovascular analysis, risk assessment, early diagnosis, treatment, and monitoring over time.

一种计算机辅助心血管分析诊断平台的研究

Cardiovascular diseases (CVDs) are the leading cause of death throughout the world. The total risk of developing CVD is determined by the combined effect ...

International Expert Consensus and Recommendations for Neonatal Pneumothorax Ultrasound Diagnosis and Ultrasound-guided Thoracentesis Procedure

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Pneumothorax is a common emergency and critical disease in newborn infants that needs rapid, clear diagnosis and timely treatment. Diagnosis and treatment based on chest X-rays are associated with delayed management and radiation damage. Lung ultrasound (US) provides useful guidance for rapid, accurate diagnosis and the precise thoracentesis of pneumothorax.

国际专家共识与新生儿肺功能超声诊断与超声引导性胸腔手术建议

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic ...

Basophil Activation Test for Allergy Diagnosis

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and specific IgE (sIgE) determination in the evaluation of IgE-mediated allergic reactions to food, insect venom, drugs, as well as some forms of chronic urticaria. However, the role of this technique in the diagnostic algorithms is highly variable and not well determined.
BAT is based on the determination of basophil response to allergen/drug cross-linking IgE activation through the measurement of activation markers (such as CD63, CD203c) by flow cytometry. This test can be a useful and complementary tool to avoid controlled challenge tests&#160;to confirm allergy diagnosis, especially in subjects experiencing severe life-threatening reactions. In general, the performance of BAT should be considered if i) the allergen/drug produces false positive results in ST; ii) there is no allergen/drug source to use for ST or sIgE determination; iii) there is discordance between patient history and ST or sIgE determination; iv) symptoms suggest that ST may result in systemic response; v) before considering a CCT to confirm the culprit allergen/drug. The main limitations of the test are related to non-optimal sensitivity, especially in drug allergy, the need to perform the test no longer than 24 h after sample extraction, and the lack of standardization between laboratories in terms of procedures, concentrations, and cell markers.

The basophil activation test is a complementary in vitro diagnostic test for the evaluation of IgE-mediated allergic reactions based on the detection of basophil activation in the presence of a specific stimulus through the measure of activation markers by flow cytometry.

嗜碱性粒细胞活化试验用于过敏诊断

The basophil activation test (BAT) is a complementary in vitro diagnostic test that can be used in addition to clinical history, skin test (ST), and ...

Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde Cholangiopancreatography (ERCP) is the primary biliary drainage method whenever possible. Percutaneous Transhepatic Biliary Drainage (PTBD) is used as a salvage method if ERCP fails. Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) provides a feasible alternative biliary drainage method where one of the methods is EUS guided Hepaticogastrostomy (EUS-HGS). Here we describe the EUS-HGS technique in a case of unresectable malignant hilar biliary obstruction to achieve biliary drainage.
Presented here is the case of a 71-year-old female with painless jaundice and weight loss for 2 weeks. Computed Tomography (CT) imaging showed a 4 x 5 cm hilar tumor with lymphadenopathy and liver metastasis. EUS fine needle biopsy (FNB) of the lesion was consistent with cholangiocarcinoma. Her bilirubin levels were 212 &#181;mol/L (&lt;15) during presentation.
A linear echoendoscope was used to locate the left dilated intrahepatic ducts (IHD) of the liver. The segment 3 dilated IHD was identified and punctured using a 19 G needle. Contrast was used to opacify the IHDs under fluoroscopic guidance. The IHD was cannulated using a 0.025-inch guidewire. This was followed by the dilation of the fistula tract using a 6 Fr electrocautery dilator along with a 4 mm biliary balloon dilator. A partially covered metallic stent of 10 cm in length was deployed under fluoroscopic guidance. The distal part opens in the IHD and the proximal part was deployed within the working channel of the echoendoscope that subsequently released into the stomach. The patient was discharged three days after the procedure. Follow up performed in the second and fourth weeks showed that the bilirubin levels were 30 &#181;mol/L and 14 &#181;mol/L, respectively. This indicates that EUS-HGS is a safe method for biliary drainage in unresectable malignant biliary obstruction.

Endoscopic Ultrasound-Guided Biliary Drainage (EUS-BD) is an alternative method of biliary decompression in malignant biliary obstruction. Here we describe the technique of EUS guided-Hepaticogastrostomy (EUS-HGS) in a case of unresectable malignant hilar biliary obstruction.

内镜超声引导下胆道引流：内镜超声引导下肝胃造瘘术治疗恶性胆道梗阻

Patients with unresectable malignant biliary obstruction often require biliary drainage to decompress the biliary system. Endoscopic Retrograde ...

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a devastating disease affecting preterm infants, characterized by intestinal inflammation and necrosis. Enteroids have recently emerged as a promising system to model gastrointestinal pathologies. However, currently utilized methods for enteroid manipulation either lack access to the apical surface of the epithelium (three-dimensional [3D]) or are time-consuming and resource-intensive (two-dimensional [2D] monolayers). These methods often require additional steps, such as microinjection, for the model to become physiologically translatable. Here, we describe a physiologically relevant and inexpensive protocol for studying NEC in vitro by reversing enteroid polarity, resulting in the apical surface facing outward (apical-out). An immunofluorescent staining protocol to examine enteroid barrier integrity and junctional protein expression following exposure to tumor necrosis factor-alpha (TNF-&#945;) or lipopolysaccharide (LPS) under normoxic or hypoxic conditions is also provided. The viability of 3D apical-out enteroids exposed to normoxic or hypoxic LPS or TNF-&#945; for 24 h is also evaluated. Enteroids exposed to either LPS or TNF-&#945;, in combination with hypoxia, exhibited disruption of epithelial architecture, a loss of adherens junction protein expression, and a reduction in cell viability. This protocol describes a new apical-out NEC-in-a-dish model which presents a physiologically relevant and cost-effective platform to identify potential epithelial targets for NEC therapies and study the preterm intestinal response to therapeutics.

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

This protocol describes an apical-out necrotizing enterocolitis (NEC)-in-a-dish model utilizing small intestinal enteroids with reversed polarity, allowing access to the apical surface. We provide an immunofluorescent staining protocol to detect NEC-related epithelial disruption and a method to determine the viability of apical-out enteroids subjected to the NEC-in-a-dish protocol.

体外 坏死性小肠结肠炎的顶端出肠样模型

Necrotizing enterocolitis (NEC) is a devastating disease affecting preterm infants, characterized by intestinal inflammation and necrosis. Enteroids have ...

Point-of-Care Ultrasound: A Review of Ultrasound Parameters for Predicting Difficult Airways

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON method, which looks for and evaluates the Mallampati classification, signs of obstruction, and neck mobility. Clinical findings help predict a higher likelihood of difficult tracheal intubation, but no clinical result reliably excludes difficult intubation. Ultrasound as an adjunct to clinical examination can provide the clinician with a dynamic anatomical airway assessment, which is impossible with clinical examination alone. In the hands of anesthesiologists, ultrasound is becoming more popular in the perioperative period. This method is particularly applicable for identifying proper endotracheal tube positioning in specific patient populations, such as those who are morbidly obese and patients with head and neck cancer or trauma. The focus is on identifying the normal anatomy, correctly positioning the endotracheal tube, and refining the parameters that predict difficult intubation. Several ultrasound measurements are clinical indicators of difficult direct laryngoscopy in the literature. A meta-analysis revealed that the distance from the skin to the epiglottis (DSE) is most associated with a difficult laryngoscopy. An ultrasound of the airway could be applied in routine practice as an adjunct to the clinical examination. A full stomach, rapid sequence intubation, gross visual anatomical abnormalities, and restricted neck flexibility prevent using ultrasound to assess the airway. The airway evaluation is performed with a linear array transducer of 12-4 MHz, with the patient in the supine position, with no pillow, and with the head and neck in a neutral position. The central axis of the neck is where the ultrasound parameters are measured. These image acquisitions guide the standard ultrasound examination of the airway.

A point-of-care ultrasound (POCUS) is a simple, non-invasive, and portable tool that enables dynamic airway assessment. Several studies have attempted to determine the role of ultrasound parameters as an adjunct to clinical examination in predicting difficult laryngoscopies.

床旁超声：预测困难气道的超声参数综述

Airway management remains a crucial part of perioperative care. The conventional approach to assessing potentially difficult airways emphasizes the LEMON ...

Managing Gestational Vomiting with Ear Plaster Therapy

Ear Plaster Therapy as a Safe and Effective Treatment for Gestational Vomiting

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as fasting, fluid infusion, and nutritional support are conventionally applied to manage NVP, their effectiveness varies. However, traditional ear plaster therapy offers a promising alternative that effectively relieves symptoms and poses no known risk to the development of embryos or fetuses. This therapy is known for its ease of application, cost-effectiveness, and favorable outcomes. Previous studies have demonstrated the efficacy of combining ear plaster therapy with conventional treatments in alleviating symptoms of nausea and vomiting in pregnant women, surpassing the results achieved with conventional treatment alone. The protocol presented herein describes a method to relieve NVP using round, smooth, and hard cowherb seeds applied to specific ear points. These seeds are gently rubbed onto the surface of the ear, utilizing the principles of acupressure. By stimulating the designated ear points, this procedure aims to regulate the body's energy flow and restore balance, thereby reducing the severity and frequency of NVP. The application of cowherb seeds on specific ear points is a straightforward technique that healthcare professionals can easily implement or self-administered by pregnant women under appropriate guidance. Overall, ear plaster therapy presents a safe, effective, and economical approach for managing gestational vomiting, offering women a potential solution to alleviate their discomfort during pregnancy.

Author Spotlight: Alleviating Nausea and Vomiting in Pregnancy with Safe and Effective Auricular Acupuncture 

The presented protocol describes a traditional Chinese medicine treatment procedure known for its safety and effectiveness in managing gestational vomiting.

耳膏疗法是一种安全有效的妊娠呕吐治疗方法

Nausea and vomiting in pregnancy (NVP) are common symptoms that often complicate early pregnancy for many women. While clinical treatments such as ...

Preparation for Ear Plaster Therapy to Treat Pregnancy Vomiting

Begin by preparing the ear plasters for ear plaster therapy. To do so, cut a medical adhesive tape into squares, each measuring 0.6 by 0.6 square centimeters. Then position one or two smooth cow herb seeds at the center of each tape square.Next, instruct the patient to assume a comfortable seated position. Examine the skin on the patient's ear to ensure that it is intact and free from any abnormalities before selecting the acupoints. To locate the potential acupoints, stabilize the ear oracle by pinching and lifting the ear helix backward and upward using the thumb and index finger of one hand, making sure the area is fully exposed.Then, using the sterile probe in the other hand, gently examine the patient's ear to identify sensitive pressure points near the six auricular points. The stomach or CO4, cardia or CO3, belly or AH8, shenmen or TF4, subcortex or AT4, and liver or CO12.

准备耳膏治疗妊娠呕吐

Ear Plaster Therapy for Nausea and Vomiting in Pregnancy

To begin, ensure the patient's ear auricle area has dried after disinfecting it with 75%alcohol, Then stabilize the auricle by pinching the ear helix with the thumb and index finger of one hand and lifting it backward and upward. Next, use the forceps to pick up the prepared ear plaster and place it onto the selected acupoint in the patient's ear, such that the cow herb seeds in the center of the plaster touches the selected point. Ask for the patient's assurance that the seed placement aligns with a sensitive or sore spot.Positioning the thumb and index finger in front of and behind the auricle. Apply moderate and tolerable pressure with rhythmic, pressing and relaxing motion to stimulate the cow herb seeds at the auricular site. Continue the rhythmic press and release at each site for three to five minutes, maintaining an even pace.Monitor the patient's overall condition for 15 minutes post-treatment. Instruct the patient or their family to stimulate the seeds by rubbing the concerned area three times a day, in the morning, at midday, and in the evening. After three days, remove the ear plaster and repeat the procedure on the opposite ear, alternating treatment between both ears.Compared to the control group, the experimental group, which received ear plaster therapy, had a significantly shorter average hospital stay and also required a significantly lower time for ketone bodies to turn negative. These suggested that ear plaster therapy can effectively reduce the treatment time for gestational vomiting. Prior to treatment, there were no statistically significant differences in PUQE scores between the experimental and control groups.However, after five days of treatment, both showed a significant reduction in the scores. But the score of the experimental group was significantly lower than that of the control group.